|
보자..
반사적 근육방어(reflexive muscle guarding)
내재근긴장(intrinsic muscle spasm)
조직손상의 정도
grade1 :
grade2 :
grade3 :
조직손상후 치유과정
1. acute inflammation 4-6days
2. healing and repair stage : 2~3weeks
3. remodeling stage : 6months~1years
panic bird...
cha10_principles_of_intervention.pdf
The proper use of therapeutic exercise in the management of musculoskeletal disorders depends on determining the
impairments, functional limitations, or disabilities. In many cases it is possible to identify the musculoskeletal structure
involved and its stage of inflammation or recovery. Examination of the involved region is an important prerequisite
for identifying the anatomical structure or structures that are causing the impairments and limiting function and also for determining whether the tissue is in the acute, subacute, or chronic stage of recovery.
- 근골격계 질환의 관리에서 적절한 운동치료의 선택은 "impairment, functional limitation or disability"에 의존함.
- 손상부위의 검사는 기능장애, 움직임 제한의 원인 구조를 결정하는데 필수적 요소이고, 조직손상이 회복기의 급성, 아급성, 만성을 결정하는데 필수임.
This chapter and subsequent chapters in this book have been written with the assumption that the reader has a background in examination, evaluation, and program planning to be able to assess impairments and develop functional goals. Utilizing
the principles presented in this chapter, the reader should be able to design therapeutic exercise programs that meet the goals and choose techniques for intervention that are at an appropriate intensity for the stage of healing of connective tissue disorders. Subsequent chapters in this section deal with specific joint, soft tissue, bony, and nerve lesions as well as common surgical interventions.
- 올바른 운동치료를 위해서 연부조직의 치유과정의 단계를 아는 것이 중요함.
SOFT TISSUE LESIONS
Examples of Soft Tissue Lesions— Musculoskeletal Disorders
Strain: Overstretching, overexertion, overuse of soft tissue. Tends to be less severe than a sprain. Occurs from slight trauma or unaccustomed repeated trauma of a minor degree.6 This term is frequently used to refer specifically to some degree of disruption of the musculotendinous unit.13
- strain : 연부조직의 과도한 늘어남, 격렬한 사용, 과도한 사용. sprain보다 덜한 경향. 일반적으로 근육-건 단위의 파열정도를 나타내는 용어.
Sprain: Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle. This term is frequently used to refer specifically to injury of a ligament and is graded as first- (mild), second- (moderate), or third- (severe) degree sprain.13
- sprain : 과도한 힘, 늘어남, 연부조직의 찢어짐, 관절낭, 인대, 힘줄, 또는 근육의 손상. 대개 인대의 손상정도를 나타내는 용어
Dislocation: Displacement of a part, usually the bony partners in a joint resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm.
탈구 : 관절에서 짝을 이루는 뼈의 이동으로 연부조직의 손상, 부종, 통증, 근긴장을 유발하는 것
Subluxation: An incomplete or partial dislocation of the bony partners in a joint that often involves secondary trauma to surrounding soft tissue.
아탈구 : 불완전한 탈구
Muscle/tendon rupture or tear: If a rupture or tear is partial, pain is experienced in the region of the breach when the muscle is stretched or when it contracts against resistance. If a rupture or tear is complete, the muscle does not pull against the injury, so stretching or contraction of the muscle does not cause pain.8
근육/건 파열 : 근육이 부분파열 되면, 통증은 근육이 늘어날때 저항에 대해 수축할때 경험함. 만약 파열이 완전하면 근육은 당기는 것이 불가능함.
Tendinous lesions/tendinopathy: Tenosynovitis is inflammation of the synovial membrane covering a tendon. Tendinitis is inflammation of a tendon; there may be resulting scarring or calcium deposits. Tenovaginitis is inflammation with thickening of a tendon sheath. Tendinosis is degeneration of the tendon due to repetitive micro trauma.
건 병증 : tenosynovitis, tendinitis, tenovaginitis, tendinosis로 구분함.
Synovitis: Inflammation of a synovial membrane; an excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease.
활액막염 : 활액막의 염증. 관절내 또는 건초에 염증이 발생한 것
Hemarthrosis: Bleeding into a joint, usually due to severe trauma.
관절 혈증 : 대개 심한 타박상으로 관절내 출혈.
Ganglion: Ballooning of the wall of a joint capsule or tendon sheath. Ganglia may arise after trauma, and they sometimes occur with rheumatoid arthritis.
강글리온 : 건초 또는 관절낭의 벽이 풍선처럼 부푼 것.
Bursitis: Inflammation of a bursa.
점액낭염 : 점액낭의 염증.
Contusion: Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory response.
타박상 : 직접 타격으로 멍듬으로 말초신경 파열, 출혈, 부종, 염증반응이 나타나는 것
Overuse syndromes, cumulative trauma disorders, repetitive strain injury: Repeated, submaximal overload and/or frictional wear to a muscle or tendon resulting in inflammation and pain.
과사용 증후군 : 과도한 사용으로 근육 또는 힘줄에 마찰에 의해 염증과 통증이 발생하는 것
Clinical Conditions Resulting from Trauma or Pathology
병리를 유발하는 조건들
In many conditions involving soft tissue, the primary pathology is difficult to define or the tissue has healed with limitations, resulting in secondary loss of function. The following are examples of clinical manifestations resulting
from a variety of causes, including those listed under the previous section.
- 연부조직과 관련된 많은 상태에서 주요 병리는 정의하기 어려움. 조직은 치유와 함께 이차기능부전을 야기하는 limitation이 발생함.
Dysfunction: Loss of normal function of a tissue or region. The dysfunction may be caused by adaptive shortening of the soft tissues, adhesions, muscle weakness, or any condition resulting in loss of normal mobility.
기능부존 : 조직 또는 구역의 정상기능 소실. 기능부전은 조직의 적응성 짧아짐, 유착, 근육위약, 정상 가동성 소실을 야기하는 상태에 의해서 야기될 수 있음.
Joint dysfunction: Mechanical loss of normal joint play in synovial joints; commonly causes loss of function and pain. Precipitating factors may be trauma, immobilization, disuse, aging, or a serious pathological condition.24
관절기능 부전 : 활액관절에서 정상관절 움직임 기능을 잃어버림. 통증과 기능소실을 야기함. 악화요인은 타박상, 고정, 저사용, 노화, 심각한 병리적 조건임.
Contractures: Adaptive shortening of skin, fascia, muscle, or a joint capsule that prevents normal mobility or flexibility of that structure.
구축 : 피부, 섬유막, 근육, 관절낭의 반응성 짧아짐이 가동성 또는 유연성을 방해하는 것.
Adhesions: Abnormal adherence of collagen fibers to surrounding structures during immobilization, after trauma, or as a complication of surgery, which restricts normal elasticity and gliding of the structures involved.
유착 : 타박상 후 고정, 수술후 고정으로 정상 탄성도와 조직의 활주가 장애를 유발하는 고정(immobilization)으로 콜라겐 섬유가 비정상적으로 유착되는 것.
Reflex muscle guarding: Prolonged contraction of a muscle in response to a painful stimulus. The primary pain-causing lesion may be in nearby or underlying tissue, or it may be a referred pain source. When not referred, the contracting muscle functionally splints the injured tissue against movement. Guarding ceases when the painful stimulus is relieved.
반사적 근육방어 : 통증자극에 반응한 지속적인 근수축.
지금 통증을 유발하는 조직은 nearby or underlying조직 또는 연관통처.
근육방어는 통증자극이 제거될때 멈춤.
Intrinsic muscle spasm: Prolonged contraction of a muscle in response to the local circulatory and metabolic changes that occur when a muscle is in a continued state of contraction. Pain is a result of the altered circulatory and metabolic environment, so the muscle contraction becomes self-perpetuating regardless of whether the primary lesion that caused the initial guarding is still irritable (Fig. 10.1). Spasm may also be a response of muscle to viral infection, cold, prolonged periods of immobilization, emotional tension, or direct trauma to muscle.24
- 내재적 근긴장 : 근육수축이 지속적으로 일어나는 상태일때, 국소적 순환과 대사변화에 반응하여 지속적인 근수축이 일어남.
- 통증은 변화된 순환과 대사환경의 결과이고, 근수축은 스스로 악화시키기 시작함.
- 근긴장은 근육의 바이러스 감염, cold, 지속적인 고정, 감정긴장, 근육손상에 반응할 수 있음.
직접적 타박상, 통증, 염증, 감염, 감정적 긴장, 추위, 고정은 반사적 근수축을 야기 --> 움직임 제한 --> 조직허혈, 대사의 정체 등으로 순환 정체 --> 통증 --> 근육 spasm --> 움직임 제한
Muscle weakness: A decrease in the strength of muscle contraction. Muscle weakness may be the result of a systemic,
chemical, or local lesion of a nerve of the central or peripheral nervous system or the myoneural junction. It may also be the result of a direct insult to the muscle or simply due to inactivity.
근위약 : 근수축 강도의 감소. 근위약은 시스템, 화학적, 신경손상의 결과로 발생할 수 있음.
Myofascial compartment syndromes: Increased interstitial pressure in a closed, nonexpanding, myofascial compartment that compromises the function of the blood vessels, muscles, and nerves. It results in ischemia and irreversible muscle loss if there is no intervention.4 Causes include, but are not limited to, fractures, repetitive trauma, crush injuries, skeletal traction, and restrictive clothing, wraps, or casts.
- 근막 구획증후군 :
조직손상 심한 정도 3단계(Severity of Tissue Injury)
Grade 1 (first-degree).
Mild pain at the time of injury or within the first 24 hours. Mild swelling, local tenderness, and pain occur when the tissue is stressed.13,14
- 손상시 또는 24시간 이내에 mild pian
- 약간의 부종, 국소적 압통 그리고 손상조직에 압박이 가해지면 통증 발생
Grade 2 (second-degree).
Moderate pain that requires stopping the activity. Stress and palpation of the tissue greatly increase the pain. When the injury is to ligaments, some of the fibers are torn, resulting in some increased joint mobility.13,14
- 활동 중단이 필요한 중등도 통증.
- 손상조직을 촉진, 압박을 가하면 심하게 통증악화.
- 인대손상이 있을때, 관절움직임 증가를 야기함.
Grade 3 (third-degree).
Near-complete or complete tear or avulsion of the tissue (tendon or ligament) with severe pain. Stress to the tissue is usually painless; palpation may reveal the defect. A torn ligament results in instability of the joint.13,14
- 힘줄, 인대의 거의 완전한 파열로 심한 통증.
- 손상조직에 stress를 줄때 일반적으로 통증이 없음. 촉진은 손상을 드러낼 수 있음. 파열된 인대는 관절의 불안전성을 야기함.
Irritability of Tissue: Stages of Inflammation and Repair
After any insult to connective tissue, whether it is from mechanical injury (including surgery) or chemical irritant, the vascular and cellular response is similar (Table 10.1).5 Tissue irritability, or sensitivity, is the result of these responses and is usually divided into three stages of inflammation and repair with the following clinical signs and symptoms.
- 연부조직 손상의 원인이 "기계적 손상, 화학적 자극, 혈관과 세포반응"으로 부터 오더라도 그 결과는 유사함.
1. Acute Stage (Inflammatory Reaction) - 4~6일
During the acute stage, the signs of inflammation are present; they are swelling, redness, heat, pain at rest, and loss of function. When testing the range of motion (ROM), movement is painful, and the patient usually guards against the motion before completion of the range is possible (Fig. 10.2A).
- 급성기에는 염증의 신호들이 존재함. 염증의 신호는 부종, 발적, 열감, 통증, 기능부전
- rom검사를 시행할때, 움직임시 통증이 발생하고, 환자는 일반적으로 움직임으로부터 보호함.
The pain and impaired movement are from the altered chemical state that irritates the nerve endings, increased tissue tension due to edema or joint effusion, and muscle guarding, which is the body’s way of immobilizing a painful area. This stage usually lasts 4 to 6 days unless the insult is perpetuated.
- 통증과 움직임 부전은 변화된 화학적 상태(altered chemical state)임.
- 변화된 화학적 상태는 신경말단을 자극, 부종때문에 손상조직의 긴장증가, muscle guarding(근육 방어)
- 이 상태는 손상이 지속되지 않는한 4-6일 지속됨.
Subacute Stage (Repair and Healing) - 2~3주 지속
During the subacute stage, the signs of inflammation progressively decrease and eventually are absent. When testing
ROM, the patient may experience pain synchronous with encountering tissue resistance at the end of the available
ROM (Fig. 10.2B).
- 아급성기 동안 염증신호는 점차적으로 줄어들고, 결국 사라짐.
- rom검사시 환자는 rom의 끝에서 조직저항을 만나면서 통증을 경험함.
Pain occurs only when the newly developing tissue is stressed beyond its tolerance or when tight tissue is stressed. Muscles may test weak, and function is limited as a result of the weakened tissue. This stage usually lasts 10 to 17 days (14 to 21 days after the onset of injury) but may last up to 6 weeks in some tissues with limited circulation, such as tendons.9
- 통증은 조직의 내성을 넘어서는 새로운 자극이 주어질때 발생함, 또는 단단해진 조직이 stressed되면 통증이 발생함.
- 근육은 약해지고 기능이 제한됨.
- 이 상태는 손상후 2-3주동안 지속됨. 하지만 6주이상 지속될 수 있는데 ... 힘줄의 circulation제한이 있을때
- 극상근 건, 후경골근건, 아킬레스 건 등
Chronic Stage (Maturation and Remodeling)
There are no signs of inflammation during the chronic stage. There may be contractures or adhesions that limit range, and there may be muscle weakness limiting normal function. Connective tissue continues to strengthen and remodel during this stage. A stretch pain may be felt when testing tight structures at the end of their available range (Fig. 10.2C). Function may be limited by muscle weakness, poor endurance, or poor neuromuscular control. This stage may last 6 months to 1 year depending on the tissue involved and amount of tissue damage.
- 만성 상태에서는 염증신호는 없음. 구축과 유착이 있을 수 있고, 움직임이 제한되고 근육위약이 발생하여 정상기능을 방해함.
- 결합조직이 이 시기에 강화되고 재구성됨.
- 스트레치 통증이 움직임의 end 범위부위에서 통증 발생.
- 기능부전은 근위약, 근지구력저하, 신경근조절의 기능저하 등에 의해서 발생함.
- 이 시기는 6개월-1년지속됨.
Chronic Inflammation (Overuse Syndrome)
An overuse syndrome is a state of prolonged inflammation. There are symptoms of increased pain, swelling, and muscle guarding that last more than several hours after activity. There are also increased feelings of stiffness after rest, loss of ROM 24 hours after activity, and progressively greater stiffness of the tissue as long as the irritation persists.
- 과사용 증후군은 지연된 염증 상태임.
- 활동후 몇시간이상 지속되는 증가된 통증, 부종 그리고 근육방어 증상이 있음.
- 또한 휴식후에 강직느낌의 증가, 활동 후 24시간 rom제한이 있음.
- 염증이 지속되는 동안 조직의 강직은 점차적으로 진행함.
Chronic Pain Syndrome
Chronic pain syndrome is a state that persists longer than 6 months. It includes pain that cannot be linked to a source of irritation or inflammation and functional limitations and disability that include physical, emotional, and psychosocial parameters.
- 만성통증증후군은 6개월이상 지속되는 통증상태임.
- 만성통증증후군은 염증상태와 기능제한, 기능부전이 논리적으로 서로 연결되지 않음. 육체적, 정신적, 정신사회적 요소를 포함.
MANAGEMENT DURING THE ACUTE STAGE
Tissue Response—Inflammation
The inflammation stage involves cellular, vascular, and chemical responses in the tissue. During the first 48 hours
after insult to soft tissue, vascular changes predominate. Exudation of cells and solutes from the blood vessels takes place, and clot formation occurs. During this period, neutralization of the chemical irritants or noxious stimuli, phagocytosis (cleaning up of dead tissue), early fibroblastic activity, and formation of new capillary beds begin.
- 염증상태는 세포성, 혈관성, 화학적 반응을 포함함.
- 조직손상후 48시간 동안 혈관성 변화가 우세함.
- 세포의 삼출물과 혈관으로부터 용질(solute)이 나와 clot이 형성됨.
- 이 기간동안 화학적 염증인자나 noxious stimuli의 중성화, 조직제거를 하는 phagocytosis, 초기의 섬유아세포 활동, 세로운 혈관생성 등이 발생함.
These physiological processes serve as a protective mechanism as well as a stimulus for subsequent healing and repair.5 Usually this stage lasts 4 to 6 days unless the insult is perpetuated.
- 이러한 생리학적 과정은 이어지는 healing and repair 과정을 위한 자극뿐 아니라 방어기전을 제공함.
Management Guidelines—Protection Phase
The therapist’s role during the protection phase of intervention is to control the effects of the inflammation, facilitate wound healing, and maintain normal function in unaffected tissues and body regions. The information provided here is summarized in Box 10.1.
관리 지침 - 보호기
- 치료사가 보호기에 중재(intervention)하는 역할은 염증의 결과를 조절, 상처 치유 촉진, 정상 조직과 비슷한 신체 부위의 정상 기능을 유지 하는것.
Patient Education
Inform the patient about the expected duration of symptoms (4 to 6 days), what he or she can do during this stage, any precautions or contraindications, and what to expect when the symptoms lessen. Patients need reassurance that the acute symptoms are usually short-lived, and they need to learn what is safe to do during this stage of healing.
환자 교육
- 환자에게 증상의 예상 기간을 설명(4-6일), 이 기간동안 할수 있는것, 경고나 부적응증, 증후가 줄어들었을 때 예측할 수 있는것 등을 설명.
- 환자에게 급성 증후는 대부분(usually) 짧게 지나감을 안심시켜야함.
- 이 치유 단계동안 안전하게 할 수 있는 것을 가르쳐야함.
Protection of the Injured Tissue
To minimize musculoskeletal pain and promote healing, protection of the part affected by the inflammatory process is necessary during the first 24 to 48 hours. This is usually provided by rest (splint, tape, cast), cold (ice), compression, and elevation. Depending on the type and severity of the injury, manual methods of pain and edema control, such as massage and gentle (grade I) joint oscillations, may be beneficial. Depending on the part involved, protection with assistive devices for ambulation may be required.
손상된 조직의 보호
- 근골격계 통증을 최소화하고 치유를 촉진하기 위해서, 염증에 손상된 부분의 보호는 첫 24-48시간동안 필요함.
- 보통 rest(스프린트, 테이핑, 깁스), cold(아이싱), compression(압박), elevation(거상) 시킴.
- 손상의 유형이나 정도에 따라, 마사지나 부드러운 관절 진동(grade 1 joint oscillations)과 같은 수기로 통증과 부종을 조절이 유용함.
- 연관 부분에 따라 보행을 위한 보조 장치로 보호가 요구됨.
Prevention of Adverse Effects of Immobility
Complete or continuous immobilization should be avoided whenever possible as it can lead to adherence of the developing fibrils to surrounding tissue, weakening of connective tissue, and changes in articular cartilage.The long-term goal of treatment is the formation of a strong, mobile scar at the site of the lesion so there is complete and painless restoration of function. Initially, the network of fibril formation is random. It acquires an organized arrangement depending on the mechanical forces acting on the tissue. To influence the development of an organized scar, begin treatment during the acute stage, when tolerated, with carefully controlled passive movements.
Immobility(고정)의 부작용 예방
- 주위 조직에 developing fibrils의 유착을 일으킬 수 있을 때
결합조직의 위약을 일으킬 수 있을 때
관절 연골을 변화시킬 수 있을 때
완전한 또는 지속적인 고정은 피해야함.
- 치료의 장기 목표는 힘을 생성하고, 손상 부위의 상처를 움직여 완벽하고 통증이 없는 기능의 회복임.
1. Tissue-specific movement.
Tissue-specific movements should be directed to the structure involved to prevent abnormal adherence of the developing fibrils to surrounding tissue and thus avoid future disruption of the scar. Tissue-specific techniques are described below.
- 손상조직에 딱 맞는 움직임은 손상주위조직에 developing fibrils의 비정상 유착을 막기위한 것이고, 반흔조직의 재손상을 피하기 위함.
2. Intensity.
The intensity (dosage) of movement should be gentle enough so the fibrils are not detached from the site of healing. Too much movement too soon is painful and reinjures the tissue. The dosage of passive movement depends on the severity of the lesion.
- 움직임의 강도는 fibril이 치유의 부위에 들러붙지 않을정도로만 충분히 부드러워야 함.
- 너무 많은 움직임이 빠르면 통증이 발생하고, 조직이 재손상됨.
- 수동적 움직임 강도는 조직손상의 정도에 의존함.
Some patients tolerate no movement during the first 24 to 48 hours; others tolerate only a few degrees of gentle passive movement. Continuous passive movement (CPM) (see Chapter 3) has been useful immediately after various types of surgery to joints; intra-articular, metaphyseal, and diaphyseal fractures; surgical release of extra-articular contractures and
adhesions; and other selected conditions.20,21 Any movement tolerated at this stage is beneficial, but it must not increase the inflammation or pain. Active movement is usually contraindicated at the site of an active pathological process unless it is a chronic disease, such as rheumatoid arthritis.
- 어떤 환자는 24~48시간동안 전혀 움직이지 못함. 다른 환자는 부드러운 수동적 움직임의 정도를 견딤.
- 지속적인 수동적 움직임은 관절 손상의 다양한 형태후에 즉시 시행할때 유용함. .....
3. General movement.
Active movement is appropriate in neighboring regions to maintain integrity in uninjured tissue and to aid in circulation and lymphatic flow.
- 능동적 움직임은 손상되지 않은 조직의 이웃부위에서 적합하고 임파순환과 혈액순환을 도울 수 있음.
4. Specific Interventions and Dosages
P R E C A U T I O N : If the movement increases pain or inflammation, it is either of too great a dosage or it should not be done. Extreme care must be used with movement at this stage.
- 만약 움직임이 통증이나 염증을 증가시키면, 움직임치료를 중단해야 함. 염증기에는 심각한 주의가 필요함.
5. Passive range of motion.
Passive range of motion (PROM) within the limit of pain is valuable for maintaining mobility in joints, ligaments, tendons, and muscles as well as improving fluid dynamics and maintaining nutrition in the joints.20,21 Initially, the range is probably very small.25 Stretching at this stage is contraindicated. Any motion gained from the PROM techniques is because of decreased pain, swelling, and muscle guarding.
- 통증이 관리되는 범위내에서 수동적 움직임은 관절, 인대, 힘줄, 근육에서 움직임을 유지하기 때문에 유용할 뿐아니라 관절에서 영양을 유지하고 활액 운동성을 증가시킴.
- 초기에 움직임의 범위는 매우 적음.
- 염증기에 스트레칭은 시행하면 안됨.
- 수동적 관절움직임으로부터 움직임을 회복하는 테크닉은 통증, 부종, 근육 방어를 줄임.
6. Low-dosage joint mobilization techniques.
Grade I or II distraction and glide techniques have the benefit of improving fluid dynamics in the joint to maintain cartilage health. These techniques may also reflexively inhibit or gate the perception of pain. Low-dosage joint mobilizations are beneficial with joint pathologies and any other connective tissue injury that affects joint motion during the acute stage.
- grade 1, 2 distraction과 활주 테크닉은 활액 운동성을 증가시키는데 유용하고 관절건강을 유지함.
- 이러한 테크닉은 통증 인지 문을 반사적으로 억제할 수 있음.
- 낮은 강도의 관절가동은 관절병리와 결합조직 회복에 유리함.
7. Muscle setting.
Gentle isometric muscle contractions performed intermittently and at a very low intensity so as not to cause pain or joint compression have several purposes. The pumping action of the contracting muscle assists the circulation and, therefore, fluid dynamics. If there is muscle damage or injury, the setting techniques are done with the muscle in the shortened position to help maintain mobility of the actin-myosin filaments without stressing the breached tissue. If there is joint injury, the position during the setting techniques is dictated by pain; usually the resting position for the joint is most comfortable. If tolerated, the intermittent setting techniques are performed in several positions.
- 부드러운 등척성 근수축은 간헐적으로 시행되고, 매우 낮은 강도에서 시행하면 통증을 야기하지 않을 뿐아니라 관절압박을 피한 상태에서 몇가지 목적에 도달할 수 있음.
- 근수축이 진행되면 순환, 활액 운동성을 도움.
- 만약 근육손상이 있다면, 근육 setting 테크닉은 짧아진 자세에서 시행되어야 조직손상의 스트레스 없이 액틴-마이오신 필라멘트의 운동성을 유지할 수 있음.
- 만약 관절손상이 있다면, 근육 setting 테크닉동안 자세는 통증에 의해서 영향을 받음. 일반적으로 관절의 열린자세는 가장 편안한 자세임.
- 만약 견딜 수 있다면 간헐적인 근육세팅 테크닉은 여러자세에서 시행됨.
8. Massage.
Massage serves the purpose of moving fluid; and if it is applied cautiously and gently to injured tissue, it may assist in preventing adhesions. Tendinous lesions are treated with a gentle dosage applied transverse to the fibers to smooth roughened surfaces or to maintain mobility of the tendon in its sheath. When applied, the tendon is kept taut. When treating muscle lesions, the muscle is usually kept in its shortened position so as not to separate the healing breach.8
- 치료적 마사지는 활액유동성을 위함. 손상된 조직에 부드럽고 조심스럽게 적용되어야 함.
- 마사지는 유착방지를 도울 수 있음.
- 힘줄 손상은 힘줄의 거친섬유에 교차마찰마사지 형태로 부드러운 강도로 적용되어야 함. 또한 건초의 움직임이 유지되도록 해야함.
- 교차마찰 마사지 등을 적용할때, 힘줄은 타이트하게 유지되어야 함.
- 근육손상을 치료할때, 근육은 일반적으로 짧아진 자세로 유지되어야 치유역행에서 분리되지 않음.
Interventions for Associated Areas
During the protection phase, maintain as normal a physiological state as possible in related areas of the body. Include techniques to maintain or improve the following.
- 염증기동안 인체의 다른 조직이 정상적인 생리기능이 유지되어야
1. Range of motion.
These techniques may be done actively or passively, depending on the proximity to and the effect on the injured tissue.
- 관절가동범위 유지테크닉은 능동적으로 또는 수동적으로 시행될 수 있음.
2. Muscle performance.
Resistance may be applied at an appropriate dosage to muscles not directly related to the injured tissue to prepare the patient for use of assistive devices, such as crutches or a walker, and to improve functional activities.
- 직접적으로 손상되지 않은 주위 조직은 저항운동이 적절히 적용될 수 있음.
3. Functional activities.
Supportive or adaptive devices may be necessary depending on area of injury and expected functional activities.
- 보조장비는 기능적 움직임에 필수일 수 있음.
4. Circulation.
The circulation is helped by performing functional activities and by using supportive elastic wraps, by elevating the part, and by using appropriate massage and muscle-setting techniques.
- 적절한 마사지와 근육세팅 테크닉 ... 거상, 탄성밴드로 지지 등으로 순환상태를 도울 수 있음.
첫댓글 너무 자세하고 훌륭한 책이라 찾아봤습니다. 책 원문 전체는 구글에서 "therapeutic exercise" 5th filetype:pdf 해서 나오는 첫번째 pdf
네.. 맞아요 완전대박 책 ㅎㅎㅎ
읽기 손상치유