前臂肌內效貼紮對罹患肘內上髁炎運動員之立即性影響

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The Immediate Effect of Forearm Kinesio Taping for

Athletes with Elbow Medial Epicondylitis

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BC

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“ ” 17 19.88±1.53 10 19.5±1.43 MGS MWFS AGFSEs RGFSEs AWFSEs RWFSEs MBPPT MTPPT 4kg MBPPV 4kg MTPPV T AGFSEs

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p=0.007 AWFSEs p=0.021 MBPPT p=0.007 MTPPT p=0.022

MBPPV p=0.005 MTPPV p=0.037 p .05

AGFSEs p=0.031 MBPPT p=0.000 MTPPT p=0.000

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The Immediate Effect of Forearm Kinesio Taping for

Athletes with Elbow Medial Epicondylitis

Student

Kun-Yu Chou Advisor

Dr. Hsiao-Yun Chang

Department of Physical Education, National Taichung University of

Education, Taichung, Taiwan

Abstract

Background and purpose: Medial epicondylitis is one of the most common elbow problems in athletes. Medial epicondylitis of the elbow, commonly referred to as ‘‘golfer’s elbow,’’ symptoms and pain appear in the medial epicondyle at the elbow. Kinesio taping is a newly method applied for rehabilitation and sports medicine, but the treatment result still lacks the clinical evidence. Therefore, the aim of this study was to compare the difference in maximal force and force sense of wrist flexor and grip strength, muscle tenderness on forearm between the healthy athletes and athletes with medial epicondylitis before and after Kinesio tape applied. Methods: Seventeen healthy athletes (mean age 19.88 ±1.53 years) and ten athletes with medial epicondylitis(mean age 19.5 ±1.43 years)were participated in this study. The maximal force and absolute and relate force sense of grip and wrist flexor, and muscle

tenderness were measured under three conditions: (1) without taping applied (WT), (2) with placebo taping applied (PT), and (3) with Kinesio taping(KT) applied. The

nonparametric tests were used to analyze the difference between healthy and injury group in three taping conditions.

Results: The results were show the significantly improvement in absolute force sense of grip strength and wrist flexor, pain scale of muscle belly and tendon location for

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athletes with medial epicondylitis before and after Kinesio tape applied(p<.05). But, the those significantly improvement was also seen in healthy group before and after Kinesio tape applied (p<.05). Other results revealed no significant difference between before and after Kinesio tape applied. Conclusion: Kinesio Tape applied on wrist flexor muscles could decrease the absolute force sense errors in athletes with suffering in medial epicondylitis, and also could improve the muscle tenderness in athletes with medial epicondylitis. However, it could not be helpful to enhance the maximal force of forearm, no matter is healthy subject or athletes with medial epicondylitis.

Key Words: Golfer’s elbow, maximal force, force sense, muscle tenderness, proprioception

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...I ...III ... V ... VII ...IX ...1 ...1 ...3 ...4 ...5 ...6 ...8 ...8 ...14 ...16 ...30 ...32 ...32 ...33 ...34 ...35 ...41

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Test items ...43 ...44 ...50 ...52 ...52 ...53 ...57 ...66 ...75 ...75 ...77 ...83 ...88 ...88 ...89 ...90 ...91 ...91 ...92 ...97 ...97 ...98 ...101

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2-1 ...22 2-2 ...25 2-3 ...26 2-4 ...28 3-1 Jamar ...39 3-2 MicroFet 2 ...39 3-3 ...40 4-1 ...52 4-2 Mann-Whitney U ...56 4-3 Mann-Whitney U ...56 4-4 Mann-Whitney U ...60 4-5 Mann-Whitney U ...61 4-6 Mann-Whitney U ...65 4-7 Mann-Whitney U ...65 4-8 Mann-Whitney U ...69 4-9 Mann-Whitney U

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...70

4-10 4kg Mann-Whitney U

...74

4-11 4kg Mann-Whitney U

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2-1 ...9 2-2 ...10 2-3 ...12 2-4 ...12 3-1 ...35 3-2 ...36 3-3 Jamar ...36 3-4 Hoggan MicroFet 2 ...37 3-5 Hoggan MicroFet 2 ...37 3-6 ...38 3-7 ...38 3-8 ...41 3-9 ...42 3-10 ...42 3-11 ...46 3-12 ...46 3-13 ...46 3-14 ...47 3-15 ...49 4-1 (MGS)...54 4-2 (MGS) ...54 4-3 (MWS) ...55

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4-4 (MWS) ...55 4-5 (RGFSEs) ...58 4-6 (RGFSEs) ...59 4-7 (AGFSEs) ...59 4-8 (AGFSEs) ...60 4-9 (RWFSEs) ...63 4-10 (RWFSEs) ...63 4-11 (AWFSEs) ...64 4-12 (AWFSEs) ...64 4-13 ...67 4-14 ...68 4-15 ...68 4-16 ...69 4-17 4kg ...72 4-18 4kg ...72 4-19 4kg ...73 4-20 4kg ...73

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1999 Lephart Pincivero Giraldo Fu 1997 Michael Michael Michael 2004

2009

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(15)

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1. 2. 3. 4. 5.

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Elbow Medial Epicondylitis

Proprioception

joint

position sense kinesthesia force sense

Grigg 1994 Lephart Pincivero Giraldo Fu 1997 Riemann Schmitz Gale McCaw 2002 Sherrington 1907

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2006

Kinesio Tape

1995 2006 Slupik Dwornik Bialoszewski Zych 2007 4kg Pain Algometer 0.5 ( kg/cm2) 4kg 0.5 100 (visual

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Henry Morris 1882

12 80

75% Jobe Ciccotti 1994 Michael Michael Michael 2004

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Michael 2004

overheads

Morris Jobe Perry Pink Healy 1989

50% 30%

Barnes Tullos 1978 King Brelsford Tullos 1969 Michael 2004

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1882 Henry Morris

valgus 2-2

Glousman Barron Jobe Perry Pink 1992 Leach Miller 1987

Galloway DeMaio Mangine 1992 Miller 1960

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Nirschl Pettrone 1979 Regan Wold Coonrad Morrey 1992 Nirschl pathologic tissue angiofibroblastic degeneration fibrosis calcification Nirschl 1988 forearm pronation 0.5 1 Bennett 1994 2-3 2-4

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2-3

2-4

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: 5% 15% Jobe Ciccotti 1994 3 6 1. 2. 3. 4. 5. Michael 2004

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McConnell Kinesio Tape

Athletic Taping

2009 2005

McConnell

McConnell Taping

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McConnell

2009 McConnell

Cover-Roll stretch McConnell

Kinesio Tape

Kenzo Kase

130~140%

origin insertion

1995 2006

Slupik Dwornik Bialoszewski Zych

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1.

Salsich Brechter Farwell Powers 2002

92.6%

Hinman Bennell Crossley McConnell 2003 18 disability

walking speed timed up and go test step test

2.

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Alt Lohrer Gollhofer 1999

Riemann

Schmitz Gale McCaw 2002 20

2005

2009

3.

Guy Rebecca Cindi Kent 1997

joint position perception Robbins Waked 1998 24

2.5% 35.5%

Callaghan Selfe Bagley Jacqueline 2002

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McConnell

2004

1.

Chang Chou Lin Lin Wang 2010 21

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20 90 Jamar 2 50% p>.05 2. 2007 11

Biodex Biodex system 3 Isokinetic

Dynanometer 60°/s 120°/s

timed up and go test single leg stance test

60°/s

120°/s 60°/s

p=0.037 120 °/s p=0.028

2005 20

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Slupik Dwornik Bialoszewski Zych 2007 27

24

24 recruitment muscle’s motor

units 72

24

72 24

Fu Wong Pei Wu Chou Lin 2008 14

12 Cybex NORM

60o 180o 60o 180o

12

Hsu Chen Lin Wang Shih 2009 17

scapular region

lower trapezius

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serratus anterior muscles

3 3-dimensional scapular motion

60 30

muscle performance Yasukawa Patel Sisung 2006 15

5 10 4 16 9 6 Melbourne Assessment 3 p < .001 p < .02

Osterhues 2004 patella dislocation

interferential current

200mg Advil

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Y medial tail weight bearing 2-1 2-1 Chang 2010 21 Jamar 2007 11 Biodex 2005 20 Biodex Slupik 2007 27 Fu 2008 14 Cybex NORM Hsu 2009 17 Yasukawa 2006 15 Osterhues 2004 1

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3. 2007 Biodex 15°/45° 2005 Biodex 80 15 30 60 30 15 60 15 30 15 Murray Husk 2001 26 Lido 26 10 8 3 (leg) repeated measures ANOVA

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mid-range

Halseth McChesney DeBeliso Vaughn Lien 2004 30

inversion 20 Plantar flexion 1 35

5 reproduction of

joint position sense

absolute error constant error

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2-2 Chang 2010 21 ( ) Jamar 2007 11 Biodex 2005 20 Biodex Murray 2001 26 Lido Halseth 2004 30 4. 2007 Biodex 60°/s 120°/s Hsu 2009 30 60

Thelen Dauber Stoneman 2008 42

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Shoulder Pain and Disability

Index pain-free active range of motion 10cm

visual analogue scale 3

Y I 2 I 3 6 2-3 2-3 2007 11 Biodex Hsu 2009 17 Thelen 2008 42 5. Thelen 2008

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pain-free 2005 12 7 8 10 2008 33 3M 3 M Micropore tape 24 Fisher

100 visual analogue scale, VAS

pressure pain

threshold maximal pain tolerance

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Osterhues 2004

cutaneous

mechanoreceptors Melzack Wall 1965

— Gate Control Theory

2008 2-4 2-4 Thelen 2008 42 2005 12 2008 33 Osterhues 2004 1 ( ) 6. 2005 1 9 29.5 4 8 22.9

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popliteal fossa 24 48 24 48 2005 30 6 24 24.9 Ultramark 9HDI 10 MHz Y 4 p 0.005 p 0.037 p 0.007 Y

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Brockett Warren Gregory Morgan Proske 1997 Jones Hunter 1983 Jones 1989 Jones Hunter 1982

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elbow valgus stress testing

pre and post-treatment design

ndependent variable dependent variable

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18 25

1. 17 18 25 1 2. 10 18 ~ 25

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1. 2.

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1. 4m 5cm 3-1 3-1 2. 4m 5cm 3-2

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3-2

3.

JAMAR

Hydraulic Hand Dynamometer 80kg

3-3

3-3 Jamar

4. MicroFet 2

Hoggan MicroFet 2

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3-5

3-4 Hoggan MicroFet 2

3-5 Hoggan MicroFet 2

5.

/ kg/cm2

1 Pain diagnostics & Thermography

Inc, NY, USA 3-6

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3-6 6. 3-7 3-7

test- retest

15

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1. Jamar

Intra-class Correlation Coefficient ,ICC） 0.932 3-1

2. MicroFet 2

ICC 0.878 3-2

3.

(visual analogue scale, VAS)

1 2 3 4kg ICC 0.857 4Kg ICC 0.906 3-3 3-1 Jamar ICC 50.933 7.21 15 50.333 6.92 15 .932 p .01 3-2 MicroFet 2 ICC 42.333 7.58 15 41.667 7.21 15 .878 p .01

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3-3 ICC 3.067 0.78 15 3.033 0.61 15 .857 4kg 6.127 2.65 15 4kg 6.073 2.24 15 .906 p .01

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13 Without taping WT Kinesio taping KT 1. 0.9 3-8 2. 1995 (1) 2004 3-9 (2) 2 Y 3-10 Placebo taping PT 3-8

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3-9

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Test items

1. Maximal Grip Strength, MGS

2. Maximal Wrist flexor Strength, MWFS

1. Absolute Grip Strength Force Sense Errors, AGFSEs 2. Related Grip Strength Force Sense Errors, RGFSEs

3. Absolute Wrist Flexor Strength Force Sense

Errors, AWFSEs

4. Related Wrist Flexor Strength Force Sense

Errors, RWFSEs

1. 2. 3. 4kg 4. 4kg

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1.

2. (1) (2)

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(3) 4kg 4kg 1. 90 3-11 2. 90 3-12 3. 3-13 3-14 1. 2. 3. 4. MicroFet 2 4kg 4kg

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3-11

3-12

3-13

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3-14 7 4kg 4kg 1. 1 50% 2. 50% 5 10 10 3-11 3-12 Dover Powers 2003

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3. 0.5kg

4kg 4kg

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SPSS for Windows 12.0

1. 2. 2 2 2 3. 4kg 4kg 1. T independent T test 2. Friedman

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Wilcoxon

3.

-U Mann-Whitney

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10 17 T F=0.00蹠 p=0.997 F=0.831 p=0.371 F=0.398 p=0.534 4-1

`

4-1 ± ± F p 10 17 19.5 ± 1.43 19.88 ± 1.53 0.000 0.997 179.1 ± 5.82 176.94 ± 4.6 0.831 0.371 76.9 ± 8.94 75.11 ± 7.62 0.398 0.534

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MGS p=0.452 MGS 53.65± 8.52kg 53.70± 9.36kg 55.30± 7.29kg 4-1 MGS MGS p=0.898 50.29± 6.48kg 50.35± 7.25kg 50.50± 6.30kg 4-2 MGS p=0.386 p=0.103 p=0.473 4-2 MGS MWS p=0.232 MWS 44.90± 6.65lb 46.25±7.90lb 46.95± 6.70lb 4-3 MWS MWS p=0.838 42.20± 6.16lb

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42.24± 7.73lb 42.29± 6.39lb 4-4 MWS p=0.204 p=0.083 p=0.204 4-3 MWS 4-1 MGS 4-2 MGS 最大握力最大握力最大握力最大握力值值值值（（（（公斤公斤公斤公斤））））最大握力最大握力最大握力最大握力值值值值（（（（公斤公斤公斤公斤））））

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4-3 MWS 4-4 MWS 最大最大最大最大屈腕肌肌屈腕肌肌屈腕肌肌屈腕肌肌力力力力值值值值（（（（磅磅磅磅））））最大最大最大最大屈腕肌肌屈腕肌肌屈腕肌肌屈腕肌肌力力力力值值值值（（（（磅磅磅磅））））

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4-2 Mann-Whitney U Mann-Whitney U 10 15.80 158.00 67.000 MGS 17 12.94 220.00 10 17.30 173.00 52.000 MGS 17 12.06 205.00 10 15.50 155.00 70.000 MGS 17 13.12 223.00 4-3 Mann-Whitney U Mann-Whitney U 10 16.55 165.50 59.500 MWS 17 12.50 212.50 10 17.45 174.50 50.500 MWS 17 11.97 203.50 10 16.55 165.50 59.500 MWS 17 12.50 212.50

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1. RGFSEs RGFSEs p=0.146 -1.69± 2.71kg -0.48± 1.40kg -0.45± 1.84kg 4-5 RGFSEs RGFSEs p=0.368 -0.19± 2.84 kg -0.97± 3.05 kg -0.16± 2.27 kg 4-6 RGFSEs p=0.187 p=0.639 p=0.414 4-4 RGFSEs 2. AGFSEs AGFSEs p=0.001 3.5± 1.10kg 1.33± 0.72kg 1.53± 1.15kg 4-7 p=0.007 p=0.005 AGFSEs p=0.673 AGFSEs

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p=0.021 3.14± 1.4kg 2.74± 1.69kg 2.01± 1.31kg 4-8 AGFSEs p=0.031 p=0.227 p=0.200 p=0.359 p=0.359 p=0.007 4-5 AGFSEs AGFSEs 4-5 RGFSEs 力量覺相對誤差力量覺相對誤差力量覺相對誤差力量覺相對誤差值值值值（（（（公斤公斤公斤公斤））））

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4-6 RGFSEs 4-7 AGFSEs 力量覺力量覺力量覺力量覺絕絕絕絕對誤差對誤差對誤差對誤差值值值值（（（（公斤公斤公斤公斤））））力量覺相對誤差力量覺相對誤差力量覺相對誤差力量覺相對誤差值值值值（（（（公斤公斤公斤公斤））））

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4-8 AGFSEs 4-4 Mann-Whitney U Mann-Whitney U 10 11.30 113.00 58.000 RGFSEs 17 15.59 265.00 10 13.00 130.00 75.000 RGFSEs 17 14.59 248.00 10 15.70 157.00 68.000 RGFSEs 17 13.00 221.00 力量覺力量覺力量覺力量覺絕對誤差值絕對誤差值絕對誤差值絕對誤差值（（（（公斤公斤公斤公斤））））

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4-5 Mann-Whitney U Mann-Whitney U 10 15.85 158.50 66.500 AGFSEs 17 12.91 219.50 10 12.10 121.00 66.000 AGFSEs 17 15.12 257.00 10 8.75 87.50 32.500 AGFSEs 17 17.09 290.50 p .05 1. RWFSEs RWFSEs p=0.741 0.48± 2.38lb 0.73± 3.1lb 0.33± 1.45lb 4-9 RWFSEs RWFSEs p=0.036 -0.47± 2.38lb 0.76± 2.86lb 0.85± 2.9lb 4-10 RWFSEs p=0.109 RWFSEs p=0.035

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RWFSEs p=0.959 p=0.187 p=0.386 p=0.902 4-6 RWFSEs 2. AWFSEs AWFSEs p=0.023 2.55± 0.95lb 1.95± 2.52lb 1.28± 0.79lb 4-11 AWFSEs p=0.021 AWFSEs p=0.333 p=0.677 AWFSEs p=0.63 2.62± 1.19lb 2.54± 1.58lb 2.44± 1.82lb 4-12 AWFSEs p=0.941 p=0.127 p=0.046 4-7 AWFSEs

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4-9 RWFSEs 4-10 RWFSEs 力量覺力量覺力量覺力量覺相相相相對誤差對誤差對誤差對誤差值值值值（（（（磅磅磅磅））））力量覺力量覺力量覺力量覺相相相相對誤差對誤差對誤差對誤差值值值值（（（（磅磅磅磅））））

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4-11 AWFSEs 4-12 AWFSEs 力量覺力量覺力量覺力量覺絕絕絕絕對誤差對誤差對誤差對誤差值值值值（（（（磅磅磅磅））））力量覺力量覺力量覺力量覺絕絕絕絕對誤差對誤差對誤差對誤差值值值值（（（（磅磅磅磅））））

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4-6 Mann-Whitney U Mann-Whitney U 10 16.65 166.50 58.500 RWFSEs 17 12.44 211.50 10 12.25 122.50 67.500 RWFSEs 17 15.03 255.50 10 14.30 143.00 82.000 RWFSEs 17 13.82 235.00 4-7 Mann-Whitney U Mann-Whitney U 10 13.85 138.50 83.500 AWFSEs 17 14.09 239.50 10 10.95 109.50 54.500 AWFSEs 17 15.79 268.50 10 10.00 100.00 45.000 AWFSEs 17 16.35 278.00 p .05

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p=0.001 2.72± 1.22 3.52± 1.13 3.54± 1.1 4-13 p=0.007 p=0.005 p=0.953 p=0.000 3.09± 0.69 3.69± 0.77 3.74± 0.75 4-14 p=0.000 p=0.001 p=0.687 p=0.334 p=0.443 p=0.386 4-8

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2.89± 1.27 4-15 p=0.022 p=0.005 p=0.483 p=0.000 2.66± 0.54 3.36± 0.75 3.52± 0.63 4-16 p=0.000 p=0.000 p=0.232 p=0.008 p=0.141 p=0.066 4-9 4-13 壓痛閾值壓痛閾值壓痛閾值壓痛閾值

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4-14 4-15 壓痛閾值壓痛閾值壓痛閾值壓痛閾值壓痛閾值壓痛閾值壓痛閾值壓痛閾值

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4-16 4-8 Mann-Whitney U Mann-Whitney U 10 12.05 120.50 65.500 17 15.15 257.50 10 12.45 124.50 69.500 17 14.91 253.50 10 12.25 122.50 97.500 17 15.03 255.50 壓痛閾值壓痛閾值壓痛閾值壓痛閾值

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4-9 Mann-Whitney U Mann-Whitney U 10 8.80 88.00 33.00 17 17.06 290.00 10 11.05 110.50 55.500 17 15.75 267.50 10 10.30 103.00 48.000 17 16.18 275.00 p .05

4kg

1. 4kg 4kg p=0.004 4.07± 2.66 2.57± 2.29 2.47± 2.02 4-17 4kg p=0.005 4kg p=0.092 4kg p=0.593 4kg p=0.011 2.64± 1.62 1.76± 1.32 1.72± 1.65 4-18

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p=0.009 4kg 4kg p=0.981 4kg p=0.243 p=0.537 p=0.473 4-9 4kg 2. 4kg 4kg p=0.038 8.15± 1.54 7.01± 2.09 6.3± 3.03 4-19 p=0.037 p=0.017 4kg 4kg p=0.333 4kg p=0.005 5.87± 2.38 5.26± 2.31 4.42± 2.75 4-20 p=0.004 p=0.035 4kg 4kg p=0.065 4kg p=0.023 p=0.115 p=0.093 4-10 4kg 4kg

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4-17 4kg 4-18 4kg 壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值

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4-19 4kg 4-20 4kg 壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值壓痛值

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4-10 4kg Mann-Whitney U Mann-Whitney U 10 16.40 164.00 61.000 4kg 17 12.59 214.00 10 15.25 152.50 72.500 4kg 17 13.26 225.50 10 15.50 155.00 70.000 4kg 17 13.12 223.00 4-11 4kg Mann-Whitney U Mann-Whitney U 10 18.45 184.50 40.500 4kg 17 11.38 193.50 10 17.15 171.50 53.500 4kg 17 12.15 206.50 10 17.35 173.50 51.500 4kg 17 12.03 204.50 p .05

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MGS MGS MGS MGS MWS MWS MWS MWS MWS MGS MWS

Fu Wong Pei Wu Chou Lin 2008

12

(88)

Lin Wang 2010

2005

2007

Slupik Dwornik Bialoszewski Zych 2007

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RGFSEs RGFSEs 4-5 RGFSEs RGFSEs RGFSEs RWFSEs RWFSEs 4-9 RWFSEs

(90)

RWFSEs

-0.47± 2.38lb 0.76± 2.86lb RWFSEs

RWFSEs RWFSEs

RWFSEs

1999 Lephart, Pincivero Giraldo Fu 1997 Michael Michael Michael 2004

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AGFSEs AGFSEs 3.5± 1.10 kg 1.53± 1.15kg AGFSEs 3.5± 1.10 kg 1.33± 0.72 kg AGFSEs AGFSEs AGFSEs AGFSEs 3.14± 1.4kg 2.01± 1.31kg AGFSEs AGFSEs p=0.007 AGFSEs 1.33± 0.72 kg 2.74± 1.69 kg AWFSEs AWFSEs AWFSEs 2.55± 0.95lb 1.28± 0.79lb AGFSEs AWFSEs

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AWFSEs AWFSEs

AWFSEs 1.95± 2.52lb

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2007 15°/45° 2005 15 30 60 30 15 60 15 30 60 30 15 Murray Husk 2001 Lido 26 10 8 10

Halseth McChesney DeBeliso Vaughn Lien 2004

Chang Chou Lin Lin

(94)

2005 Murray 2001 Chang 2010 2007 Halseth 2004 2007 2005 Chang 2010 Murray 2001 Halseth 2004 4

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kg/cm2 2.72± 1.22 3.54±1.1 2.72± 1.22 3.52±1.13 3.09± 0.69 3.74± 0.75 3.09± 0.69 3.69± 0.77

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1.9± 0.95 2.89± 1.27 1.9± 0.95 2.89± 1.27 2.66± 0.54 3.52± 0.63 2.66± 0.54 3.36± 0.75

4kg

100 (visual analogue scale, VAS)

4kg

4kg 4.07± 2.66

2.47± 2.02 4kg

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4kg 4gk 4kg 4kg 2.64± 1.62 1.72± 1.65 4kg 2.64± 1.62 1.76± 1.32 4kg 4kg 4kg

4kg

4kg 4kg 8.15± 1.54 6.3± 3.03 4kg 8.15± 1.54 7.01± 2.09 4kg 4kg 4kg 4kg 5.87± 2.38 4.42± 2.75 4kg 5.87± 2.38 4.42± 2.75 4kg 4kg 4kg

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4kg

2004 Michael Michael Michael 2004 Nirschl Pettrone 1979 Regan Wold Coonrad Morrey 1992

4kg

Melzack Wall 1965

2008 Thelen Dauber Stoneman 2008

2005

Osterhues 2004

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(100)

(101)

(102)

(103)

2004 (Dimitros, K. & Konstantine, R., 2001) 2009 2008 36(3) 145-150 1995 2006 2005 3 2006 2006 094NCKU5530012 2005 2005 093YM005530033 1999 1999 087NCPES421013 2005 3 2007 2007 2005 2005 093NCPE5420004

(104)

2004

092YM005595010

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