髕腱炎(Patellar Tendinitis)是一種過度使用的疾病，通常會影響運(yùn)動員，在一項研究中總發(fā)病率為 14% 。髕腱炎多見于跳躍運(yùn)動，在排球運(yùn)動員中發(fā)病率高達(dá)40%，籃球運(yùn)動員的髕腱炎患病率和發(fā)病率分別為 32% 和22 %。根據(jù)癥狀的嚴(yán)重程度，受嚴(yán)重髕腱炎影響的運(yùn)動員中有 30% 沒有重返運(yùn)動場，其中 50% 在診斷后 15 年仍存在膝痛 。在其他情況下，在治療 3 到 14 天的時間后可以恢復(fù)運(yùn)動。

癥狀：

隱匿起病的髕骨下緣膝前痛

初期：活動后疼痛

晚期：長時間屈曲疼痛（“電影院征”），活動時疼痛

在髕腱區(qū)域出現(xiàn)疼痛后，大多數(shù)人都會選擇進(jìn)行冷敷、抬高以及加壓，在急性期進(jìn)行軟組織損傷原則的處理是正確的，然而在急性期過后髕腱的處理至關(guān)重要。

本文主要是了解髕腱炎一線治療（保守）方案

1、非甾體抗炎藥?

在急性期和慢性期使用非甾體抗炎藥 (NSAID's) 治療肌腱病仍然存在爭議。據(jù)報道，非甾體抗炎藥會阻礙軟組織愈合。雖然疼痛可能會減輕，但它們對肌腱修復(fù)有負(fù)面影響。在反應(yīng)性肌腱病中，這可能是首選效果，因為這可能會抑制導(dǎo)致肌腱腫脹的蛋白質(zhì)。

2、皮質(zhì)類固醇注射?

皮質(zhì)類固醇用于減輕疼痛，但也減少細(xì)胞增殖和蛋白質(zhì)產(chǎn)生，因此可用于反應(yīng)性肌腱病。在肌腱注射后第 7 天和第 21 天重復(fù)使用肌腱周圍皮質(zhì)類固醇已顯示可減小肌腱直徑。

3、物理治療???

應(yīng)提供有關(guān)選擇性休息的建議，以便在一段時間的急性超負(fù)荷或不習(xí)慣的運(yùn)動后允許適當(dāng)?shù)募‰煊希ㄗC據(jù)水平：2a），應(yīng)重點關(guān)注盡早恢復(fù)活動。

使用髕骨帶和運(yùn)動膠帶對疼痛有短期效果。

髕骨帶以及肌貼

在因疲勞和高 SIN 而無法進(jìn)行等張運(yùn)動的情況下，等長收縮被建議作為一種可能的鎮(zhèn)痛運(yùn)動。（證據(jù)等級：2a）已發(fā)現(xiàn)等距運(yùn)動在減輕疼痛方面優(yōu)于有氧運(yùn)動和阻力運(yùn)動。

等長收縮

離心負(fù)荷一直是最主要的康復(fù)方法。證據(jù)表明，所有負(fù)荷計劃都有助于減輕疼痛和恢復(fù)功能，但離心-同心類型具有更高的患者主觀滿意度（證據(jù)水平：1a）。這可能是由于時間投入和計劃所需的痛苦。離心-同心練習(xí)可以從自重深蹲開始，但重要的是負(fù)重。腿部推舉或膝關(guān)節(jié)伸展等健身器材可控制負(fù)荷量。如果適合患者，杠鈴深蹲或箭步蹲可能是一個很好的進(jìn)階。

箭步蹲

肌腱神經(jīng)塑性訓(xùn)練

這是一種側(cè)重于運(yùn)動控制而不是肌肉力量本身作為治療肌腱病的負(fù)荷策略

肌腱神經(jīng)可塑性訓(xùn)練使用基于力量的訓(xùn)練和外部刺激作為優(yōu)化神經(jīng)可塑性的策略，這被證明對髕腱病有效。

動態(tài)神經(jīng)肌肉穩(wěn)定技術(shù)（DNS）

還研究了使用沖擊波等替代療法。已經(jīng)表明，沖擊波療法對于對常規(guī)療法無反應(yīng)的患者是一種安全的方法，應(yīng)始終與其他方法結(jié)合使用。（證據(jù)等級：1a）

沖擊波療法

USGET（引導(dǎo)電流電解技術(shù)）提供比沖擊波療法更好的結(jié)果，而且還結(jié)合離心運(yùn)動療法。（證據(jù)等級：1b）

超聲引導(dǎo)電流電解技術(shù)（USGET）

相關(guān)證據(jù)等級：

等長運(yùn)動可誘導(dǎo)鎮(zhèn)痛并減少髕腱病的抑制作用。（里約熱內(nèi)盧 2015）（證據(jù)等級 1b）

髕腱病：臨床診斷、負(fù)荷管理和具有挑戰(zhàn)性的病例介紹的建議。(Malliaris 2015)（證據(jù)等級 1a）

髕腱?。ㄌS膝）的物理治療。(Rudavsky 2014)（證據(jù)等級 1a）

跟腱和髕腱病負(fù)荷計劃。(Malliaris 2013)（證據(jù)等級 1a）

Abat, F. 等人?！氨容^超聲引導(dǎo)電流電解技術(shù) (USGET) 與常規(guī)電物理治療治療髕骨肌腱病的有效性的隨機(jī)對照試驗?！?實驗骨科雜志3 (2016)：PMC2017 年 12 月 19 日。（證據(jù)級別 1b）

物理治療師可能會推薦您一下這些運(yùn)動：

西班牙深蹲（等距運(yùn)動）

相關(guān)視頻請閱讀公眾號PT黃魯

跳箱運(yùn)動

下肢訓(xùn)練

跳箱運(yùn)動

功能性訓(xùn)練

我們拒絕標(biāo)準(zhǔn)化“食譜”式的治療，每個患者情況都是不同的，對于康復(fù)的反應(yīng)也是不同的，每位患者都是獨立的個體，任何康復(fù)計劃都應(yīng)該以患者目標(biāo)為中心。物理治療師是運(yùn)動專家，我們會根據(jù)您的身體情況個性化定制診療方案。

關(guān)于我們

SPTA致力于通過物理治療師的實踐，教育和研究，提高社會對物理治療在國家醫(yī)療保健系統(tǒng)中作用的認(rèn)識和理解，從而踐行物理治療行業(yè)愿景，改善人類健康和生活質(zhì)量。

想要了解更多關(guān)于診療服務(wù)、健康科普以及術(shù)后恢復(fù)，請持續(xù)關(guān)注我們

向作者咨詢

公眾號｜PT 黃魯

自媒體｜物理治療師黃魯

相關(guān)文獻(xiàn)：

1、Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. Journal of Foot and Ankle Research. 2020 Dec;13(1):1-0.

2、↑ Jump up to:2.0 2.1 2.2 2.3 Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. The Journal of orthopaedic and sports physical therapy. 2015 Sep:1-33. (level of evidence: 2a)

3、↑ Breda SJ, Oei EH, Zwerver J, Visser E, Waarsing E, Krestin GP, de Vos RJ. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British journal of sports medicine. 2021 May 1;55(9):501-9.

4、↑ Lian ?B, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports a cross-sectional study. The American journal of sports medicine. 2005 Apr 1;33(4):561-7. level of evidence 4

5、↑ Maffulli N, Oliva F, Loppini M, Aicale R, Spiezia F, King JB. The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy. Muscles Ligaments Tendons J. 2017;7(2):315-22.

6、↑ Maciel Rabello L, Zwerver J, Stewart RE, van den Akker-Scheek I, Brink MS. Patellar tendon structure responds to load over a 7-week preseason in elite male volleyball players. Scand J Med Sci Sports. 2019;29(7):992-9.

7、↑ Kumc.edu. (2017). JayDoc HistoWeb. [online] Available at: http://www.kumc.edu/instruction/medicine/anatomy/histoweb/ [Accessed 16 Sep. 2017].

8、↑ Palastanga N, Field D, Soames R. Anatomy and human movement: structure and function. Elsevier Health Sciences; 2012.

9、↑ Lin TW, Cardenas L, Soslowsky LJ. Biomechanics of tendon injury and repair. Journal of biomechanics. 2004 Jun 1;37(6):865-77.

10、↑ Zhang G, Ezura Y, Chervoneva I, Robinson PS, Beason DP, Carine ET, Soslowsky LJ, Iozzo RV, Birk DE. Decorin regulates assembly of collagen fibrils and acquisition of biomechanical properties during tendon development. Journal of cellular biochemistry. 2006 Aug 15;98(6):1436-49.

11、↑ McNeilly CM, Banes AJ, Benjamin M, Ralphs JR. Tendon cells in vivo form a three dimensional network of cell processes linked by gap junctions. Journal of anatomy. 1996 Dec;189(Pt 3):593

12、↑ Jump up to:12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine. 2009 Jun 1;43(6):409-16.

13、↑ Knapik JJ, Pope R. Achilles Tendinopathy: Pathophysiology, Epidemiology, Diagnosis, Treatment, Prevention, and Screening. J Spec Oper Med. 2020 Spring;20(1):125-40.

14、↑ Kountouris A, Cook J. Rehabilitation of Achilles and patellar tendinopathies. Best practice & research clinical rheumatology. 2007 Apr 1;21(2):295-316.

15、↑ Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T. Relationship between landing strategy and patellar tendinopathy in volleyball. British journal of sports medicine. 2007 Jul 1;41(7):e8-.

16、↑ Malliaras P, Cook J, Ptasznik R, Thomas S. Prospective study of change in patellar tendon abnormality on imaging and pain over a volleyball season. British journal of sports medicine. 2006 Mar 1;40(3):272-17、↑ Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD, Victorian Institute of Sport Tendon Study Group. The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Journal of Science and Medicine in Sport. 1998 Jan 31;1(1):22-8.

18、↑ Ferry ST, Dahners LE, Afshari HM, Weinhold PS. The effects of common anti-inflammatory drugs on the healing rat patellar tendon. The American journal of sports medicine. 2007 Aug 1;35(8):1326-33.

19、↑ Riley GP, Cox M, Harrall RL, Clements S, Hazleman BL. Inhibition of tendon cell proliferation and matrix glycosaminoglycan synthesis by non-steroidal anti-inflammatory drugs in vitro. Journal of Hand Surgery (British and European Volume). 2001 Jun 1;26(3):224-8.

20、↑ Fredberg U, Bolvig L, Pfeiffer‐Jensen M, Clemmensen D, Jakobsen BW, Stengaard‐Pedersen K. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper's knee and Achilles tendinitis: a randomized, double‐blind, placebo‐controlled study. Scandinavian journal of rheumatology. 2004 Mar 1;33(2):94-101.

21、↑ Tallon C, Coleman BD, Khan KM, Maffulli N. Outcome of surgery for chronic Achilles tendinopathy a critical review. The American Journal of Sports Medicine. 2001 May 1;29(3):315-20.

21、↑ Maffulli N, Testa V, Capasso G, Oliva F, Sullo A, Benazzo F, Regine R, King JB. Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients. Clinical Journal of Sport Medicine. 2006 Mar 1;16(2):123-8.

22、↑ Simpson M, Smith T. Quadriceps tendinopathy-a forgotten pathology for physiotherapists? A systematic review of the current evidence-base. Phys Ther Rev. 2011;16(6):455-61. (level of evidence: 2a)

23、↑ Reinking MF. Current concepts in the treatment of patellar tendinopathy. International journal of sports physical therapy. 2016 Dec;11(6):854.

24、↑ Naugle KM, Fillingim RB, Riley JL 3rd. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012 Dec;13(12):1139-50. doi: 10.1016/j.jpain.2012.09.006. Epub 2012 Nov 8. PMID: 23141188; PMCID: PMC3578581.

25、↑ van Rijn D, van den Akker-Scheek I, Steunebrink M, Diercks RL, Zwerver J, van der Worp H. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clin J Sport Med. 2019;29(3):181-7.

26、↑ Jump up to:27.0 27.1 27.2 Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes. Sports medicine. 2013 Apr;43(4):267-86.

27、↑ Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, Cook J. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2015 Sep 25:bjsports-2015.

28、↑ Kertzman, P., Lenza, M., Pedrinelli, A., & Ejnisman, B.(2015). Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature. Revista Brasileira de Ortopedia, 50(1), 3–8.

29、↑ Abat, F., Sánchez-Sánchez, J. L., Martín-Nogueras, A. M., Calvo-Arenillas, J. I., Yajeya, J., Méndez-Sánchez, R., … Gelber, P. E. (2016). Randomized controlled trial comparing the effectiveness of the ultrasound- guided galvanic electrolysis technique (USGET) versus conventional electro- physiotherapeutic treatment on patellar tendinopathy. Journal of Experimental Orthopaedics, 3, 34.

30、↑ The Knee Resource. Spanish Squats - Isometric Exercise for Patellar Tendinopathy. Available from: https://youtu.be/mik90mAS6fU [last accessed 01/03/2018]

31、↑ The Knee Resource. Patellar Te

ndinopathy Rehab - Isotonic Exercises. Available from: https://youtu.be/g0XPFL1IwEc [last accessed 01/03/2018]

32、↑ The Knee Resource. Patellar Tendinopathy Rehab - Energy Storage Exercises. Available from: https://youtu.be/ppBl9L-OlH4 [last accessed 01/03/2018]

33、↑ Patellar Tendinopathy Rehab - Kinetic Chain Strengthening Exercise. Available from: https://youtu.be/t1blThXvLIk [last accessed 01/03/2018]

Get Top Tips Tuesday and The Latest Physiopedia updates