[運動討論] 足球選手的傷害預防(2) Football Injury Prevention(2)

、

FIFA 11+的第一部份

包含的低速的跑步與主動伸展總共六個動作
The first part of FIFA 11+ is running exercise.

6 exercises include running at low speed with active stretch.

首先我們要先了解場地的設定
如下圖所示
利用半個足球場進行第一部分的訓練
每個角錐的間距為六公尺
總計六個角錐
First, we need to know how to set the field.
As the picture shown below:
Using half of the football field for part 1 and 3
Each course has six pairs of cones, around 5-6m apart

第一個動作 直線跑
向前跑到最後一個三角錐然後繞回
回程的時候要比去程略快
總共做兩次
Movement 1, STRAIGHT AHEAD
Jog straight to the last cone,
slightly more quickly on the way back
Two sets

這是基本暖身動作
注意的要點是維持上半身的穩定
與維持骨盆下肢良好的排列
This is the basic exercise for all exercises.
The point is to maintain trunk stability and good lower extremities alignment 
第二個動作 開髖
向前跑到第一個三角錐的時候停下
執行一個右髖關節的向外開的旋轉
跑到下一個三角錐時換邊開髖
總共做兩次
Movement 2, HIP OUT
Jog to the first cone. stop and lift your knee forwards. 
Rotate your knee to the side and put your foot down. 
Jog to the cone and do the exercise on the other leg.
Two Sets

第三個動作 收髖
向前跑到第一個三角錐的時候停下
執行一個右髖關節的向內收的旋轉
跑到下一個三角錐時換邊收髖
總共做兩次
Movement 2, HIP IN
Jog to the first cone. stop and lift your knee to the side. 
Rotate your knee forward and put your foot down. 
Jog to the cone and do the exercise on the other leg.
Two Sets

第二與第三個動作強調髖關節的主動伸展動作
同時也需要單腳站立平衡與上半身穩定的能力
下面是示範影片連結
The second and third movement focus on the active stretch of the hip joint.
Also, it challenges the trunk stability and the balance in single leg stance.
Below is the video demonstrating movement 1-3.

第四個動作 繞同伴
向前跑到第一個三角錐
成90度角向同伴水平移動
兩人互繞一個圈後水平移動回角錐處
然後往下一個角錐前進
重複動作
總共執行兩次
Movement 4, CIRCLING PARTNER
Jog forwards to the first cone. 
Shuffle sideways at a 90-degree angle towards your partner
Shuffle an entire circle around one other and back to the first cone.
Jog to the next cone and repeat the exercise.
2 Sets

第五個動作 跳躍肩撞
向前跑到第一個三角錐
成90度角向同伴水平移動
兩人靠近後做水平跳躍讓肩膀互相接觸後平移回角錐處
然後往下一個角錐前進
重複動作
總共執行兩次
Movement 4, JUMPING with SHOULDER CONTACT
Jog forwards to the first cone. 
Shuffle sideways at a 90-degree angle towards your partner
Side jump toward each other to make shoulder contact and back to the first cone.
Jog to the next cone and repeat the exercise.
2 Sets

這兩個動作都加入了冠狀面的移動模式
也是在大多數運動裡面最容易受傷的時候
模擬球場上的移動與對抗
是很有意思的暖身動作
下面是第四與第五個動作的示範連結
Those two movements involve the movement on the frontal plane.
It's also the most vulnerable plane of movement for most exercises.
By simulating the movement and competition on the field,
make it a fun and efficiency as a  warm-up exercise.
Below is the video demonstrating movement 4 and 5

第六個動作 前後衝刺
向前跑到第二個三角錐
然後背向衝刺回到第一個三角錐
重複向前兩個角錐, 向後一個角錐
直到最後一個角錐為止
總共執行兩次
Movement 6 QUICK FORWARD and BACKWARD SPRINT
Run quickly to the second cone then run backward quickly to the first cone, 
keeping your hips and knees slightly bent. 
Repeat, running two cones forwards and one cone backward.

這個動作的注意重點與第一個相同
同樣要維持穩定與排列
但多增加了前後移動的轉換能力
下面是示範影片
The principle is the same as the first movement,
keep trunk stable and good lower extremities alignment.
But adding the transition between forward and backward movement.
Below is the video demonstrating movement 6

第一個階段
強調的重點在於
不同移動情況下維持軀幹穩定與理想下肢排列
這也是避免運動中受傷的基礎之一
In FIFA 11+ Part 1,
Trunk stability and ideal lower limb alignment under different movement situation are emphasized
It is also the basic strategy to prevent sports injury.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[運動討論] 足球選手的傷害預防(1) Football Injury Prevention(1)

四年一次的世界盃足球賽又開始啦

資深老球迷與一日球迷都準備好出動了嗎
Here comes FIFA 2018
Be prepared, all old and bandwagon fans.  

世足賽期間當然要應景寫足球相關的文章

首發的內容當然要遵照我們的重要概念之一 - 預防勝過治療

所以我們要來介紹一個非常有效的足球員傷害預防計畫 FIFA11+

During this festival period, I definitely need to write something about it.

The very first article must accommodate one of our core value - "Prehab than Rehab" 

So here I'd like to introduce a very effective football injury prevention program, FIFA 11+

FIFA 11+是由跨國際專家團隊

在使用各式傷害預防計畫後

藉由他們的實際經驗整合而成

最原始是設計於14歲以上的業餘足球選手

後來也發展出了FIFA 11+ for kid以及

FIFA 11+ is developed by an international group of experts

based on their experience with different prevention program.

It is first implemented to amateur football player above 14 years old.

The program for kid is also developed lately.

根據Barengo et all, 2014的系統性回顧 

在普遍的情況下執行此計畫後可以降低隊伍30-70%的受傷數

另外在每週至少執行1.5次計畫的高配合選手身上

針對所有傷害的機率可以降低35%

According to a systemic review by Barengo et all, 2014

In general, the team which applied this program has the decreased injury number from 30-70%

For the high compliance player who performed the program at least 1.5 time/week,
all injuries risk can be reduced by 35%

FIFA 11+總共分成三個部分, 十五個動作

第一部份是低速的跑步配合主動伸展

第二部分是六組針對核心, 腿部力量, 平衡, 敏捷的訓練

第三部分是中高速的跑步配合急停與切入

There are 15 movements, 3 parts

Part one is running exercise at low speed with active stretch

Part two is a set of six exercises that focus on core, leg strength, balance, and agility.

Part three is running exercise at mod/high speed with plan and cut

未來幾篇文章

我們會深入探討三個部分的動作

配合動作力學上的分析

來看看這些動作的目的以及為什麼會有效

In the future post,

I'll dig deeper into those movements.

With movement analysis,

let's figure out what those movements aim to and why they are effective.

Enjoy you FIFA 2018!

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[進階肌動學] 多裂肌的深層分析 Deeper into Multifidus

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.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[基礎伸展] 上斜方肌 Upper trapezius stretch

By Mikael Häggström.When using this image in external works, it may be cited as:Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.orBy Mikael Häggström, used with permission. (Image:Gray409.png) [Public domain or Public domain], via Wikimedia Commons

上斜方肌是另一條肩頸相關的重要肌肉
與提肩胛肌關係密切

負責的動作有頸椎後仰, 同側側彎, 對側旋轉

而在肩膀的位置則負責肩胛骨的上提與上轉

Upper trapezius is another important muscle of neck-shoulder area
It has the close relationship with levator scapulae
The movement at the cervical are extension, same side side-bending, opposite side rotation
And the movement at the shoulder are elevation and upward rotation

上斜方肌過度緊繃的時候

常見的情況有
1. 頭部旋轉, 側彎活動受限
2. 肩關節活動障礙
3. 在枕骨下外側, 頸肩連線中點 或後3/1鎖骨處產生酸痛點
Some common conditions while upper trapezius is tight:
1. Neck side-bending and rotation limitation
2. Shoulder dysfunction

3. Tender points over the lateral suboccipital area, mid-point of the shoulder, or 1/3 of the clavicle

靜態伸展上斜方肌的動作是
1. 頭部向對側側彎加上同側旋轉
2. 對側手拉住頭部
3. 同側手向下固定
The static stretch includes the following movement:
1. Neck side bends to opposite side and turns to the same side.
2. Opposite hand holds the neck
3. Same side arm anchor at the bottom
Below is the standard static stretch of upper trapezius.

https://learnmuscles.com/glossary/upper-trapezius-stretching/

一樣由我示範如何執行動態伸展
頭部的姿勢維持不變
讓同一側的肩胛上抬, 再下壓
利用肩胛骨上下的動作進行上斜方肌的伸展
Let me show you how to perform dynamic stretch to this muscle
The head and opposite hand position remain.
The same side shoulder elevates up and down,
using scapula elevation/depression to stretch this muscle.

斜方肌也是辦公室一族非常容易不舒服的位置
藉由簡單的左右旋轉就可以分辨到底是斜方肌還是提肩胛肌的緊繃
Upper trapezius is also the common tight muscle among office population
By simply rotating your head to both sides, you can differentiate which muscle is truly tight.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[基礎伸展] 提肩胛肌 Levator scpulae stretch

By modified by Uwe Gille - Gray Image:Gray409.png, Public Domain, Link

提肩胛肌是一條連接頸椎與肩胛的重要肌肉

由頸椎第一至第四橫突, 向下連接到肩胛上角

負責的動作有頸椎後仰, 同側側彎, 同側旋轉

而在肩膀的位置則負責肩胛骨的上提與下轉
Levator scapulae are the muscles that connect cervical and scapula
From C1-C4 transverse process to superior angle of scapula
The movement at the cervical are extension, same side side-bending, same side rotation
And the movement at the shoulder are elevation and downward rotation

提肩胛肌過度緊繃的時候
常見的情況有
1. 頭部旋轉, 側彎活動受限
2. 肩關節活動障礙
3. 在頸部或是肩胛上緣產生酸痛點
Some common conditions while levator scapulae are:
1. Neck side-bending and rotation limitation
2. Shoulder dysfunction
3. Tender point over the lateral neck or superior angle of scapula

靜態伸展提肩胛肌的動作是
1. 頭部向對側旋轉約45度然後往下看
2. 對側手拉住頭部
3. 同側手舉高並貼住頸椎
而伸展這條肌肉的標準模範
由勝文替你示範
The static stretch includes the following movement:
1. Neck rotates to opposite side about 45 degrees and bends down.
2. Opposite hand holds the neck
3. Same side arm raises up and holds the neck
Below is the standard static stretch of levator scapulae.

動態伸展是另一個很不錯的方式
有些時候甚至比起靜態伸展更能維持舒緩的效果
頭部的姿勢維持不變
同一側的手往上舉高, 再移動回來
利用肩胛骨旋轉的動作進行提肩胛肌的伸展
Dynamic is another good way to stretch levator scapulae.
Sometimes it's more effective than the static stretch.
The head and opposite hand position remain.
The same side arm raise all the way up and back down,
using scapula rotation to stretch this muscle.

提肩胛肌是辦公室一族非常容易緊繃的一條肌肉
使用電腦之餘記得做運動
可以大幅降低肩頸僵硬與痠痛的機會
Levator scapula is getting tight easily among office population.
Remember to do some exercise while using the computer.
That can help you decrease the chance of neck stiffness and pain.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[進階肌動學] 胸椎的3D動作 Thoracic 3-dimensional movement

前幾周在直播時我們提及了簡單的胸椎旋轉

這篇文章將會更進一步的講解關於胸椎的動作

In the last live-stream, I talked about some tips of thoracic rotation

This article will explain more detail about thoracic movement.

  

By Anatomography (en:Anatomography (setting page of this image)) [CC BY-SA 2.1 jp (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)], via Wikimedia Commons

脊椎在活動上總共有六度的活動度

分別是三個平面上的旋轉與平移

our spine segment has 6 degrees of freedom

It can rotate or transit on three different planes.

Photo credit: Neupsykey.com

延伸自上次講的旋轉與側彎

我們需要提到大名鼎鼎的Fryette's Laws

Fryette's Laws是Harrison Fryette, D.O.(1876-1960)所提出椎體動作的原則

最原始的Fryette's Laws只有兩條

直到1948由CR Nelson, D.O.再加以補充

成為了今天被大家熟知的三大原理

When we talk about the spine rotation and side-bending,

we can't miss the famous Fryette's Laws

There were only 2 laws in the original version

In 1948, CR Nelson, D.O. added the third law.

Make those three laws become the well-known Fryette's Laws.

其原則如下:

The three laws are as follow:

1. 在椎體正中位置下, 椎體側彎時會伴隨椎體向對側旋轉

1. When the spine is in neutral, side bending to one side will accompany the opposite side rotation

Photo credit: Musculoskeletalkey.com

2. 在椎體非正中位置下, 椎體側彎會伴隨椎體向同側旋轉

2. When the spine is not in neutral, side bending to one side will accompany the same rotation.

Photo credit: Musculoskeletalkey.com

3. 椎體在某一個平面上的動作產生變化時, 會影響其餘兩個平面的活動

3. When motion is introduced in one plane it will modify motion in the other two planes.

如果你是正在就讀物理治療學系的學生

麻煩請念到這裡即可

因為上面描述的是簡化過後的脊椎動作, 也是考試的標準答案

If you are a PT/PTA student, please stop right here.

The content above simplifies spine movement, but also the standard answer for testing.

最近一篇針對胸椎活動的系統性回顧

在2007年PS Sizer等人發表

針對胸椎耦合動作的結論是沒有結論

過去數十年間的研究所得出來的結果無法取得一致性

The most recent review of the thoracic coupled movement is in 2007, published by PS Sizer et al.

The conclusion for joint coupling of the thoracic spine is no conclusion.

There is no consistency from those research over the past several decades.  

但這不代表Fryette's Laws就從此失去了代表性

它描述的也許是一個在理想情況下的動作

針對不同的情況我們的身體會做出相對應的反應

But it doesn't mean Fryette's Laws is wrong.

It might describe the movement under the ideal condition.

Our body should respond to what they encounter.

中立本身是一個動態的概念

如果無法找到所謂的中立位置

那沒辦法去判斷到底動作適用於哪一條原理

Neutral is a dynamic concept

If there's no true neutral position,

how can we decide which movement should follow which law?

這邊要額外提及另一位大師級人物Philip E. Greenman, O.D

在其著作Principles of Manual medicine裡

對於Fryette's Laws第二原理提出了我覺得非常適用於臨床的觀點

如果胸椎先做出了側彎的動作, 那會有對側旋轉的耦合動作

如果胸椎先做出了旋轉的動作, 那會有同側側彎的耦合動作

Here's another master I need to mention on this topic, Philip E. Greenman, O.D.

In his book Principles of Manual medicine,

he proposed an idea about spine movement which I thought is really helpful in practice.

If the side-bending is introduced first, then it will accompany the opposite rotation.

If the rotation is introduced first, then it will accompany the same side side-bending.  

藉由上面提到的這些原理與概念

我們可以進行更精準的臨床評估, 處理, 與動作選擇

By knowing all those concepts,

we can do the better evaluation, treatment, and movement integration.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。

[翻譯] Anatomy Angel: 上斜方肌 Upper Trapezius

原文連結: http://www.drdooleynoted.com/anatomy-angel-upper-trapezius/

斜方肌是一條超讚的肌肉
除了協助脊椎活動與穩定外, 也產生肩膀的活動

這條肌肉的名字來自於它的形狀(Trapezoid)
這條肌肉的起點從頭骨往下延伸到最後一節胸椎

往外連接到肩胛骨脊以及肩峰(Acromion), 以及部分的鎖骨(Clavicle)

斜方肌被認為是四肢的肌肉

主要產生脖子以及肩膀的動作, 而只有一點點的中背動作

藉由筋膜的連接, 斜方肌絕對是穩定脊椎在矢狀面上活動不可或缺的一環

這條肌肉是一條非常強壯的伸肌

斜方肌是唯一一條被歸類為四肢但卻被腦神經支配的肌肉

但是並不是被腦幹所支配

C1-C5的腹枝(Ventral Rami, 動作與感覺神經)實際上會離開脊椎並且向上進入頭骨內

然後再次離開頭骨與運動終板(Motor end plate)接觸

這就是斜方肌以及胸鎖乳突肌被腹枝支配的路徑

所以斜方肌是由上頸椎所支配

在這個區域低強度的關節壓迫會增加上段肌肉的活性

當我們開始嘗試維持抬頭的時候, 我們逐漸獲得頸椎的弧度

然而許多人到今日卻還是使用他們的脖子來控制各種動作 

維持抬頭是我們第一個重要的動作成就
我們被設計成在這個姿勢下尋求穩定度與動作

上斜方肌可以抬起以及上旋肩胛骨, 還可以做出脖子側彎與伸展的動作
像想一下你正在聳肩, 這就是上斜方肌的動作

上斜方肌與下斜方肌和下前鋸肌形成力偶
做出肩胛骨上旋的動作

 

但是當頸椎被壓迫或是上斜方肌過度使用時
會阻礙順暢的力偶動作

由於上斜方肌連接到鎖骨與肩峰上
也會造成肩鎖關節活動的障礙, 特別是過頭的活動

所以當肌肉過度使用時, 這條執行過頭動作肌肉的實際上也會造成動作本身的障礙

如果讓上斜方肌去主導了我們的動作
肩膀的生物力學會有顯著的變化
隨之而來的就是肩關節的不穩定 

所以許多的肩膀問題開始於脖子的問題

記得: 上斜方肌連接到脖子與頭骨

如果你只專注於肩膀本身而沒有考慮到脖子, 那可能會錯失了重要關鍵 

評估脖子 

然後評估上下斜方肌與前鋸肌的力偶

從這裡開始, 然後延伸到肩膀的主要活動肌群, 例如胸肌或闊背肌

並且也不要忘記穩定肌群, 例如旋轉肌袖

但是千萬不要跳過脖子與脊椎
事實上, 我建議你從這裡開始

如果你的客戶對你沒有處理肩膀感到困惑
讓他們了解解剖學上斜方肌的位置, 以及這條肌肉是如何被脖子所影響

As always, it’s your call. 

– Dr. Kathy Dooley

All Right Reserved to Dr. Kathy Dooley, Translated by I-Chen Liu

本著作由Dr. Kathy Dooley製作, I-Chen Liu翻譯