근육의 분류에 대한 논문 : 기능적 분류, 구조적 분류, 조직학적 분류 - 더 번약해야 ...

[문형철]

근육은 흔히 형태, 조직학적으로 지근(red muscle), 속근(white muscle)로 구분한다. 

이 구분만으로 근육의 다양한 기능들을 설명하기에는 턱없이 부족하다.

panic bird...

-  functional abilities에 기반을 둔 많은 분류가 있음. 예를들면 (postural/phasic and/or stabilizer/mobilizer) and reaction capacity (tight/overactive/hypertonic and weak/inhibited).

- muscle  fiber type distribution에 기초한 분류도 있음. slow twitch/type I/slow oxidative/SO; fast twitch/type IIa/fast oxidative glycolytic/FOG; fast twitch/type IIb/fast glycolytic/FG)

- structural locale에 의한 분류도 있음.  (local/global).

superficial muscle는 흔히 global muscle이고, origin and insertion이 2 joint이상 길게 연결, 대개 mobilizer기능

deeper muscle는 흔히 local muscle, 1 joint muscle, 대개 intrinsic muscle, 큰 움직임의 muscle action보다는 stabilizer 기능

트레이닝을 받지 않은 사람들, 통증을 앓는 사람들은 쉽게 global muscle, mobilizer를 사용, 이 과정에서 근육의 overactivation을 초래하여 근육통증(DOMS)를 유발하고, abnormal motor movement를 만들어내고 지속되면 poor posture로 악화되는 viscious cycle

- 만약 작은 근육을 흔히 사용한다면 그 근육은 쉽게 근 피로에 빠지고 쉽게 give up

stabilizer를 사용하는 방법은 치료사에 의해서 정확하게 트레이닝 되어야 함

반드시 slow, low-range범위에서 

- 만약 빠른 움직임, 강한 힘, high-range가 되면 대근육을 사용하는 우를 범하게 됨. 

참고) 크레이그 리벤슨 논문

Your body's musculature serves two functions. One, is to produce movement and the second is to control or guide that movement. The large, superficial muscles produce movement and are usually very active and easy to train. The

deeper muscles which guide movements are important for preventing injury and they often become weak when you are in pain and thus require specific therapeutic exercises to activate and train them.

다른 논문

Further, the evidence of muscle stability dysfunction is defined as motor control deficits and decreased recruitment efficiency in the local system, and recruitment and functional changes in the global system. It occurs locally as a dysfunction of the recruitment and motor control of the deep segmental stability system resulting in poor control of the neutral joint position.  Dysfunction occurs globally, as an imbalance between the monoarticular muscle stabilizers and biarticular muscle mobilizers or movement producing muscles. These imbalances occur in terms of alteration in functional length tests and recruitment patterns of these specific muscles. The spinal stability dysfunctions are further classified in more detail as depicted in Table 2.

When considering dynamic stabilization, it is useful to consider the classification of muscles in relation to function. 

Stabilizer muscles are described as primarily monoarticular or segmental, deep, working to control movement, and having static holding capacities. Mobility muscles are described as biarticular or multisegmental, superficial, working concentrically with acceleration of movement and producing power.

And Muscle Classification System:

A Position Statement

By Rodney Corn MA, PES, CSCS

and the NASM Performance Team

When reviewing the variety of terms associated with muscle classification, it is apparent that many inconsistencies exist.  This can be detrimental to the health and fitness professional who desires to effectively communicate with other related professionals.  Furthermore, it can cause confusion and increase anxiety that may exist when learning the intricacies of kinetic chain concepts.  Thus it is imperative that the National Academy of Sports Medicine (NASM) provides a simplistic position on this matter.  It must be stressed, however, that categorizations or generalizations made about the human body cannot encompass the vast variability that exist within this complex system.  Any generalizations made in this statement are for ease of explanation, description and communication and should be interpreted with caution.

- 근육의 분류와 관련한 다양한 용어를 review할때, 명백히 많은 혼란이 존재

- 이는 건강 전문가가 다른 분야의 전문가와 효과적으로 소통하는데 피해를 끼칠 수 있음. 게다가 kinetic chain 개념의 복잡성을 배울때 많은 혼란과 근심거리를 야기함.

- 그래새 NASM은 이 문제에 대해서 simplistic position을 제공하려 함. 

- categorizations(범주화) or generalizations(개념화)가 필요. 

- generalization(개념화)는 explanation, description and communication을 쉽게 함. 

Background

Many different approaches have been taken to categorize muscle function and dysfunction.  These include distinguishing muscles based more on their proposed functional abilities (postural/phasic and/or stabilizer/mobilizer) and reaction capacity (tight/overactive/hypertonic and weak/inhibited).^1,2 fiber type distribution (slow twitch/type I/slow oxidative/SO; fast twitch/type IIa/fast oxidative glycolytic/FOG; fast twitch/type IIb/fast glycolytic/FG)^3,4 and structural locale (local/global).^5,6,7

^- muscle function and dysfunction 범주화가 있음. 

-  functional abilities에 기반을 둔 많은 분류가 있음. 예를들면 (postural/phasic and/or stabilizer/mobilizer) and reaction capacity (tight/overactive/hypertonic and weak/inhibited).

- muscle  fiber type distribution에 기초한 분류도 있음. slow twitch/type I/slow oxidative/SO; fast twitch/type IIa/fast oxidative glycolytic/FOG; fast twitch/type IIb/fast glycolytic/FG)

- structural locale에 의한 분류도 있음.  (local/global).

Position

While each of these can be rationalized for validity, the NASM has chosen to use the terms “local” and “global” muscles suggested by Bergmark.⁵  The following text will expand the meaning of the terms local and global and explain the characteristics these muscles show a tendency to display in response to their environment.  

- NASM에서는 1989년 Bergmark(버그마크)가 제안한 local and global muscle분류를 선택하여 사용함. 

참고) 1989년 Bergmark(버그마크)가 제안한 local and global muscle분류 논문

Stability of the lumbar spine. A study in mechanical engineering. Bergmark A.

Source

Department of Solid Mechanics, Lund Institute of Technology, Sweden.

Abstract

From the mechanical point of view the spinal system is highly complex, containing a multitude of components, passive and active. In fact, even if the active components (the muscles) were exchanged by passive springs, the total number of elements considerably exceeds the minimum needed to maintain static equilibrium. In other words, the system is statically highly indeterminate. The particular role of the active components at static equilibrium is to enable a virtually arbitrary choice of posture, independent of the distribution and magnitude of the outer load albeit within physiological limits. Simultaneously this implies that ordinary procedures known from the analysis of mechanical systems with passive components cannot be applied. 

Hence the distribution of the forces over the different elements is not uniquely determined. Consequently nervous control of the force distribution over the muscles is needed, but little is known about how this achieved. This lack of knowledge implies great difficulties at numerical simulation of equilibrium states of the spinal system. These difficulties remain even if considerable reductions are made, such as the assumption that the thoracic cage behaves like a rigid body. A particularly useful point of view about the main principles of the force distributions appears to be the distinction between a local and a global system of muscles engaged in the equilibrium of the lumbar spine. 

The local system consists of muscles with insertion or origin (or both) at lumbar vertebrae, whereas the global system consists of muscles with origin on the pelvis and insertions on the thoracic cage. Given the posture of the lumbar spine, the force distribution over the local system appears to be essentially independent of the outer load of the body (though the force magnitudes are, of course, dependent on the magnitude of this load). Instead different distributions of the outer load on the body are met by different distributions of the forces in the global system. Thus, roughly speaking, the global system appears to take care of different distributions of outer forces on the body, whereas the local system performs an action, which is essentially locally determined (i.e. by the posture of the lumbar spine). The present work focuses on the upright standing posture with different degree of lumbar lordosis. The outer load is assumed to consist of weights carried on the shoulders. By reduction of the number of unknown forces, which is done by using a few different principles, a unique determination of the total force distributions at static equilibrium is obtained.

Definition

It is often suggested that there are two interdependent muscular systems that enable our bodies to maintain proper stabilization while concurrently distributing forces for the production of movement.  Crisco and Panjabi⁸ have stated that this concept may stem from the great Leonardo Da Vinci.  Da Vinci suggested that muscles located more centrally to the cervical spine (local) provided intersegmental stability (support from vertebrae to vertebrae) while the more lateral muscles (global) supported the cervical column as a whole to produce movement. 

- 움직임생성을 위한 힘의 분산을 하는 동안 적절한 안정성을 유지할 수 있는 두가지 상호의존하는 근육시스템이 있음. 

- 레오나르도 다빈치가 제안한 개념.  움직임을 생성하는 전체로서  lateral muscle(global)이 cervical column을 지지하는 동안 cervical spine 중심에 위치한 근육(local muscle)은 intersegmental stability를 제공??

Local Muscles 

The local muscles are predominantly involved in joint support or stabilization.^5,9,10  They are not typically movement producers, but provide stability to allow movement of a joint.  They usually are located in close proximity to the joint and often have a poor mechanical advantage for movement production.¹¹  They also have a broad spectrum of attachments to the passive elements of the joint that make them ideal for increasing joint stiffness and thus stability.^5,6,12,13,14

 A list of common local muscles include the:^1,5,15

- local muscle은 joint support or stabilization과 연관되어 있음. local muscle는 전형적으로 움직임 생산자가 아니고 관절의 움직임 동안 안정성을 제공. 

- local muscle는 관절과 연접해 가까이 위치해 있고, 때로 움직임 생성을 위한 poor mechanical advantage를 갖음. 

·         Deep cervical flexors

·         Rotator cuff

·         Rhomboids

·         Mid and lower trapezius

·         Transversus abdominis

·         Multifidus

·         Diaphragm

·         Muscles of the pelvic floor

·         Gluteus medius and minimus

·         External rotators of the hip

·         Vastus medialis obliquus

Global Muscles

The global muscles are predominantly larger and responsible for movement.  They consist of more superficial musculature that attach from the pelvis to the rib cage and/or the upper and lower extremities.^{5,6,13,14,[i]16}  They are associated with movement of the trunk and limbs and equalizing external loads placed upon the body.⁶   They also are important for transferring and absorbing forces from the upper and lower extremities to the pelvis.⁶

The major global muscles include the:^1,5,15

^{- global muscle는 크고 움직임을 책임지는 역할. global muscle는 좀더 superficial 근육으로 pelvis 에서 rib caged에 부착되어 있음. global muscle는 체간과 상지의 큰 움직임과 연관되어 있고, ...}

·         Sternocleidomastoid

·         Upper trapezius

·         Levator scapulae

·         Pectoralis major

·         Deltoid

·         Latissimus dorsi

·         Rectus abdominis

·         External obliques

·         Erector spinae

·         Gluteus maximus

·         Hamstrings

·         Rectus femoris

·         Iliopsoas

·         Adductors

·         Gastrocnemius/soleus

Concepts

To properly rationalize a general classification scheme for muscle function and dysfunction, it is important to review some basic concepts that will help to illuminate how muscles move and respond to movement and their environment.  First and foremost, we must highlight some very important constants concerning the human body and movement:^{12,17,18,19,20}

1.      All humans have similar structure and function

2.      All humans act under the constant force of gravity

3.      All muscles are capable of providing stabilization in some capacity

4.      All movement and muscle is controlled by the nervous system

The Nervous System

Ironically, it is the fourth constant, the nervous system, that allows for the most variability within the human body and is often the most overlooked.  Panjabi[ii]²¹ has alluded to the importance of the nervous system working in concert with muscular and articular systems in controlling stabilization and movement.  Bullock-Saxton¹⁷ noted that some muscles as a result of the location would work against gravity more so than other muscles.  In turn, this will influence the sensory input into the nervous system from muscles and joints that can alter interpretation and responding actions. 

Research has also demonstrated that by changing the frequency of stimulation to a motor unit, the biochemical properties can change (i.e. slow twitch muscle fiber that is rapidly stimulated converts to fast twitch fiber and vice versa).^22,23,24,25 This type of response has been noted in the transversus abdominis.⁶

The nervous system also plays a major role in the inhibition of muscles either through pain or as a result of reciprocal inhibition.^{4,13,26,27,28,29}  Inhibition of a muscle is a decrease in the neural drive to that muscle that reduces its ability to respond to stimuli with proper timing^18,20 and can thus result in a loss of proper strength (weakness). 

Pain is highly influential on the nervous system.  Research has demonstrated alterations to afferent and efferent motor responses in the presence of pain.^30,31,32  This often effects the local muscles as they have been shown to have a propensity to inhibition as a result of pain.^{9,12,32,[iii]33} 

Reciprocal inhibition is a principle whereby a tight muscle will cause decreased neural input to its functional antagonist (inhibition).^{4,13,15,26,27,28,29}  Electromyographic (EMG) data has demonstrated that tight muscles have a propensity to activate (simulate concentric action) easier and at times when they would normally remain less active.^4,15,29  Tightness is characterized by a decrease in the resting length of a muscle as well as the common occurrence of overactivity (heightened neurological state).^{4,12,18,20,29}  Global muscles show a propensity to becoming tight. 

Ultimately, the nervous system dictates the status of muscles and their function.  It is the nervous system that creates inhibition either through pain or as a result of antagonistic muscle tightness/overactivity.

Rationale

It is known that non-diseased humans have near identical neuromusculoskeletal structure and perform a variety of similar activities under the constant force of gravity.  Thus it can be deduced that the human body will respond to stimuli in a similar manner.  Therefore, generalizing musculature within the human body can be justified for ease of description and communication. 

The NASM has chosen to address and categorize muscles as “local” and “global”.  These terms, when defined, promote an awareness of the muscles location that has a major influence on their biomechanical function.^5,10,11  In contrast, muscles that are labeled as “postural” and “phasic” or “stabilizers” and “mobilizers” make reference to a specific action that can more easily be misconstrued. 

Postural and Phasic

Support for this statement lies in the previously mentioned third and fourth constants.  The terms postural and phasic denote actions performed based upon fiber type.  Postural being predominantly slow twitch/type I/SO and phasic being fast twitch/type IIa/FOG.^3,4  However, in the fourth constant it is stated that all movement and thus muscle is controlled by the nervous system.  As the nervous system is designed to be highly adaptable, it can alter the stimulation and response of effector motorneurons.^22,23,24,34

Research has demonstrated that change in nervous stimulation to a motor unit, such as that seen in disuse or injury, can alter the physical characteristics of that motor unit.^22,24,34  For example, a type I motor-unit stimulated at a high frequency will change in physical characteristics to a type II and/or vice versa.³⁵

Therefore it is the nervous system and not necessarily the fiber type distribution within the muscle that is ultimately responsible for the muscle action.

Stabilizer and Mobilizer

The terms stabilizer and mobilizer again refer to a specific action performed by the muscle.  Inconsistency can arise from the third constant, which stated that all muscles are capable of providing stabilization in some capacity.  The best way around this is delineating primary, secondary and tertiary stabilizers, which many professionals do use.  Thus it might be better to just use the term “stabilizers” with varying degrees of stabilization (primary, secondary and tertiary).  In either case, the premise is still being placed on the action of the muscle that can be directly influenced and changed by neural input.

Local and Global

The terms local and global simply refer to the location of the muscle in relation to the joint of motion.  Local and global muscles are deemed more prone to stabilization not based upon fiber type, rather on their biomechanical advantage (or disadvantage) relative to the joint.  The smaller the moment arm (leverage system) of the muscle, the less torque or motion (concentric/eccentric action) it will be able to induce.  Thus by default, they may be better delegated to stabilizing (isometric action).  Conversely, a larger moment arm generally indicates a muscle’s greater distance from the joint and the greater potential to manipulate movement.^9,11,36

Conclusion

There is much confusion among heath and fitness professionals pertaining to terminology used for muscle classification.  Many professionals use terms that are pertinent to specific actions of muscles based upon their fiber type.  However, as all motion and muscle is controlled by the nervous system, research has shown that these actions and characteristics can be altered via neural input.^{22,23,24,25,34,35}  Therefore, classification based upon specific fiber type actions may be misleading.

The NASM has chosen to use the terms “local” and “global” muscles to denote differences in musculature.  This system of classification is based upon physical location and biomechanical properties rather than fiber type distribution. 

Local muscles are biomechanically less advantageous to manipulate movement of a joint and thus may be better suited for stabilization.  These muscles show a propensity to inhibition, defined as a decrease in the neural drive to a muscle that reduces its ability to respond to stimuli with proper timing^18,20 and can thus result in a loss of proper strength (weakness).

Global muscles have greater biomechanical advantages to manipulate movement of a joint(s).  These muscles show a propensity to become tight, defined as a decrease in the resting length of a muscle as well as the common occurrence of overactivity (heightened neurological state).^{4,12,18,20,29}

Many classifications exist and all can be rationalized to make sense in certain populations.  The key is to develop them so they make sense in any population. Ultimately, this can only be achieved through proper definition and rationale that comes as a result of a genuine concern to illuminate the most pertinent applicable information.  The NASM has taken the industry up on this offer and delivered a proposal for muscle classification.  Please remember that the human body is very interdependent and complex.  No categorization that attempts to generalize the systems of the body will be able to precisely simplify this complexity.  However, for ease of explanation, education and communication, we must strive to create accurate simplicity of the human body.

References

1.      Jull G, Janda V. Muscles and motor control in low back pain: assessment management. In Twomey L (ed.). Physical therapy of the low back. New York: Churchill Livingstone; 1987.

2.      Bullock-Saxton J, Janda V, Bullock M. Reflex activation of gluteal muscles in walking. Spine 1993; 18:704.

3.      Hu J. Stimulation of craniofascial muscle afferents inducing prolonged facilitory effects in trigeminal nociception brainstem neurons. Pain 1992; 48:53.

4.      Liebension C. Integrating rehabilitation into chiropractic practice (blending active and passive care). Chapter 2. In Liebenson C (ed.). Rehabilitation of the Spine.  Baltimore, Williams and Wilkins, 1996.

5.      Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Ortho Scand 1989;230(suppl):20-4.

6.      Richardson C, Jull G, Toppenberg R, Comeford M. Techniques for active lumbar stabilization for spinal protection. Australian J Physiother 1992; 38:105-12.

7.      Norris C. Functional load abdominal training. J Bodywork Movement Ther 1999; 3:150-8.

8.      Crisco JJ, Panjabi MM. The intersegmental and multisegmental muscles of the spine: A biomechanical model comparing lateral stabilizing potential. Spine 1991;7:793-9.

9.      Richardson C, Jull G, Hodges P, Hides J. Therapeutic exercise for spinal segmental stabilization in low back pain. London: Churchill Livingstone; 1999.

10.  Bastide G, Zadeh J, Lefebvre D. Are the little muscles what we think they are? Editorial. Surg Radiol Anat 1989; 11:256.

11.  Boduk N. Clinical Anatomy of the Lumbar Spine. 3^rd edition. New York: Churchill Livingstone; 1997.

12.  Norris C. Response from Chris Norris. Position statement. J Bodyworks Movement Ther 4(4):232-5.

13.  Clark MA. Integrated training for the new millennium. Thousand Oaks, CA: National Academy of Sports Medicine; 2001.

14.  Clark MA. An integrated approach to human movement science. Thousand Oaks, CA: National Academy of Sports Medicine; 2001.

15.  Janda V: Muscle Function Testing. London: Butterworth; 1983.

16.  Lee D. The pelvic girdle. London: Churchill Livingstone; 1999.

17.  Bullock-Saxton J. Response from Joanne Bullock-Saxton. Position statement: a global view. J Bodyworks Movement Ther 4(4):227-9.

18.  Murphy Dr. Response from Donald R. Murphy. Position statement. J Bodyworks Movement Ther 4(4):229-32.

19.  Richardson C. Response from Carolyn Richardson. Position statement. J Bodyworks Movement Ther 4(4):235-36.

20.  Tunnell PW. Response from Pamela W. Tunnell. Position statement. J Bodyworks Movement Ther 4(4):237-41.

21.  Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement.   Spinal Disord 1992; 5:383-9.

22.  Buller  AJ, Eccles JC, Eccles RM. Interaction between motorneurons and muscles in respect of the characteristic speeds of their responses. J Physiol 1960; 150:417-39.

23.  Al-Amood WS, Buller AJ, Pope R. Long-term stimulation of cat fast twitch skeletal muscle. Nature 1973; 244:225-7.

24.  Dubowitz V. Cross-innervated mammalian skeletal muscle: histochemical, phyusiological and biomechanical observations. J Physiol 1967; 193:481-96.

25.  Hennig R, Lomo T. Effects of chronic stimulation on the size and speed of long-term denervated and innervated rat fast and slow skeletal muscles. Acta Physiologica Scand 1987; 130:115-31.

26.  Clark MA. A scientific approach to understanding kinetic chain dysfunction. Thousand Oaks, CA. The National Academy of Sports Medicine; 2001.

27.  Bullock-Saxton JE: Muscles and Joint: Inter-Relationships with pain and movement dysfunction. University of Queensland. Course Manual, 1997.

28.  Chaitow L:  Muscle Energy Techniques.  New York: Churchill Livingstone; 1997.

29.  Hammer WI. Muscle imbalance and postfacilitation stretch. Functional Soft Tissue Examination and Treatment by Manual Methods. In Hammer WI (ed.). 2^nd edition. Gaithersburg, MD: Aspen Publications; 1999.

30.  Grubb A, Stiller R, Schaible HG. Dynamic changes in the receptive field properties of spinal cord neurons with ankle input in rats with chronic unilateral inflammation in the ankle region. Exp Brain Res 1993; 92:441-52.

31.  Schaible HG, Grubb B. Afferent and spinal mechanisms of joint pain. Pain 1993; 55:5-54.

32.  Mense S, Simons DG. Muscle pain: understanding its nature diagnosis and treatment. Philadelphia: Lippincott Williams & Wilkins; 2001.

33.  Hopkins JT, Ingersoll CD, Krause BA, Edwards JE, Cordova ML. Effect of knee joint effusion on quadriceps and soleus motorneuron pool excitability. Med Sci Sports Exerc 2001; 33(1):123-6.

34.  Romanul FCA, Van Der Meulen JP. Slow and fast muscles after cross innervation. Enzymatic and physiological changes. Arch Neurol 1967; 17:387-402.

35.  Gunderson K, Leberer E, Lomo T, Pette D, Staron RS. Fibre types, calcium-sequestering proteins and metabolic enzymes in denervated and chronically stimulated  muscles of the rat. J Physiol 1988; 398:177-89.

36.  Hodges PW. Is there a role for the transversus abdominis in lumbo-pelvic stability? Man Ther 1999; 74-86.

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[문형철]

- functional abilities에 기반을 둔 많은 분류가 있음. 예를들면 (postural/phasic and/or stabilizer/mobilizer) and reaction capacity (tight/overactive/hypertonic and weak/inhibited).
- muscle fiber type distribution에 기초한 분류도 있음. slow twitch/type I/slow oxidative/SO; fast twitch/type IIa/fast oxidative glycolytic/FOG; fast twitch/type IIb/fast glycolytic/FG)
- structural locale에 의한 분류도 있음. (local/global).