關於 muscle assessment ，我們在網路上蒐集到這些相關的討論、資訊與評價

#維生素D 與骨骼健康、曬太陽可合成…這類的資訊大家已經有觀念了🌞
近年研究也發現缺乏維生素D與慢性發炎、罹癌率和免疫力等有關。
那與運動表現呢❓

⚠️維生素D與維護肌肉正常功能有關。

但你知道嗎，根據統計台灣成年人約有六成，體內維生素D不足，和年齡、性別、生活作息、飲食、膚色等都有關係
➡️男性（尤其肥胖的男性）和停經後的婦女最常見

而運動員之間相比較，與他們「照射陽光」的時間有關，
例如：訓練地點的緯度（影響可日照時間）、季節、室內外運動的不同，

➡️平均有 #超過六成的 #室內運動員經檢驗 發現維生素D不足

👨🏻‍⚕️部分研究顯示，連續8週每天補充5000IU維生素D，與肌肉骨骼性能改善有正向影響，
（無論是對運動員或健康的一般人，垂直跳躍高度和10公尺衝刺時間等運動表現都有進步）。
其他研究則顯示體內維生素D含量，與左手握力和下肢力量有顯著相關，有補充維生素D的運動員，在負重反握引體向上這項測驗發現表現更好。

但也不全然實驗都是正面結果，也有些實驗的結果是沒有顯著影響，因此維生素D對運動表現性能還有待未來更多進一步實驗探究。

最後，除了透過每天日曬、日常攝取富含維生素D的食物外，嚴重不足者亦可透過額外補充維生素D加快補充！

資料來源：
1. Al-Horani, H., Abu Dayyih, W., Mallah, E., Hamad, M., Mima, M., Awad, R., & Arafat, T. (2016). Nationality, gender, age, and body mass index influences on vitamin D concentration among elderly patients and young Iraqi and Jordanian in Jordan. Biochemistry research international, 2016.

2. AlQuaiz, A. M., Kazi, A., Fouda, M., & Alyousefi, N. (2018). Age and gender differences in the prevalence and correlates of vitamin D deficiency. Archives of osteoporosis, 13(1), 1-11.

3. Close, G. L., Russell, J., Cobley, J. N., Owens, D. J., Wilson, G., Gregson, W., ... & Morton, J. P. (2013). Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. Journal of sports sciences, 31(4), 344-353.

4. Fairbairn, K. A., Ceelen, I. J., Skeaff, C. M., Cameron, C. M., & Perry, T. L. (2018). Vitamin D3 supplementation does not improve sprint performance in professional rugby players: a randomized, placebo-controlled, double-blind intervention study. International journal of sport nutrition and exercise metabolism, 28(1), 1-9.

5. Farrokhyar, F., Tabasinejad, R., Dao, D., Peterson, D., Ayeni, O. R., Hadioonzadeh, R., & Bhandari, M. (2015). Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis. Sports medicine, 45(3), 365-378.

6. Johnson, L. K., Hofsø, D., Aasheim, E. T., Tanbo, T., Holven, K. B., Andersen, L. F., ... & Hjelmesaeth, J. (2012). Impact of gender on vitamin D deficiency in morbidly obese patients: a cross-sectional study. European journal of clinical nutrition, 66(1), 83-90.

7. Książek, A., Dziubek, W., Pietraszewska, J., & Słowińska-Lisowska, M. (2018). Relationship between 25 (OH) D levels and athletic performance in elite Polish judoists. Biology of sport, 35(2), 191.

8. Verdoia, M., Schaffer, A., Barbieri, L., Di Giovine, G., Marino, P., Suryapranata, H., ... & Novara Atherosclerosis Study Group. (2015). Impact of gender difference on vitamin D status and its relationship with the extent of coronary artery disease. Nutrition, Metabolism and Cardiovascular Diseases, 25(5), 464-470.

9. Wiciński, M., Adamkiewicz, D., Adamkiewicz, M., Śniegocki, M., Podhorecka, M., Szychta, P., & Malinowski, B. (2019). Impact of vitamin D on physical efficiency and exercise performance—A review. Nutrients, 11(11), 2826.

10. Han, Q., Li, X., Tan, Q., Shao, J., & Yi, M. (2019). Effects of vitamin D3 supplementation on serum 25 (OH) D concentration and strength in athletes: a systematic review and meta-analysis of randomized controlled trials. Journal of the International Society of Sports Nutrition, 16(1), 1-13.

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【矯正性運動（Corrective exercise）】

上篇『肌肉失衡』的文章，談及了「什麼是肌肉失衡、造成的原因、以及可能帶來的影響』，這篇會討論常用來處理肌肉失衡的方式：矯正性訓練（Corrective exercise）。

在進入主題前，整理上篇肌肉失衡的重點：

・許多慢性疼痛、沒有辦法根治的緊繃或痠、無法進步是源自於肌肉失衡
・肌肉失衡指的是：兩邊對側肌肉（相互拮抗的）在肌力、長度、穩定性等上有差異
・肌肉失衡造成的原因包括：長時間的姿勢、重複性的動作、運動專項、習慣等
・肌肉失衡的影響：產生的力量減少、改變出力的方式（變得較沒有效率）、使部分肌肉過度使用而引起症狀、讓身體處在更容易受傷的狀態

文章連結：https://www.facebook.com/permalink.php?story_fbid=277285067135152&id=106269640903363

如果確定肌肉失衡影響到功能或產生不適了，可以嘗試矯正性訓練。

什麼是矯正性訓練？
各個學派、品牌可能都有提倡自己一套系統來解決肌肉失衡，對我來說只要能改善肌肉失衡的方式，我都認為是矯正性訓練，例如把縮短、緊繃的肌肉利用伸展、滾筒放鬆、震動、徒手放鬆；把被抑制、拉長的肌肉透過動作控制訓練、單關節訓練等，上述的處理或方法我都認為是矯正性訓練的一環。

以美國國家運動醫學學院（NASM）的概念，處理有四大原則跟步驟，分別是：

＊Inhibition （抑制）
＊Elongation（拉長）
＊Activation（活化）
＊Integration（整合）

1. 抑制（Inhibition）：將緊縮、持續用力的肌肉先放鬆、抑制掉

長期失衡下，較短縮的肌肉是很容易被拿來使用的，而導致其他該出力的肌肉不容易被喚醒，所以首要步驟是先把緊縮的肌肉「關機」（叫它不要太嗨）

透過任何能抑制肌肉的方式，例如滾筒、震動槍、激痛點按壓等，來降低肌肉的活性，以圓肩為範例，就是要按壓胸大肌、胸小肌及上斜方肌。

2. 拉長（Elongation）：將剛抑制好的肌肉，拉回應該要的長度

建議先完成抑制再做拉長，因為如果試圖直接拉長很嗨、張力很高的肌肉，大腦會反射性地對抗讓肌肉更收縮，所以要趁剛被抑制，慢慢將肌肉拉長

透過的方式主要是伸展（stretching）或PNF伸展（Proprioceptive neuromuscular facilitation）等，以圓肩為範例，可以透過牆角伸展胸肌、用耳朵貼肩膀的方式伸展上斜方肌

3. 活化（Activation）：將平時被抑制的肌肉叫醒

就很像拔河一樣，對手太強、太緊繃所以被牽著鼻子走，所以要趁對手變弱、沒那麼緊繃時，趕快把繩子拉回來一些，但是這些長時間沒出力或被抑制的肌肉，已經變得很虛弱，所以起初要訓練它們需設定在低強度、較緩慢的動作，不然高強度或較快速的情況下，鄰近的肌肉就會來幫忙，反而沒練到已經很虛弱的肌肉。

以圓肩為範例，可以用彈力帶做低拉（low row）或不用重量的情況下訓練中斜方肌、下斜方肌等

4. 整合（Integration）：讓剛被平衡的肌肉，適應日常動作或運動專項上

剛平衡好的肌肉，很快就會忘記為什麼要平衡，或隨著原本的生活習慣或課表，馬上又會回到失衡的狀態，因此要趕快讓剛平衡的肌肉，結合到一些功能性或平時會做的動作

以圓肩為範例，可能是長時間只練胸或久坐造成，因此要讓肌肉先固定在平衡的位置，同時執行推、拉等動作，例如維持肩胛骨後縮、下沈、不聳肩的情況下，做臥推、划船等動作

大致的原則是這樣，但實際矯正性訓練的課表怎麼設計、操作、怎麼確保肌肉真的被抑制、有活化到應該出力的肌肉等，非常吃專業人員的經驗跟學識背景，若有需求還是建議專精動作控制的專業人員，例如物理治療師等。

上述的原則是引用NASM-CES證照的指定參考書：NASM essentials of corrective exercise，適用於一般民眾、有興趣的人，內容較基礎、沒有探討太深。如果有一定醫學、解剖基礎，對矯正性訓練或肌肉失衡有興趣的人，可以參考下列書單，特別是Janda及Sahrmann，兩位都是肌肉失衡最早的提倡者。

延伸閱讀：
1. Corrective exercise solutions by Evan Osar
2. Diagnosis and treatment of movement Impairment syndrome by Shirley Sahrmann
3. Assessment and treatment of muscle imbalance: The Janda approach by Page, Frank and Lardner.

其他文章：https://jackchen.sport.blog/
其他圖片：https://www.instagram.com/chenhc82/

#muscleimbalance #correctiveexercise #elongation. #integration #activation #inhibition #uppercrosssyndrome #physiotherapy #exercisetherapy #therapeuticexercise #physiotherapist #肌肉失衡 #矯正性運動 #整合 #伸長 #活化 #抑制 #上交叉症候群 #物理治療 #運動治療 #物理治療師 #陳曉謙

2020
11/29—12/5 in Taipei City

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A holistic assessment of the root cause of soreness and discomfort in the position of the trunk and limbs.

Being suspicious of joint stability?

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2 joint activity is limited
3️ Unable to resolve muscle tension and pain
4 ️muscle lacking force, endurance regression
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Allen Iverson felt no satisfaction from knocking off the top team in the league, just added pressure.


Carmelo Anthony scored 29 points, Iverson added 28 and the Denver Nuggets spoiled the return of Kevin Garnett, holding on for a 124-118 victory over the Boston Celtics on Tuesday night.

"Winning this game puts a lot of pressure on us, because if you can beat a team like this, then you can beat all the other teams," Iverson said. "We have enough talent to scare some people, but we just have to bring it night in and night out."

The Nuggets even beat the Celtics at full strength -- kind of. Garnett, who's been out since Jan. 25 with a strained abdominal muscle, wasn't his flashy self, finishing with four points on 2-of-7 shooting in close to 21 minutes of action. He also had eight rebounds.

"It was good to get back," said Garnett, who planned to play Wednesday night at Golden State. "It felt good."

His coach didn't mince words when asked about his star's performance.

"Not very good," said Rivers, whose team was 16-0 against the Western Conference before the loss. "But you have to expect that when he sits out that long. He was rusty."

Garnett would agree with the assessment. He felt a little winded, but chalked it up to the Mile High City.

"It feels like I've been out for a couple of years," he said. "There wasn't a lot of air out there."

His legs, though, felt rejuvenated. The nine-game break did him wonders.

"I felt like I was 27," Garnett said. "I felt young."

Garnett came in averaging 19.2 points and 9.9 rebounds this season, and anchoring a Celtics defense that's allowing an NBA-low 89.4 points per game.

However, the Nuggets dictated the pace of play, scoring the most points against the Celtics this season. The previous high was 114 points scored by Toronto and Cleveland.

"We didn't want to get into an offensive shootout," Rivers said. "We did that and still had a chance to win."

Paul Pierce scored 24 points and Rajon Rondo added 22. Ray Allen, fresh off his 28-point performance at Sunday's All-Star Game, scored 14 of his 20 points in the first quarter. He went 2-for-10 after the opening 12 minutes.

But Allen almost helped bring the Celtics back. He cut the lead to 121-118 on a 3-pointer with 13 seconds remaining when Anthony jumped up to grab his shot that was short of the rim. However, Anthony was called for goaltending. And although the Nuggets held on, Nuggets coach George Karl was upset about the call.

"Wow," Karl said. "He [referee Bennie Adams] likes making big calls and bad calls at the end of the game. How can you call goaltending when the ball is halfway below the rim?"

Anthony didn't understand the call, either.

"I could have stood right under the basket and not even jump and it would have fell right into my hands," Anthony said.

The Nuggets can't complain too much about the officiating -- they were sent to the line a season-high 49 times, hitting 34 of them. The Celtics were 19 of 28 from the free throw line.

"We got a good whistle," Karl said.

Now, he's hoping that with this win comes a little more respect.

"I think the team deserves better acceptance for what it's done," Karl said.

Not that Iverson is putting much stock in one game.

"I don't look at it as we beat the best team in the league, a win is a win," Iverson said. "Obviously, we can compete with anybody. No one seems to know how much talent we have."

Game notes
The Suns and Nuggets will play an outdoor game in Indian Wells, Calif., during the 2008-09 preseason. Camby said he may have to work on his jumper to make it more aerodynamic. "I have a high release -- it's probably not too good outdoors," he said. ... Celtics F Brian Scalabrine was out with a strained right groin. ... Denver is 22-6 at the Pepsi Center this season. ... Boston F Leon Powe had 13 points and tied a season high with 11 rebounds. ... The Nuggets had 19,894 fans in attendance, the largest regular season crowd in franchise history.