【踮起腳尖痛,腳踝也會有夾擠問題?】
(這次文章內容稍長,若懶得看文字內容可直接觀看影片)
大家應該對於肩夾擠、髖夾擠這兩個名詞不陌生,但你有聽過腳踝夾擠嗎?夾擠指的是我們的骨頭過度擠壓到周遭的軟組織,可能是肌腱、韌帶或是滑液膜等等,造成疼痛或角度受限。夾擠是一個症候群,並非一個特定的病症,夾擠症候群底這個名詞底下,可能夾到的組織不同,造成的原因歧異度也非常大,造成評估上其實並不是那麼容易。腳踝夾擠雖然沒有像肩夾擠一樣有被正式分類成不同的夾擠類型,但仍能根據症狀呈現的方式跟解剖構造簡單分為前夾擠跟後夾擠,若還要再細分還會分前內側、前外側夾擠,以及後內側、後外側夾擠。
前側夾擠的症狀主要出現在腳踝背屈末端角度的時候,脛距關節 (Tibiotalar joint) 前側的組織受到擠壓。腳踝前側的有不少脂肪、滑囊組織,正常情況,這些組織會在腳踝背屈15度過後受到擠壓,但如果在遠端脛骨前側或是距骨頸有增生的骨頭的話,便可能限縮前側的空間,讓組織提早受到壓迫。如果長期在這角度下活動,就可能進一步造成慢性的發炎,或是造成關節囊韌帶的增生。除此之外,如果腳踝曾經扭過傷,造成韌帶或皺襞增厚的話,也是可能造成前側夾擠的原因之一。
雖然這些解剖構造上的變化已有多篇文章有所描述。但造成這些組織增生的原因卻仍不是很清楚。因為運動員有比較高的比例有這樣的問題,有些學者認為前側夾擠可能是因為頻繁地做出大角度的背屈,或是因為運動過程中受到的外力,讓前側軟骨邊緣反覆受到衝擊所造成。也有些學者認為,踝關節的不穩定,造成關節有不正常的微小滑動,也是一個可能造成骨質增生、或是軟組織受到夾擠的的原因。另外在比較早期的文章,一開始學者認為前側的骨質增生可能是來自於頻繁地蹠屈,牽拉到關節囊,進而造成關節處的增生,只是這樣的假設被後來的研究給推翻了。
因為前側夾擠症狀大多是在腳踝背屈的末端角度下出現,上樓梯、跑步、走上坡、爬梯還有深蹲是幾個比較容易會加劇前側疼痛的活動。若未接受妥善治療,在症狀後期可能會因為組織的增生或疼痛,造成更進一步的活動度受限、夾擠和周圍組織的傷害,再回頭限制關節活動度與功能,形成惡性循環。
後側夾擠的症狀主要出現在腳踝蹠屈到末端角度的時候,脛距關節與距跟關節後側的組織受到擠壓。後側夾擠常出現在需要頻繁把腳踝往下壓的人身上,像是芭蕾舞者、需要頻繁跳躍的運動員等等。與前側夾擠雷同,後側夾擠可能是骨質或是軟組織的夾擠,或是兩者同時存在。距骨後外側 (trigonal process) 的骨質增生是比較常被認為導致後側夾擠的原因。除此之外,頻繁的將腳板大幅度的往下踩,可能會導致後側關節囊、後下脛腓韌帶、三角韌帶的後側韌帶發炎,產生疤痕組織,進而造成組織增厚。另外我們的屈足拇長肌的肌腱經過距骨後側的內、外骨突中間的凹槽,也很容易因為過度使用,或是周遭骨質的增生,造成肌腱病變,像是肌腱或腱鞘炎的問題。
與前側夾擠的疼痛大多較為淺層、可觸摸的到相反,後側夾擠的症狀通常較為模糊,比較難有一個特定的單點疼痛,而且位置較深,通常落在阿基里斯腱底下。這也讓後側夾擠不容易和阿基里斯腱或是腓骨長肌的問題做區分。因為症狀出現在腳踝往下踩的時候,走下坡、下樓梯或是穿鞋跟較高的鞋子是幾個容易誘發症狀出現的活動。芭蕾舞者之所以比較容易出現這樣的症狀,被認為是因為需要頻繁的做出踮腳站,承重在前足的關係。
雖然影像檢查出來的骨質、軟組織的病變被認為是可能導致腳踝夾擠的原因之一,但實際上研究還是有提到,我們仍然不能光靠這些影像結果證據就判斷踝關節是否夾擠。影像檢查與我們的症狀表現之間的相關程度有限,仍需要結合其他理學檢查做綜合判斷才行。針對踝關節夾擠的介入,目前比較常見的作法仍是先採取保守治療,若在急性疼痛期,需要先避免會造成疼痛的動作,有必要的話也會使用消炎藥來控制疼痛。在非急性期,甚至是已經是慢性問題的個案,我們則需要著重在踝關節穩定、本體感覺的訓練上,畢竟前面有提到,踝關節不穩、扭傷都是可能造成夾擠的原因之一。與其他肌肉骨骼問題一樣,即使解剖構造上的異常也會被認為是造成踝關節夾擠的原因,但大多數的個案都能在不開刀的情況下有很好的進步。若有類似的狀況,一樣記得先找醫療人員的協助,避免症狀隨著時間越變越嚴重。底下的影片 (6:52) 將跟大家分享幾個簡單的踝關節穩定與本體感覺的訓練。
Impingement syndrome is a common musculoskeletal problem in shoulder and hip joints. But have you ever heard of ankle impingement? Impingement syndrome refers to abnormal contact of bony structures or soft tissue, e.g., tendon, ligament, synovial tissue, resulting in pain and restriction. Through different causes of impingement syndrome, it includes different medical signs or symptoms. Therefore, causes of impingement syndrome differ from person to person, making it more difficult to make a right diagnosis. Although ankle impingement is not officially classified into different types like shoulder impingement, researchers still sort it into anterior and posterior impingement according to anatomical structures are involved. More specifically, it can be classified into anteriomedial, anteriolateral, posteriomedial and posteriolateral impingement.
Symptoms of anterior ankle impingement are generally induced by compression of anterior margin of tibiotalar joint in terminal dorsiflexion. There are adipose and synovial tissues in the anterior joint space. Normally, these tissues are compressed after 15 degree of dorsiflexion in healthy individuals. However, if there is osteophyte at anterior distal tibia or talus neck, it will take up the space and limit ankle movement, causing early compression. This will result in chronic inflammation, synovitis, and capsuloligamentous hypertrophy. Apart from this, ankle sprain, thickened anterior tibiofibular ligament and synovial plica are also possible causative factors.
Even though structural pathologies are well described in much research, their exact etiologies are still less understood. Research showed that athletes are tend to affected by anterior impingement, and it led to hypothesis that pathologies are caused by repetitive impact injury to anterior chondral margin from hyper-dorsiflexion or direct impact during sports. Chronic ankle instability has also been hypothesized to be the causative factor of anterior impingement, because abnormal repetitive micromotion may develop bony and soft tissue lesions. In addition, early research hypothesized anterior osteophyte is caused by traction to the anterior capsule during repetitive plantar flexion, but this theory was disproved by later anatomic studies.
Anterior impingement symptom typically presents as anterior ankle pain during terminal dorsiflexion. Climbing stairs, running, walking up hills, ascending ladders and deep squat are common aggravating activities. If anterior impingement doesn’t get treated well, in the later stage, joint mobility may be further restricted due to mechanical block or pain, resulting in vicious circle.
Posterior ankle impingement symptom typically occurs in terminal plantarflexion, due to compression of tissues posterior to the tibiotalar and talocalcaneal joint. Posterior impingement tend to occur in athletes who need to plantarflex frequently, like ballet dancers, etc. Similarly, posterior impingement can result from compression of bony or soft tissue in isolation or in combination. Trigonal process of posterior talus is the most common cause of posterior impingement. Besides this, repetitive hyper-plantarflexion may cause posterior capsule, inferior tibiofibular ligament, and posterior fiber of deltoid ligament inflammation, scarring, and thickening. Lastly, tendinitis and tenosynovitis are easily found in flexor hallucis longus tendon, running between the medial and lateral posterior process of the talus. This probably results from overuse or irritation from surrounding abnormal bony tissue. The tissues mentioned above are all possible causative factors to the posterior ankle impingement.
In contrast to patients with anterior impingement pain that are accessible to palpation, posterior impingement pain is less specific, deep to the Achilles tendon. This makes it difficult to differentiate from Achilles tendon or peroneal tendon pathology. Since posterior impingement symptom is usually irritated by repetitive plantarflexion, walking downstairs, downhill running, and wearing high-heeled shoes are some common exacerbated activities to posterior impingement syndrome. Ballet dancers are commonly affected by posterior impingement syndrome due to weight bearing on forefoot in plantarflexion position over and over again.
Though osseous or soft tissues abnormality in radiography is seen to be one of the causes of ankle impingement, it doesn’t mean that we can simply blame patient’s symptom on these structural pathology. In fact, there is a limited correlation between medical image findings and our symptom. We should integrate patient’s history, physical examination, imaging studies, etc., for accurate diagnosis. Conservative treatment remains first option to manage ankle impingement. In acute stage, patient should avoid from doing provocative activities. If it is necessary, NSAIDs can be used for pain management. In chronic stage, clinicians should focus on ankle stability and proprioception training because ankle instability and sprain are both causative factors of ankle impingement. Just like other musculoskeletal disease, even though structural abnormality is thought to be a possible cause of ankle impingement, most ankle impingement cases still respond well to conservative treatment. If you have any similar medical problem, please find medical professions for help. The video below will show you some simple ways to train our ankle stability and proprioception.
參考資料:
https://pubmed.ncbi.nlm.nih.gov/27608626/
https://link.springer.com/article/10.1007/s00247-019-04459-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065672/
#腳踝夾擠 #踝關節不穩 #腳踝扭傷 #本體感覺訓練 #物理治療 #ankleimingement #ankleinstability #anklesprain #proprioception #physiotherapy #hunterptworkout
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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【肌肉、韌帶斷裂:復健訓練的意義】
『我的跟腱完全斷裂,一輩子不能打球了』
『動完手術後,我的韌帶接回去了,為什麼還要復健』
以十字韌帶斷裂為例,韌帶主要是維持關節的穩定性。斷裂後,可能失去很大部分的穩定性,然而,穩定性的構成不只是韌帶,還有肌肉、本體感覺等其他能力
有些人在斷裂後,不需要手術還是不影響生活及運動,主要的原因是他們除了韌帶,其他身體能力是足夠的。復健訓練的用意就是在讓還可以進步的能力持續往上
就像是廚房有三位廚師,平常都只有一個廚師在工作,另外兩個在偷懶,而當有工作的廚師請病假,則要設法讓偷懶的廚師也能上工
不管有沒有手術,如果沒有接受3-6個月高品質的物理治療 (保守治療),先不要說『我不行了、我一輩子不能打球、運動』等
所有圖片: https://www.instagram.com/chenhc82/
#rupture #tear #muscle #tendon #ligament #rehabilitation #exercise #training #stability #compensation #proprioception #noncoper #coper #injuryprevention #physiotherapist #CSCS #斷裂 #撕裂 #肌肉 #肌腱 #韌帶 #復健 #運動訓練 #穩定性 #代償 #本體感覺 #運動訓練 #運動表現 #預防傷害 #物理治療師 #肌力與體能訓練師 #陳曉謙
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🔶🔷《學生表揚》🔷🔶
【Single Leg Deadlift 人體第七個動作】
【咩人需要做?】【SLDL 好處】
【與Running Coach及Sports Scientist合作】
呢個學生減脂過程都係keep住好穩定
呢一點亦有賴佢自己on diet及勤力操練
而佢亦一直都想「跑好d」
經我轉介後就跟隨左一名Running Coach及Sports Scientist - Hoyin Yuen
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🔴 我亦非常榮幸再次同另一位教練合作😆😆
(我非常welcome學生們跟多一個以上既教練,因為咁樣佢地會進步得更快)
Hoyin同我商量後,我地都一致認同於肌力訓練上要加多d single leg exercise
單腿訓練往往能夠帶來極多好處😍
亦都係我以往非常忽略既一環😕
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🔵 Single Leg Deadlift 適合乜人? 究竟有乜用?
首先 係『乜運動及專項都適合!!』
SLDL 能夠係一種臀部及後腿既 activation exercise
係 progress 後: 包括 負重、節奏、姿勢改良後更可以成為strength training exercise
亦絕對係一個好FUNTIONAL既動作😌😎
⚠️ 試想想你跌左野落地,而個d位亦不方便你踎低
你只會用SLDL、Split squat、lunges形式去拎
當然SLDL下你不能平衡,你係唔會去做😂
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🔵🔵🔵 SLDL 好處:
我先分做三大主要適合所有人士既point
1. 提升髖關節穩定性 Enhance Hip Joint Stability
2. 減低背部壓力 Reduce the Back Pressure
3. 加強足踝關節本體感受 Increase Ankle Proprioception
🔶🔶 1. 提升髖關節穩定性 Enhance Hip Joint Stability
當進行SLDL時,令到我地個臀部 (external rotation complex) 伸展多左,髖關節係呢個情況下會用多左力,長期訓練後就能加強整個髖關節穩定性💪🏻💪🏻💪🏻
往往雙腿平衡訓練 (equilibrium movement) 係較難比到呢個功效,所以對於降低受傷風險,肌肉既Range of Motion,關節穩定性全部都有益處🤟🏻
就算 Olympic Weightlifter 呢種雙腿平衡參與最多既運動員都會做到,其他運動又點會唔做先👏🏻👏🏻
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🔶🔶 2. 背部壓力減低 Reduce the Back Pressure
進行SLDL時,由於重量非常接近支點、上身軀幹與一腿同時陏,所以對背部壓力係極少,張力都去哂我地hip及hamstring當中😋
對build up肌肉又得、增強肌力亦得、做個靚臀亦得、得左!
同時亦可以利用輔助形式幫背部有傷患、做deadlift/ hip thrust/ squat 時有不適感既人先增強臀部感應、穩定性、「拉與送髖」操作,非常有效🤩🤩
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🔶🔶 3. 加強足踝關節本體感受 Ankle Proprioception
barefoot training、腳掌足踝訓練、腳趾是否有用力
近年來都迅速受到名運動界別重視
當SLDL或大部分單腳訓練時,我地既ankle必需擁有良好既本體感受,從而作出平衡、力量、控制離心向心、穩定性等等,亦促進DLS (Deep Longitudinal subsystem) 控制同功效
(我都係溫番書先記得呢個系統😂😂😂😂😂😂)
加強Ankle能力,好多人會係咪都用Bosu,但其實SLDL都係一個非常好既選擇,長遠落去,你ankle及腳掌既韌性、彈性、感受、穩定性都會越來越好👌🏻
對於力量發展、防止受傷、加強雙腿訓練都非常有用🔥🔥
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💡💡 做SLDL時,唔一定要lock實個膝頭,比佢屈少少對於臀部既張力會更加多,反而之後腿都攰臀部都未有feel
用乜tempo、重量、姿勢當然係按你目標所定
呢位學生要跑好d,「送髖」「頂推」當然不能少
但可以再同步d快d,慢慢糾正同練習🙌🏻
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先感謝意見及remind
Hoyin Yuen - S&C, Running Coach, Sports scientist
Cyrus movewell
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🔶🔶‼️ 一對一訓練 正在進行 ‼️🔶🔶
聯絡方法: Inbox 我吧 🤣📩📩📩
或者 📲📲 whatsapp我 (下面為快速 CHAT link)
❇️❇️ https://wa.me/+85253736331 ❇️❇️
❗️想參與多d Q&A 及 上堂實況❓
可以follow我個人Instagram:
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💡 www.facebook.com/jimzacdon 💡
💰💰💰訓練前評估為 HKD $600 💰💰💰
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