【講師日記-專業課程教學筆記】
部落格好讀版:https://suzannettw.pixnet.net/blog/post/360808271
2021 第一堂 #KineticControl 課程由 CE-Low Back & Hip 揭開序幕
【指導動作 Palpation skill 也很重要 】
在冷冷6度的寒冬,主辦單位康卓健康 OPTimal COntrol Wellness Center 特別準備了暖暖包讓大家暖暖手,以免實作練習 palpation 時著涼。
在動作教學中,指導者的 hand cuing 是十分重要的一環,指導動作或是訓練時,教會個案自己 self palpation 也是非常重要的。
時常可以看到,只要個案自己的手一放上去,我們什麼都不必多做,馬上可以看到個案動作模式的改變。
與個案一起 palpate是學員們剛開始練習指導動作時,容易忽略的地方。
提醒大家一定要記得,指導動作時,教會個案 self palpation,可以讓你的動作教學得心應手許多。
【動作發想原則】
在課堂上,有一位學員無法在 standing 下做出 pelvis side shift 的動作,於是我請學員在 low bridge 下練習後,再回到 standing ,幅度明顯變大,感覺也輕鬆許多。
學員問我是怎麼想到要先在 bridging 下練習的呢?
很老實說,我沒有仔細想過這個問題,往往自己在練習或是在教動作時,各種五花八門的動作就會飛入我的腦海中;當一切變得太熟悉,往往會忘記當初這些動作是如何絞盡腦汁想出來的,一切是多麼的得來不易。
經由學員的提問,讓再次仔細整理了我的思路。
給魚不如給釣竿,除了分享我想到的訓練的方式外,我也想要跟大家分享我設計動作的思路以及靈感來源:
1.改變姿勢:同樣的動作,能不能在其他姿勢下完成
◼Upright: sit, stand, incline
◼Non- upright : supine, prone, side lying, crook lying, all four
2.外在刺激: facilitation / support/ resistance,透過調整外在刺激的強度、方向,讓動作變簡單或是困難
彈力帶、roller、瑜珈球、寶特瓶、棍子、巧拼、椅子、桌子、皮帶......都是個案方便取得的小道具
3.self feedback: 視覺/感覺/觸覺
用不同的方式讓個案試試看,哪種回饋對個案來說,可以減少或是增加難度
4.各種方式都先自己嘗試看看,或是大膽的在個案身上試試,沒有達到預期的效果,換一個方法就好。這個方案在A個案身上不適用,或許B個案會適用,每個個案都是獨一無二的,個案是我們最好的老師:)
5.絞盡腦汁還是想不出來,代表該再去進修上課了,不論是哪們哪派都好,只要能融會貫通都是好工具。
希望今天的筆記對各位有幫助,也希望各位在課堂上有所收穫,期待我們下次見:)
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🔔2021 CMS 課程一覽與報名連結:
https://optcontrol.wixsite.com/optcontrol/course-list
⭐ 康卓健康 Optimal Control Wellness Center
IG: optimalcontrol.wellness https://www.instagram.com/optimalcontrol.wellness/
⭐ 湯士萱物理治療師
IG: suzannetang.physio https://www.instagram.com/suzannetang.physio/
#康卓健康 #OPTimalCOntrolWellnessCenter #動作健康 #表現卓越 #MovementHealth #ComeraMovementScience #CMSAsiaHub #KineticControl #ThePerformanceMatrix #MovementSciencePractitioner #物理治療專業進修課程 #PTCPE #PhysiotherapyContinueProfessionalEducation
同時也有2部Youtube影片,追蹤數超過29萬的網紅ASMR Cham,也在其Youtube影片中提到,This ASMR video includes whispers, light triggers, brushing, ear cleaning and a scientist trying to experiment on you. When you woke up in the morning...
palpation 在 Hunter 物理治療師 Facebook 的最佳貼文
【踮起腳尖痛,腳踝也會有夾擠問題?】
(這次文章內容稍長,若懶得看文字內容可直接觀看影片)
大家應該對於肩夾擠、髖夾擠這兩個名詞不陌生,但你有聽過腳踝夾擠嗎?夾擠指的是我們的骨頭過度擠壓到周遭的軟組織,可能是肌腱、韌帶或是滑液膜等等,造成疼痛或角度受限。夾擠是一個症候群,並非一個特定的病症,夾擠症候群底這個名詞底下,可能夾到的組織不同,造成的原因歧異度也非常大,造成評估上其實並不是那麼容易。腳踝夾擠雖然沒有像肩夾擠一樣有被正式分類成不同的夾擠類型,但仍能根據症狀呈現的方式跟解剖構造簡單分為前夾擠跟後夾擠,若還要再細分還會分前內側、前外側夾擠,以及後內側、後外側夾擠。
前側夾擠的症狀主要出現在腳踝背屈末端角度的時候,脛距關節 (Tibiotalar joint) 前側的組織受到擠壓。腳踝前側的有不少脂肪、滑囊組織,正常情況,這些組織會在腳踝背屈15度過後受到擠壓,但如果在遠端脛骨前側或是距骨頸有增生的骨頭的話,便可能限縮前側的空間,讓組織提早受到壓迫。如果長期在這角度下活動,就可能進一步造成慢性的發炎,或是造成關節囊韌帶的增生。除此之外,如果腳踝曾經扭過傷,造成韌帶或皺襞增厚的話,也是可能造成前側夾擠的原因之一。
雖然這些解剖構造上的變化已有多篇文章有所描述。但造成這些組織增生的原因卻仍不是很清楚。因為運動員有比較高的比例有這樣的問題,有些學者認為前側夾擠可能是因為頻繁地做出大角度的背屈,或是因為運動過程中受到的外力,讓前側軟骨邊緣反覆受到衝擊所造成。也有些學者認為,踝關節的不穩定,造成關節有不正常的微小滑動,也是一個可能造成骨質增生、或是軟組織受到夾擠的的原因。另外在比較早期的文章,一開始學者認為前側的骨質增生可能是來自於頻繁地蹠屈,牽拉到關節囊,進而造成關節處的增生,只是這樣的假設被後來的研究給推翻了。
因為前側夾擠症狀大多是在腳踝背屈的末端角度下出現,上樓梯、跑步、走上坡、爬梯還有深蹲是幾個比較容易會加劇前側疼痛的活動。若未接受妥善治療,在症狀後期可能會因為組織的增生或疼痛,造成更進一步的活動度受限、夾擠和周圍組織的傷害,再回頭限制關節活動度與功能,形成惡性循環。
後側夾擠的症狀主要出現在腳踝蹠屈到末端角度的時候,脛距關節與距跟關節後側的組織受到擠壓。後側夾擠常出現在需要頻繁把腳踝往下壓的人身上,像是芭蕾舞者、需要頻繁跳躍的運動員等等。與前側夾擠雷同,後側夾擠可能是骨質或是軟組織的夾擠,或是兩者同時存在。距骨後外側 (trigonal process) 的骨質增生是比較常被認為導致後側夾擠的原因。除此之外,頻繁的將腳板大幅度的往下踩,可能會導致後側關節囊、後下脛腓韌帶、三角韌帶的後側韌帶發炎,產生疤痕組織,進而造成組織增厚。另外我們的屈足拇長肌的肌腱經過距骨後側的內、外骨突中間的凹槽,也很容易因為過度使用,或是周遭骨質的增生,造成肌腱病變,像是肌腱或腱鞘炎的問題。
與前側夾擠的疼痛大多較為淺層、可觸摸的到相反,後側夾擠的症狀通常較為模糊,比較難有一個特定的單點疼痛,而且位置較深,通常落在阿基里斯腱底下。這也讓後側夾擠不容易和阿基里斯腱或是腓骨長肌的問題做區分。因為症狀出現在腳踝往下踩的時候,走下坡、下樓梯或是穿鞋跟較高的鞋子是幾個容易誘發症狀出現的活動。芭蕾舞者之所以比較容易出現這樣的症狀,被認為是因為需要頻繁的做出踮腳站,承重在前足的關係。
雖然影像檢查出來的骨質、軟組織的病變被認為是可能導致腳踝夾擠的原因之一,但實際上研究還是有提到,我們仍然不能光靠這些影像結果證據就判斷踝關節是否夾擠。影像檢查與我們的症狀表現之間的相關程度有限,仍需要結合其他理學檢查做綜合判斷才行。針對踝關節夾擠的介入,目前比較常見的作法仍是先採取保守治療,若在急性疼痛期,需要先避免會造成疼痛的動作,有必要的話也會使用消炎藥來控制疼痛。在非急性期,甚至是已經是慢性問題的個案,我們則需要著重在踝關節穩定、本體感覺的訓練上,畢竟前面有提到,踝關節不穩、扭傷都是可能造成夾擠的原因之一。與其他肌肉骨骼問題一樣,即使解剖構造上的異常也會被認為是造成踝關節夾擠的原因,但大多數的個案都能在不開刀的情況下有很好的進步。若有類似的狀況,一樣記得先找醫療人員的協助,避免症狀隨著時間越變越嚴重。底下的影片 (6:52) 將跟大家分享幾個簡單的踝關節穩定與本體感覺的訓練。
Impingement syndrome is a common musculoskeletal problem in shoulder and hip joints. But have you ever heard of ankle impingement? Impingement syndrome refers to abnormal contact of bony structures or soft tissue, e.g., tendon, ligament, synovial tissue, resulting in pain and restriction. Through different causes of impingement syndrome, it includes different medical signs or symptoms. Therefore, causes of impingement syndrome differ from person to person, making it more difficult to make a right diagnosis. Although ankle impingement is not officially classified into different types like shoulder impingement, researchers still sort it into anterior and posterior impingement according to anatomical structures are involved. More specifically, it can be classified into anteriomedial, anteriolateral, posteriomedial and posteriolateral impingement.
Symptoms of anterior ankle impingement are generally induced by compression of anterior margin of tibiotalar joint in terminal dorsiflexion. There are adipose and synovial tissues in the anterior joint space. Normally, these tissues are compressed after 15 degree of dorsiflexion in healthy individuals. However, if there is osteophyte at anterior distal tibia or talus neck, it will take up the space and limit ankle movement, causing early compression. This will result in chronic inflammation, synovitis, and capsuloligamentous hypertrophy. Apart from this, ankle sprain, thickened anterior tibiofibular ligament and synovial plica are also possible causative factors.
Even though structural pathologies are well described in much research, their exact etiologies are still less understood. Research showed that athletes are tend to affected by anterior impingement, and it led to hypothesis that pathologies are caused by repetitive impact injury to anterior chondral margin from hyper-dorsiflexion or direct impact during sports. Chronic ankle instability has also been hypothesized to be the causative factor of anterior impingement, because abnormal repetitive micromotion may develop bony and soft tissue lesions. In addition, early research hypothesized anterior osteophyte is caused by traction to the anterior capsule during repetitive plantar flexion, but this theory was disproved by later anatomic studies.
Anterior impingement symptom typically presents as anterior ankle pain during terminal dorsiflexion. Climbing stairs, running, walking up hills, ascending ladders and deep squat are common aggravating activities. If anterior impingement doesn’t get treated well, in the later stage, joint mobility may be further restricted due to mechanical block or pain, resulting in vicious circle.
Posterior ankle impingement symptom typically occurs in terminal plantarflexion, due to compression of tissues posterior to the tibiotalar and talocalcaneal joint. Posterior impingement tend to occur in athletes who need to plantarflex frequently, like ballet dancers, etc. Similarly, posterior impingement can result from compression of bony or soft tissue in isolation or in combination. Trigonal process of posterior talus is the most common cause of posterior impingement. Besides this, repetitive hyper-plantarflexion may cause posterior capsule, inferior tibiofibular ligament, and posterior fiber of deltoid ligament inflammation, scarring, and thickening. Lastly, tendinitis and tenosynovitis are easily found in flexor hallucis longus tendon, running between the medial and lateral posterior process of the talus. This probably results from overuse or irritation from surrounding abnormal bony tissue. The tissues mentioned above are all possible causative factors to the posterior ankle impingement.
In contrast to patients with anterior impingement pain that are accessible to palpation, posterior impingement pain is less specific, deep to the Achilles tendon. This makes it difficult to differentiate from Achilles tendon or peroneal tendon pathology. Since posterior impingement symptom is usually irritated by repetitive plantarflexion, walking downstairs, downhill running, and wearing high-heeled shoes are some common exacerbated activities to posterior impingement syndrome. Ballet dancers are commonly affected by posterior impingement syndrome due to weight bearing on forefoot in plantarflexion position over and over again.
Though osseous or soft tissues abnormality in radiography is seen to be one of the causes of ankle impingement, it doesn’t mean that we can simply blame patient’s symptom on these structural pathology. In fact, there is a limited correlation between medical image findings and our symptom. We should integrate patient’s history, physical examination, imaging studies, etc., for accurate diagnosis. Conservative treatment remains first option to manage ankle impingement. In acute stage, patient should avoid from doing provocative activities. If it is necessary, NSAIDs can be used for pain management. In chronic stage, clinicians should focus on ankle stability and proprioception training because ankle instability and sprain are both causative factors of ankle impingement. Just like other musculoskeletal disease, even though structural abnormality is thought to be a possible cause of ankle impingement, most ankle impingement cases still respond well to conservative treatment. If you have any similar medical problem, please find medical professions for help. The video below will show you some simple ways to train our ankle stability and proprioception.
參考資料:
https://pubmed.ncbi.nlm.nih.gov/27608626/
https://link.springer.com/article/10.1007/s00247-019-04459-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065672/
#腳踝夾擠 #踝關節不穩 #腳踝扭傷 #本體感覺訓練 #物理治療 #ankleimingement #ankleinstability #anklesprain #proprioception #physiotherapy #hunterptworkout
palpation 在 湯士萱物理治療師 Suzanne Tang Physiotherapist Facebook 的最佳解答
【2019 10th World Congress Low Back and Pelvic Pain
Antwerp, Belgium 系列】
Workshop 1 (October 27)
Diane Lee, PT, Canada
【Diastasis Rectus Abdominis – Implications for Assessment & Treatment of Thoraco-Lumbar Pelvic Pain & Disability 】
Great workshop day with Diane Lee 😍
⬛️Inspiring points:
◼️Palpation SIJ movement 的新手勢
◼️Detailed anatomy of abdominal
EO, IO & TrA palpating 及 cuing isometric contraction 的方式
◽️EO:decrease xiphoid angle
◽️IO: increase xiphoid angle
◽️Upper TrA: hug the rib cage
◼️Head curl up observation: EO dominant? IO dominant? RA dominant?
◼️Linea alba palpation 及張力評估
腹橫肌分成上中下三個部分,需分開評估
◼️腹直肌分離,最重要的不是縮小腹直肌間的間距,而是重新建立 fascia tension。
◼️重新建立 fascia tension 就如訓練 tendinopathy 一樣,後期需 overloading training
🔴再次強調,臨床上絕對不會用單一一個測試來斷定診斷結果,必需整體考量主訴、病史、多個測試,得到最完整及精確的診斷
————————————————————————
練習第一個測試動作,Diane 老師確認了我們的檢查結果,說:「非常好,這是一個正常的SIJ!」
心想:「耶!我的 SI 終於恢復正常,我終於可以脫離「病人示範組」了!」
第二個 practice 是要露出肚皮,觀察收縮腹橫肌時,肚子形狀的變化,沒想到 Diane 老師看完我的肚皮後就緊緊牽起我的手說:「Suzanne 來~」
「來喔~大家來看一下Suzanne 的肚子」
然後....我就又成了有趣的示範model 😅
Diane 老師還用超音波看了我的腹橫肌
幸好最近肚子練得還不錯,這告訴我們隨時都要練好,因為出來上課隨時都可能被抓上台展現肚皮😆
p.s. Robert Schelp 坐在我們左邊耶~
palpation 在 ASMR Cham Youtube 的最佳解答
This ASMR video includes whispers, light triggers, brushing, ear cleaning and a scientist trying to experiment on you.
When you woke up in the morning you were a giant(。☉∆☉)wow☆
Don't worry. I will investigate and experiment on you.
Do you see me? Do you listen to me?
Please relax, relax , relax👩⚕️
Click the bell to have notifications, like & subscribe :)
Thank you for your support🌸 https://www.patreon.com/ASMRCham
(Special Videos per a month♡)
⭐Timeline⭐
00:00 ara ara?
01:08 palpation
02:42 giant's face measurement
06:26 examine eyes and ears (light trigger)
08:19 giant’s ear cleaning
16:04 feather pick
22:10 eyebrow cut
27:09 brushing
33:01 extra
…………………………………………………………
⭐Membership(special video per month) https://www.youtube.com/channel/UCRz3cGfqeMPSHMBN6CxKQ9w/join
⭐Paypal:https://paypal.me/ASMRCham
⭐️Twitter:https://twitter.com/ChamAsmr
⭐️Instagram:https://www.instagram.com/cham_asmr
⭐E-mail:cham_asmr_niconico@yahoo.co.jp
palpation 在 ASMR Cham Youtube 的最佳貼文
This ASMR video includes closeup whispers, light triggers, glove sounds, skin sounds, scalp massage, ear cleaning. Click the bell to have notifications, like & subscribe :)
I've always wanted to shoot medical ASMR videos, and this time it finally came true 👩⚕️
When I saw myself wearing a white coat, I remembered that I was wearing it in a science class when I was a student, and it was nostalgic 💓
I hope you will enjoy it ☺️
I went to a dermatologist during this time (because my eyelids have pain).
So the moment I entered the doctor's office and saw a female doctor in a lab coat, I was moved by the fact that it was exactly the same as the ASMR RP😂lol
Thank you for your support🌸 https://www.patreon.com/ASMRCham
(Special Videos per a month♡)
⭐Timeline⭐
00:00 Intro
00:24 putting gloves (gloves sound)
00:53 Palpation (hand movements)
03:54 checking your eyes (light trigger)
14:29 checking your eyes (finger movements)
19:08 examing scalp (scalp massage)
27:04 hearing test (closeup whisper)
32:19 checking ears (light trigger/whisper)
35:42 cleaning ears
41:08 after the medical exam
…………………………………………………………
⭐Membership(special video per month) https://www.youtube.com/channel/UCRz3cGfqeMPSHMBN6CxKQ9w/join
⭐Paypal:https://paypal.me/ASMRCham
⭐️Twitter:https://twitter.com/ChamAsmr
⭐️Instagram:https://www.instagram.com/cham_asmr
⭐E-mail:cham_asmr_niconico@yahoo.co.jp
palpation 在 Palpation - Medical Encyclopedia - MedlinePlus 的相關結果
Palpation is a method of feeling with the fingers or hands during a physical examination. The health care provider touches and feels your ... ... <看更多>
palpation 在 PALPATION在劍橋英語詞典中的解釋及翻譯 的相關結果
palpation 的意思、解釋及翻譯:1. an examination of something, usually an organ or part of the body, by touching it with the…。了解更多。 ... <看更多>
palpation 在 Palpation - Wikipedia 的相關結果
Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health ... ... <看更多>