前十字韌帶反射：韌帶的傷讓大腦抑制了肌肉，產生代償
常看好痛痛文章的朋友們，一定知道肌肉的代償有時候是疼痛的來源，以及韌帶受損或是關節不穩定時，可以透過肌力訓練使肌肉協助穩定關節。因此試著釐清與解除肌肉代償、透過運動治療與肌力訓練來改善活動與運動問題，是復健醫學、運動醫學很重要的一環。
什麼是肌肉代償？
代償意為一條肌肉幫另一條肌肉工作，來完成你原本想做的動作。如果代償是因為某些肌肉無法工作而需要其他肌肉代勞，就有可能引發疼痛。但是代償並不一定都不好，許多優秀的運動選手身體也有完美的肌肉代償，讓他們發揮出超乎常人的運動能力。
另外值得先提的是十字韌帶的功能在於穩定膝關節，不要讓大腿與小腿的骨頭跑到不對的位置去，所以許多關於十字韌帶的復健與治療也都提到大腿肌群的訓練，有助於幫助穩定膝關節。
好的，花了那麼多時間鋪梗後，我們要來進入正題了：其實在解決代償與肌力訓練之前，你可能會需要先解決韌帶的問題！
為什麼這麼說呢？
在以前醫療界一直有個說法認為前十字韌帶受傷的人股四頭肌(大腿前側肌力)比前十字韌帶沒受傷的人更難鍛鍊，但原因不得而知。2003 年 Konishi 教授為了測試韌帶裡的壓力受器是否和肌力有關聯，於是透過注射麻藥來阻斷前十字韌帶上的壓力受器。令人驚訝的事情發生了！被打針的人股四頭肌的力量在肌電圖上這時候竟然變大了！
前十韌帶反射的原理
後來我們發現如果韌帶受傷或是處於不穩定的狀態，大腦會自動去修正韌帶或者不穩定地方附近的肌群，來防止進一步的傷害。以前十字韌帶受傷的例子來說，大腦會抑制大腿前側與後側的肌群，也就是股四頭肌與膕旁肌，這是因為大腦覺得膝關節不穩定，所以不要讓肌肉出太多力以防小腿骨頭(脛骨)跑掉，這同時也會讓膝蓋下方的髕骨韌帶因為力量不均衡而疼痛。
這樣的現象我們稱之為前十字韌帶反射。
這樣的現象會帶來許多困擾，例如並非全部的十字韌帶受傷都需要開刀，而透過肌力訓練確實證明能夠協助韌帶穩定關節，現在肌力卻被大腦抑制住了。另一個問題是某些肌肉的力量被抑制後，很容易出現其他代償的狀況，這也不是我們所樂見的。
評估與治療的方法
幸運的是這些年來學界發展出很多種評估與治療方式來解決這樣的問題，例如在NKT(神經動能療法)裡面就有提到疤痕與韌帶對於肌肉的影響。而在NKT的源頭理論: 應用肌動學 (Applied Kinesiology) 中，有提到透過按壓的手法或是其他方法 (例如磁力) 來暫時阻斷韌帶、大腦與肌肉間的反射，來測試肌力是否因此改變。
韌帶的強化可以透過增生療法，將葡萄糖或血小板之類的增生溶液注射到受損韌帶來幫助修復。同時注射時加入一些微量麻藥來停止大腦的反射與抑制，並且在注射後確認原本被抑制的肌群是否可以發力，這樣可以確定此次注射的韌帶是否真正是造成肌肉無力的元兇。肌力測試、確認韌帶與肌肉關係、增生注射與注射後復測，這樣的流程可以同時做診斷與治療。王偉全醫師今年開辦的Injectional Kinesiology (注射肌動學)中也強調，注射後透過一些治療手法來改變大腦對肌肉的認知，這些都有助於韌帶與肌肉的恢復，改善疼痛、關節不穩定、動作代償等問題。
即使透過注射改善某些肌肉不能發力，因為剛叫回來的肌肉發力不穩定，動作模式也要重新學習，因此注射後的運動還是非常重要。因此搭配物理治療師與運動教練，還是不能跳過的一環。
合作撰寫：
好痛痛 (粉絲頁連結)
劉炳塘復健科醫師 (翔暘復健專科診所連結) (翔暘復健專科診所粉絲頁)
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