多裂肌是人體背側重要的核心肌群 由薦骨開始一路向上到頸椎 每一個單位向上2-4節脊椎連結到棘突上 是重要的脊椎穩定肌群 Multifidus is the important core muscle on the back From sacrum all the way up to neck Every unit goes 2-4 segment above toward the spinous process.
Play an important role as a lumbar stablizer
由於多裂肌本身的組織排列
在身體向前彎曲時多裂肌可以產生最大的肌力
這也間接證實了多裂肌在矢狀面上身為穩定肌群的能力
Due the the sacromere length change,
Multifidus generates max strength output during trunk flexion.
That somehow implies the ability as a trunk stabilizer on saggital plane.
許多的研究顯示在慢性下背痛的患者身上
會發現多裂肌失能的狀況
也會在影像學上觀察到
明顯腰部多裂肌受到脂肪組織取代萎縮的現象
Many researches showed that multifidus dysfunction occur among chronic low back pain population.
Also form image studies,
the fat will infiltrate multifidus tissue, A.K.A multifidus atrophy.
因此如何正確的評估與誘發多裂肌的活動
對於下背痛的患者來說非常重要
Thus, its important to assess and activate multifidus for low back pain population.
臨床上有兩個適合評估多裂肌的動作
多裂肌抬高測試(MLT)以及後彎測試
There are two excellent movements can be used to assess multifidus.
Multifidus Lifting Test (MLT) and multi-segmental extension test
多裂肌抬高測試是在四足跪姿下進行
受試者需先維持脊椎中立
然後將腳或手抬起
如果腰椎無法維持姿勢就是陽性
MLT is performed under quadruped position
The subject need to get the neutral spine first,
then raising arm or leg or both.
Belly dropping or can not maintain neutral spine are consider positive
後彎動作是另一個非常簡單可以快速執行的理學測試
主要評估要點有兩個
1. 腰椎是否過度前凸
2. 脊椎是否有折點出現
這兩個現象都表示多裂肌的失能導致無法有效的分散後彎壓力
Multi-segmental extension is another easy PE.
There are two signs we need to watch out
1. Hyperlordorsis of the lumbar
2. Any hinge point on the spine
Both signs tell you that multifidus is dysfuntion that cannot distribute the pressure properly.
當我們處理完結構上或肌肉控制的問題之後
我們必須要指導個案如何正確使用多裂肌
下面介紹兩個我常用的多裂肌啟動與訓練的方式
After dealing with the structural issue and motor control issue,
we need to teach them how to use their multifidus.
Below are two exercises I use a lot to activate multifidus.
改良多裂肌超人式
傳統超人式在執行上容易過度使用脖子與豎脊肌群
反而可能造成更多的症狀產生
而在將手腳抬起前
先讓上肢往身體收進來
可以徵召核心穩定肋骨
Mofified Superman by Dr. Kathy Dooley
Original superman may over recruit neck and erector spinae during practice,
which might make the symptom worse.
Instead, you can add a pulling movement of the arms before raising limbs.
That can help you recruit core muscles to stabilize ribs during movement.
側躺多裂肌啟動
想像你的胯下與背後有一條線連接在一起
將這條線縮短並把腰椎向上略為抬高
從屁股的位置給予一個輕輕向前推的力量
另一隻手可以去感受多裂肌是否收縮或式產生過度豎脊肌活化
Sidelying Mf activation
Think about there's a ling connecting your groin and lumbar spine
Contracting this line gently and lifting lumbar vertebra up slightly
Then you can give light resistance to push pelvis forward
Another hand can touch their back to feel if the Mf is contracting or erector is over activating.
多裂肌是背後的核心
協助我們抵抗重力與旋轉
下背的穩定除了腹肌核心以外
多裂肌的訓練是一個不可忽略的重要因素
Multifidus is core of the back.
It assists us against gravity and rotation.
In order to stabilize low back spine,
multifidus is one muscle you can not neglect.
參考文獻
1. Freeman, M. D., Woodham, M. A., & Woodham, A. W. (2010). The role of the lumbar multifidus in chronic low back pain: a review. PM&R, 2(2), 142-146.
2.Ward, S. R., Kim, C. W., Eng, C. M., Gottschalk IV, L. J., Tomiya, A., Garfin, S. R., & Lieber, R. L. (2009). Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. The Journal of Bone and Joint Surgery. American volume., 91(1), 176.
3. Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873-888.
4. Kjaer, P., Bendix, T., Sorensen, J. S., Korsholm, L., & Leboeuf-Yde, C. (2007). Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?. BMC medicine, 5(1), 2.
許多的跑者都曾經或現在依然有膝蓋疼痛的問題 髕骨股骨疼痛症候群(PFPS)是一大部分這些雜症的總稱 PFPS來自於髕骨與股骨摩擦產生的發炎與疼痛
特別常見於下面這種跑姿
Many runners have/had knee pain problem. Patella Femoral Pain Syndrome (PFPS) is a common term to conclude most of those pain. The definition of PFPS is the friction between knee cap and femur that causes the symptom.
This symptom can be found especially with the runner who runs like this.
上面這張圖有兩種常見的錯誤跑姿出現
但我們先把重點放在支撐腳上 這種情況有人稱為膝外翻, 膝蓋碰撞, 或是特倫得堡步態 我們從後方觀察可以見到下列特色 1. 骨盆往對側掉 2. 過度髖內收/內轉 3. 膝蓋外展 上面這三點會造成髕骨的向外位移
There are two common running posture error in this picture.
But let's focusing on supporting knee first. Some may call this knee valgus, knocked knee, or Trendelengberg gait We can observe three features from back view: 1. Contralateral pelvic drop 2. Excessive hip Adduction/Internal rotation 3. Knee Abduction Those features can lead to the lateral tracking of the knee cap
傳統上對於PFPS的治療很直觀
訓練控制骨盆以及股骨動作的肌肉就好棒棒可以解決問題呢 你做了大腿外展運動, 蚌殼外轉運動....等等 可是為什麼老是反反覆覆, 或者多跑一下就又不行了呢
The traditional treatment concept to PFPS is simple.
Training those muscles that control pelvis and hip movement can solve it. You've done hip abduction exercise, clam exercise....etc. But you're still suffered from it or the pain always comes and goes.
過去幾年的研究可以告訴我們這個問題的解答
在前瞻性研究的部份
臀部的肌肉力量對於預測PFPS的產生/此種步態的產生完全沒有預測力
但在橫斷面研究發現
有PFPS的人會有臀部肌力減少的現象
這指向了一個結果：臀部無力是PFPS造成的結果
而Wilson et al 2009的研究指出
臀中肌的啟動時間與耐力是唯二針對跑步過度髖內收的良好預測因子
結論：PFPS是一個神經肌肉控制失能的結果
Past researches might provide the answer to this question
Prospective researches showed the hip strength can not predict the present of PFPS.
Cross Section studies showed the population with PFPS has decreased hip strength.
That said, the HIP STRENGTH INSUFFICIENCY IS THE RESULT OF PFPS.
According to Wilson et al 2009,
the GluMed onset time and duration are the only two factors can be used to predict excessive hip adduction.
In conclusion: PFPS IS THE RESULT OF NEUROMUSCULAR DYSFUNCTION
