肌肉不平衡的评估与治疗：JANDA方法VIP免费

PhilPagePhD,PT,ATC,CSCS,FACSMBatonRouge,Louisiana静态姿势StaticPosture平衡Balance步态Gait肌肉长度MuscleLength运动模式MovementPatterns扳机点TriggerPoints检查感觉运动系统的状态&建立假设Examinestatusofsensorimotorsystem&formulatehypothesis对于感觉运动系统状态来说尤为重要尤为重要MOSTIMPORTANTMOSTIMPORTANTviewofthestatusofthemotorsystem为恰当的肌肉长度测试和力量测试提供线索，以确认在静态姿势中所见Cuestoappropriatemusclelengthorstrengthteststoconfirmwhatisobservedinstaticposture寻求姿势链中系统性适应Lookforsystematicadaptationsinchain优势眼在正中线上Dominanteyeinthemidline使用平衡、阴影&“想象”Usesymmetry,shadows,&“visualize”过度生长圆隆形，凸起Hypertrophyrounded,convex生长不足平，凹陷Hypotrophyflat,hollow,concave站立位，脱衣拖鞋Standing,clothesoff,noshoes侧面观LATERALVIEW后面观POSTERIORVIEW前面观ANTERIORVIEW12345678936294213578110头前伸颈椎前凸增加圆肩胸椎后凸增加A型（髋）TypeA(hip)B型（背部）TypeB(back)髋轻度屈曲膝轻度屈曲胸腰段后凸腰椎前凸骨盆前倾头前伸胸椎后凸腰椎曲度减小膝过伸感觉运动系统功能状态的指标Indicatoroffunctionalstatusofsensorimotorsystem基本原理Rationale观察功能稳定性控制中的骨盆控制Observepelviccontrolforfunctionalstability平衡策略的指标Indicatorofbalancestrategies说明站立中期的单腿站立Single‐legstanceindicativeofmid‐stance臀中肌功能Functionofgluteusmedius观察足部外形和功能Observationoffootformandfunction定量&定性Quantitative&QualitativeDiscriminatesLBPvs.Controls(Byl&Sinnot,1991)测试Test手臂置于体侧；将一足抬离地面Armsatside;raise1legoffthefloor髋屈曲45º，膝屈曲90ºHipflexedto45ºandkneeto90º睁眼平衡练习5‐10秒Practicebalancewitheyesopenfor5‐10sec双目直视前方并闭眼Thenfixgazestraightaheadandcloseeyes尝试保持此姿势30秒‐2次机会Trytomaintainfor30seconds–2chances失败出现Failureoccurs若脚碰到支撑腿或地面ifthefoottouchesthelegonthesupportlegorthefloor出现跳跃动作hoppingoccurs手臂触碰某物以达到支撑目的thearmstouchsomethingforsupport在多平面评估肌肉功能稳定性Evaluatesfunctionalstabilityofmusclesinmultipleplanes将姿势评估和单腿站立测试中得到的信息进行综合考虑Combineinformationfrompostureandsingle‐legstancetest步态模式Gaitpattern病理原因PathologyTrendelenburg臀中肌无力G.Mediusweakness“Lurch”臀大肌无力G.Maximusweakness膝过伸KneeHyperextension股四头肌无力Quadricepsweakness足拍地FootSlap胫骨肌无力Tibialisweakness跳跃步态VaultingGait腰方肌紧张Quadratustightness运动的质量Qualityofmovement肌肉放电顺序和速度Musclefiringorderandspeed收缩强度Intensityofcontraction大脑中所想为运动，而非肌肉Brainthinksintermsofmovement,notmuscle徒手肌力测试不能给予我们以激活速度、放电模式或关节稳定性方面的信息Manualmuscletesting(MMT)doesnotgiveusinformationonspeedofactivation,firingpatternsorjointstabilization在测试中很强壮的肌肉可能会在功能性运动中受到抑制AmusclethattestsstrongmaybeinhibitedwithfunctionalmovementMMT只能用来量化力弱MMTusedonlytoquantifyaweakness1.1.髋伸展髋伸展HipextensionHipextension主要作用于步态周期的站立相末期essentialinterminalstanceofthegaitcycle2.2.髋外展髋外展HipabductionHipabduction主要作用于单腿支撑相维持骨盆侧方稳定性essentialforlateralpelvicstabilityinsinglelimbstance3.3.屈膝两头起屈膝两头起CurlCurl‐‐upup评估髂腰肌&腹肌间的关系estimatestherelationshipbetweentheiliopsoas&abdominals4.4.头屈曲头屈曲HeadflexionHeadflexion决定了SCM&颈深屈肌群的关系DeterminesrelationshipbetweenSC...