Publication:

肩部訓練對肩峰鎖骨下空間之影響

研究背景：過頂投擲運動是在適當時間動作下整合上、下肢之肌肉動力鍊協調後產生的運動模式，過度投擲訓練容易引起肩部肌群前後力量平衡性，造成肩胛活動異常，使肩下空間減少，導致肩關節夾擠症後群，嚴重者除會引發肩盂唇上方病變外，還可能引發旋轉肌袖破裂症狀，影響投擲表現。能增加運動員基礎肌肉能力方法是運動訓練，主要可強化較弱的肌群力量，給予肌肉組織在投擲捲曲期與加速期時保護性避免運動傷害。本實驗探討在患有肩夾擠症候群之投擲型運動員中，若能增加肩袖肌群、下斜方肌與前鋸肌活性，對肩峰下空間的影響。研究方法：招募棒球專長隊15名與健康大專男性15名，皆先進行運動測試後進行四週肩部肌群運動訓練，運動訓練每週進行三次，四週後再進行第二次運動測試，使用等速肌力測試儀將肩關節固定在00、300、600下分別進行35%、55%、100%的肩胛平面外展之運動測試。運用超音波探測肩峰下空間距離改變、以肌肉電位訊號儀採集上斜方肌、下斜方肌、前鋸肌之肌電訊號。探討四週肩部訓練對改善肩關節夾擠症候群之影響。研究結果：發現下斜方肌/前鋸肌功能比經運動訓練前後相較，在健康大專組35% max、55%max、100%max-00abd、300 abd、600 abd (35%最大肌力-300外展角度以35%max-300 abd表示)作用下活性皆有顯著改變，棒球專長組則無變化。前鋸肌/上斜方肌功能比經運動訓練前後相較，健康大專組在35% max、55% max -300 abd、600 abd與100% max -00 abd、300 abd、600 abd作用下有顯著活性比值提高，棒球專長組則在35%max-300abd、600 abd作用下有顯著活性改變，在其餘各力量角度下並無太大改變。肩峰鎖骨下空間變化經由運動訓練前後相較，健康大專組在35% max、55% max -300abd、600abd與100% max -600 abd作用下有顯著提升肩峰下空間，棒球專長組則在35% max、55% max、100% max -600 abd作用下有顯著提升肩峰下空間。結論：經由肩部運動訓練四週後，對健康大專組而言，能增加下斜方肌與前鋸肌活性，並改善肩胛活動中下斜方肌與前鋸肌活化比率，進而增加肩峰鎖骨下空間。但對於棒球專長組而言，運動訓練除能有效改善肩袖肌肉外，增加前鋸肌在肩胛活動中活化比率能有效改善肩峰鎖骨下空間。運動訓練能改善未接受過投擲型專項訓練之一般大專生之肩胛活動中下斜方肌、前鋸肌活性比率，而改善有接受過投擲型專項訓練之棒球專長隊之肩胛活動中前鋸肌活化比率來改善肩峰鎖骨下空間之距離。本研究建議有肩夾擠症候群之投擲型運動員與一般肩夾擠患者能進行本研究之肩部訓練進行訓練，進而改善肩部不適症狀。

Research background: Overhead throwing is a sport mode resulted from integration of coordination for the muscles of upper and lower limbs kinetic chain when action in the appropriate time. Excessive throwing training is easy to cause power balance problem in the shoulder muscles anterior posterior, resulting in abnormal scapula activity; less acromioclavicular space will cause shoulder impingement syndrome, even worse, superior labrum anterior and rotator cuff tear may occur to affect throwing performance. Exercise training is the way to increase athlete’s basic muscle ability, which mainly can reinforce weaker muscle strength and provide protection for muscular tissue to avoid sport injury during throwing curving and acceleration period. This experiment discussing the influence of increasing activities for the rotator cuff, lower trapezius and serratus anterior on the acromioclavicular space for throwing type athletes who suffering from shoulder impingement syndrome. Research method: Recruit 15 college baseball professionals and 15 health male college students to conduct shoulder muscles exercise training for four weeks, including three exercises per week and then the second exercise training four weeks later. Use isokinetic dynamometer to fix shoulder joint at 00、300、600 for exercise testing of 35%, 55% and 100% scapula abduction, ultrasonic wave to detect the change in acromioclavicular space and myoelectric signal instrument to collect myoelectric signals from upper and lower trapezius and serratus anterior. The research discussing the influence of four-week shoulder training on the improvement of shoulder joint impingement syndrome. Research result: Compared efficiency ratio of lower trapezius/serratus anterior before and after exercise training, the activity was significant changed in the group of health male college students under the action for 35%, 55% and 100% at 00、300、600 (output power at abduction angle), which activity was no significant changed in the group of college baseball professionals. Compared efficiency ratio of serratus anterior/upper trapezius before and after exercise training, the activity ratio was significantly increased in the group of health male college students under the action for 35% and 55% at 300、600, 100% at 00、300、600 , which activity has significantly changed in the group of college baseball professionals under the action for 35% at 300 and 600 , but little changed at other angles. Compared the changed of acromioclavicular space before and after exercise training, the space was significantly increase in the group of health male college students under the action for 35% and 55% at 300、600, and 100% at 600 , which space was significantly increase in the group of college baseball professionals under the action for 35%, 55% and 100% at 600. Conclusion: Health male college students after four-week shoulder exercise training can increase the activity in lower trapezius/serratus anterior and improved activity ratio for lower trapezius/serratus anterior in scapula activity, further increased acromioclavicular space. For college baseball professionals, exercise training can not only improve rotator cuff muscles but also increased activity ratio for serratus anterior in scapula activity to effectively improve acromioclavicular space. Exercise training can improve activity ratio in lower trapezius/serratus anterior for general college students who have not received throwing professional training, and improve activity ratio for serratus anterior in scapula activity as well as acromioclavicular space for baseball professionals who was received throwing professional training. This research proposes throwing type athletes and general patients who suffering from shoulder impingement syndrome can received training to improve discomfort symptom on their shoulders.