테니스엘보에 팔꿈치 마사지 스트레칭 하지마세요! 제대로 된 테니스엘보 치료법 자가 치료 운동

Mr.Physio 호주물리치료사 June 13, 2019
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1:1 평가/상담 신청하고 나에게 맞는 운동 추천 받기 https://mrphysio.com.au/p/dd0296 For English, visit https://www.mrphysio.net/ #테니스엘보치료법 #테니스엘보운동 #테니스엘보 #테니스엘보스트레칭 #테니스엘보자가치료 #엘보우치료운동 관련링크 1. 어깨 운동입니다 (3분 18초정도 부터 7분 정도까지 나오는 회전근개 원심성 운동들도 같이 해주세요) https://youtu.be/iSJP6RhgJIM 2. 연구에 따르면 50%가 넘는 테니스/골프엘보 환자의 목 특히 하부경추 C6-7에서 팔꿈치로 이어지는 신경에 이상이 발견되었다고 합니다. 목 운동 영상입니다. https://youtu.be/XptrV7pIuM0 테니스엘보 재활운동 순서 1.근육마사지 1분 하루 5번 (운동 전) 2.버티기 45초 x 하루 5번 3.근육 늘려주는 운동(3kg 3setx15회를 목표로 서서히 늘려주세요) 이 운동은 3set x 15번 하루 2회씩 매일매일 해주는 게 원칙이지만 본인의 능력껏 시작하시고 천천히 늘려나가주세요~ 0.5kg로 3set x 15번을 통증 할 수 있다고 하면 그 다음날 1kg로 2set x 5-10번 정도 해보고 또 다음날은 2set x 10-15번, 3set x 10번 이런 식으로 자기 페이스대로 천천히 늘려가시는 거에요. 증상이 완화될수록 운동을 할 때 더 강하고 빠른 저항을 줘서 힘줄이 더 강하게 운동할 수 있도록 해주시면 좋습니다. 주의사항 1. 운동을 하실 때는 통증이 없는 것을 원칙으로 하되, 10을 기준으로 3이하의 통증은 괜찮습니다. 하지만 건의 문제는 운동 후 24시간을 지켜봐야 하는데 운동 중/운동 후/ 그리고 다음 날까지 평소와 다른 새로운 통증이 발생하거나 증상이 악화되거나 하면 안됩니다. 만약 그렇다면 지금 하시는 운동을 할 준비가 안 되어 있다는 말입니다. 예를 들면 버티기 운동 30초를 하시다가 어느 날 40초로 올렸더니 통증이 증가했다면 통증 부위(힘줄)에 ice를 해주시고 다시 근육마사지와 함께 원래 했던 30초 버티기 운동을 2-3일 정도 해주신 후 또 다시 35초 또는 40초 정도로 조금씩 조금씩 늘려나가시면 됩니다. 2. 한꺼번에 횟수나 강도를 엄청 늘려버리면 더 악화될 수 있으니 정말 적은 횟수부터 시작하시면서 정말 천천히 늘려나가시는 걸 추천드립니다 (많은 분들이 욕심내다 더 안 좋아지셔서 몇 주 더 고생하십니다.. 힘줄의 회복은 사실 뼈의 회복보다 오래 걸릴 수 있는 것이라 아주 많이 인내하셔야 합니다) 재활의 핵심은 너무 많이 해서도 안되고 너무 적게 해서도 안되며 중간지점인 '적당히'를 스스로 찾으시는 겁니다. 재활기간은 최소 3개월은 보셔야 합니다. 연구결과에 따르면 운동을 하더라도 통증이 가라앉기까지는 4-6주정도까지 걸릴 수 있고 스포츠활동을 할 정도로 회복되기까지는 3-6개월 정도 걸린다고 합니다 (개개인의 편차가 있겠지만요) 스포츠를 하시는 분들은 통증이 없어졌다고 바로 복귀하시면 안되고 운동량을 20-30% 정도에서 시작해서 서서히 늘려주셔야 합니다. 영상에 나오는 운동들을 운동 전 스트레칭 대신 사용하셔도 좋습니다. 운동을 안 하는 분들도 가끔씩 해주시면 좋아요~ 안전재활하세요 ! 참고문헌 Cook, J. L., Rio, E., Purdam, C. R., & Docking, S. I. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. British journal of sports medicine, 50(19), 1187-1191. 용수철처럼 늘어나면 제 자리로 돌아가는 탄성력이 힘줄의 주기능인데 계속 늘어난 상태가 되면 당연히 그런 기능이 떨어지기 때문에 탄성력이 떨어진다고 말씀드린 거구요 이 논문에서도 퇴행성 변화가 진행된 부위는 disfunctional 또는 disoriented 되며 그것을 도넛의 구멍난 부분에 비유했습니다. 구멍난 부분은 제 기능을 못한다는 얘기죠. Cook, J. L., & Purdam, C. (2012). Is compressive load a factor in the development of tendinopathy?. Br J Sports Med, 46(3), 163-168. 힘줄이 뼈에 지속적으로 압박(compressive loading)되거나 Stretch-shortening cycle 혹은 둘 다 동시에 발생하는 상황을 겪게 되면 건염의 발생 가능성이 커진다. 거의 모든 건염은 뼈와 가까이 붙어 있는 부위에 발생하고 이런 건염이 있을 때는 compressive loading을 줄이기 위한 일환으로 스트레칭은 피해야 한다. 대신 마사지와 같은 다른 테크닉으로 근육을 이완시키는 방법 등을 사용할 수 있다고 했습니다. Witvrouw, E., Mahieu, N., Roosen, P., & McNair, P. (2007). The role of stretching in tendon injuries. British journal of sports medicine, 41(4), 224-226. 원심성수축이나 동적 스트레칭(ballistic stretching)이 정적인 스트레칭보다 효과가 뛰어나다 6주간의 정적 스트레칭이 아킬레스건의 뻣뻣함에 전혀 영향을 주지 못한 반면 ballistic stretching 또는 원심성 수축은 효과가 있었다. van Dyk, N., Behan, F. P., & Whiteley, R. (2019). Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med, bjsports-2018. 햄스트링에 관한 연구라 테니스 엘보에 바로 적용을 시키기는 어렵지만 8459명의 스포츠 선수들을 대상으로 시행한 햄스트링 원심성 운동이 이들의 햄스트링 부상 확률을 51% 감소 시켰다는 논문입니다. Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine, 43(7), 1704-1711. 영상에서 언급된 아킬레스건염 재활 논문입니다. 본인 체중을 이용한 아킬레스건 원심성 운동이 무거운 웨이트 트레이닝과 비슷한 효과가 있었다고 합니다. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med, 49(19), 1277-1283. 이 논문은 중간에 나오는 등척성 운동(버티기 운동)에 대한 효과입니다. 여전히 슬개건염에 대한 논문이지만 역시 본인 체중의 70% 정도를 이용하여 45초 정도 버텼을 때 통증완화의 효과가 있었다고 합니다. 테니스 엘보에 관한 연구는 아직 많이 부족하기 때문에 다른 건염들에 관한 연구들을 참고해서 재활 방향을 설정하시는 게 좋을 것 같아서 알려드렸습니다.

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