WFU

2017年11月10日 星期五

關於跑者受傷這件事





路跑風潮

隨著跑步的人口增加,跑者據在一起討論的事情不外乎是比賽、成績、配備、運動傷害。在台灣當跑者有著運動傷害時,往往先試著按摩忍痛繼續練習,當疼痛影響到走路時才開始就醫。而台灣醫學對於運動醫學卻相當得漠視,但隨著近年來運動人口的增加,開始有逐漸改善的情況。

跑者的型態也開始從just finish,逐漸轉變成追求成績,傳統的練法跟科學化訓練都有不少支持者,但不變的是受傷的比例還是一樣的居高不下。Garmin、Nike、美津濃等廠商都有在辦馬拉松訓練營,有著專業的教練,比一般跑者更多的資源,但是受傷的人數絲毫沒有減少的狀況。每個訓練營不同的教練有不同的說法,但證據或許更能客觀的描述受傷這件事情。

常見的運動傷害及成因

跑者常見的運動傷害包含:足底筋膜炎、骼脛束摩擦綜合症、髕骨股骨症候群、脛前疼痛、疲勞性骨折、各種肌群拉傷等等。多數的運動傷害並不需要開刀治療,發生運動傷害的比例落在20-80%,隨著跑者的年資增加,產生運動傷害的比率有下降的趨勢。根據一個將近3000個跑者的研究,運動傷害容易發生在男性、一週跑6天以上、週跑量超過30mile的跑者身上。

除了少數的研究把受傷的特定原因單獨挑出來,大多數的研究認為受傷是多方原因造成的。少數特定原因包含之前有受傷的病史、沒有完整的復健治療、沒有找到受傷的原因、過高的跑量、肥胖等。各種多重加重因素包含個人的身體素質及外在的配備和訓練方式。

個人身體上的狀況常常被認為是導致受傷的原因,像是O型腿、 高足公低足弓等等,但是研究發現,這都找不到跟受傷明顯的關聯。但是如果肢體上有所不平衡(如長短腿),確實有可能會造成受傷。

性別在不同研究上有不同的發現,但總歸一句無法用性別來當作受傷的風險因子。年紀被認為是跑步受傷的原因,跟一般人想的不一樣,越年輕受傷的機會是增加的,當超過40歲後風險反而降低,但是這可能是當跑者在40歲以前受傷就會退出跑場,不再被列入統計,40歲以上的這些跑者反而是選擇性偏誤後剩下的一群。

當個人的身體似乎不是造成受傷的主因後,接著就要探討訓練的方式。當週跑量超過65公里後,被認為會增加受傷的機會,一些書上都會提到的,週跑量不要一週增加超過10%,要不然可能會增加受傷的風險,但在一些對於剛剛從是跑步訓練的跑者的研究上,發現這樣的法則得不到證據的支持(有經驗的跑者?),但是還是建議逐漸增加跑量而非突然大量增加跑量。

突然改變訓練的量跟方式,也是造成受傷的原因之一。而定期從事間歇跑被認為是可以預防膝蓋受傷。拉筋暖身被一般跑者是為避免受傷的一個重要儀式,但是找不到支持這樣做法的證據,但這可能牽涉到實驗設計的困難,拉筋暖身的方式太多樣化,無法好好設計怎樣的暖身是否可以避免受傷。

足測、跑鞋能降低受傷風險?


近幾年很流行的足測,廠商針對個人的腳型,跑步姿態去選購合適的跑鞋,結果許多臨床實驗發現這並無法降低受傷的風險。至於多久應該要換鞋呢,一般市售的跑鞋約在400-800公里的跑量後就會喪失一半以上的吸震能力,因此建議500-800公里就應該要把跑鞋給替換掉。

shoe drop(鞋跟到鞋底的落差,一般競速鞋大多為低落差6mm左右,強調高避震性的跑鞋通常超過10mm),再給跑者穿上0,6,10mm shoe drop的鞋後,發現10mm的組別,受傷風險明顯降低(Nike vaporfly 4%,adidas adios的競速鞋款剛好都是10mm)。

赤足或是極度薄底跑鞋(陸王?vibram)研究的樣本數量還是太少,但是初步認為使用這樣的穿著方式,會使步幅減少、中足或前足著地,初步認為可能可以降低受傷的風險。


延伸閱讀


Anatomy for Runners 跑者解剖學 (一)

Anatomy for Runners 跑者解剖學 (二)


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