上背部疼痛族群和無症狀族群的圓肩程度差異

Difference in Rounded Shoulder Posture between Patients with and without Upper Back Pain

上背部疼痛普遍存在台灣社會的上班族中，而從過去學校教育中都提到認為不正常的姿勢是造成上背部疼痛的主要原因，例如圓肩（round shoulder）等，而圓肩在過去的研究中已確定是造成上背部疼痛的誘發因子，臨床醫療人員認為在這種情況下，適當幫病患改正不正常的姿勢，上背部疼痛就能獲得明顯的改善，然而上背部痛患者和無症狀者在圓肩姿勢（胸小肌緊縮）上是否有顯著的差異，希望藉此研究能獲得實質的數據，來幫助治療師在臨床上協助改善病患的上背部疼痛。本實驗是收集在民國 101 年 3 月至 7 月間來彰濱秀傳醫院復健部門診，由復健科醫師診斷有上背部疼痛的患者共 23 名，且編為實驗組，並在根據實驗組的年齡、身高及體重為對照，收集 23 位正常受試者編為控制組。本實驗主要是量測每個受試者圓肩的程度，採用正躺於治療床上，請受試者放輕鬆，不要用力挺胸，而改變原本的姿勢，施測者手拿類似鐵尺或是長條木板，來量測治療床到受試者的肩峰（acromion）的外側垂直距離，在木條上做上記號，之後再放在皮尺旁對照出真實長度，用同樣的測量方式紀錄另一側，並將這樣的資料紀錄下來，採用公厘（mm）為單位。統計方式以 Mann-Whitney U-tests（p < 0.05）來比較實驗組跟控制組在圓肩的差異，同時也比較實驗組跟控制組本身左邊與右邊在圓肩是否有差異。在比較實驗組與控制組的基本資料中，兩組間並無達到顯著的差異，而在比較兩組間圓肩的差異時，發現不管是比較左邊 p（= 0.332）或右邊（p = 0.144）都無達到顯著的差異，然而再個別比較各組本身左邊及右邊，發現在實驗組有達到顯著的差異（p < 0.05），而在控制組則無達到顯著的差異（p = 0.892）。本研究發現有上背部疼痛的患者與正常人在圓肩的程度無明顯相關性，但在上背部疼痛患者發現是兩側圓肩的程度不一，那代表患者兩側軟組織在柔軟度及肌肉力量上會有所差異，這樣的差異會造成兩側頸椎受力不一致，可能是造成患者有上背部疼痛的可能原因之一。臨床意義：在臨床上遇到有上背部疼痛的患者，除了要衛教病患注意姿勢外，也需要著重在頸部、胸部及肩部周圍的肌肉柔軟度，使兩側可以平衡，藉此減少上背部疼痛的機會。

Background: The main reasons causing upper back pain are poor postures including rounded shoulder and kyphosis. Physiotherapists usually teach patients with upper back pain to correct their posture but the effectiveness of such correction on patients with upper back pain and those without symptoms remains unclear. This study compared the degree of rounded shoulder between healthy people (control group) and patients with upper back pain (experimental group). Method: To quantify the degree of rounded shoulder, the physical therapist measured the distance between the posterior aspect of the lateral acromion process and the positioned perpendicular to the wall. The difference between control and experimental groups were compared using descriptive statistics and Mann-Whitney U-tests (p < 0.05). Result: There was no significant difference in basic data between the experimental and control groups (p > 0.05). There was no differences in degree of rounded shoulder (p > 0.05), neither the right (p = 0.332) nor the left side (p = 0.144) in the control group. There was significant difference in degree of rounded shoulder between the right and left side in the experimental group (p < 0.05). Discussion: Results showed no significant difference in degree of rounded shoulder between healthy people and patients with upper back pain. However, the degree of rounded shoulder on right and left sides in patients with upper back pain was uneven. The symmetrical muscles surrounding the cervical spine suffered imbalance and abnormal biometrical differences were found. These situations caused upper back pain in the patients. Clinical Information: When patients with upper back pain come to our OPD for help, the physical therapist not only should correct their posture, but also try to improve the muscular flexibility surrounding the cervical spine, upper thoracic spine and shoulder. Patients with upper back pain would get improvement after these treatments.