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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