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研究生:羅佳安
研究生(外文):Christopher Lo
論文名稱:乾針療法對膕旁肌疲勞者步態的影響
論文名稱(外文):The Effects of Dry Needling on Gait Patterns in Subjects with Hamstring Muscle Fatigue
指導教授:洪士文張祝芬張祝芬引用關係
指導教授(外文):Shih-Wun HongChu-Fen Chang
口試委員:陳顥齡何宗融
口試日期:2021-08-23
學位類別:碩士
校院名稱:慈濟大學
系所名稱:物理治療學系碩士班
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:英文
論文頁數:57
中文關鍵詞:乾針療法肌肉疲勞表面肌電圖
外文關鍵詞:Dry NeedlingMuscle FatigueSurface Electromyography
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背景:肌肉疲勞是健康人和運動員中最常見的症狀之一。肌肉疲勞可以描述為所涉及的肌肉可以產生的最大力量或力量的減少,並且在持續的體育活動發作後它可以逐漸發展。有許多治療肌肉疲勞的方法,例如休息,使用合成產品,天然產品和營養補品。緩解肌肉疲勞的另一種方法是通過乾針療法。乾針療法是肌筋膜觸發點(TrPs)的一種已知治療方法,但在當前的物理治療工作領域並不普遍。它被認為是一種相對新型的侵入性干預措施,可以由在美國獲得許可的物理治療師採用。對於肌筋膜疼痛患者,乾針療法可用於誘導肌筋膜觸發點的立即鎮痛,而無需麻醉。在短期內,乾針還被證明對減輕與TrP有關的疼痛,增加ROM以及改善生活質量有效。儘管已經有許多研究對各種肌肉的TrP使用乾針療法治療,但很少或沒有關於乾針療法對膕旁肌疲勞的研究。

目的:本研究旨在確定乾針對膕旁肌疲勞的健康受試者步態模式的有效性。受試者將被指示在治療帶的阻力下進行膝關節屈曲練習,以引起肌肉疲勞。使用3D運動分析和測力板記錄下肢數據,然後計算得到運動學數據。乾針組與假乾針組相比,乾針組在減輕疲勞方面具有顯著差異。

方法:從慈濟大學和花蓮社區招募年齡在20-35歲之間的參與者。每個受試者都是通過海報傳單招募的,並根據非概率和便利抽樣進行選擇。總共有3組:乾針組(實驗)、假乾針組和控制組。受試者的入選標準是過去一個月沒有任何影響正常行走和平衡的下肢疼痛和神經疼痛。受試者的排除標準將是受試者是否患有前交叉韌帶或後交叉韌帶撕裂、手術、金屬過敏、害怕針頭、出血性疾病並且目前正在服用抗凝藥物。

實驗會使用九台紅外攝像機(VICON、Bonita 3.0 和 Nexus 2.10 軟件,英國)、3D 動作捕捉系統和測力台(AMTI,Advanced Medical Technology,美國)用於收集數據。受試者被指示做各種動作,包括屈膝以誘導膕旁肌疲勞。根據他們被隨機分配到哪個組,受試者將被指示為每個組執行動作。使用的統計分析是具有事後的三向方差分析,顯著性設定為 p < 0.05。

結果:對於膝角,乾針干預與疲勞後相同。然而,對於膝關節力矩,在負載響應期間有更大的伸肌。在膕旁肌疲勞期間,膕旁肌被縮短,因此在膝力矩期間更大的伸肌,因為膕旁肌是膝屈肌。乾針提高了膕旁肌的屈伸能力。

結論:根據這項研究的結果,乾針確實改善了受試者在膝蓋時刻(實驗性)的步態模式,因為它在負荷響應期間表現出更大的伸肌。然而,這是乾針干預唯一的積極變化。

關鍵字:乾針療法,肌肉疲勞,表面肌電圖

Background: Muscle fatigue is one of the most common symptoms that can occur in both healthy people as well as athletes. Muscle fatigue can be described as a reduction of maximal force or power that the involved muscles can produce, and it can develop gradually after onset of sustained physical activity. There are many methods to treat muscle fatigue, such as resting, use of synthetic products, natural products, and nutritional supplements. An alternative for relieving muscle fatigue is through dry needling. Dry Needling is a known concept of treatment for myofascial trigger points (TrPs), but it is not commonplace in the current physical therapy work field. It is considered a relatively new type of invasive intervention that can be utilized by physical therapists who are licensed in the United States. Dry needling can be used to induce immediate analgesia of the myofascial trigger point without hyperaesthesia for patients with myofascial pain. Dry needling has also been shown to be effective in the short term for pain alleviation related to TrPs, increase in ROM, and the improvement of quality of life. Although there have been numerous studies on the use of dry needling treatment for TrPs for various muscles, there have been little to no research done on the effect of dry needling on muscle fatigue for the hamstring muscle.

Purpose: This study aims to determine the effectiveness of dry needling on gait patterns for healthy subjects with induced hamstring muscle fatigue. Subjects will be instructed to do knee flexion exercises with resistance from therabands to induce muscle fatigue. Data of the lower extremities will be recorded with the use of three-dimensional motion analysis and force plates, and then will be calculated to obtain kinematic data. The hypothesis is that dry needling would have a significant difference of reducing fatigue in the dry needling group compared to the sham and control groups.

Methods: Participants were recruited between the ages of 20 to 35 years old from Tzu Chi University and the Hualien Community. Each of the subjects were recruited via poster fliers and selected based on non-probability with convenience sampling. There is a total of 3 groups: the dry needling group (experimental), the sham dry needling group, and the resting group (control). The inclusion criteria for the subjects will be not having any lower extremity pain and neurological pain that can affect normal walking and balance for the past month. The exclusion criteria for the subjects will be if the subjects have had anterior or posterior cruciate ligament tears, surgery, metal allergy, fear of needles, bleeding disorders, and are currently taking anticoagulant medications.

The experiment will use nine infrared cameras (VICON, Bonita 3.0 with Nexus 2.10 software, UK), 3D motion capture system, and force plates (AMTI, Advanced Medical Technology, USA), were used to collect data. Subjects were instructed to do a variety of actions, including knee flexion for induced muscle fatigue at the hamstrings. Depending on which group they were randomly assigned to, the subjects would be instructed to perform actions for each group. Statistical analysis used were three-way ANOVA with post hoc and the significance was set at p < 0.05.

Result: For the knee angle, the dry needling intervention was the same as post-fatigue. For the knee moment however, there was greater extensor during the loading response. During hamstring fatigue, the hamstring muscle is shortened, hence the greater extensor during knee moment since the hamstring muscle is a knee flexor muscle. Dry needling has improved the flexion extension ability of the hamstring muscle.

Conclusion: Based on the results of this study, dry needling did improve gait patterns for subjects at the knee moment (experimental), as it showed greater extensor during loading response. However, this was the only positive change for the dry needling intervention.

Keywords: Dry Needling, Muscle Fatigue, Surface Electromyography


Table of Contents
Chapter 1: Introduction

1.1 Background 1
1.2 Literature Reviews 3
1.2.1 Dry Needling for Clinical Purposes 3
1.2.2 Gait 3
1.2.3 Acupuncture 4
1.2.4 Heat and Cold Therapy 4
1.2.5 TENS 5
1.2.6 Massage Therapy 6
1.2.7 Functional Assessment Scale for Hamstrings (FASH) 6
1.3 Aims of This Study 7
Chapter 2: Materials and Methods

2.1 Subjects and Eligibility Criteria 7
2.2 Equipments 9
2.2.1 3-Dimensional Vicon Motion Analysis System 9
2.2.2 Noraxon USA Ultium EMG 10
2.2.3 Dongbang Stress Free Needle 11
2.3 Procedures 11
2.3.1 3D Motion Analysis System 12
2.3.2 Noraxon USA Ultium EMG 13
2.3.3 Dry Needling (Experimental) 14
2.3.4 Dry Needling (Sham) 16
2.3.5 Resting (Control) 17
2.4 Data Analysis 17
2.4.1 3D Motion Analysis System 17
2.4.2 Noraxon USA Ultium EMG 17
2.5 Statistical Analysis 19
2.6 Questionnaire Data and Analysis 19
Chapter 3: Results

3.1 Questionnaire results 19
3.2 Fatigue Effect (Experimental) 19
3.2.1 Joint Kinematics (Hip Angles) 19
3.2.2 Joint Kinematics (Knee Angles) 20
3.2.3 Joint Kinematics (Ankle Angles) 21
3.2.3 Joint Kinematics (Hip Moments) 22
3.2.3 Joint Kinematics (Knee Moments) 23
3.2.3 Joint Kinematics (Ankle Moments) 23
3.3 Dry Needle Effect (Experimental) 24
3.3.1 Joint Kinematics (Hip Angles) 24
3.3.2 Joint Kinematics (Knee Angles) 25
3.3.3 Joint Kinematics (Ankle Angles) 25
3.3.4 Joint Kinematics (Hip Moments) 26
3.3.5 Joint Kinematics (Knee Moments) 27
3.3.6 Joint Kinematics (Ankle Moments) 27
3.4 Dry Needle Effect (Sham) 28
3.4.1 Joint Kinematics (Hip Angles) 28
3.4.2 Joint Kinematics (Knee Angles) 28
3.4.3 Joint Kinematics (Ankle Angles) 29
3.4.4 Joint Kinematics (Hip Moments) 30
3.4.5 Joint Kinematics (Knee Moments) 31
3.4.6 Joint Kinematics (Ankle Moments) 31
Chapter 4: Discussion 32
Chapter 5: Conclusion 34
Tables 35
References 39
Appendix 42







List of Figures
Figure 1. Vicon, Bonita 3.0 with Nexus 2.10 Software, UK 9
Figure 2. Noraxon USA Ultium EMG 10
Figure 3. Dongbong Stress Free Needle 11
Figure 4. Marker position for lower limb 13
Figure 5. EMG position for lower extremities 14
Figure 6. Locations for needling of hamstring muscles 15
Figure 7. Insertion of needles on the hamstring muscles 16
Figure 8. 100% MVC of the biceps femoris 18
Figure 9. MVC of biceps femoris post-induced fatigue 18
Figure 10. Hip Angle comparison between pre and post fatigue 20
Figure 11. Knee Angle comparison between pre and post fatigue 21
Figure 12. Ankle Angle comparison between pre and post fatigue 22
Figure 13. Hip Moment comparison between pre and post fatigue 22
Figure 14. Knee Moment comparison between pre and post fatigue 23
Figure 15. Ankle Moment comparison between pre and post fatigue 24
Figure 16. Hip Angle comparison between post fatigue and intervention 24
Figure 17. Knee Angle comparison between post fatigue and intervention 25
Figure 18. Ankle Angle comparison between post fatigue and intervention 26
Figure 19. Hip Moment comparison between post fatigue and intervention 26
Figure 20. Knee Moment comparison between post fatigue and intervention 27
Figure 21. Ankle Moment comparison between post fatigue and intervention 27
Figure 22. Hip Angle (Sham) comparison between post fatigue and intervention 28
Figure 23. Knee Angle (Sham) comparison between post fatigue and intervention 29
Figure 24. Ankle Angle (Sham) comparison between post fatigue and intervention 30
Figure 25. Hip Moment (Sham) comparison between post fatigue and intervention 30
Figure 26. Knee Moment (Sham) comparison between post fatigue and intervention 31
Figure 27. Ankle Moment (Sham) comparison between post fatigue and intervention 32


Tables

Table 1. Experimental Group (Dry Needling) Demographic Data 35
Table 2. Experimental Group (Sham) Demographic Data 35
Table 3. Control Group (Resting) Demographic Data 36
Table 4. Functional Assessment Scale Hamstring (FASH) Items 36
Table 5. Functional Assessment Scale Hamstring Results (Experimental) 37
Table 6. Functional Assessment Scale Hamstring Results (Sham) 37
Table 7. Functional Assessment Scale Hamstring Results (Control) 37

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