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研究生：	林信宇 Lin, Hsin-Yu
論文名稱：	比較手肘支撐對有無頸痛之智慧型手機使用者的肌肉活性與姿勢之效果 Comparing the effect of elbow support on posture and muscle activities between the smartphone users with and without chronic neck pain
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：	2022
畢業學年度：	110
語文別：	英文
論文頁數：	92
中文關鍵詞：	肘部支撐、智慧型手機、姿勢、肌肉活動、疼痛壓力閾值
外文關鍵詞：	Elbow support, Smartphone, Posture, Muscle activity, Pain pressure threshold
相關次數：	點閱：65 下載：30
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摘要
背景與目的：科技日益發展，智慧型手機已成為生活必需用品。隨著智慧型手機的高普及率，肌肉骨骼系統疾病盛行率也提高。智慧型手機族常見的肌肉骨骼系統疼痛位置為：頸部、肩膀、上背、上肢、下背，其中以頸部盛行率為最高(17.3%~89.9%)。分析其危險因子，主要三項包括： 1. 錯誤的身體姿勢 2. 過長的使用時間 3.高重複性動作。常見錯誤姿勢為頸部彎曲和駝背，此姿勢與頸部疼痛可能有關聯，因此如何改善姿勢相當重要。近年的研究多探討，如何降低使用智慧型手機時的肌肉活動以及姿勢改善。研究者發現在手肘支撐下進行打字任務，頭頸屈曲角度會改善、豎頸肌與上斜方肌的肌肉活動會顯著降低，且較不會感到疲累與不適。然而，先前研究多專注在健康年輕使用者使用智慧型手機時的姿勢與肌肉活動，對於有頸部疼痛的年輕使用者尚無研究。因此，本研究目的包括：(1) 評估年輕人使用智慧型手機時，肘部支撐、使用時間對肌肉活動和姿勢的影響。(2) 探討使用肘部支撐是否能更有效地減輕患有頸部疼痛的年輕人頸部和上肢的肌肉骨骼負荷。
方法：本研究選取32名年輕成人 (平均年齡：22.8± 2.6歲 ) 參與實驗，包括16名健康組、16名頸部疼痛組。頸部疼痛組，視覺疼痛分數需大於兩分、頸部失能量表需大於五分。實驗程序共有三個步驟，包括：靜態坐姿測量、五分鐘肘部支撐打字、五分鐘無肘部支撐打字。首先，在靜態坐姿下紀錄休息時的姿勢與肌肉活動作為基準。接著隨機執行有無支撐的五分鐘打字任務，且任務間給予五分鐘的休息時間。用3D動作分析系統與肌電系統記錄打字任務時前後30秒的姿勢及肌肉活動變化。打字任務開始前與結束後，皆測量頸部不適程度與雙側上斜方肌疼痛壓力閾值。本實驗使用三因子變異數重複測量分析 (重複因子為時間及支撐)來比較兩組受試者在執行打字任務時的測量結果。
結果：肘部支撐顯著改善打字時的姿勢 (減少了頭部與頸部彎曲角度。頭、頸 : p<0.001)，且手腕會較為放鬆 (手腕伸直角度增加 : p<0.001)。同時它可以減少雙側頸椎豎脊肌 (右側 : p<0.001、左側：p=0.014)、右上斜方肌 (p=0.006)和指淺屈肌 (p=0.042)的肌肉活動以及打字所造成的頸部不適程度 (p<0.001)。在五分鐘打字後，頭屈曲角度(p=0.024)、腕伸直角明顯增加 (p=0.018)，而肘屈曲角度 (p=0.002)、指淺屈肌肉活動 (p=0.018)、雙側斜方肌上痛壓閾值 (右側、左側: p<0.001)明顯下降。在頸部屈曲角度的分析發現三因子間有顯著交互作用(p=0.002)，在無肘部支撐下打字，頸部疼痛組頸屈曲角度隨打字時間顯著減少(p=0.015)，而健康組卻是有增加的趨勢(p=0.131)。在腕伸直角度的分析發現時間x組別雙因子間顯著交互作用(p=0.022)，隨著打字時間增加，健康組腕關節伸直角度增加較頸部疼痛組多。在左上斜方肌疼痛壓力閾值分析發現時間 x 組別雙因子顯著交互作用(p=0.03)。打字任務後，健康組左上斜方肌疼痛壓力閾值比頸部疼痛組降低多。在右上斜方肌疼痛壓力閾值分析發現支撐 x 時間雙因子顯著交互作用(p=0.045)。在肘部支撐下完成打字任務，兩組的右上斜方肌疼痛壓力閾值比無肘部支撐時下降的少。
結論：肘部支撐可有效改善智慧型手機使用者的姿勢並減少頸部肌肉活動以及頸部不適。五分鐘的打字任務後會改變年輕人的使用姿勢、肌肉活性和頸部不適。兩組在打字任務時，都會將智慧型手機拿的更靠近身體。在無肘部支撐下，兩組有著不同的姿勢策略。綜合以上結果，我們建議年輕人可以使用肘部支撐來使用智慧型手機，以保持良好的使用姿勢及減少頸部肌肉活動。未來建議可以延長打字時間來探討時間對姿勢與肌肉活性的影響，同時也可以招募更嚴重的頸部失能受試者來探討組別差異。

Abstract
Background and purposes: With the development of technology, smartphones have become a necessity of life. With the high penetration of smartphones, the prevalence of musculoskeletal disorders (MSDs) also increased. The common locations of the MSDs among smartphone users are: neck, shoulders, upper back, upper limbs, and lower back. Among them, the prevalence rate of neck is the highest (17.3%-89.9%). There are three main risk factors for the MSDs of the smartphone users, including awkward posture, excessive use time, and high repetitive movements. The common faulty postures are excessive neck flexion and humpback position, which may be associated with neck pain. How to improve posture while using the smartphone is very important. Recent studies have explored how to reduce muscle activity and improve posture while using the smartphone. The researchers found that typing with elbow support could improve the head and neck flexion angle, and significantly reduce the muscle activities of the cervical erector spine and upper trapezius. Also, the users had less fatigue and neck discomfort. However, no studies have examined the effect of forearm support in young smartphone users with neck pain who may have higher muscle activity and worse posture while using smartphones. Therefore, the purposes of this study were: (1) to investigate the effect of elbow support and time on muscle activity and posture during smartphone use in young adults (2) to evaluate whether the elbow support is more effective in reducing their musculoskeletal load on the neck and upper extremities in young adults with neck pain.
Methods: Thirty-two young adults (mean age: 22.8 ± 2.6 y/o) were included in our study (16 healthy adults and 16 neck pain adults). The inclusion criteria for neck pain group are the visual analogue score greater than 2, and the neck disability index greater than 5. The experimental procedure consists of three parts: baseline data measurement, five minute-typing with elbow support, and five minute-typing without elbow support. First, resting posture and muscle activities were recorded in the static sitting position as the baseline data. Then both groups randomly performed five-minute typing tasks (with and without elbow support). There was a five-minute break between the two tasks to reduce muscle fatigue bias. Before the start of the typing task and immediately after typing task, the subjects’ upper trapezius pain pressure threshold and neck discomfort were recorded. The 3D motion analysis system and the wire EMG system were used to record the changes in posture and muscle activity. The subjects’ muscle activities and postural changes were recorded for 30 seconds right after the typing task start, and 30 seconds before the end. A three-way repeated measures analysis of variance (RMANOVA) was used to analyze the joint angle, EMG signals, perceived neck discomfort, and pain pressure threshold for the effects of group, elbow support, and time.
Results: Elbow support significantly improved the typing posture (reduced head/ neck flexion: p<0.001), and reduced wrists tension (increased wrist extension, p<0.001). It also reduced muscle activities of bilateral cervical erector spine (right: p<0.001, left: p=0.014), right upper trapezius (p=0.006), flexor digitorum superficialis (p=0.042) and neck discomfort (p<0.001). After five minutes typing, the head flexion (p=0.024), and wrist extension angle (p=0.018) significantly increased, while elbow flexion angle (p=0.002), muscle activity of flexor digitorum superficialis (p=0.018), and pain pressure threshold of bilateral upper trapezius (right, left: p<0.001) significantly decreased. A significant interaction among support x time x group (p=0.002) was found for neck flexion angle. Under the no support condition, the neck pain group significantly decreased their neck flexion angle after five minutes typing task (p=0.015). However, the healthy group had an increasing trend (p=0.131). A significant interaction among time x group (p=0.01) for wrist extension angle was found. After five minutes typing, wrist extension angle increased more in the healthy group than the neck pain group (p=0.022). A significant interaction among time x group (p=0.03) was found for the pain pressure threshold of the left upper trapezius. After the typing task, the pain pressure threshold of the healthy group decreased more than the neck pain group. A significant interaction among support x time (p=0.045) was found for the pain pressure threshold of right upper trapezius. Typing under the elbow support condition, the pain pressure threshold tended to decrease less than under no elbow support.
Conclusion: Using the elbow support is effective in improving posture and reducing not only neck muscle activities but also neck discomfort among the young adults while using smartphones. Five-minute typing task can affect posture, muscle activity, and neck discomfort. After a five-minute typing task, both groups moved the smartphone closer to the body. For the group difference, two groups use different posture strategies when they are using smartphones, especially under no support condition. Above all, our results suggested that use smartphones with elbow support could improve the posture and muscle activities. Future studies could increase the usage time to explore the effect of time, and recruit the subjects with greater neck disability to explore the group differences.

Abstract I
摘要 IV
誌謝 VI
Chapter 1 Introduction 1
1.1  The penetration rate of smartphone and the prevalence of musculoskeletal symptoms 1
1.1.1 Common musculoskeletal disorders for the smartphone users 1
1.1.2 Definition and prevalence of chronic neck pain 2
1.2 The risk factors and mechanism of neck pain for the smartphone users 3
1.3 Characteristics of the smartphone users 5
1.3.1 Posture 5
1.3.2 Electromyography 6
1.3.3 Pain pressure threshold 8
1.4 Common interventions for chronic neck pain 9
1.4.1 Manual therapy 9
1.4.2 Physical activity or exercise 9
1.4.3 Ergonomics intervention 10
1.5 Research gap and motivation 12
1.6 Purposes and hypotheses 13
Chapter 2 Material and method 14
2.1 Participants 14
2.2 Experimental procedures 14
2.2.1 Test procedures 15
2.2.2 Outcome measures 17
2.2.3 Statistical analysis 18
Chapter 3 Results
3.1 Demographic data 20
3.2 Posture 20
3.2.1 Head flexion angle 20
3.2.2 Neck flexion angle 21
3.2.3 Shoulder flexion angle 21
3.2.4 Elbow flexion angle 21
3.2.5 Wrist extension angle 21
3.3 Electromyography 22
3.3.1 Neck muscles 22
3.3.2 Upper extremity muscles 23
3.4 Perceived neck discomfort 23
3.5 Pain pressure threshold 23
Chapter 4 Discussion
4.1 Main findings 25
4.2 Demographic data 26
4.3 Posture 26
4.3.1 Elbow support did improve postures in the young adults while using smartphones 26
4.3.2 Neck pain affect neck and wrist postures while using a smartphone 27
4.3.3 The head flexion angle increased after the typing task 28
4.4 Electromyography 29
4.4.1 Elbow support reduced most of the neck muscle activities, but less
forearm muscle activities 29
4.4.2 The group difference of the muscle activities was not significant 30
4.4.3 The time factor only affected some data of the muscle activities 31
4.5 Using the elbow support can reduce perceived neck discomfort 32
4.6 Pain pressure threshold was affected by time factor 32
4.7 Limitation 34
Chapter 5 Conclusion 35
References 36
Appendix 84
Appendix 1 84
Appendix 2 86
Appendix 3 89
List of Tables
Table 1. Demographic data of participants 45
Table 2. Resting sitting position 45
Table 3. Head flexion angle(°) under different conditions and at different time points for both groups 46
Table 4. Condition difference of postural results 47
Table 5. Time difference of postural results 47
Table 6. Neck flexion angle(°) under different conditions and at different time points for both groups 48
Table 7. Shoulder flexion angle(°) under different conditions and at different time points for both groups 49
Table 8. Elbow flexion angle(°) under different conditions and at different time points for both groups 50
Table 9. Wrist extension angle(°) under different conditions and at different time points for both groups 51
Table 10. RMS of static EMG 52
Table 11. Muscle activity of the right cervical erector spine (percentage %) under different conditions and different time points for both groups 53
Table 12. Muscle activity of the left cervical erector spine (percentage %) under different conditions and different time points for both groups 54
Table 13. Muscle activity of the right upper trapezius (percentage %) under different conditions and different time points for both groups 55
Table 14. Muscle activity of the left trapezius (percentage %) under different conditions and different time points for both groups 56
Table 15. Condition difference of electromyographic results (percentage %) 57
Table 16. Time difference of electromyographic results (percentage %) 57
Table 17. Muscle activity of the flexor digitorum superficialis (percentage %) under different conditions and different time points for both groups 58
Table 18. Muscle activity of the extensor digitorum (percentage %) under different conditions and different time points for both groups 59
Table 19. Muscle activity of the extensor carpi radials brevis (percentage %) under different conditions and different time points for both groups 60
Table 20. Muscle activity of the abductor pollucis brevis (percentage %) under different conditions and different time points for both groups 61
Table 21. Perceived neck discomfort score under different conditions and at different time
points for both groups 62
Table 22. Perceived neck discomfort under different conditions 63
Table 23. Perceived neck discomfort at different time points 63
Table 24. Perceived neck discomfort in different groups 63
Table 25. Pain pressure threshold of the left upper trapezius (kg) for both groups 64
Table 26. Pain pressure threshold of the left/ right upper trapezius at different time points 65
Table 27. Pain pressure threshold of the right upper trapezius (kg) for both groups 66 
List of Figures
Figure 1. The flow chart of the experiment 67
Figure 2. Elbow support instrument 68
Figure 3. The data collection process 68
Figure 4. Marker placement and angle definition 69
Figure 5. Comparison of the head flexion angle between two conditions 70
Figure 6. Comparison of the head flexion angle between two time points 70
Figure 7. Comparison of the neck flexion angle between two conditions 71
Figure 8-1. Neck flexion angle – support x time x group interaction (The health group) 72 
Figure 8-2. Neck flexion angle – support x time x group interaction (The neck pain group) 72
Figure 9. Comparison of the shoulder flexion angle between two conditions 73
Figure 10. Comparison of the elbow flexion angle between two time points 73
Figure 11. Comparison of the wrist extension angle between two conditions 74
Figure 12. Comparison of the wrist extension angle between two time points 74
Figure 13. Wrist extension angle: a significant support x time interaction 75
Figure 14. Comparison of the muscle activity for the right cervical erector spine between two conditions 76
Figure 15. Comparison of the muscle activity for the left cervical erector spine between two conditions 76
Figure 16. Comparison of the muscle activity for the right upper trapezius between two conditions 77
Figure 17. Comparison of the muscle activity for the left upper trapezius between two time
points 77
Figure 18. Comparison of the muscle activity for the flexor digitorum superficialis between two conditions 78
Figure 19. Comparison of the muscle activity for the flexor digitorum superficialis at
different time points 78
Figure 20. Comparison of the perceived neck discomfort at different conditions 79
Figure 21. Comparison of the perceived neck discomfort at different time points 79
Figure 22. Comparison of the perceived neck discomfort for different groups 80
Figure 23. Perceived neck discomfort score: a significant support x time interaction 81
Figure 24. Perceived neck discomfort score: a significant time x group interaction 81
Figure 25. Comparison of the pain pressure threshold for the left upper trapezius at
different time points 82
Figure 26. The pain pressure threshold for the left upper trapezius: a significant time x group interaction 82
Figure 27. Comparison of the pain pressure threshold for the right upper trapezius at
different time points 83
Figure 28. The pain pressure threshold for the right upper trapezius: a significant support x time interaction 83
                                    

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創市際雙週刊第一七一期，取自https://www.ixresearch.com/reports/創市際雙週刊第一七一期-20210302

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