Stretching Chapter 1. Understanding PNF stretching 스포츠재활실습 2 주차. 임승길 What? PNF?? 1. Proprioceptive 움직임과체위에관한정보를제공하는감각수용기 2. Neuromuscular 신경과근육 3. Facilitation 더쉽게되도록 고유감각수용기를적절하게자극함으로써신경 - 근육의반응을촉진시키는치료적방법 왜 PNF 를하는가? 근력 저항성트레이닝에의한변화 유연성 협응성 (Coordination) 각각의운동요소의선택적재교육 Neuromuscular control Joint stability Coordinated mobility 1
Streching techniques 신장반사 1. Contract-relax 2. Hold-relax 3. Slow-reversal-hold-relax Muscle energy techniques PNF contract-relax & hold-relax techniques 의변형기법 PNF와신경생리학적인원리가같다. 5가지구성요소 1. 환자의능동적인근수축 2. 특정방향으로근수축 3. 환자에의한근수축강도의조절 4. 관절의위치를 AT가조절 5. AT의적절한저항적용 MET 의치료 techniques 1. Isometric 2. Concentric isotonic 3. Eccentric isotonic 4. Isolytic Concentric contraction by the patient while the AT applies an external force in the opposite direction, overpowering the contraction and lengthening that muscle 2
MET 의임상적적용 1. 단축, 구축또는강직된근육의신장 2. 약한근육또는근육군의강화 Chapter 2. Stretching basics 3. muscle pumping 을통한부종의감소 4. 제한된움직임이있는관절의 Mobilization 5. Fascia 의스트레칭 Stretching Static stretching Pain-free stretching Types of stretching Ballistic & static Passive & active Seated hamstring stretching Passive stretching The PNF hold-relax hamstrings stretch 3
Facilitated hamstrings stretching Chapter 3. Spiral-diagonal patterns a. Sartorious, anteriortibialis b. biceps brachii c. levator scapular muscle Iliopsoas: three plans of movement Chapter 4. Stretches for the lower extremity Hamstrings anatomy 4
Functional assessment Straight leg hamstring stretch Hip flexion to 90 deg with the knee straight is ideal Bent knee hamstrings stretch Hamstrings self-stretch Quadriceps group Quadriceps functional assessment ROM Extension: 0~-10(hyperextension)deg Flexion: 130 deg 5
약간의도움으로뒷꿈치가엉덩이에닿을수있다. Quadriceps stretch Quadriceps self-stretch Psoas & Iliacus Psoas & Iliacus functional assessment Modified Thomas test The left lower leg extends, indicating a tight quadriceps, and possible a tight tensor fascia latae, on the left. The left thigh lifts off the table, indicating a tight psoas on the left. 6
Iliopsoas stretch-prone Iliopsoas stretch-supine External rotation 잘못된자세 Iliopsoas self-stretch Tibilis anterior anatomy & functional assessment Tibilis anterior strech Gastrocnemius-soleus 7
Gastrocnemius-soleus functional assessment 20deg Tight soleus Gastrocnemius-soleus stretch-prone 50deg: tight tibialis anterior Soleus stretch-prone Gastrocnemius-soleus self-stretch & soleus self-stretch Peroneals and tibialis posterior anatomy & functional assessment Evertor(Peroneal) stretch-supine 8
Invertor(Posterior tibialis) stretchsupine Hip adductors anatomy & functional assessment Supine stretch for the short & long adductors Short & long adductor self stretch Short adductor: knee bend Long adductor Short adductor: knee bend Long adductor Hip abductors anatomy & functional assessment Side-lying stretch for the hip stretch & supine stretch for the hip abductors Adductor tightness test IT band syndrome pain sites 9
Hip abductor self-stretch Pirifomis anatomy & functional assessment Isometric Piriformis stretch-supine & piriformis self-stretch D1 extension(toe-off) stretch & D2 extension(turnout) stretch The right leg is flexed, adducted, and externally rotated The right leg is flexed, abducted, and internally rotated D1 flexion(soccer kick) stretch The knee is bent, Chapter 5. Stretchs for the upper extremity the thigh is extened, abducted, and interally rotated. 10
Rotator cuff muscles Shoulder functional assessment Subscapularis stretch-supine Infraspinatus and teres minor stretch-prone Pectoralis, biceps & triceps Elbow functional assessment 11
Pectoralis major stretchprone & self stretch Biceps stretch-supine & self stretch Be sure the stretcher dose not lift his sternum. Triceps stretch-prone & self stretch Wrist flexors and extensor anatomy & functional assessment Wrist flexor stretch-supine Wrist extensor stretch-supine & self stretch 12
D1 extension(reverse push-up) stretch & D1 flexion(self-feeding) stretch D2 flexion(drawing a sword) stretch & D2 extension(sheathing a sword) stretch The shoulder is flexed, adducted, and externally rotated; forearm is supinated and the wrist and fingers flexed. The shoulder is extended, abducted, and internally rotated; forearm is pronated and the wrist and fingers extended. The shoulder is extened, adducted, and internally rotated; forearm is pronated and the wrist and fingers flexed. The shoulder is flexed, abducted, and externally rotated; forearm is supinated and the wrist and fingers extended. Chapter 6. Stretches for the torso & neck Cervical area anatomy Cervical area functional assessment Upper trapezius stretch-supine Flexion: 85 deg Extension: 70 deg Rotation: 80 deg Lateral flexion: 40 deg 13
Sternocleidomastoid(SCM) stretchsupine Scalene stretch-supine & self stretch Levator scapular stretch-supine Thoracic & lumbar area Thoracic & lumbar functional assessment Back extensors stretch-seated Flexion: 90 deg Extension: 30 deg Rotation: 45 deg 턱을당기고 Lateral flexion: 30 deg Isometric contraction stretch 14
Back extensors stretch-seated Trunk rotators stretch-seated Knees slightly bend Rhomboid stretch Quadratus lumborum(ql) stretch-side lying & self stretch-seated Latissimus dorsi stretch-prone, side lying 감사합니다. Isometric contraction 15