簡單好懂的醫療知識
拉近你與健康的距離

什麼是胸大肌拉傷?2步驟復健治療緩解

在初步的客觀評估,我們可以看到左肩前外側有一個小瘀青,左胸大肌的外緣也有一塊肌肉凸出來。我請Allan把雙手往上舉高,在舉到快180度的時候他說會有明顯疼痛感。接著我針對肩關節週邊肌群做阻力測試,明顯的看到在左手往內夾(飛鳥夾胸的動作)會有無力感,當手往外打開的時候也會有疼痛。

💥 Pectoralis Tear(附中文)
“What do you need to know”

Allan came forward to me last week suffering from pain after trying for his bench press PR. He was worried that his injury might to be risky to keep training. So he decided to consult a physical therapist before going back to training

Upon initial observation, we can see a small bruise on the left anterior shoulder, and a bulge of muscle lateral to the pectoralis major. I asked Allan to raise his arm up and pain resulted. I followed with a series of resistance test of the shoulder joint. There was weakness in horizontal adduction of the arm and when the arm is outstretched to the side

To determine the severity of tendon injury, I follow the general grading for tendon rupture:

Grade I : Overstretching of a tendon without a loss of function
Grade II : Continuity of the tendon is intact but strength is significant reduced
Grade III : Complete disruption of a tendon

From my objective evaluation, Allan’s injury is a typical Grade I to II pectorals tendon tear. I suggested an MRI with the orthopedic doctor for a follow-up. In the next video I will be posting what exercises I gave him.
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💥 胸大肌拉傷
“個案分享”

Allan 上禮拜嘗試卧推PR後,因為胸大肌的疼痛來就診。他很害怕這個受傷會讓他不能繼續訓練,決定先找一個物理治療師評估一下,看看專業的意見,給他訓練上的建議

在初步的客觀評估,我們可以看到左肩前外側有一個小瘀青,左胸大肌的外緣也有一塊肌肉凸出來。我請Allan把雙手往上舉高,在舉到快180度的時候他說會有明顯疼痛感。接著我針對肩關節週邊肌群做阻力測試,明顯的看到在左手往內夾(飛鳥夾胸的動作)會有無力感,當手往外打開的時候也會有疼痛

要如何決定拉傷的嚴重度?我參考一般臨床肌腱拉傷的分級:

第一級: 輕度拉傷,功能不受影響
第二級 : 中度拉傷,肌纖維中度損傷,但肌纖維不完全斷裂,肌力明顯受影響
第三級 : 重度拉傷,肌肉完全斷裂


從我的客觀評估,明顯的能判斷Allan的疼痛是因為胸大肌肌腱第一到第二級拉。我建議他找骨科醫生做進一步諮詢,照核磁共振確認受傷的狀況。下一篇發文我會告訴大家胸大肌拉傷的運動
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#jamesthephysio signing out
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#physicaltherapy #physiotherapy#rehab #dpt #prehab #physio#exercises #workout #functionalfitness#strengthandconditioning#functionaltraining #personaltraining#injuryprevention #fisio#fisioterapeutas #fitness #pectear#tendon #物理治療 #運動醫學 #肌腱拉傷 #重訓 #概念 #相信專業 #預防 #健康促進

 

💥 Rehab for Pectoralis Tear(附中文)
“ Isometrics “

Let us revisit my latest case of pectoralis tear. Allan is experiencing pain trying to lift his arm up actively, and stretching out wide to the side can result in pain. When I ask him to relax and let me lift his arm up, still he would experience pain at 160º of flexion.

In an acute case of Grade I to II muscle tear, it is not advisable to conduct isotonic exercises. So what kind of exercises can we do ? Simple. Isometrics ! The safest way to exercise

Here are the exercises I gave him:

1️⃣ Banded Iso Flexion Hold
2️⃣ Foam Roller Extension Hold

There is nothing special about these exercises, especially when clinicians are unsure of the patient condition, start from easy and simple exercises might reap the best results for the patient

The point being, exercises do not have to be complicated ! I often tell my patients, there is no good or bad exercises, there is just LOAD, and all depends on how it is programmed. Put all the “ breathing quackery “ , “ fascial sling “ , “ ultra-functional training “ aside, I would suggest start with easy, simple, straightforward exercises
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💥 胸大肌拉傷治療
“ 等長訓練 “

我們再來看一下我最近胸大肌拉傷的案例。Allan主訴說拉傷後舉手會痛,手往外水平打開時也會痛。我請他手放鬆,再把他的手被動往上帶,在往上舉快160º依然也會感覺疼痛

第一到第二級肌肉拉傷的個案,急性期是不建議用等張運動來做治療或訓練。最安全的方式是做等長收縮訓練,以下是我給他的運動:

1️⃣ 彈力帶肩關節屈曲等長收縮
2️⃣ 滾筒肩關節伸直等長收縮


這些運動不是什麼特定系統的運動,就只是簡單遵守物理治療原則而設計的運動,特別當你對病人的狀況不確定時,更應該保守一點,為病人最大利益設想

最後,其實想帶出一個重點,運動不需要弄得很玄很複雜,運動也沒有所謂的好壞之分,只有運動的負荷多與少,按治療師的計劃跟訓練目的,沒有運動是不好的。我常建議其他治療師,先不要想著一來就要練「蛤蟆呼吸法」、「功能性筋膜訓練」,先從根本的動作出發,改變負荷,運動處方應該先從簡單開始
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#jamesthephysio signing out
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#physicaltherapy #physiotherapy#rehab #dpt #prehab #physio#exercises #workout #functionalfitness#strengthandconditioning#functionaltraining #personaltraining#injuryprevention #fisio#fisioterapeutas #fitness #pectear#tendon #物理治療 #運動醫學 #肌腱拉傷 #重訓 #概念 #相信專業 #預防 #健康促進

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