上背痛、膏肓痛與肩胛骨之間的關係 (by 李冠頡物理治療師)
現代的工作與生活型態,迫使我們經常處於手臂往前伸的狀態,例如打電腦、滑手機、看書、寫字。這時候如果缺乏活動、變換姿勢、伸展的話,有可能會影響到肩胛骨以及附近的肌肉,進而導致上背痛,也俗稱膏肓痛。
姿勢 X 肩胛骨 X 上背痛
當我們坐著並且把手往前伸的時候,你的肩胛骨會往前凸、往前傾,這樣你才能把手更往前伸。可是這個狀態下其實肩胛骨是處於比較不穩定的狀態。身體為了穩定住肩胛骨,提肩胛肌、上斜方肌、中斜方肌、菱形肌會進入被拉長可是又要出力的狀態。
上述肌肉在被伸展且需要拉住肩胛骨的情況下,是容易疲勞、緊繃、變硬的。肌肉如果長期緊繃,就有機會產生激痛點(trigger point),激痛點是因為肌纖維長期處於收縮狀態,造長局部循環障礙,使得身體分泌出緩激肽來擴張血管,同時緩激肽會刺激機械性受器與壓力受器,讓你身體那個點變得輕輕碰壓就很痛。
激痛點除了會很痛以外,久了可能會慢慢演變成一整片的筋膜痛(myofascia pain)。
而且上背痛常常不會單獨出現,手臂長時間前伸的同時,頸部通常也會跟著前伸,讓被拉長無法有效出力的上斜方肌還要支撐頭部的重量,也很容易導致酸痛。
水牛肩與富貴包
肩胛骨附近的肌肉過度緊繃不只可能造成酸痛,也可能會導致脊椎的活動度降低,也就是能夠彎曲的能力變差,或是卡在過度彎曲的狀態。常見的相關問題包括烏龜頸、駝背、水牛肩(富貴包)。
烏龜頸、駝背很常見,出去路上走一圈可能就能看到幾個,而富貴包(又稱水牛肩)是指因為姿勢不良,頸椎第6或7節長期往後凸,在不正常增生組織下凸出一包。
但重點不在外觀,因為骨頭結構改變,脂肪堆積是很難逆回去的,即便你解決了肌肉、關節活動問題、恢復健康了,富貴包很可能還是在那裡。
物理治療的重點在於找出病因、解決疼痛、改善肌肉平衡、增加關節活動度,主要目的不要放在改善外觀上。
你可以怎麼做呢?
你可以選一張好的椅子,讓腰和背靠在椅背上有好的支撐,最好在腰椎第2~4節處(下背往內凹處的上緣)有個枕頭撐住,撐上去超舒服的!再來把椅子靠近辦公桌近一點,或是把鍵盤拉近自己,避免長時間過度把手往前延伸,造成肩胛骨位置跑掉。
一直按摩是沒用的
光是去按摩緊繃的肌肉是沒用的,你只會短暫舒服,過沒多久又痛起來。如果已經痛了,那建議去找醫生和物理治療師做診斷、評估和治療,因為姿勢與肌肉問題可能導致上背痛,但是上背痛並非就一定是姿勢與肌肉問題!這點非常重要。
假如是姿勢與肌肉問題,記得做運動訓練,讓斜方肌、菱形肌、下斜方肌、前鉅肌變強,幫你穩住肩胛骨!
最終的根本之道,還是停止久坐、改善姿勢與工作的桌椅、把肌肉訓練好!
延伸閱讀:
合作撰寫:
好痛痛(粉絲頁連結)、李冠頡物理治療師(專欄連結) (臉書訊息連結)
參考文獻
- J Occup Rehabil. 2014 Jun;24(2):316-24. doi: 10.1007/s10926-013-9441-1. Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial.
- Kinesiology of the Musculoskeletal System Foundations for Rehabilitation 2nd -Donald A. Neumann
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