腳踝扭傷該怎麼看醫生?做訓練? (by 林杏青復健科總醫師、郭仕政物理治療師)
腳踝扭傷是非常常見的運動傷害,甚至沒事走在路上都會可能會不小心扭一下。所以好痛痛決定寫成系列文來讓大家更新對腳踝扭傷的認識。(第一篇腳踝簡介點此連結)
這篇文章原稿由林杏青復健科總醫師和專長健身、籃球的郭仕政物理治療師一起撰寫,兩位將告訴大家:
- 腳踝扭到、受傷的嚴重程度分級
- 就醫、治療的觀念
- 該如何自己鍛鍊腳踝的穩定度? (腳踝的肌肉與本體感覺)
- 格鬥時如何折斷別人腳踝?
腳踝扭傷的嚴重程度分級
腳踝扭傷大部分受傷的是韌帶,所以會以韌帶的撕裂傷程度做分級。
輕微腳踝扭傷:
會輕微腫痛,大部分還可行動與負重,撕裂傷要在顯微鏡下才看得到。用手去移動腳踝時,還不會有不穩定感
中度腳踝扭傷:
中度腫痛,韌帶部分撕裂,大部分無法行走與負重。醫生用手去移動你的腳踝時,會有不穩定感。
重度腳踝扭傷:
超級腫痛,韌帶完全斷裂,無法行走與負重,用手搬動腳踝會很不穩,因為少一條韌帶了。
常見問題:我很久以前就斷了一條韌帶了,該怎麼辦?
回答:韌帶的功能是穩定關節,通常一個關節上面會有很多韌帶幫助穩定,少一條會比較不穩沒錯。但是你可以靠肌肉來幫助穩定。
有些運動愛好者、運動選手身上曾因為運動受傷少一兩條韌帶,這並不罕見,但經過長期的訓練,他的關節穩定度還是很優良。如果擔心的話可以去找醫生或物理治療師幫你評估看看。
腳踝扭傷一定要照 X 光嗎?
答案是不一定,扭傷不見得會傷到骨頭。需不需要 X 光就讓醫生來判斷吧。我們下面提供了一個高度準確、證據力高的判斷方法給大家參考一下。
假如你紫色區域扭傷疼痛,加上 A 或 B 兩個地方骨頭痛,可能需要照 X 光。
如果你綠色區域扭傷疼痛,加上 C 或 D 兩個地方骨頭痛,可能需要照 X 光。
當然這個方法的準確率雖高,但也不是 100% ,所以你有可能是統計學中的少數,這件事在診斷與治療時還請體諒一下醫療人員。
嚴重腳踝扭傷要不要開刀?
答案是各有利弊。
韌帶嚴重撕裂傷開刀後,未來比較不容易反覆扭傷,平均來說會稍微更穩定些。而採取保守治療的人(功能性訓練加上副木保護)未來會比較不穩一些些。但是研究發現開刀的人未來骨關節炎的比例比較高。所以要不要開刀需要和醫生好好討論。
腳踝扭傷後可以怎麼治療?
受傷基本上都會經過三個步驟來復原:發炎、增生、重塑。
發炎就是一開始的腫痛,雖然現在許多新研究認為不需要太抑制發炎,但是發炎沒控制好也是很不好的。所以有研究認為扭傷的前 4 到 5 天可以冰敷、休息。你會說這怎麼和前陣子運動受傷只要前六小時冰敷的說法不一樣?對,其實這件事還未有定論,而且依照不同受傷程度也會不同。
另外短期內,建議扭傷後用護具固定腳踝 5 到 7 天,嚴重一點的可能 10 天。
軟組織(包含肌肉、肌腱、韌帶等等)需要時間去復原,有時候需要的是耐心,醫療上能夠幫上忙的地方並不多。所以你有可能輕微腳踝扭傷去看醫生,但是卻什麼事都沒發生就回家了。
小明氣噗噗說:「我腳扭到去看醫生,醫生診斷說腳扭到,叫我回家休息,廢話我當然知道我腳扭到啊~我看醫生就是想要快點好,我後天還要打比賽耶!」
沒辦法,這時候你需要的就是時間。當然如果硬是止痛、固定起來,硬是上場比賽那又是另一個故事了,風險也由自己承擔。
腳踝扭傷後的訓練?
剛剛不是才說受傷後需要時間休息,怎麼現在又跟我講訓練?搞得我好亂。
休息的意思是指叫你不要再上場比賽、不要再做高強度的訓練。事實上我們並不會讓他完全休息,我們可以在不疼痛、或是可以忍受的疼痛範圍,對腳踝做一些活動,可以讓他復原更好。這部分會需要物理治療師從旁協助、觀察你的復原情形。
當你脫離急性期,進入復原期時,可以開始做一些腳踝穩定的訓練,讓你的腳踝附近的肌肉更強壯、更能保護腳踝,也訓練本體感覺的復原。下面由郭仕政物理治療師示範給你看:
第一個動作是單腳站立,第二個動作是閉眼單腳站立;
第三個動作是用腳去觸碰數個目標物來訓練腳踝穩定;
第四個是單腳站在不穩定的軟墊上,最後一個是閉眼站在不穩定的軟墊上。各位自己在家可以使用枕頭之類的物品代替。
記得!站立的那隻腳,膝蓋要對齊腳趾2、3趾!!
腳踝關節技
最後,由中壢的盆栽巴西柔術學院台灣支部示範腳踝鎖,一種能造成別人腳踝扭傷的關節技!
腳踝鎖是柔術足部關節技的一種,俗稱阿基里斯腱固。
雖然動作中壓迫阿基里斯腱,但造成傷害卻不是因為阿基里斯腱,而是拉長距腓骨關節,並對距腓韌帶等穩定關節的韌帶施壓,造成類似腳踝向內「翻船」的傷害。
新手常犯的錯誤是直接將腳背用力下壓,雖然造成距骨和脛骨、舟狀骨和距骨關節的摩擦疼痛,和阿基里斯腱擠壓疼痛,但這樣的疼痛並不足以讓對手投降。
合作撰寫:
好痛痛 (粉絲頁連結)
林杏青復健科總醫師 – 柔術醫師 (專欄連結) (粉絲頁連結)
郭仕政物理治療師 (專欄連結) (粉絲頁連結)
感謝:
盆栽巴西柔術學院台灣支部
好痛痛舉辦的課程活動們 (點此連結)
註:本部落格文章是以科普、衛教為出發點,不代表任何人的生理狀況。每個人的身體皆不相同,有任何疑問請詢問自己的醫師、物理治療師、專業教練。
參考資料:
- Treatment of acute ankle ligament injuries: a systematic review, Wolf Petersen · Ingo Volker Rembitzki ·Andreas Gösele Koppenburg · Andre Ellermann · Christian Liebau · Gerd Peter Brüggemann · Raymond Best, Arch Orthop Trauma Surg (2013) 133:1129–1141
- Update on Acute Ankle Sprains, JEFFREY D. TIEMSTRA, MD, Department of Family Medicine, University of Illinois College of Medicine, Chicago, Illinois, American Family Physician, June 15, 2012 , Volume 85, Number 12
- Ortho Info, American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/
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