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研究生：	黃挺鈞 Huang, Ting-Chun
論文名稱：	比較刮痧與肌內效貼布在腳踝不穩定族群下肢動作與肌肉活動之表現 Comparison of the effects between Gua Sha and Kinesio Taping treatment on lower extremity movement and muscle activation in subjects with chronic ankle instability
指導教授：	卓瓊鈺 Cho, Chiung-Yu
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2018
畢業學年度：	106
語文別：	英文
論文頁數：	67
中文關鍵詞：	側向跳躍、刮痧、肌內效貼布、下肢運動學、肌電圖
外文關鍵詞：	Lateral hopping task, Gua Sha, Kinesio Taping, Kinematics, Surface electromyography
相關次數：	點閱：96 下載：2
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背景與目的:腳踝扭傷常好發於運動員，主要的後遺症為慢性腳踝不穩定。前人指出慢性腳踝不穩定的患者易有腓骨長肌活化反應遲緩以及腳踝外翻肌群肌力下降等問題，而在執行功能性活動如側向跳躍著地時則易有較少腳踝外翻的情形出現。一般研究者認為腓骨長肌是避免腳踝內翻的重要肌肉，腳踝不穩定的族群如果無法產生適當的腓骨長肌的活化以保護腳踝，則可能會發生再度扭傷，因此，增加腓骨長肌的活化為本篇研究的主要治療目標。針對腳踝不穩定族群近年來較為流行的治療方式為使用肌內效貼布治療。前人指出肌內效貼布可以增加本體感覺、耐力、肌肉活化量進而增加活動表現。然而，這類型的治療需要耗費較高成本，因此本篇研究也想證明其他的治療方式是否有著相似的效果。而刮痧是亞洲常見的治療方式，過去學者發現刮痧應用在患者身上可以改善疼痛、增加血流量。然而目前對於刮痧使用在腳踝不穩患者的關節運動學與肌肉活化量的影響尚未清楚。因此本篇研究的目的乃在比較刮痧與肌內效貼布應用在腳踝不穩的患者的下肢運動學與肌肉活動表現之效果。

方法:本實驗收納了38位年齡介於20到60歲的腳踝不穩定患者，並且隨機分配至三組，其中12位為控制組，而另外12位為肌內效貼布組，最後14位為刮痧組；受試者在介入前皆需完成臨床測試以及側向跳躍之任務，同時收集跳躍過程中的成功次數、肌電圖以及動作訊號；接著三組皆會先接受1分鐘的腳踝關節鬆動術。之後控制組則會給予5分鐘的運動指導，刮痧組會接受5分鐘的刮痧介入，而肌內效貼布組會使用肌內效貼布貼在腓骨長肌上，直到完成所有臨床測試與功能性任務。各組治療後，會再執行治療前的所有測試。本研究使用二因子重複測量分析，重複因子為時間(治療前、後)，試圖比較三組受試者在執行側向跳躍時的下肢動作調節能力與肌肉活化程度之表現與臨床評估測試的結果。

結果: 在肌電圖分析方面，針對腓骨長肌研究結果顯示有明顯的時間與組別的交互作用(p=0.044)，在經過治療後，肌內效貼布組的側向跳躍著地後期的腓骨長肌活化量上升(p=0.031)而刮痧組維持了原本的腓骨長肌活化量(p=0.239)。在運動學方面，在額狀面的腳踝動作結果顯示，有明顯的時間與組別的交互作用(p=0.046)，兩組治療組在治療後在執行側向跳躍任務的著地瞬間，皆能維持原本的腳踝內翻角度(刮痧組: p=0.819，肌內效貼布組: p=0.506)，但控制組卻明顯增加了腳踝內翻的角度(p=0.012)。此外，在成功率研究結果顯示，發現有時間的主要效果(p<0.01)，所有受試者在治療後明顯增加了側向跳躍任務的成功率。而在疼痛閾值、耐力測試與腳踝背曲肌力的研究結果顯示，發現皆有時間的主要效果(p<0.05)，所有受試者在治療後，疼痛閾值與下肢耐力也明顯上升。然而，所有受試者在治療後，則減少了腳踝背曲的肌力。另外針對本體感覺研究結果顯示，有明顯的時間與組別的交互作用(p=0.039)，刮痧組明顯改善了本體感覺錯誤(p=0.046)。

結論:在經過治療後，肌內效貼布組能使著地後的腓骨長肌活化量提升，刮痧與肌內效貼布組皆能維持原本的側向跳躍著地瞬間之內翻角度，然而控制組則是增加了腳踝內翻角度，所以兩組治療組在治療後或許可以維持關節的穩定度。另外在治療後，刮痧能改善腳踝的本體感覺。因此對於腳踝不穩定族群，刮痧可建議為另一種治療方式，因為它不需要昂貴的成本。本研究指出刮痧與肌內效貼布皆能立即的改善側向跳躍時下肢運動學與肌肉活化量，以降低腳踝不穩定族群再度扭傷的風險。

Background and purpose: Ankle sprain is the most common injury in athletes. One main sequela of ankle sprain is chronic ankle instability (CAI). Previous research reported that the CAI group had peroneus longus reaction time delay, and reduced ankle eversion strength. Previous research also reported that the CAI subjects had a less-everted ankle than the normal group while performing the lateral hopping task. Peroneus longus was regarded as a very important muscle to prevent ankle inversion. If the CAI group could not generate enough peroneus muscle activation to protect the ankle, they might get ankle sprain again. Therefore, the peroneus muscle was the target treatment muscle in this study. Recently, Kinesio Taping is usually used in sports or rehabilitation. Previous researches reported that the Kinesio Taping can improve proprioception, muscle endurance, muscle activation and functional performance. However, the cost of Kinesio Taping was high. The researcher would like to find out whether other treatment could obtain similar effect as Kinesio Taping. Gua Sha is a traditional healing technique widely used in Asia. Gua Sha was usually used for reducing pain and increasing blood flow. However, the effect of Gua Sha on kinematics and surface electromyography in chronic ankle instability patients is still unclear. Thus, the purpose of this study was to compare the effect of the Kinesio Taping and Gua Sha treatment on the lower extremity movement and muscle activation for the chronic ankle instability patients.

Methods: Thirty-eight participants were eligible for this study. The participant’s age ranged from 20 to 60 years old. The subjects were randomly divided into three groups. There were 12 subjects in the control group, 12 subjects in the Kinesio Taping group, and 14 subjects in the Gua Sha group. All subjects were asked to perform the clinical examination and the lateral hopping task. While performing the lateral hopping task, successful rate, surface electromyography and kinematic data of the lower extremity were collected simultaneously. After above procedures, all three groups received mobilization treatment for 1 minute on the subject’s injured ankle. Then, different interventions were performed on three groups. The total treatment time was 5 minutes. The kinesio Taping was applied to the Kinesio Taping group until they finished all of the examination and functional task. After treatment, participants were asked to perform the same procedure as pre-treatment. Two-way ANOVA with repeated measure on time was used to analyze all clinical examination results, lower extremity movement and muscle activation among three groups.

Result: For the surface electromyography data, there was a significant time x group interaction on muscle activation of the peroneus longus (p=0.044). After intervention, Kinesio Taping increased the muscle activation of the peroneal longus during post-landing phase (p=0.031), however, the Gua Sha group maintained the same level of muscle activation (p=0.239). For the kinematic data, there was a significant time x group interaction on the ankle motion of frontal plane (p=0.046). Gua Sha and Kinesio Taping could help subjects maintain a less inverted ankle at initial contact after intervention (Gua Sha group: p=0.819, Kinesio Taping group: p=0.506), however, the control group had a more inverted ankle after intervention (p=0.012). For the successful rate, there was a main effect on time (p<0.01). All subjects increased their successful rate while the subjects were performing the lateral hopping tasks after intervention. For the pain pressure threshold, muscle endurance, and ankle muscle strength, main effect on time were found (p<0.05). All subjects increased their pain pressure threshold, and muscle endurance after intervention. However, all subjects decreased the muscle strength of the ankle dorsiflexor after intervention. For the proprioception error data, a significant time x group interaction was found (p=0.039). Gua Sha increased proprioception ability (p=0.046) after intervention.

Conclusion: After intervention, Kinesio Taping could increase the muscle activation of the peroneal longus during post-landing phase. Gua Sha and Kinesio Taping could help the CAI subjects to maintain a less inverted ankle at initial contact after intervention. However, the control group had a more inverted ankle. Both intervention groups might improve the ankle stability after interventions. Besides, Gua Sha was effective in improving the ankle joint proprioception. Gua Sha was recommended as another treatment for the CAI patients due to its effect and low cost. Gua Sha and Kinesio Taping provided immediate effect on lower extremity movement and muscle activation in subjects with chronic ankle instability, which might also decrease the risk of recurrent ankle sprain.

Contents
Abstract	I
摘要	V
誌謝	VIII
Chapter 1 Introduction	1
1.1 Epidemiology of chronic ankle instability and its pathophysiology	1
1.2 Surface electromyography (SEMG) study for chronic ankle instability	3
1.3 Kinematic study for chronic ankle instability	5
1.4 Current intervention for chronic ankle instability patients	7
1.4.1 Manual therapy	7
1.4.2 Exercise treatment	8
1.4.3 Kinesio Taping treatment	8
1.4.4 Gua Sha treatment	11
1.4.5 Motivation and purpose	13
Chapter 2 Method	15
2.1 Subjects	15
2.2 Instruments	16
2.2.1 Motion capture system	16
2.2.2 Surface Electromyography (EMG)	17
2.2.3 Kinesio Taping tool	18
2.2.4 Gua Sha tools	18
2.2.5 Body temperature measuring tool	18
2.2.6 Algometry	19
2.3 Experiment procedure	19
2.4 Functional task	20
2.4.1 Lateral hopping task	20
2.5 Clinical examination	21
2.5.1 Proprioception test	21
2.5.2 Heel rise up task	22
2.5.3 Lower-limb strength test	22
2.5.4 Foot and ankle ability measure (FAAM)	23
2.5.5 Cumberland ankle instability tool (CAIT)	23
2.6 Statistical Analysis	24
Chapter 3 Results	25
3.1 Demographic characteristics of participants	25
3.2 Clinical tests	25
3.2.1 Proprioception test	25
3.2.2 Body temperature	25
3.2.3 Muscle strength	26
3.2.4 Pain pressure threshold	26
3.2.5 Heel rise test	26
3.2.6 Foot and ankle ability measure (FAAM)	27
3.2.7 Surface Electromyography (EMG)	27
3.2.8 kinematics of the ankle joint	27
3.2.9 Successful rate	28
Chapter 4 Discussion	29
4.1 Kinematic data and EMG data during the lateral hopping from 200ms pre-landing to 200ms post-landing	29
4.1.1 Gua Sha and Kinesio Taping were effective in reducing the ankle inversion at initial contact of the lateral hopping task	29
4.1.2 Kinesio Taping was effective in increasing the peroneus longus activation during post-landing phase	30
4.1.3 Kinesio Taping and Gua Sha showed no significant effect in horizontal and sagittal planes of ankle motion during pre-and post-landing phase	32
4.2 Clinical examinations	32
4.2.1 Gua Sha was effective in improving proprioception ability	32
4.2.2 All participants decreased the muscle strength of the dorsiflexor	33
4.2.3 All participants had a higher pain pressure threshold after intervention	34
4.2.4 All participants had a higher muscle endurance after intervention	35
4.2.5 All participants had a higher successful rate while performing the lateral hopping task	35
4.2.6 Kinesio Taping was effective in improving score on activities of daily living	36
4.3 Limitations and future study	36
Chapter 5 Conclusion	38
References	39
Appendix	63
Appendix 1 Cumberland ankle instability tool (CAIT):英文、繁體中文版	63
Appendix 2 Foot and Ankle Ability Measure (FAAM)	65
 
List of Tables
Table 3.1 Participant’s characteristics for three groups.	48
Table 3.2 Performance of proprioception for three groups. (degree)	49
Table 3.3 Body temperature measurement for three groups. (°C)	49
Table 3.4 Ankle muscle strength measurement for three groups. (pound)	50
Table 3.5 Pain pressure threshold for three groups. (kg/cm2)	50
Table 3.6 Performance of heel rise tests for three groups. (repetitions)	51
Table 3.7 Successful rate for three groups. (%)	51
Table 3.8 Scores of foot ankle ability measure (FAAM)	52
Table 3.9 EMG data for peroneus longus while the subjects were performing the lateral hopping task. (%)	52
Table.3.10 Comparison of the ankle motion in sagittal plane. (dosiflexion /plantarflexion) during the lateral hopping task. (degree)	53
Table.3.11 Comparison of the ankle motion in frontal plane (inversion / eversion) during the lateral hopping task. (degree)	54
Table.3.12 Comparison of the ankle motion in horizontal plane (abduction/adduction) during the lateral hopping task. (degree)	55

 
List of Figures
Fig.2.1 Marker set placement and segment of lower extremities.	56
Fig.2.2 Lateral hopping task.	56
Fig.2.3 Degree of ankle motion in frontal plane. (one representative person in each group) (positive: eversion, negative: inversion)	57
Fig.3.1 Experimental flow chart.	58
Fig.4.1 EMG data for peroneus longus while the subjects were performing the lateral hopping task during the pre-landing phase.	59
Fig.4.2 EMG data for peroneus longus while the subjects were performing the lateral hopping task during the post-landing phase. A significant time x group interaction was found. (*:p<0.05)	59
Fig.4.3 Body temperature measurement for three groups. (*:p<0.05)	60
Fig.4.4 Scores of activities of daily. A significant time x group interaction was found. (*:p<0.05)	60
Fig.4.5Performance of heel rise tests for three groups. A significant main effect on time was found. (**:p<0.01)	61
Fig.4.6 Pain pressure threshold for three groups. A significant main effect on time was found. (*:p<0.05;**:p<0.01)	61
Fig.4.7 Proprioception for three groups. A significant time x group interaction was found. (*:p<0.05)	62
                                    

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