研究背景與目的:慢性頸部疼痛是現今社會中非常普遍的骨骼肌肉問題之一。過去研究也發現此族群會有疼痛失能、頸胸椎活動度受限、頸部整體肌肉力量降低、深層頸部屈曲和伸直肌肌力降低或神經肌肉控制能力降低、本體感覺缺損等問題，並且近幾年也發現此族群會有呼吸上的相關問題，包含不正常的呼吸模式、呼吸肌肌力下降、及橫膈膜厚度及活動度下降。過去已有許多研究針對此族群進行不同介入治療，包含電療、徒手治療、貼紮、肌筋膜放鬆、或運動;已有研究證實穩定性運動相比電熱療能更顯著改善其相關問題。當橫膈膜是最重要呼吸肌與脊椎穩定肌之一，且研究已發現慢性頸痛患者有呼吸功能下降與橫膈膜功能失常之問題，所以呼吸肌訓練應具做為慢性頸痛運動介入之可能模式。而過去針對此族群進行呼吸訓練之研究較少，且結果不一致。因此，本研究的目的為針對慢性頸部疼痛患者進行頸椎穩定性運動合併呼吸肌肌力訓練，去探討呼吸肌訓練疼痛失能、橫膈膜功能及呼吸相關能力的影響，並同時檢測頸椎活動度、頸椎肌肉力量和胸廓活動度之變化。
研究方法:本研究為前驅隨機雙盲對照研究，主要研究對象為慢性頸部疼痛族群。 總共 29 位患者完成本研究，包括接受六週頸椎穩定性運動合併呼吸肌肌力訓練的實 驗組 15 人，及單純只接受六週頸椎穩定性運動的控制組 14 人。所有個案皆於六週 內完成每週兩次的頸椎穩定性運動。頸椎穩定性運動介入之首週藉由壓力生理回饋 儀(Stabilizer pressure biofeedback)進行顱頸屈曲(Cranio-cervical Flexion, CCF)運動， 針對深頸屈肌及深頸伸肌重新再教育;而第二及第三週會進行在背部有支撐下去移 動肢體，第三週更會藉由沙包或彈力帶去加上阻力給予運動難度增加;而第四及第 五週則會在沒有背部支撐下去移動肢體，第五週再藉由沙包或彈力帶加上阻力給予 難度增加;第六週則是進展到多關節的活動。而實驗組另外同時會於家中進行每天 兩回合的呼吸肌肌力訓練，包含每天給予阻力 60%最大吸氣及最大吐氣壓力在吸氣端及吐氣端各進行兩回合，每回合 30 下，並且由另一位治療師監督。結果量測包含 疼痛(視覺類比量表及數字評定量表)、失能(頸部失能量表)、呼吸功能(橫膈膜厚 度、活動度及肌力)、呼吸肌肌力、肺功能(用力呼氣量、第一秒最大用力呼氣量和 每分鐘最大自主通氣量)、頸椎活動度、頸椎肌肉力量及胸廓活動度。所有結果量測 在介入前及介入後量測，並以成對樣本和獨立樣本 T 檢定去分別檢驗組內及組間差 異。
結果:總共為期 6 週共 12 次的頸椎穩定性運動介入合併呼吸肌肌力訓練後，相較於 前測，實驗組在疼痛、失能、最大吸氣壓力、肺功能之每分鐘最大自主通氣量及胸 廓活動度下段皆有顯著改善。在呼吸功能上橫膈膜厚度及活動度有增加之趨勢，但 沒有達到顯著改善。對照組在疼痛失能及橫膈膜在吸氣和吐氣的厚度也有進步。然 而實驗組及對照組相比並無顯著的組間差異。
討論與結論:本研究是第一篇針對慢性頸部疼痛進行頸椎穩定性運動合併呼吸肌肌 力訓練之前驅隨機分配研究，且包含檢測橫膈膜及呼吸相關功能。目前結果僅發現 完成 6 週共 12 次的頸椎穩定性運動合併呼吸肌肌力訓練的介入後，或許可以改善此 族群的疼痛、失能、最大吸氣壓力、每分鐘最大自主通氣量及下段的胸廓活動度， 但這樣的改善程度並無顯著高於控制組，所以目前合併呼吸肌肌力訓練是否可以更 加改善慢性頸部疼痛族群之問題，仍需要未來更多研究去確認呼吸肌肌力訓練在阻 力強度、個案依從性及姿勢上的影響，並且需要更多的樣本數及失能程度中度或以 上的族群，去確認呼吸肌肌力訓練對於慢性頸部疼痛族群的重要性。

Chronic neck pain is a prevalent musculoskeletal issue involving pain, disability, limited mobility, decreased strength, and proprioceptive deficits. It is often associated with respiratory dysfunctions, such as abnormal breathing patterns and reduced respiratory muscle strength, as well as impaired diaphragm mobility and strength. While stabilization exercises have been found more effective than electrotherapy, and diaphragm is the main respiratory muscle and one of the spinal stabilization muscles, research on respiratory muscle training is limited. This study aimed to assess the effects of combining cervical stabilization exercises with respiratory muscle training on pain, disability, diaphragm function, and respiratory capabilities in patients with chronic neck pain. In this pilot randomized double-blind controlled trial, 29 patients were divided into two groups: 15 in the experimental group received six weeks of combined training, while 14 in the control group received only cervical stabilization exercises. Both groups underwent cervical stabilization exercises twice per week for six weeks. The experimental group also performed daily respiratory muscle training at home. Outcome measures included pain, disability, respiratory function, respiratory muscle strength, lung function, cervical range of motion, cervical muscle strength, and chest expansion, assessed before and after the intervention. Experimental group showed significant improvements in pain, disability, maximal inspiratory pressure, maximal voluntary ventilation, and lower chest expansion after the six-week intervention. Diaphragm thickness and mobility showed a trend toward improvement but were not statistically significant. Control group also showed improvements in pain, disability and diaphragm thickness in inhalation and exhalation. However, no significant differences were observed between the groups. This is the first study to combine cervical stabilization exercises with respiratory muscle training in patients with chronic neck pain. While the combined intervention showed potential improvements, further research with larger samples and more severe disability levels is needed to confirm the benefits of respiratory muscle strength training in this population.

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