醫生說我有「髕骨外翻」，那會怎麼樣嗎？
發表於2022-03-20由JACK CHEN撰寫POSTED IN 運動科學、運動醫學、常見問題已加上的標籤 物理治療、矯正性訓練、緊繃、運動傷害、肌肉失衡、股骨内旋、膝蓋疼痛、重量訓練、訓練、髕骨外翻
「治療師，我膝蓋痛好久了」
「醫師怎麼說呢？」
「醫生說我髕骨有外翻」
一、什麼是髕骨外翻？
「髕骨（Patella）」俗稱膝蓋骨，即在我們膝蓋上的一顆圓圓的骨頭，而「外翻」指的是往身體外的方向傾斜，即是髕骨相對於股骨（大腿骨）往外翻出，可以想像成書被翻開的樣子。
有無髕骨外翻多以「X光」來判斷，因爲X光可以直接看到骨頭的樣貌，也有人會用肉眼觀察、觸診等方式。
二、髕骨外翻會痛嗎？是種病嗎？
大多人會有個誤解，以為「髕骨外翻會造成疼痛，就是一種疾病」，但實際上：
髕骨外翻不是一種病也不是診斷，它是一個現象
髕骨外翻（Patella tilt）不是一種疾病，它代表的是「我們觀察到髕骨有往外翻的狀況」，就像是胸口摸起來「硬硬的」，「硬硬的」是個現象、事實，但背後代表的意義不確定，有可能是肌肉緊繃、水腫，也有可能是良性腫瘤、惡性腫瘤等。
髕骨外翻可能造成疼痛，也可能不會
在過去研究中，發現膝蓋有痛或沒有痛的人，都有可能呈現髕骨外翻，所以髕骨外翻不一定會有疼痛或有疾病，但「或許有關聯」。
三、髕骨外翻的重要性？
由於髕骨是往外傾斜的，會導致膝蓋的關節面，即大腿骨（股骨）跟髕骨之間不是密合的，有點類似「脫軌或信封沒密合」，而造成關節接觸面積變小。關節接觸面積變小，會導致單點承受的壓力過大，當壓力大到一定程度，即會產生疼痛。這邊可以想像成「很多人站在一條獨木舟上」，當大家保持社交距離，平均分佈地站著，船的壓力可以分散，但如果都集中在一處，該處壓力過大整條船就會沉。
四、真的是髕骨外翻嗎？
髕骨外翻的成因很多，這邊列舉常見的兩大類：
- 髕骨被往外拉
這邊會分成是連接在髕骨外側的軟組織（例如筋膜、韌帶、肌腱等）過於「出力或緊繃」，所以髕骨被往外扯；但也有可能是連接在髕骨內側的軟組織，過於「無力或鬆弛」，因爲内側肌肉無力維持平衡，一樣造成髕骨被力量較大的外側肌肉往外拉。這是一個相對位置的概念，意思是說「當有台車呼嘯而過，可能是我們踩煞車，或對方催油門」，所以當髕骨往外偏移，可以是外側的力過大或內側的力過小。
- 大腿骨（股骨）往內轉
延續相對位置的概念，其實可能「髕骨並沒有動，而是相對的大腿骨往內轉」，而導致「髕骨看起來是外翻的」
五、髕骨外翻怎麼處理？
應該先確定「需不需要處理」，也就是釐清「是不是髕骨外翻造成疼痛」。如果沒有疼痛，髕骨外翻不見得需要處理，但如果有伴隨疼痛，以下是常見的方式，包括運動治療、徒手治療、注射、貼紮、矯正性運動等：
- 消除髕骨外側拉力
例如滾筒、伸展、徒手放鬆來減少外側軟組織（肌肉、筋膜等）的張力
- 增加髕骨內側拉力
訓練附著在髕骨內側的肌肉群，試圖把髕骨拉回到內側
- 避免大腿骨往內轉
訓練臀部肌群可以減少大腿骨往內轉（像是內八的姿勢）
現今研究發現，對於能改善長期膝蓋痛較有效的方式似乎是第三點，即「訓練臀部肌群」，但我的建議是，每個人狀況並不同，因此除了訓練臀部肌群，伸展、貼紮、滾筒及其他治療方式，也是可以同時嘗試的。
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『希望透過所學，將運動醫學、運動科學、運動訓練等知識，用最簡單的語言分享給需要的人』
–陳曉謙 物理治療師/肌力與體能訓練師
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