- 學位論文
懸吊式訓練對於下背痛患者的效果
The effects of sling exercise training for clients with low back pain
摘要
背景：有84%的民眾一生中曾患有下背痛，其中有11-12%的人有失能的情形發生，23%會發展成慢性下背痛。久坐的生活與工作型態常發生下背痛，不斷復發的下背痛則可能會造成健保支出的負擔，因此下背痛確實是值得關注的健康相關議題。過去文獻曾探討過健康人與下背痛者間肌肉力量、肌肉耐力以及肌肉活化協同性的差異。然而，就本研究所知，過去較少有研究探討穩定性訓練後對下背痛患者的肌肉共同活化協同性的影響，且過去下背痛運動訓練相關研究的評估參數多以功能性體適能或是臨床問卷做為訓練效果，但鮮少有研究探討運動訓練對於主觀感受的改善是來源自於肌力、肌耐力或肌肉活化的協同性的改善。目的：探討脊椎穩定性運動訓練的臨床效果對疼痛與失能程度的改善效果，與其他生理參數的相關性，以做為臨床運動訓練之參考的依據。方法：以懸吊系統做為腰椎穩定性運動訓練模式，下背痛患者將接受六週的運動訓練，評估訓練前與後的改善效果，並探討其疼痛強度、失能程度以及恐懼與逃避信念分數(病患主觀的參數)與軀幹肌力、肌耐力以及肌肉活化的協同性(客觀的生理參數)之相關性。結果：本研究結果顯示，訓練組在六週的訓練後，疼痛強度、失能程度相較於訓練前有顯著的降低，而肌肉力量則是有顯著的增加(P<0.05)；然而，控制組在六週後其疼痛強度與失能程度並沒有顯著的降低，肌肉力量也沒有顯著的增加。然而，訓練組在六週懸吊式訓練後，肌耐力指標中的動作維持時間與中位頻的斜率衰減並沒有顯著改善，僅有左側的多裂肌的中位頻斜率衰減有顯著改善。另外，本研究也未發現六週的懸吊訓練對肌肉共同活化協同性有顯著的改善。肌肉力量的改善與訓練後的疼痛強度、失能程度以及恐懼與逃避信念呈現負相關，且根據複迴歸統計結果顯示，肌肉力量的改善對於下背痛患者在訓練後其疼痛強度的下降可預測約43%，對失能程度可預測31%，而對恐懼與逃避信念的身體活動量與工作則分別可預測51%以及62%。結論： 六週懸吊運動訓練對於疼痛強度、失能程度、肌肉力量的改善有顯著的改善效果。軀幹肌肉力量的改善最能預測訓練後疼痛強度、失能程度與恐懼與逃避信念的降低。
並列摘要
Background: The life prevalence of low back pain (LBP) is 84%, and 11-12% of them have disability, and 23% of them will develop to chronic LBP. Prolong sitting may lead to LBP, and recurrent LBP may be a big burden for the health insurance. Thus, the low back pain is an important issue and deserves further investigation to concern about. Previous studies conferred the difference of muscular strength, endurance, and muscular activation imbalance between LBP group and healthy control group. However, to our knowledge, few studies investigated the effects of spinal stabilization exercise on muscular activation synergy. Previous studies investigated the training effects on functional fitness, muscular strength or clinical questionnaire (including pain intensity scale or Oswestry back pain disability questionnaire). However, few studies conferred the improvement of clinical questionnaire was caused by objective parameter improvement (such as, muscular strength, endurance or muscle contraction synergy). Purposes: To investigate the effects of lumbar stabilization exercise on clinically examined function, and the association between the improvements of the self-reported pain and activity limitation and physiological parameters, in order to provide a basis of clinical use for exercise training. Methods: Sling exercise trainings were used to train low back pain participants for 6 weeks. The trunk muscular activation synergy during trunk stability test, trunk muscular strength and endurance, (objective parameters), and pain and disability levels (subjective parameters) were measured before and after training. Results: The results of this study showed that the pain intensity, disability level and muscular strength was improved significantly for the training group (P<0.05), but not for control group. The endurance was not improved significantly for both groups and for maintenance time and the slope of median frequency, except the slope of median frequency for left multifidus showed a significant improved after training. However, the improvement of trunk muscle co-activation was not found in this study. The improvement of muscular strength was negative correlates to the pain intensity, disability levels and fear avoidance beliefs after training, and according to the results of multiple regressions, the trunk muscle improvement could predict 43% of the reduction in pain intensity, 31% of improvement in disability level, 51% of improvement in fear avoidance beliefs of physical activity and 62% of improvement in fear avoidance beliefs on work. Conclusion: The sling exercise training can reduce pain and disability level, and improve trunk muscular strength. The trunk muscle improvement was a predictor for the reduced pain intensity, disability levels and fear avoidance beliefs.