髕腱肌腱病變(膝蓋前側疼痛),仍持續從事運動及團練,怎麼辦?

關於髕腱肌腱病變,但你又要繼續參與運動或團練,山姆提供學員幾項建議:

髕腱肌腱病變主要原因是「過度使用」,例如大量跳躍、跑步等,控制訓練量、安排適當休息甚至接受治療是有「必要」的,但如果你必須參與訓練,建議在訓練前,除了喚醒身體各部位的肌肉之外,在熱身時可以安排「等長訓練」,研究證實等長訓練可以立即減輕髕腱肌腱疼痛並改善肌肉的運動表現。

文獻來源:Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”?

Heavy slow resistance (isotonic) and isometric exercise have been shown to reduce pain and allow continued sports participation with high adherence. Isometric exercise has been shown to reduce patellar tendon pain immediately as well as immediately improve muscle performance, probably by reducing cortical inhibition. The study by Rio et al6 was a small controlled laboratory-based study that demonstrated efficacy but not effectiveness. From a practical perspective, reduction in inhibitory drive (and functionally an improvement in quadriceps maximal voluntary contraction) means that isometric exercise may have the potential to be used immediately before games and training sessions without causing deficits in muscle performance.

而文獻提到的動作是使用西班牙式深蹲(Spanish Squat),進行5組×30秒。研究主要針對的對象是「季中」運動員,也就是正在賽季的運動員,對於有髕腱肌腱病變但對比賽有高度出席意願的運動員,我們如何協助他們呢?在器材有限的情況下,只需要一條牢固繩子的「西班牙式深蹲」是不錯的選擇,方式是在比賽前進行「5組×30秒」的等長訓練。

isometric_squat_quadricpes

圖:擷取至文獻

也可以使用「北歐腿後彎舉束帶」來進行西班牙式深蹲。

而山姆則是使用「分腿蹲」或「後腳抬高蹲」等長訓練的方式來進行,「3~4組×30秒/每邊(組間休息30秒)」,在進行分腿蹲等長維持的時候,可以讓上半身前傾,想像下巴在膝蓋的上方,讓身體更多體重可以放在前腳上。

就我實務上的經驗,等長訓練可以立即減輕疼痛。比方說,髕腱肌腱病變的人,在進行跪坐腳跟時,膝蓋前側可能會覺得不適,而經過等長訓練之後,這個不適會明顯的減少;而當你運動結束後,比方說跑步、越野跑、球類運動等,覺得膝蓋前側緊繃,使用滾筒按摩都無法放鬆時,也可以使用等長訓練來處理。

在另一篇文獻中也提到,也是有學員問到的,滾筒按摩(膝蓋前側的肌肉)、運動肌貼、護膝等有沒有幫助,對於「減輕症狀」是有的,讓運動員或運動愛好者可以持續的參加運動,但這是「應急」的做法,並沒有研究證實這有「療效」,這個觀念務必要有。

Rollga滾筒按摩大腿前側

圖片擷取至《強膝訓練》。

文獻:Physiotherapy management of patellar tendinopathy (jumper’s knee)

Passive interventions
Other techniques may be useful in augmenting an exercise program; however, there is little evidence for effect of passive treatments for patellar tendinopathy. Exercise, pulsed ultrasound and transverse friction massages have been compared, and exercise had the best effects in the short and long term.Manual therapy techniques, including myofascial manipulation of the knee extensor muscle group, have had a positive effect on reducing pain in patellar tendinopathy patients in short-term and long-term follow-up. Other passive therapies, including braces and taping techniques, are often used clinically to help unload the patellar tendon, however, no evidence supports their efficacy. Passive therapies are best used to reduce symptoms in season so the athlete can continue to participate in rehabilitation and sport.

所以對於有膝蓋前側不適的人,仍然想要持續運動,不妨可以這樣做:

熱身前:進行「肌肉喚醒術」,透過神經方面讓肌肉上線,然後透過滾筒去按摩膝蓋周圍的肌肉。
熱身中:安排「等長訓練」,立即減緩疼痛。

而髕腱肌腱病變的復健方式,我的做法是透過「訓練前1小時食用明膠果凍」,然後搭配強度高的「等長訓練」,這部份可以在「從跳躍膝問題來認識肌腱復腱、營養補給及傷害預防訓練」了解到內容。

訓練前:1小時服用至少15公克的明膠+維他命C
訓練中:等長訓練,修復肌腱。

而為了避免髕腱肌腱病變,除了控制訓練劑量、安排適當的休息及治療外,發展強壯的股四頭肌群也是重點之一,由它們來分攤肌腱吸收衝擊的工作,這也是為什麼我們會強調分腿蹲這類的動作。

以上整理,希望對學員有幫助。

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