mid-thoracic dysfunction(흉추4-8) 치료적 운동법 9가지. 크레이그 리벤슨

[문형철]

현대인에게 엄청 중요한 운동법 중 하나가 브뤼거 호흡운동이다.

흉추의 과도 전만을 정상화하고 호흡량을 늘려주고..

브뤼거 호흡운동이 중요한 이유에 대한 크레이그 리벤슨 논문(클릭)!!

중흉추 기능부전 자세한 논문(클릭)

위 두글을 읽은 후 보면 짱!!

panic bird...

T4~8 dysfunction is a common perpetuating factor of muscle imbalance, trigger points, joint dysfunction, and faulty movement patterns. It is often asymptomatic, but is a key source of biomechanical overload involving the neck, TMJ,

shoulder, arm, and even low back regions.

Self-treatment of mid-thoracic dysfunction. a key link in the body axis. Part 2. Treatment.pdf

Self-treatment of mid-thoracic dysfunction. part3.pdf

Introduction

Dysfunction involving excessive T4~T8 kyphosis is very common. Symptoms arising from regions at a distance to the mid-thoracic area are often secondary to T4~T8 dysfunction. Parts One and Two of this series have shown how to assess and treat this dysfunction. In this third and final part of the series some basic clinical issues important for successful incorporation of these management strategies into your practice will be discussed. In particular, the why (rationale), when (indications), what (skills), and how (practical integration) of addressing T4~8 dysfunction will be summarized.

- 흉추 4~8번의 과도한 전만은 매우 흔한 부정렬임. 

- part 3 임상 issue 논문에서는 치료법에 대해서 토의함. 

- 왜, 언제, 어떻게, 무엇을 해야 하는지에 대해서 정리함. 

Why

Mid-thoracic dysfunction affects the whole body's center of alignment, and thus posture. Head and neck forces are increased as a result of the head forward posture. Shoulder strain and glenohumeral impingement is more likely due to the forward drawn shoulder. Lumbar disc syndromes and nerve impingement have been shown to result from repetitive end-range flexion overload (Callaghan &McGill 2001). Faulty respiration and mid-thoracic dysfunction affect one another. The most common fault with improper respiration is inhalation by means of raising the rib cage vertically (Fig. 1). Vertical chest breathing overactivates the scalenes and shoulder girdle elevators (i.e. upper trapezius, levator scapulae) and results in poor fixation of the lower ribs (Lewit1999).

- 중흉추 기능부전은 인체 전체정렬의 중심과 자세에 영향을 미침. 

- 두부와 경추힘은 head forward posture의 결과로 증가함. 

- 어깨 긴장과 충돌증후군은 쉽게 발생함. 

- 허리디스크로 인한 신경포착이 쉽게 발생함.

- faulty respiration 과 중흉추 기능부전은 다양한 분야에 영향을 미침. 아래 그림과 같이 늑골이 들리는 호흡을 야기함. 

- 그 결과 부호흡근인 사각근이 과도하게 활성화되고 견갑대가 들림. 

 Similarly, in the supine position if the diaphragm is not functioning properly during inhalation, the lower ribs will move cephalad (Fig. 2). 

- 마찬가지로 누운자세에서 횡격막은 흡기시 제대로 기능하지 못하고, 하부늑골이 머리쪽으로 움직일 수 있음. 

Without fixation of the lower ribs during trunk extension tasks the mid-thoracic spine cannot extend properly and  compensatory lumbo-sacral or thoraco-lumbar hyperextension typically results (Fig. 3)

- 몸통 신전 동안 하부늑골이 고정되지 못하면 충흉추는 적절하게 신장되지 못하고 요천추 또는 흉요추에서 과도한 신전이 발생함. 

When

T4~T8 dysfunction should be treated whenever head/neck, upper quarter, mid back, or low back problems are seen in a patient with decreased extension mobility of the midthoracic spine. The standing arm elevation test is a basic assessment

tool for screening purposes (see JBMT 5(2): 90±98) (Fig. 4). 

- 흉추 4-8번 기능부전은 두부/경추, 상부운동사슬, 중흉추, 하부요추 문제가 있을때마다 치료해야 함. 

- 선자세 팔들어 올리기 검사는 중흉추 기능부전을 평가하는 기본적인 검사법임. 

Also, eval‎uation of static posture both seated and standing is important (Fig. 5). 

- 또한 앉은 자세와 선자세에서 정적인 검사는 중요함. 

Increased thoraco-lumbar hypertonus is a classic sign of overactivity of the superficial `global' muscles and indicates poor `deep' muscle function (Janda 1996, Richardson 1999, Jull 2000, Hodges 2002) (Fig. 6).

- 증가된 thoraco-lumbar hypertonus는 중흉추 기능부전 환자에서 전형적으로 발생하는 근육 과활성화 현상임. 

When observation of the patient indicates that T4~8 dysfunction is present, motion palpation of passive joint mobility and quality of end-feel is also indicated. This is best performed in the seated position as shown by BruE gger (Fig. 7) (BruE gger 2000, Petak 2002).

- 환자가 중흉추 기능부전이 있을대, 수동적 관절움직임의 움직임 촉진과 끝느낌의 질은 진단에 중요함. 

- 아래그림과 같이 앉아서 검사함. 

What

Managing T4~T8 dysfunction requires a broad skill set incorporating postural advice, manual manipulation, and

therapeutic exercise. A number of exercises have been recommended in this series (see Table 1).

- 흉추4-8번 기능부전 치료는 다양한 기법이 있음. 

- 자세 조절 제안, 수기치료, 치료적 운동법

- 많은 운동법이 제안됨. 

- 브뤼거 호흡 자세 운동법

- wall lean  운동법

- upper back cat 운동법

- back stretch on the ball 운동법

- back stretch with foam rolls 운동법

- active prayer stretch 운동법

- Kolar's wall slide with arm elevation 운동법

- lower abdominal breathing

-  Kolar's prone trunk extension

How

Knowing why mid-thoracic dysfunction is clinically important, when it should be addressed, and what techniques are therapeutic is only the beginning point for successful management of the patient with a problem in this area. 

Unless it is understood how to incorporate this knowledge and skill into patient care eciently results will be unsatisfactory. First, patients should appreciate how important this dysfunction is as a perpetuater of their symptoms. Second, they should appreciate how even when symptoms decrease that prevention of recurrence depends on optimizing functional integrity in this area.

Insight by the patient about the importance of economical upright posture arises gradually as a result of a continued dialogue between health care provider and patient. A moment or two per session spent explaining the relationship between function and pain is essential. Each exercise has its particular advantages and disadvantages. What follows is a brief review of practical issues regarding the exercises presented in this series.

1. Brugger relief position

Advantages:

. This exercise is ideal for use at the workplace as a `micro-break'.

. It activates an entire chain of muscles linked to the upright posture and thus works at a neurological level.

- 장점은 아무때나 편하게 할 수 있다. 상부사슬과 연결된 근육의 entire chain을 다 활성화할 수 있다. 

Disadvantages:

. There is a tendency to hyperextend the lumbo-sacral and thoraco-lumbar spines with this exercise. Thus, performing it with active exhalation is important.

. Most low back patients benefit more from getting out of the chair completely, so this exercise is more suitable for neck and upper quarter patients or the Brugger exercise can be performed in the standing posture.

- 단점은 이 운동을 하면서 요천추, 흉요추 과전만을 만들 수 있음. 그래서 active exhalation이 중요함.

- 요통환자는 의자에 앉는 것이 적절하지 않으므로 경추, upper quarter환자에게 적합. 브뤼거 exercise는 서서 시행할 수 있음. 

2. Wall lean

Advantages:

. This exercise is effective for individuals with a fixed thoracic kyphosis who have relatively good motor control.

Disadvantages:

. If the patient has diculty relaxing their upper trapezius.

. If the patient is hyperlordotic.

3. Upper back cat

Advantages:

. Strongly isolates the mid-thoracic region.

Disadvantages:

. Requires good motor control to perform.

. Is sometimes dicult for the patient to avoid overstretch of the shoulder.

4. Back stretch on the ball

Advantages:

. Extremely comfortable and relaxing.

. Head can be supported.

. Promotes improved respiration.

Disadvantages:

. Difficult at first if the person has poor balance.

. Requires a very large ball if the patient is barrel chested or has a fixed head forward posture.

. Can cause dizziness at first. 

5. Back stretch with foam rolls

Advantages:

. Excellent segmental isolation of the area of fixed kyphosis.

Disadvantages:

. Can be painful at first.

6. Active prayer stretch

Advantages:

. Increases strength of the dorsal erector spinae.

Disadvantages:

. Requires a high level of motor control.

. Difficulty to relax upper trapezius.

7. Kolar's wall slide with arm elevation

Advantages:

. Is highly functional since it incorporates arm elevation, squatting and breathing.

Disadvantages:

. Requires high level of motor control to coordinate.

8. Lower abdominal breathing(Fig. 2)

Advantages:

. Trains diaphragmatic breathing with proper fixation of the lower ribs.

Disadvantages:

. Advanced exercise.

9. Kolar's prone trunk extension(Fig. 3)

Advantages:

. Facilitates the dorsal erector spinae.

. Trains co-activation of oblique abdominal muscles with dorsal erector spinae so that lumbar spine hyperextension does not substitute for thoracic extension.

Disadvantages:

. Requires a very high level of motor control.

. Difficult to avoid lumbar hyperlordosis.

Summary

T4±8 dysfunction is a common perpetuating factor of muscle imbalance, trigger points, joint dysfunction, and faulty movement patterns. It is often asymptomatic, but is a key source of biomechanical overload involving the neck, TMJ, shoulder, arm, and even low back regions. 

Treatments which aim only at the site of symptoms are bound to fail if function is disturbed due to excessive kyphosis in the mid-back. Rehabilitation of the upright posture is fundamental to optimization of function in the locomotor system. Any source of peripheral nociception that is perpetuated by increased kyphosis is best treated by concurrent treatment of the peripheral pain generator and the biomechanical source of overload in the postural kinetic chain. Neurological programs for maintenance of the upright posture are `hard-wired' into the central nervous system making rehabilitation of the mid-thoracic area of central importance both biomechanically and

neurophysiologically. 

A classic example of the importance of this region for function is if one attempts either full inhalation or arm elevation in the slumped posture and then compares it with sitting upright in a Brugger position. As this series and these examples show improving the upright posture immediately improves function. Treatment of pain in the locomotor system should always be accompanied by rehabilitation of function. This series has shown how the mid-thoracic region can be assessed and treated and why this is `linked' to a multitude of common musculoskeletal pain syndromes.

[문형철]

브뤼거 호흡 자세 운동법
- wall lean 운동법
- upper back cat 운동법
- back stretch on the ball 운동법
- back stretch with foam rolls 운동법
- active prayer stretch 운동법
- Kolar's wall slide with arm elevation 운동법
- lower abdominal breathing
- Kolar's prone trunk extension

[gait1004]

감사합니다.^^

[재치만점]

좋은 정보에 감사드립니다 운동치료에 잘 응용하고 유용하게 쓰겠습니다

[박정성]

좋은 정보 감사드립니다 운동치료할때 많이 이용하겠습니다^^