動態貼紮對慢性踝關節不穩定族群在單腳著地的影響

Abstract

踝關節扭傷佔運動傷害的大宗，多數會造成反覆扭傷，其中四成會演變成慢性踝關節不穩定，進而影響生活品質或運動表現，過去文獻建議除本體覺、肌力與神經肌肉控制等運動治療外，另外配合外在支撐可達到保護與預防的效果，其中採用的方式包括護具與貼紮，由於貼紮輕薄貼附皮膚，更廣泛使用於運動場上。一般貼紮包括不具彈性的運動貼布與具彈性的肌內效貼布，基於不同貼布特性，帶來效用亦有所不同，其中機轉包括限制踝關節動作的生物機械效用、減緩疼痛、改變肌肉收縮時序的神經生理效用、與心理層面安慰劑效用。動態貼布由於材質的特殊性，回彈力高，主要效益為機械效益，調整關節肌肉負荷、改善動作控制。目的：本研究探討慢性踝關節不穩定族群進行動態貼紮後，在動作策略上與能量吸收的改變，以利臨床應用。方法：招募23位實驗參與者，以坎伯蘭踝關節不穩定問卷為依據，分別納入踝關節不穩定組與健康控制組。動作測試為單腳著地動作，要求實驗參與者非測試腳站在40公分高台上垂直落地，以測試腳單腳著地平衡4~6秒。實驗過程使用Kistler測力板 (2000 Hz)、Vicon紅外線攝影機 (250 Hz) 與Delsys無線肌肉電訊號 (2000 Hz) 同步收集下肢運動學、動力學與肌電參數資料。統計方法以混合設計二因子變異數分析進行統計考驗，顯著水準訂為 α=.05。結果：研究發現動態貼紮可以顯著減少慢性踝關節不穩定族群踝關節與髖關節的能量吸收。結論：動態貼紮不會限制踝關節動作，且可以減少踝關節做為主要緩衝關節的程度，可成為慢性踝關節不穩定族群進行運動時，踝關節貼紮的另一項選擇。Ankle sprains are the most frequent injuries sustained by athletes, and most of them would turn into recurrent ankle sprains. Unfortunately, there was forty percent of ankle sprain becoming chronic ankle instability (CAI), which influenced quality of life or exercise performance. Past studies suggested that people with CAI need external support to achieve protection and prevention, as well as exercise therapies such as proprioception, strengthening, and neuromuscular control. There were two kinds of external support, including brace and taping. However, taping was used more frequently by athletes because of light and thin which can contact to skin. Non-elastic exercise tape and kinesio-tape were two kinds of popular tapes. The effects of taping were different according to different characteristic of tapes, such as biomechanical effect of limiting ankle mobility, neurophysiological effect of decrease pain threshold and changing timing of muscle activation, and psychological effect of placebo. There was a new tape, dynamic tape (DT), and the main effect was providing mechanical support which can adjust muscle loading and improve motor control because of high elastic characteristic. Purpose: The purpose of the study was to assess the changes of movement strategy and shock absorption after dynamic taping applying onto ankles in CAI. Methods: We enrolled 13 CAI and 10 control participants according to Cumberland ankle instability tool. All participants performed single leg drop landing protocol. They were asked to stand on a 40 cm platform by un-tested leg, landed on floor by test leg, and kept balance for 4~6 seconds. Kistler force platform (2000 Hz), Vicon infared camera (250 Hz), and Delsys wireless EMG sensors (2000 Hz) were used for collecting kinematic, kinetic, and muscle activation parameters during experiments. Two-way ANOVA was conducted to compare the difference of biomechanical parameters among groups (CAI and Control) and interventions (Pre-tape and Post-tape). The significant level was set at α=.05. Results: The main finding of this study was dynamic taping could significantly decrease the shock absorption of ankle and hip joints in CAI. Conclusion: Dynamic taping would not limit ankle mobility and could decrease impact of ankle joint during landing. It could be another choice of ankle taping for CAI group.