高明峰Kao, Ming-Feng2017-02-272025-07-302017-02-272017-02-27https://ir.ntus.edu.tw/handle/987654321/71015學位類別：碩士校院名稱：國立台灣體育大學系所名稱：運動健康科學系碩士班學號：19606001畢業學年度：98年論文頁數：90頁　　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.目　次 第壹章　緒論……………………………………………………………1 　第一節　研究背景與動機……………………………………………1 　第二節　研究目的……………………………………………………2 　第三節　研究問題……………………………………………………3 　第四節　研究假設……………………………………………………4 　第五節　名詞解釋……………………………………………………5 　第六節　研究範圍與限制……………………………………………6 第貳章　文獻探討………………………………………………………8 　第一節　髕股骨疼痛症候病因分析…………………………………8 　第二節　療效評估方式的選擇………………………………………20 　第三節　肌筋膜鬆弛術………………………………………………26 第參章　研究方法與步驟………………………………………………36 　第一節　研究大綱與研究架構………………………………………36 　第三節　實驗流程與實驗方法………………………………………40 第肆章　研究結果………………………………………………………50 　第一節　受測對象基本資料分析……………………………………50 　第二節　治療前後肌肉長度與Q角度之差異比較……………………51 　第三節　治療前後髕股骨疼痛症候群嚴重程度量表與 　　　　　前膝痛疼痛量表之差異比較………………………………56 　第四節　治療前後肌肉長度與療效相關性比較……………………59 第伍章　討論……………………………………………………………60 　第一節　治療前後身體結構和自覺量表之比較分析………………60 　第二節　肌筋膜鬆弛術改善髕股骨疼痛症候群症狀的原因………67 　第三節　快速、安全、有效的治療選擇……………………………70 第陸章　結論與建議……………………………………………………71 參考文獻…………………………………………………………………72 　附錄……………………………………………………………………841068074 bytesapplication/pdf結構線;柔軟度;艾力試驗(Ely’s test)，;直膝抬腿試驗(Straight Leg Raising Test)Alignment;Flexibility;Ely’s test;Straight Leg Raising Testthesis