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[原因] 膝关节疼痛的造成因素

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    发表于 2017-4-7 10:26:11 | 显示全部楼层 |阅读模式
         膝关节是下肢运动中重要的关节,其独特的结构和功能使得人体可以完成许多复杂性的运动。比如:蹬伸、扭转、滑步移动、加速变向和减速制动等。
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         膝关节疼痛问题复杂多变,治疗时需要具体原因具体分析,从损伤机制的根源入手,才能取得疗效。一般来说,膝关节疼痛的原因总结有以下几点:
    4.2.jpg
    1.骨盆过度前倾或后倾的状态下腘绳肌长期处于被动拉长或缩短的状态。可能会导致作用于膝关节旋转功能受限或产生不必要的代偿,更会加大关节韧带和半月板不必要的负荷;腰骶区域的损伤也可能会造成膝关节肌肉功能减退,反之腘绳肌的过度紧张和无力也会造成腰部疼痛等问题的出现;
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    2.股二头肌的短头为单关节肌肉。在膝关节旋转异常的情况下,进行长期大负荷的运动经常会损伤到该肌肉,出现疼痛的位置往往在腓骨头周围或长短头肌腹和肌腱的连接处;
    4.4.jpg
    3.膝关节外侧和后外侧疼痛,可能和股二头肌、腘肌有关。大家往往忽略了腓肠肌内、外侧头对膝关节的影响;特别是在脚过度的内外八字的案例中,腓肠肌的内外侧头也经常处于疲劳状态;
    4.5.jpg
    4.半膜肌对膝关节后部和关节结构内部的稳定性起到重要作用,特别是在出现半月板损伤的案例中;
    4.6.jpg
    5.由于腘绳肌伸髋、屈膝和内、外旋小腿作用于下肢的功能不同,肌肉拉伤后疼痛的位置也有所差异,这与拉伤时的下肢动作有直接关系;也要考虑腘绳肌在下肢开链和闭链运动中功能性的转化。

    6.双关节肌肉收缩的主动不足和被动不足,往往代偿和肌肉劳损也是这样产生的;在治疗过程中,一定要充分考虑和利用双关节肌收缩的特性;
    4.7.jpg
    7.由于股二头肌的功能因素,在考虑膝关节功能及损伤的问题上,请不要忽略腓骨的存在和其在胫腓关节的运动;
    4.8.jpg
    8.腘绳肌可代偿前交叉韧带(ACL)的功能,有效防止胫骨相对股骨前移。出现前交叉韧带损伤的案例,必须加强腘绳肌离心和向心收缩的肌力康复训练;

    9.髋屈肌群过度活跃的情况下,臀大肌和腘绳肌会出现功能性减弱(交替抑制)的现象,这一点在身体其他关节也经常出现;
    4.9.jpg
    10.腘绳肌由于结构特点原因,不是最主要的髋伸肌肉,常常协助臀大肌进行工作。当主动肌臀大肌功能效率下降的情况下,协同肌腘绳肌被迫主导髋伸运动,长期处于被动疲劳的状态。造成膝关节旋转异常或肌肉拉伤,也会出现同功能肌肉的代偿性疼痛;两者也是背部运动链中重要的环节。

    11.膝关节过伸往往造成膝关节膝关节反屈过大,导致韧带和后侧关节囊长期拉长,会造成腘肌的代偿、损伤和产生疼痛。有时膝关节后部出现肿胀,并引起下肢功能障碍。所以很多女性在长期穿高跟鞋的情况下,出现膝关节疼痛实属正常。

    12.在临床上经常发现,很多膝关节疼痛的病例疼痛位置发生在膝关节的后侧。这与腘肌的保护性痉挛有直接关系,因为它经常在膝关节失稳的情况下扮演稳定关节的角色(特别是在韧带或半月板损伤的案例中)。膝关节稳定性受到影响时,腘肌更多的被动维持膝关节的稳定性,这样旋转膝关节的功能必然受到非常大的影响。

    13.臀大肌的旋转功能作用于股骨的外旋,当臀大肌旋转功能异常时,腘肌的离心收缩功能就非常费力。所以过度使用也会产生疼痛。从这一点也可以充分证明臀大肌在旋转股骨的功能上帮助膝关节减少屈膝解锁的异常有非常大的作用。(特别是在跳起到落地屈膝缓冲的动作中);臀大肌的功能性不足,往往会造成髌股关节综合症、梨状肌综合症、大腿后侧肌肉拉伤、前交叉韧带、半月板损伤、下背部疼痛等问题;

    14.股四头肌的紧张很容易造成髌股关节的压力,要想充分的放松、伸展股四头肌,仅靠拉伸是远远不够的。可选择利用主动肌与拮抗肌原理激活、练习臀肌和腘绳肌。
    4.10.jpg
    15.腘肌的离心收缩也可协助鹅掌垫肌肉完成胫骨旋转时的减速工作;

    16.膝关节的稳定性和运动控制能力,需要肌肉和韧带产生的力相互作用,对于控制水平面和冠状面的运动尤其重要;

    17.做手法需考虑如何通过胫骨的旋转,更准确的拉伸和训练刺激到腘绳肌内外侧不同的肌肉;

    18.腘绳肌伸展性不足时,完成下肢训练动作(如深蹲)会相应增加腰椎的剪切力;

    19.当髋关节充分伸展时,腘绳肌便会相对缩短,屈膝的作用较弱,股二头肌的短头和腘肌扮演非常重要的屈膝作用。



    本文源自:针刀临床实战AB班

    责任编辑:针刀李班长

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    发表于 2017-5-18 00:12:33 | 显示全部楼层

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