健康男性後層胸腰筋膜於肌筋膜放鬆術後之機械變形－動態超音波研究

Mechanical Deformation of Posterior Thoracolumbar Fascia after Myofascial Release in Healthy Male Participants - A Study of Dynamic Ultrasound

王嘉杰(Ka-Kit Wong)

指導教授 ： 王淑芬

國立臺灣大學/醫學院/物理治療學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02365

摘要

背景：後層胸腰筋膜於脊椎系統中所扮演的生物力學角色越來越備受關注。此筋膜張力之上升被認為可以控制脊椎節間動作及為薦髂關節提供額外的穩定。因此筋膜的特性便成為了解後層胸腰筋膜功能的重要參數。另外，肌筋膜放鬆術是一種徒手治療技術主要用於受限之筋膜或者肌肉使其回復正常之長度及張力。至目前為止，尚未有針對肌筋膜放鬆術對後層胸腰筋膜筋膜特性（剛性指標和遲滯現象指標）、筋膜變形及力量影響之研究。
目的：本實驗的目的為：一）量化肌筋膜放鬆術對健康男性後層胸腰筋膜筋膜特性、筋膜變形及力量之立即影響；二）評估造成剛性指標改變之可能因素。
方法：本實驗將徵召健康無下背痛及有固定運動之男性受試者。在俯姿下請受試者漸進地進行手臂下壓動作直到最大出力然後漸進放鬆，並同時記錄後層胸腰筋膜之變形與動作之力量以計算剛性指標、遲滯現象指標及變形速度。利用單因子重覆測量共變數分析（One-way repeated measures ANCOVA），在控制變形速度後比較肌筋膜放鬆術前、後，剛性指標或遲滯現象指標之差異。利用二因子重覆測量變異數分析（two-way repeated measures ANOVA）比較50%和100%最大出力時筋膜變形於肌筋膜放鬆術前、後的差異以及比較50%和100%最大出力時力量於肌筋膜放鬆術前、後之差異。若任何交互作用達顯著水平，將進行事後分析並以Bonferroni方式作調整。Pearson相關係數用於評估肌筋膜放鬆術前、後剛性指標比值（〖剛性指標〗_後/〖剛性指標〗_前 ×100%）與力量比值（〖∆力量差異（50%和100%）〗_後/〖∆力量差異（50%和100%）〗_前 ×100%）的相關性以及剛性指標比值與筋膜變形差異（50%和100%最大出力時筋膜變形之差異）之變化量（〖∆變形差異〗_後-〖∆變形差異〗_前）的相關性。若任何參數之分佈不符合常態分佈則使用相對應之無母數分析。顯著水平值設定在0.05。
結果：共十位健康男性參與本試驗（年齡: 22.8±2.0歲、身高: 1.77±0.05公尺、重量: 66.6±6.1 公斤及身體質量指數: 21.3±1.5）。主要發現為在肌筋膜放鬆術後剛性指標有明顯下降，另外，50%和100%最大出力時筋膜變形之差異會上升，但力量和遲滯現象指標則無明顯之改變。其次，剛性指標比值與肌筋膜放鬆術前、後筋膜變形差異之變化量呈高度負相關（r=-0.77），與力量比值呈一般正相關（r=0.38）。
結論：肌筋膜放鬆術後，健康男性後層胸腰筋膜剛性指標會下降但沒有改變其黏彈特性。未來之研究可以探討此剛性指標之下降是否來自於肌筋膜放鬆術對平衡結締組織之立即適應和（或）增加肌肉－筋膜節點於多層結構的結締組織中之滑動。

關鍵字

超音波 ； 胸腰筋膜 ； 闊背肌 ； 肌筋膜放鬆術

並列摘要

Background: There was increased interest in the biomechanical roles of the posterior thoracolumbar fascia (PLF) in the spinal system. Tensioning the PLF had been proposed to control the spinal segments and provide sacroiliac stability. Therefore, fascial properties became the important variables for interpreting function of the PLF. Myofascial release was one of the manual techniques aiming to restore the normal length and tension of restricted soft tissues. However, no study focused on quantifying the effects of myofascial release on fascial properties, deformation of the PLF and force output at present. Purposes: The purposes of this study were 1) to quantify the immediate effects of myofascial release on fascial properties, deformation of the PLF and force output in healthy male individuals and 2) to evaluate the possible factors related to changes in stiffness index of the PLF after myofascial release. Methods: Individuals who had no history of low back pain and regularly took part in exercises were recruited. Deformation of the PLF and force output during task were recorded simultaneously when participants performed ramped “press up” (isolated arm depression with elbow extension) up to maximal voluntary contraction (loading) following by ramped relaxation (unloading) in prone. Data of deformation of the PLF and force output were used to calculate 1) stiffness index, 2) hysteresis index and 3) deformation rate of the PLF represented by 1) the slope of the regression line of the loading curve above 50% MVC, 2) the percentage of the area within the loading-unloading curve to the area under the loading curve and 3) the slopes of the regression lines of deformation-time data above 50% MVC, from 0% to 100% MVC during loading and from 100% to 0% MVC during unloading, respectively. Separated one-way repeated measures ANCOVA were conducted to compare differences in the stiffness index or hysteresis index of the PLF before and after myofascial release using corresponding deformation rate of the PLF as covariate. Separated two-way repeated measures ANOVA were used to compare deformation of the PLF or force output with MVC (50%, 100% MVC) and release (before, after) as repeated factors. Post hoc analysis with Bonferonni adjustment was conducted if any interaction was significant. Separated Pearson correlation coefficient were used to analyze the relationship between the ratio of stiffness index (〖Stiffness index〗_after/〖Stiffness index〗_before ×100%) and 1) the ratio of △ force output (〖△ force output〗_after/〖△ force output〗_before ×100%) or 2) the difference in △ deformation (between 50% and 100% MVC) of the PLF before and after myofascial release (〖△deformation〗_( after)-〖△ deformation〗_before). Corresponding nonparametric tests were used if distribution of any outcome variable was deviated from normal. The alpha level was set at 0.05. Results: Ten healthy male were recruited for this study. Their age, height, weight and BMI were 22.8±2.0 years old, 1.77±0.05 m, 66.6±6.1 kg and 21.3±1.5, respectively. After myofascial release, the primary findings included a decrease in stiffness index, a greater difference in deformation between 50% and 100% MVC (△deformation) but no significant changes in force output and hysteresis index. Secondly, the ratio of stiffness index had good negative correlation with the difference in △deformation (r=-0.77) and fair positive correlation with the ratio in △force output (r=0.38). Conclusion: After myofascial release, stiffness index of the PLF decreased without change in viscoelasticity in healthy male participants. Further studies could investigate this decrease in stiffness index of the PLF is attributed to effects of myofascial release on whether immediate adaption of parallel connective tissues and/or potential enhance sliding of the muscle-fascia complex among multi-layer connective structures.

並列關鍵字

Ultrasonography ； Thoracolumbar fascia ； Latissimus dorsi ； Myofascial release

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