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	<title>肩關節肌腱發炎 &#8211; 新竹全人物理治療所部落格-治療師網誌</title>
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	<description>我們是位於新竹的自費物理治療所，這個全人物理治療所部落格，由物理治療師親自撰文分享各類物理治療、運動治療，如運動傷害、肩頸酸痛、下背痛...等，衛教文章、臨床經驗、個案分享~</description>
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	<title>肩關節肌腱發炎 &#8211; 新竹全人物理治療所部落格-治療師網誌</title>
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		<title>靠運動與伸展，解決肩夾擠症候群！</title>
		<link>https://blog.wellness82.com.tw/509/</link>
					<comments>https://blog.wellness82.com.tw/509/#respond</comments>
		
		<dc:creator><![CDATA[全人物理治療所]]></dc:creator>
		<pubDate>Fri, 22 Nov 2019 07:55:54 +0000</pubDate>
				<category><![CDATA[『肩關節』讓人好不舒服]]></category>
		<category><![CDATA[物理治療衛教文章]]></category>
		<category><![CDATA[全人物理治療所]]></category>
		<category><![CDATA[徒手治療]]></category>
		<category><![CDATA[新竹徒手治療]]></category>
		<category><![CDATA[新竹物理治療]]></category>
		<category><![CDATA[棘上肌]]></category>
		<category><![CDATA[肌腱炎]]></category>
		<category><![CDATA[肩夾擊]]></category>
		<category><![CDATA[肩夾擠症候]]></category>
		<category><![CDATA[肩膀痛]]></category>
		<category><![CDATA[肩膀舉高痛]]></category>
		<category><![CDATA[肩部旋轉肌群不平衡]]></category>
		<category><![CDATA[肩關節復健]]></category>
		<category><![CDATA[肩關節肌腱發炎]]></category>
		<guid isPermaLink="false">https://blog.wellness82.com.tw/?p=509</guid>

					<description><![CDATA[文/ 張藍之  物理治療師 本篇要介紹「肩夾擠症候群」的檢查方式、治療方式與復健運動。而「肩夾擠症候群」的 成&#8230;]]></description>
										<content:encoded><![CDATA[<p>文/ 張藍之  物理治療師</p>
<p>本篇要介紹「肩夾擠症候群」的檢查方式、治療方式與復健運動。而「肩夾擠症候群」的</p>
<p>成因與相關解剖位置，可參考「<a title="肩夾擠症候群≠五十肩" href="https://blog.wellness82.com.tw/499/" target="_blank" rel="noopener noreferrer" data-cke-saved-href="http://wellness82.pixnet.net/blog/post/273914158">肩夾擠症候群≠五十肩</a> 」。</p>
<p>理學檢查</p>
<p>下列為臨床常用理學檢查方式<sup>1</sup>，若測試結果為陽性表示可能為「肩夾擠症候群」。但在醫師</p>
<p>與物理治療師確診前，不能妄下結論喔。</p>
<p><span lang="EN-US">Neer</span>測試：施測者一手固定住肩胛骨，另一手用力將手臂往上抬，產生疼痛即為陽性。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="13"><img decoding="async" class="cke_widget_element" title="Neer" src="http://pic.pimg.tw/wellness82/1425651045-2912254294_n.jpg" alt="Neer" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651045-2912254294_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651045-2912254294_n.jpg%22%2C%22alt%22%3A%22Neer%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22Neer%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span lang="EN-US">Hawkin</span>測試：將手臂舉高至90∘，前臂往下旋轉，產生疼痛即為陽性。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="12"><img decoding="async" class="cke_widget_element" title="Hawkin" src="http://pic.pimg.tw/wellness82/1425651139-2306063175_n.jpg" alt="Hawkin" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651139-2306063175_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651139-2306063175_n.jpg%22%2C%22alt%22%3A%22Hawkin%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22Hawkin%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span lang="EN-US">Drop arm</span>測試：將手臂外展至90∘，再慢慢放回身體旁邊。放下過程中若產生疼痛，且無法</p>
<p>緩慢執行動作，即為陽性。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="11"><img decoding="async" class="cke_widget_element" title="drop arm" src="http://pic.pimg.tw/wellness82/1425651197-1555461150_n.jpg" alt="drop arm" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651197-1555461150_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651197-1555461150_n.jpg%22%2C%22alt%22%3A%22drop%20arm%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22drop%20arm%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>「肩夾擠症候群」的物理治療</p>
<p>軟組織按摩：放鬆胸小肌。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="10"><img decoding="async" class="cke_widget_element" title="pectoralis minor release" src="http://pic.pimg.tw/wellness82/1425651299-2471302225_n.jpg?v=1425651303" alt="pectoralis minor release" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651299-2471302225_n.jpg?v=1425651303" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651299-2471302225_n.jpg%3Fv%3D1425651303%22%2C%22alt%22%3A%22pectoralis%20minor%20release%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22pectoralis%20minor%20release%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>關節鬆動術：放鬆肩膀關節囊，導正動作模式。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="9"><img decoding="async" class="cke_widget_element" title="mob" src="http://pic.pimg.tw/wellness82/1425651338-2745773483_n.jpg?v=1425651343" alt="mob" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651338-2745773483_n.jpg?v=1425651343" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651338-2745773483_n.jpg%3Fv%3D1425651343%22%2C%22alt%22%3A%22mob%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22mob%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>靠運動與伸展解決「肩夾擠症候群」</p>
<p>「肩夾擠症候群≠五十肩」文中有提到造成「肩夾擠症候群」的原因，包括胸小肌過緊、</p>
<p>前鋸肌無力與旋轉肌群無力。下面提供針對這些問題的肌力訓練與伸展動作。</p>
<p>I-T-Y式這系列動作可以訓練肩胛骨之穩定度，用肩胛骨帶動動作，不可僅用肩膀施力。</p>
<p>下面示範單手執行，亦可兩手同時動作。啞鈴重量可視個人狀況調整，裝水的寶特瓶也是</p>
<p>很好的選擇。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="8"><img decoding="async" class="cke_widget_element" title="ITY" src="http://pic.pimg.tw/wellness82/1425651668-3466327045_n.jpg" alt="ITY" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651668-3466327045_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651668-3466327045_n.jpg%22%2C%22alt%22%3A%22ITY%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22ITY%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span lang="EN-US">I</span>式：趴姿，手臂垂在床外，向後抬起，停留10秒，重複5下。雙手同時執行就像英文字母</p>
<p>「I」。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="7"><img decoding="async" class="cke_widget_element" title="I" src="http://pic.pimg.tw/wellness82/1425651712-3317561839_n.jpg?v=1425651718" alt="I" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651712-3317561839_n.jpg?v=1425651718" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651712-3317561839_n.jpg%3Fv%3D1425651718%22%2C%22alt%22%3A%22I%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22I%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span lang="EN-US">T</span>式：趴姿，手臂垂在床外，向旁邊抬起，停留10秒，重複5下。雙手同時執行就像英文字母</p>
<p>「T」。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="6"><img decoding="async" class="cke_widget_element" title="T" src="http://pic.pimg.tw/wellness82/1425651749-2174356745_n.jpg" alt="T" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651749-2174356745_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651749-2174356745_n.jpg%22%2C%22alt%22%3A%22T%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22T%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span lang="EN-US">Y</span>式：趴姿，手臂垂在床外，向斜上抬起，停留10秒，重複5下。雙手同時執行就像英文字母</p>
<p>「Y」。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="5"><img fetchpriority="high" decoding="async" class="cke_widget_element alignnone" title="Y" src="http://pic.pimg.tw/wellness82/1425651786-3051998255_n.jpg" alt="Y" width="600" height="450" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651786-3051998255_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651786-3051998255_n.jpg%22%2C%22alt%22%3A%22Y%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22Y%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>胸小肌伸展：人與牆面垂直，手貼在牆面，身體向對側旋轉。肩膀前端至鎖骨下方有牽拉的</p>
<p>感覺。停留30秒，重複3次。若感覺手掌麻木需暫停動作。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="4"><img decoding="async" class="cke_widget_element" title="stretch minor" src="http://pic.pimg.tw/wellness82/1425651831-2731348451_n.jpg" alt="stretch minor" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651831-2731348451_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651831-2731348451_n.jpg%22%2C%22alt%22%3A%22stretch%20minor%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22stretch%20minor%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="3"><img decoding="async" class="cke_widget_element" title="stretch minor 2" src="http://pic.pimg.tw/wellness82/1425651866-64366504_n.jpg?v=1425651873" alt="stretch minor 2" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651866-64366504_n.jpg?v=1425651873" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651866-64366504_n.jpg%3Fv%3D1425651873%22%2C%22alt%22%3A%22stretch%20minor%202%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22stretch%20minor%202%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>前鋸肌肌力訓練：面對牆壁，雙手掌貼住牆面，手肘打直，利用肩胛骨後夾將胸口往牆面</p>
<p>靠近，再將肩胛骨分開使胸口遠離牆面，緩慢重複10下。</p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="2"><img decoding="async" class="cke_widget_element" title="前鋸肌0" src="http://pic.pimg.tw/wellness82/1425651926-1346718779_n.jpg" alt="前鋸肌0" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651926-1346718779_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651926-1346718779_n.jpg%22%2C%22alt%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C0%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C0%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="1"><img decoding="async" class="cke_widget_element" title="前鋸肌1" src="http://pic.pimg.tw/wellness82/1425651950-2047485934_n.jpg?v=1425651956" alt="前鋸肌1" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651950-2047485934_n.jpg?v=1425651956" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651950-2047485934_n.jpg%3Fv%3D1425651956%22%2C%22alt%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C1%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C1%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p><span class="cke_widget_wrapper cke_widget_inline cke_image_nocaption cke_widget_selected" data-cke-widget-wrapper="1" data-cke-filter="off" data-cke-display-name="圖片" data-cke-widget-id="0"><img decoding="async" class="cke_widget_element" title="前鋸肌2" src="http://pic.pimg.tw/wellness82/1425651979-402741094_n.jpg" alt="前鋸肌2" border="0" data-cke-saved-src="http://pic.pimg.tw/wellness82/1425651979-402741094_n.jpg" data-cke-widget-data="%7B%22hasCaption%22%3Afalse%2C%22src%22%3A%22http%3A%2F%2Fpic.pimg.tw%2Fwellness82%2F1425651979-402741094_n.jpg%22%2C%22alt%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C2%22%2C%22width%22%3A%22%22%2C%22height%22%3A%22%22%2C%22title%22%3A%22%E5%89%8D%E9%8B%B8%E8%82%8C2%22%2C%22lock%22%3Atrue%2C%22align%22%3A%22none%22%2C%22classes%22%3Anull%7D" data-cke-widget-upcasted="1" data-cke-widget-keep-attr="0" data-widget="image" /><span class="cke_reset cke_widget_drag_handler_container"><img decoding="async" class="cke_reset cke_widget_drag_handler" title="拖曳以移動" src="image/gif;base64,R0lGODlhAQABAPABAP///wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==" width="15" height="15" data-cke-widget-drag-handler="1" /></span><span class="cke_image_resizer" title="拖曳以改變大小">​</span></span></p>
<p>雖然診斷同樣為「肩夾擠症候群」，但每個人狀況還是略有不同，關節囊緊縮的程度、</p>
<p>肱骨頭位移的程度等因素，都會影響復原時間。詳細情況還是必須諮詢醫師與物理治療師。</p>
<p>而復健運動的執行原則，是不能誘發出原本的疼痛。若忍痛執行將無法訓練到正確的肌群，</p>
<p>也會影響動作控制，可能讓症狀惡化喔！</p>
<p><strong>因為原創文章,若要分享內容請原文轉貼,並註明出處。</strong></p>
<p>參考資料：</p>
<p><span lang="EN-US">1.Mustafa C., Kenan A., Murat B., Ilhan K., Havva C., Fikret T.(2000). Diagnosis values of clinical diagnostic </span><span lang="EN-US">tests in </span></p>
<p><span lang="EN-US">subacrominal impingement syndrome. Ann Rheum Dis. 59:44-47.</span></p>
]]></content:encoded>
					
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		<title>『網球個案分享』&#8211;因一場車禍造成肩關節脫臼，現在的他，每次打完網球，肩關節前後側都會疼痛</title>
		<link>https://blog.wellness82.com.tw/173/</link>
					<comments>https://blog.wellness82.com.tw/173/#respond</comments>
		
		<dc:creator><![CDATA[全人物理治療所]]></dc:creator>
		<pubDate>Sun, 16 Jun 2019 16:31:00 +0000</pubDate>
				<category><![CDATA[『肩關節』讓人好不舒服]]></category>
		<category><![CDATA[物理治療個案分享]]></category>
		<category><![CDATA[物理治療衛教文章]]></category>
		<category><![CDATA[運動處方治療]]></category>
		<category><![CDATA[全人物理治療所]]></category>
		<category><![CDATA[強化核心肌群與外旋肌肌力訓練]]></category>
		<category><![CDATA[徒手治療]]></category>
		<category><![CDATA[整脊及矯正偏移的骨盆]]></category>
		<category><![CDATA[核心肌肉控制力]]></category>
		<category><![CDATA[深層肌肉放鬆]]></category>
		<category><![CDATA[物理治療師]]></category>
		<category><![CDATA[物理治療評估]]></category>
		<category><![CDATA[網球運動傷害]]></category>
		<category><![CDATA[肩夾擠症候]]></category>
		<category><![CDATA[肩部旋轉肌群不平衡]]></category>
		<category><![CDATA[肩關節外旋受限]]></category>
		<category><![CDATA[肩關節外旋角度正常]]></category>
		<category><![CDATA[肩關節肌腱發炎]]></category>
		<category><![CDATA[肩關節脫臼復健]]></category>
		<category><![CDATA[肩關節脫臼物理治療]]></category>
		<category><![CDATA[車禍後物理治療]]></category>
		<category><![CDATA[關節角度鬆動]]></category>
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					<description><![CDATA[文/蔡郁羚物理治療師 25歲的廖先生 在四年前因車禍造成左手肩關節脫臼，不巧地他剛好是左撇子 正職是工程師外，&#8230;]]></description>
										<content:encoded><![CDATA[<div style="clear: both;text-align: center"></div>
<div style="clear: both;text-align: left">文/蔡郁羚物理治療師<a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25B0-2581-25E9-259D-25A2.jpg"><img decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25B0-2581-25E9-259D-25A2.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<div></div>
<div>
<h4>25歲的廖先生 在四年前因車禍造成左手肩關節脫臼，不巧地他剛好是左撇子<br />
正職是工程師外，平常喜愛打網球。<br />
車禍後在高雄認真復健半年後，就沒有再針對肩部做訓練了，<br />
因此到現在，每次打完網球，肩關節前側、後側都會疼痛好幾天&#8230;</h4>
</div>
<div>2018/05/31 第一次來到了全人物理治療所，做了<span style="background-color: yellow;font-size: large">理學檢查</span>發現：</div>
<div>
<ul>
<li><span style="font-weight: normal"><span style="font-size: large">站姿下，骨盆偏向左側</span> &#8212;-&gt;靜態姿勢下身體也是歪的</span>?</li>
<li><span style="font-weight: normal"><span style="font-size: large">左肩關節活動度測試</span>：</span></li>
</ul>
<blockquote>
<ol>
<li><span style="font-weight: normal">手上舉、外展、內旋皆正常</span> ?</li>
<li><span style="font-weight: normal">外旋受限，到底會痛<span style="font-weight: bold"> ?</span></span></li>
</ol>
</blockquote>
<ul>
<li><span style="font-weight: normal"><span style="font-size: large">肩關節肌力測試</span>：</span></li>
</ul>
<blockquote>
<ol>
<li><span style="font-weight: normal">外旋轉肌：MMT 4 可以抵抗<span style="color: red">中等</span>阻力 ? </span></li>
<li><span style="font-weight: normal">內旋轉肌：MMT 5 滿分，可以抵抗最大阻力?</span></li>
<li><span style="font-weight: normal">棘上肌： MMT 4 可以抵抗<span style="color: red">中等</span>阻力 ?</span></li>
</ol>
</blockquote>
<h4><span style="font-weight: normal">?肩膀疼痛的個案，常見肩部旋轉肌群不平衡：<span style="color: blue">外旋肌力&lt; 內旋肌力 </span></span></h4>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25BB-2596-25E5-2585-2588-25E7-2594-259F.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25BB-2596-25E5-2585-2588-25E7-2594-259F.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<ul>
<li><span style="font-weight: normal"><span style="font-size: large">動態評估</span>：</span></li>
</ul>
</div>
<div style="clear: both;text-align: center">
<p><iframe title="肩關節脫臼後，肩關節疼痛。網球選手：動態評估" width="1170" height="658" src="https://www.youtube.com/embed/i8TdP_Y9s4o?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></p>
</div>
<div></div>
<div>
<blockquote>
<ul>
<li><span style="font-weight: normal">發球動作發現問題?</span></li>
</ul>
</blockquote>
<blockquote><p><span style="font-weight: normal"> &#8212;-&gt;肩關節外旋受限</span></p></blockquote>
<blockquote><p><span style="font-weight: normal"> &#8212;-&gt;肋骨上翻，核心肌肉控制力不佳</span></p></blockquote>
<blockquote><p><span style="font-weight: normal"> &#8212;-&gt;身體被分段工作，下肢與上半身無法很好的傳至手臂，造成肩關節加壓。</span></p></blockquote>
<p>影片截圖分析：發球動作</p>
<div>
<h4><span style="font-weight: normal">正確發球動作揮拍時，需要把手臂往上舉與往外旋轉，發現廖先生受傷後</span><span style="font-weight: normal">肩膀外旋角度就受限了，所以在發球時，</span><span style="font-weight: normal">身體只能</span><span style="color: red;font-weight: normal">代償</span><span style="font-weight: normal">用</span><span style="color: red;font-weight: normal">折腰</span><span style="font-weight: normal">來做出類似的動作，反而使壓力點跑到肩關節與腰椎。</span></h4>
</div>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E6-25AD-25A3-25E7-25A2-25BA-25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E6-25AD-25A3-25E7-25A2-25BA-25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E9-258C-25AF-25E8-25AA-25A4-25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E9-258C-25AF-25E8-25AA-25A4-25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<div></div>
<div>
<h4>發球動作1. &#8212;&gt; 2. 影片截圖分析</h4>
</div>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C12.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C12.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<div>可看見當肩關節外旋受限時，手舉越高越想用力發球時，肋骨越來越上翻，折腰角度越來越大。</div>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C123.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-2599-25BC-25E7-2590-2583-25E5-258B-2595-25E4-25BD-259C123.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<div style="clear: both;text-align: center"></div>
<p><span style="color: #222222;font-family: , 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;letter-spacing: 1.399999976158142px">核心是由四條肌肉組成，上圖右方圖示可看見核心組成一個長方體，穩定脊椎與上半身。當核心肌肉用力時，脊椎弧度保持完美，肋骨不會跑出上翻。所以只要看見肋骨上翻，核心肌群一定失敗了！</span></p>
<p>當肋骨上翻出現，伴隨而來的就是<span style="background-color: white"><span style="color: red">身體被分段工作</span></span>了，下肢與上半身的力，<span style="color: red">無法</span>很好的傳至手臂，如此一來，發球力量下降外，長期下來還會使腰椎退化、肩關節肌腱發炎或產生肩夾擠症候。</p>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258A-259B-25E7-25B7-259A-25E8-25A2-25AB-25E9-2598-25BB-25E6-2596-25B7.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258A-259B-25E7-25B7-259A-25E8-25A2-25AB-25E9-2598-25BB-25E6-2596-25B7.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<p>下圖為正確力量傳導。下肢與上半身很好地將力量傳至手臂。</p>
<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258A-259B-25E7-25B7-259A-25E8-2589-25AF-25E5-25A5-25BD.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258A-259B-25E7-25B7-259A-25E8-2589-25AF-25E5-25A5-25BD.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
<h4>影片截圖分析：反拍動作</h4>
<div>反拍動作時，發現上半身會出現多餘的往前彎曲跟側彎，這個動作會使上半身跟下半身分成一前一後，此時接著做出揮拍，一樣會導致<span style="color: red">身體力量不能很好的傳至手臂</span>，擊球瞬間肩膀會被<span style="color: red">加壓</span>。</div>
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<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258F-258D-25E6-258B-258D-25E5-258B-2595-25E4-25BD-259C.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-258F-258D-25E6-258B-258D-25E5-258B-2595-25E4-25BD-259C.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
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<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25AF-25B6-25E7-2589-25B9-25E7-2593-25B6-25E6-258A-2598-25E8-2585-25B0.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E5-25AF-25B6-25E7-2589-25B9-25E7-2593-25B6-25E6-258A-2598-25E8-2585-25B0.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
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<h4>在物理治療評估後，首先：<span style="color: blue">重建外旋角度?</span></h4>
<p>安排了<span style="background-color: yellow">徒手治療</span>，利用深層肌肉放鬆、關節角度鬆動、整脊及矯正偏移的骨盆，使外旋角度增大and疼痛下降。徒手治療完後，馬上再進行一次動態評估，看看沒有外旋受限的問題，揮拍動作有什麼改變？</p>
<p><span style="text-align: center">由下方截圖分析可看到：肩關節外旋角度正常後，腰椎代償的折腰動作及肋骨上翻動作變<span style="color: blue">小</span>了???</span></p>
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<div style="clear: both;text-align: center"><a style="margin-left: 1em;margin-right: 1em" href="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-25B6-25B2-25E7-2590-2583-25E7-2599-25BC-25E7-2590-2583-25E5-25BE-2592-25E6-2589-258B-25E5-25BE-258C.jpg"><img loading="lazy" decoding="async" class="alignnone" src="https://blog.wellness82.com.tw/wp-content/uploads/2019/06/25E7-25B6-25B2-25E7-2590-2583-25E7-2599-25BC-25E7-2590-2583-25E5-25BE-2592-25E6-2589-258B-25E5-25BE-258C.jpg" alt="新竹物理治療, 新竹自費物理治療, 新竹運動治療, 物理治療個案分享" width="1024" height="536" border="0" data-original-height="628" data-original-width="1200" /></a></div>
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<p><span style="font-family: 'arial' , 'helvetica' , sans-serif">折腰角度及肋骨上翻雖變小，但軀幹還是<span style="color: blue">沒有達到標準穩定</span>，<span style="color: blue">核心控制</span>能力還是較<span style="color: blue">弱</span>，所以接著<span style="background-color: yellow">運動處方治療</span><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px">：</span><span style="font-size: large"><span style="color: blue;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px">強化核心肌群</span><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px">與</span><span style="color: blue;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px">外旋肌肌力</span><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px">訓練，強化之前沒有出力作用的肌肉。在診所做了幾組訓練後，開立回家功課的處方運動，希望下次還揮拍動作能再更加改善。</span></span></span></p>
<p><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px"><br />
</span>本篇內容為單次的評估分析及治療內容，希望之後有機會再繼續follow~</p>
<h3 style="clear: both;color: #333333;font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;margin: 0px"><span style="color: red">打破<a style="color: #6699cc;text-decoration: none" href="http://wellness82.com/" target="_blank" rel="noopener noreferrer"><span style="color: red">物理治療</span></a>的迷思</span></h3>
<div style="color: #333333;font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;font-size: 14.850000381469727px">以這個個案而言，如果頭痛醫頭、腳痛醫腳、依部位收費，個案大概被當成拆解的零件了！疼痛常見是一連串的力學錯誤產生的產物，若只治療疼痛部位，是無法根治問題的產生。改變身體錯誤的模式，一直是最困難但卻最根本的治療。</div>
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<p><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px"><span style="color: #ff0000">※本部落格之文章皆為<a href="http://wellness82.com" target="_blank" rel="noopener noreferrer">全人物理治療所</a>所有，禁止任何全部或部份之拷貝、截取行為，如果喜歡本文歡迎直接分享網址，或聯絡本所授權。</span></span><span style="color: #333333;font-family: 'arial' , 'tahoma' , 'helvetica' , 'freesans' , sans-serif;font-size: 14.850000381469727px"><br />
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