淋巴按摩對於爆發型選手在跑步以後造成的下肢腫脹及表現之影響

Abstract

背景：運動後，不管是在運動員或一般健康族群皆常見下肢腫脹的問題，腫脹被定義為過多的組織液堆積在組織間隙中。過去研究發現健康族群在十五分鐘的慢跑後其小腿體積平均增加31.2 毫升，下肢體積的增加被認為可能是高強度訓練、淋巴管及血管受緊繃軟組織壓迫及重力的影響。下肢的腫脹不只對運動員表現及恢復有極大的影響，同時也可能造成纖維化、失能及攣縮等問題。從本實驗的先驅性研究發現下肢腫脹不只發生在運動後，健康受試者在經過五分鐘的瑞典式按摩後的小腿圍徑不僅比運動後還低，相較於運動前的起始值也是較低的，由此可知，下肢腫脹除了在運動後產生也有可能在休息狀態下出現。然而，過去並沒有研究探討是否有治療方式可以減少短跑選手在休息及運動後所產生的下肢腫脹。按摩在過去研究被證實可以透過增加關節角度、增加血液灌流及促進恢復等來幫助運動員，但是並沒有研究探討淋巴按摩對於減少下肢腫脹的療效並同時比較其他治療如冷水浸泡及靜態伸展。 目的：本研究探討淋巴按摩對於短跑選手在跑步後造成的下肢腫脹及表現的立即性及短期療效 方法：本研究招募介於20至30歲且專項為短距離的田徑選手，在基本資料收集及前測後，每位受試者會接受所有三種治療介入包括淋巴按摩、冷水浸泡及靜態伸展，每週進行一項治療共進行三週，治療項目的順序為隨機分配，成效評估包含利用視覺類比量表評估不適程度、下肢體積、壓痛閾值、立定跳遠距離，量測時間分別為運動前、運動後、治療後及治療後十分鐘。受試者特徵會以敘述性統計表示，另外會以三因子變異數分析、重複測量的方式來比較各項介入療效的差異，同時分析各成效中是否有任何交互作用，若有會再進行事後比較分析，p 值小於0.05 代表具有顯著差異。 結果：本實驗共招募14位受試者，男性及女性各7位，受試者平均年齡為20.86 ± 0.95 歲，平均身高為171.29 ± 9.44 cm，體重為62.86 ± 10.92 kg，休息時平均心跳為67 ± 12 bpm，運動時心跳為147 ± 13 bpm，跑步機速率平均為5.81 ± 0.37 mph。在運動後，不管是在慣用腳或非慣用腳，小腿體積、不適程度、壓痛閾值及立定跳遠距離皆有顯著的上升。小腿體積改變的部分，進行淋巴按摩腳相較於未治療腳在比較（1）運動前至立即治療後（2）運動前至治療後十分鐘（3）運動後至立即治療後等三個時段時，治療腳皆有較顯著的下降（-44.6 ± 13.2 ml、-32.6 ± 13.1 ml、 -29 ± 13.2 ml），進行靜態伸展腳相較於未治療腳在比較運動前至立即治療後，治療腳有較顯著的下降（-19.8 ± 7.8 ml），進行冷水浸泡腳相較於未治療腳則在各時段皆無顯著差異。比較三種治療之間的療效，淋巴引流較能降低小腿體積，比較部分時段有顯著差異。在不適程度的改變量，進行淋巴按摩腳相較於未治療腳在比較（1）運動後至立即治療後（2）運動後至治療後十分鐘，治療腳皆有較顯著的下降（-1.1 ± 0.4 cm、-1.28 ± 0.4 cm），進行靜態伸展腳相較於未治療腳皆無顯著差異，進行冷水浸泡腳相較於未治療腳在比較運動後至立即治療後，治療腳有較顯著的下降（-1.2 ± 0.4 cm），比較三種治療之間的療效並無顯著差異。在壓痛閾值的改變量，進行淋巴引流腳及進行冷水浸泡腳相較於未治療腳皆無顯著差異，進行靜態伸展腳相較於未治療腳在運動後至立即治療後，治療腳有較顯著的上升（6.1 ± 2.0 N），比較三種治療之間的療效並無顯著差異。在立定跳遠距離的改變量，比較三種治療之間的影響並無顯著差異。 結論：短跑選手的慣用腳及非慣用腳皆在跑步運動後，小腿體積及立定跳遠距離皆有顯著的上升，透過淋巴按摩可以立即地降低小腿體積，同時相較於靜態伸展及冷水浸泡，淋巴按摩有更好的短期療效，最後，在比較三種治療之間對於立定跳遠距離的影響，並無顯著差異。

Background: Lower extremity edema has often been seen after exercise in healthy individuals, especially explosive athletes, in sports physical therapy practice. Edema is defined as excessive fluid accumulation in the interstitial space. Recent studies showed that there could be an increase in fluid up to 31.2 ml after a 15-minute running bout in healthy individuals. Fluid accumulation may be resulted from (1) high intensity training, (2) compression of blood and lymph vessels due to increased soft tissue tension and (3) the effect of gravity. Lower extremity edema not only causes great impact on athlete's recovery and performance, it can also lead to fibrosis, dysfunction and contracture. Our pilot study showed that lower extremity edema existed during post-exercise sessions, and decreased ankle circumference was found after a 5-minute massage session, not only when compared to the status after exercise, but also when compared to the baseline (resting). This result from our pilot study showed that lower extremity edema may exist both during resting and after exercise. However, no studies to date investigated the solutions to decrease lower extremity edema during resting and after exercises in explosive athletes. Massage has been proven beneficial to athletes by increasing range of motion and skin blood flow, and promoting recovery, however, no study to date investigated the effect of lymphatic massage on lower extremity edema and compared that to different common recovery modalities such as cold-water immersion and static stretching. Purposes: To explore the effects of lymphatic massage on sprinter's gastrocnemius after treadmill exercise on edema and performance with immediate follow-ups. Methods: This study recruited both male and female explosive athletes age between 20-30 years old. After individuals' enrollments and baseline data collections, all subjects received all three different treatments (massage, cold water immersion and static stretching) in randomized orders a week apart, respectively. Outcome measures were: visual analogue scale (VAS) score, lower leg volume, pressure pain threshold and horizontal jump distance. All measurements were recorded at baseline, immediately after exercise, immediately after treatment, and 10 minutes after treatment as the follow up. Descriptive statistics were used for participants' characteristics. Three-way ANOVA (3 treatments x 4 times x 2 legs) with repeated measures design was used to detect differences, and post-hoc analyses were used when interactions are identified. p value of < .05 was used in this study. Results: We recruited 14 participants, half male and half female. The average age was 20.9 ± 1.0 years old. The average body height was 171.3 ± 9.4 cm and body weight was 62.9 ± 10.9 kg. The average exercise heart rate was 147.5 ± 13.1 bpm and the mean speed of treadmill exercise was 5.8 ± 0.4 mph. After treadmill exercises, there were significant increases of lower leg volume, perception of discomfort, pressure pain threshold and horizontal jump distances in both dominant and non-dominant legs. For changes in lower leg volume, legs treated with lymphatic massage comparing to non-treatment legs had significant greater decreases from (1) baseline to immediately after treatment (2) baseline to 10 minutes after treatment (3) immediately after exercise to immediately after treatment (-44.6 ± 13.2 ml, -32.6 ± 13.1 ml, and -29 ± 13.2 ml, respectively). Legs treated with static stretching comparing to non-treatments legs had significant greater decreases from baseline to immediately after treatment (-19.8 ± 7.8 ml). No significant differences were found for cold water immersion. Comparing the three interventions, lymphatic massage showed superior immediate effects on decreasing lower leg volume when compared to other treatments at different time points. For changes in perception of discomfort, legs treated with lymphatic massage comparing to non-treatment legs had significant greater decreases from (1) baseline to immediately after treatment (2) baseline to 10 minutes after treatment (-1.1 ± 0.4 cm and -1.3 ± 0.4 cm). Leg treated with cold-water immersion comparing to non-treatment legs also showed significant greater decreases from immediately after exercise to immediately after treatment (-1.2 ± 0.4 cm). There were no significant differences found for static stretching and between the three interventions. For changes in pressure pain threshold, significant differences were only found when comparing legs treated with static stretching and legs without treatment from immediately after exercise to immediately after treatment. The treatment legs had significant greater increases in pressure pain threshold (6.1 ± 2.0 N). No significant differences were found when comparing the three interventions. Finally, no significant differences were found between the three treatments in horizontal jump distance. Conclusions: Both dominant and non-dominant legs of explosive athletes showed significant increase in lower leg volume and horizontal jump distance after treadmill exercise. Lymphatic massage could significantly decrease lower leg volume after treadmill exercise when compared to no-treatment, and superior immediate outcomes when compared to static stretching and cold-water immersion. Finally, no significant differences between three treatments in horizontal jump distance.