내게 꼭 필요한 근육탐구의 지침 2가지 - 각 근육의 촉진법과 근육재교육방법

[문형철]

전신통합생역학치료법에서 가장 어려운 탐구분야가 어디냐고 물으면 주저없이

"근육"이라고 말하겠다.

근육의 미세구조, 대구조, 수축기전, 장력기전, 근육동원기전, 근육역학(muscle mechanics)

기시 종지, 신경지배, 흔히 일어나는 질병문제들, Trp문제, 짝힘의 문제, 근육치료법(PIR, RI, PNF, 허혈성압박, 의학적 스트레칭), 운동법

이 모든 것을 다 이해해도 꼭 넘어서야 할일이 있다. 

1. 각각의 근육을 촉진하는 구체적인 방법

2. 아래 글에서 보는 바와같이 근육의 기능 재교육 방법

panic bird....

사례) 근육촉진법과 기능재교육방법

경추 근육의 촉진법

An entire group of muscles is encountered when therapists use palpation for orientation. The superficial muscles are the only muscles that can be palpated reliably ( Fig. 1 2.28). Therapists are able to do this by orienting themselves either immediately adjacent to the row of spinous processes or on the edge of the occiput and by instructing their patients to tense the appropriate muscle to confirm‎‍ its position.

- 천층근육은 오직 신뢰할만하게 측정가능함. 

The multisegmental muscle belly of the semispinalis is found near the spinous processes and is one of the oblique intrinsic muscles. It occupies the space between the midline and the laminae of the vertebrae. Its insertion is located immediately inferior to the superior nuchal line. where half of its width is covered by the descending part of the trapezius before it attaches itself onto the superior nuchal line. The anterior edge of the muscle can be palpated by starting at its insertion on the clavicle and moving in a superomedial direction. The insertion of the semispinalis capitus occupies approximately a third of a widely curved line on the edge of the occiput between the mid-line and the tip of the mastoid process. 

The splenius capitis inserts into the middle third of this line. This strong rotator and extensor belongs to the superficial

layer of the intrinsic muscles of the back. The lateral third of the line is occupied by the sternocleidomastoid.

This muscle does not only insert onto the mastoid process, but also somewhat posterior to it. This can be easily recognized

in the lateral view of this region (Fig. 1 2.29). The sternocleidomastoid aids orientation when the (1-0 transverse processes are being palpated. The  C1 transverse  process is usually found anterior to the muscle, the C2 transverse process directly posterior to the muscle, and the C3 transverse process along its posterior edge.

This muscle is a helpful guiding structure for therapists who wish to correctly locate the transverse processes. The sternocleidomastoid must often be pushed to the side so that therapists can pal pate closer to the transverse processes.

상부 경추 근육 upper cervical muscle

The following deep. short suboccipital muscles are of importance:

• Rectus capitis posterior major and minor:

- Rectus capitis posterior major extends from the C2 spinous process and travels obliquely in a superior direction where it inserts into the inferior nuchal line.

- Rectus capitis posterior minor extends from the C1 posterior tubercle to the inferior nuchal line.

• Obliquus capitis superior and inferior:

- Obliquus capitis inferior extends from the anterior surface of the C2 spinous process. travels in a super or and quite lateral direction. and inserts onto the Cl transverse process.

- Obliquus capitis superior extends from the Cl transverse process in an almost lateral direction in the sagittal plane and inserts into the inferior nuchal line   (retromastoid process, see the section "Anatomy of the Occiput and the Upper Cervical

Spine" above, p. 322).

• Rectus capitis lateralis and anterior:

- See the section "Anterior and Lateral Muscles" below for a description of their course.

The upper cervical muscles ( Figs. 1 2.30 and 1 2.31 ) are supplied by a very large proprioceptive innervation and

are important for the fine control of upper cervical movements. These muscles, in combination with the short

anterior muscles, form the upper cervical spine's own muscle apparatus. This muscle apparatus takes advantage of the special anatomical features (e.g., using the long lever of the Cl transverse process and the C2 spinous process) and the special biomechanics found in the upper cervical region, and ensures that the upper cervical joints are approximated using the strength of their tissues. Together with the mechanoreceptors in the CO{Cl to C2{C3 joint capsules, the muscle spindles of these muscles form the third organ for balance.

상부경추 근육촉진

The upper cervical muscles are covered completely by superficial muscles, making it difficult to reliably locate these structures using palpation. the deep transverse deformation of the functional massage techniques (see the section "Functional Massage" below, p. 349) can be used to easily access the muscles and to relieve tension. 

경추의 앞쪽 옆쪽의 근육들

The anterior muscles in the cervical spine are divided into two systems according to their position:

• Superficial, prevertebral muscles found anterior to the organs of the throat.

• Deep, prevertebral muscles found directly anterior to the vertebral bodies.

The superficial prevertebral muscles are further divided topographically into the following:

• Suprahyoid muscles: these muscles are found in the floor of the mouth and connect the hyoid bone with the mandible. 

They belong functionally to the muscles of mastication (Rauber and Kopsch, 1 987, p. 659).

• Infrahyoid muscles, also called the strap muscles: these muscles connect the hyoid bone with the larynx (thyroid

cartilage) and the sternum. According to Rauber and Kopsch ( 1987, p. 659), they participate in complex actions such as "chewing, swallowing, and phonation."

From a mechanical point of view, they form a kinematic flexor chain when the mouth is closed and the jaw closers

( masseter and temporalis) are active, producing some strength when the cervical spine i s flexed.

How Does this Affect Palpation?

The correct localization of the hyoid bone and the prominent sections of the larynx is used to confirm‎‍ the level of

the cervical vertebrae. The palpation of posterior structures is very difficult in the supine position, for example, when locating the exact position of the C4 lamina. The anterior structures are used as a further aid here.

The hyoid bone is mostly found deep in the angle between the floor of the mouth and the vertical surface of the throat, at approximately the level of C3. Its position varies a lot. It is quite often found at the level of the mandible and i s then difficult to reach. Please refer to the section "Anterior Palpation Techniques" below, page 362.

The deep prevertebral muscles include:

• Rectus capitis lateralis and anterior:

- Rectus capitis lateralis extends superiorly from the C1 transverse process onto the lateral part of the occiput.

- Rectus capitis anterior extends i n a superomedial direction from the anterior aspect of the C1 transverse process to the basilar part of the occiput.

• Longus colli and capitis:

- Course of longissimus capitis: this muscle is divided into several sections. Its vertically and transversely oriented fibers extend from approximately T3 to the atlas and rest against the vertebral bodies on both sides.

- Course of longus capitis: from the C3-C6 transverse processes, traveling in the depression between the transverse process and vertebral bodies, and inserting onto the basilar part of the occiput.

The recti muscles and longus capitis, in combination with the short posterior muscles of the neck, ensure that the

upper cervical joints are approximated. These muscles should be trained when the upper cervical region is unstable. 

The "longus group" of muscles is known clinically as the stabilizers of the cervical spine. Physical therapy treatment for instability, particularly in the lower cervical spine, should aim to recruit the longus colli muscle. Falla et al. (2004) proved in their EMG study how important the longus colli and longus capitis muscles (deep flexors of the neck) are. These muscles were shown to be less active during craniocervical flexion i n patients with chronic cervical symptoms compared with people who were free of symptoms. The patients' symptoms responded positively to the training of these muscles.

The deep prevertebral muscles ( Fig. 1 2.32) cannot be palpated. They have only been included in this chapter due to their great importance in clinical practice.

• Scaleni muscles. 

According to Rauber and Kopsch (1987, p. 665), these muscles belong to the deep lateral muscles of the neck and are the continuation of the intercostal muscles in the cervical region. Due to this, the scaleni muscles also originate on the anterior tubercle of the transverse process, the rudiments of the cervical ribs. Their muscle bellies form a cone-shaped covering

over the pleural dome, with nerves and vessels being able to pass through two gaps in the muscles (scalenus gaps) ( Fig. 1 2.33). 

It is obvious that their suitability as respiratory aid muscles is based on their position and their site of origin :

- Course of scalenus anterior: extends anterolaterally from the C3-C4 transverse processes onto the first rib. The phrenic nerve accompanies it for part of its course.

- Course of scalenus medius: from the C3-C7 transverse processes down onto the first rib.

- Course of scalenus posterior: travels more posteriorly from the C5-C7 transverse process down onto the second rib.

The scaleni muscles can be reached well using palpation. They cover the anterolateral region of the throat and are only partially covered by the sternocleidomastoid. The anterior scalenus gap ( Fig. 1 2.34) is formed by the  sternocleidomastoid and scalenus anterior. The subclavian vein and the phrenic nerve pass through here.

The posterior scalenus gap ( Fig. 1 2 .34) is formed by the scalenus anterior and scalenus medius. The subclavian artery

and the brachial plexus pass through this gap. The constriction of these structures as they pass through this gap in the muscles is known as "scalenus syndrome" or a form of "thoracic outlet syndrome."

경추의 신경과 혈관들

대후두 신경과 소후두 신경

- 대후두 신경은 semispinalis captis와 splenius capitis사이를 지나 후두부로 올라 감

- 소후두 신경은 scm과 splenius capitis사이를 지나 후두부로 올라감. 

Upper cervical flexion is important for maintenance of good spinal statics. The results of the head/neck flexion test can often be predicted on the basis of postural analysis of the head and neck. In standing analysis a head forward posture with a chin poke indicates agonist/antagonist/synergist muscle imbalance. In particular, the cervical extensors (the upper trapezius and suboccipitals) are not balanced by the co-activation of the DNFs ± longus colli and capitus. As a result sternocleidomastoid substitution occurs. 

- 상부경추 굴곡은 좋은 척추 정적자세를 유지하는데 중요한 역할. 

- 두부/경부 굴곡검사는 두부와 경부의 자세분석의 기초위에 예측할 수 있음. 

- 선자세 분석에서 턱이 들린자세와 함께 head forward posture는 주동근/길항근/협력근 불균형을 예측할 수 있게 함. 

- 특히, 경추신전근(상부승모근과 후두하근)은 경추심부굴곡근(경장근, 두장근)의 상호-수축에 의해 불균형됨. 

The clinical relevance of this imbalance is that treatment of the myofascial or articular pain generators without subsequent neuromuscular reeducation will likely not correct the underlying problem.

- 이러한 불균형의 임상적 중요성은 근육신경 재교육없이 근막 또는 관절통증 generator 치료는 근본적인 문제를 교정할 수 없음을 보여줌.

For instance, if trigger points in the SCM or painful cervical joints are present the inhibition of the DNFs must be corrected or else it is likely the trigger points or joint dysfunction will recur.Sometimes, it is the trigger point or joint dysfunction which is primary. The key is to see the chain reaction in the motor system and determine when the joint dysfunction, trigger points and movement patterns are all normalized. 

- 예를들어, 만약 흉쇄유돌근에 발통점 또는 경추에 통증성 관절이 있다면 억제된 DNFs는 반드시 교정되어야 하고, 그렇지 않으면 발통점이나 관절기능부전은 다시 발생함. 

- 때로 발통점이나 관절기능부전이 primary임. 

- 핵심은 운동계에서 사슬반응을 보고 관절기능부전, 발통점, 움직임 패턴이 표준화되어야 함. ....