발 아치를 만드는 내재근 트레이닝 운동법!

[문형철]

Eval‎uation and Retraining of the Intrinsic Foot Muscles for Pain Syndromes Related to Abnormal Control of Pronation

panic bird...

평발, 족궁이 무너진 문제는 두가지. 

1) 발의 내재근(foot intrinsic muscle)은 4개의 층으로 구성

2) posterior tibialis의 약화가 주원인이 되어 야기되는 overpronation. 

발의 재활운동은 주로 posterior tibialis와 본 논문의 내재근 운동으로 구성하면 될듯

발의 내재근을 강화하여, medial longitudinal arch를 유지하고 강화, 보행시 고유수용감각능력을 증진시키는 운동

- short foot exercise 설명동영상

- short foot exercise 방법동영상

- 수건에 500g 아령을 올려놓고, 최대 12kg까지 올려놓고 근력강화운동

Eval‎uation and Retraining of the Intrinsic Foot Muscles for.pdf

Abstract

Little clinical research exists on the contribution of the intrinsic foot muscles (IFM) to gait or on the specific clinical eval‎uation or retraining of these muscles. The purpose of this clinical paper is to review the potential functions of the IFM and their role in maintaining and dynamically controlling the medial longitudinal arch. Clinically applicable methods of eval‎uation and retraining of these muscles for the effective management of various foot and ankle pain syndromes are discussed.

Introduction:

The medial longitudinal arch (MLA) has been described as a critical structure of the foot that contributes to shock absorption and the attenuation of forces transmitted to the body during gait (Donatelli 1996). Many structures may contribute to varying degrees to support the MLA including the plantar fascia (Fuller 2000), ligaments such as the plantar calcaneo-navicular ligament (Borton & Saxby 1997), extrinsic foot muscles such as the tibialis posterior muscle (Soballe et al 1988) and the intrinsic foot muscles (IFM) (Fiolkowski et al 2003). 

- 내측 종아치는 발의 충격흡수, 보행시 체중분산에 관여하는 중요한 구조물로 묘사

- 내측 종아치를 구성하는 구조물은 족저근막, 발바닥인대, 후경골근과 같은 외재근, 그리고 내재근으로 구성.

Although there are many papers describing the role of the plantar fascia, ligaments and the extrinsic muscles of the foot in supporting the MLA, little clinical research exists on the contribution of the IFM in the maintenance and the dynamic control of the MLA. Moreover, there is little written on the topic of specific clinical eval‎uation and retraining of the IFM. The purpose of this clinical paper is to review the potential functions of this group of muscles and how dysfunction of the IFM may potentially be a contributing factor to various foot and ankle conditions. Clinically applicable methods of eval‎uation and retraining of the IFM will also be reviewed. This is to provide clinicians with a potentially effective management option for various pain syndromes related to abnormal control of pronation and reduced dynamic control of the MLA.

The IFM may be divided and grouped into four layers. 

1) The first layer consists of the abductor hallucis (ABH), flexor digitorum brevis (FDB), and the abductor digiti minimi (ABDM). 

2) The second layer includes the quadratus plantae (QP) and the lumbricals (LUM). 

3) The third layer includes the adductor hallucis transverse (ADHT), adductor hallucis oblique (ADHO), flexor hallucis brevis (FHB) and flexor digiti minimi brevis (FDMB). 

4) The forth layer includes the interossei (INT) muscles (Kura et al 1997). 

The IFM are diagrammatically represented in Figure 1. Of all the IFM, the abductor hallucis and the adductor hallucis have the greatest physiological cross-sectional area (Kura et al 1997), which supports the hypothesis that these are the most dominant IFM.

Several clinically common overuse injuries and syndromes have been linked to pes planus and excessive pronation, including plantar fasciitis, Achilles tendonitis, hallux valgus, tibialis posterior and tibialis anterior overuse syndromes (Hintermann & Nigg 1998, Van Boerum & Sangeorzan 2003, Kaufman et al 1999). 

It is the authors’ hypothesis that the primary biomechanical cause of some foot and ankle syndromes is not ‘excessive pronation’, but rather a ‘lack of pronation control’. The IFM may have a functional role for stabilizing the foot during single-limb balance (Travell & Simons 1992). They are also active during gait and function similar to elastic springs by supporting the MLA and maintaining the concavity of the foot (Moore 1985). It is therefore suggested that effective neuromuscular control of the IFM is essential in order to stabilize the tarsal and metatarsal bones and modulate the rate of pronation. This ‘fine tune’ control is not only required for static control of the MLA, but is likely essential for the dynamic control of the MLA from the heel-strike to the toe-off phase of the gait cycle. Considering the complex movements occurring at the inter-tarsal, tarso-metatarsal and the metatarso-phalageal joints during the gait cycle, the IFM must be able to consistently activate the right amount and at the exact right time during the stance phase of gait in order to be able to attenuate the forces placed on the articular and soft tissues throughout the lower extremity.

[윤연우]

감사합니다. ^^

[인준]

고맙습니다 !

[박건용]

IFM
first layer(3muslces) - abductor hallucis, flexor digitorum brevis, and the abductor digiti minimi
second layer(5m/2tendons) - quadratus plantae and the lumbricals(4)/ flexor hallucis longus tendon, flexor digitorum longus tendon
third layer(3m) - adductor hallucis(transverse, oblique head), flexor hallucis brevis and flexor digiti minimi brevis
forth layer(7m/2t) - interosseous(3plantar/4dorsal)/tibialis posterior tendon, peroneus longus tendon
3537로 외우니 암기가 되네요.
왜 FDB가 있는데 힘도 약한 FDMB가 따로 필요할까요?
내재근동영상에 장비골근,후경골근건이 크로스하는게 인상적입니다.

[송영석]

가장 마지막에 있는 그림
first layer- 1, second layer - 2, third layer - 3,4, forth layer-5

[여인호]

● medial longitudinal arch(MLA)는
충격을 흡수하고 .gait 과정에서 신체로 가해지는 힘을 완하시켜.
이 MLA를 유지하는 것이
각종인대, tibialis posterior, intrinsic muscle(4 layers)!
따라서 overpronation되어 MLA가 없어진 상황은 위 3개를 손 대야 해.
but 인대는 못움직여. 따라서 근육 움직임으로 족궁 잡아야돼.
→short foot exercise! (intrinsic muscle) * tibialis posterior는 다른 곳에.
이때 주의할 것은 무릎은 90도, 발을 앞으로 향하고, 허리펴고 친인하고 (정렬맞춰서)

*intrinsic muscle은
1.한발서기에서 균형을 담당 (정적)
2.또한 발의 볼록한 모양을 만들어, gait시 스프링과 같은 역활 (동적)

[박수홍]

medial longitudinal arch(MLA)
걷고 움직이는 충격을 분산 흡수
4개의 층으로 구성
1st layer- abductor hallucis, flexor digitorum brevis, and the abductor digiti minimi
2nd layer- quadratus plantae and the lumbricals/flexor hallucis longus tendon, flexor digitorum longus tendon
3rd layer- adductor hallucis(transverse, oblique head), flexor hallucis brevis and flexor digiti minimi brevis
4th layer- interosseous(3plantar/4dorsal)/tibialis posterior tendon, peroneus longus tendon
움직임을 만들고 구성하는 것이 근육!
운동으로 족궁을 만들어야함! 수건끌어 당기기, 글자쓰기 등!

[장은석]

★ IFM과 MLA
IFM이 MLA의 기능에 중요한 역할을 함.
내측 종아치 - 충격흡수, 보행시 체중분산 역할. 외재근, 내재근으로 구성
* IFM의 4가지 층
The first layer - ABH, FDB, ABDM
The second layer - QP, LUM
The third layer - ADHT, ADHO, FHB, FDMB
The fourth layer - INT

[gait1004]

하나씩 알아가고 있음 ㅎㅎ

[-지니-]

오 재밌어요~

[정일영]

발아치를 만드는 내재근 운동. 감사합니다