主動靜態伸展與主動動態伸展對腿後腱肌肌肉功能表現及離心運動後誘發肌肉損傷之影響

Abstract

研究背景：伸展運動經常被作為熱身活動項目之一，因伸展運動被認為能增進柔軟度、提升運動表現及可能有預防肌肉損傷之效益，因此經常被作為預防運動損傷策略之一。傳統伸展運動包括；靜態伸展、彈震式伸展及本體感覺神經肌肉促進術，大部份研究發現伸展運動會立即降低肌肉功能表現（特別是靜態伸展），但是對降低肌肉損傷無顯著效益。相反地，主動式靜態與主動式動態伸展類型，不僅能增進腿後腱肌群柔軟度之外，更能同時增進下肢肌力。但是，此伸展運動類型是否有預防或降低因肌肉離心收縮所造成肌肉損傷呢?目前尚未有研究提出論證。研究目的：探討主動式伸展運動是否能降低因離心運動後造成的肌肉損傷。研究方法：研究招募36名健康大專男性，並以隨機分配方式分成（每組皆12名受試者）；主動靜態伸展組（每伸展15秒、組間休息15秒，反覆6組）、主動動態伸展組（連續伸展15下為1組、每組休息15秒，反覆6組，進行節奏則以節拍器每分鐘60下控制）及控制組（不進行任何伸展訓練）。所有受試者在伸展運動後需進行離心運動（膝屈肌以每秒30度角速度進行最大離心收縮，反覆進行10下為一組，共進行6組）。三組分別在伸展前、伸展後立即、離心運動後立即與後5天休息期，各進行所有依變項測驗，包含：心跳率、核心溫度、最大等長收縮、被動直腿抬舉測試、肌肉僵硬度（形變面積）、本體感覺、酸痛值、血液肌酸激酶活性及肌紅蛋白濃度。統計分析：本研究以獨立樣本t考驗進行三組受試者基本資料分析比較。並以二因子混合設計變異數分析（ANOVA）進行統計分析；若ANOVA有顯著差異的話，再使用杜凱氏法（Tukey’s）進行事後比較。顯著水準設定P< .05。結果：伸展運動後，心跳率方面；主動靜態伸展組 （67.9%）、主動動態伸展組（119.6%）及控制組（41.5%）皆顯著提升，主動動態組顯著高於主動靜態與控制組。關節活動度方面；主動靜態組與主動動態組皆顯著增進關節活動度（分別5.0 ± 0.40及10.8 ± 0.40），控制組則顯著降低關節活動度（-4.1 ± 1.10）。肌肉僵硬度（形變面積)；主動動態組（5.6%） 顯著高於主動靜態組（-6.7%）與控制組（-5.7%）。最大等長收縮肌力方面；主動靜態組肌力值（3.4 ± 1.9牛頓米）顯著高於控制組與主動動態組（此兩組則顯著降低肌力分別為-9.6 ± 2.4及-13.4 ± 2.1牛頓米）。本體感覺方面；主動動態組與控制組在30度與70度測得絕對誤差值顯著大於主動靜態組。離心運動後，主動靜態組與主動動態組所測得肌肉損傷症狀（降低程度較小如肌肉力量、肌肉痠痛及肌肉僵硬及較少增加的肌酸激酶活性與肌紅蛋白濃度）程度皆顯著小於控制組。此外，主動靜態組損傷程度仍顯著小於主動動態組與控制組。結論：本研究結果與先前研究相符合，主動式伸展運動能提升心跳率及關節活動度，伸展後肌肉功能有降低情形。在離心運動後，主動式伸展運動能降低肌肉損傷程度，由其是主動靜態組。建議未來進行下肢運動或競賽之前可選擇主動靜態組伸展運動型態。

Background：Three types of stretching (static stretching, proprioceptive neuromuscular facilitation, ballistic stretching) have been traditionally used to increase hamstring flexibility, improve performance and reduce muscle strain. Various studies, however, have shown that stretching prior to exercise reduces muscle performance and studies showing no efficacy for stretching reducing injury risk. In contrast, the active static stretching (AS) and active dynamic stretching (AD) types can increase flexibility and muscle force. The specific mechanisms and how these types stretching can prevent the hamstring strains are not clear. Purpose: This study investigated whether active stretching exercises would attenuate muscle damage induced by maximal eccentric exercise. Methods: Thirty-six young male students were allocated to active static stretching (AS, consisted of 6 sets of 15-s with a 15-s rest between sets), active dynamic stretching (AD, consisted of 6 sets of 15 repetitions per set with a 15-s rest between sets and a rhythm of 60 bits/min), or control group (n=12 per group). All subjects performed eccentric exercise (six sets of 10 maximal isokinetic 300/s lengthening contractions of knee flexors) immediately after stretching. Heart rate (HR), core temperature (CT), maximal voluntary isometric contraction (MVIC), passive range of motion of straight leg raising (ROM), area under curve (AUC) for muscle stiffness measurement, proprioception, soreness and markers of muscle damage (plasma creatine kinase (CK) activity, myoglobin (Mb) ware recorded before and after stretching as well as every day following the eccentric exercises for 5 days. These outcomes were compared among the groups. Statistical analyses：The baseline measures were compared among the groups by a independent-samples t-test. A two-way repeated-measures analysis of variance design was used to analyze the data with Tukey’s post hoc test. The statistical significance was set at P< 0.05. Results: After stretching, the HR significantly increased for AS (67.9%), AD (119.6%), and CON (41.5%). The increase in AD was significantly higher than the increase in AS and CON (P<.05). The change of ROM was significantly higher in AS (50 ± 0.40) and AD (10.80 ± 0.40) compared to that in CON (-4.10 ± 1.10). The change of AUC was significantly higher in AD (5.6%) compared to those in CON (-5.7%) and AS (-6.7%). For the MVIC, increase in AS (3.4 ± 1.9 Nm) was significantly different from those in CON (-9.6 ± 2.4 Nm) and AD (-13.4 ± 2.1Nm). The proprioception of knee joints, the AEE was significantly higher in AD and CON in 30 and 70 degree of knee flexion compared to those in AS (P<.05).Compared to the CON group, both AS and AD groups showed significantly less decrease in muscle strength, muscle soreness, muscle stiffness, and less increase in CK activity and Mb concentration after eccentric isokinetic exercise. Furthermore, there were also smaller changes on muscle damage markers in AS compared to those in AD and CON groups. Conclusions: In agreement with the literature, active stretching can increase HR and ROM immediately after stretching. Muscle performance, however, decrease after stretching. Following the eccentric exercise, active stretching can be effective in attenuating muscle damage, especially with AS stretching.