[運動討論] 足球選手的傷害預防(3) Football Injury Prevention(3)

FIFA 11+的第二部份

是六組針對核心, 腿部力量, 平衡與敏捷的訓練
每一組動作又分成三個難度
The second part of FIFA 11+ consists of 6 exercises including core, strength, balance, and agility.
Each exercise has three difficulty level.

我們先介紹前三組動作與困難度的變化
Let's go through the first three movements and their progression.

第一個動作 棒式
Movement 7 Bench

初級
利用前臂與雙腳將自己支撐起來
將肩胛往脊椎收, 腹部與臀部出力
讓身體維持一直線
執行三組, 每組20-30秒
Beginner - The Bench Static
Suppor with forearm and feet.
Pull scapula toward the spine and engage core and gluteus.
Keep trunk straight.
3 sets, 20-30 secs

中級與高級
起始動作與初級相同
中級的動作需要單腳抬起於空中維持兩秒, 雙腳交替
執行三組, 每組40-60秒
高級的動作則須將腳抬離地面10-15公分, 維持20-30秒
執行雙側各三組
Intermediate - Alternate and Advanced - Lift and Hold
The same starting position as the beginner.
Intermediate ask you to raise the leg and hold for 2 sec, then alternating.
3 sets, 40-60 secs
Advanced ask you to raise the leg at least 10-15 cm above ground, and hold 20-30 secs
3 sets on each side

這是一個標準的核心訓練方式
中級與高級動作加入動態下肢動作更能刺激核心的誘發
This is a typical core strengthening.
The intermediate and advanced add lower extremity movement to activate core more.

第二個動作 側棒式
Movement 8 Sideway Bench

初級
側躺, 用上肢與下方的腿支撐
下面的膝蓋彎曲90度
將骨盆與抬起直到身體與膝蓋呈一直線
兩側各執行三組, 每組20-30秒
Beginner - Static
Sidelying, supporting with the forearm and bottom leg
Bending bottom knee to 90 degrees
Raise the pelvis until form a straight line
3 sets on each side, 20-30 secs for each set

中級
與初級相似但下面的腳需伸直
抬高骨盆直到頭到腳成一直線
然後再緩緩放下
兩側各執行三組, 每組20-30秒
Intermediate - Raise and Lower Hip
Similar to the beginner but straight the bottom leg.
Raise pelvis till form a straight line,
and slowly put it down.
3 sets on each side, 20-30 secs for each set

高級
與中級動作相通
再額外加上將上面的腳緩緩抬高放下
兩側各執行三組, 每組20-30秒
Advanced - Leg Lift
Similar to the intermediate.
But lift the top leg up and down slowly while holding the straight line position
3 sets on each side, 20-30 secs for each set

側棒式也是一個標準的核心訓練模式
是用來訓練冠狀面上的穩定
此外還可以訓練到動力鏈中的側鍊
初級與中級的差別在於力臂的變化
而高級加入了動態干擾以及對側髖外展肌整合的能力

示範影片如下
Below is the video demonstrating movement 7 and 8

第三個動作 腿後肌訓練
膝蓋與髖同寬, 雙手抱胸
緩緩向前傾
過程需保持身體到膝蓋一直線
無法維持姿勢時
向前承重在手掌上, 呈現伏地挺身姿勢
初級執行一組, 3-5次
中級執行一組, 7-10次
高級執行一組, 最少12-15次
Movement 7 Hamstring
Kneeling with knees hip-width apart and crossing arms
Slowly lean forward, keep straight from knee to head.
Put the weight over hand in push-up position while you can't hold the lean forward position.
Beginner, 1 set, 3-5 reps
Intermediate, 1 set, 7-10 reps
Advanced, 1 set, at least 12-15 reps

這個動作又稱作北歐式腿後肌運動
是腿後肌離心收縮訓練的經典代表
研究指出對於腿後肌受傷預防以及傷後復健都有很好的成效
This is also known as Nordic Hamstring Exercise.
It's a classic eccentric training of hamstring.
Researches showed this exercise is effective for hamstring injury prevention and rehab.

示範影片如下
Below is the video demonstrating movement 9

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(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。