筋膜放鬆術對腓腸肌肌肉肌腱複合體長度之影響

Abstract

運動員常出現腓腸肌肌肉肌腱複合體緊繃現象，導致踝背屈角度受限，進而 產生傷害。為緩解緊繃問題，物理治療師常建議使用伸展運動或筋膜放鬆術來放 鬆緊繃的肌肉。過去的研究顯示:對腓腸肌肌肉肌腱複合體施行筋膜放鬆術可增 加踝背屈角度，但卻無研究直接量測其對腓腸肌肌肉肌腱複合體的總長度與三段 (阿基里斯腱、腓腸肌筋膜、肌腹)長度的變化。因肌肉肌腱複合體含有三種不 同黏彈性質的組織;截至目前，尚無研究探討筋膜放鬆術對哪一段的效益較佳。 因此本研究旨在探討施行筋膜放鬆術後，腓腸肌肌肉肌腱複合體的總長度與三段 長度的變化，並比較使用筋膜放鬆術與靜態伸展運動後立即效應之差異 。 本研究為前瞻性、方便抽樣、隨機分配、單盲性、前後測的設計，徵召 34 名規律運動、有腓腸肌緊縮、但無臨床症狀之成人進行實驗。介入治療有二:受 試者以隨機方式決定施行筋膜放鬆術或靜態伸展運動。筋膜放鬆術接受平均 4.8 ± 0.5 分鐘的治療;而靜態伸展運動則是做 5 個 1 分鐘膝屈曲下的蹠屈肌伸展。量測 變項為腓腸肌肌肉肌腱複合體之跟腱、腓腸肌筋膜、肌腹的長度，並加總計算總 長度，以及腳踝最大背屈角度。長度量測使用全景超音波影像進行腓腸肌影像擷 取，並以自製的 LabVIEW 程式進行長度量測。最大踝背屈角度量測則使用電子 量角器，分別量測承重與未承重、以及膝屈曲與膝伸直的最大踝背屈角度。同 時，使用自製的承重箭步測試器量測最大箭步距離。治療後再重複量測所有變 項，用以比較腓腸肌肌肉肌腱複合體施行筋膜放鬆術或靜態伸展運動後的立即效 應。研究的結果使用 SPSS v.22 軟體進行統計分析。 本研究結果發現無論是介入筋膜放鬆術或靜態伸展運動後，無論是否承重、 非承重時最大踝背屈角度顯著的變大(F= 9.845 ‒ 21.954，p < 0.05)。若細看複 合體各個部位的變化，發現筋膜放鬆組及靜態伸展組的腓腸肌肌肉肌腱複合體長長度變化都只有出現在筋膜長度變長(F= 11.985，p < 0.01);表示最大踝背屈角 度的增加來自筋膜的被延長，因為鬆弛結締組織的筋膜較其他部位更容易被外力 所延展。本研究的研究意義是為物理治療師在臨床提供筋膜放鬆術的療效研究證 據，證據水準為 2B，建議臨床上可以使用筋膜放鬆，但須繼續更新相關知識。

A tight gastrocnemius muscle-tendon unit (GAS-MTU) is commonly found in athletes, resulting in a limited range of ankle dorsiflexion that predisposes soft tissue injuries. To solve this problem, physical therapists usually suggest them to perform stretching exercises and/or apply myofascial release to the GAS-MTU. Recent research showed that myofascial release has the effect to improve the angle of maximal ankle dorsiflexion (DFmax). However, it is not clear whether change in length of the GAS-MTU does exist after myofascial release. Furthermore, since different viscoelastic properties are found in different portions of the GAS-MTU (including the Achilles tendon, gastrocnemius fascia and muscle belly), it is also unknown which portion(s) of the GAS-MTU really change(s) after myofascial release. Therefore, the purposes of this research were to investigate immediate changes in length of each portion and total length of the GAS-MTU after myofascial release or static stretching exercises and compare the differences between these 2 interventions. This research is prospective, convenient sampling, random allocation, single-blinded and pretest-posttest design. Thirty-four active adults with regular exercises but with tightness of the GAS-MTU were recruited. All participants randomly received myofascial release or static stretching exercises to the GAS-MTU. Myofascial release onto the GAS-MTU was performed for the myofascial group with an average executed time of 4.8 ± 0.5 min while the stretching group executed 5 repetitions of 1-min static stretch exercises with the knee flexed. Outcome variables were length measurement of each portion of the GAS-MTU, including the Achilles tendon, gastrocnemius fascia and muscle belly, DFmax with or without weight-bearing and maximal lunge distance of the weight-bearing lunge test (WBLT). Length of each portion of the GAS-MTU was measured on panoramic ultrasonographic images using a customized LabVIEW program. DFmax with or without weight-bearing conditions were measured using an electrogoniometer. Maximal lunge distance of the WBLT was measured using a customized lunge distance device. All variables were measured before and after intervention and differences within and between groups were compared. All variables were analyzed using the SPSS v.22 program. A significant increase in DFmax with the knee extended regardless of weight- bearing were noted (F= 9.845 ‒ 21.954, p < 0.05) after intervention no matter which intervention was given. If length of each portion of the GAS-MTU was checked, such elongation was only found in the fascia portion (F= 11.985, p < 0.001) in both myofascial release and static stretching groups, indicating that increase in DFmax came from lengthening of the fascia portion. As a loose connective tissue, the fascia portion, is easy to be elongated by any external forces. The clinical significance of this research is to provide a solid evidence of effect of myofascial release on a tight GAS-MTU but it is fair recommended in clinical use because its level of evidence is at the 2B level.