特定肩关节康复运动对肩外旋肌的激活效应
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摘要
目的比较开链与闭链运动与肩关节外旋不同组合下,冈下肌和三角肌后束的激活情况。方法 2018年4至6月,19例健康成人完成开链肩关节中立位外旋(0°开链组)、开链肩关节外展90°位外旋(90°开链组)、闭链肩关节中立位外旋(0°闭链组)、闭链肩关节外展90°位外旋(90°闭链组) 4个动作,采用无线表面肌电图(sEMG)获取冈下肌和三角肌后束的振幅均方根(RMS),计算标准化RMS (RMS%)、肌肉激活时刻和冈下肌/三角肌后束激活比率。结果 90°闭链组三角肌后束RMS%最小,且低于0°闭链组(P <0.05)。冈下肌/三角肌后束激活比率90°闭链组中最大,且高于90°开链组(P <0.05),0°开链组也高于90°开链组(P <0.05)。90°闭链组冈下肌激活最早,且早于90°开链组(P <0.05)和0°开链组(P <0.05);0°闭链组三角肌后束激活最迟,晚于90°开链组(P <0.05)。结论闭链肩关节外展90°位外旋动作能最快激活冈下肌,适合在累及冈下肌肩袖损伤的早期康复中使用。
Objective To investigate the activities of infraspinatus(IS) and posterior deltoid(PD) under shoulder external rotation at open kinetic chain(OKC) and closed kinetic chain(CKC) exercise with shoulder abduction 0° and 90° to determine the optimal external rotation rehabilitation exercise.Methods From April to June, 2018, 19 healthy adults finished the movement of 0° OKC, 0° CKC, 90° OKC and 90°CKC. The root mean square(RMS) of IS and PD was recorded with surface electromyography(sEMG), then the standardized RMS(RMS%), ratio of IS/PD and onset time of activation were calculated.Results RMS% of PD was the minimal at 90° CKC, and was less than that of 0° CKC(P < 0.05). IS/PD was the most at90° CKC, and was more than that of 90° OKC(P < 0.05). The onset time of IS was the earliest in 90° CKC, and earlier than that of 90° OKC(P < 0.05) and 0°OKC(P < 0.05). The onset time of PD was the latest in 0° CKC,and latter than that of 90° OKC(P < 0.05).Conclusion 90°CKC activates IS mostly and earliest, which can be used in early rehabilitation for rotator cuff injury.
Objective To investigate the activities of infraspinatus(IS) and posterior deltoid(PD) under shoulder external rotation at open kinetic chain(OKC) and closed kinetic chain(CKC) exercise with shoulder abduction 0° and 90° to determine the optimal external rotation rehabilitation exercise.Methods From April to June, 2018, 19 healthy adults finished the movement of 0° OKC, 0° CKC, 90° OKC and 90°CKC. The root mean square(RMS) of IS and PD was recorded with surface electromyography(sEMG), then the standardized RMS(RMS%), ratio of IS/PD and onset time of activation were calculated.Results RMS% of PD was the minimal at 90° CKC, and was less than that of 0° CKC(P < 0.05). IS/PD was the most at90° CKC, and was more than that of 90° OKC(P < 0.05). The onset time of IS was the earliest in 90° CKC, and earlier than that of 90° OKC(P < 0.05) and 0°OKC(P < 0.05). The onset time of PD was the latest in 0° CKC,and latter than that of 90° OKC(P < 0.05).Conclusion 90°CKC activates IS mostly and earliest, which can be used in early rehabilitation for rotator cuff injury.
引文
[1]高庆峰,何耀华,王勇平,等.关节镜下肩袖间隙滑移技术修补巨大回缩型肩袖损伤[J].中华创伤骨科杂志,2013,15(7):553-558.
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[3]Sayampanathan A A,Andrew T H.Systematic review on risk factors of rotator cuff tears[J].J Orthop Surg,2017,25(1):1-9.
[4]Melis B,Nemoz C,Walch G.Muscle fatty infiltration in rotator cuff tears:descriptive analysis of 1688 cases[J].J Orthop Trauma,2009,95(3):319-324.
[5]Frisch K E,Marcu D,Baer G S,et al.The influence of partial and ful thickness tears on infraspinatus tendon strain patterns[J].J Biomech Eng,2014,136(5):1-6.
[6]毕然然,崔芳,王惠芳,等.运动性肩袖损伤表面肌电及等速肌力测试研究[J].中国运动医学杂志,2015,34(2):193-196.
[7]朱文辉,王予彬,郝跃东,等.运动员创伤性肩关节前不稳定表面肌电的特征[J].体育科研,2011,32(6):49-54.
[8]Camp C L,Zajac J M,Pearson D B,et al.Decreased shoulder externa rotation and flexion are greater predictors of injury than internal rota‐tion deficits:analysis of 132 pitcher-seasons in professional basebal[J].Orthop J Sports Med,2017,33(9):1629-1636.
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[11]Kang J I,Moon Y J,Choi H,et al.The effect of exercise types for rota‐tor cuff repair patients on activities of shoulder muscles and upper limb disability[J].J Phys Ther Sci,2016,28:2772-2777.
[12]Boeck R L,D?hnert M B,Pav?o T S.Open kinetic chain versus closed kinetic chain in advanced rehabilitation rotator cuff[J].Fisioter Mov2012,25(2):291-299.
[13]Reinold M M,Wilk K E,Fleisig G S,et al.Electromyographic analy‐sis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises[J].J Orthop Sports Phys Ther,2004,34(7)385-394.
[14]Bohlooli N,Ahmadi A,Maroufi N,et al.Differential activation of scapular muscles,during arm elevation,with and without trigger points[J].J Bodyw Mov Ther,2016,20(1):26-34.
[15]Yu I Y,Lee D K,Kang M J,et al.Effects of three infraspinatus muscle strengthening exercises on isokinetic peak torque and muscle activity[J].J Sport Rehabil,2017,10:1-21.
[16]Lim O B,Kim J A,Song S J,et al.Effect of selective muscle training using visual EMG biofeedback on infraspinatus and posterior deltoid[J].J Hum Kinet,2014,44(1):83-90.
[17]Jang J H,Oh J S.Changes in shoulder external rotator muscle activity during shoulder external rotation in various arm positions in the sagitta plane[J].J Phys Ther Sci,2014,26(1):135-137.
[18]Gummesson C,Atroshi I,Ekdahl C.The Disabilities of the Arm Shoulder and Hand(DASH)outcome questionnaire:longitudinal con‐struct validity and measuring self-rated health change after surgery[J]BMC Musculoskelet Disord,2003,4(1):11-16.
[19]Kang M H,Oh J S,Jang J H.Differences in muscle activities of the in‐fraspinatus and posterior deltoid during shoulder external rotation in open kinetic chain and closed kinetic chain exercises[J].J Phys Ther Sci,2014,26(6):895-897.
[20]Kim J W,Yoon J Y,Kang M H,et al.Selective activation of the infra‐spinatus during various shoulder external rotation exercises[J].J Phys Ther Sci,2012,24(7):581-584.
[21]Lumsdaine W,Smith A,Walker R G,et al.Morphology of the humeral insertion of the supraspinatus and infraspinatus tendons:Application to rotator cuff repair[J].Clin Anat,2015,28(6):767-773.
[22]Keating J F,Waterworth P,Shawdunn J,et al.The relative strengths of the rotator cuff muscles.A cadaver study[J].J Bone Joint Surg Br,1993,75(1):137-140.
[23]Kuechle D K,Newman S R,Itoi E,et al.Shoulder muscle moment arms during horizontal flexion and elevation[J].J Shoulder Elbow Surg,1997,6(5):429-439.
[24]Alpert S W,Pink M M,Jobe F W,et al.Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds[J].JShoulder Elbow Surg,2000,9(1):47-58.
[25]Christie K.功能解剖肌与骨骼的解剖、功能及触诊[M].汪华侨,郭开华,麦全安,译.天津:天津出版传媒集团,2013:76-84.
[26]Mall N A,Lee A S,Chahal J,et al.An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears[J].Ar‐throscopy,2013,29(2):366-376.
[27]Bacle G,Gregoire J M,Patat F,et al.Anatomy and relations of the in‐fraspinatus and the teres minor muscles:a fresh cadaver dissection study[J].Surg Radiol Anat,2016,39(2):1-8.
[28]Challoumas D,Dimitrakakis G.Insights into the epidemiology,aetiolo‐gy and associations of infraspinatus atrophy in overhead athletes:a sys‐tematic review[J].Sports Biomech,2017,16(3):325-341.
[29]Jobe F W,Pink M.The athlete's shoulder[J].J Hand Ther,1994,7:107-110.
[30]Sahrmann S.Diagnosis and treatment of movement impairment syn‐dromes[J].J Orthop Sports Phys Ther,2005,3(5):295-297.
[31]宋为平,曾磊,李全意.优秀排球运动员冈下肌萎缩症23例临床报道[J].中国运动医学杂志,2015,34(12):1208-1210.
[32]Ha S M,Kwon O Y,Cynn H S,et al.Selective activation of the infra‐spinatus muscle[J].J Athl Train,2013,48(3):346-352.
[33]Lee D,Lee S,Han S.Changes in the electromyographic activities of the infraspinatus and posterior deltoid according to abduction angles of the shoulder joint during shoulder external rotation in closed kinetic chain exercise[J].J Phys Ther Sci,2016,28(10):2748-2750.
[34]Giacomo G D,Pouliart N,Vita A D,et al.肩关节功能解剖图谱[M].柴益民,顾文奇,译.北京:北京大学出版社有限公司,2016:62-64.
[35]张红娟,王明明,段惠芳.本体感觉神经肌肉促进法结合针刺治疗冈下肌劳损疗效观察[J].中国运动医学杂志,2016,35(4):357-358.
[36]Kim T Y,Kim M,Yoon B C.The onset time of neck and shoulder mus‐cles activation during shoulder elevation in older and young adults[J].Arch Orthop sports Phys Ther,2017,13(1):27-36.
[37]Kibler W B,Mc Mullen J,Uhl T.Shoulder rehabilitation strategies,guidelines,and practice[J].Oper Tech Sports Med,2012,20(1):103-112.
[2]朱鸣镝,汤锦波,凌树才,等.肩关节运动时肌肉力臂改变的实验研究[J].中国临床医学,2007,14(2):221-225.
[3]Sayampanathan A A,Andrew T H.Systematic review on risk factors of rotator cuff tears[J].J Orthop Surg,2017,25(1):1-9.
[4]Melis B,Nemoz C,Walch G.Muscle fatty infiltration in rotator cuff tears:descriptive analysis of 1688 cases[J].J Orthop Trauma,2009,95(3):319-324.
[5]Frisch K E,Marcu D,Baer G S,et al.The influence of partial and ful thickness tears on infraspinatus tendon strain patterns[J].J Biomech Eng,2014,136(5):1-6.
[6]毕然然,崔芳,王惠芳,等.运动性肩袖损伤表面肌电及等速肌力测试研究[J].中国运动医学杂志,2015,34(2):193-196.
[7]朱文辉,王予彬,郝跃东,等.运动员创伤性肩关节前不稳定表面肌电的特征[J].体育科研,2011,32(6):49-54.
[8]Camp C L,Zajac J M,Pearson D B,et al.Decreased shoulder externa rotation and flexion are greater predictors of injury than internal rota‐tion deficits:analysis of 132 pitcher-seasons in professional basebal[J].Orthop J Sports Med,2017,33(9):1629-1636.
[9]Young S W,Dakic J,Stroia K,et al.High Incidence of infraspinatus muscle atrophy in elite professional female tennis players[J].Am JSports Med,2015,43(8):1989-1993.
[10]Kibler W B.Shoulder rehabilitation:principles and practice[J].Med Sci Sports Exerc,1998,30(4):40-50.
[11]Kang J I,Moon Y J,Choi H,et al.The effect of exercise types for rota‐tor cuff repair patients on activities of shoulder muscles and upper limb disability[J].J Phys Ther Sci,2016,28:2772-2777.
[12]Boeck R L,D?hnert M B,Pav?o T S.Open kinetic chain versus closed kinetic chain in advanced rehabilitation rotator cuff[J].Fisioter Mov2012,25(2):291-299.
[13]Reinold M M,Wilk K E,Fleisig G S,et al.Electromyographic analy‐sis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises[J].J Orthop Sports Phys Ther,2004,34(7)385-394.
[14]Bohlooli N,Ahmadi A,Maroufi N,et al.Differential activation of scapular muscles,during arm elevation,with and without trigger points[J].J Bodyw Mov Ther,2016,20(1):26-34.
[15]Yu I Y,Lee D K,Kang M J,et al.Effects of three infraspinatus muscle strengthening exercises on isokinetic peak torque and muscle activity[J].J Sport Rehabil,2017,10:1-21.
[16]Lim O B,Kim J A,Song S J,et al.Effect of selective muscle training using visual EMG biofeedback on infraspinatus and posterior deltoid[J].J Hum Kinet,2014,44(1):83-90.
[17]Jang J H,Oh J S.Changes in shoulder external rotator muscle activity during shoulder external rotation in various arm positions in the sagitta plane[J].J Phys Ther Sci,2014,26(1):135-137.
[18]Gummesson C,Atroshi I,Ekdahl C.The Disabilities of the Arm Shoulder and Hand(DASH)outcome questionnaire:longitudinal con‐struct validity and measuring self-rated health change after surgery[J]BMC Musculoskelet Disord,2003,4(1):11-16.
[19]Kang M H,Oh J S,Jang J H.Differences in muscle activities of the in‐fraspinatus and posterior deltoid during shoulder external rotation in open kinetic chain and closed kinetic chain exercises[J].J Phys Ther Sci,2014,26(6):895-897.
[20]Kim J W,Yoon J Y,Kang M H,et al.Selective activation of the infra‐spinatus during various shoulder external rotation exercises[J].J Phys Ther Sci,2012,24(7):581-584.
[21]Lumsdaine W,Smith A,Walker R G,et al.Morphology of the humeral insertion of the supraspinatus and infraspinatus tendons:Application to rotator cuff repair[J].Clin Anat,2015,28(6):767-773.
[22]Keating J F,Waterworth P,Shawdunn J,et al.The relative strengths of the rotator cuff muscles.A cadaver study[J].J Bone Joint Surg Br,1993,75(1):137-140.
[23]Kuechle D K,Newman S R,Itoi E,et al.Shoulder muscle moment arms during horizontal flexion and elevation[J].J Shoulder Elbow Surg,1997,6(5):429-439.
[24]Alpert S W,Pink M M,Jobe F W,et al.Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds[J].JShoulder Elbow Surg,2000,9(1):47-58.
[25]Christie K.功能解剖肌与骨骼的解剖、功能及触诊[M].汪华侨,郭开华,麦全安,译.天津:天津出版传媒集团,2013:76-84.
[26]Mall N A,Lee A S,Chahal J,et al.An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears[J].Ar‐throscopy,2013,29(2):366-376.
[27]Bacle G,Gregoire J M,Patat F,et al.Anatomy and relations of the in‐fraspinatus and the teres minor muscles:a fresh cadaver dissection study[J].Surg Radiol Anat,2016,39(2):1-8.
[28]Challoumas D,Dimitrakakis G.Insights into the epidemiology,aetiolo‐gy and associations of infraspinatus atrophy in overhead athletes:a sys‐tematic review[J].Sports Biomech,2017,16(3):325-341.
[29]Jobe F W,Pink M.The athlete's shoulder[J].J Hand Ther,1994,7:107-110.
[30]Sahrmann S.Diagnosis and treatment of movement impairment syn‐dromes[J].J Orthop Sports Phys Ther,2005,3(5):295-297.
[31]宋为平,曾磊,李全意.优秀排球运动员冈下肌萎缩症23例临床报道[J].中国运动医学杂志,2015,34(12):1208-1210.
[32]Ha S M,Kwon O Y,Cynn H S,et al.Selective activation of the infra‐spinatus muscle[J].J Athl Train,2013,48(3):346-352.
[33]Lee D,Lee S,Han S.Changes in the electromyographic activities of the infraspinatus and posterior deltoid according to abduction angles of the shoulder joint during shoulder external rotation in closed kinetic chain exercise[J].J Phys Ther Sci,2016,28(10):2748-2750.
[34]Giacomo G D,Pouliart N,Vita A D,et al.肩关节功能解剖图谱[M].柴益民,顾文奇,译.北京:北京大学出版社有限公司,2016:62-64.
[35]张红娟,王明明,段惠芳.本体感觉神经肌肉促进法结合针刺治疗冈下肌劳损疗效观察[J].中国运动医学杂志,2016,35(4):357-358.
[36]Kim T Y,Kim M,Yoon B C.The onset time of neck and shoulder mus‐cles activation during shoulder elevation in older and young adults[J].Arch Orthop sports Phys Ther,2017,13(1):27-36.
[37]Kibler W B,Mc Mullen J,Uhl T.Shoulder rehabilitation strategies,guidelines,and practice[J].Oper Tech Sports Med,2012,20(1):103-112.