脊柱疾病悬吊 PPT课件.ppt

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1、 脊柱疾病的康复治疗江苏省人民医院康复医学科卞 荣国际疼痛研究学会的疼痛定义为：n疼痛是一种不愉快的感觉和情感体验，与真实的或潜在的组织损伤有关，疼痛一词用来描述这类损伤n慢性疼痛的持续时间超过3个月，伴有日常生活和/或工作活动时的显著功能障碍n下腰痛（LBP）的明确特异性解剖诊断的意义远不如在下腰痛综合征中那样重要：绝大多数患者的症状可在一周内缓解，只有少数患者的症状68周后仍持续存在。考虑到非特异性下腰痛的自然史，即绝大多数患者的症状均可自发缓解，因此大多无需明确的解剖诊断下腰痛的流行病学n人类一生中的发生率为69%90%n下腰痛是造成45岁以下人群功能障碍的主要原因n是造成45岁以上人群

2、功能障碍的第三位原因脊柱的相关韧带脊柱的韧带n长期举重物可导致脊柱韧带复合体（棘上韧带、棘间韧带、后纵韧带、前纵韧带和黄韧带）承受应力n黄韧带含有神经末梢n后纵韧带含有大量受窦椎神经（腹腔内脏支和自主神经灰支交通）支配的游离神经末梢n前纵韧带受灰支交通支和腹支的支配nC:Documents and SettingsAdministrator桌面颈腰生物力学6.JPG椎间盘脊柱关节的运动脊柱的相关肌群肌力测量的主要肌肉nL2、L3髋屈肌nL3、L4膝伸肌nL4、L5踝背屈肌nL5踇背伸肌nS1踝跖屈肌背深层肌肉n背深层肌（即背固有肌）与颈后肌延续，包括深层的横突棘肌群和较浅层的竖脊肌群。它们的功

3、能是伸脊柱和防止脊柱塌陷。腰方肌、腰大肌、背阔肌、腹内斜肌、腹横肌和胸腰筋膜均辅助上述功能。枕下肌-夹肌n头夹肌：起于项韧带下部及C7、T1-T3椎体的棘突，止于上项线下部及颞骨乳突。n颈夹肌：起于T3-T6棘突，止于C1-C3横突。n一侧收缩时可使头向同侧屈和回旋，同时收缩可使头颈伸直 n从内侧到外侧分别称棘肌、最长肌和髂肋肌 n起于骶骨背面、髂嵴后部、腰椎棘突和胸腰筋膜，止点棘肌止于颈胸椎棘突、最长肌止于颈胸椎横突和颞骨乳突，髂肋肌止于肋骨的肋角。n功能：两侧的颈竖脊肌收缩使寰枕关节和脊柱颈部的后伸，一侧收缩则产生侧屈前外侧躯干肌n腹直肌：屈躯干 n腹外斜肌：为一侧收缩使躯干转向对侧，并向

4、同侧屈曲。n腹内斜肌：为一侧收缩躯干屈向同侧，并旋转躯干向对侧的肩。n腹横肌：增加腹压 n肋间外肌和肋间内肌：提肋和降肋 n膈：吸气胸腰筋膜胸腰筋膜 n也称胸背筋膜，是一强健的复合结构，它像一条巨大的韧带连结肋、椎骨、髂骨和骶骨之间，还连结后椎骨间韧带系统和三块躯干肌。这筋膜系统提供提举重物越过头和用高速投掷物体时稳定躯干的特殊能力 核心核心（core）n“核心”这个名词最早在康复医学和运动医学领域广泛讨论有10多年。nBehm在2010年提出：解剖的“核心核心”为中轴骨（包括脊柱、肩带和骨盆带）以及与中轴骨相关的所有的软组织（韧带、肌腱和肌肉等）。3、Behm,D.G.B.D.G.,et a

5、l.,The use of instability to train the core musculature.何为何为“核心（核心（core）”核心肌群的分类核心肌群的分类5、Bergmark,A.,Stability of the lumbar spine.A study in mechanical engineering.Acta Orthop Scand Suppl,1989.230:p.1-54.近来很多研究认为腹横肌腹横肌与多裂肌多裂肌是脊柱稳定的最主要的肌肉7,87.Cholewicki J,Simons AP,Radebold A.Effects of external tru

6、nk loads on lumbar spine stability.J Biomech.2000;33(11):1377.8.Fredericson M,Moore T.Core stabilization training for middle and long distance runners.New Stud Athl.2005;20:25-37.核心稳定核心稳定(Core Stability)n“核心稳定核心稳定”就是指身体控制中轴骨上各关节链的机械稳定能力2,4。n脊柱受到干扰后帮助恢复平衡的能力n可在运动中稳定和维持人体脊柱、骨盆、髋关节牢固性3 n核心稳定性的优劣取决于位于核心

7、部位的肌肉、韧带和结缔组织的力量以及它们之间的协作。2.Hodges,P.W.and C.A.Richardson,Inefficient muscular stabilization of the lumbar spine associated with low back pain:a motor control evaluation of transversus abdominis.3、杨宇,马继政,张仁祥,韩峰.关于体育运动中核心稳定性训练之研究.南京体育学院学报:自然科学版.2008;(2):25.The beliefs1.That certain muscles are more i

8、mportant for stabilisation of the spine,in particular transverses abdominis(TA).2.That weak abdominal muscles lead to back pain3.That strengthening abdominal or core muscle can reduce back pain4.That a strong core will prevent injury.Passive stabilityActive stabilitySerge Gracovetskys“controlled ins

9、tability”Serge Gracovetsky 2005 Stability or controlledinstability?Evolution at work.In:Movement,StabilityandLumboPelvicPain2ndEditionCh14“It was also proposed that the width of the neutral zone was related to the stability of the joint.These conclusions were drawn from cadaver experiments and mathe

10、matical models on which an extensive amount of damage had to be inflicted to the joint before an unstable response was obtained.So far,the neutral zone argument has remained academic.”During movement,muscle that are“not working”are just as important as muscles that are working!Complexity of trunk st

11、abilisationnCONCLUSIONS:No single muscle dominated in the enhancement of spine stability,and their individual roles were continuously changing across tasks.Clinically,if the goal is to train for stability,enhancing motor patterns that incorporate many muscles rather than targeting just a few is just

12、ifiable.nKavcic N,Grenier S,McGill SM.Determining the stabilizing role of individual torso muscles during rehabilitation exercises.Spine.2004 Jun 1;29(11):1254-65.Stability is only another motor control patternSkillsComposite abilitiesComposite abilitiesContraction abilitiesContraction abilitiesForc

13、e(static&dynamic),velocity and lengthForce(static&dynamic),velocity and length Balance,Balance,motor motor relaxation,relaxation,coordination,coordination,fine fine control,control,reaction time,transition ratereaction time,transition ratereciprocal activationreciprocal activation(Movement)(Movement

14、)Motor complexityMotor complexityCo-contraction Co-contraction(Stability,dynamic/static)(Stability,dynamic/static)Synergetic abilitiesSynergetic abilitiesLedermanE2005ScienceandPracticeofManualTherapy,Elsevier.Increase in spinal compressionIncrease in spinal compressionReduce range of movementReduce

15、 range of movementIncrease energy expenditureIncrease energy expenditureIncrease co-contractionIncrease co-contractionIncrease stabilityIncrease stabilityAstudyprovingthatyoucantlearntoplaythepianobypracticingonabanjo.Stanton,R.,Reaburn,P.R.&Humphries,B.(2004).Theeffectofshort-term Swiss ball training on core stability and runningeconomy.JStrengthCondRes18,522-528.上交叉综合症下交叉综合症下腰痛的悬吊治疗核心稳定训练