拉傷！最常見的運動傷害就是肌肉拉傷、肌腱拉傷！
拉傷和扭傷可以說是運動傷害中最常見的兩種，意即肌肉或肌腱被拉扯而受傷。這篇文章會告訴你：
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- 常見的拉傷是怎麼發生的？
-
- 以及我們該如何預防拉傷？
- 假設你不幸還是遇到拉傷了，那該怎麼處理？
拉傷的資料到處都是，好痛痛統整寫出最專業易懂的一篇給你！！
拉傷的定義
你知道嗎？並不是所有的軟組織(肌肉、肌腱、韌帶、脂肪墊、滑液囊等等)因為拉扯受傷都叫拉傷。拉傷是指發生在肌肉與肌腱上，因為拉扯的受傷。而扭傷大多是指關節部份因為過大力量的扭扯，造成韌帶受傷，有時附加骨裂效果。
肌肉和肌腱是有方向的我想大家都知道，肌肉可以順著這個方向收縮和放鬆。當肌肉、肌腱沒辦法承受發生在他身上的力量時，他就有可能撕裂、受傷，這就是拉傷。
拉傷依照收縮方式來分類
肌肉收縮的運作有分成三種：向心收縮、等長收縮、離心收縮。
我們拿小明當作例子，小明在健身中心舉啞鈴，看到校花小美經過，想展現他的男子氣概給小美看，希望能留下健美的印象，於是換了一顆超重的啞鈴，我們叫它啞鈴醬。
當小明把啞鈴醬往上舉的過程中，啞鈴醬移動的方向和肌肉收縮的方向差不多，肌肉越收縮越短，這個叫做向心收縮！
因為啞鈴醬很重，她很久沒控制體重了，不對，其實她生下來就那麼重了。小明因為沒舉過那麼重的啞鈴，奮力一提，產生劇烈疼痛，發生了拉傷。原因是肌肉突然負荷過大。
所以各位千萬不要為了求偶、比賽成績、耍中二等原因讓自己做超過負荷的事，不划算。
假設小明沒有因為向心收縮受傷，他把啞鈴醬舉在一個位置不動，讓肱二頭肌變大變硬，故意等小美經過讓她看一眼。這時候小明的肱二頭肌正在等長收縮，意思是肌肉持續收縮，但長度沒有改變。
小美看都沒看一眼的經過小明，誰叫小明長得不像金城武。小明很氣餒的把啞鈴醬緩緩放回架子上。這時候肱二頭肌其實還是在收縮，但是啞鈴醬移動的方向和肌肉收縮的方向相反，肌肉收縮的過程卻在拉長，這就叫做離心收縮。
如果不這麼做的話，啞鈴醬會蹦的一聲掉到地上，會被館長罵，我是說運動場館的館長。
離心收縮是最容易拉傷的時候。有在運動、健身的大家要多注意。
上面提到的拉傷原因大致上可以歸類在因為負荷過大，其他常見肌肉拉傷原因還有兩種：
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- 力量不平衡：你身體做一個動作時，經常是數條肌肉、肌群一起收縮和放鬆的。假如你的肌肉不平衡，某些肌肉特別 high、超用力，其餘較弱的肌肉跟不上就有可能拉傷。
- 力量不平衡：你身體做一個動作時，經常是數條肌肉、肌群一起收縮和放鬆的。假如你的肌肉不平衡，某些肌肉特別 high、超用力，其餘較弱的肌肉跟不上就有可能拉傷。
- 肌肉太緊繃：假如你運動前沒有好好暖身，肌肉還沒足夠充血、提升溫度；或是比賽時太緊張，肌肉緊繃，就有可能無法負荷力量而拉傷。
依照拉傷的程度來分類
輕度肌肉拉傷
只有一小部分肌肉纖維撕裂傷，一小部分是指比頭髮的粗細還細的纖維，這樣就足夠讓你好痛痛了！通常這時候外觀不會有差異，但是按壓或出力的時候會感受到疼痛。
中度肌肉拉傷
許多部分的肌肉纖維斷裂，出血導致腫大，功能已經受損，肌力下降，會有無力感，無法完整活動關節。這時候已經不是好痛痛的等級了，是超痛痛！！
重度肌肉拉傷
肌肉大範圍斷裂至全數斷裂，肌肉會收縮至兩端，斷裂部位會凹陷下去，你會無法活動那條肌肉。常發生於肌肉與肌腱的交合處，常常需要手術處理。
拉傷了該怎麼辦？
大家常聽到的運動傷害(拉傷、扭傷)處理方式是 RICE，米飯。對，就是在受傷的地方敷上米飯，糙米更好，給他敷個七七四十九天就會好了。才怪，受傷要就醫，不要亂信偏方。
RICE 是在 1978 年被制訂出來的一個運動傷害處理流程，但是現在已經過時了，不過還是簡單提一下。R = Rest 休息，I = Ice 冰敷，C = Compression 施壓，E = Elevation 把患部抬高。
舊觀念簡單說是抑制發炎，然後讓他休息恢復。但是新觀念有很大的不同！！！
新的拉傷(包括扭傷)醫療觀念
新的醫學研究於2013年在The American Journal of Sports Medicine指出，抑制、延遲發炎對你的受傷恢復沒有比較好。發炎是身體的自然反應，他正在發送一些炎症細胞、巨噬細胞促進傷口癒合。
這時候你冰敷的話，會讓血管收縮，使得巨噬細胞無法抵達受傷的地方。甚至受傷的組織、細胞可能會因為缺乏血液而死亡，有可能會造成永久性的神經損傷。同時冰敷也會降低力量、速度、耐力、協調性。
所以新的觀念裡，大大降低了冰敷的重要性，有些研究認為冰敷主要的目的在於止痛。Gabe Mirkin 博士在2014年《Why Ice Delays Recovery》中表示，運動受傷發生時，應該停止運動，並且抬高患部利用重力來減少腫脹，或是利用加壓繃帶來達到同樣效果。只需要在受傷後六小時內冰敷 2 到 3 次即可，每次低於十分鐘，中間間隔至少二十分鐘。之後就不需要冰敷了。
假如你受傷程度較重、或是無法移動、有開放性傷口、失去意識，要馬上找專業醫療人士處理。
在新的觀念裡，也不建議受傷後就完全休息。受傷脫離急性期後，就可以在可承受的範圍內活動。這樣有幾個好處：
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- 不要讓肌肉因為都不動而萎縮。
- 不要讓肌肉因為都不動而萎縮。
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- 讓大腦時時刻刻更新患部的資料，避免復原後他還是被大腦過度保護著。
- 讓大腦時時刻刻更新患部的資料，避免復原後他還是被大腦過度保護著。
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- 適度的活動可以增加血液循環，幫助自癒。
- 適度的活動可以增加血液循環，幫助自癒。
- 動一動可以讓組織長得更加整齊、美好。例如輕微伸展受傷那條肌肉，每次伸展大概 30秒，重複5次。受傷肌肉從輕的力量漸進到重的力量慢慢訓練，過程中不應該感到特別疼痛。
新的觀念的縮寫可以變成 POLICE ，Protect 保護、Optimal Loading 適當負荷(剛剛講的復原時動一動)、Ice 冰敷 (剛受傷時敷一些就好)、 Compression 壓迫、 Elevation 抬高。
如何預防拉傷？
前面提到拉傷是因為肌肉無法承受他遇到的力量拉扯。所以預防方法就是讓他可以承受這個力量拉扯。
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- 運動前要好好的熱身，例如先在球場跑個幾圈再上場，讓肌肉好好充血、體溫升高。這時候肌肉為了運動已經做好準備，可以發會更大的力量與韌性，更不容易拉傷。
- 運動前要好好的熱身，例如先在球場跑個幾圈再上場，讓肌肉好好充血、體溫升高。這時候肌肉為了運動已經做好準備，可以發會更大的力量與韌性，更不容易拉傷。
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- 訓練運動的協調性，有時候你拉傷是因為你做錯了動作，或是以很奇怪的方式在殺球、跳躍之類的。使用錯誤的肌肉做錯誤的事情，會提高拉傷的機率。所以找個專業的教練幫你把運動的協調性、姿勢訓練好，是有助於避免運動傷害的。
- 訓練運動的協調性，有時候你拉傷是因為你做錯了動作，或是以很奇怪的方式在殺球、跳躍之類的。使用錯誤的肌肉做錯誤的事情，會提高拉傷的機率。所以找個專業的教練幫你把運動的協調性、姿勢訓練好，是有助於避免運動傷害的。
- 鍛鍊肌肉，尤其是離心收縮。把肌肉練強一點，他能夠承受的力量就越大，一般而言也就越不容易拉傷。
沒用的預防方式：
運動前拉筋、不熱身，沒有顯著效果。光是拉筋本身沒有證據可以預防受傷，因為把筋拉鬆也降低了強度和穩定度。
但如果某些運動需要很高的柔軟度才能達到運動表現，還是要考慮拉筋，例如某些特殊舞、體操、武術等等。
關於拉傷的簡介就講到這邊。記得運動前好好熱身、運動時量力而為，比較不會受傷唷～
假如你衰小拉傷了，可以使用這個搜尋器找醫生和物理治療師(點此連結)。
延伸閱讀：如何分辨肌肉酸痛和拉傷、常見的大腿後側膕旁肌拉傷
協助：
林杏青復健科醫師-柔術醫師 (專欄連結) (粉絲頁連結)
林暐閎物理治療師 (專欄連結) (物理治療所連結)
李冠頡物理治療師 (專欄連結)
黃冠維物理治療師 (粉絲頁連結)
郭仕政物理治療師 (專欄連結)
好痛痛的運動傷害書籍，集結 2 位醫師、6 位物理治療師、2 位運動教練一起教你如何預防/處理運動傷害 (博客來連結) (誠品連結)
參考文獻：
https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
http://stoneathleticmedicine.com/2014/04/rice-the-end-of-an-ice-age/
http://journals.sagepub.com/toc/ajsb/41/6
http://journals.sagepub.com/doi/abs/10.1177/0363546503260757?journalCode=ajsb
您好:想請問文中拉傷肌肉後動一動可以讓組織長得更加整齊。對於扭傷的韌帶處理方式是?謝謝您。
等我們之後扭傷系列文會提到。到時候會提醒您，感謝～
好奇職業運動員賽後冰敷也會造成肌肉能力的降低嗎？
那是一個統計結果，所以單從那篇原始文無法回答你的問題。
但若你說的是那種一般賽後冰敷的話，我認為應該只有短暫效應，長期來說沒影響。
我猜你說的應該是這篇 https://blog.easepain.tw/ting-cheng-hao/delayed-onset-muscle-soreness/ 裡面提到的這種。
感謝回覆，這個資訊和連結非常實用 : )
離心收縮有什麼是針對小腿的運動方式嗎？
聽不懂….你想問的是如何訓練小腿的離心收縮？
這個還是要請你去詢問你的體能教練，要看看你平常從事的運動項目需要什麼樣的鍛鍊。
運動拉傷後如果噴了消炎止痛的噴劑，是否會影響到肌肉的恢復，因為產品上有說會抑制前列腺素的產生，少了這種激素會不會使肌肉恢復受到影響?
最近跑步前忘記做暖身，結果過程中臀部突然一陣抽痛，後來就一直酸痛到現在，請問這樣也要做復健治療嗎？還是吃消炎止痛藥就會慢慢好？
如果痛超過兩週，有可能不是單純的痠痛，建議給醫生看一下
建議參考這篇：https://blog.easepain.tw/atx-yao-ssu-yuan/muscle-soreness-and-strain/
你好 我想請問
小腿的骨頭被硬式棒球打到腫起來
打到的前一二天都有冰敷並且只剩一點微腫而已（沒有熱敷）
但已經過了3個禮拜了 還是沒有完全消腫
而且腳踝內側的關節和膝蓋外側都會隱隱作痛
請問我應該怎麼處理？？
我人在日本留學…應該去掛哪一科比較好呢
最近跑步前忘記做暖身，結果過程中臀部突然一陣抽痛，後來就一直酸痛到現在，請問這樣也要做復健治療嗎？還是吃消炎止痛藥就會慢慢好？
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