Publication:

肌筋膜鬆弛術對髕股骨疼痛症候群之療效探討

目的：探討肌筋膜鬆弛術(Myofascial Release)對髕股骨疼痛症候群(Patellofemoral pain syndrome)之療效。儘管髕股骨疼痛症候群的成因尚不明確，但研究指出連接至髕骨之特定肌群(四頭肌、腿後肌群與小腿後肌)柔軟度不足，改變了髕骨於股骨溝內的滑動軌道，使得髕股骨間作用力上升為主要成因之一。肌筋膜鬆弛術(Myofascial Release)主要用途為鬆弛軟組織，過程是以延長牽拉(prolong stretch)的方式鬆弛軟組織。由於肌肉為軟組織的一種，且特定肌群柔軟度不足是髕股骨疼痛症候群的成因之一。因此本研究目的即為：以肌筋膜鬆弛術鬆弛為治療方法，鬆弛股四頭肌、腿後肌群與小腿後肌，再經由統計分析治療前後身體組成(肌肉柔軟度)與自覺量表的變化，來探討肌筋膜鬆弛術對於髕股骨疼痛症候群是否具有療效？方法：22位髕股骨疼痛症候群患者於兩週內進行三次肌筋膜鬆弛術的治療(每次30分鐘)。治療前後請患者分別填寫前膝痛疼痛量表(Anterior Knee Pain Scale)、髕股骨疼痛症候群嚴重程度量表(PFPS Severity Scale)，並進行股四頭肌、腿後肌群、小腿後肌之長度量測、Q角度之量測。所得資料以SPSS套裝軟體第18版進行統計分析。以成對樣本t檢定 (pair t-test)比較治療前、後之各量測成績之差異，其考驗顯著差異水平設定為p < 0.05。以皮爾森相關系數(Pearson)檢驗前膝痛疼痛量表、髕股骨疼痛症候群嚴重程度量表與三組肌群間的相關程度，考驗顯著差異水準設定為p < 0.05。最後再以無母數檢定之Wilcoxon符號等級檢定(Wilcoxon signed-rank test)分析不同病史長短與療效間的關係。結果：治療前後前膝痛疼痛量表、髕股骨疼痛症候群嚴重程度量表兩種量表成績與身體組成(股四頭肌長度、大腿後肌長度與小腿後肌長度)皆有顯著差異。Q角度在治療前後無顯著差異。股四頭肌長度與AKPS之間有中度相關(r=.482)、腿後肌群長度與PSS之間(r=.387)有弱相關。病史較短者(1-10個月)，相對於病史較長者(11-20個月)，有較佳的療效。結論：不論從身體組成(肌肉長度)或自覺量表來看，肌筋膜鬆弛術在鬆弛股四頭肌、腿後肌群與小腿後肌之後，可明顯改善髕股骨疼痛症候群的症狀。相較於病史較長者(11-20個月)，肌筋膜鬆弛術對於病史較短者(1-10個月)有較佳的療效。未來研究建議可持續探討肌筋膜鬆弛術之長期療效與個別肌群對於髕股骨疼痛症候群的影響程度。

Purpose: To investigate therapeutic effects of Myofascial Release for individuals with patellofemoral pain syndrome. The mechanism for patellofemoral pain syndrome is not well understood; however, it has been suggested that the condition may arise from limited muscle flexibility that alter tracking of the patella within the femoral trochlear notch, contributing to increased patellofemoral contact pressures that result in pain and dysfunction. Specifically, limited flexibility of the quadriceps, hamstrings and calf muscles have been implicated. The main effect of Myofascial Release is used to soften soft tissues. During applying Myofascial Release, therapist uses prolong stretch to loosen soft tissue. Muscle is soft tissue too and poor flexibility on specific muscle groups has been implicated with patellofemoral pain syndrome. Therefore, in this research Myofascial Release was used to soften specific muscle groups on subjects to investigate the therapeutic effects of Myofascial Release on subjects with patellofemoral pain syndrome. Method: 22 subujects (17 female and 5 male) were enrolled to this research. All the subjects were treated with Myofascial Release for three sessions within two weeks. Before and after treatments, Q angle, Anterior Knee Pain Scale(AKPS), PFPS Severity Scale(PSS) and lengths of these quadriceps, hamstrings and calf muscle groups were measured for further analysis. We performed paired t-tests to test for differences between the pre-test and post-test and Pearson's product-moment correlation coefficient to test the levels of correlation between AKPS, PSS and muscle lengths of quadriceps, hamstrings and calf muscle groups. Wilcoxon signed-rank test is used to analyze therapeutic effects for different duration of history. Results: Scores of AKPS, PSS, and flexibility of quadriceps, hamstrings and calf muscles improve except Q angle. Pearson product-moment correlation coefficients indicated that changes in quadriceps flexibility were moderatly correlated with changes in AKPS(r=.482) and changes in hamstring muscles poorly correlated with changes in PSS(r=.387). Wilcoxon signed-rank test indicated that subjects with shorter history(1-10 months) showed better prognosis than subjects with longer history(11-20 months). Conclusion: The results support that increasing flexibility of quadriceps, hamstrings and calf muscle groups by Myofascial Release helps to improve symptom and sign of subjects with patellofemoral pain syndrome. Compared to subjects with longer history(11-20 months), therapeutic effets of Myofascial Release is better for subjects with history within 10 months. Further research is needed to evaluate the long-term therapeutic effets of Myofascial Release and to determine which muscle group has more influence on patellofemoral pain syndrome.