種疼痛課程下肢跟腱炎

課程目標(biāo)Introducetheclinicalpresentationclinicalanatomy,pathology,clinicalkinesiology,andclinicalbiomechanicsoftwoCommonFootandAnkleDisorders:AchillesTendinitis介紹常見(jiàn)足部及踝關(guān)節(jié)疾病－跟腱炎臨床表現(xiàn)，臨床解剖，病理學(xué)，臨床人體運(yùn)動(dòng)科學(xué)及臨床生物力學(xué)課程目標(biāo)ProvidetheEducation/CounselingStrategiesandExerciseManagementOptionsforindividualswithAchillesTendinitis提供對(duì)跟腱炎的教育／咨詢(xún)策略及運(yùn)動(dòng)管理方案Wewillcontinueintroducingeachofthebelowforcommonmusculoskeletalconditions:我們會(huì)繼續(xù)逐個(gè)介紹在常見(jiàn)肌肉骨骼問(wèn)題中的以下方面clinicalpresentation臨床表現(xiàn)clinicalanatomy臨床解剖pathology病理學(xué)clinicalkinesiology臨床人體運(yùn)動(dòng)科學(xué)clinicalbiomechanics臨床生物力學(xué)clinicalpresentation: thecommonlyreportedproblemsorconcernsoftheindividualwiththecondition臨床表現(xiàn)：常見(jiàn)的個(gè)體主訴或顧慮AchillesTendinitis-clinicalpresentation:跟腱炎臨床表現(xiàn)Achillesareapain-aggravatedbyexerciseactivity,primarilyrunning跟腱部位疼痛－鍛煉活動(dòng)（主要是跑步）伴隨加重AchillesTendinitis-clinicalpresentation:跟腱炎臨床表現(xiàn)Recentincreaseinexercisedose/training近期運(yùn)動(dòng)量／訓(xùn)練加大AchillesTendinitis-clinicalpresentation:跟腱炎臨床表現(xiàn)Feelingofcalfstiffnessfollowingprolongedimmobility,suchassleepingorprolongedsitting長(zhǎng)時(shí)間制動(dòng)（如睡覺(jué)或久坐不動(dòng)）后感覺(jué)小腿僵硬AchillesTendinitis-clinicalpresentation:跟腱炎臨床表現(xiàn)LimitedAnkleDorsiflexionWeakCalfMusclesAchillesTendonTendernesstoTouch踝關(guān)節(jié)背屈受限小腿肌力減弱跟腱壓痛AchillesTendinitis-clinicalanatomy:跟腱炎－臨床解剖graphicofAchillestendon-showinglocationandattachments跟腱圖片顯示位置和連接AchillesTendinitis-clinicalanatomy:跟腱炎－臨床解剖slidesuggestion:頁(yè)面建議：graphicofdetailofAchillesTendoninsertion-perhapsshowingareaoflimitedvascularization跟腱止點(diǎn)細(xì)節(jié)圖片－可顯示血管化受限區(qū)域AchillesTendinitis-clinicalanatomy:跟腱炎－臨床解剖graphicofdetailofAchillesTendoninsertion-perhapsshowingareaofcalcanealbursaeandtendonsheath跟腱止點(diǎn)細(xì)節(jié)圖片－可顯示跟骨滑囊和腱鞘AchillesTendinopathy-clinicalanatomy:跟腱炎－臨床解剖slidesuggestion:頁(yè)面建議：graphicofdetailoflateralAchillesTendonandSuralnerve-perhapsshowingareaapainthatmaymimicAchillesTendonPain外側(cè)跟腱和腓腸神經(jīng)細(xì)節(jié)圖片－可顯示可擬出跟腱炎疼痛的區(qū)域pathology: thetissueproblembelievedtobeassociatedwiththereportedcomplaint病理: 被認(rèn)為跟患者主訴相關(guān)的組織問(wèn)題AchillesTendinitis-pathology:跟腱炎－病理學(xué)slidesuggestion頁(yè)面建議graphicofanormalversuspathologicalAchillesTendon(ifthereisoneavailable)(perhapsacomparisonMRIcouldalsowork)正常與病理下的跟腱圖片（如果能找到的話）（或者M(jìn)RI的對(duì)比圖片）pathology:病理學(xué)itisversusopathyitis和opathy的區(qū)別itis=inflammationitis＝炎癥opathy=undefinedpathologyopathy＝不確定的病變pathology:病理學(xué)：ForAchillesareapain-itismostoftenNOTaninflammation跟腱部位疼痛－通常不是炎癥thus所以AchillesTendinopathyisamoreappropriateterm-andthetermusedintheclinicalpracticeguidelineAchillesTendinopathy（下文使用跟腱病變翻譯）是更合適的表達(dá)，并用在臨床實(shí)踐指南中）clinical

kinesiology: relevantmovementthatmaybenormalorabnormal-theusualgoalistoreducetheabnormalmovementpatternsandtopromotenormal,painfreemovement臨床人體運(yùn)動(dòng)學(xué):

正?；虍惓５南嚓P(guān)運(yùn)動(dòng)－目的通常是減少異常的運(yùn)動(dòng)模式和促進(jìn)正常，無(wú)痛的運(yùn)動(dòng)AchillesTendinopathy-clinicalkinesiology:跟腱病變－臨床人體運(yùn)動(dòng)學(xué)slidesuggestions-normalfunctionofthesoleuswhenstanding站立時(shí)比目魚(yú)肌的正常功能graphicsand/orvideosthatdescribetheroleoftheandsoleusduringstanding(preventkneeflexion/buckling)-eccentriccontrolofelongation(ankledorsiflexon)在站立時(shí)比目魚(yú)肌的作用（防止－膝關(guān)節(jié)壓曲／屈曲）－伸長(zhǎng)的離心控制（踝關(guān)節(jié)背屈）比目魚(yú)肌的功能AchillesTendinopathy-clinicalkinesiology:跟腱病變－臨床人體運(yùn)動(dòng)學(xué)slidesuggestions-normalfunctionofthesoleusandgastrocnemiuswhenwalking頁(yè)面建議－行走時(shí)比目魚(yú)肌和腓腸肌的正常功能graphicsand/orvideosthatdescribetheroleoftheandsoleusandgastrocnemiusduringwalking-focusingoneccentricactivityatmidstancetoterminalstance(controltibialadvancementfrommidstancetoterminalstance,limitsexcessivekneeflexion/bucklingandaidsinprovidingkneeextensionatfrommidstancetoterminalstance)描述在行走過(guò)程中比目魚(yú)肌和腓腸肌的作用－注重于支撐中期到支撐末期的離心運(yùn)動(dòng)（從支撐中期到支撐末期控制脛骨的前推，限制膝關(guān)節(jié)過(guò)度屈曲／壓曲及在支撐中期到支撐末期對(duì)伸膝提供輔助）clinicalbiomechanics: relevantmechanicalabnormalitythatmaybecausingtheunderlyingtissueproblem:-usuallyassociatedwithabnormalmovement-thecommonfocusoftreatmentistonormalizemechanics-usuallyusingspecificstretchingexercisesortargetedstrengtheningexercises臨床生物力學(xué): 可能導(dǎo)致相關(guān)組織問(wèn)題的相應(yīng)力學(xué)異常? 一般跟動(dòng)作異常相關(guān)? 常見(jiàn)的治療焦點(diǎn)是將力學(xué)正?；蜃⒅卦鰪?qiáng)肌力訓(xùn)練AchillesTendinopathy-clinicalbiomechanics:跟腱病變－臨床生物力學(xué)slidesuggestion頁(yè)面建議perhapsagraphicshowingwhenduringwalkingorrunningwherethetendonisonmosttension展示在行走或跑步過(guò)程中跟腱處于張力最大的位置的圖片AchillesTendinopathy-clinicalbiomechanics:跟腱病變－臨床生物力學(xué)perhapsagraphicshowingtheforcesonthetendonwitheccentricloading-maybeincomparedtoconcentricloading在離心負(fù)荷時(shí)作用在跟腱上的力－跟向心負(fù)荷做對(duì)比AchillesTendinopathy-clinicalbiomechanics:跟腱病變－臨床生物力學(xué)perhapsagraphicshowingtheforcesonthetendonwithjumpingandorlandingfromajump跳躍和／或落地時(shí)作用在跟腱上的力afterabreakwewilldiscuss:在休息過(guò)后我們會(huì)討論Education/CounselingStrategiesAndExerciseManagementOptionsforindividualswithAchillesTendinopathy跟腱病變患者的教育／咨詢(xún)策略和訓(xùn)練管理方案Education/CounselingStrategiesandExerciseManagementOptionsforindividualswithAchillesTendinopathy跟腱病變患者的教育／咨詢(xún)策略和訓(xùn)練管理方案Education/CounselingStrategiesforindividualswithAchillesTendinopathy跟腱病變患者的教育／咨詢(xún)策略rememberthecommonclinicalpresentation:記住常見(jiàn)臨床表現(xiàn)Achillesareapain-aggravatedbyexerciseactivity,primarilyrunning跟腱部位疼痛－運(yùn)動(dòng)（主要是跑步）加重Recentincreaseinexercisedose/training近期運(yùn)動(dòng)量／訓(xùn)練增加Feelingofcalfstiffnessfollowingprolongedimmobility,suchassleepingorprolongedsitting長(zhǎng)時(shí)間制動(dòng)（如睡覺(jué)或久坐不動(dòng)）后感覺(jué)小腿僵硬AchillesTendinopathy:FocusofFitnessEducation/TrainingTips跟腱病變：注重健康教育／訓(xùn)練技巧? Assistwithdeterminingtheoptimalwalkingorrunningexercisetrainingloadtoadjustweight-bearingloadtoAchillestendontolerance? 幫助確定最佳的行走或跑步訓(xùn)練的重量或?qū)⒇?fù)載調(diào)整到跟腱可以承受的范圍AchillesTendinopathy:FocusofFitnessEducation/TrainingTips跟腱病變：注重健康教育／訓(xùn)練技巧? Considerfootwearmodifications,suchasincreasecushioning,and/oruseofheelliftsororthoticstoreducesymptoms? 考慮鞋履的調(diào)整，如增加緩沖墊，及／或使用增高墊或矯形器來(lái)減輕癥狀Observations,comments,questionsaboutFitnessEducation/TrainingTipsforindividualswithAchillesTendinopathy對(duì)于跟腱病變患者的健康教育／訓(xùn)練技巧有意見(jiàn)，評(píng)論和問(wèn)題ExerciseManagementOptionsforindividualswithAchillesTendinopathy跟腱病變患者的訓(xùn)練管理方案Stretching:Calf/gastrocnemius拉伸：小腿／腓腸肌Strengthening:Gastrocsoleus-eccentric&concentric力量鍛煉：比目魚(yú)肌－離心和向心收縮Calf/GastrocnemiusStretching小腿／腓腸肌拉伸CalfStretching-Level1小腿拉伸－第一階CalfStretching-Level1小腿拉伸－第一階PerformanceCues? Standfacingawall? Ensurethatyourfootispointingstraightforwards.Overallweightshouldbetowardstheouterborderofthefootbyrotatingthelowerlegoutwardsslightly.Thisshouldenhancethearchontheinsideofyourinvolvedfoot.Maintainthispositionthroughoutthestretch.? Inducethestretchonthebackofthelowerlegbykeepingtheheelonthegroundandleaningthebodyforwards.動(dòng)作提示? 面對(duì)墻站立? 確保腳平直對(duì)著前方。隨著小腿略微向外旋轉(zhuǎn)，整體重量應(yīng)該朝向腳的外邊界。這個(gè)動(dòng)作應(yīng)該增大參與的腳的足弓。在拉伸中保持這個(gè)姿勢(shì)。? 通過(guò)將足跟保持在地上并且身體前傾來(lái)增加下肢后側(cè)的拉伸CalfStretching-Level1小腿拉伸－第一階INSERTVIDEOINTOKEYNOTEPRESENTATIONHERE在此處插入視頻CalfStretching-Level1&2小腿拉伸－第一／二階CalfStretching-Level2小腿拉伸－第二階PerformanceCues? Standfacingawallwiththelegtobestretchedbehindyou.Placethefrontofthisfootontoaraisedsurfaceorwedgetoenhancethebendattheankle.? Makesurethatyourfootispointingstraightforwards,perpendiculartothewall.Overallweightshouldbetowardstheoutsideofthefootbyrotatingthelowerlegoutwardsslightly.Thiswillenhancethearchontheinsideofthefootduringthestretch.Maintainthispositionthroughoutthestretch.? Nowstartfeelingthestretchonthebackofyourlowerlegbykeepingtheheelonthegroundandleaningthebodyforwards.動(dòng)作提示? 面對(duì)墻站立，讓你后面的腿牽拉。將后面的腳放在一個(gè)斜面或楔形墊上來(lái)增加踝關(guān)節(jié)的彎曲? 確保你的腳平直指向前，與墻面垂直。隨著小腿略微向外旋轉(zhuǎn)，整體重量應(yīng)該朝向腳的外邊界。這個(gè)動(dòng)作應(yīng)該增大參與的腳的足弓。在拉伸中保持這個(gè)姿勢(shì)。? 保持腳跟在地面上并將身體前傾，現(xiàn)在開(kāi)始感覺(jué)腿部后方的拉伸CalfStretching-Level2小腿拉伸－第二階INSERTVIDEOINTOKEYNOTEPRESENTATIONHERE在此處插入視頻GoPractice練習(xí)Tryvariationswithkneeflexion-totargettheSoleus嘗試不同的膝關(guān)節(jié)屈曲來(lái)確定比目魚(yú)肌Toenhancethestretchtothesoleusmuscle,letthekneebendslightly-butstilldowhatisnecessarytokeepanarchinthefootasyoustretch讓膝關(guān)節(jié)稍彎曲來(lái)增加比目魚(yú)肌的拉伸－但在拉伸時(shí)仍需保持必要的足弓高度AnyquestionsorcommentsaboutCalfStretching任何關(guān)于小腿拉伸的問(wèn)題或評(píng)論Strengthening力量訓(xùn)練Gastrocsoleus-eccentric&concentric比目魚(yú)?。x心收縮和向心收縮Gastrocsoleus/FibularisLongusEccentricStrengthening-Level1比目魚(yú)肌／腓骨長(zhǎng)肌向心收縮力量訓(xùn)練－第一階GastrocSoleusEccentricStrengthening-Level1比目魚(yú)肌向心收縮力量訓(xùn)練－第一階PerformanceCues? Startinstandingposition,feetslightlyapartandflatontheground? Performthisexercisebarefoot? Keepingtheballofthefootontheground,raiseyourarchawayfromthegroundslightly.Maintainthispositionthroughouttheexercise.? Performa‘heelraise’-withbothfeet-whilekeepingmuchofthepressurethroughthe“ball”ofthebigtoe,notthethroughthepinkytoe? Holdbriefly? Lifttheuninvolvedfootoffoftheground? Slowlylowertheotherheelbacktotheground? Foradditionaleccentricstress-wearaweightedvestorbackpack動(dòng)作提示? 從站立位開(kāi)始，雙腳平方在地上并稍分開(kāi)? 赤腳進(jìn)行訓(xùn)練? 保持跖球在地面上，慢慢地將足弓從地面抬起。在訓(xùn)練中保持這個(gè)姿勢(shì)? 進(jìn)行“提踵”－使用雙腳且保持大部分重量在大腳趾的“肉墊”處而不是小腳趾? 短暫停住? 將不參與鍛煉的腳抬離地面? 慢慢地將另一個(gè)足跟放回地面? 額外的離心收縮－使用重力背心或背包AnyquestionsorcommentsaboutGastrocSoleusEccentricStrengthening-Level1任何關(guān)于比目魚(yú)肌小腿三頭肌離心收縮力量訓(xùn)練－第一階的問(wèn)題或評(píng)論嗎？GastrocSoleusEccentricStrengthening-Level2比目魚(yú)肌離心收縮力量訓(xùn)練－第二階PerformanceCues? Startinstandingposition,standingononefoot? Performthise