摘要：離心訓練是治療下肢慢性肌腱病變(chronic tendinopathy) 一個重要的項目，受訓者必需在運動時增加主動肌(agonist muscles) 肌肉與肌腱長度的總合(total length of myotendinous complex)，過去前瞻式(prospective) 或採隨機控制實驗(randomized control trail) 之研究顯示，接受離心訓練的患者多能得到降低疼痛的治療結果，但是這些研究之間，對訓練強度、執行方式以及治療成果(outcome measure) 缺乏客觀或一致的定義，使得這項訓練的治療成果與臨床機制未受到普遍認可與了解，目前有關機制中，受到重視的假設包括運動調控(motor regulation)、肌腱機械特性(mechanical properties) 以及肌腱的氧化代謝(oxidative metbolism)，本研究企圖以上述三項參數，以及與運動表現有關的指標，描述中段肌腱退化(tendinosis in middle-portion tendon) 患者，其肌腱在上述參數上的特徵，其次有別於過去，本研究將利用等速離心(isokinetic eccentric)訓練治療這些肌腱退化患者，重複分析上述三項重要參數在治療前中後以及一年的追蹤後的表現，治療的肌腱包括髕骨肌腱以及阿基里氏肌腱，治療的對象包括不同族群(運動員與非運動員族群)，治療處方包括不同速度(慢速及高速) ，以比較等速離心訓練在不同族群以及使用不同速度之療效是否相同，另外將等速離心訓練之療效與等速向心(isokinetic concentric) 訓練比較。研究之貢獻將來包括，一、比較出現中段肌腱退化的肌腱和健康無症狀之肌腱之間，彼此在上述三類特性差異，二、可觀察這些出現肌腱退化的肌腱，在接受等速離心或等速向心訓練前後，上述三類參數以及疼痛特徵和運動表現是否具有顯著改善，並比較不同族群間的治療效果，可做為將來評估各族群癒後(prognosis)之參考，三、配合一年的追蹤觀察，比較接受不同速度或不同收縮方式之等速訓練的受訓肌腱，在一年後上述三類參數以及疼痛特徵和運動表現是否能夠持續存在改善或改變，以做為離心訓練治療此類傷害之臨床機制的參考。
Abstract: Middle portion tendinosis is a common and significant clinical problem characterized byactivity-related pain, focal tendon tenderness and intratendinous imaging changes. Thepatellar and Achilles tendon are common involved in sports and extensively investigated intendinosis which believed to relate to the neurovascular ingrowth and tendon mechanicalproperties. However, little evidence has directly supports that motor regulation, tendonoxidative metabolism or mechanical properties significantly change after tendinosis. Researchis required to better understand the mechanisms of tendinosis at the neural, metabolic andmechanical levels and to develop new scientifically based training to treat tendinosis moreeffectively. The aims of this three-year study are to (1) analyze the differences of motorregulation, tendon mechanical properties and tendon oxidative metabolism, and painconditions (with questionnaire and VAS) between tendons with chronic tendinosis and healthyasymptomatic tendons; and to (2) discover the interventional effects of isokinetic training(eccentric and concentric) on the above characteristics and pain conditions; and to (3)discover the interventional effects of speeds (high speed and low speed) during isokineticeccentric training on the above characteristics and pain conditions. In addition, one yearprospective observation is conducted to analyze the long term effects of isokinetic training onthese parameters. Furthermore, comparisons are also made between recreational athletic andnon-athletic groups.Parameters of motor regulation include agonist activation level and antagonistcoactivation. Tendon mechanical properties are analyzed by strain-stress curve includingstiffness, elastic energy input, elastic energy dissipated and hysteresis. Tendon oxidativemetabolism is mainly represented by concentrations of the hemoglobin bound with oxygen.These above parameters are assessed with surface electromyography, isokinetic dynamometer,electro-goniometer, electrical stimulator (for nerve conduct test), near-infraredspectroscopy/imaging and high frequency ultrasound.In the first year, we are going to translate the questionnaires of “Victorian Institute ofSport Assessment score (VISA score)” and “Victorian Institute of Sport Assessment-Achillesquestionnaire (VISA-A) into Chinese version. Reliabilities of theses questionnaire survey arealso performed with patients with injuries in their patellar or Achilles tendons. In addition,test-retest reliability of measurements regarding tendon oxidative metabolism are conductedon thirty subjects without any injuries in their dominant lower extremities. The concentrationsof hemoglobin in their patellar tendon or Achilles tendon are measured before, during andafter thirty continuous isometric exercises.From the second year to the third, qualified patients with middle portion tendinosis intheir patellar or Achilles tendon (sixty to eighty for each) are recruited from National TaiwanUniversity Hospital. These tendinosis are differential diagnosed by high frequency ultrasound,physical examinations and palpation. The additional inclusion criteria of patients includehaving no evidences of mal-alignment in their lower extremities, for example: a leg-lengthdiscrepancy (difference of distance from the anterior superior iliac spine to the superiorsurface of the most prominent aspect of the medial malleolus) of more than 1.5cm. Thesepatents according to their injury locations (patellar vs. Achilles tendon) respectively join atwelve-week training with different programs (concentric vs. eccentric) for their injuredtendons. Eccentric trainings for the tendinosis in the Achilles tendon are performed atdifferent speeds (high vs. low). All these patents will be evaluated before and after thetwelve-week training, and one year after the training.