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研究生：	李琬晴 Lee, Wan-Ching
論文名稱：	使用肌內效貼布與護踝在蹠屈肌疲勞後對於功能性踝關節不穩運動員動作表現的影響 The Effect of kinesio tape and lace-up ankle brace on movement after fatiguing plantar flexor muscle in athletes with functional ankle instability (FAI)
指導教授：	林呈鳳 Lin, Cheng-Feng
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：	2016
畢業學年度：	104
語文別：	英文
論文頁數：	112
中文關鍵詞：	腳踝扭傷、外在護具、姿勢控制、單腳側落著地、單腳往前跳躍著地
外文關鍵詞：	ankle sprain, external support, postural control, single-leg lateral drop landing, one-leg jump landing
相關次數：	點閱：110 下載：2
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背景:腳踝扭傷是運動員常見的肌肉骨骼傷害，其中超過八成來自於內翻性扭傷造成。腳踝扭傷常見發生在比賽後半段或長時間的訓練後，顯示由於持續肌肉收縮導致疲勞是腳踝扭傷重要的因素。運動員常見使用護踝或肌內效貼布等外在護具預防復發性腳踝扭傷，但鮮少研究探討對於護具在肌肉疲勞後如何影響踝關節不穩運動員的動作控制與肌肉活性;因此，本篇研究目的為探討使用護踝與肌內效貼布在蹠屈肌疲勞後對於功能性踝關節不穩運動員動作表現的影響。
方法:三十三位踝關節失能量表(CAIT)分數低於24分的運動員被定義為功能性踝關節不穩，並被分配到控制組(n=11)、肌貼組(n=11) 和護踝組(n=11)。實驗流程需先收集疲勞前測資料，包括單腳往前跳躍著地(one-leg jump landing)與單腳側落著地(single-leg lateral drop landing)，接著進行蹠屈肌疲勞測試；疲勞測試結束後再執行相同動作收集疲勞後測資料。肌貼組使用肌內效貼布分別貼在脛前肌、腓長肌和腓腸肌三條肌肉，而護踝組則使用綁帶型護踝(lace-up ankle brace)；在疲勞測試與疲勞後測皆給予兩組運動員不同護具使用。主要分析參數包括單腳往前跳躍著地和單腳側落著地在疲勞前測與後測的下肢關節角度、肌電訊號與肌肉共同收縮指數、運動學與力學表現。使用克‐瓦二氏檢定 (Kruskal‐Wallis test)比較三組疲勞前後的差值是否有顯著差異。
結果:在疲勞狀態下，沒有使用護具的運動員在單腳側落著地 (1)有較多的關節動作; (2)最大垂直地面反作用力下降; (3) 身體質量中心的晃動變大; (4)身體壓力中心的距離增加與速度變大。使用護踝的運動員在單腳側落著地 (1)使用較伸直姿勢的著地方式; (2)最大垂直地面反作用力增加; (3)腓腸肌在著地後100毫秒的肌電訊號減少。使用肌貼的運動員在單腳側落著地 (1)減少身體動作控制時的晃動; (2)最大垂直地面反作用力減少。有無使用護具的運動員在單腳往前跳躍著地動作上則並無太多差異；整體而言，在疲勞後使用護具的運動員的下肢關節角度有重新分配的變化:踝關節的背屈角度減少而增加膝關節與髖關節的伸直角度。另外，著地前的腓腸肌肌電訊號上升
結論:疲勞會使動態動作控制變差並讓蹠屈肌無法有效的出力；使用綁帶型護踝能夠提供腳踝較高的穩定度並減少身體動作控制的晃動，但被動的角度限制反而讓踝關節在著地時承受過多的力量並抑制正常肌肉活性的表現。而使用肌內效貼布能夠提供踝關節在著地時處在較好的位置並改善腳踝吸收力量的表現，但較無法提供對於遠端關節間的動作控制。對於需要長期使用護具的運動員來說，需要額外訓練下肢肢段間神經肌肉控制與加強腳踝附近肌群的肌力訓練，降低再次傷害的可能性。

Background: Ankle sprain is a prevalent musculoskeletal injury that occurs in athletes, and more than 80% of ankle sprains are caused by inversion trauma. Ankle sprain commonly occurs in the later period during matches or in prolong training, it gives a clue that timing is an important factor to ankle sprain, because a constant muscle contraction leads to muscle fatigue. It is common for athletes using external ankle support such as ankle brace or kinesio tape in preventing recurrent ankle sprain. The effect of external support, however, combing fatigue condition to evaluate how external support affect movement control and muscle activity is still unknown. The purpose of this study was to investigate the immediate changes of kinetics, kinematics, and EMG parameters after fatiguing plantar flexor muscle in functional ankle instability athletes with or without external support.
Method: Thirty-three athletes who had CAIT score less than 24 were identified with functional ankle instability (FAI). They were allocated to the control group (n=11), the ankle brace group (n=11), and the kinesio tape group (n=11). The process of the experiment was conducted from pre-fatigue tasks including single-leg lateral drop landing and one-leg jump landing to plantar flexor muscle fatigue protocol and then post-fatigue tasks the same as the pre-fatigue tasks. The kinesio tape group applied kinesio tape on tibialis anterior, peroneus longus, and gastrocnemius, and the ankle brace group applied lace-up ankle brace during fatigue protocol and post-fatigue tasks, respectively. The outcome measures were the joint angle of lower extremity, muscle activity, the co-contraction index, and the kinetic and kinematic variables. The Kruskal-Wallis test was performed to test the significance of median of all dependent variables among three groups. The post hoc test was then conducted for any group difference.
Results: In fatigue condition, the athletes without external support performed single-leg lateral drop landing (1) had a greater joint motion and; (2) had a decreased peak vertical group reaction force (3) had greater COM range; (4) increased COP range with faster COP velocity. After fatigue, the athletes with ankle brace performed single-leg lateral drop landing with (1) an extended landing posture and; (2) an increased peak vertical ground reaction force; (3) a decreased muscle activity of gastrocnemius in the post 100ms landing phase. In athletes with kinesio tape, they had (1) a decreased postural sway; (2) a decreased peak vertical ground reaction force in single-leg lateral drop landing. During one-leg jump landing task, little difference was found, the athletes with external support redistributed joint motion after fatigue; they had a decreased ankle dorsiflexion, and had extended joint angle upon knee and hip joint. In addition, an increased muscle activation of gastrocnemius was found in pre-landing phase.
Conclusions: Fatigue impaired dynamic postural control and disabled ankle musculature from sufficient force output. The application of lace-up ankle brace provided ankle joint stability and less postural sway, but the passive constraint put ankle joint to sustain excessive force and inhibited normal muscle activation after landing. The use of kinesio tape provided ankle joint a better landing position and dissipated force while it had little support on proximal joints. Athletes with ankle instability utilized external support for long-term use, additional inter-segmental neuromuscular control and ankle musculature strengthening program would be necessary to prevent secondary injury

目錄(Table of Content)
中文摘要 (Chinese abstract) ………………………………………...III
英文摘要 (English abstract) …………………………………....V
致謝 (Acknowledgement) …………………………………………VIII
目錄 (Table of content) …………………………………………...X
表目錄 (List of Table) ………………………………………………...XII
圖目錄 (List of Figure) ……………………………………………………XIV
Chapter 1 Background ………………………………………………1
Chapter 2 Literature review ………………………………………...3
	2.1 Epidemiology of ankle instability	…………...3
	2.2 Ankle instability and postural control……..5
	2.3 Electromyography study for ankle instability………….6
		2.3.1 Root mean square (RMS) …………………………………6
		2.3.2 Co-contraction index (CI) …………………………7
		2.3.3 Muscle reaction time ………………………………8
	2.4 Kinetic study ………………………………………………………9
	2.5 Fatigue effect ……………………………………………………10
	2.6 External support ……………………………………………………13
	2.7 Research purpose ………………………………………..14
	2.8 Hypothesis …………………………………………….15
Chapter 3 Method ……………………………………………..16
	3.1 Subjects …………………………………………….16
	3.2 Instruments ……………………………………………17
		3.2.1 Motion capture system …………………………..17
		3.2.2 Force plate ………………………………….19
		3.2.3 Surface electromyography ……………………………19
	3.3 Experimental procedure ………………………………………………19
		3.3.1 Task collection …………………………………...22
		3.3.2 Fatigue protocol ……………………………….24
		3.3.3 Kinesio tape and lace-up ankle brace application ……………….26
	3.4 Data reduction ……………………………………...28
		3.4.1 Parameters ………………………………….28
		3.4.2 Phase Definition ……………………………………33
	3.5 Statistical analysis ………………………….33
Chapter 4 Result ………………………………………………………35
	4.1 Basic data …………………………………………..35
	4.2 One-leg jump landing ……………………………………37
		4.2.1 Kinetic parameters ………………………………….37
		4.2.2 Kinematic parameters …………………………………43
		4.2.3 COM-COP maximal displacement.…………………51
		4.2.4 EMG parameters ……………………………………………………55
	4.3 Single-leg lateral drop landing ……………………………..59
		4.3.1 Kinetic parameters …………………………………….59
		4.3.2 Kinematic parameters ……………………………………66
		4.3.3 COM-COP maximal displacement ………... 73
		4.3.4 EMG parameters ……………………………………………………78
Chapter 5 Discussion …………………………………………….82
	5.1 One-leg jump landing …………………………………………82
		5.1.1 Kinetic parameters ………………………………….82
		5.1.2 Kinematic parameters ………………………………………84
		5.1.3 EMG parameters …………………………………………………85
	5.2 Single-leg lateral drop landing ……………………………..86
		5.2.1 Kinetic parameters …………………………………….86
		5.2.2 Kinematic parameters ………………………………………90
		5.2.3 EMG parameters ……………………………………………………92
	5.3 Limitation ……………………………………….……….93
Chapter 6 Conclusion ……………………………………..……. 95
Reference ………………………………………………………….97
附錄 (Appendix) ……………………………………………..111
 
表目錄(List of Table)
Table 3-1 Borg Rate of Perceive Exertion scale ……………………………………………..25
Table 4-1 Basic data ………………………………………………………………………….36
Table 4-2 Kruskal-Wallis Test and post hoc of kinetic variables for one-leg jump
landing in the three groups ………………………………………………………...39
Table 4-3 Kruskal-Wallis Test and post hoc of difference of COP variables in dynamic
phase during one-leg jump landing in the three groups …………………………...41
Table 4-4 Kruskal-Wallis Test and post hoc of difference of COP variables in balance 
phase during one-leg jump landing in the three groups …………………………...42
Table 4-5 Kruskal-Wallis Test and post hoc of difference of joint angle at initial 
contact for one-leg jump landing in the three groups ……………………………..46
Table 4-6 Kruskal-Wallis Test and post hoc of difference of maximal joint angle 
for one-leg jump landing in the three groups ……………………………………...48
Table 4-7 Kruskal-Wallis Test and post hoc of difference of range of joint angle 
for one-leg jump landing in the three groups ……………………………………...50
Table 4-8 Kruskal-Wallis Test and post hoc of difference of COM variables in 
dynamic phase during one-leg jump landing in the three groups …………………52
Table 4-9 Kruskal-Wallis Test and post hoc of difference of COM variables in 
balance phase during one-leg jump landing in the three groups …………………..53
Table 4-10 Kruskal-Wallis Test and post hoc of difference of COM-COP maximal displacement during one-leg jump landing in the three groups …………...................................54
Table 4-11 Kruskal-Wallis Test and post hoc of difference of root mean square 
of EMG (%MVC) for one-leg jump landing in the three groups ………………..57
Table 4-12 Kruskal-Wallis Test and post hoc of difference of co-contraction 
index (%) for one-leg jump landing in the three groups …………………………58
Table 4-13 Kruskal-Wallis Test and post hoc of kinetic variables for single-leg 
lateral drop landing in the three groups ………………………………………….61
Table 4-14 Kruskal-Wallis Test and post hoc of difference of COP variables in 
dynamic phase during single-leg lateral drop landing in the three groups ………64
Table 4-15 Kruskal-Wallis Test and post hoc of difference of COP variables in 
balance phase during single-leg lateral drop landing in the three groups ……….65
Table 4-16 Kruskal-Wallis Test and post hoc of difference of joint angle at initial
contact for single-leg lateral drop landing in the three groups …………………..68
Table 4-17 Kruskal-Wallis Test and post hoc of difference of maximal joint 
angle for single-leg lateral drop landing in the three groups …………………….69
Table 4-18 Kruskal-Wallis Test and post hoc of difference of range of joint angle for single-leg lateral drop landing in the three groups …………………………………………71
Table 4-19 Kruskal-Wallis Test and post hoc of difference of COM variables in 
dynamic phase during single-leg lateral drop landing in the three groups ………75
Table 4-20 Kruskal-Wallis Test and post hoc of difference of COM variables in 
balance phase during single-leg lateral drop landing in the three groups ……….76
Table 4-21 Kruskal-Wallis Test and post hoc of difference of COM-COP maximal displacement 
during single-leg lateral drop landing in the three groups ………………………...77
Table 4-22 Kruskal-Wallis Test and post hoc of difference of root mean square 
of EMG (%MVC) for single-leg lateral drop landing in the three groups ……….80
Table 4-23 Kruskal-Wallis Test and post hoc of difference of co-contraction 
index (%) for single-leg lateral drop landing in the three groups ………………..81
 
圖目錄 (List of Figure)
Figure3-1 Camera ……………………………………………………………………………18
Figure 3-2 Marker setting ……………………………………………………………………18
Figure 3-3 Flow chart of experimental procedure …………………………………………...21
Figure 3-4 Single-leg lateral drop landing …………………………………………………...22
Figure 3-5 One-leg jump landing …………………………………………………………….23
Figure 3-6 The demonstration of One-leg jump landing …………………………………….24
Figure 3-7 Fatigue protocol ………………………………………………………………….25
Figure 3-8 External support ………………………………………………………………….27
Figure 3-9 Kinesio tape application ………………………………………………………….27
Figure 3-10 The force plate coordinate and global coordinate ………………………………28
Figure 4-1 Peak vertical ground reaction force during one-leg jump landing ……………….38
Figure 4-2 Loading rate during one-leg jump landing ……………………………………….38
Figure 4-3 Loading time during one-leg jump landing ………………………………………38
Figure 4-4 Joint angle at initial contact during one-leg jump landing ……………………….43
Figure 4-5 Maximal joint angle during one-leg jump landing ……………………………….44
Figure 4-6 Range of joint angle during one-leg jump landing ……………………………….45
Figure 4-7 The root mean square of EMG during one-leg jump landing ……………………56
Figure 4-8 Peak vertical ground reaction force during single-leg lateral drop landing ……...59
Figure 4-9 Loading rate during single-leg lateral drop landing ……………………………...60
Figure 4-10 Loading time during single-leg lateral drop landing ……………………………60
Figure 4-11 The COP range in dynamic phase during single-leg lateral drop landing ………63
Figure 4-12 The COP velocity in dynamic phase during single-leg lateral drop landing ……63
Figure 4-13 Maximal joint angle during single-leg lateral drop landing …………………….67
Figure 4-14 Range of joint angle during single-leg lateral drop landing …………………….67
Figure 4-15 The COM range in dynamic phase during single-leg lateral drop landing ……..74
Figure 4-16 The root mean square of EMG during single-leg lateral drop landing …………79
 

                                    

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