어깨충돌 증후군(Shoulder Impingement) 운동 - Janda approach

[소향]

 <원문 요약>

얀다(Janda)의 상부교차증후군(Upper cross Syndrome)에서는 상부승모근과 하부승모근의 근육불균형에 대해 이야기 합니다. 상부승모근의 활동이 촉진되고 하부승모근은 억제되어 있다고 합니다. 쉽게 이야기하면 상부승모근은 강하고 하부승모근은 약한 경향성이 있습니다.

어깨의 문제를 지닌 환자들이 이러한 근육불균형을 가지고 있는 경우가 많습니다. 특히 2차적인 견봉하 어깨충돌증후군(secondary subacromial impingement)을 가진 환자들에게서 나타납니다.

아래의 운동방법들이 견갑골과 회전근계의 근육불균형을 회복시키는 좋은 방법 중에 하나가 될 것으로 보입니다.

* 상부교차증후군 관련글 : http://cafe.daum.net/POWERZONE4U/1B0P/32

Shoulder Impingement Exercises for Muscle Balance

by Dr. Phil on January 31, 2011

Shoulder impingement and rotator cuff injuries often respond well to physical therapy exercises. The success of the exercise program will depend on an accurate clinical assessment and an evidence-based approach to prescribing appropriate interventions. Two expert physical therapists and clinical researchers published an excellent review on the rehabilitation of shoulder impingement syndrome and rotator cuff injuries in the British Journal of Sports Medicine.

Drs. Todd Ellenbecker and Ann Cools offer a well-detailed description of the literature behind range of motion limitations, scapular dyskinesis, and muscle balance. Both authors have published extensively in these areas of clinical research, giving them an excellent perspective at translating evidence into practice by sharing their expertise. Their article featured some unique exercises for restoring shoulder muscle balance.

I was pleased to see discussion on muscle balance, particularly of the upper and lower trapezius, since this was the topic of my PhD dissertation. I was not surprised to see the discussion, however, since Ann Cools has been one of the top researchers in this area. When making a clinical decision on therapeutic exercise prescription, it’s not enough to just know which muscles are activated at the highest levels…the balance between muscle strength is just as important.

Relative EMG activation between antagonist muscles must be considered, particularly the upper trapezius to lower trapezius (UT:LT) ratio in patients with shoulder dysfunction. As Dr. Vladimir Janda noted, the upper trapezius tends to be tight and strong, while the lower trapezius tends to be weak. While this imbalance is commonly noted in his Upper Crossed Syndrome, the imbalance is regularly seen in patients with secondary (functional) subacromial impingement.

Cools et al. published an excellent paper on exercises with optimal UT:LT ratios. These exercises, as well as those suggested in Ellenbecker and Cools’ paper would be great choices for restoring muscle imbalance of the scapula and rotator cuff.

Used with permission The Hygenic Corporation

REFERENCE: Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010 Apr;44(5):319-27.

[RKCKOREA]

무거운 중량을 드는 것보다 많은 반복 횟수를 유도하는 것보다 정확한 자세로 정교화된 동작 패턴이 중요함은 rehab이든 reconditioning이든 training이든 같은 이치인 듯 하네요.