脊柱疾病的物理治療

腰椎的常用治療技術

李旺祥昆明醫學院康復治療專業教研室腰椎的常用治療技術SelectionofTechniquesFactorsforconsideration:--Degreeofsymmetryofsymptoms&signs--Structure(s)involved--Areaofthespineinvolved--DiagnosisPhysiotherapymanagementManualtherapy-Posturalcorrection-Passivemobilisation-Exercises(stretching,strengthening,endurancetraining)ErgonomicassessmentandadvicePosturalcorrection--Comprehensiveanalysisisrequired.--Head&neck&thorax&lumbar&pelvisandLLposition--Inter-relationshipswiththerestofspinalcolumn&extremitye.g.pelvicgirdlePassivemobilisation--PassivejointMobilisation(physiological&Accessorymovement)--Traction(manualormechanicaltraction)Passivemobilisation1.PassivephysiologicalUni-planar(extension,flexion,sideflexion,rotation)Multi-planar(combinedmovement)GradeI-IV2.Passiveaccessory--Centraltechnique--Unilateraltechnique--Transverse--GradeI-IV--Performwithsegmentatvariouspositions/rangeofmotion1.Areaofsymptom(Bodychart)a.centralorbilateral

–usebilateraleffectingtechniquee.g.traction,longitudinalmovt.b.unilateral-useunilateraleffectingtechniquese.g.2.Effectivesoftechnique,dosoawayfromsideofpain這樣的痛苦離開嗎

,dosoonsideofpain這樣的疼痛嗎

3.Intervertebrallevelfromwhichsymptomarises

Lumbaspine(1)(2)(3)(4)traction

4.Mostpainfultechniqueversesleastpainfultechnique

Ifintoleratetograde1,chooseanothertechnique.Choosethemorepainfulone.Itiseasiertoassessimprovement.5.PathologySomepathologiesdictatethetechniquetobeused

a.severenerverootpain–traction

b.chronicstiffarthriticchanges–usemovements++

c.discogenic–generalised

d.chronicnerverootpain–movement++TherapeuticExercises1.Activemobilisation2.Stretching3.Strengthening(localandglobalmuscles)4.Endurance(localandglobalmuscles)Therapeuticexercise--Multi-cervicalunit.--Gradedresistancetrainingforallsixdirectionsofcervicalmovements.--Uni-planaraction.--Computerisedtrainingformonitoringprogression&forresearchpurpose.SpecificexerciseA)Extensionexercises--Inpronelying--InstandingB)Flexionexercises--Insupinelying--InsittingC)Combinedflexion&extensionin4-pointkneeling(cat&dog)D)Rotationexercise--Incrooklying--Instanding

CoreStabilizationConceptsAspecificcorestrengtheningprogramcan:IMPROVEdynamicposturalcontrolEnsureappropriatemuscularbalance&jointarthrokinematicsinthelumbo-pelvic-hipcomplexAllowforexpressionofdynamicfunctionalperformancethroughouttheentirekineticchainIncreaseneuromuscularefficiencythroughouttheentirebodySpinalstabilizationMusteffectivelyutilizestrength,power,neuromuscularcontrol&enduranceofthe“primemovers”Weakcore=decreasedforceproduction&efficiencyProtectivemechanismforthespineFacilitatesbalancedmuscularfunctioningoftheentirekineticchainEnhancesneuromuscularcontroltoprovideamoreefficientbodypositioningFlexibilityThereareavarietyofexercisesthatcanbeperformedCoreStabilizationTrainingProgramLevelI:StabilizationLevelII:StabilizationandStrengthLevelII:StabilizationandStrengthLevelIII:IntegratedStabilizationStrengthLevelIV:ExplosiveStabilizationAbdominalNeuromuscularControlTestSupinew/knees&hipsin90°

BPcuffplacedunderlumbarspine(L4-L5)&raisedto40mmHgPerformsdrawinginmaneuver(bellybuttontospine)LowerlegsuntilpressuredecreasesAssesseslumbarspinemovingintoextension(abilityoflowerabswalltopreferentiallystabilizethelumbo-pelvic-hipcomplex)HipflexorsbegintoworkasstabilizersIncreasesanteriorshearforces&compressiveforcesatL4-L5Inhibitstransversusabdominis,internaloblique&multifidusStretchingexercise

HamstringTFL(tensorfascialata)闊筋膜張肌RectusFemorisNeuralmobilisationexerciseSciaticnerve

–insitting,anteriorpelvictilt,ankleDFandactivekneeextension.ErgonomicsIntradiscalPressureinVariousPosturehighestpressureoccurswhensittinginslouchedposture椅子的形態何種好?如何久站不傷身?如何移動床最安全?Guidelinesforselectionof

mobilisationtechniquesReferencesPrentice,W.E.(2004).RehabilitationTechniquesforSportsMe