美国留学生文章-选择 MET 来治疗肌肉的方法和技巧

2018-12-05 10:39:35      点击:

 

 

 

 

Ruddy's work was a part of the base on which Mitehell.Snr, and others, constructed MET, and his work is worthy of study and application since it offers, at the very least, a useful means of modifying the employment of sustained isometric con-traction, and has particular relevance to acute problems and safe self-treatment settings. Examples of Ruddy's method will be described in later chapters.

鲁迪的作品是米切尔先生和其它人构建 MET 的一部分基础;鲁迪的作品值得研究和应用,因为该作品至少提供了对持续等长收缩运用进行修改的有用方法,并且对急性问题和自我治疗条件具有特殊意义。鲁迪方法的示例将在后面章节进行描述。

 

Isotonic concentric strengthening MET methods

等张同心增强 MET 方法

 

Contractions which occur against resistance that is then overcome, allow toning and strengthen of the muscle(s) involved in the contraction. For example:

此时,抗阻收缩已克服,收缩所涉及的肌肉能够恢复弹性并得到增强。例如:

 

•The practitioner positions the limb, or area, so that a muscle group will be at resting length, and thus will develop a strong contraction.

医生通过放置肢体或部位,使肌肉组处于静止长度,从而产生强收缩。

 

•The practitioner explains the direction of movement required, as well as the intensity and duration of that effort. The patient strongly contracts the muscle with the objective of moving the muscle through a complete range, rapidly (in about 2 seconds).

医师向患者解释所需运动的方向以及施力的强度和持续时间。患者有力地收缩肌肉,试图在整个范围内快速地(大约 2 秒钟内)活动肌肉。

 

•The practitioner offers counterforce that is slightly less than that of the patient's contraction, and maintains this throughout the contraction. This is repeated several times, with a progressive increase in practitioner's counterforce (the patient's effort in the strengthening mode is always close to maximal).

医师施加略小于患者收缩的反作用力,并在整个收缩期间保持该力度。重复若干次,并且医师的反作用力逐步加大(患者用于拉伸的施力始终接近其最大力度)。

 

•Where weak muscles are being toned using these isotonic methods, the practitioner allows the concentric contraction of the muscles (i.e. offers only partial resistance to the (contractile effort).

如果使用这些等张方法使虚弱的肌肉恢复弹性,医师即允许肌肉同心收缩(即,针对收缩施力仅施加部分阻力)。

 

•Such exercises should always involve practitioner effort which is less than that applied by the patient. The subsequent isotonic concentric contraction of the weakened muscles should allow approximation of t!ie origins and insertions to be achieved under some degree of control by the practitioner.

训练期间,医师应始终施加小于患者的力度。随后,在医师一定程度的控制下,通过等张同心收缩,允许接近虚弱肌肉的起端和附着物。

 

•Isotonic efforts are usually suggested as being of short duration, ultimately employing maximal effort on the part of the patient.

通常情况下,建议等张施力为短期施力,并最终对患者部位进行最大施力。

 

•The use of concentric isotonic contractions to tone a muscle or muscle group can be expanded to become an isokinetic, whole joint movement (see below).

采用同心等张收缩使肌肉或肌肉组恢复弹性,该方法可扩展为等速、全关节运动(参见下文)。

 

Isotonic eccentric alternatives

等张偏心备选方法

 

Norris (1999) suggests that there is evidence that when rapid movement is used in isotonic concentric activities it is largely phasic, type II, fibres that are being recruited. In order to tone postural (type 1) muscles that may have lost their endurance potential, eccentric isotonic exercises, performed slowly, are more effective. Norris states: l^ow resistance, slow movements should be used... eccentric actions have been shown to be better suited for reversal of serial sarcomere adaptation/

诺里斯(于 1999 年)提出有迹象显示当在等张同心活动中采用快速运动时,将会主要恢复位相性第二型纤维。为了使可能已失去耐力潜能的姿势肌(第一型)恢复弹性,缓慢地进行偏心等张训练更加有效。诺里斯说:可使用低阻力、慢速运动... 偏心动作已证实更适用于若干肌节适应的恢复。

 

Rapidly applied isometric eccentric manoeuvres ('isolytic') are described later in this chapter.

快速施加等张偏心力量的方法 ('isolytic') 将在本章节后面部分进行描述。

 

Example of a slow eccentric isotonic stretch (SEIS)

缓慢偏心等张拉伸 (SEIS) 的示例

 

rationale: In the case of an individual with hamstring hypertonicity accompanied by inhibited quadriceps, a slow eccentric isotonic stretch (SEIS) of the quadriceps would both tone these and reciprocally inhibit the hamstrings, allowing subsequent stretching of the hamstrings to be more easily achieved.

基本原理:如果个体患有绳腱过度紧张并且四头肌受抑制,那么对四头肌进行缓慢偏心等张拉伸 (SEIS) 将会既使这些肌肉恢复弹性,又能使绳腱相互抑制,从而更容易拉伸绳腱。

 

• The patient is supine with hip and knee of the leg to be treated, flexed. (Note; it is sometimes easier to perform this manoeuvre with the patient prone.)

患者臀部朝下仰卧,腿部关节弯曲,准备接受治疗。(注意:某些情况下,患者俯卧更易于执行动作。)

 

• The practitioner extends the flexed knee to its first barrier of resistance, palpating the tissues proximal to the knee crease for first sign of 'bind'.

医师伸开弯曲的膝盖至其第一个阻力层,对膝盖折痕邻近组织进行触诊,查找第一个“绑定”迹象。

 

• The patient is asked to resist,'using a little more than half available strength, the attempt the practitioner will make to slowly flex the knee fully.

要求患者以略大于一半力气的力度施加阻力,医师将试图缓慢完全地弯曲膝盖。

 

An instruction should be given which makes clear the objective, 'I am going to slowly bend your knee, and I want you to partially resist this, but to let it slowly happen'.

应向患者进行说明讲解目标,“我将要缓慢地弯曲您的膝盖,我希望您施加部分阻力,但要缓慢进行”。

 

After performing the slow isotonic stretch of the quadriceps the hamstring should be retested for length and ease of straight leg raising, and if necessary, the hamstrings should be taken into a stretched position and held for 30 seconds before repeating the procedure.

对四头肌执行缓慢等张拉伸后,应重新检测绳腱以保证直腿抬高的距离和舒适度;如需,绳腱应置为拉伸姿势并保持 30 秒钟,然后重复该程序。

 

Strengthening a joint complex with isokinetic MET

使用等张 MET增强关节复合体

 

A variation on the use of simple isotonic concentric contractions, as described above, is to use isokinetic contraction (also known as progressive resisted exercise). In this method the patient, starting with a weak effort but rapidly progressing to a maximal contraction of the affected muscle(s), introduces a degree of resistance to the practitioner's effort to put a joint, or area, through a full range of motion. An alternative or subsequent exercise involves the practitioner partially resisting the patient's active movement of a joint through a rapid series of as full a range of movements as possible.

如上所述,简单等张同心收缩的变化即为采用了等张收缩(也称为进阶抗阻训练)。通过此方法,患者从轻微施力开始,逐步快速对受损肌肉进行最大程度地收缩,在关节或部位的整个活动范围内对医师施加了一定程度的阻力。在替代训练或随后训练中,医师尽量在一组全范围运动,对患者关节的主动运动施加部分阻力。

 

 Mitchell et al (1979) describe an isokinetic exercise as follows: ‘The counterforce is increased during the contraction to meet changing contractile force as the muscle shortens and its force increases.’ This. approach is described as being especially valuable in improving efficient and coordinated use of muscles, and in enhancing the tonus of the resting muscle. 'In dealing with paretic muscles, isotonics (in the form of progressive resistance exercise) and isokinetics, are the quickest and most efficient road to rehabilitation/

米切尔等人(于 1979 年)描述等张训练如下:“在收缩期间增强反作用力,通过肌肉缩短提高力量,从而适应不断变化的收缩力。”根据描述,此方法对于提高肌肉使用的效率和协调性,提高静止肌肉的紧张度更具价值。“在治疗轻瘫肌肉的过程中,等张训练(采用进阶抗阻训练的形式)和等速训练是进行康复的最快捷最有效方法。”

 

 The use of isokinetic contraction is reported to be a most effective method of building strength, and to be superior to high repetition, lower resistance exercises (Blood 1980). It is also felt that a limited range of motion, with good muscle tone, is preferable (to the patient) to normal range with limited power. Thus the strengthening of weak musculature in areas of limitated mobility is seen as an important contribution, towards which isokinetic contractions may assist,

据报道,采用等张收缩是加强体能的最有效方法,并且优于高重复率、低抗阻的训练(布拉德于1980年)。另外,报道还认为具有良好肌肉弹性的有限运动范围好于(对患者来说)对常规范围施加有限力道。因此,在有限运动范围内增强虚弱的肌肉组织应视为具有重要贡献,该贡献可由等张收缩提供佐证。

 

 Isokinetic contractions not only strengthen (largely phasic, type II) fibres, but have a training effect which enables them to subsequently operate in a more coordinated manner. There is often a very rapid increase in strength. Because of neuromuscular recruitment, there is a progressively stronger muscular effort as this method is repeat-ed. Contractions and accompanying mobilisation of the region should take no more than 4 seconds for each repetition, in order to achieve maximum benefit with as little fatiguing as possible of either the patient or the practitioner. Prolonged contractions should be avoided (DiGiovanna 1991).

等张收缩不仅可增强(位相性,第二型)纤维,还具有训练效果,因此能够以更协调的方式进行操作。力度经常出现非常快速的增强。由于神经肌肉性的恢复,肌肉施力将会随着此方法的重复而逐步增强。收缩及其伴随的部位运用每次重复应不超过 4 秒钟,以医患双方尽量少受疲劳来实现最佳效果。应避免拖延收缩时间(迪约奥瓦纳于 1991 年)。

 

 The simplest and safest applications of isokinetic methods involve small joints such as those in the extremities, largely because they are more easily controlled by the practitioner's hands. Spinal joints are more difficult to mobilise and to control when muscular resistance is being utilised at close to full strength.

最简单安全的等张应用方法需要小关节(例如骨端关节)进行参与,很大程度上由于这些关节更易于医师的手来控制。如果以接近全部力量施加肌肉阻力,脊柱关节更难移动和控制。

 

 The options for achieving increased tone and strength via these methods therefore involves a choice between a partially resisted isotonic con-traction, or the overcoming of such a contraction, at the same time as the full range of movement is being introduced. Both of these options can involve virtually maximum contraction of the muscles by the patient. Home treatment of such conditions is possible via. self-treatment, as in other MET methods.

因此,要通过这些方法实现提高弹性和力量,可在引进全范围运动的同时,选择部分抗阻等张收缩或克服此类收缩。这 2 个选项均可实质上最大收缩患者肌肉。可通过其它 MET 治疗方法,针对这种情况进行家庭治疗。

 

 DiGiovanna (1991) suggests that isokinetic exercise increases the .work which a muscle can subsequently perform more efficiently and rapidly than either isometric or isotonic exercises.

迪约奥瓦纳(于 1991 年)提出等张训练可改善治疗工作,通过该训练,肌肉比其它等长训练或等张训练运用更加有效快速。

 

 

 To summarise:

总结:

 

• To tone weak phasic (stabiliser, see Ch. 2) muscles, perform concentric isotonic exercises using full strength, rapidly (4 seconds maximum).

针对弹性弱的位相性(稳定肌,请参见第 2 章)肌肉,使用全力快速执行同心等张训练(最长 4 秒钟)。

 

•To tone weak postural (mobiliser, see Ch. 2) muscles, slowly perform eccentric isotonic (i.e. SEIS above) exercises using increasing degrees of effort.

针对弹性弱的姿势肌(驱动肌,请参见第 2 章),逐步加力缓慢执行同心等张(例如,上述缓慢偏心等张拉伸)训练。

 

• In order to tone postural fibres, slow speed, eccentric resistance is most effective (Norris 1999).

要恢复姿势性纤维,慢速同心阻力具有最佳效果(诺里斯于 1999 年)。

 

Reduction of fibrotic changes with isolytic (isotonic eccentric) MET

采用isolytic(等张偏心)MET 降低肌肉化

 

As discussed above, when a, patient initiates a contraction, and it is overcome by the practitioner, this is termed an 'isotonic eccentric contraction' (e.g. when a patient tries to flex the arm and the practitioner overrides this effort and straightens it during the contraction of the flexor muscles). In such a con-traction the origins and insertions of the muscles (and therefore the joint angles) are separated, despite the patient's effort to approximate them.

如上所述,患者刚开始收缩即由医师克服,这种情况称为“等张偏心收缩”(例如,当患者试图弯曲胳臂,医师克服此动作并在屈肌收缩期间伸直胳臂)。在此收缩过程中,尽管患者试图使肌肉的起端和附着物接近,该起端和附着物(从而引起关节角)仍将分离。

 

 When such a procedure is peformed rapidly this is termed an isolytic contraction, in that it involves the stretching and to an extent the breaking down (sometimes called 'controlled microtrauma’) of fibrotic tissue present in the affected muscles.

如果快速执行此程序,即称为等张偏心 (isolytic) 收缩,在此过程中,受损肌肉的纤维组织拉伸并一定程度地受到损坏(某种情况下,称为可控微创)。

 

 Micro trauma is inevitable, and this form of 'controlled' injury is seen to be useful especially in relation to altering the interface between elastic and non-elastic tissues - between fibrous and non- fibrous tissues. Mitchell (Mitchell et al 1979) states that: 'Advanced myofascial fibrosis sometimes requires this "drastic" measure, for it is a powerful stretching technique/

微创不可避免,并且“可控”伤害形式视为有益,尤其对于在弹性组织和非弹性组织以及纤维和非纤维组织之间改变接口的情况。米切尔(米切尔等人于 1979 年)提出“某些情况下,高肌筋膜纤维化需要这种“烈性”措施,因为该措施是一种强大的拉伸技术。”

 

 'Adhesions' of this type are broken down by the application of force by the practitioner which is just a little greater than that of the patient. Such procedures can be uncomfortable, and patients should be advised of this, as well as of the fact that they need only apply sufficient effort to ensure that they remain comfortable.. Limited degrees of effort are therefore called for at the outset of isolytic contractions.

这种“粘连组织”在医师施力过程中受到损坏,医师施力比患者施力略大。应告知患者该程序可能产生痛苦,还应据实要求患者仅需施加确保其舒适度的足够力量即可。因此,施力限度称为等张偏心收缩初始点。

 

 However, in order to achieve the greatest degree of stretch (in the condition of myofascial fibrosis for example), it is necessary for the largest number of fibres possible to be involved in the isotonic eccentric contraction. There is an apparent contra-diction to usual practice in that, in order to achieve as large an involvement as possible, the degree of contraction should be a maximal one, likely to produce pain which, while undesirable in most manual treatment, may be deemed necessary in a given instance.

但是,为了实现更大程度地拉伸(例如,在高肌筋膜纤维化的病例中),必须使尽量多的纤维参与等张偏心收缩。日常训练中存在明显收缩 - 为了使更多纤维参与。应采用最大程度地收缩 - 可能会产生痛苦,虽然这种痛苦在大多数手法治疗中尽量避免,但根据给定病例,该痛苦可能必不可少。

 

 Additionally, in many situations the procedure involving a maximal contraction might be impossible to achieve if a large muscle group (e.g. ham-strings) is involved, especially if the patient is strong and the practitioner slight, or at least inadequate to the task of overcoming the force of the contracting muscle(s). In such a situation less than optimal contraction is called for, repeated several times perhaps, but confined to specific muscles where fibrotic change is greatest (e.g. tensor fascia lata), and to patients who are not frail, pain- sensitive, or in other ways unsuitable for what is a vigorous MET method.

另外,在很多情况下,如果大群肌肉组(例如,绳腱)参与运动,尤其当患者体格强壮而医师纤细且至少不适合从事克服收缩肌肉工作时,那么此程序将会因要求最大程度收缩而无法实现。在此种情况下,需要收缩小于最佳力度并可能重复若干次,但该方法仅限于纤维化最严重的特定肌肉(例如,阔筋膜张肌)和体格强壮、痛觉敏感的患者以及其它不适用于 MET 烈性疗法的情况。

 

 Unlike SEIS, which have the aim of strengthening weak postural (mobiliser) muscles, and which are performed slowly (as discussed earlier in this chapter), isolytic contractions aimed at stretching fibrotic tissues are performed rapidly.

不同于旨在增强虚弱姿势肌(驱动肌)并需缓慢执行(如本章节前文所述)的缓慢偏心等张拉伸,等张偏心收缩旨在拉伸纤维化组织并需快速执行。

 

Summary of choices for MET in treating muscle problems “

选择 MET 来治疗肌肉问题的总结

 

To return to Goodridge's introduction to MET (see earlier in this chapter) - using the adductors as our target tissues we can now see that a number of choices are open to the practitioner once the objective has been established, for example to lengthen shortened adductor muscles.

回顾古德里奇关于 MET(请参见本章节前文)的介绍 将内收肌用于目标组织,我们即可发现一旦确立目标,医师便拥有大量选择,例如可拉长已缩短的内收肌。