今天’的客座博客作者将是  对你们这些人并不陌生 在推特上关注我们。德里克(@ DerekGriffin86)是MSK物理治疗师,拥有体育彩票大乐透博士学位和Twitter常规!他’也是一个方便的跑步者!他’非常慷慨地同意分享他对体育彩票大乐透的观点并解决棘手的问题,“why do I hurt?”…

德里克(Derek)引领潮流
德里克(Derek)引领潮流

了解跑步者的痛苦:我们是否落后于时代?

Injury and pain among runners are common across all levels of experience and competition. The causes of most pain and 受伤 in running are believed to be many but physical factors related to training loads, flexibility/muscle balance and biomechanics are among those most commonly cited. The majority of the research that has examined running-related injuries has focused on one or a combination of these factors.

Despite a growing body of scientific studies on running 受伤, it could be argued that the research to date is biased towards a “tissue-based” model of pain. Let me explain! Early models and beliefs about pain suggested that pain is generated by 受伤 or damage to our body tissues (e.g. muscle, ligament, tendon, bone). For example, when you sprain an ankle, a “pain signal”由韧带的组织损伤产生的“β-内酰胺”会导致体育彩票大乐透。而且,基于这样的理解,体育彩票大乐透被认为是组织健康的准确反映,而更多的体育彩票大乐透意味着更多的组织损伤。在关注这些信念的科学准确性之前,首先考虑以下传闻。

体育彩票大乐透与组织损伤:微弱的关系

退伍军人恩里科·伦托尼(Enrico Lentoni)在一次 最近的采访 the 受伤 he sustained during an explosion, while fighting in the Battle of the Bulge:

”一块弹片切开了他的脸的右侧,切开了他的胸部,打破了锁骨”.
However, despite the severe tissue 受伤 and damage, he felt no pain in the initial aftermath of the 受伤.
“他说,所有这一切一直没有痛苦。当炮弹爆炸时,脑震荡非常严重,我感觉不到体育彩票大乐透,但是却流了很多血。”
但是,这个故事有一个转折!
“爆炸三个月后,体育彩票大乐透开始了”, said Lentoni. “It was severe”, he said. “我头疼我的肩膀体育彩票大乐透。这种痛苦将持续到未来16年”

This example illustrates the disconnect between tissue damage and pain very well and casts doubt on the accuracy of traditional models of pain. When the tissue damage was severe, he reported little or no pain. However, three months after the 受伤 (when the tissues likely had healed), the pain began and continued for 16 years. A more recent example was that of a professional American basketball player who sustained a severe lower leg 受伤 during a match. His account of the experience was interesting (see picture below);

Please note the picture below contains a graphic image of an 受伤. 
点击图片放大。
IMG_0592

 

关于跑步相关体育彩票大乐透的现代解释:为神经科学腾出空间

Thankfully, many experimental studies have since supported these anecdotal accounts of a disconnect between tissue 受伤 and pain. 今天, pain is best understood as a perception, that is produced by the brain in response to perceived threat or 危险 (Moseley, 2012). At a most fundamental level, pain is an extremely sophisticated device that ultimately promotes survival (Crook et al. 2014). Our body tissues contain what can be considered “danger sensors”(科学上称为伤害感受器)可以提醒大脑注意“组织中的问题”这在跑步者中可能是过度训练负荷,生物力学改变,力量下降的结果& conditioning etc. In the presence of inflammation which results from tissue 受伤, these sensors become more sensitive and fire more readily (Basbaum et al. 2009). In many cases, pain will be experienced if the brain decides that protecting the painful body part is the most important thing for survival. For example, the pain of “shin splints” could mean that the bone and/or surrounding tissues is being subjected to too much stress. However under some circumstances, even in the presence of significant tissue 受伤, pain could impede survival and this explains why sometimes in the presence of severe tissue damage, the individual does not report significant pain. Consider the soldier that was injured in battle-it is quite conceivable that escape from the 威胁 environment (i.e. battlefield) was prioritised over protecting the injured tissues and this could explain the failure to experience much pain in the initial aftermath following the 受伤. So the brain literally weights up the options! Importantly the body tissues have NO ABILITY to produce pain by themselves. Instead, they send information to the brain and ultimately the brain make the final decision on what to do. As part of its decision making process it considers many other pieces of information i.e. the context surrounding the 受伤 (where it happened, how it happened, any immediate 危险 other than the tissue 受伤, previous similar injuries and their outcome). In reality, the brain can decide whether action is needed or not in response to the 危险 messages from the tissues depending on the specific circumstances. (Wiech et al. 2014) Sometimes it gets it right and other times it may get it wrong!

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Pain in runners: Injury, 灵敏度 or both?

上面的例子并不能说明组织损伤或损伤对于跑步者的体育彩票大乐透体验并不重要。常见的跑步伤害群(膝盖体育彩票大乐透,IT乐队,“shin splints”)建议“组织中的问题”至少部分负责。训练错误,肌肉无力/失衡/柔韧性问题以及跑步生物力学都可能“sensitise”通过响应组织过载等触发炎症来危害我们组织中的危险传感器。如前所述,“danger” information is sent to the brain for further processing and pain can be the response in an attempt to get the runner to take note and address the issue (ensure rest, appropriate rehabilitation etc.). To complicate matters, as the 危险 message travels to the brain, the message can be “edited” (turned up or suppressed) as it passes through the spinal cord. It is now well established in the literature that factors like poor sleep (Schuh-Hofer et al. 2013), negative expectations (Bingel et al. 2011; Kessner et al. 2014), worry, anxiety, depression (Ligthart et al. 2013; 2014), fear (Crombez et al. 2012) , stress (Chen et al. 2011; Fagundes et al. 2013; Scott et al. 2013) and negative beliefs about the 受伤 (Wiech et al. 2008; Wertli et al. 2014) all have the capacity to amplify the 危险 messages. Therefore the brain is alerted to more “danger”体育彩票大乐透反应可能无法反映组织损伤的程度。这样的因素可以“pre-sensitize”我们的神经系统,即使组织中的微小变化也可能导致体育彩票大乐透体验(Denk等,2014)。这导致了体育彩票大乐透与伤害之间重要的概念区别。尽管伤害(即组织损伤)通常与体育彩票大乐透有关,但对于经历体育彩票大乐透而言并不必要。睡眠不足,压力和焦虑等因素(称为“stressors”) can sensitize our “danger sensors”即使没有组织损伤也是如此。在这种情况下的体育彩票大乐透可以被视为增加“sensitivity”而不损害组织。考虑到这一点,有理由认为,仅考虑组织健康而不考虑这些其他因素将导致较差的结果。我认为这个词“sensitivity”比“injury”,后者专门指的是结构性损伤,很少或根本没有考虑过许多​​已知会影响体育彩票大乐透的其他非物理因素。期限“sensitivity”但是确实承认身体因素很可能是造成体育彩票大乐透的原因。

 

IMG_0591

 

您对自己的看法“injury”会影响你的痛苦

我之前提到过大脑如何处理和解释“danger”消息因上下文而异。大多数跑步者从严格的生物力学角度了解他们的痛苦,临床医生通常会强调自己的病痛或不善(太紧,不够强壮,动作不佳,跑步技巧不佳等)。这可能“threatening”大脑可以在决策过程中使用的信息,并可能导致“danger messages” being amplified or interpreted as more 危险ous than they really are (Legrain et al. 2011). 更多over runners gather information about their pain from different sources (Internet, fellow runners, previous experiences, clinicians) and all of this can have a significant impact on the pain that they feel. Basically, the more 威胁 or negative the information is, the more pain.

以类似于体育彩票大乐透的方式,最近的研究证实,比赛中经历的疲劳并非简单地反映出肌肉中正在发生的事情。相反,研究表明,听音乐,先前的积极经历,竞争对手的知识,接近终点线的知识等都具有影响疲劳和调节性能的能力(Noakes 2012)。它’s the brain that’体育彩票大乐透,疲劳和表现的最终控制者。

 

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管理与跑步相关的痛苦时间,让关节外思考!

There should be no recipes when it comes to addressing running-related pain. A good treatment plan always begins with a good assessment. Importantly however, while an assessment of the physical factors (training loads, previous 受伤, progressions, biomechanics, strength, flexibility etc.) is important, a “bigger picture”透视是必需的。基于我们对体育彩票大乐透的现代理解,应进行充分的循证评估(Vibe-Fersum等,2013; Jones& O’Shaughnessy 2014).

  • 生活方式因素,包括睡眠,饮食,体育锻炼,久坐行为
  • Cognitive factors (personal beliefs about the 受伤, what has the runner been told/advised by other?)
  • Psychological factors (such as worry, anxiety, fear, stress, life events and depression in relation to the 受伤/pain and in their everyday lives)
  • Individual factors (such as previous experiences, previous 受伤 & coping styles).

所有 of the above have the capacity to influence pain at many levels (Simons et al. 2014). The 灵敏度 of our “danger sensors” and our nervous system in general changes based on these factors regardless of whether there is any demonstrable tissue damage or 受伤. Furthermore, when 危险 messages are sent from the tissues, all of the above factors can change how the brain “interprets” these 危险 messages (Ursin 2014). Of course, assessing and managing the physical factors such as training loads, biomechanics, strength and conditioning etc is still important. However this “big picture”在我看来,当前有关跑步相关体育彩票大乐透的研究文献缺少这种观点。从跑步者对体育彩票大乐透的纯粹生物力学的理解到神经科学的理解的转变无疑将是一个值得发展的过程。

 

得到您期望的体育彩票大乐透(或缓解体育彩票大乐透)?

哪里“组织中的问题”(由于力量不足,生物力学改变等)是跑步者的重要因素’体育彩票大乐透,则需要通过基于锻炼的结构化康复计划来解决这些问题。然而,跑步者有一种新兴趋势,即依赖于不太可能改变结构或改善组织健康的干预措施。这些包括(但不限于)泡沫滚动,胶带,按摩,霜,油和手动疗法。这类干预措施通常会受到好运的跑步者和临床医生的积极评价。跑步者应认识到,通过这种干预获得的感觉到的体育彩票大乐透缓解通常是短期的,这是由于对感觉信息处理的改变(危险信号受到抑制)以及与治疗相关的积极期望(基于个人信念,热情的治疗师等)驱动的。是缓解体育彩票大乐透的关键因素。跑步者(和临床医生)需要意识到,他们对特定疗法的信念和期望会影响他们对该疗法的反应。有大量的研究证据清楚地表明,积极的期望可以通过多种疗法缓解体育彩票大乐透(Tracey 2010; Bingel等人2011; Schenk等人2014)。重要的是,这与所有治疗有关,包括绑带,泡沫卷起,力量训练,步态训练等,并且’许多干预研究都没有考虑期望的作用,这一点并不明显。当然,任何减少某人的治疗’痛苦永远很重要。然而,如果这种治疗是以更可能导致长期改善的治疗为代价的(由于强度,生物力学等的改变),那么这显然是一个问题。重要的是,缓解体育彩票大乐透并不意味着在最初情况下组织已经改变或参与了体育彩票大乐透。我们需要对如何进行一些干预保持开放的态度“work”特别是如果他们是“novel” or “trendy”。希望缓解体育彩票大乐透,您’可能会得到它!安慰剂对照研究和长期随访研究在现有文献中并不多。不管拟议机制看起来多么合理,在安慰剂之上和之外的许多干预措施的有效性仍有待确定。

 

概要

总而言之,问题的答案“why do I hurt?”很复杂。在我看来,对跑步的身体需求的传统关注和强调是错误的,不足以回答这个问题。新兴的关于体育彩票大乐透的研究强调必须关注跨身体,生活方式,认知,社会和心理领域的更广泛的问题。跑步相关的体育彩票大乐透可以比作拼图游戏。它由许多块组成,这些块以特定方式组合在一起以完成图片。大家’的图片是不同的,有些作品比其他作品更重要,但图片只包含所有作品。跑步者和临床医生的工作是确定每个人的身体状况,并据此设计康复计划。最后,这是伟大的埃塞俄比亚人Haile Gebrselassie的片段。它探讨了他如何在1996年的亚特兰大奥运会上获得亚运会金牌奖杯,尽管阿奇里斯持续遭受痛苦。一个真实的例子,说明周围的环境“injury”最终将决定您感到的体育彩票大乐透程度或功能丧失的严重程度。他的大脑可能更关心奥运金牌!!

 

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关键信息:

  1. 两者之间没有明确的关系“injury” and pain. 更多 受伤 does not necessarily mean more pain and vice versa.
  2. The next time you feel pain,ask the question: Am I injured or am I 敏化d? Of course it can be both as is often the case.
  3. 为了更好地管理您的体育彩票大乐透/受伤,必须考虑“big picture”除了传统的物理因素,例如强度,生物力学,柔韧性等。

在Twitter上关注Derek– @ DerekGriffin86

MISCP博士Derek Griffin博士
肌肉骨骼理疗专家
特拉利物理治疗诊所
月桂树法院角49号
橡树园路
特拉利,凯利
电话/传真:+353(0)66 7128863
www.traleephysio.ie

参考文献:

Moseley,G.L.(2012)。向人们传授体育彩票大乐透:为什么我们不断在丛林中跳动?体育彩票大乐透管理,2(1),1-3。

Crook,R。J.,Dickson,K.,Hanlon,R。T.,&Walters,E.T.(2014年)。伤害性敏化降低了捕食风险。生物学,24(10),1121-1125。

Basbaum,A。I.,Bautista,D。M.,Scherrer,G。,&朱利叶斯(2009)。体育彩票大乐透的细胞和分子机制。 Cell,139(2),267-284。

Wiech,K.,Vandekerckhove,J.,Zaman,J.,Tuerlinckx,F.,Vlaeyen,J.,&特蕾西(I.)(2014)。先验信息对体育彩票大乐透的影响涉及偏见的感知决策。 《现代生物学》,24(15),R679-R681。

Schuh-Hofer,S.,Wodarski,R.,Pfau,D.B.,Caspani,O.,Magerl,W.,Kennedy,J.D.,&Treede,R.D.(2013年)。一整夜的睡眠不足会促进全身性痛觉过敏的状态:一种替代性体育彩票大乐透模型,用于研究失眠与体育彩票大乐透的关系。体育彩票大乐透,154(9),1613-1621。

美国的宾格尔(Bingel),弗吉尼亚州的瓦尼加斯凯拉(Wanigasekera),肯塔基州的维希(Wiech),Mhuircheartaigh,R.N。,李(M.C.),波隆纳(Ploner),&特蕾西(I.)(2011)。预期的治疗对药物疗效的影响:对阿片类药物瑞芬太尼的镇痛效果进行成像。科学转化医学,3(70),70ra14-70ra14。

Kessner,S.,Forkmann,K.,Ritter,C.,Wiech,K.,Ploner,M.,&宾格尔(U.Bingel)(2014)。治疗史对治疗结果的影响:心理和神经生物学基础。 PloS one,9(10),e109014。

Ligthart,L.,Gerrits,M.M.,Boomsma,D.I.&Penninx,B.W.(2013年)。焦虑和抑郁通常与偏头痛和体育彩票大乐透有关:对相互关系的调查。体育彩票大乐透杂志,14(4),363-370。

Ligthart,L.,Visscher,C.M.,van Houtem,C.M.,Geels,L.M.,Vink,J.M.,de Jongh,A.,&Boomsma,D.I.(2014年)。荷兰人口样本中多种体育彩票大乐透症状和焦虑抑郁的合并症。体育彩票大乐透杂志,15(9),945-955。

Crombez,G.,Eccleston,C.,Van Damme,S.,Vlaeyen,J.W.,&Karoly,P.(2012年)。避免慢性体育彩票大乐透的恐惧模型:下一代。临床体育彩票大乐透杂志,28(6),475-483。

Chen X,Green,P.G., &Levine,J.D.(2011年)。压力增强了大鼠的肌肉伤害感受器活性。神经科学,185,166-173。

Fagundes,C.P.,Glaser,R.,&Kiecolt-Glaser,J.K.(2013年)。整个人生过程中充满压力的早期生活经历和免疫失调。大脑,行为和免疫力,27,8-12。

斯科特(Scott,K. M.),科嫩(Koenen),K。C.,阿吉拉尔(Aguilar-Gaxiola),S。,阿隆索(Alonso),J。,安格迈尔(Angermeyer),MC。… &Kessler,R.C.(2013年)。终身创伤事件与随后的慢性身体状况之间的关联:一项跨国,跨领域的研究。一,8(11),e80573。

威克(Wiech),波隆纳(Ploner),&特蕾西(I.)(2008)。体育彩票大乐透感知的神经认知方面。认知科学的趋势,12(8),306-313。

Wertli,M.,Burgstaller,J.M.,Weiser,S.,Steurer,J.,Kofmehl,R., &于美国(2014)。巨灾对非特异性下腰痛患者治疗效果的影响:系统评价。脊柱,39(3),263-273。

丹克(Denk),麦马洪(S.&特蕾西(I.)(2014)。体育彩票大乐透易感性:神经生物学的观点。自然神经科学,17(2),192-200。

Legrain,V.,Iannetti,G.D.,Plaghki,L.,&Mouraux,A.(2011年)。重新加载的体育彩票大乐透矩阵:人体的显着性检测系统。神经生物学进展,93(1),111-124。

Noakes,T.D.(2012年)。疲劳是大脑的一种情绪,它调节运动行为以确保保护全身的稳态。生理学前沿3。

盛传Fersum,K.,O’Sullivan,P.,Skouen,J.S.,Smith,A.,&Kvåle,A.(2013年)。基于分类的认知功能治疗对非特异性慢性下腰痛患者的疗效:一项随机对照试验。欧洲体育彩票大乐透杂志,17(6),916-928。

琼斯(L. E.),& O’Shaughnessy,D.F.(2014年)。体育彩票大乐透和运动推理模型:介绍用于综合体育彩票大乐透评估的简单工具。手动疗法,19(3),270-276。

西蒙斯(Simons,L.E.),埃尔曼(Elman),&Borsook,D.(2014年)。慢性体育彩票大乐透中的心理处理:一种神经系统方法。神经科学&生物行为评论,39,61-78。

Ursin,H.(2014年)。脑部对外部和内部刺激敏感。心理神经内分泌学,42,134-145。

特蕾西(I.)(2010)。获得您所期望的痛苦:安慰剂,nocebo的机制和对人体的重新评估作用。自然医学,16(11),1277-1283。

Schenk,L.A.,Sprenger,C.,Geuter,S.,&Büchel,C.(2014年)。一项功能性磁共振成像研究表明,期望治疗需要增强止痛效果。 PAIN®,155(1),150-157。

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