種疼痛課件-膝韌帶扭傷-knee ligament

Introduce

the

clinical

presentation

clinical

anatomy,

pathology,

clinical

kinesiology,

and

clinical

biomechanics

of

a

Common

KneeDisorders:Knee

Ligament

Sprain介紹常見膝關(guān)節(jié)異常：膝關(guān)節(jié)韌帶扭傷的臨床表現(xiàn)，臨床解剖學(xué)，病理學(xué)，臨床

運(yùn)動科學(xué)，臨床生物力學(xué)Provide

the

Education/Counseling

Strategies

and

Exercise

Management

Options

for

individuals

wit ee

Ligament

Sprains

/

Knee

Movement

Coordination

Impairments給膝關(guān)節(jié)韌帶扭傷／膝關(guān)節(jié)活動協(xié)調(diào)

的患者提供教育／咨詢策略和運(yùn)動管理方案會繼續(xù)在以下幾個方面介紹常見肌肉骨骼情況臨床臨床表現(xiàn)臨床解剖病理學(xué)運(yùn)動科學(xué)臨床生物力學(xué)clinical

presentation:臨床表現(xiàn):the

commonly

reportedproblems

or

concernsof

theindividual

with

thecondition患者對于病情的常見主訴和顧慮Knee

Ligament

Sprain

-

clinical

presentation:膝關(guān)節(jié)韌帶扭傷－臨床表現(xiàn)History

of

knee

injury膝關(guān)節(jié)的受傷史Knee

Ligament

Sprain

-

clinical

presentation:膝關(guān)節(jié)韌帶扭傷－臨床表現(xiàn)Feelings

of

the

knee

“giving

way”,

especially

with

changes

of

direction感覺膝蓋“忽然失穩(wěn)”，特別是在轉(zhuǎn)向的時候Knee

Ligament

Sprain

-

clinical

presentation:膝關(guān)節(jié)韌帶扭傷－臨床表現(xiàn)Recurrent

knee

effusion反復(fù)的膝關(guān)節(jié)積液Knee

Ligament

Sprain

-

clinical

presentation:膝關(guān)節(jié)韌帶扭傷－臨床表現(xiàn)Pain

with

single-leg

loading

such

as

hop or

directionalchanges單腳支撐（比如跳躍或改變方向）時覺得疼痛Knee

LigamentSprain

-

clinicalpresentation:膝關(guān)節(jié)韌帶扭傷－臨床表現(xiàn)引起Knee

joint

laxity,

usually

due

to

anterior

crucia igament

insufficiency

or

rupture膝關(guān)節(jié)松弛，通常由于前交叉韌帶減弱或Sensorimotor

deficits感覺運(yùn)動缺失，由于韌帶上的本體感受器損傷Strength

deficits肌肉強(qiáng)度減小，因?yàn)樘弁炊惚芑蛘咭种萍∪獾募せ頚nee

Ligament

Sprain

-

clinical

anatomy:膝關(guān)節(jié)韌帶扭傷：臨床解剖Knee

Ligament

Sprain

-

pathology:膝關(guān)節(jié)韌帶扭傷－病理學(xué)膝關(guān)節(jié)韌帶扭傷－臨床Knee

Ligament

Sprain

-

clinical

kinesiology:運(yùn)動科學(xué)Education/Counseling

StrategiesandExercise

Management

Optionsfor

individuals

withKnee

Movement

Coordination

Impairments膝關(guān)節(jié)活動協(xié)調(diào)

（共濟(jì)失調(diào)）的教育／咨詢策略和訓(xùn)練管理方案Rehabilitation

Specialists

describe

it

anKnee

Movement

Coordination

Impairments康復(fù)師們形容這個為膝關(guān)節(jié)活動協(xié)調(diào)

（共濟(jì)失調(diào)）Becausethe

focus

of

treatment

is

training

to

use

the

muscles

andmovement

coordination

systems

to

keep

the

knee

joint

(Femur

andTibia)

in

the

mid-range

position

-

tolimit-range

or

"giving-way"

episodes治療的重點(diǎn)是通過訓(xùn)練患者使用肌肉及運(yùn)動協(xié)調(diào)系統(tǒng)來保持膝關(guān)節(jié)（股骨和脛骨）在活動度的中段位置，來減少達(dá)到活動度末端或“忽然失穩(wěn)“的發(fā)生remember

the

common

clinical

presentation:記住常見的臨床表現(xiàn)History

ofknee

injury膝關(guān)節(jié)受傷史Feelings

of

the

knee“giving

way”,

especiallywith

changes

of

direction感覺膝關(guān)節(jié)“忽然失穩(wěn)”，特別是當(dāng)做出方向改變動作時Recurrentknee

effusion反復(fù)發(fā)作的膝關(guān)節(jié)積液Pain

with

single-leg

loading

such

as

hop or

directional

changes單腿負(fù)重比如跳躍或方向改變時伴有疼痛Knee

Ligament

Sprain

/

Knee

Movement

Coordination

Impairments膝關(guān)節(jié)韌帶扭傷／膝關(guān)節(jié)運(yùn)動協(xié)調(diào)

（共濟(jì)失調(diào)）Focus

of

Fitness

Education/

TrainingTips健康教育和訓(xùn)練技巧的焦點(diǎn)Assist

with

determiningthe

needfor

surgical

repair

-

based

uponinjury,level

of

strength

and

sensorimotor

control

available,

and

athletic

or

occupationalneeds幫助確定手術(shù)修復(fù)的必要性－根據(jù)受傷情況，肌肉健康（肌力）程度和感覺運(yùn)動神經(jīng)的情況和

體育或工作的需要Knee

Ligament

Sprain

/

Knee

Movement

Coordination

Impairments膝關(guān)節(jié)韌帶扭傷／膝關(guān)節(jié)運(yùn)動協(xié)調(diào)

（共濟(jì)失調(diào)）Focusof

Fitness

Education/

Training

Tips健康教育和訓(xùn)練技巧的焦點(diǎn)Progress

strengthand

neuromusculartraining

as

able

and

needed

for

performance

of

desired

activity根據(jù)目標(biāo)活動表現(xiàn)的實(shí)際情況和需求，逐步強(qiáng)化肌肉和神經(jīng)肌肉訓(xùn)練Exercise

Management

Optionsfor

individuals

withKnee

Ligament

Sprain

/

Knee

Movement

Coordination

Impairments患者的膝關(guān)節(jié)韌帶扭傷／膝關(guān)節(jié)運(yùn)動協(xié)調(diào)運(yùn)動管理方案Strengthening:肌肉強(qiáng)化訓(xùn)練：Hip

AbductorsHip

External

RotatorsQuadricepsGastrocSoleus

-

Fibularis

Longus髖外展肌群髖外旋肌群股四頭肌比目魚?。韫情L肌Progressive

Loading

&

SensorimotorTraining漸進(jìn)式負(fù)載和感覺運(yùn)動神經(jīng)訓(xùn)練Hip

Abductors

Strengthening-

Level

1髖外展肌群強(qiáng)化－第一階Hip

AbductorsStrengthening

-

Sidelyingat30degrees

of

HipFlexion

-

Clam

S s

-

(Level

1a):

Activation髖外展肌群強(qiáng)化訓(xùn)練－側(cè)躺且髖屈30度－蚌式－（第1a階）：激活Performance

CuesLie

on

your

side,

feet

togetherwithsocks

on,

both

legsand

hips

bent45-90

degrees.

Back

can

be

supported

on

awall

to

minimize

twisting

in

the

trunk

andpelvis.Draw

the

belly

buttonin

towards

the

spine,

liftingthelower

side

of

the

trunkslightly

away

from

the

table/groundMaintaining

this

position,

lift

thetopleg

up

and

slowly

lower

it

back

downOnce

you

can

perform15

ofthebentleg

lifts

withoutlosing

form,

then

add -

usually

using

a

resistivebandThe

next

progression

would

be

to

performa

side

leg

raise

with

a

straight

legAnd,

then

progress

to

addingresistantto

the

side

leg

raises動作提示側(cè)臥，雙腳靠攏并著襪子，雙腿和髖部屈曲約45－90度。后背可靠在墻上以減少軀干和盆骨的旋轉(zhuǎn)將腹部向內(nèi)收靠近脊椎，慢慢把身體底部一側(cè)抬離床面／地面保持這個在能夠保持，把上方的退抬起然后再慢慢放下正確的情況下能夠重復(fù)15次時，增加難度－通常使用彈力帶下一步是直腿抬起再下一步是給直腿抬起加Hip

AbductorsStrengthening-

Sidelyingat0

degreesof

HipExtension-

Side

LegRaises-

(Level

1c):

Activation髖外展肌群強(qiáng)化訓(xùn)練－側(cè)躺且髖伸0度－側(cè)腿抬高－（第1c階）：激活Hip

Abductors

Strengthening(Level2):Side

Planks

from

Knees

-

with

Arm

and

Leg

Progressions髖外展肌群強(qiáng)化訓(xùn)練（第二階）：膝關(guān)節(jié)支撐側(cè)橋附帶

和腿部運(yùn)動Hip

Abductors

Strengthening

(Level

2):Side

Planks

from

Knees

-

with

Arm

and

Leg

Progressions髖外展肌強(qiáng)化訓(xùn)練（第二階）：膝關(guān)節(jié)支撐側(cè)橋附帶

和腿部運(yùn)動Performance

Cues的動作Lie

on

your

side

and

prop

yourself

up

on

your

elbowLift

your

hips

so

that

you

are

holding

yourself

up

between

your

elbow

and

kneesDO

NOT

allow

your

body

to

twistLower

your

hips

and

thighs

toward

the

ground

and

then

raise

to

the

half

plank

positionWhen

you

are

strong

and

stable

with

your

half-planks,

add

arm

movements

in

line

with

your

body

(like

a

snow

angel)Then

progress

to

performing

clams s

in

the

half

plank

positionThen

progress

to

moving

your

arm

across

your

body

-

while

kee your

hips

and

trunk

very

stable動作提示：側(cè)躺并用肘部把身體支撐起來把髖部抬起讓肘部和膝部支撐著身體不要讓身體旋轉(zhuǎn)讓髖部和大腿下降接近地面然后再提高至半平板位置當(dāng)你做半平板更強(qiáng)壯和穩(wěn)定之后，在跟你的身體同一個平面上增加（像Snow

Angel的動作）然后在半平板的

上遞進(jìn)到蚌式然后遞進(jìn)到

在胸前橫移運(yùn)動－當(dāng)你可以把髖部和軀干保持非常穩(wěn)定的時候Hip

Abductors

Strengthening

(Level

3)Side

Planks

from

Feet

-

with

Leg

Progressions髖外展肌群強(qiáng)化訓(xùn)練（第三階）腳部支撐側(cè)橋－腿部漸進(jìn)式運(yùn)動Hip

Abductors

Strengthening

(Level

3)Side

Planks

from

Feet

-

with

LegProgressions髖外展肌群強(qiáng)化訓(xùn)練（第三階）腿部支撐側(cè)橋－腿部漸進(jìn)式運(yùn)動Performance

CuesLie

on

your

side

and

propyourself

up

on

yourelbowLiftyour

hips

so

that

you

are

holding

yourselfup

between

your

elbow

and

feetDO

NOT

allow

yourbody

totwistWhen

you

arestrong

and

stable

with

yourfull-planks,

lower

your

hips

and

thighs

toward

the

ground

and

then

raise

to

the

full

plank

positionThen,

progress

to

loweringof

your

topleg動作提示側(cè)臥并用肘部將身體支撐起來將髖部抬起，你是用肘部和腿部在支撐身體避免身體的旋轉(zhuǎn)當(dāng)你的力量和穩(wěn)定性足夠做全平板的時候，將髖部和大腿下降到地面然后在抬起回到全平板的然后慢慢地把在上方的腿放下來Hip

Abductors

Strengthening

(Level

4)Standing

Hip

Abduction

-

Progressions髖外展肌群強(qiáng)化訓(xùn)練－第四階站位髖外展肌群－漸進(jìn)式訓(xùn)練Hip

Abductors

Strengthening

-

Level

4髖外展肌群強(qiáng)化訓(xùn)練－第四階STANDING

HIP

HIKES站位提臀訓(xùn)練Performance

CuesStand

on

one

leg,

with

the

other

leg

in

line

with

footjust

offof

the

groundDraw

the

belly

button

in

towards

the

spine

and

hold

throughout

the

exerciseAllow

thehip

that

you

are

standingon

to

drop

out

to

the

sideslightlyUse

your

outer

hip

muscles

to

help

‘pull

you

back

in

line

.

Try

to

keep

the

opposite

footoff

of

the

ground.This

exercise

should

be

completed

slowly

with

controlA

mirror

or

standing

with

the

hip

about

6

inches

from

a

wall

may

be

helpfulto

give

feedback

in

proper

performance動作提示單腳站立，另一側(cè)腳對齊且稍抬離地面將肚臍向脊椎方向內(nèi)收且在整個訓(xùn)練中保持這個站立腳一側(cè)的臀部可以稍向外側(cè)傾使用你臀部外側(cè)的肌肉來幫助你把臀部“拉回并對齊”，嘗試保持對側(cè)腳離開地面這個訓(xùn)練應(yīng)該緩慢且有控制地進(jìn)行站在鏡子前或離 約6英寸（約15厘米）處可以提供回饋來幫助正確地進(jìn)行訓(xùn)練Hip

Abductors

Strengthening

-

Level

4髖外展肌群強(qiáng)化訓(xùn)練－第四階SINGLE-LEG

SQUATS

WITH AND

DIAGONAL

REACHES單腿下蹲合并阻力和對角線伸夠Performance

CuesStand

on

one

leg

with

theraband

wrapped

around

this

knee.

The

theraband

should

be

attached

to

a

secure

table

or

desk.

The

other

foot

should

be

held

up

with

the

leg

close

to

the

other.Draw

the

belly

button

in

towards

the

spine

and

hold

throughout

the

exercisePerform

a

single

leg

squat

to

90

degreesThe

band

will

be

pulling

your

knee

inwards

–

use

your

outer

hip

muscles

to

pull

against

the

band

and

keep

you

knee

‘in

line’

with

your

foot

and

ankleThis

exercise

should

be

completed

slowly

with

controlWhen

you

can

complete

15

repetitions

of

this

exercise

try

to

reach

the

opposite

hand

of

the

standing

leg

to

touch

and

object

diagonally

in

front

of

the

standing

leg動作提示單腿站立且用彈力帶繞在膝關(guān)節(jié)處。彈力帶應(yīng)固定在牢固的桌子或凳子處。另一側(cè)腳應(yīng)靠近將肚臍處往脊椎方向內(nèi)收且在整個練習(xí)中保持這個單腳下蹲至90度彈力帶會將你的膝關(guān)節(jié)往內(nèi)拉－用你臀部外側(cè)的肌肉跟彈力帶對抗并且保持膝關(guān)節(jié)和腳和踝在一條直線上這個訓(xùn)練應(yīng)該在緩慢和有控制的情況下完成當(dāng)你能重復(fù)15次以后，嘗試用站立腳對側(cè)

去做一個對角線的運(yùn)動來觸碰站立腳前面的物體Thereis

a

lot

of

researchinthe

scientifi erature

that

linkstrunk

andhipabduction

strength

to

preventionknee

ligament

injuries

and

tosuccessfulrehabilitation

ofkneeligamentinjuries在學(xué)術(shù)文獻(xiàn)中有許多研究，把軀干和髖外展力量相結(jié)合，來防止膝關(guān)節(jié)韌帶受傷和幫助膝關(guān)節(jié)韌帶受傷成功康復(fù)Can

anyone l

be

a

biomechanical

reason

for

this

relationship?有人可以說出這個關(guān)系中的生物力學(xué)方面的原因嗎？Hip

External

Rotators

Strengthening

-

Level

1Hip

External

RotationStrengthening:Sitting

ER

usingelasticPerformance

CuesSiton

a

study

table

with

your

le er

the

side

-

knee

at

90

degrees

and

hip

at

90

degreesAttach

an

elastic band

or

cord

to

the

ankle/foot

area

with

the

other

end

to

a

study

objectMove

the

ankle

inward

-

externally

rotating

the

hip

against

the髖外旋肌力量訓(xùn)練－水平1髖外旋肌力量訓(xùn)練：坐位外旋（使用彈力帶）動作提示：·坐在桌上腿放在桌邊－膝蓋90°，髖關(guān)節(jié)90°·腳踝處系上彈力帶，同時把彈力帶的另一端固定在桌腿上·向內(nèi)側(cè)移動腳踝－抗阻外旋髖關(guān)節(jié)Hip

External

Rotators

Strengthening

-

Level

2Hip

External

Rotators

Strengthening:

Sitting

ER

using

cable/pulleyPerformance

CuesSit

on

a

study

table

with

yourle er

the

side

-

knee

at

90

degrees

and

hip

at

90

degreesAttach

cable/pulley with

a

cuff

at

the

ankle

areaMove

the

ankle

inward

-

externally

rotating

the

hip

against

the髖外旋肌力量訓(xùn)練－水平2髖外旋肌力量訓(xùn)練：坐位外旋（使用繩索/滑輪組合）動作提示：·坐在桌上腿放在桌邊－膝蓋90°，髖關(guān)節(jié)90°·腳踝處套上繩索/滑輪組合·向內(nèi)側(cè)移動腳踝－抗阻外旋髖關(guān)節(jié)Hip

External

RotatorsStrengthening

-Level

3Hip

External

Rotation

Strengthening:

Standing

ER

using

cable/pulleyPerformance

CuesStand

with

your

hip

in

slight

flexion,

heel

on

the

floorAttach

anelastic band

orcordto

theankle/foot

area

with

the

other

endto

a

study

objectMove

thefoot

outward

-externallyrotatingthehip

against

the髖外旋肌力量訓(xùn)練－水平3髖外旋肌力量訓(xùn)練：站立位外旋（使用繩索/滑輪組合）動作提示：·髖微屈站立，腳跟在地上·腳踝處套上繩索/滑輪組合·向外側(cè)移動腳踝－抗阻外旋髖關(guān)節(jié)Hip

External

RotatorsStrengthening

-

Level

4Hip

External

Rotation

Strengthening:

Standing

ER

using

cable/pulleyPerformance

CuesStand

in

a

lunge

position,

holding

a

handle

attached

to

a

cable/pulley in

your

outstretched

armsPosition

your

legs/body

so

that

the

hip

external

rotators

of

one

buttock

are

the

primary

movers

driving

the

rotation

against

the髖外旋肌力量訓(xùn)練－水平4髖外旋肌力量訓(xùn)練：站立位外旋（使用繩索/滑輪組合）動作提示：·弓箭步站姿，伸展·定位腿/身體，一臂握住繩索/滑輪組合的把手部的髖外旋?。ㄔ瓌蛹。┦湛s抗阻外旋There

is

a

lot

of

research

in

the

scientifierature

that

links

trunk

and

hip

external

rotation

strength

to

prevention

knee

ligament

injuries

and

to

successful

rehabilitation

of

knee

ligament

injuriesCan

anyone l

be

a

biomechanical

reason

for

this

relationship?The

answer

is

similar

to

the

answer

given

for

hip

abductors

strength

and

motor

control有很多科研文獻(xiàn)顯示：軀干和髖外旋肌力量與預(yù)防膝關(guān)節(jié)韌帶損傷以及膝關(guān)節(jié)韌帶損傷后的成功康復(fù)之間存在關(guān)聯(lián)。哪一位能說出這種關(guān)聯(lián)的生物力學(xué)原理？Strengthening:Hip

Abductors

Hip

External

RotatorsQuadricepsGastrocSoleus

-

FibularisLongusProgressive

Loading&Sensorimotor

Training力量訓(xùn)練：髖外展肌

髖外旋肌

股四頭肌腓腸肌、比目魚?。韫情L肌負(fù)荷進(jìn)階和運(yùn)動感覺訓(xùn)練QuadricepsStrengthening-

Level1股四頭肌力量訓(xùn)練－水平1QuadricepsStrengthening-

Level2WallSlides股四頭肌力量訓(xùn)練－水平2倚墻深蹲QuadricepsStrengthening-

Level2WallSlidesPerformance

CuesStand

with

back

supported

against

thewall,

feet

shoulder

width

apart

and

14-20

inchesfrom

thewallDraw

the

abdominals

in

towards

your

spine,

and

roll

your

weight

towards

theoutside

of

your

feet.

Thisshould

raise

your

arches

in

your

feet

slightly.

Maintainboth

of

thesepositions

throughout

theexercise.Slide

your

bodydown

thewalluntil

your

kneesbend60

degreesto90degreesOnce

you

arestrong

enough,

assignified

byperforming

thedoubleleg-repeattheabove

exercise

–

but

standingonly

on

the

oneinvolvedleg。股四頭肌力量訓(xùn)練－水平2倚墻深蹲動作提示：·背倚墻站立，雙腳與肩同寬，離墻14~20英寸（35.56~50.8cm）·收腹，膝蓋略微外展，這樣可以適當(dāng)提高足弓。做練習(xí)過程中，保持這個·降低身體，膝蓋彎曲60°~90°·一旦你足夠強(qiáng)壯（雙腿深蹲），接著可以重復(fù)以上動作－但是，是單腿下蹲。QuadricepsStrengthening-

Level3Eccentric

Steps股四頭肌力量訓(xùn)練－水平3離心臺階QuadricepsStrengthening-

Level3Performance

CuesStand

sideways

on

a

stair

or

a

step

stool

with

weight

on

the

involved

leg.Draw

the

abdominals

in

towards

your

spine

and

shift

your

weight

slightly

towards

the

outside

of

your

feet.

Maintain

these

positions

throughout

theexercise.Keetheknee

inline

over

your

big

toe,bend

the

standing

leg(‘stepdown’)

to

touch

the

opposite

heel

tothe

ground,

andthenstand

back

upStep

downtotheside

–andforwardMovements

should

be

slow

and

controlled

in

both

directions

of

motion.Weight

should

not

shift

comple y

onto

theuninvolvedleg股四頭肌力量訓(xùn)練－水平3離心臺階動作提示：·站在樓梯或踏凳邊上，重心放在練習(xí)腿上·收腹，重心略微移向腳外側(cè)。練習(xí)過程中，始終保持這個·站立腿下蹲，膝蓋保持在大腳趾的上方，然后再站起·向前邊下蹲·動作慢且控制好方向·重心不要移向非練習(xí)腿Quadriceps

Strengthening

-

Level

4Stars股四頭肌力量訓(xùn)練－水平4星號練習(xí)Quadriceps

Strengthening

-

Level

4Performance

CuesStand

on

single

leg

with

weight

on

the

involved

legDraw

the

abdominals

in

towards

your

spi