臺灣博碩士論文加值系統

背景：姿勢對於脊椎整體的排列位置與彼此間力量的分佈扮演著重要的角色。在日常生活中，駝背姿勢是經常發生的習慣性不良姿勢之一，但是當沒有重大損傷出現前，姿勢不良的問題是很容易被忽略的。在處理姿勢問題時，物理治療師經常透過運動治療的介入來改善。GYROKINESIS是一種結合呼吸且連續、流動的動作系列，其中的好處包含增進柔軟度、肌肉力量和改善不良的姿勢。然而，卻沒有研究探討GYROKINESIS應用在姿勢改善的效用。研究目的：探討12週，每週兩次的GYROKINESIS訓練對於駝背姿勢、胸椎活動度、頭部前置角度、前彎柔軟度、軀幹屈肌與伸肌的耐力、身體組成、胸廓活動度、自覺整體姿勢改善之程度等方面的改善效果。研究方法：本研究為前瞻性、隨機分組，且進行兩個月追蹤之臨床實驗。將收入60位駝背姿勢的受測者並隨機分組到控制組(n=30)，GYROKINESIS運動介入組 (n=30)。 介入組進行12週，每週兩次的GYROKINESIS運動訓練。療效評估是在12週的GYROKINESIS訓練完成6周、完成12周時以及 2 個月的追蹤期後。療效測量包括 (1)胸椎後凸角度(thoracic kyphosis angle)，各在一般站姿、自我調整站姿、一般坐姿以及自我調整坐姿等四種狀態下測量。(2)胸椎前彎、後伸、側彎和旋轉活動度。(3)其他測量項目：頭和肩的前置角度、軀幹屈肌與伸肌耐力、身體前彎柔軟度、胸廓活動度以及自覺整體姿勢改善之程度。統計分析：以二維重複測量變異數分析(two-way repeated measures ANOVAs)分析比較組間或組內是否存在顯著差異。結果：療效測量包括胸椎後凸角度，相較於控制組，GYROKINESIS運動介入組在一般站姿(p<0.001)、自我調整站姿(p<0.001)、一般坐姿(p<0.001)以及自我調整坐姿(p<0.001)、胸椎活動度在矢狀面(p<0.001)、額狀面(p=0.001)、頭前置角度(p<0.001)、身體前彎柔軟度(p=0.002)、胸廓活動度(p<0.001)、軀幹屈肌(p<0.001)、伸肌耐力(p<0.001)、平板式測試(p<0.001)以及自覺整體姿勢改善程度於整體健康狀況(p<0.001)和姿勢(p<0.001)皆在12週運動後有顯著的效用。GYROKINESIS運動介入組之組內比較結果顯示大部份的測量結果皆有顯著的改善，包括在一般站姿之胸椎後凸角度由44.3度減少到33.8°(p<0.001)、自我調整站姿之胸椎後凸角度由28.9度減少到23.7度(p<0.001)、一般坐姿之胸椎後凸角度由41.7度減少到34.4度(p<0.001)以及自我調整坐姿之胸椎後凸角度由29.6減至22.9度(p<0.001)；矢狀面胸椎活動度由66.1增加至80.6度(p<0.001)、額狀面由82.2增加至90.1度(p<0.001)；頭前置角度由38.6減少至36度(p=0.001)、身體前彎柔軟度由1.9增加至6.13公分(p<0.001)、胸廓活動度由5.4增加至6.7公分(p<0.001)、軀幹屈肌耐力由111.3秒增加至182.7秒(p<0.001)、伸肌耐力由103.8秒增加至148.9秒(p<0.001)；平板式測試(plank test)由70.5秒進步到104.0秒(p<0.001)。兩個月的追蹤測試發現療效大多能維持。結論：這是第一篇探討GYROKINESIS動態伸展運動介入於改善駝背姿勢和脊椎活動度之成效研究。GYROKINESIS動態伸展運動介入於改善駝背姿勢、脊椎活動度、頭前置角度、身體前彎柔軟度、胸廓活動度、軀幹屈肌和伸肌耐力在介入12週後和兩個月的追蹤時皆有顯著的成效。

Background: In daily living, habitual poor posture has often been found, and commonly, with insufficient concern. One of the most common poor postures is the thoracic kyphosis posture. For managing the faulty posture, exercises have been recommended as a major intervention. GYROKINESIS® is an exercise system comprising circular, fluid movements that engage the spine and pelvis combined with specific breathing patterns. Benefits of this form of exercise are purported to include improved flexibility and muscle strength as well as improved posture. However, its effects have not been investigated. Purpose: The purpose of this study is to investigate the effects of 12-week GYROKINESIS® training on improving thoracic kyphosis posture, thoracic mobility, forward head/shoulder posture, trunk forward bending flexibility, muscle endurance of trunk flexor, extensor, and plank test, and perceived improvement in overall health and posture. Study design: A prospective, randomized controlled trial with 2-month longitudinal follow-up study. Methods: Sixty participants aged from 18 to 40 years with thoracic kyphosis posture (kyphosis angle  40o) were recruited into this study. They were randomized into two groups: (1) the control group (CG, n=30), (2) the GYROKINESIS® group (GG, n=30). Subjects of GG received 12 weeks, twice a week of GYROKINESIS® intervention. Evaluation was performed at the beginning of the intervention, upon the completion of the 6 weeks, 12 weeks intervention, and at the 2-month follow-up. Outcome measures: Outcome measures included thoracic kyphosis angle, thoracic mobility (the range of motion of the thoracic flexion, extension, side bending, rotation), forward head angle, trunk forward bending flexibility, chest mobility, muscle endurance of trunk flexors, extensors, the plank test, and perceived improvement on posture and overall health. Statistical analysis: Two-way repeated measures ANOVAs were used to examine the between-group and within-group differences (α = 0.05). Results: Compared to the control group, a 12-week GYROKINESIS exercise showed significant effects on most of the outcomes including thoracic kyphosis posture (p<0.001), thoracic mobility in sagittal plane (p<0.001) and frontal planes (p=0.001), forward head posture (p<0.001), forward bending flexibility (p=0.002), chest mobility (p<0.001), muscle endurance of trunk flexors (p<0.001), extensors (p<0.001), plank test (p<0.001), and perceived improvement in overall health (p<0.001) and posture (p<0.001). At the 2-month follow-up, the effectiveness found in the GG could also be maintained in most of the outcomes. Within-group comparisons for the GYROKINESIS group revealed significant improvements after 12 weeks in thoracic kyphosis posture (from 44.3 to 33.8 degrees, p<0.001), thoracic mobility in sagittal plane (from 66.1 to 80.6 degrees, p<0.001), frontal plane (from 82.2 to 90.1 degrees, p<0.001), forward head angle (from 38.6 to 36 degrees, p=0.001), trunk forward bending flexibility (from 1.9 to 6.13 centimeters, p<0.001), chest mobility (from 5.4 to 6.7 centimeters, p<0.001), muscle endurance of trunk flexors (from 111.3 to 182.7 seconds, p<0.001), extensors (from 103.8 to 148.9 seconds, p<0.001), the plank test (from 70.5 to 104.0 seconds, p<0.001), and perceived improvement in overall health (p<0.001) and posture (p<0.001). Conclusion: This is the first study to investigate the effectiveness of GYROKINESIS exercises on adults with the thoracic kyphosis posture. GYROKINESIS exercise trainings were effective on improving the thoracic kyphosis posture, thoracic mobility, forward head angle, chest mobility, standing forward bending flexibility, trunk muscle endurance of flexors, extensors, the plank test, and perceived improvement in overall health and posture after 12 weeks training and at the 2-month follow-up.

謝誌 i
中文摘要 ii
Abstract v
Table of Content viii
List of Tables xi
List of Figures xiii
List of Appenendix xv
Chapter 1 Introduction 1
1.1 Background 1
1.2 Significance of the Study 2
1.3 Purpose of the Study 3
Chapter 2 Literature Review 4
2.1 Posture 4
2.2 Thoracic Kyphosis Angle and Its Measurements 7
2.3 Normative Range of Motion of the Thoracic Spine 8
2.4 Problems of the Thoracic Kyphosis Posture 10
2.5 Treatment for the Thoracic Hyper-kyphosis Posture and Restricted Thoracic Mobility 11
2.6 Introduction to the GYROKINESIS exercise system 21
2.7 Summary 22
2.8 Purpose of the Study 23
Chapter 3 Methods 24
3.1 Study Design 24
3.2 Participants 24
3.2.1 Inclusion criteria 24
3.2.2 Exclusion criteria 24
3.3 Study Flow 25
3.4 Outcome Measurements and Testing Procedures 26
3.4.1 Primary outcome 26
3.4.1.1 Thoracic kyphosis angle 26
3.4.1.2 Thoracic mobility 29
3.4.2 Secondary outcome 32
3.4.2.1 The Forward Head and Forward Shoulder Angle 32
3.4.2.2 Trunk and Lower Extremity Flexibility 33
3.4.3 Chest mobility 34
3.4.4 Trunk Muscles Endurance 35
3.4.5 Global perceived improvement 37
3.5 Intervention 37
3.6 Statistical Analysis 39
3.7 Preliminary Study 40
Chapter 4 Results 45
4.1 Demographic Data 45
4.2 The Thoracic Kyphosis Angle 46
4.2.1 In standing position 46
4.2.2 In sitting posture 48
4.3 Thoracic mobility 49
4.3.1 Sagittal plane mobility 49
4.3.2 Frontal plane mobility 50
4.3.3 Horizontal plane mobility 51
4.4 The Forward Head and Forward Shoulder Angle 51
4.4.1 The forward head angle 52
4.4.2 The forward shoulder angle 53
4.5 Trunk and Lower Extremity Flexibility: The Standing Forward Bending Test 54
4.6 The chest mobility 55
4.7 The Trunk Muscle Endurance 56
4.7.1 The trunk flexor endurance 56
4.7.2 The trunk extensor endurance 57
4.7.3 The plank test 57
4.8 Perceived Improvement 58
Chapter 5 Discussion 61
5.1 Improvement in the Thoracic Kyphosis Posture 62
5.2 Improvement of the Thoracic Mobility 68
5.3 Improvement in Forward Head/Shoulder Angle 70
5.4 Chest expansion 73
5.5 The Standing Forward Bending Flexibility 74
5.6 Improvement in Trunk Muscle Endurance 75
5.7 Improvement in Global Perceived Improvement 77
5.8 Limitations 77
5.9 Clinical Relevance 77
Chapter 6 Conclusion 79
References 80

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