【踮起腳尖痛,腳踝也會有夾擠問題?】
(這次文章內容稍長,若懶得看文字內容可直接觀看影片)
大家應該對於肩夾擠、髖夾擠這兩個名詞不陌生,但你有聽過腳踝夾擠嗎?夾擠指的是我們的骨頭過度擠壓到周遭的軟組織,可能是肌腱、韌帶或是滑液膜等等,造成疼痛或角度受限。夾擠是一個症候群,並非一個特定的病症,夾擠症候群底這個名詞底下,可能夾到的組織不同,造成的原因歧異度也非常大,造成評估上其實並不是那麼容易。腳踝夾擠雖然沒有像肩夾擠一樣有被正式分類成不同的夾擠類型,但仍能根據症狀呈現的方式跟解剖構造簡單分為前夾擠跟後夾擠,若還要再細分還會分前內側、前外側夾擠,以及後內側、後外側夾擠。
前側夾擠的症狀主要出現在腳踝背屈末端角度的時候,脛距關節 (Tibiotalar joint) 前側的組織受到擠壓。腳踝前側的有不少脂肪、滑囊組織,正常情況,這些組織會在腳踝背屈15度過後受到擠壓,但如果在遠端脛骨前側或是距骨頸有增生的骨頭的話,便可能限縮前側的空間,讓組織提早受到壓迫。如果長期在這角度下活動,就可能進一步造成慢性的發炎,或是造成關節囊韌帶的增生。除此之外,如果腳踝曾經扭過傷,造成韌帶或皺襞增厚的話,也是可能造成前側夾擠的原因之一。
雖然這些解剖構造上的變化已有多篇文章有所描述。但造成這些組織增生的原因卻仍不是很清楚。因為運動員有比較高的比例有這樣的問題,有些學者認為前側夾擠可能是因為頻繁地做出大角度的背屈,或是因為運動過程中受到的外力,讓前側軟骨邊緣反覆受到衝擊所造成。也有些學者認為,踝關節的不穩定,造成關節有不正常的微小滑動,也是一個可能造成骨質增生、或是軟組織受到夾擠的的原因。另外在比較早期的文章,一開始學者認為前側的骨質增生可能是來自於頻繁地蹠屈,牽拉到關節囊,進而造成關節處的增生,只是這樣的假設被後來的研究給推翻了。
因為前側夾擠症狀大多是在腳踝背屈的末端角度下出現,上樓梯、跑步、走上坡、爬梯還有深蹲是幾個比較容易會加劇前側疼痛的活動。若未接受妥善治療,在症狀後期可能會因為組織的增生或疼痛,造成更進一步的活動度受限、夾擠和周圍組織的傷害,再回頭限制關節活動度與功能,形成惡性循環。
後側夾擠的症狀主要出現在腳踝蹠屈到末端角度的時候,脛距關節與距跟關節後側的組織受到擠壓。後側夾擠常出現在需要頻繁把腳踝往下壓的人身上,像是芭蕾舞者、需要頻繁跳躍的運動員等等。與前側夾擠雷同,後側夾擠可能是骨質或是軟組織的夾擠,或是兩者同時存在。距骨後外側 (trigonal process) 的骨質增生是比較常被認為導致後側夾擠的原因。除此之外,頻繁的將腳板大幅度的往下踩,可能會導致後側關節囊、後下脛腓韌帶、三角韌帶的後側韌帶發炎,產生疤痕組織,進而造成組織增厚。另外我們的屈足拇長肌的肌腱經過距骨後側的內、外骨突中間的凹槽,也很容易因為過度使用,或是周遭骨質的增生,造成肌腱病變,像是肌腱或腱鞘炎的問題。
與前側夾擠的疼痛大多較為淺層、可觸摸的到相反,後側夾擠的症狀通常較為模糊,比較難有一個特定的單點疼痛,而且位置較深,通常落在阿基里斯腱底下。這也讓後側夾擠不容易和阿基里斯腱或是腓骨長肌的問題做區分。因為症狀出現在腳踝往下踩的時候,走下坡、下樓梯或是穿鞋跟較高的鞋子是幾個容易誘發症狀出現的活動。芭蕾舞者之所以比較容易出現這樣的症狀,被認為是因為需要頻繁的做出踮腳站,承重在前足的關係。
雖然影像檢查出來的骨質、軟組織的病變被認為是可能導致腳踝夾擠的原因之一,但實際上研究還是有提到,我們仍然不能光靠這些影像結果證據就判斷踝關節是否夾擠。影像檢查與我們的症狀表現之間的相關程度有限,仍需要結合其他理學檢查做綜合判斷才行。針對踝關節夾擠的介入,目前比較常見的作法仍是先採取保守治療,若在急性疼痛期,需要先避免會造成疼痛的動作,有必要的話也會使用消炎藥來控制疼痛。在非急性期,甚至是已經是慢性問題的個案,我們則需要著重在踝關節穩定、本體感覺的訓練上,畢竟前面有提到,踝關節不穩、扭傷都是可能造成夾擠的原因之一。與其他肌肉骨骼問題一樣,即使解剖構造上的異常也會被認為是造成踝關節夾擠的原因,但大多數的個案都能在不開刀的情況下有很好的進步。若有類似的狀況,一樣記得先找醫療人員的協助,避免症狀隨著時間越變越嚴重。底下的影片 (6:52) 將跟大家分享幾個簡單的踝關節穩定與本體感覺的訓練。
Impingement syndrome is a common musculoskeletal problem in shoulder and hip joints. But have you ever heard of ankle impingement? Impingement syndrome refers to abnormal contact of bony structures or soft tissue, e.g., tendon, ligament, synovial tissue, resulting in pain and restriction. Through different causes of impingement syndrome, it includes different medical signs or symptoms. Therefore, causes of impingement syndrome differ from person to person, making it more difficult to make a right diagnosis. Although ankle impingement is not officially classified into different types like shoulder impingement, researchers still sort it into anterior and posterior impingement according to anatomical structures are involved. More specifically, it can be classified into anteriomedial, anteriolateral, posteriomedial and posteriolateral impingement.
Symptoms of anterior ankle impingement are generally induced by compression of anterior margin of tibiotalar joint in terminal dorsiflexion. There are adipose and synovial tissues in the anterior joint space. Normally, these tissues are compressed after 15 degree of dorsiflexion in healthy individuals. However, if there is osteophyte at anterior distal tibia or talus neck, it will take up the space and limit ankle movement, causing early compression. This will result in chronic inflammation, synovitis, and capsuloligamentous hypertrophy. Apart from this, ankle sprain, thickened anterior tibiofibular ligament and synovial plica are also possible causative factors.
Even though structural pathologies are well described in much research, their exact etiologies are still less understood. Research showed that athletes are tend to affected by anterior impingement, and it led to hypothesis that pathologies are caused by repetitive impact injury to anterior chondral margin from hyper-dorsiflexion or direct impact during sports. Chronic ankle instability has also been hypothesized to be the causative factor of anterior impingement, because abnormal repetitive micromotion may develop bony and soft tissue lesions. In addition, early research hypothesized anterior osteophyte is caused by traction to the anterior capsule during repetitive plantar flexion, but this theory was disproved by later anatomic studies.
Anterior impingement symptom typically presents as anterior ankle pain during terminal dorsiflexion. Climbing stairs, running, walking up hills, ascending ladders and deep squat are common aggravating activities. If anterior impingement doesn’t get treated well, in the later stage, joint mobility may be further restricted due to mechanical block or pain, resulting in vicious circle.
Posterior ankle impingement symptom typically occurs in terminal plantarflexion, due to compression of tissues posterior to the tibiotalar and talocalcaneal joint. Posterior impingement tend to occur in athletes who need to plantarflex frequently, like ballet dancers, etc. Similarly, posterior impingement can result from compression of bony or soft tissue in isolation or in combination. Trigonal process of posterior talus is the most common cause of posterior impingement. Besides this, repetitive hyper-plantarflexion may cause posterior capsule, inferior tibiofibular ligament, and posterior fiber of deltoid ligament inflammation, scarring, and thickening. Lastly, tendinitis and tenosynovitis are easily found in flexor hallucis longus tendon, running between the medial and lateral posterior process of the talus. This probably results from overuse or irritation from surrounding abnormal bony tissue. The tissues mentioned above are all possible causative factors to the posterior ankle impingement.
In contrast to patients with anterior impingement pain that are accessible to palpation, posterior impingement pain is less specific, deep to the Achilles tendon. This makes it difficult to differentiate from Achilles tendon or peroneal tendon pathology. Since posterior impingement symptom is usually irritated by repetitive plantarflexion, walking downstairs, downhill running, and wearing high-heeled shoes are some common exacerbated activities to posterior impingement syndrome. Ballet dancers are commonly affected by posterior impingement syndrome due to weight bearing on forefoot in plantarflexion position over and over again.
Though osseous or soft tissues abnormality in radiography is seen to be one of the causes of ankle impingement, it doesn’t mean that we can simply blame patient’s symptom on these structural pathology. In fact, there is a limited correlation between medical image findings and our symptom. We should integrate patient’s history, physical examination, imaging studies, etc., for accurate diagnosis. Conservative treatment remains first option to manage ankle impingement. In acute stage, patient should avoid from doing provocative activities. If it is necessary, NSAIDs can be used for pain management. In chronic stage, clinicians should focus on ankle stability and proprioception training because ankle instability and sprain are both causative factors of ankle impingement. Just like other musculoskeletal disease, even though structural abnormality is thought to be a possible cause of ankle impingement, most ankle impingement cases still respond well to conservative treatment. If you have any similar medical problem, please find medical professions for help. The video below will show you some simple ways to train our ankle stability and proprioception.
參考資料:
https://pubmed.ncbi.nlm.nih.gov/27608626/
https://link.springer.com/article/10.1007/s00247-019-04459-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065672/
#腳踝夾擠 #踝關節不穩 #腳踝扭傷 #本體感覺訓練 #物理治療 #ankleimingement #ankleinstability #anklesprain #proprioception #physiotherapy #hunterptworkout
同時也有1部Youtube影片,追蹤數超過315萬的網紅Jordan Yeoh Fitness,也在其Youtube影片中提到,▷Connect with Me Instagram: https://www.instagram.com/jordanyeohfitness Facebook: http://facebook.com/jordanyeohfitness Personal Training Web App: htt...
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shoulder joint movement 在 James Phua Facebook 的最讚貼文
CHEST & ABS WORKOUT🔥
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A total of 450 reps that helps you to burn large amount of calories just by doing this exercises at home.
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There’s no jumping, no skipping, no hopping which is joint friendly for your knee.
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All you need to do is to control a little bit of the movement and do it at your own pace of your workout (please never rush).
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Swipe till the end and you’ll see a workout summary. You can screenshot and follow the routine.
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Overall the muscle worked are chest, shoulder, triceps and abs. Eventually you will feel the burn after few round.
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【《金融時報》深度長訪】
今年做過數百外媒訪問,若要說最能反映我思緒和想法的訪問,必然是《金融時報》的這一個,沒有之一。
在排山倒海的訪問裡,這位記者能在短短個半小時裡,刻畫得如此傳神,值得睇。
Joshua Wong plonks himself down on a plastic stool across from me. He is there for barely 10 seconds before he leaps up to greet two former high school classmates in the lunchtime tea house melee. He says hi and bye and then bounds back. Once again I am facing the young man in a black Chinese collared shirt and tan shorts who is proving such a headache for the authorities in Beijing.
So far, it’s been a fairly standard week for Wong. On a break from a globe-trotting, pro-democracy lobbying tour, he was grabbed off the streets of Hong Kong and bundled into a minivan. After being arrested, he appeared on the front pages of the world’s newspapers and was labelled a “traitor” by China’s foreign ministry.
He is very apologetic about being late for lunch.
Little about Wong, the face of Hong Kong’s democracy movement, can be described as ordinary: neither his Nobel Peace Prize nomination, nor his three stints in prison. Five years ago, his face was plastered on the cover of Time magazine; in 2017, he was the subject of a hit Netflix documentary, Joshua: Teenager vs Superpower. And he’s only 23.
We’re sitting inside a Cantonese teahouse in the narrow back streets near Hong Kong’s parliament, where he works for a pro-democracy lawmaker. It’s one of the most socially diverse parts of the city and has been at the heart of five months of unrest, which has turned into a battle for Hong Kong’s future. A few weekends earlier I covered clashes nearby as protesters threw Molotov cocktails at police, who fired back tear gas. Drunk expats looked on, as tourists rushed by dragging suitcases.
The lunch crowd pours into the fast-food joint, milling around as staff set up collapsible tables on the pavement. Construction workers sit side-by-side with men sweating in suits, chopsticks in one hand, phones in the other. I scan the menu: instant noodles with fried egg and luncheon meat, deep fried pork chops, beef brisket with radish. Wong barely glances at it before selecting the hometown fried rice and milk tea, a Hong Kong speciality with British colonial roots, made with black tea and evaporated or condensed milk.
“I always order this,” he beams, “I love this place, it’s the only Cantonese teahouse in the area that does cheap, high-quality milk tea.” I take my cue and settle for the veggie and egg fried rice and a lemon iced tea as the man sitting on the next table reaches over to shake Wong’s hand. Another pats him on the shoulder as he brushes by to pay the bill.
Wong has been a recognisable face in this city since he was 14, when he fought against a proposal from the Hong Kong government to introduce a national education curriculum that would teach that Chinese Communist party rule was “superior” to western-style democracy. The government eventually backed down after more than 100,000 people took to the streets. Two years later, Wong rose to global prominence when he became the poster boy for the Umbrella Movement, in which tens of thousands of students occupied central Hong Kong for 79 days to demand genuine universal suffrage.
That movement ended in failure. Many of its leaders were sent to jail, among them Wong. But the seeds of activism were planted in the generation of Hong Kongers who are now back on the streets, fighting for democracy against the world’s most powerful authoritarian state. The latest turmoil was sparked by a controversial extradition bill but has evolved into demands for true suffrage and a showdown with Beijing over the future of Hong Kong. The unrest in the former British colony, which was handed over to China in 1997, represents the biggest uprising on Chinese soil since the 1989 pro-democracy movement in Beijing. Its climax, of course, was the Tiananmen Square massacre, when hundreds, perhaps thousands, of people were killed.
“We learnt a lot of lessons from the Umbrella Movement: how to deal with conflict between the more moderate and progressive camps, how to be more organic, how to be less hesitant,” says Wong. “Five years ago the pro-democracy camp was far more cautious about seeking international support because they were afraid of pissing off Beijing.”
Wong doesn’t appear to be afraid of irking China. Over the past few months, he has lobbied on behalf of the Hong Kong protesters to governments around the world. In the US, he testified before Congress and urged lawmakers to pass an act in support of the Hong Kong protesters — subsequently approved by the House of Representatives with strong bipartisan support. In Germany, he made headlines when he suggested two baby pandas in the Berlin Zoo be named “Democracy” and “Freedom.” He has been previously barred from entering Malaysia and Thailand due to pressure from Beijing, and a Singaporean social worker was recently convicted and fined for organising an event at which Wong spoke via Skype.
The food arrives almost immediately. I struggle to tell our orders apart. Two mouthfuls into my egg and cabbage fried rice, I regret not ordering the instant noodles with luncheon meat.
In August, a Hong Kong newspaper controlled by the Chinese Communist party published a photo of Julie Eadeh, an American diplomat, meeting pro-democracy student leaders including Wong. The headline accused “foreign forces” of igniting a revolution in Hong Kong. “Beijing says I was trained by the CIA and the US marines and I am a CIA agent. [I find it] quite boring because they have made up these kinds of rumours for seven years [now],” he says, ignoring his incessantly pinging phone.
Another thing that bores him? The media. Although Wong’s messaging is always on point, his appraisal of journalists in response to my questions is piercing and cheeky. “In 15-minute interviews I know journalists just need soundbites that I’ve repeated lots of times before. So I’ll say things like ‘I have no hope [as regards] the regime but I have hope towards the people.’ Then the journalists will say ‘oh that’s so impressive!’ And I’ll say ‘yes, I’m a poet.’ ”
And what about this choice of restaurant? “Well, I knew I couldn’t pick a five-star hotel, even though the Financial Times is paying and I know you can afford it,” he says grinning. “It’s better to do this kind of interview in a Hong Kong-style restaurant. This is the place that I conducted my first interview after I left prison.” Wong has spent around 120 days in prison in total, including on charges of unlawful assembly.
“My fellow prisoners would tell me about how they joined the Umbrella Movement and how they agreed with our beliefs. I think prisoners are more aware of the importance of human rights,” he says, adding that even the prison wardens would share with him how they had joined protests.
“Even the triad members in prison support democracy. They complain how the tax on cigarettes is extremely high and the tax on red wine is extremely low; it just shows how the upper-class elite lives here,” he says, as a waiter strains to hear our conversation. Wong was most recently released from jail in June, the day after the largest protests in the history of Hong Kong, when an estimated 2m people — more than a quarter of the territory’s 7.5m population — took to the streets.
Raised in a deeply religious family, he used to travel to mainland China every two years with his family and church literally to spread the gospel. As with many Hong Kong Chinese who trace their roots to the mainland, he doesn’t know where his ancestral village is. His lasting memory of his trips across the border is of dirty toilets, he tells me, mid-bite. He turned to activism when he realised praying didn’t help much.
“The gift from God is to have independence of mind and critical thinking; to have our own will and to make our own personal judgments. I don’t link my religious beliefs with my political judgments. Even Carrie Lam is Catholic,” he trails off, in a reference to Hong Kong’s leader. Lam has the lowest approval rating of any chief executive in the history of the city, thanks to her botched handling of the crisis.
I ask whether Wong’s father, who is also involved in social activism, has been a big influence. Wrong question.
“The western media loves to frame Joshua Wong joining the fight because of reading the books of Nelson Mandela or Martin Luther King or because of how my parents raised me. In reality, I joined street activism not because of anyone book I read. Why do journalists always assume anyone who strives for a better society has a role model?” He glances down at his pinging phone and draws a breath, before continuing. “Can you really describe my dad as an activist? I support LGBTQ rights,” he says, with a fist pump. His father, Roger Wong, is a well-known anti-gay rights campaigner in Hong Kong.
I notice he has put down his spoon, with half a plate of fried rice untouched. I decide it would be a good idea to redirect our conversation by bonding over phone addictions. Wong, renowned for his laser focus and determination, replies to my emails and messages at all hours and has been described by his friends as “a robot.”
He scrolls through his Gmail, his inbox filled with unread emails, showing me how he categorises interview requests with country tags. His life is almost solely dedicated to activism. “My friends and I used to go to watch movies and play laser tag but now of course we don’t have time to play any more: we face real bullets every weekend.”
The protests — which have seen more than 3,300 people arrested — have been largely leaderless. “Do you ever question your relevance to the movement?” I venture, mid-spoonful of congealed fried rice.
“Never,” he replies with his mouth full. “We have a lot of facilitators in this movement and I’m one of them . . . it’s just like Wikipedia. You don’t know who the contributors are behind a Wikipedia page but you know there’s a lot of collaboration and crowdsourcing. Instead of just having a top-down command, we now have a bottom-up command hub which has allowed the movement to last far longer than Umbrella.
“With greater power comes greater responsibility, so the question is how, through my role, can I express the voices of the frontliners, of the street activism? For example, I defended the action of storming into the Legislative Council on July 1. I know I didn’t storm in myself . . . ” His phone pings twice. Finally he succumbs.
After tapping away for about 30 seconds, Wong launches back into our conversation, sounding genuinely sorry that he wasn’t there on the night when protesters destroyed symbols of the Chinese Communist party and briefly occupied the chamber.
“My job is to be the middleman to express, evaluate and reveal what is going on in the Hong Kong protests when the movement is about being faceless,” he says, adding that his Twitter storm of 29 tweets explaining the July 1 occupation reached at least four million people. I admit that I am overcome with exhaustion just scanning his Twitter account, which has more than 400,000 followers. “Well, that thread was actually written by Jeffrey Ngo from Demosisto,” he say, referring to the political activism group that he heads.
A network of Hong Kong activists studying abroad helps fuel his relentless public persona on social media and in the opinion pages of international newspapers. Within a week of his most recent arrest, he had published op-eds in The Economist, The New York Times, Quartz and the Apple Daily.
I wonder out loud if he ever feels overwhelmed at taking on the Chinese Communist party, a task daunting even for some of the world’s most formidable governments and companies. He peers at me over his wire-framed glasses. “It’s our responsibility; if we don’t do it, who will? At least we are not in Xinjiang or Tibet; we are in Hong Kong,” he says, referring to two regions on Chinese soil on the frontline of Beijing’s drive to develop a high-tech surveillance state. In Xinjiang, at least one million people are being held in internment camps. “Even though we’re directly under the rule of Beijing, we have a layer of protection because we’re recognised as a global city so [Beijing] is more hesitant to act.”
I hear the sound of the wok firing up in the kitchen and ask him the question on everyone’s minds in Hong Kong: what happens next? Like many people who are closely following the extraordinary situation in Hong Kong, he is hesitant to make firm predictions.
“Lots of think-tanks around the world say ‘Oh, we’re China experts. We’re born in western countries but we know how to read Chinese so we’re familiar with Chinese politics.’ They predicted the Communist party would collapse after the Tiananmen Square massacre and they’ve kept predicting this over the past three decades but hey, now it’s 2019 and we’re still under the rule of Beijing, ha ha,” he grins.
While we are prophesying, does Wong ever think he might become chief executive one day? “No local journalist in Hong Kong would really ask this question,” he admonishes. As our lunch has progressed, he has become bolder in dissecting my interview technique. The territory’s chief executive is currently selected by a group of 1,200, mostly Beijing loyalists, and he doubts the Chinese Communist party would ever allow him to run. A few weeks after we meet he announces his candidacy in the upcoming district council elections. He was eventually the only candidate disqualified from running — an order that, after our lunch, he tweeted had come from Beijing and was “clearly politically driven”.
We turn to the more ordinary stuff of 23-year-olds’ lives, as Wong slurps the remainder of his milk tea. “Before being jailed, the thing I was most worried about was that I wouldn’t be able to watch Avengers: Endgame,” he says.
“Luckily, it came out around early May so I watched it two weeks before I was locked up in prison.” He has already quoted Spider-Man twice during our lunch. I am unsurprised when Wong picks him as his favourite character.
“I think he’s more . . . ” He pauses, one of the few times in the interview. “Compared to having an unlimited superpower or unlimited power or unlimited talent just like Superman, I think Spider-Man is more human.” With that, our friendly neighbourhood activist dashes off to his next interview.
shoulder joint movement 在 Jordan Yeoh Fitness Youtube 的最佳貼文
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This is an exercise guide to help you to understand the 3 heads of the Shoulder muscle, Front, Side, and Back.
I try not to make things too technical here because the 3 heads of Shoulder are actually very small when you compare to other big muscle group like the Chest, Back, and Legs.
Technique and tempo is the key to develop a good shoulder. Do not go too heavy because the Shoulder joint is one of the most important joint for any upper body movement (frontal, sagittal, and transverse plane), so take good care of them. :)
shoulder joint movement 在 ACTIVE RANGE OF MOTION OF THE GLENOHUMERAL JOINT 的推薦與評價
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