Trailwalker 2009

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1 樂施毅行者 2018 物理治療師的建議 Oxfam Trailwalker 2018 Physiotherapy Advice 熊國佳香港物理治療學會運動物理治療專研組 Frank Hung Hong Kong Physiotherapy Association Sports Specialty Group

2 內容 Content 毅行常見的肌肉骨骼傷患 Commonly Seen Musculoskeletal Problems in TW 預防及訓練方案 Prevention and Training Protocols 行山鞋的選擇 How to Choose Trail Walking Shoes

3 功能性鍛煉運動 Functional Training 伸展運動 Stretching Exercise 泡綿滾筒運動 Foam Roller Exercise 練習時段 Practical Session

6 毅行常見的肌肉骨骼傷患 Commonly Seen Musculoskeletal Problems in TW

7 70-80% 為下肢傷患 70-80% lower limb problems 當中膝關節傷患佔 70% in which 70% knee problems 前膝痛症及髂脛束綜合症為最常見的肌肉骨骼傷患 Anterior Knee Pain and Iliotibial Band Syndrome most common

8 前膝痛症 ( 髕股關節疼痛症候群 ) Anteria Knee Pain (Patellofemoral Pain Syndrome)

10 成因 Causes 下肢運動力學連鎖反應 Poor Lower Limb Biomechanics 肌肉不平衡 ( 股四頭 - 股內側臀中股臀大股過弱 ) Muscle imbalance (Weak in Vastus Medialis, Gluteal Max, Med)

13 成因 Causes 下肢運動力學連鎖反應 Poor Lower Limb Biomechanics 生理結構異常 ( 如膝外翻和扁平足 ) Knock knee or Flat foot 運動鞋錯配 Wrong choice of shoes

14 成因 Causes 超負荷 Overloading 體重訓練強度量度遠超過肌肉及相關軟組織所能承受 Overweight and overtraining that exceed the body can handle

15 預防措施 Preventive Measures: 按部就班的訓練方法 Progressive training 留意身體反應 ( 紅橙綠訊號 ) Listen to your body for warning signals 有需要時應暫停訓練或調節形式量度及強度 ( 例如減少落山訓練加密步頻收細步幅 ) Take a break or adjust the type, volume or intensity of training (e.g. decrease downhill training, increase the cadence and decrease the stride length)

16 冰敷 Ice pack 冰敷患處分鐘 10 to 15 minutes 按需要一日可冰敷 3-5 次 3 to 5 times a day

17 功能性運動鍛煉以加強下肢肌肉耐力及關節穩定性 ( 臀大中肌及股內側頭 )( 例如棒式撐體蚌式運動阻力橫向滑步分腿蹲 ) Functional training to improve the joint stability and endurance strength of lower limb muscles (e.g. gluteal max., med., and vastus med.)(with plank, clam shell ex., side steps with resistance band, split squat)

18 棒式 Plank

19 蚌式運動 Clam Shell Exercise

20 阻力橫向滑步 Side Steps with resistance band

21 分腿蹲 Split Squat

22 利用泡綿滾筒 Foam Roller 放鬆下肢肌肉, 特別對四頭中外側及髂脛束等軟組織 Foam rolling to release the tightness of the muscles and fascia esp. lateral side of quadriceps and IT band

23 泡綿滾筒運動 Foam Roller Exercise

24 配合伸展運動, 保持下肢肌肉的柔韌性 Stretching ex to improve the lower limb flexibility 選擇合適的運動鞋 Right choice of sports shoe

25 股四頭肌 Quadriceps Femoris

27 髂腰肌 Iliopsoas

29 髂脛束綜合症 Iliotibial Band Syndrome

31 成因 Causes 下肢運動力學連鎖反應 Poor Lower Limb Biomechanics 髖部外展肌群變弱 ( 臀中股臀大股過弱 ) Weak hip abductors (Weak in Gluteal Max, Med) 髖部屈曲肌 ( 髂腰肌闊筋膜張肌 ) 髖部外旋肌 ( 梨狀肌 ) 及髖部伸展肌 ( 臀大肌和大腿後側肌群 ) 過度的緊繃 Tight hip flexors (iliopsoas, tensor fascia lata), hip external rotator (piriformis) and hip extensors (gluteus max., hamstrings)

33 成因 Causes 超負荷 Overloading 訓練量度 ( 長課 ) 遠超過肌肉及相關軟組織所能承受 Overtraining (too far too soon) that exceed the body can handle

34 預防措施 Preventive Measures : 按部就班的訓練方法 Progressive training 留意身體反應 ( 紅橙綠訊號 ) Listen to your body for warning signals 有需要時應暫停訓練或調節形式量度及強度 ( 例如暫停長課山路或單車訓練加密步頻收細步幅 ) Take a break or adjust the type, volume or intensity of training (e.g. stop long run, hilly run or bicycle training, increase the cadence and decrease the stride length)

35 冰敷 Ice pack 冰敷患處分鐘 10 to 15 minutes 按需要一日可冰敷 3-5 次 3 to 5 times a day

36 功能性運動鍛煉以加強下肢肌肉耐力及關節穩定性 ( 臀大中肌及股內側頭 )( 例如棒式撐體蚌式運動阻力橫向滑步分腿蹲 ) Functional training to improve the joint stability and endurance strength of lower limb muscles (e.g. gluteal max., med., and vastus med.)(with plank, clam shell ex., side steps with resistance band, split squat)

37 利用穴位按壓 ( 風市穴 ) 及 Foam Roller 放鬆下肢肌肉, 特別針對臀大肌梨狀肌闊筋膜張肌及髂脛束邊緣 ( 靠近股四頭肌及大腿後肌外側 ) Acupressure at Feng Shi (GB31) and foam rolling to release the tightness esp. gluteus max., piriformis, tensor fascia lata and IT band

38 按壓風市穴 Acupressure at Feng Shi

39 臀大肌 / 梨狀肌 Gluteus Max./Piriformis

40 闊筋膜張肌 Tensor Fascia Latae

41 髂脛束 IT Band

42 配合伸展運動, 保持下肢肌肉的柔韌性 Stretching ex to improve the lower limb flexibility 選擇合適的運動鞋 Right choice of sports shoe

43 股四頭肌 Quadriceps Femoris

44 闊筋膜張肌 Tensor Fasciae Latae

45 臀大中小肌及梨狀肌 Gluteal muscles and Piriformis

47 行山鞋的選擇

50 行山鞋的作用配合腳型, 有效分散壓力保持腳部平穩可吸震堅固的槓杆用作前推動力

51 找出自已的腳型正常的腳型扁平足高腳弓足

54 過度內翻正常體位過度外翻

55 扁平足支撐型運動鞋正常腳型中性型運動鞋高腳弓足吸震型運動鞋

56 支撐型運動鞋內側足弓處有較硬材質較硬及穩固腳撐矯形鞋墊

57 如何選擇行山鞋先了解腳型 ( 亞洲人腳型 ) 注意鞋的保護避震支撐及透氣等設計傍晚之後住試鞋自備行山襪腳跟留一手指的空間長度繫上鞋帶, 下蹲試鞋柔軟度

58 試行上落斜板或單腳趷高腳試鞋頭有冇頂趾新鞋一般要平日試著一兩星期才可落場操山行山鞋一般壽命 400 至 800 公里

59 功能性鍛煉運動 Functional Training

60 功能性鍛煉運動 Functional Training 的目為及性定穩節關強增量力肉肌升提度敏靈 The main goals are to improve the muscle strength, joint stability and body proprioception 核心肌群強化訓練 Core Stability Training 棒式 Plank

61 髖關節臀部及大腿肌肉強化訓練 Hip, Gluteal and Thigh Muscles Strengthening 蚌式運動 Clam Shell Exercise 分腿蹲 Split Squat

62 棒式 Plank 手肘 90 度屈曲, 上臂垂直支撐上身, 從肩膀到腳踝維持一直線, 腳掌與地面垂直, 腳趾著地 Elbow at 90 degree, plant the elbow directly under the shoulders, squeeze the scap., abs and glutes to stabilise the body 保持棒式姿勢 20~30 秒, 休息 15~30 秒, 重複 3-5 次 Hold 20-30s, rest 15-30s, rep. 3-5 times

64 常見錯誤 Most Commom Planking Mistakes 用手推導致身體往後 Overuse of upper limbs to push back 上背部肩胛骨沒收緊固定 Hanging on scapula, sagging of mid thorax 下背腰部下垂 Collapsing the lower back 臀部抬太高 Reaching the butt to the sky

66 變化棒式 Variations 側棒式 side plank 手部 / 上半身移動 with upper limb and trunk movement 腳部 / 下半身旋轉移動 with lower limb and trunk rotation

68 蚌式運動 Clam Shell Exercise 有效強化大臀及中肌 To strengthen the hip abductors such as glutes 垂正側躺, 雙腿併攏, 髖屈 45 度, 膝屈 90 度 Lie on side, legs together, bend hips to 45 degrees and knees at 90 degrees

69 收緊腰腹穩定骨盆, 保持雙腳腳跟併攏, 將上方的腿外旋, 抬高膝蓋指向上, 並維持 10 秒, 然後將上方腿放下 Set the core muscles to stabilise the pelvic, float the upper leg upwards while keeping the feet together, hold for 10s, then bring the leg down 左右腳重複動作 5-10 次 Repeat 5-10 times each leg

70 動作全程腰部以上維持穩定, 臀部在動作時, 不要同腰部一起轉 Focus on not allowing the alignment of the body to be disrupted with leg movement

73 短片示範 73 Clam Ex

74 分腿蹲 Split Squat 有效強化肌頭四及大臀及臀中肌 To strengthen the Glutes and Quads 立站步箭弓後前, 直腰, 後腳腳跟離地 Back straight, split steps with the heel of back leg off the ground 低蹲下向腿雙, 心重體身垂直前, 降下向於多屈不頭膝腳 90 度 Bend both knees to lower the body in a sagittal plan, both knees make roughly a 90 degrees angle in the bottom

75 蹲下與站起之過程中, 後腳之膝蓋不觸地 Back knee should not touch the ground. From the bottom position, stands back up. 複動作 5-10 次前後腳交換再做 Repeat 5-10 times each leg

76 正確示範 Correct

77 錯誤示範 Wrong 膝關節向內旋轉 Knee internal rotated 膝關節過份屈曲 Front knee too flexed

78 短片示範 78 Split Squat

79 進階 Progression 滑步式後弓步 Slide Board Reverse Lunge 後弓步 Reverse Lunge

80 短片示範 80 滑步式後弓步 Slide Board Reverse Lunge

81 短片示範 81 後弓步 Reverse Lunge

82 伸展運動 Stretching

83 伸展運動 Stretching Exercise: 動態 vs 靜態伸展運動前動態伸展運動後靜態伸展動態伸展 Dynamic stretching 開合跳高抬腿抱膝分腿蹲高抬腿跑踢臀跑前後交互腳步側跑

84 靜態伸展 Static stretching 了解所需伸展肌肉群的方向及位置確立一個穩固的姿勢動作要慢切忌彈動式伸展持續伸展 15 至 30 秒, 重覆 3 至 4 次

85 腓腸肌 Gastrocnemius

89 大腿屈肌群 ( 膕繩肌 ) Hamstrings

92 股四頭肌 Quadriceps Femoris

94 闊筋膜張肌 Tensor Fasciae Latae

96 髂腰肌 Iliopsoas

98 臀大中小肌及梨狀肌 Gluteal muscles and Piriformis

100 泡綿滾筒運動 Foam Roller Exercises

101 泡綿滾筒 Foam Roller 又名瑜珈棒瑜伽滾輪或按摩滾筒藉由滾筒於繃緊的肌筋膜上進行滾動及按壓以達至自我肌筋放鬆 A self-myofascial release technique to boost flexibility and recovery

102

103 禁忌症及需關注事項 Precautions and Containdications 骨質疏鬆症孕婦糖尿病兼有血液循環障礙下肢靜脈曲張受傷或腫脹的區域及關節位置上不可採用 Foam Roller 來進行自我按摩 Not to be used with conditions such as osteoporosis, pregnancy, diabetics, varicose vein or over joints, areas with soft tissues injury * 如有任何疑問, 應向醫生及相關專業人士查詢 Please check with the medical professionals for further enquiry

104 操作方式及注意事 How to use foam roller 藉由不同的體位, 將需要放鬆的身體部位置於 Foam Roller 上 Place the roller under the body part 利用身體四肢與地面的接觸面積, 來增減按壓時肌筋膜所受的力度 Use the limbs to support the body weight to reduce the pressure on the tender spot

105 透過緩慢的滾動, 尋找痠痛點, 並在痠痛點的附近, 來回滾動 5-10 次 Roll slowly 5-10 times over the area to locate the tender spot 亦可在痠痛點停住 ( 一般大約 20 秒 ), 直到痠痛減緩及軟組織變軟 Stay at the tender spot for ~20s

106 滾動或按壓時應盡量放鬆相關肌肉及保持呼吸 Need to stay relax and keep breathing 在訓練後 1 天內進行按壓, 再搭配靜態伸展運動使能達到最好的放鬆及復原效果 Best result with rolling and stretching within 24 hours of training

107 硬度 / 大小 / 長短的選擇 With different sizes, length and stiffness

108 比目魚肌 / 腓腸肌 Calf Muscles

109 短片示範 Foam Roller Calf

110 脛骨前肌 Tibialis Anterior

111 股四頭肌 Quadriceps Femoris

112 臀大肌 / 梨狀肌 Gluteus Max./Piriformis

113 短片示範 Foam Roller ITBand

114 闊筋膜張肌 Tensor Fascia Latae

115 髂脛束 IT Band

116 短片示範 Foam Roller Piriformis

117

118 Q & A

119 完成就是勝利!!!

Trailwalker 2009

Trailwalker 2009 樂施毅行者 2017 物理治療師的建議 Oxfam Trailwalker 2017 Physiotherapy Advice 熊國佳香港物理治療學會運動物理治療專研組 Frank Hung Hong Kong Physiotherapy Association Sports Specialty Group 內容 Content 毅行常見的肌肉骨骼傷患 Commonly Seen Musculoskeletal