研究背景與目的:隨著科技的蓬勃發展，電子產品使用率越來越高，許多學生或是上班族群經常使用電子產品作為溝通或處理公務的工具，然而使用電子產品需要長時間維持在固定姿勢，也常需要重複使用上肢及手部的操作，因此容易造成肩頸及上肢肌肉骨骼系統症狀。前人調查亞洲地區電腦使用者的上肢肌肉骨骼系統症狀，其中盛行率最高為頸部(37.1％)其次為肩部(34.3％)。因此針對電腦使用者給予肩頸的治療介入及衛教是非常重要的。先前的文獻指出，頭顱頸屈曲訓練(主動治療)與按摩(被動治療)都可以改善頸痛患者的姿勢以及降低肌肉活性，前人也發現按摩比頭顱頸屈曲訓練更能改善姿勢且放鬆肌肉。但過去文獻強調的手法是較大範圍的按摩，對於穴位按摩單點刺激(被動治療)改善姿勢及降低肌肉活性的效果仍然未知。因此本研究試圖探討，對於慢性頸部疼痛成年人給予頭顱頸屈曲訓練或穴位按摩是否可以立即改善其姿勢或是降低頸部淺層肌肉活性。
研究方法:本研究收入39位慢性頸部疼痛成年人，隨機分成三組包括:頭顱頸屈曲訓練組、穴位按摩組及衛教影片控制組，治療時間均為六分鐘。在治療前後，受試者會分別在無壓力及有壓力情境下，執行各三分鐘的電腦打字任務。研究者使用六台紅外線攝影機與肌電訊號擷取器，紀錄休息時以及從事電腦打字的姿勢與肌電訊號。此外，在治療前後還會測量頸痛患者休息時的心跳變異性、左右側上斜方肌疼痛壓力閾值、疼痛視覺類比量表以及情境─特質焦慮量表。統計方法使用重複量測雙因子變異數分析來分析靜態姿勢、心跳變異性、左右側上斜方肌疼痛壓力閾值、疼痛視覺類比量表及情境─特質焦慮量表的治療前後差異，而打字時姿勢與肌電訊號則使用重複量測三因子變異數分析。
結果:在靜態姿勢控制方面，在治療介入之後，所有受試者的靜態顱椎角有提升趨勢(p=0.067)，但並沒有達顯著差異；而在水平前移的距離，只有穴位按摩組明顯下降(p= 0.022)，其他兩組則無明顯改變。在打字時的姿勢控制方面,研究者發現穴位按摩組在治療後的顱椎角顯著上升(p=0.015)，其他兩組則無明顯改變;所有受試者在治療後打字時的水平前移則都有顯著下降(p=0.037)。肌電訊號方面，在治療前後，大部分的肌肉肌電訊號都沒有明顯的改變(p>0.05)。在自主神經系統控制方面，本研究發現頭顱頸屈曲訓練組的交感神經活性顯著下降(p=0.007)、副交感神經活性顯著上升(p=0.007)，而其他兩組則無明顯差異。在其他臨床測試方面，本研究發現，頭顱頸屈曲訓練組(p<0.001)與穴位按摩組(p=0.001)在左右側上斜方肌疼痛壓力閾值皆顯著提高，相反的衛教影片組的左側上斜方肌疼痛壓力閾值則顯著下降(p=0.004)，右側上斜方肌疼痛壓力閾值(p=0.098)則無明顯改變。頭顱頸屈曲訓練組(p<0.001)與穴位按摩組(p=0.003)在疼痛視覺類比量表分數顯著下降，而衛教影片控制組(p=0.011)則顯著上升。在心理層面的評估方面，結果發現三組在情境─特質焦慮量表分數皆顯著下降(p<0.001)。
結論:在經過六分鐘的治療之後，頭顱頸屈曲訓練及穴位按摩皆能改善慢性頸部疼痛患者的疼痛強度、焦慮以及提升疼痛壓力閾值。而頭顱頸屈曲訓練組可顯著提升副交感神經活性及降低交感神經活性，穴位按摩組對於改善姿勢有較佳的效果。未來，在臨床上，不管是主動治療的運動介入或被動治療的穴位按摩均可運用於臨床上常見的慢性頸部疼痛患者身上。

Introduction: Previous studies reported cranio-cervical flexion training might improve posture and reduce superficial neck muscle activity, but few studies have explored the treatment effect of acupressure massage on posture and neck muscle activity. Therefore, the purpose of this study was to compare the effect between acupressure massage and cranio-cervical flexion training on muscle activities and posture for the chronic neck pain patients. Method: This study included 39 chronic neck pain patients and they were randomly assigned to three groups, including cranio-cervical flexion training(CCFT), acupressure massage, and control group. Each treatment session lasts for 6 minutes. Posture of the neck and head angles were recorded by the motion capture cameras; muscle activities were recorded by the electromyogram (EMG). Autonomic nervous system activity were recorded by the Heart rate variability. Results: For the static posture, all groups had a tendency to increase the craniovertebral (CV) angle. While for the horizontal forward displacement, only the acupressure massage group significantly decreased after treatment. For the typing posture, CV angle significantly increased only for the acupressure massage group. For the horizontal forward displacement during typing, all groups significantly decreased the distance after treatment. For the EMG, all groups significantly increased the muscle activity of the neck extensor and bilateral upper trapezius under the stress condition. For the HRV frequency, only the CCFT significantly increased the high frequency and decreased the low frequency. Conclusion: The CCFT could decrease the sympathetic nervous system activity and increase the parasympathetic nervous system activity, while acupressure massage could improve postures

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