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:



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



•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).



•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).



•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.



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



•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).



Isotonic eccentric alternatives



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.)



• 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'.



• 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.



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'.



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.



 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,



 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.



 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:



• 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.



 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.



 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.



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。