慢性疼痛不要只用筋膜槍 Massage is not the only way to release chronic pain

不是哪裡緊就放鬆哪裡

杜婉瑜 Diane

15 min readOct 23, 2020

在臨床上常常聽患者說：『我去讓人按摩，剛按完很輕鬆，但是過沒多久痛的地方還是痛』或『我平常就是痛了就打一下按摩槍，但是也沒真正好過』。這顯現出問題不在於被按摩的肌肉本身。

今天這篇文章就來談談為什麼筋膜槍不適合所有人，尤其是有慢性疼痛的患者。

疼痛的原因？

首先要了解為什麼會疼痛。最常見的有幾種：

肌肉筋膜緊繃

單純的運動，或活動、勞動力增加產生的肌肉痠痛緊繃。常見於假日運動員、搬家、大掃除過後等等。
→ 這時候使用筋膜槍是很好的選擇。

肌肉拉傷

突來的外力或不正當的使力讓肌肉無法保持正常長度，而產生的拉扯。常見於競技運動、搬重物、突然滑倒跌倒等等。
常常聽患者說『因為坐姿不良讓我的腰拉傷了』，但其實坐在那邊不會讓肌肉突然被拉扯。
→ 過了發炎腫脹期，可以使用筋膜槍放鬆拉傷與沾黏的肌肉。

韌帶拉傷

突然的外力、撞擊或是不正當的使力，讓關節位置不對導致連結的韌帶拉傷。常見於跌倒腳踝韌帶扭傷、運動膝蓋十字韌帶受傷、投球肩關節韌帶拉傷、手突然撐地手腕韌帶拉傷等等。
→ 在適當的韌帶保護下，可以使用筋膜槍『放鬆拉傷韌帶以外的肌肉組織』。

姿勢不良

＊現在大部分的人是這個問題＊
坐姿、站姿、運動姿勢不良、勞動姿勢不良都屬這類型。不良的姿勢會讓肌肉產生失衡，導致肌肉的僵硬與酸痛。
→不能單靠按摩放鬆解決問題，而要找出哪裡姿勢不良才能根治。

代償過後過度出力

姿勢不良後衍生的問題。當姿勢讓肌肉失衡時，會有些肌肉睡著不會用，另一些過度使用。舉個例子：如果一個人重心一直在左腳，左腳就會長期緊繃痠痛。過度使用的肌肉長期處在高張狀態，易緊繃、沾黏等問題。
→必須要喚醒睡著的肌肉，才能取得平衡。

關節壓迫

常見的問題像是椎間盤突出、骨刺、膝蓋退化等等。撇除先天骨骼發育不全者，這些通常是長期姿勢不良與代償的結果！當緊繃的肌肉無法繼續支撐，會直接影響到骨頭受力。因此，關節壓迫的人常發生於老年人，已經累積40–50年不正常的骨頭受力產生的結果。
→由於關節已經病變，因此按摩效果有限。需靠肌力的鍛鍊，才能撐起被壓迫的骨頭。

神經壓迫

神經的壓迫常見於腕隧道、坐骨神經、脊神經、臂叢神經等等。這些通常是長期姿勢不良與代償的結果！與關節壓迫非常相似，當有一定的壓迫累積，就會壓到神經組織。常有麻、痛、脹的感覺。
→解決神經的壓迫需要靠矯正姿勢與骨頭擺位才能得以減壓，筋膜按摩效果不能長久。

骨折

撞擊造成的骨折通常第一時間會被發現並且診斷。
不易發現的是骨質疏鬆者脊椎塌陷造成的骨裂，有時候會被誤診為肌肉緊繃或腰部常見的痠痛。若是牽扯到骨折，那必須要先解決骨頭結構的問題，同時確保骨頭的支撐性。
→骨折與骨裂的痛感與一般痠痛感不ㄧ樣。筋膜槍的震動反而會使疼痛更劇烈。

其它

臟器、腫瘤與免疫系統的問題疼痛也會反應在身體上。譬如說，心臟不適會有左肩痛的問題，有時候會被誤會是肩膀的發炎。有時候可以找到一個規律疼痛的時機，如：有氧運動後、飯後、飢餓時、半夜自己痛起來、晨間等等。如不是因為『做了某件事情』或『動了某個肢體』而產生的疼痛，則需近一步就醫檢查血液與臟器。
→早點就診檢查，比在家使用筋膜槍一直試圖放鬆本來就沒問題的地方來得安心。

能夠分辨出疼痛的來源，還是要請專業醫療人員診斷、照影像以及全身性的評估才會曉得！

I often hear my clients say: “I feel better after massage therapy, but it doesn’t last long.” or “I use massage gun to relieve my soreness whenever it gets worse, however, the pain is still there.” These tell us that the problem might not be from the muscle. Other solutions should be considered into therapy.
This article is to discuss why massage guns or massage therapy is not suitable for everyone, especially chronic pain patients.

Where does pain come from?

The first step is to find what causes pain; the following are some common examples:

Muscle and fascia tightness from activities

Tightness comes after “sudden” increasing of activities which do not happen everyday. For example: weekend athletes, whole house cleaning, moving or packing for a trip.
→ Massage is suitable for this situation.

Muscle strain

Muscle strains if there is a sudden force add on to your muscle which cannot maintain in the normal length. It is often seen in sport matches, lifting heavy weight and slipping accidents.
→ Massage can be used after inflammation phase for releasing scar tissues and tightness.

Ligament strain

When joints part during sudden external force or movement, ligaments are likely to be strained. For instance, ankle sprains and cruciate ligament strains.
→It is suitable to use massage guns to release muscle tissues around the injured ligament. It should be noted that ligament protection is important during massaging.

Faulty posture

***The Majority of people with chronic pain have posture problems***
Slouch sitting, crossing your legs and flat feet are examples of faulty posture. This may lead to muscle imbalance, tightness and stiffness.
→ Posture reeducation is recommended for this group of people.

Muscle compensation

Faulty posture can lead to muscle imbalance. Muscles may be lengthened and weak; some may be shortened and tight. The alterations of muscle tone is a muscle compensation, which can cause muscle pain and fatigue.
→ Instead of massaging tight muscles, we should first evaluate for any muscle compensations.

Joint compression

Some examples of joint compression are: disc herniation, bony spurs and joint degeneration. Uneven pressure to joints lead to bony deformation, which usually come from faulty postures. When fatigue (weak) muscles or other tissues no longer function as structural support, stress adds on to the bony structures.
→ Massage therapy has limited pain relieving effect on deformed joint (bone). Muscle strengthening around the joints is recommended.

Nerve compression

Carpal tunnel syndrome, sciatica, and thoracic outlet syndrome are common nerve compression diagnoses. It is also highly related to faulty postures and muscle compensation. You may feel numbness, pain and distending pain if the nervous tissues are compressed for a period of time.
→ To release nerve compression, posture reeducation is needed.

Fracture

Some cases with severe osteoporosis may have a high risk of compression fracture, which is not always the first to be diagnosed. Therefore, it is important to rule out any bony (structural) changes or fracture before any other conservative treatment.
→ Massage to the fracture site is a contraindication.

Others

Pain may exist in those with organ dysfunction, cysts or immune system problems. For example, pain refers to the left limb in patients with heart disease. This may lead to “misunderstanding” the problem source and delaying the right medical treatment. Therefore, if the pain does not improve after all kinds of treatment, blood work or whole-body check up is needed.
→ Seek for medical help early to prevent severe consequences.

To know what kind of pain you have, please seek your physician or physiotherapist for evaluation.

談談姿勢不良帶來的後果 Consequences of faulty posture

在臨床上遇到太多都是從姿勢不良衍生出肌肉過度使用、肌肉代償、韌帶壓迫、關節壓迫與神經壓迫相關的問題。
追溯到一開始，患者會說，
『剛開始時好時壞，吃個止痛藥熱敷就沒事，可是最近做什麼都沒辦法減輕疼痛』
或者『我的問題從學生的時候就隱隱約約的不適，最近因為工作了所以就變嚴重了』
還有『我的痛好像會跑來跑去，上次我按摩這裡不痛了，可是過沒幾天另一個痛點又跑出來』

Faulty posture or asymmetrical posture habits lead to many problems, such as muscle compensation, muscle overuse, bony and nerve compression.
Tracing back to the earliest symptoms, some may recall:
“When I take pain killers, the pain will go away. However recently, there is nothing I can do to relieve it.”
“I have had some back issues during school age, but it got worse when I started working full time.”
“The pain seems to change places, sometimes here, and sometimes there.”

共同點有以下這些：
1. 時間拖得非常久。沒有完整的處理過或是找到適合的治療方式。
2. 中間歷經很多變化（肌肉用力的方式，避免疼痛的姿勢與動作），養成了現在的問題。
3. 症狀常常出現於長時間固定在某個姿勢。如久坐、久站、躺。
4. 按摩會有短暫的放鬆效果。
There are somethings in common from these cases:
1. The problems are chronic and do not receive the right treatment.
2. Pain characteristic change over time due to posture compensations and muscle imbalance.
3. Symptoms aggravate during prolonged postures, eg, sitting, standing.
4. Massage slightly relives the pain for a short amount of time.

長期姿勢不良會形成惡性的循環。（如下圖）
Prolonged faulty postures cause a vicious cycle to the body. （See the figure below)