腿长不等的评估、临床意义和神经调控康复治疗(3)

来源:临床神经外科杂志 【在线投稿】 栏目:综合新闻 时间:2021-08-24
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摘要:19. GAIT: LOCKED UNLOCKED 步态:锁定和解锁 HEEL STRIKE: THE FOOT/ANKLE EVERT WHICH LOCK THE SUBTALAR JOINT (BLUE) AND UNLOCKS THE MIDFOOT (RED)脚跟着地:足/踝关节外翻,锁定距下关节

19. GAIT: LOCKED & UNLOCKED 步态:锁定和解锁

HEEL STRIKE: THE FOOT/ANKLE EVERT WHICH LOCK THE SUBTALAR JOINT (BLUE) AND UNLOCKS THE MIDFOOT (RED)脚跟着地:足/踝关节外翻,锁定距下关节(蓝色,稳定),解锁中足(红色,准备吸收力量)(本体感觉缺失踝扭伤,足跟着地时距下关节不及时锁定,足内翻扭伤)

SWING PHASE: AS THE FOOT AND ANKLE SWING THROUGH THE AIR THE SUBTALAR JOINT (BLUE) INVERTS WHICH UNLOCKS THE JOINT AND CAUSES THE MIDFOOT (RED) TO LOCK 摆动相:当足和踝在空中摆动时,距下关节(蓝色)内翻,解锁关节,并导致中足(红色,跗横关节)锁定(帮助推进)

20. Treatment options for LLD 腿长不等的治疗选项

(1)Correcting motor inhibitions 纠正运动抑制

Lower extremity scan determines inhibitions 下肢筛查确定抑制

Upper extremity scan may be prudent because posterior torsional line adaptation is in play. Ie. Right short leg will affect left shoulder girdle 上肢筛查可能是明智的,因为后扭转线适应正在发挥作用。即,右短腿会影响左侧肩带

In general the muscles involved are the psoas, gluteus maximus, medius, serratus anterior, quadratus lumborum 一般来说,涉及的肌肉是腰大肌、臀大肌、臀中肌、前锯肌、腰方肌

(2)Psoas pecking: lumbar plexus neuromodulation 腰大肌轻啄:腰丛神经调控

Lumbar plexus 腰丛:T12-L5;LFCN, lateral femoral cutaneous nerve 股外侧皮神经:F, femoral 股神经;O, obturator (anterior / posterior)闭孔神经(前/后)

通过腹直肌筋膜。

(深部筋膜链(1)-腰大肌轻啄)

(3)EPE technique: when to use it and why?能量进入点技术:何时和为何使用?

After we restore motor activation, after we address the trophic changes in tissue due to maladaption, and after we restore local soft tissue mechanics we must keep in mind the incoming forces at the entry points of energy.在我们恢复运动激活,处理了由于适应不良引起的组织营养性改变,并且恢复局部软组织力学后——我们必须记住能量进入点的传入力(附属运动)。

Learning to address the foot/ankle in the lower extremity and the wrist/hand will be necessary to remove maladaptations.学习处理下肢的足踝和手腕将是必要的,以消除适应不良。

I use it whenever the patient presenting to me has had the problem for 3 months or greater.每当患者出现问题超过3个月时,我就使用它。

(足踝功能障碍的附属运动和康复治疗)

(4)When to add a lift 何时增加足垫

Runners with greater than 3mm LLD should use a lift.跑步者LLD大于3mm应使用足垫。

Martens et al, recommend a lift in anything over 6mm Martens等,建议在任何超过6mm中使用足垫

Large discrepancies of one inch (25.4mm) or more should be added gradually. inch (6mm) every four weeks until symptoms abase 差异大于一英寸(25.4mm)应逐渐增加。每四周英寸(6mm),直到症状减轻。

(5)Lift caveats 足垫说明

Ideally lift should cover entire length of foot 理想情况下,足垫应该覆盖整个足长(不只足跟)。

A calcaneal lift will decrease activation of the gastrocnemius and tibialis anterior muscles.跟骨足垫会降低腓肠肌和胫前肌的激活。

The greater the lift, the greater the inhibition of these muscles over time 垫高越多,随着时间的推移,这些肌肉的抑制越大。

If lifts are added, make sure to address the motor points of these muscles on each visit 如果增加了足垫,确保在每次就诊时处理这些肌肉的运动点。

21.总结

(1)不要认为有长短腿就是问题,纠正长短腿不是唯一解决方案。

(2)长短腿会发生,会影响肌骨系统。

(3)始终要做功能性评估并治疗患者以改善功能,未必需要足跟垫。

文章来源:《临床神经外科杂志》 网址: http://www.lcsjwkzzzz.cn/zonghexinwen/2021/0824/705.html



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