[進階肌動學] 如何伸展胸腰肌筋膜 How to stretch your thoracolumbar fascia

 

胸腰肌筋膜是人體後側一片極為重要的結構

在漫長的演進過程中, 胸腰肌筋膜協助了直立姿勢以及傳遞核心到上下肢的力量

在我們行走的動作中扮演了不可或缺的重要角色

Thoracolumbar fascia (TLF) is a crucial structure at the back of our trunk

With the human evolving,   

TLF helps us  keeping the upright and transmitting force from core to extremities.

It plays an important role in our daily life especially walking.

Neumann, page 362

在近代的多數研究中

將胸腰肌筋膜分為三個部分: 腹層, 中層, 以及背層

多數時候我們看到的菱形狀筋膜只代表了後層的筋膜

實際上整個胸腰肌筋膜在不同層有著不同方向的走向, 是一個多面向的支撐結構

請記得筋膜組織本身相較於韌帶肌腱是一個較不規律的結構 

但長期的姿勢與習慣可以造成漸進性的方向變化

In most research, TLF is described as a three-layer system: anterior, middle, and posterior.

The diamond-shape we are used to seeing is just showing the posterior layer of TLF.

In fact, the TLFhas many different directions within different layers.

It's a multiple-supporting structure.

Remember the fascia is a less regular structure compare to the ligament or tendon.

The long-term posture and habit can cause the gradual change on it. 

下面使用的伸展方式主要以背層為主, 從兩個面向切入:

1. 中央神經系統CNS:

    利用魯菲尼受器(Ruffini receptor)傳遞訊息到中央神經系統, 藉此改變筋膜與周遭組織張力

2. 自主神經系統ANS:

    利用呼吸以及間質受器(Interstitial receptor)傳遞訊息給自主神經系統

    調控筋膜內的血管壓力與平滑肌組織

The following stretches mainly focus on the posterior layer.

Two concepts will be integrated into stretching:

1. Central Nervous System, CNS:

    Ruffini receptor will send a message to the CNS to regulate the tension of fascia and surrounded tissue.

2. Autonomous Nervous System, ANS

    Breathing and interstitial receptor can affect ANS that regulates the vessel pressure and smooth muscle in the fascia.   

Schleip R 2003: Fascial plasticity – a new neurobiological explanation. Journal of Bodywork and Movement Therapies

綜合上述生理學看法, 靜態伸展絕對不是伸展筋膜的好方法

Base on those physiology concepts, the static stretch in not a good idea for fascia.

第一種伸展方式使用土耳其起立(Turkish get-up)的起始姿勢

The first stretch is the starting position of Turkish get-up

https://squatuniversity.com/tag/squat-university/

吐氣時收縮核心, 利用呼吸誘發ANS反映以及使用核心增加胸腰肌筋膜張力

手肘與腳底頂地, 利用臀大肌與闊背肌增加胸腰肌筋膜張力

然後吸氣產生360度的軀幹擴張並且放鬆, 

可以在腰部使用一個伸展球或網球產生深層慢速的壓力去刺激肌間質受器

Breath out to facilitate core.

Using breathing to affect ANS and core to increase the tension of TLL.

Elbow and feet against the ground, increasing tension by activating Glu Max and Latissmus Dorsi.

Then breath in to create 360-degree expansion and relax.

You can further put a stretch ball or tennis ball to create a deep and slow pressure to stimulate interstitial receptor.

另一種伸展方式利用鳥狗式(Bird-dog)

需要比較好的核心與身體控制能力

The other stretch is more dynamic via the Bird-dog exercise

This one needs better core and body control ability.

https://howtoloseweight.com.pk/easy-exercises-lose-stubborn-back-fats/

在手肘碰觸膝蓋過程中, 同時加入吐氣與脊椎屈曲的動作

回復姿勢時吸氣同時加入臀肌與背肌的啟動來增加筋膜張力

While your elbow touch you knee, breath out and bend your spine to create more stretch.

Back to the posture above and engage Glu muscles and back muscles to load TLL.

當然放鬆筋膜的方式不是只有這兩種方式

但要特別注意肌肉與筋膜的伸展需要考量到不同受器的影響

如果你能合法的執行徒手技術, 在加壓的同時給予主動動作會有很好的效果

下次我會更深入的談談已知關於筋膜我們所了解的東西

想要更進階的了解筋膜的生理反應與解剖意義請關注這系列的文章

Of course there's more way to stretch your TLF.

Just need to know there're many receptor actions need to be considered in different soft tissues.

If you can perform manual technique legally, you can achieve an amazing result by pressure with active movement.

Next time I'll discuss deeper about what we know about TFL so far.

If you're interested in advanced physiology and anatomy of TFL,

I'd like to share it once I gather all the materials I need.

任何的運動或是治療都一樣
有沒有正確的執行以及適不適合這個人執行才是最大的關鍵
Every exercise or treatment has the same concept
"The keys are accuracy and adequacy "

本著作由I-Chen Liu, PT, MS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: 外展姆肌 Abductor Hallucis

原文連結: http://www.drdooleynoted.com/anatomy-angel-abductor-hallucis/

外展姆肌(Abductor Hallucis)是大姆指向內遠離第二趾的主要動作肌

這個向心收縮的動作被稱為大拇趾外展
在足旋前(Pronation)時能夠有效延展前足的面積

在步態推進期這條肌肉的離心動作非常重要
藉由將屈姆長肌伸長來協助大姆趾承重並且產生強大的推進力

因此, 外展姆肌完成了步態懸吊期(suspension phase)的足旋前動作
同時協助推進期的啟動

如果一個人沒有完成過足內翻的動作, 就會產生不完全的推進
而在這種情形下, 某些人的腳會使用其他的方式來代償

內收姆肌會開始將大姆趾向外拉, 產生姆趾外翻的情況
同時這也會抑制外展姆肌的活動, 使之進入休眠狀態

當外展姆肌開始失去作用, 身體重量會開始向足外側移動
造成一個假的足旋後(Supination)
當腳趾屈肌以及旋後肌被過度使徵召時, 大姆趾會開始向腹側旋轉(Turn Ventrally)
產生一個會使外展姆肌更被抑制的姿勢

現在外展姆肌處於一個彎曲第一蹠骨(Metatarsal)的完美姿勢
使大姆趾更往地上旋轉
因此造成的過度壓力, 會產生姆囊腫(Bunion)

姆囊腫是一個足旋後的策略
但不代表你的旋後動作做得好

如果無法先做好足旋前, 你永遠無法做出好的足旋後

由於外展姆肌是完成足旋後的重要肌肉, 有姆囊腫的腳是無法旋後也無法旋前的

你的腳會卡在一個之間的狀態

但這是可以改變的

就算你已經接受了姆趾外翻手術
你也絕對需要去改變這個狀態
請記住一件事實: 你的身體是動態的而手術是靜態的

在姆囊腫切除術中, 內收姆肌通常會被切開以避免更多的偏移產生
但這不表示你的大腳趾能馬上了解如何再次外展

大姆趾需要學習如何從屈曲狀態減壓並且回到外展的狀態

你可以學到如何重新訓練大姆趾外展動作同時減壓
你也可以學到如何在半跪姿下指導正確的旋後

如果旋後是完美旋前的重要關鍵
那你兩者都需要學習

這裡隨時有人可以幫助

接受正確的評估, 接受適當的矯正

NKT以及AIM的臨床職業者是非常好的選擇

大姆趾外展能力的越好
就會對膝蓋, 髖, 足, 以及脊椎有更好的提示
讓地上來的力量產生適當的分佈

As always, it’s your call.

– Dr. Kathy Dooley

下面是一些額外的影片連結:

半跪姿足旋後(Half-Kneeling Pronation)

大姆趾減壓(Big-Toe Decompression)

三平面穩定訓練(Triplanar Stability Drill)

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

[進階肌動學] 如何伸展豎脊肌 How to stretch your erector spinae

豎脊肌(Erector Spinae)是背部三組肌肉的總稱
由外至內分別是髂肋肌(Iliocostalis), 最長肌(Longissmus), 以及棘肌(Spinalis)
每一組肌肉又都可以各自區分出三個區塊
Erector spinae is the name for 3 back muscle groups
From lateral to medial, they're iliocostalis, longissmus, and spinalis
Each of them can also be divided into 3 sub muscles

 

髂肋肌在最外側, 可分為腰髂肋肌, 胸髂肋肌, 與頸髂肋肌
腰髂肋肌下端連接在髂骨, 薦骨, 下胸與腰椎脊突, 以及髂腰筋膜上
上端連接在第六到第十二肋骨下緣
胸髂肋肌的下端連接在第六到第十二肋骨上緣, 在腰髂肋肌連接處的內側
上端連接在第一到第六肋骨下緣, 有些人會到第七頸椎的橫突
頸髂肋肌的下端則是連接在第一到第六肋骨, 下端在第四到第六頸椎橫突上
產生的動作都是後彎, 同側側彎, 以及同側旋轉
Iliocostalis locates at the most lateral side, including iliocostalis lumborum, thoracis, and cervicis
The lower part of lumborum connects to the iliac, sacrum, lower thoracic and lumbar SP, and iliolumbar fascia.
The upper part of lumborum connects to the lower border of rib 6 to 12
The lower part of thoracis connects to the upper border of rib 6-12, medial to the lumborum
The upper part of thoracis connects to the lower border of rib 1-6, some may have it to C7 TP.
The upper part of cervics connects to the rib angle 1-6, upper part to C4-6 TP
They have the same actions: extension, ipislateral sidebend, ipislateral rotation

最長肌在中間, 可分為胸最長肌, 頸最長肌, 與頭最長肌
胸最長肌下端與腰髂肋肌共享連接處
上端連接在胸椎橫突, 上腰椎橫突, 以及所有肋骨的結節到肋骨角之間
頸最長肌下端連接在第二到第五或六胸椎橫突上, 上端連接在第二到六頸椎橫突
頭最長肌下端連接在中到下頸椎的橫突與關節面上, 上端連接到乳突
同樣產生後彎, 同側側彎, 與同側旋轉
Longissmus locates at the middle of erectors, including logissmus thoraci, cervicis, and capitis
The lower part of thoracis share the same connection with iliocostalis lumborum.
The upper part of thoracis connects to the thoracic TP, upper lumbar TP, and all rib between rib tubercle and rib angle
The lower part of cervicis connects to T2-5 or 6 TP, upper part to C2-6 TP
The lower part of capitis connects to middle to lower cervical TP and articulate process.
The upper part of capitis connects to the mastoid process that can affect head movement.
They have the actions of extension, ipislateral sidebend, and ipislaterl rotation

棘肌在最內側, 分為胸棘肌, 頸棘肌, 與頭棘肌
胸棘肌的下端同樣與其他豎脊肌共用, 上端連接在胸椎第三到第八節的棘突上
頸棘肌的下端連接在第六頸椎到第十二胸椎棘突上
上端接在第二頸椎棘突, 有時會延伸到第三會第四頸椎
頭棘肌的下端連接在下頸椎與上胸椎棘突上, 上端連接在上下頸線處
動作是後彎, 同側側彎, 而只有頭棘肌會做出同側旋轉
Spinalis locates the most medial side of erectors, including spinalis thoracis, cervicis, and capitis
The lower part of thoracis also share the connections with other lumbar erectors
The upper part of thoracis connects to T3-8 SP
The lower part of thoracis connects to T6-12 SP and the upper part to C2 SP, some may goes to C3-4
The lower part of capitis connects to the lower cervical and upper thoracic SP.
The upper part of capitis connects to the superior and inferior nuchal line.
They have the actions of extension and ipislateral flexion. Only the capitis can do ipislateral rotation

伸展的基本原則就是往反方向做動作
但如果缺少了脊椎間的相對動作
反而會無法伸展到我們想要的區域
The basic principle of stretch is doing the opposite directions of the muscle actions.
However in erector stretching, we can't get it without intersegmental movement.
Instead, it might get worse like the picture shown below.

http://www.bandhayoga.com/keys_PNF.html

如果有足夠能力能主動控制動作
貓拱背(Cat-Camel)的動作會是一個很好的伸展
注意脊椎間的動作要完整呈現出一個漂亮的弧線
下面紅褲子哥就有腰椎活動不足以及過度拱背的問題
If your client has enough ability to control their movement.
Cat-Camel exercise is a good one to stretch erector spinae bilaterally.
Remember you should see a nice spine cure while stretch it.
The second picture shows over stretch at thoracic with low mobility of lumbar.

 

被動的伸展則可以用膝蓋抱胸或是跪趴的姿勢處理

The passive stretch can be performed by knee to chest or worship postion

 

 

如果是要強調單側的話

需要加入側彎或是旋轉的元素

同樣的有足夠能力主動控制時

可以嘗試下圖的伸展姿勢, 這是右側豎脊肌伸展

If you want to focus on one side only

you could add rotation or sidebending in the stretch.

When your client is capable to do the following movement

it's nice to try stretching in this position.

The picture shows the R erector spinae stretch

http://www.g4physio.co.uk/blog/common-stretches-advice/kneeling-back-rotation-stretch/

或者是被動的伸展姿勢

Or you can do it passively.

 

這些都是很好的伸展方式

取決於個案的能力與需求

Those are few good stretches.

You can create you own by following the basic principle.

It depends on your client's need and ability.

如果你想要伸展上段的豎脊肌 就要加入更多頭頸部動作

如果你想要伸展中段的豎脊肌 就要加入更多胸腔的動作

如果你想要伸展下段的豎脊肌 就要加入更多腰椎骨盆的動作

If you want to stretch upper part erector, add more head-neck movement.

If you want to stretch middle part erector, add more thoracic motion.

If you want to stretch lower part erector, add more lumbar-pelvic movement.

藉由上面的解剖學說明

也可以藉由固定部分脊椎或肋骨

或者是加壓伸展的方式

去更專注在目標肌群的伸展

With the understanding of the anatomy,

you can also fix part of the spine or rib or compress specific area 

to focus more on your target muscles.

 
任何的運動或是治療都一樣
有沒有正確的執行以及適不適合這個人執行才是最大的關鍵
Every exercise or treatment has the same concept
"The keys are accuracy and adequacy "

本著作由I-Chen Liu, PT, MS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: 多節伸展 Muti-Segmental Extension

原文連結:
http://www.drdooleynoted.com/anatomy-angel-thoughts-on-multi-segmental-extension-mse/

在最近的NKT讀書會中
我們依循Gray Cook的脈絡討論了多節伸展測試(MSE test)

此外我們將不同區段分開來討論
觀察在伸展測試時不同位置的理想壓力分佈
以及指出一般動作模式中常見的代償

理想壓力分佈的動作模式下, MSE需要達到下列幾項要求:

1. 足踝產生背屈動作(Dorsiflexion)同時重心前移以及腳跟貼地
2. 平衡的兩側屈膝以及脛骨前移 

3. 髖伸展10-30度,取決於受測者的解剖構造與能力
    同時髂前上棘(ASIS)前移超過腳趾
4. 脊椎每一節間適當的壓力分佈, 沒有任何單節/多節過度伸展
5. 雙手過頭與耳朵切齊
6. 沒有肋骨浮起(Rib Flaring)

而MSE常見的錯誤模式包含有:

1. 腳踝無法背屈, 或者/並且有兩側膝屈曲不對稱
2. 沒有髖伸展動作, 造成髖關節鎖死在足跟或中足位置
3. 過度的腰椎伸展以及折點產生, 伴隨胸椎的伸展性降低
4. 過度的脖子伸展, 特別是手臂無法切齊耳朵又沒有肘屈曲代償的受測者
5. 肋骨浮起, 通常伴隨有T12伸展鎖死的現像, 限制了上胸椎與髖伸展活動度
 
在下面的個案觀察中, 我們找到了一些常見的模式以及其造成的後續結果:

1. T6-11無法伸展, 伴隨T12的折點, 右側大腳趾屈曲抓地, 以及缺少髖伸展

可能的代償者: 右屈姆長肌(Flexor hallucis longus), 豎脊肌, 髂肌
可能的受抑制組織: 臀大肌

2. 手臂無法達到耳朵位置(缺少T1-4伸展), 肩胛骨超過腳跟但多於髖關節超過腳趾

可能的代償者: 胸腰豎脊肌(Thoracolumbar Erector Spinae), 髂肌, 髖屈肌


可能的受抑制組織: 多裂肌, 頸長肌(Lonhus Colli)

3. 過度的頸伸展, 減少上胸椎的伸展
3. Excessive cervical extension, decreased upper thoracic extension

可能的代償者: 頸伸肌(半棘肌Semispinalis, 上斜方肌, 頭夾肌Splenius Capitis)
可能的受抑制組織:腹橫肌的離心收縮, 胸椎豎脊肌, 頭長肌


4. 腳趾抓地並且缺少髖伸展

可能的代償者: 屈趾長肌
可能的受抑制組織: 臀大肌, 多裂肌, 腰肌的離心收縮

試著去降低那些代償者強烈的動機來促進MSE整體的壓力分佈並且避免受傷

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

[進階肌動學] 呼吸大不同 The different breathing strategies during lifting exercise

上兩周我回到了台灣
第一周忙著協助精繪解剖的團隊在亞洲的首次教學
第二周則是我個人首次的講座課程"呼吸的評估與動作整合"
Couple weeks ago, I came back to Taiwan for 12 days.
I was honor to assist the very first Immaculate Dissection Course in Asia in the first week.
At the second week, I gave my first seminar in Taiwan.
It's the one-day course about breathing assessment and movement integration.

在四天的課程當中
有許多學員提出了非常棒的觀點以及疑問
其中飛熊大特別提出了關於舉重與健力呼吸訓練方式的差異
下面會用課程內提到的內容以及近期的科學研究來討論
During the 4 seminars in 3 different cities, there were many great questions from attendees.
Especially in Tainan, I had a great discussion with FlyingBear.
He's devoted in promoting weight lifting exercise in Taiwan.
We talked about why there's different breathing strategies between weight lifting and powerlifting.
That's a fascinating question I'd like to share and discuss with some material I covered during seminar

如果你搜尋運動時如何呼吸
或者是請教健身房的巨巨
你一定會得到各式各樣的答案
"向心吸氣, 離心吐氣" "吸氣, 閉氣, 用力, 吐氣" "用力吐氣, 放鬆吸氣"
這些都是常見的模式
正確的答案是 不.一.定
If you google "How to breath during training/exercising"
Or asking bros in the gym
You surely can get all kind of answers such as
"Concentric with inhale, Eccentric with exhale"
"Inhale, hold, exhale"
"Exhale while exerting, inhale while relaxing"
That's all common patterns you'll see in the gym.
My answers is "It depends".

就像標準動作需要依照每個人的個體差異來修正
呼吸方式也需要依照你的訓練目的而調整
Just like the standard movement should be modified to fit individual differences.
Breathing pattern should be adjusted with your purpose.

用健力與舉重做一個簡單的比較
舉重的項目有挺舉與抓舉兩項
而健力則是硬舉, 深蹲, 以及臥推三種
Let's back to the question about weight lifting and power lifting.
The weight lifting includes: Snatch, Clean and Jerk.
The powerlifting includes: Deadlift, Squat, and Bench Press.
這兩者間除了動作的差異以外
最大的差異性在於速度
或者我們可以說瞬間爆發力
Other than the movement itself,
The biggest difference between those two competition is SPEED
Or we can mention to POWER

 
Dr. M. Hagins做了一系列腹內壓與呼吸之間關聯性的研究
在研究中, 吸氣並且閉氣時可以產生最大腹內壓
並且在舉重物的過程中, 腹內壓也與承重有相關性
Dr. M. Hagins had a series of researches about breathing and IAP.
In her study, the maximum IAP can be achieved with inhalation and hold.
And the lifting load has a positive relationship with IAP

講座中我們也提到
吸氣後可以達到最穩定的狀態
在核心穩定的情況下
四肢才能夠發揮最大力量
在健力競賽需要挑戰單次的最大極限的情況下
吸氣後閉氣產生脊椎剛性與最大腹內壓
同時利用努責效應
可以讓我們舉起最大重量
In my seminar, we talked about the same concept of IAP
Once you inhale and hold, you can get maximum core stability.
Under that stable condition, the extremities can exert maximum strength.
In the powerlifting competition, you need to challenge body maximum loading in one time.
That's the time you need to inhale and hold to increase spine rigidity and IAP.
Also, this technique can cooperate with Valsalva maneuvre.
Then you can lift, squat, or press the maximum weight in a steady condition.

另外一種會產生最大腹內壓的方式
就是強烈的腹部肌肉收縮
最容易理解的代表動作就是咳嗽
The other way to create maximum IAP is strongly contraction the abdominal muscles.
The typical way to explain it is coughing. That's sometime why your disc herniated after coughing.

在需要肢體協調以及快速的運動中許多人會自然使用這個技巧
經典的代表例子就是網球擊球時的吼聲或者是武術中攻擊時的出聲
除了有心理加強的作用外
這種方式可以產生腹內壓的同時將核心的力量送到四肢
產生瞬間的最大出力的同時又不會失去動作的協調
因此舉重的訓練反而會強調吐氣的重要性

Many people will use this technique in the sport that need body coordination and speed.
Such as the yelling while smashing tennis or fizzing while punching.
This sound can not only provide the mental enhancement,
but also create a strong force that can flow to your extremities.
It produce the maximum force in the short period without impede the movement coordination.
That's the pattern what the weight lifting is aiming for.

呼吸的模式取決於你的使用目的
只要能夠知道自己該使用的方式為何
就是正確的答案
Which strategy you should use is depend on your purpose.
As long as you know why you breath in this particular pattern,
then it's your correct answer.

正確的執行與適合的選擇才是關鍵
"The keys are accuracy and adequacy"

本著作由I-Chen Liu, PT, MS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。