髂脛束放鬆肌貼以及伸展運動對髂脛束組織延展性之影響

Abstract

髂脛束對於維持人類姿勢而言扮演一個非常重要的角色。在單腳站立時，站立腳的髂脛束強化髖關節外展力矩，用以提供骨盆穩定度，而不至於骨盆傾斜。若髂脛束延展性差，會影響到髖關節以及膝關節在走路時以及跑步的運動學，也會降低跑步的效率。髂脛束症候群常發生在跑者或自行車者髂脛束較緊的人，一般使用的髂脛束伸展運動來放鬆髂脛束，然而並非所有髂脛束太緊者都可以藉此改善症狀。近年來，運動員常使用髂脛束放鬆肌貼，在運動員的主觀感受以及觸診時的硬度都發現有改善，但是卻缺乏客觀的方法量測髂脛束的延展性的變化。因此，本研究之目，用剪力波彈性影像儀測量髂脛束的硬度變化，以了解不同伸展技術對於組織延展性的影響。 本研究計畫為前瞻性、介入性、單盲性、前後實驗，徵召30名規律運動的無髂脛束症候群症狀的成人進行實驗。實驗分兩部分：第1部分實驗是2周的剪力波彈性影像儀量測髂脛束硬度之信度，受試者在簽署研究同意書後，在同一天接受剪力波彈性影像儀測量髂脛束硬度，一個小時後再接受同一施測者之的第2次量測，一周後再進行第3次量測，並且進行不同施測者之量測。使用組間相關係數、變異係數、標準誤、以及最小可偵測差異，來分析同醫師測者在同一日或不同日的信度。第2部分實驗是3周的髂脛束肌貼成效實驗，受試者在簽署研究同意書後，以隨機次序接受髂脛束放鬆貼紮、偽髂脛束放鬆貼紮以及髂脛束的靜態伸展等三種伸展技術，每種技術施行時間相隔一周。量測的變項將包括剪力波彈性影儀測量之髂脛束的硬度、以液體傾斜儀測量修正型歐柏測試的髖關節內收角度，以及使用超音波影像儀測量髕股距離。所有變項皆在介入前後各測量一次。所有統計分析以SAS軟體進行，並以重複量測變異數分析介入前後以及三種伸展技術之間的差異。 本研究主要結果如下：(一)在執行髂脛束放鬆肌貼後，顯著降低末端髂脛束硬度，但是闊筋膜張肌的硬度卻沒有任何改變。(二)在執行伸展運動後，只有近端的闊筋膜張肌的硬度下降，遠端的髂脛束硬度卻沒任何改變。(三)修正型歐伯測試的髖關節內收角度在髂脛束放鬆肌貼後以及伸展運動後，皆有顯著的上升。(四) 髕股距離只有在髂脛束放鬆肌貼後，有明顯增加，但是在其他介入卻沒有任何改變。(五)所有量測變項在偽髂脛束放鬆貼紮後，皆沒任何改善。 本研究室世界上第一篇探討髂脛束放鬆貼紮後放鬆的效應，尤其是運用剪力波彈性影像儀量測髂脛束硬度的變化，為世界首創。同時這也是首度同時量測闊筋膜張肌以及髂脛束兩種組織硬度的研究，發現兩者在不同技術下有不同的結果。本研究發現，髂脛束放鬆肌貼可使遠端髂脛束的硬度下降，而髂脛束伸展運動僅能降低闊筋膜張肌的硬度；過去使用髂脛束伸展運動來放鬆髂脛束的想法需做修正。

Iliotibial band (ITB) plays an important role in maintaining posture. The TFL acts as an abductor of the hip joint during a single-leg stance; therefore, the ITB during TFL contraction produces a moment to control pelvis level. In addition, the poor extensibility of the ITB affects the walking and running kinematics of the hip and knee joint; simultaneously, reduces the efficacy in running. Iliotibial band syndrome (ITBS) is a common symptom occurred on the runners. Generally, we usually use stretching exercise to elongate the ITB, however, not all the patients can improve by using this method. We developed new method which was ITB releasing taping (ITBRT). It not only improves the subjective feeling but also changes the feeling of palpation. But, there was no objective instrument to certificate the changes of the extensibility of the ITB. Therefore, the purpose of this research project will be to examine the extensibility of the ITB using shear wave elastography (SWE). This research project was prospective, interventional, single-blinded and pre-post design. There were 30 healthy participants with regular exercise for this research project. Before the experiment, all participants must sign the consent. Three interventions were employed on all participants. All participants received in a random order 1 session of ITBRT for an hour, other session of sham intervention 1 week later and another session of stretching intervention 1 week later. Stiffness of the ITB and tensor fascia lata (TFL) were measured using SWE, modified Ober’s test was defined as angle of hip adduction using fluid-filled inclinometer and patella-condyle distance (PCD) was evaluated using ultrasonography. All assessments were carried out before and after each intervention. All statistical analyses were executed using SAS 3.4. In addition, all variables were used repeated measures to examine the relationship between taping condition and time (pre- vs. post-intervention). The intrarater correlation coefficients were used to represent intrarater reliability. The results of this research were 1) The stiffness of the ITB significantly decreased only after using ITBRT, but no significant difference was noted in the TFL; 2) The stiffness of the TFL decreased after stretching exercise, but no difference in ITB; 3) The angle of hip adduction had great increase in ITBRT and stretching group, but there was no change in sham group; 4) Only ITBRT improve the distance of the PCD; 5) There were no significant changes in sham group. It was the first study in the world to discuss the effects of the relaxation after using ITBRT; especially, using the SWE instrument to measure changes in the stiffness of the ITB and TFL. At the same time, it is also the first time to measure the 2 kinds of ITB and TFL of tissue stiffness in the study which we found that there were different results under 2 tissues. In our study, the results revealed that the ITBRT did really decrease the stiffness of the ITB as well as the stretching exercise can only reduce the stiffness of the TFL. In the past, the concept that stretching exercise changed the extensibility of the ITB needed to be modified.