骨盆底肌、核心肌群與橫膈膜活動在不同呼吸任務下之性別差異

Ultrasound imaging study of the gender-based effects of different breathing tasks on pelvic floor muscles, core muscles, and diaphragm activity

緒論：在體育運動與訓練過程中，呼吸控制與核心穩定皆會影響動作表現、力量輸出與傷害預防。骨盆底肌、核心肌群與橫膈肌彼此間的協調運作，對維持軀幹穩定與調節腹內壓尤為重要。然而呼吸模式與性別在這些肌群的活動反應差異上，尚缺乏明確的實證比較。本研究旨在探討不同呼吸任務下，骨盆底、核心肌群與橫膈膜的動態表現，並分析性別間與任務間的差異。方法：本研究納入45名健康大學生（男性21名、女性24名），平均年齡22.17±1.51歲，進行八種呼吸任務，包含2種骨盆底收縮、4種吐氣任務、2種預先吸氣任務（最大吸氣與努責用力）。使用超音波影像觀察骨盆底位移、核心肌群厚度、橫膈膜位移變化，並分析性別間與任務類別間的差異。結果：不同呼吸任務對骨盆底、核心肌群與橫隔膜皆產生顯著影響（p < .001），部分任務觀察到性別差異。「夾緊肛門」能創造最大的骨盆底上提；「努責用力」與「阻力吐氣」造成骨盆底最大下移。男女在骨盆底活動部分沒有性別差異，男性在多數任務中核心活化程度顯著高於女性，尤其在「用力吐氣」任務中男性可以創造顯著的腹橫肌厚度改變（p < .024）。在吐氣時增加吐氣阻力會增加骨盆底下推的風險，反之，吐氣任務中增加骨盆底上提動作能有效預防骨盆下移（p = .001），也能有效啟動核心肌群參與（p < .001）。結論：本研究證實呼吸任務對骨盆底、核心肌群與橫膈膜皆有顯著影響效果。男性在核心活化與呼吸核心協同控制上表現優於女性，在活動中具備較佳的呼吸核心盆底間的整合能力。「夾緊肛門」口令更能有效誘發骨盆底上提。女性若欲預防骨盆底障礙，需增加呼吸訓練時核心肌群徵召的引導。較高的腹內壓會增加骨盆底下落的風險，骨盆底「預上提」可有效降低骨盆底下降的風險並增加核心肌群參與。本研究結果可作為運動訓練、核心穩定策略與性別化指導的參考指標。

Introduction: In sports and training, breathing control and core stability significantly influence movement performance, force output, and injury prevention. The coordinated interaction between the pelvic floor, core, and diaphragm is critical for maintaining trunk stability and regulating intraabdominal pressure (IAP). However, evidence comparing the activation responses of these muscles under different breathing patterns and between sexes remains limited. This study aimed to investigate the dynamic responses of the pelvic floor, core muscles, and diaphragm during various breathing tasks and to analyze sex differences. Methods: A total of 45 healthy college students (21 males, 24 females; mean age 22.17±1.51 years) participated. Participants performed eight breathing tasks, including two pelvic floor contractions, four forced exhalation tasks, and two pre-inhalation tasks (maximal inhalation and Valsalva maneuver). Ultrasound imaging was used to assess pelvic floor displacement, core muscle thickness changes, and diaphragm movement. Differences between sexes and task types were analyzed. Results: Different breathing tasks significantly affected the pelvic floor, core muscles, and diaphragm (p < .001), with some tasks showing sex differences. ''Anal tightening'' induced the greatest pelvic floor elevation, while the ''Valsalva maneuver'' and ''resisted exhalation'' caused the largest pelvic floor descent. No significant sex differences were found in pelvic floor displacement; however, males demonstrated significantly greater core activation in most tasks, especially during ''forceful exhalation,'' where males exhibited significantly greater transversus abdominis thickness changes (p < .024). Adding exhalation resistance increased the risk of pelvic floor descent, whereas incorporating pelvic floor pre-contraction during exhalation effectively reduced pelvic floor descent (p = .001) and enhanced core muscle activation (p < .001). Conclusion: This study confirmed that breathing tasks significantly influence the pelvic floor, core muscles, and diaphragm. Males demonstrated superior core activation and better coordination between breathing and core-pelvic floor control compared to females. The ''anal tightening'' cue effectively induced pelvic floor elevation. To prevent pelvic floor dysfunction, females should focus on guided core muscle recruitment during breathing training. Higher intra-abdominal pressure increases the risk of pelvic floor descent, but precontraction of the pelvic floor can effectively mitigate this risk and enhance core muscle participation. These findings provide important references for sports training, core stability strategies, and gender-specific exercise instruction.