由于以下原因,您无权编辑此页:
- 您请求的操作仅限于组中的用户:===常规处理=== {{#ev:youtube|cg6iS7xe4rk}} {{#ev:youtube|_ZzFSCU0Y1Q}}对于早期的内撞击,投掷者(投掷者,特别是投手的肩关节撞击发生率很高)或涉及的患者报告肩部僵硬,不像正常情况那样松动。已描述了内撞击的三个阶段(表)。
在开始更复杂的动态练习之前,最初的重点是纠正肌肉不平衡,不稳定和ROM缺陷。(方案见表1)
2008年,cooling等人根据临床文献和临床经验发表了网球运动员内撞击康复指南。这些指南的部分内容有证据支持,但讨论的许多治疗方法尚未得到医学研究的验证,因此,在进行研究之前,这些指南可能为临床医生治疗内撞击提供一个基础起点。要知道这个协议是针对运动人群的。然而,它也可以应用于非运动人群,通过纳入特定活动的功能活动,而不是特定运动。非运动员也可能不需要一直进入第三阶段,这取决于他们希望回到的活动水平。====第一阶段==== *软组织活动,如按摩,放松,收缩放松和低能量,高重复的动力训练 *肩胛骨设置:内收,抬高,凹陷 Muraki T, Aoki M, Izumi T, Fujii M, Hidaka E, Miyamoto S.胸小肌在被动肩部运动和拉伸技术中的延长:尸体生物力学研究。中国生物医学工程学报,2009;39 (4):393 - 391 * oscillation, hold stretch, and scapular side-lying distraction tonic and phasic muscle coordination *Increase shoulder ROM
• Decrease posterior capsule tightness *Strengthening to rebuild soft tissue supportPhilip W McClure et al., Shoulder Function and 3-Dimensional Kinematics in People With Shoulder Impingement Syndrome Before and After a 6-Week Exercise Program, September 2004 *Neuromuscular re-education to prevent recurrence *Restore proper muscle balance and endurance *Proprioceptive training and dynamic stability exercises
• Closed chain exercises: are suggested because axial compression exercises that put stress through the joint in a weight-bearing position result in joint approximation and improved co-contraction of the rotator cuff muscles. *Ultrasound and electrostimulation: for reducing the pain and inflammation ==== Phase Two ==== *Improve dynamic stability-restoration muscle balance: more complex and activity specific exercises. With muscle imbalances already addressed, the therapist can begin to add dynamic movements into rehab using “tactile cueing” to ensure the patient is engaging the scapular musculature before beginning a movement. Progress to verbal cueing. *Strengthening exercises: Target all shoulder and scapular musculature. Start introducing eccentric and open kinetic chain exercises in order to begin preparing for specific athletic overhead movements. *MobilisationsVermeulen et al., Comparison of High-Grade and LowGrade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, Physical Therapy ,March 2006 Robert C. Manske et al., A Randomized Controlled Single-Blinded Comparison of Stretching Versus Stretching and Joint Mobilization for Posterior Shoulder Tightness Measured by Internal Rotation Motion Loss, April 2010 ==== Phase Three ==== Functional rehabilitation plan: Designed to prepare the athlete to return to full athletic activity. Strengthening exercises are continued and plyometrics are initiated using both hands and limiting external rotation at first, progressing to one-handed drills and gradually working into increasing velocity and resistance.