機器翻譯字幕，僅供參考：

Hi guys! So, have you been told that you've got a

嗨，大家好！那么，您是否被告知

Haglund's Deformity in the back of your heel,

您的足跟后部有 Haglund 畸形，

or a heel spur that's causing your pain in your Achilles tendon or at the back

或者足跟骨刺導致您的跟腱或

of your heel? Well, in this video I'm going to explain

足跟后部疼痛？好吧，在這個視頻中，我將解釋

why you don't have to pay too much attention to the fact that you've got a

為什么您不必過多關注您患有 Haglund 畸形的事實，

Haglund's Deformity and why you can absolutely get yourself

以及為什么您完全可以

better and pain-free without doing anything to that bony

在不做任何事情的情況下讓自己變得更好和無痛

prominence in the back of the heel. So, for those of you who don't know me my

后跟骨突出。所以，對于那些不認識我的人來說，我的

name is Maryke. I'm one of the physiotherapists from

名字是 Maryke。我是treatmyachilles.com 的

treatmyachilles.com, where you can get online physiotherapy

之一，您可以通過視頻通話獲得在線物理治療

assessment as well as treatment all via video call. So, have a look at the

評估和治療。因此，

description of this video if you want the link to our website.

如果您想要我們網站的鏈接，請查看該視頻的描述。

Okay, so what is Haglund's Deformity? Now, in this X-ray you'll notice that on the

好的，那么什么是 Haglund 畸形？現在，在這張 X 光片中，你會注意到在

back of that heel there's a bony prom... pointy bit there and

那個腳后跟的后面有一個骨質的舞會……那里是尖尖的，

then also some bone at the bottom there. Now the top

然后還有一些骨頭在那里。現在頂部的

arrow is pointing to the Haglund's Deformity

箭頭指向 Haglund 的畸形

and that's quite a small one, you can get it a little bit larger than that as well.

，這是一個很小的，你也可以讓它比它大一點。

And the bottom one is pointing to calcification in the tendon,

底部的一個指向肌腱中的鈣化，

so just there where the Achilles tendon is attaching it started forming a little...

所以就在跟腱附著的地方，它開始形成一點……

forming a little bit of bony bits in there.

在那里形成一點點骨頭。

So, how does it normally happen that you're diagnosed with this?

那么，您被診斷出患有這種疾病通常是如何發(fā)生的呢？

What happens is, you develop pain in the back of your heel and you go to the

發(fā)生的情況是，您的腳后跟出現疼痛并去看

doctor. The doctor says "Let's do an x-ray". They

醫(yī)生。醫(yī)生說“讓我們做個 X 光片”。他們

do an X-ray... comes back like this. And the doc says "Hmm, you've got a

做了 X 光檢查……就這樣回來了。醫(yī)生說：“嗯，你有

Haglund's Deformity that's the cause of your pain." Well,

哈格倫德畸形，這是你痛苦的原因?！?嗯，

not really. Let me explain to you what is causing your pain.

不是真的。讓我解釋一下是什么導致了你的痛苦。

So that bony bit on its own is not painful, it's just there, it's the

所以那塊骨頭本身并不痛苦，它就在那里，它

shape of your bone, okay. So that doesn't create pain. If you

是你骨頭的形狀，好吧。所以這不會造成痛苦。如果您

look at an MRI scan, the pain you feel in your back of your

查看 MRI 掃描，您在

heel usually at that point is coming either from

腳后跟后部感到的疼痛通常

the Achilles tendon - insertional tendinopathy -

來自跟腱 - 插入性肌腱病 -

or from the bursa behind the tendon, which is called the bursitis when it

或來自肌腱后面的滑囊，當它發(fā)炎時稱為滑囊炎

becomes inflamed and sore and painful. You can have either of those or both of

又痛又痛。您可以同時擁有其中一個或兩個

them at the same time. Now why am I saying that the Haglund's

?，F在我為什么要說哈格倫的

Deformity is not the cause of that pain. So,

畸形不是那種痛苦的原因。所以，

let me explain to you why people tend to think it is the cause of the pain.

讓我向你解釋為什么人們傾向于認為這是痛苦的原因。

So the theory is you've got the bony spur there or the Haglund's Deformity

所以理論上你那里有骨刺或哈格倫德

there. So if you think... if you can picture this

畸形。所以如果你想……如果你可以把它想象

as the back of my heel, if I go over my heel like when I walk,

成我的腳后跟，如果我走路時越過腳后跟，

can you see that the Achilles tendon pulls tight over there

你能看到跟腱在那里拉緊

and it causes compression? And that's quite normal and happens in all of us

并導致壓縮嗎？這很正常，發(fā)生在我們所有人

and it isn't painful in itself. That bursa that's in there is meant to

身上，它本身并不痛苦。那里的滑囊是為了

stop friction between the tendon and the bone

阻止肌腱和骨骼之間的摩擦，然后

and again so that gets compressed every day with every step you give...

每天你的每一步都會被壓縮……

absolutely normal. Now the idea why people say that Haglund's Deformity can

絕對正?！，F在人們說哈格倫德畸形會

cause pain in those structures is because it can decrease the the um...

導致這些結構疼痛的想法是因為它可以減少

space you have in the back of the heel so you're more

你在腳后跟后部的空間，所以你更有

likely to compress it in that position then.

可能在那個位置壓縮它。

But now here's why I say - and there's quite a few people who

但現在這就是我說的原因——在研究中有很多人

agree with me on this in the research - it's not necessarily the cause of that

同意我的觀點——這不一定是造成這種痛苦的原因

pain. Because you can get somebody who's been

。因為你可以找到一個被

diagnosed with a Haglund's Deformity, if you X-ray both feet,

診斷出患有哈格倫德畸形的人，如果你對雙腳進行 X 光檢查，

have it in both feet. They're shaped exactly the same but they have pain in one foot

則雙腳都有。它們的形狀完全相同，但一只腳有疼痛，而另一只

and don't have it in the other foot. Also, that Haglund's Deformity is not

腳沒有。此外，哈格倫德的畸形

something that forms overnight or in a week or in a month

不是在一夜之間、一周或一個月內形成的

even. It would be there for years and years and years without causing trouble

。

before one day you now develop heel pain. Then also you get lots and lots of

在你現在患上足跟痛的那一天之前，它會存在很多年，而且不會造成麻煩。然后還有很多

people with insertional tendinopathy plus

患有插入性肌腱病和

bursitis - because remember that's the structures actually causing the pain in

滑囊炎的人-因為請記住，實際上是結構引起了那里的疼痛

there, not the deformity - who doesn't have a Haglund's Deformity. So

，而不是畸形-他們沒有哈格倫德畸形。

there's three reasons why I say it's not necessarily the cause of

所以我說這不一定是

your pain. So what if I'm saying it's not...

你痛苦的原因有三個原因。那么，如果我說它不是... 那

Why do you then have the heel pain there? It's a classic case of overload.

你為什么會有腳后跟痛呢？這是一個經典的超載案例。

So if we think of this: your Achilles tendon as well as your bursa

因此，如果我們想到這一點：你的跟腱和滑囊

is used to receiving a certain amount of compression load,

都習慣于接受一定量的壓縮負荷，

and the body is brilliant at building the structures up

而身體在構建結構

to cope with that. So you're walking around, running around, doing your runs

來應對這一點方面表現出色。所以你四處走動，四處奔跑，做你的跑步

and stuff... no issue. But now if for some reason

和其他事情......沒問題。但是現在如果由于某種原因

you make a sudden change in your habits and you massively increase the amount of

你突然改變了你的習慣，并且你大量增加了壓縮量

compression, that this part is under over a period of

，這部分超過了一段

time, it will be too much for it, because

時間，這對它來說太過分了，因為

you haven't given it time to slowly build up to that point

你沒有給它時間慢慢地建立到那個點

and that's when it flares up. Now what type of activities can cause it to

，那就是它爆發(fā)的時候。現在，什么類型的活動會導致它

suddenly overload and suddenly say "Whoa this is too much compression to what I'm

突然超負荷并突然說“哇，這對我

used to?" Classic one that I see, and this is

習慣的壓縮太大了？” 我看到的經典之作，

in non-runners as well as runners, is when they

在非跑步者和跑步者中都是如此，當他們

move from wearing a shoe with a bit of a heel

從穿有點后跟的鞋

to flat shoes. So if we think of regular people, non-runners,

轉向平底鞋時。因此，如果我們想到普通人，非跑步者

it can be when you go from winter shoes to summer shoes, so flip flops,

，可能是當你從冬鞋換到夏鞋、人字拖，

or walking barefoot a lot. So now your Achilles tendon and bursa was in this

或者經常光腳走路的時候。所以現在你的跟腱和滑囊一直處于這個

position the whole time. So you can see it's not going to get

位置。所以你可以看到那里不會有

that much compression over there because it's not

那么大的壓縮，因為它沒有

pulling that tight. But now you go to flat

拉得那么緊。但是現在你

shoes or to barefoot: can you see that the compression is now going to increase

穿平底鞋或赤腳：你能看到壓力現在會

suddenly? Now if you make that switch slowly and

突然增加嗎？現在，如果你慢慢地進行這種轉換并且

you've built up to it, absolutely fine, because the body

你已經適應它，那絕對沒問題，因為

then has time to adapt those structures and cope with it. For runners it'll be if

身體有時間適應這些結構并應對它。例如，對于跑步者來說，如果

you go from a shoe with quite a bit of a

你從鞋跟落差很大的鞋子

heel drop, so heel-toe drop, to minimalist shoes, for instance. That

，比如跟腳趾落差，到極簡主義的鞋子。這

can make... that's one of the most common reasons why I see in runners um... why the

可以使......這是我在跑步者身上看到的最常見的原因之一......為什么

insertional Achilles can flare up. Another common cause can be if you do a

插入的跟腱會突然爆發(fā)。另一個常見的原因可能是，如果你在平地上做了

lot of walking on flat and then suddenly you add in a

很多步行，然后突然增加了

lot of hill walking, because walking up the hill, again you'll

很多山路步行，因為上山時，你會再次

pull that tight and you increase the compression there.

拉得那么緊，你會增加那里的壓力。

So massive increase in compression forces. Or,

如此巨大的壓縮力增加?；蛘?，

in lockdown, what we've seen a lot is suddenly people are working from home

在封鎖期間，我們經?？吹饺藗兺蝗辉诩夜ぷ?，

so now you have all this free time because you're not commuting so you can

所以現在你有這么多空閑時間，因為你沒有通勤，所以你可以

increase your exercise dramatically and it can be that you walk

顯著增加鍛煉，而且你可以

a lot more than what you used to, same distance than what you're used to, same

走更多路比你習慣的，相同的距離，相同的

route, but just more often. Same thing for running: you're used to

路線，但更頻繁。跑步也是一樣：你習慣

running three times a week... "Brilliant, I've got time for five or six

了一周跑三遍……“太棒了，我現在有時間一周跑五六

times a week now!" But guess what? Your structures hasn't adapted to it. So,

次了！” 但猜猜怎么了？你的結構沒有適應它。所以，

yes the Haglund's Deformity decreases the space there and it may predispose you

是的，Haglund 畸形減少了那里的空間，它可能會使您

to get being more sensitive to increased compression forces,

對增加的壓縮力更加敏感，

but it's that sudden increase in load of the compression forces that causes it.

但正是壓縮力負載的突然增加導致了它。

So how do you get it better?... Do you need surgery to take that Haglund's away?

那么你如何讓它變得更好呢？... 你需要手術把那個 Haglund 帶走嗎？

Well I hope from the previous bit you would have realized that, no, you

好吧，我希望從前面的內容你會意識到，不，你

don't really. Um... because... and the reason I say that is: one,

真的沒有。嗯...因為...我這么說的原因是：第一，

you would have had that Haglund's Deformity for years without pain

你會在沒有疼痛的情況下患有 Haglund 畸形多年

and, two, I've seen plenty of patients get better

，第二，我看到很多

with the Haglund's Deformity, back to full sport,

患者因 Haglund 畸形而好轉，恢復完整 運動，

still have the Haglund's there, so it obviously wasn't the main issue there.

仍然有哈格倫德，所以這顯然不是主要問題。

So how do you get it better? We treat the bits that's causing the pain.

那么你如何讓它變得更好呢？我們處理引起疼痛的部分。

So if we think it's excessive compression

因此，如果我們認為

when the foot goes into dorsiflexion that's causing the irritation in the

當足部進入背屈時過度壓縮會導致

Achilles tendon as well as the bursa, we want to take

跟腱和滑囊受到刺激，我們希望

that compression off for a little bit. So for a short period of time we may get

稍微減輕這種壓縮。因此，在短時間內，我們可能會讓

you to only wear shoes with a heel on it. So regular trainers

您只穿帶后跟的鞋子。例如，普通的訓練師

for instance, or even put a heel lift in your shoe so

，甚至在你的鞋子里放一個腳跟提升裝置，

that you don't go into that areas where it compresses. And

這樣你就不會進入它壓縮的區(qū)域。

that may mean that you've got to wear shoes for a short period of time in...

這可能意味著你必須在……在你的房子里穿短時間的鞋子，

in your house until it decides to calm down.

直到它決定平靜下來。

How long that period of time is will depend on how sensitive yours is,

這段時間有多長取決于你的敏感程度，

how long it's been irritated for, and a lot of other factors around that.

它被激怒的時間，以及與此相關的許多其他因素。

So that's the first step, is offload it, get it out of that position.

所以這是第一步，卸載它，讓它離開那個位置。

Um second bit on that as well: you'll often find that then other

嗯，第二點：你經常會發(fā)現，其他的

activities like squats and stuff in the gym can flare it up as well because it

活動，比如深蹲和健身房里的東西，也會讓你興奮起來，因為它

causes that dorsiflexion so lifting your heels without... so putting a

會導致背屈，所以抬起你的腳后跟而不用……所以

plate under your heels when you squat, brilliant way of continuing squatting,

在你的腳后跟下放一個盤子 當你深蹲時，絕妙的方式繼續(xù)深蹲的

then. Then, the second bit will depend on

話。然后，第二位將

whether it's a bursitis or a tendinopathy or the combination. If

取決于它是滑囊炎還是肌腱病或兩者兼而有之。如果

there's a bursitis involved, then using a short course of

涉及滑囊炎，那么使用短期

anti-inflammatories may be useful for it to calm down more

抗炎藥可能有助于它更快地平靜下來

quickly, but remember to check with your doc,

，但請記住咨詢您的醫(yī)生，

because you may not be okay with taking anti-inflammatories,

因為您可能不適合服用抗炎藥，

there may be a reason why you shouldn't take them. Anti-inflammatories don't

可能會有 你不應該接受它們的原因。抗炎藥

help for tendinopathies. What we know from the research is that

對肌腱病沒有幫助。我們從研究中了解到，

tendinopathies don't really have a massive inflammatory component to them,

肌腱病實際上并沒有大量的炎癥成分，

so don't take it just for healing for tendinopathy. It's only if there's a

所以不要僅僅為了治療肌腱病而服用它。只有出現

bursitis that you could try a short course, but when I say short course:

滑囊炎才可以嘗試短期課程，但是當我說短期課程時：

five to ten days. But check with your GP. Um... then also

五到十天。但是請咨詢您的全科醫(yī)生。嗯……那

if a bursitis is really really really persistent and does not want to calm

如果滑囊炎真的真的很頑固，不想平靜

down, there are certain injections that can be

下來，有一些注射

useful for it, but those are only as a last resort,

劑對它有用，但那些只是作為最后的手段，

because usually, for bursitis, they will inject

因為通常，對于滑囊炎，他們會 將

corticosteroid into the bursa, not the tendon.

皮質類固醇注入滑囊，而不是肌腱。

But the bursa is really close to the tendon and we know that corticosteroids

但是滑囊離肌腱很近，我們知道皮質類固醇

is not good for the tendon and you can't keep it to just the bursa, there will be

對肌腱不好，你不能只把它放在滑囊上，也會有

a little bit that spreads to the tendon as well.

一點點擴散到肌腱。

So it's a last resort if the bursa doesn't want to calm down. Usually what

因此，如果法氏囊不想平靜下來，這是最后的手段。通常

we find is, for our patients, if we can offload it okay with the shoes, they

我們發(fā)現，對于我們的患者來說，如果我們可以用鞋子卸下它，他們

don't need any of that. The next bit with offloading is to stop

就不需要任何東西。卸載的下一點是停止

stretching your calf and your Achilles and... into dorsiflexion. So I was

拉伸你的小腿和你的跟腱，并且......進入背屈。所以

really shocked once again when I googled Haglund's Deformity

當我在谷歌上搜索 Haglund 的畸形

to see if I could get nice pictures for this talk, um...

，看看我能不能為這次談話找到漂亮的照片時，我真的又一次震驚了，嗯

to find how many articles of people who claim to know how to treat this

……找到多少聲稱知道如何治療這種疾病的人的文章

tell them to stretch... so that typical calf stretch for the runners.

告訴他們伸展…… 所以跑步者的典型小腿伸展。

Or put a band around it pull your foot towards you. Now

或者在它周圍放一條帶子，把你的腳拉向你?，F在

can you see that if you're going to stretch your foot like that

你能看到，如果你要像這樣伸展你的腳，

all it's going to do is increase the compression,

它所要做的就是增加壓力，

increase the load on those structures that's sensitive and don't like

增加那些敏感且不喜歡壓力的結構上的負荷，這

compression, and it's going to be like poking a

就像戳

bruise. So your pain is just going to escalate and it's just going to get

瘀傷一樣 . 所以你的痛苦只會升級，而且只會變得

worse. So please, if you're doing calf stretches

更糟。因此，如果您

for an insertional tendinopathy or bursitis or Haglund's Deformity that

因插入性肌腱病或滑囊炎或 Haglund 畸形

you've been told for is causing the pain, stop stretching. That's one of the best

導致疼痛而進行小腿拉伸，請停止拉伸。這是你能做的最好的事情之一，

things you can do is just to stop stretching

就是停止拉伸

and get yourself into a shoe that doesn't cause that drop.

，讓自己穿上不會導致跌落的鞋子。

And you'll be amazed after a couple of weeks how much your pain decreases.

幾周后你會驚奇地發(fā)現你的疼痛減輕了多少。

Now, we do need - once that acute pain is settled down - we do

現在，我們確實需要——一旦那種劇烈的疼痛平靜下來——我們確實

need to start loading it up gently. But when it comes to this

需要開始輕輕地加載它。但是，當涉及到這種

condition, it's not the first thing you need to

情況時，這不是您需要急于解決的第一件事

rush into. You need to get it to calm down a little bit first,

。你需要先讓它冷靜一點，

okay. So, when we do start loading it, it's going to be with heel raise type

好吧。所以，當我們開始加載它時，它將是腳跟抬高類型的

things, where you go up on your toes, but it's going to be different,

東西，你的腳趾會向上，但它會

from your mid portion Achilles tendinopathy.

與你的中部跟腱病有所不同。

You're not going to load it over the side of a step because - can you see if

你不會將它加載到臺階的一側，因為 - 你能看到如果

you drop your heel over the side of a step, you're going to get that

你的腳后跟落在臺階的一側，你會再次得到那種

compression again, and it won't be ready for it. So we may

壓縮，而且它還沒有準備好 . 因此，我們可能會

opt for things like isometrics where you just hold it or

選擇諸如等距運動之類的方法，您只需握住它或

doing your heel raises but doing it to floor level. Sometimes I get my patients

抬起腳后跟，但要達到地面水平。有時我讓我的病人

who are really sensitive to start going up and down but with a

開始上下移動非常敏感，但

shoe with a heel on, so we're really limiting that range of

鞋子有后跟，所以我們真的限制

motion where we strengthen it through. And then, as you get stronger, as it calms

了我們加強它的運動范圍。然后，當你變得更強壯，當它平靜

down, as it starts to accept more compression,

下來，當它開始接受更多的壓縮時，

we bring it into more positions where it's more compressed.

我們將它帶到更多壓縮的位置。

But it's really useful working with a physio to... to know and understand

但是與理療師一起工作真的很有用……知道并理解

when to make those transitions, because if you do it too quickly,

何時進行這些轉換，因為如果你做得太快，

then you'll just flare it up. So these things are not stuff that needs to be

那么你就會把它點燃。所以這些東西不是需要

thrown at it all at once. It's a stage by stage process of, "Okay,

一次性扔掉的東西。這是一個階段性的過程，“好吧，

it's calmed down for this, now let's add that." So,

這件事平靜下來，現在讓我們添加那個?！?所以，

that's how I get my patients back from an insertional tendinopathy

這就是我如何讓我的患者從插入性肌腱病

and a bursitis with or without a Haglund's Deformity.

和滑囊炎中恢復過來，無論是否有 Haglund畸形。

Now yes, of course, it won't ever treat a 100% of people, and

現在是的，當然，它永遠不會治療 100% 的人，而且

there are some cases that eventually go on to

有些病例最終會進行

surgery and does well with surgery. But why is it that some people don't get

手術并且手術效果很好。但為什么有些人沒有變得

better? So, one, is that it could be that your

更好呢？所以，一個，可能是你的

Haglund's Deformity or bone spur or stuff is just so severe and so big that it

哈格倫德畸形或骨刺或其他東西太嚴重了，太大了以至于它

does poke directly on that tendon and because

直接戳到了肌腱上，而且因為

of the shape of your foot and everything else

你的腳的形狀和其他一切

it just doesn't get to a position that we can get it to not do that.

它都沒有 到一個我們可以讓它不這樣做的位置。

So in those cases it may be useful to shave that piece of bone off.

因此，在這些情況下，將那塊骨頭剃掉可能會很有用。

Second, what I often find is that people just don't offload it for long enough, so

其次，我經常發(fā)現人們只是沒有足夠長的時間卸載它，所以

they don't give it enough time to recover and calm down.

他們沒有給它足夠的時間來恢復和平靜。

This is not something that you can say "Oh I offloaded it for a week or two and

這不是你可以說的“哦，我卸載了它一兩個星期，

now it's it's still not getting better." Achilles tendinopathy and bursitis takes

現在它仍然沒有好轉。”跟腱病和滑囊炎

at least three months, 12 weeks, to show good... good improvement.

至少需要 3 個月12 周才能顯示出良好的……良好的改善。

And then it can take up to six months to get back to where you want to be.

然后可能需要長達六個月的時間才能回到你想去的地方。

Now that may sound long, but listen, recovery from surgery isn't any shorter.

現在這聽起來可能很長，但聽著，從手術中恢復并不會更短。

So please don't see surgery as a short term solution, um... if you're going to have

因此，請不要將手術視為短期解決方案，嗯...如果您要進行

surgery, depending on what they do, you can have long standing recovery

手術，取決于他們的工作，之后您可以長期康復

after that. I'm working with people who, still a year later after surgery for

。我正在和一些人一起工作，這些人在手術后

this type of thing is, not much better than what they were

一年后的情況并不比

before the surgery. So... but then, I do have other people who

手術前好多少。所以......但是，我確實有其他人比我

is massively better, so don't take it as "Surgery is

好得多，所以不要認為“手術

always a bad thing." It's just about, make sure you really follow the guidelines

總是一件壞事”。只是，

properly before you decide to go on to surgery.

在決定進行手術之前，請確保您確實正確遵循了指南。

Also, I would go for other things first before surgery. So

另外，我會在手術前先去做其他事情。因此，

if rehab and offloading's not worked, consider shockwave,

如果康復和卸載不起作用，請考慮沖擊波，

especially if it's an insertional tendinopathy. I've had good results with

特別是如果它是插入性肌腱病。當患者不想對治療產生反應時，我已經取得了很好的效果

patients with that when it's not wanted to react

to the treatments... the other types of treatments we've tried.

……我們嘗試過的其他類型的治療。

Another one that could be useful, is if you try

另一個可能有用的方法是，如果您嘗試

different types of injections. There are different things that clinicians can do.

不同類型的注射。臨床醫(yī)生可以做不同的事情。

So PRP doesn't seem to work that well at

所以PRP 目前似乎沒有那么好用

the moment. I don't think they figured it out properly.

。我認為他們沒有正確地解決這個問題。

Bursitis seems to react well to corticosteroid but, like I said,

滑囊炎似乎對皮質類固醇反應良好，但就像我說的那樣，

not the first instance to decide to do that.

并不是第一個決定這樣做的人。

I wouldn't go for steroids into the Achilles tendon: that is

我不會將類固醇用于跟腱：這

in my books a little bit irresponsible because it does predispose you

在我的書中有點不負責任，因為它確實使您

to Achilles tears. But there are... there are high volume injection

容易流淚。但是有......有大容量注射

type injections and there are other injections that's experimental that's

類型的注射，還有其他正在進入市場的實驗性注射

coming onto the market and if the risk is low with an injection,

，如果注射的風險很低，

I would always try that first before you go on to surgery.

我總是會在你繼續(xù)手術之前先嘗試。

Okay. Oh yes and then the other thing is, again, why it may not work, conservative

好的。哦，是的，然后另一件事是，為什么它可能不起作用，保守

treatment, is if you've just neglected it for too long.

治療，是如果你忽視它太久了。

So you've taken months and months and months that you've

所以你花了幾個月，幾個月，幾個月，你

just kept on annoying it, didn't follow the right treatment advice, so that the

一直在煩惱它，沒有遵循正確的治療建議，所以

bursa may be a bit thickened and there's just no way that it can be

法氏囊可能有點增厚，沒有辦法卸載它

offloaded, um... or that it becomes happy to carry

，嗯 ......或者它變得很樂意攜帶

loads. So in those cases, taking the bursa out

負載。因此，在這些情況下，取出法氏囊

can be a solution for it as well. So let me know if you've got any questions,

也是一種解決方案。因此，如果您有任何問題，請告訴我

and if you need more help with your injury,

，如果您在受傷方面需要更多幫助，

you're welcome to consult one of us via video call. The link is

歡迎您通過視頻電話咨詢我們其中一位。該鏈接

top of this video, but also in the bottom in the description.

位于該視頻的頂部，也位于說明的底部。

Take care!

小心！