Publication:

使用儀器治療對於慢性踝關節不穩定運動員本體感覺的影響

本體感覺輸入提供中樞神經系統對於身體位置、關節動作方向與速度的訊息。對於骨骼肌肉系統傷害，儀器治療是一個經常被使用的治療方式，在許多文獻中已證實儀器治療可以有效降低發炎反應與減輕疼痛。但是對於使用儀器治療後是否會影響到本體感覺回饋或平衡，目前仍少有相關文獻探討。因此，本研究目的為探討儀器治療使用後是否會改變踝關節的本體感覺與站立平衡。使用的儀器介入包括冷療、經皮神經電刺激(TENS)和超音波，共有34位單側慢性踝關節不穩定受試者，在使用儀器治療之前和之後（0和30分鐘），利用Biodex等速肌力儀測量踝關節本體感覺，並進行星型平衡測試。使用二因子重複量數變異數分析，以比較使用儀器治療前後的差異和健側患側的差異。結果發現在星型平衡測試中，立即冷療介入後的跨步距離比冷療介入前顯著較小，而立即和30分鐘TENS介入後的跨步距離比TENS介入前顯著較大，立即和30分鐘超音波介入後的跨步距離比超音波介入前顯著較大。在踝關節本體感覺測試中，患側的絕對誤差比健側顯著較大。冷療介入後對於站立平衡有負面影響，但TENS介入後或超音波介入後對於站立平衡有正面影響。當運動員接受冷療後，若立即回到運動場訓練或比賽，可能會提高受傷的發生率。

Proprioception plays a critical role in injury prevention by affording the correct afferent message. Therapeutic modality is often used for the treatment of disorders in musculoskeletal system. Previous studies indicated that the use of therapeutic modality can effectively decrease pain and inflammation. However, little is known about the influence of therapeutic modality on the proprioception. Therefore, the purpose of this study was to investigate the effect of therapeutic modality on proprioception in subjects with chronic ankle instability. Thirty four subjects were participated in this study. Cryotherapy, transcutaneous electrical nerve stimulation (TENS) and ultrasound were used as modality interventions. Ankle proprioception tests were measured by Biodex isokinetic dynamometer and star excursion balance tests were conducted. Data collection was performed in pre-intervention, immediately and 30-minute after intervention. Two-way ANOVA with repeated measures were used to compare the differences between pre-intervention and post-intervention, and between affected and unaffected sides. The results showed that immediately after cryotherapy showed a significantly lesser reaching distance than pre-cryotherapy in star excursion balance test. Immediately and 30-minute following TENS program showed a significantly greater reaching distance than pre-TENS in star excursion balance test. Immediately and 30-minute following ultrasound program showed a significantly greater reaching distance than pre-ultrasound in star excursion balance test. Affected side had a significantly greater absolute error than unaffected side in ankle proprioception test. Cryotherapy might have risky effect on dynamic standing balance while TENS or ultrasound program might have positive effect on dynamic standing balance. The risk of injury following a return to sports activity might be enhanced immediately after cryotherapy.