肌腱變性(Tendinosis)的自我照顧

在臉書上看到Boxer Li講師分享的「Tendinosis VS. Tendinitis 肌腱變性與肌腱發炎」,其中關於「肌腱變性(Tendinosis)若肌腱長期反覆經受輕微外傷或肌腱本身有慢性磨損,導致腱纖維變性,變細,日後輕微扭傷即可造成肌腱斷裂,這謂之肌腱自發性斷裂。」要如何自我照顧呢?山姆伯伯查到了一篇文章,分享給大家。

NCBI的網站上介紹了8個針對肌腱變性(Tendinosis)的自我照顧的建議,山姆伯伯做個簡譯分享:

1. Rest (休息)

People with low-grade tendon injuries often find it difficult to rest as much as is necessary, especially as symptoms subside. With repetitive work tasks, the patient is recommended to take a break for one minute every 15 minutes and a five-minute break every 20–30 minutes.

( 人們在輕微的肌腱受傷時,休息是必要的,但要休息卻是件困難的事情。從事重複動作的工作時,建議病人每隔15分鐘要休息1分鐘;每隔20~30分,要休息5分鐘。)

This reduction isn’t much considering its role in preventing long-term pain and disability. Some people will need to rest even more than this at the start of treatment. The patient should be advised to stay aware of their body as it heals. If the activity they are engaging in is causing pain, then they are probably doing too much.

( 這樣的休息方式對於預防長期疼痛或殘病並不算太好。有些人甚至需要更多的休息時間,並且在進行治療的過程中,要懂得掌握自己的身體狀況。若病人從事活動引起疼痛時,他們可能做的太多了。)

2. Adjust ergonomics and biomechanics (調整人體工學設計及出力方式)

Small changes can make a big difference. With regard to ergonomics, for example, cashiers are encouraged to press the register keys as lightly as possible, and computer users should be sure their wrists are resting in a neutral position while typing.

( 小的變化會帶來很大的不同。考慮到人體工學設計,比如,收銀員盡可能輕巧的按下註冊鍵;電腦族在進行打字時,應該確保手腕放置在一個適中的位置。)

Larger companies and government organizations often have an ergonomic specialist available to consult with employees about their workstations. Physical therapists are experts at recognizing and adjusting improper biomechanics that might be causing injury.

( 善長於人體工學的專家可以提供民眾關於工作環境設計上的建議;而物理治療師可以識別與調整民眾可能會造成傷害的的力學方式。)

3. Use appropriate support (合適的護具)

Physical therapists can also recommend appropriate support to reduce tensile stress on the tendon, such as bracing or taping

( 物理治療師也可以建議病患適宜的護具,減少對於肌腱的拉伸應力,像是護具或貼紮。)

4. Stretch and keep moving, though conservatively (伸展並谨慎地保持活動)

Lightly stretching and moving the affected area through its natural range of motion while minimizing pain will prevent shortening of the related muscles (preserving active range of motion and flexibility). It can also increase circulation, thereby assisting the healing process.

( 在自然的活動範圍下,輕微的伸展及活動受傷的區域,可以減少庝痛、防止相關肌肉的短縮,讓肌肉主動保持其活動範圍及柔軟度,同時也可以增加血液循環,有助於治癒的過程。)

Stretching can also elongate the muscle-tendon unit, reducing the tension placed on the tendon during activity, thereby reducing the chemical changes that cause degeneration.

( 伸展也可以拉長肌鍵單位,減少活動時在肌鍵上的張力,進而減少會導致肌腱變性的化學變化。)

5. Apply ice (冰敷)

Ice causes vasoconstriction and is thought to address the abnormal neovascularization of the tendon tissue. Clinical experience indicates that icing is helpful for tendinopathies even though the reason why it works is not yet fully understood.

( 冰敷會導致血管的收縮,並且被認為可以解決肌腱組織的異常新生血管(Neovascularization)。臨床經驗指出,冰敷有助於肌腱病變,但原因尚未被完全的了解。)

Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon.

( 一天進行數次冷敷,並且在活動結束後也需要,每次進行15~20分鐘。各次冰敷之間至少要間隔45分鐘,讓組織先回到正常的溫度。)

6. Eccentric strengthening (離心訓練)

An eccentric strengthening regimen done 1–2 times daily for 12 weeks has been clinically proven to be a very successful treatment for tendinosis, especially when the exercises are performed slowly. Eccentric strengthening is “lengthening a muscle while it is loaded and contracting.”For example, lengthening one’s bicep while holding a dumb-bell in one’s hand would stimulate eccentric contraction.

(每日進行1~2次離心訓練,連續進行12週,在臨床上已被證明是治療肌腱變性非常成功的方式,尤其以緩慢的方式來進行動作。註:離心運動可以先參考「負向進行的訓練方式」。)

Eccentric strengthening effectively stimulates collagen production, improves collagen alignment, and stimulates collagen cross-linkage formation, in turn improving tensile strength. Eccentric strengthening might also help to reduce ground substance and tendon volume (swelling/thickening).

( 離心訓練有效地刺激膠原蛋白的生成,改善膠原蛋白的排列,並刺激膠原蛋白交叉連繫的形成,進而改善抗拉強度(Tensile Strength)。離心訓練可能也有助減少基底質及肌腱體積(腫脹與增厚)。)

It has also been proposed that part of the benefit of eccentric strengthening is the stretching involved, as described above. It can be helpful to consult with a physical therapist to maximize the benefit of strengthening exercises and to minimize the possibility of re-injury.

而離心訓練也有伸展肌肉的益處,在上面已經有介紹到。離心訓練的益處,可以將再度受傷的可能性降到最底。)

7. Massage (按摩)

Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied to the tendon serves to stimulate fibroblast activity and generate new collagen. Stasinopoulos and Johnson report that applying deep-friction to the tendon for at least ten minutes after the numbing effect has been achieved results in reduced pain and increased strength and mobility.

(按摩會促進血液循環及細胞的活性,尤其在進行完適宜的深層按摩。在肌腱上進行深層的按摩會刺激纖維母細胞(fibroblast)的活性,並且產生新的膠原蛋白。研究指出,在麻木的感覺出現之後,進行肌腱深層的按摩至少10分鐘,可以減少疼痛,並增加肌力及靈活度。)

Lowe states that he has found it effective to apply friction to the tendon in multiple short bursts of 20–30 seconds interspersed with other techniques; this strategy allows for mobilization of the tissue while minimizing discomfort for the patient. Myofascial techniques and trigger-point therapy can reduce fascial restrictions, scar tissue, and trigger points in the muscle connected to the tendon, relieving tension on the tendon.

( 肌筋膜技術及激痛點治療可以減少肌膜限制、疤痕組織及位在肌肉連結肌腱處的激痛點,並且釋放肌健上的張力。)

Myofascial techniques, lengthening deep-tissue techniques, stretching and active-release techniques can reset muscle memory to a more lengthened position, reducing the tension placed on the tendon during activity. A variety of massage techniques can decrease overactive pain messages from sympathetic nervous system firing, increase circulation, and improve overall tissue health.

( 肌筋膜技術、延長深層組織技術、伸展及主動放鬆技術可以重置記肉記憶,更延長其位置,減少在活動中對於肌健的張力。各種按摩技術可以減少來自於亢奮的交感神經系統所產生的過度活躍的疼痛信息,並增加血液循環及提供整體組織的健康。)

8. Nutrition (營養)

Vitamin C, manganese, and zinc are all important for the synthesis of collagen production. Vitamin B6 and Vitamin E have also been linked to tendon health. Patients might benefit from talking with their primary health care provider or a nutrition specialist to be sure their intake of these nutrients is sufficient.

(維他命C、錳、鋅都是膠原蛋白生產的合成過程中十分重要的營養素。維他命B6及維他命E也跟肌腱的健康有關聯。患者可以跟健康照設的專業或是營養專家進行咨詢,以確保攝取足夠的營養。)

希望以上的幫助對於大家對於自我照顧上有所幫助囉。

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山姆伯伯
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