貼紮治療對於肌筋膜疼痛症候群短期的療效

Kinesio Taping on Short-Term Changes in Subjects with Myofascial Pain Syndrome: a Randomized Controlled Trial

趙雨雯(Yu-Wen Chao)

指導教授 ： 林居正

國立臺灣大學/醫學院/物理治療學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.11111

摘要

背景：肌筋膜疼痛症候群是一種相當常見因肌肉失調而產生的慢性疼痛的情況，
主要的特徵是在肌肉上可以找到緊束的條索與激痛點。臨床上，有些研究已證實
肌內效貼紮對於這些病患的療效，但其機轉還尚未釐清。在這篇研究裡，我們使
用了肌肉張力計 (評估肌肉僵硬的程度) 以及肌動圖 (評估肌肉收縮時所產生
的壓力波)來檢驗肌內效貼紮對於這些患者的作用機轉。目的：本試驗之目的以
患有上斜方肌肌筋膜疼痛症候群為研究對像探討 (1) 在分別經過壓痛點鬆弛術
與肌內效貼紮跟單獨接受壓痛點鬆弛術兩種介入後對於肌動圖訊號的影響，肌肉
的僵硬程度，疼痛的程度與壓力疼痛閾值 (2) 兩種介入對於肌動圖訊號，肌肉
的僵硬程度，疼痛的程度與壓力疼痛閾值之間的相關係數的影響。實驗設計:以
31 位在上斜方肌肉有激痛點為研究對象，受試者會隨機分配成兩組:壓痛點鬆弛
術組跟壓痛點鬆弛術與貼紮組。兩組受試者分別接受一次壓痛點鬆弛術，但第二
組另外再接受兩次的貼紮並於第三天進行一次更換，兩組均於治療前後以及第七
天量測肌動圖生理訊號，肌肉僵硬程度，疼痛程度以及壓力疼痛閾值。實驗結果:
兩組受試者的壓力疼痛閾值在介入後跟追蹤期都有顯著的進步 (d=5.57;
p<0.005, d=4.01, p<0.005)。相較於壓痛點鬆弛術組，壓痛點鬆弛術加貼紮組的組織位移程度在治療過後以及追蹤期都有顯著增加 (27%差異，p<0.05)。在立即治療後以及追蹤期的評估也發現，壓痛點鬆弛術加貼紮組的振幅明顯大於壓痛點鬆弛術組 (在4 與5 公斤下，p<0.05)，但是兩組的肌動圖頻率在兩個時間點上沒有任何差異(p>0.05)，兩組的肌動圖振幅跟其它變項之間全部為輕度相關。在立即治療後，兩組的肌動圖頻率與壓力疼痛閾值之間呈現中到高度相關 (r=-0.30 - -0.95)。結論: 結果顯示壓痛點鬆弛術與壓痛點鬆弛術加貼紮可讓上斜方肌肌筋膜疼痛患者有緩解疼痛的效果。而肌內效貼紮對於肌肉的特性像是組織位移程度以及肌動圖振幅提供了附加的效果。立即治療後，壓痛點鬆弛術加貼紮組的肌動圖頻率與壓力疼痛閾值之間的中度相關闡明了透過貼紮可改變激痛點
的特性。這個假設尚需進一步的長期追蹤研究驗證。
關鍵詞：肌筋膜疼痛症候群，貼紮，徒手治療，肌動圖

關鍵字

肌筋膜疼痛症候群 ； 貼紮 ； 徒手治療 ； 肌動圖

並列摘要

Background: Myofascial pain syndrome (MPS) characterized by the presence of trigger points (TrPs) and palpable taut band of muscle fibers is a common chronic pain disorder. Clinically, some evidence supports the application of kinesio tape in these patients. The underlying mechanism, however, is not clear. In this study, we used myotonometer (muscle stiffness measurement) and mechanomyography (MMG, muscle contraction pressure wave measurement) to validate proposed mechanism of kinesio tape in these patients. Objective: The purposes of this study are (1) to investigate the effects of manual pressure release and manual therapy plus kinesio taping on pressure pain threshold, muscle stiffness and vibration amplitude/frequency of muscle contraction in subjects with upper trapezius trigger point; (2) to examine the relationship between pressure pain threshold, muscle stiffness, and vibration amplitude/frequency following treatments involving manual pressure release and manual pressure release plus kinesio taping. Design: Thirty one subjects with upper trapezius trigger point were randomly allocated to one of the following group: manual pressure release (MPR) group and manual pressure release plus kinesio taping (MKT) group. Subjects in both groups received one session of manual pressure release, but subjects in the MKT group also received taping two times applied for 3 days and re-applied for other 4 days. Main outcome measures were pain intensity, pressure pain threshold, MMG signal, and muscle stiffness. Subjects were assessed at baseline, immediately post-intervention and after 7 days follow up. Results: Subjects in both groups improved their pain sensitivity from baseline to immediately after intervention and to follow-up (d=5.57, p<0.005; d=4.01, p<0.005). A significant improvement on tissue displacement was found in the MKT group compared to MPR group immediately after intervention and at follow-up (27% difference, p<0.05). Subjects in the MKT group showed significant higher MMG amplitude than that of MPR group immediately after intervention and follow up (at 4 and/or 5kg force level, p<0.05). However, no significant difference was found for the MMG frequency between groups (p>0.05). A poor to fair relationship was found in all of the comparison between MMG amplitude and other outcomes for both groups. A fair to excellent relationship (r= -0.30 - -0.95) was found between MMG frequency and PPT in baseline and immediately after intervention for both group. Conclusion: Manual pressure release and manual pressure release plus taping are effective in reducing pain in subjects with upper trapezius trigger point. Kinesio taping has an additional effect on muscle characteristics like tissue displacement and muscle contraction amplitude. The moderate relationship between MMG frequency and pressure pain threshold in MKT also support that trigger point muscle characteristics may be changed by taping. Long-term follow-up study is needed to validate this assumption.

並列關鍵字

Myofascial pain syndrome ； taping ； manual therapies ； mechanomyography

參考文獻

Kuo HW, Chang KT. The Effect of X-shape Kinesio Taping methods for short term pressure pain thresholds on upper trapezius muscle. Journal of Airiti 2011; 50: 37-44.

Wang YH, Chen SM, Chen JT, Yen WC, Kuan TS, Hong CZ. The effect of taping therapy on patients with myofascial pain syndrome: a pilot study. Taiwan Journal of Physical Medicine and Rehabilitation 2008; 36: 145-50.

Van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996; 46: 519-23.

point manual. 1, 2nd ed. Williams &Wilkins, Baltimore;1999.

Iagnocco A, Filippucci E, Meenagh G, DelleSedie A, Riente L, Bombardieri S, Grassi W, Valesini G. Ultrasound imaging for the rheumatologist I: Ultrasonography of the shoulder. Clin Exp Rheumatol 2006; 24: 6-11.