是什麼引起了下腰痛？（一）

Posted on October 14, 2016 by Dr. Aaron Horschig

我有個很大的毛病就是看不慣醫生或者一些醫療實習生不怎麼花時間給解釋基礎的解剖結構和他們傷病產生的原因（致病機制）。今天我將簡短的介紹一些腰部的解剖結構和一些深蹲中常見的的運動損傷。

脊柱

腰椎並不只是一堆骨頭，是由輕微彎曲的小骨頭-椎骨構成，每個椎骨中間由椎間盤分隔開來，椎間盤給運動的椎骨提供了緩衝（像一個空氣包），脊柱上的椎骨通過背後的小關節突關節連接起來，這些關節允許脊柱進行屈伸和旋轉，整體上，整個脊柱被一些不同的組織（肌肉，椎間盤，關節囊和筋膜）連接在一起。

受傷機制

對於「什麼導致了下腰痛」這樣的問題，最簡單的回答就是腰椎結構上過度的壓力和拉力導致了疼痛。對於力量型運動員來說，因為以下三件事導致這些壓力變成了細微損傷累積的原因。

1、不合理的運動模式和技術

2、過度的負荷（對腰椎過大的壓力）

3、不合理的訓練周期或計劃

身體的每一部分（從骨頭到關節到跨過它們分布的肌肉）在受傷和撕裂之前都有個承受負荷的上限值。如果運動員可以在臨界點的邊緣卻不超過臨界點進行訓練，就可以在提高力量和運動表現方面有很大進步，然而如果超過了臨界點，疼痛和損傷便接踵而至。

當我們走了一天或者是在鍛煉的時舉起負重，當脊柱處於中立位時是最高效的，中立位的脊柱可以承受很高的負荷，但是如果脊柱在承受負荷時持續的脫離中立位，脊柱就會發生細小的損傷（比如在硬拉的時候腰背過度屈曲，深蹲的時候過度的」臀部眨眼「），脊柱在承受過度負荷或壓力的時候也會產生細小的損傷，每個人脊柱的承受極限是不一樣的，脊柱上一點點細微損傷最終都會觸發臨界值導致疼痛和無法承受負荷。

在疼痛出現在身體上會有個特殊時間點，對於大多數人來說，損傷是個長期積累的結果，這意味著雖然你在彎腰系鞋帶或者完成最後一個抓舉，損傷都會在那個特殊的點發生。

後續持續不定時更新

References

1. Katani PT, Ichikawa N, Wakabayashi W, et al. Studies of spondylolysis found among weightlifters. Br J Sports Med. 1971 Nov; 6(1):4-8
2. Dangles CJ & Spencer DL. Spondylolysis in competitive weightlifters. J Sports Med. 1987;15:634-635
3. Yochum TR & Rowe LJ. The natural history of spondylolysis and spondylolysthesis: Essentials of Skeletal Radiology. T.R. Yochum and L.J. Rose, eds. Baltimore: Williams & Wilkins. 1987;243-272
4. Stone MH, Fry AC, Ritchie M, et al. Injury potential and safety aspects of weightlifting movements. Strength and Conditioning. 1994 June; 15(3):15-21
5. McGill SM. The biomechanics of low back injury: implications on current practice in industry and the clinic. J Biomechanics. 1997;30(5):465-475
6. McGill, SM. Back Mechanic: The step by step McGill Method to fix back pain. Backfitpro Inc. 2015
7. Frontera WR, Silver JK, Rizzo TD Jr. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain and Rehabilitation. 3rd Saunders. 2014
8. Wade KR, Robertson PA, Thambyah A, Broom ND. How healthy discs herniate: a biomechanical and microstructural study investigating the combined effects of compression rate and flexion. Spine. 2017;39(13):1018-28
9. Callaghan JP & McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin Biomech. 2001;16(1): 28-37
10. Claudio T, Drake JD, Callaghan JP, McGill SM. Progressive disc herniation: an investigation of the mechanism using radiologic, histochemical, and microscopic dissection techniques on a porcine model. Spine. 2007;32(35):2869-74
11. Manchikanti L, Hirsch JA, Falco FJ, Boswell MV. Management of lumbar zygapophysial (facet) joint pain. World J Orthop. 2016;7(5):315-37
12. Gunning JL, Callaghan JP, McGill SM. Spinal posture and prior loading history modulate compressive strength and type of failure in the spine: a biomechanical study using a porcine cervical spine model. Clin Biomech. 2001;16:471-80
13. Dreyer SJ & Dreyfuss PH. Low back pain and the zygapophysial (facet) joints. Arch Phys Med Rehabil. 1996;77:290-300
14. Reynolds AF, Weinstein PR, Wachter RD. Lumbar monoradiculopathy due to unilateral facet hypertrophy. Neurosurgery. 1982;10(4):480-6
15. Wilde GP, Szypryt ET, Mulholland RC. Unilateral lumbar facet hypertrophy causing nerve root irritation. Ann R Coll Surg Engl. 1988;70:307-10
16. Indahl A, Kaigle A, Reikeras O, Holm S. Electromyographic response of the porcine multifidus musculature after nerve stimulation. Spine. 1995;20(24):2652-8
17. Cohen SP & Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106:591-614
18. Marshall LW & McGill SM. The role of axial torque in disc herniation. Clin Biomech. 2010;25(1):6-9
19. van Die?n JH, Weinans H, Toussaint HM. Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain. Med Hypotheses. 1999; 53(3):246-52
20. Dickerman RD, Pertusi R, Smith GH. The upper range of lumbar spine bone mineral density? An examination of the current world record holder in the squat lift. Int J Sports Med. 2000;21(7):469-70
21. Oftadeh R, Perez-Viloria M, Villa-Camacho JC, Vaziri A, Nazarian A. Biomechanics and mechanobiology of trabecular bone: a review. J Biomech Eng. 2015;137(1):0108021-0180215
22. Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low back pain. Global Spine J. 2013;3(3):153-164
23. McGill SM, Carroll B. Gift Of Injury. Backfitpro Inc. 2017
24. McGill SM. Spine flexion exercise: myths, truths and issues affecting health and performance. Backfitpro.com. Web. March 10, 2018.
25. Granhed H, Jonson R Hansson T. The loads on the lumbar spine during extreme weight lifting. Spine. 1987;12(2):146-9
26. Walters PH, Jezequel JJ, Grove MB. Case study: bone mineral density of two elite senior female powerlifters. J Strength Cond Res. 2012;26(3):867-72
27. Cholewicki J, McGill SM, Norman RW. Lumbar spine loads during the lifting of extremely heavy weights. Med Sci Sports Exerc. 1991;23(10):1179-86
28. Spencer K & Croiss M. The effect of increased loading on powerlifting movement form during the squat and deadlift. J Hum Sport Exerc. 2015;10(3):764-774
29. Cholewicki J & McGill SM. Lumbar posterior ligament involvement during extremely heavy lifts estimated from fluoroscopic measurements. J Biomech. 1992;25(2):17-28
30. Yates JP, Giangregorio L, McGill SM. The influence of intervertebral disc shape on the pathway of posterior/posterolateral partial herniation. Spine. 2010;35(7):734-73

原文鏈接：What Causes Low Back Pain?

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