开链运动与闭链运动

开链运动与闭链运动,康复中心张廷峰,目 录,概念,比较,在康复中的应用,运动特点,1,2,3,4,总结,5,运动链,人体若干环节借助关节按一定顺序衔接起来,称运动链。在人体上,上肢由肩带、上臂、肘关节、前臂、腕关节、手等形成上肢运动链;下肢由髋关节、大腿、膝关节、小腿、踝关节、足等形成下肢运动链。人们通常将一侧上下肢视为一条长链，每个关节均为链扣。,In open kinetic chain (OKC) exercise, the terminal segment of the extremity moves freely without any external resistance. The sequential activation of muscles in OKC exercise from proximal to distal allows rapid acceleration and speed of the distal segment. In closed kinetic chain (CKC) exercise, the distal segment of the extremity is fixed, and proximal motiontakes place in multiple planes.A common error in developing an exercise program is failure to assess the proximal and distal segments of the entire extremity, or kinetic chain. A kinematic chain is a series of interrelated joints that constitute a complex motor unit, constructed so that motion at one joint will produce motion at the other joints in a predictable manner. Whereas kinematics describes the appearance of motion, kinetics involves the forces, whether internal (e.g., muscle contractions or connective tissue restraints) or external (e.g., gravity, inertia, or segmental masses) that affect motion. Initially, a closed kinetic chain (CKC) was characterized as the distal segment of the extremity in an erect, weight-bearing position, such as the lower extremity when a person is weight bearing. Subsequently, when the distal segment of the extremity is free to move without causing motion at another joint, such as when non-weight bearing, the system was referred to as an open kinetic chain (OKC). When force is applied, the distal segment may function independently or in unison with the other joints. Movements of the more proximal joints are affected by OKC and CKC positions. For example, the rotational components of the ankle, knee, and hip reverse direction when moving from an OKC to CKC position.Because of incongruities between the lower and upper extremity, particularly in the shoulder region, several authors have challenged the traditional definition of OKC and CKC positions. Stabilizing muscles in the scapulothoracic region produces a joint compression force that stabilizes the glenohumeral joint much in the same manner as a CKC in the lower extremity. Although debate continues on defining CKC and OKC relative to the upper extremity, there remains general agreement that both CKC and OKC exercises should be incorporated into an upper and lower extremity rehabilitation program.Injury and subsequent immobilization can affect the proprioceptors in the skeletal muscles, tendons, and joints. In rehabilitation, it is critical that CKC activities be used to retrain joints and muscle proprioceptors to respond to sensory input. Closed kinetic chain exercises are recommended for several reasons. Closed kinetic chain exercises stimulate the proprioceptors, increase joint stability, increase muscle coactivation, allow better utilization of the SAID (Specific Adaptations to Imposed Demands) principle, and permit more functional patterns of movement and greater specificity for athletic activities.In contrast, OKC exercises can isolate a specific muscle group for intense strength and endurance exercises. In addition, they can develop strength in very weak muscles that may not function properly in a CKC system because of muscle substitution. Although OKC exercises may produce great gains in peak force production, the exercises are usually limited to one joint in a single plane (uniplanar), have greater potential for joint shear, have limited functional application, and have limited eccentric and proprioceptive retraining. However, OKC exercises can assist in developing a patient-athletic trainer rapport through uniplanar and multiplanar manual therapeutic techniques.When ROM has been achieved, repetition of motion through actual skill movements can improve coordination and joint mechanics as the individual progresses into phase three of the program. For example, a pitcher may begin throwing without resistance or force application in front of a mirror to visualize the action. This also can motivate the individual to continue to progress in the therapeutic exercise program.,英语原文,梯队成员23人;主任医师7人，副主任医师8人,一.开链运动概念,近端固定，远端游离的活动即为开链运动。如股四头肌椅训练、使用哑铃进行肱二头肌训练是典型的例子。此时多为单关节的活动。,开链运动图释,股四头肌训练,颈前下拉,二.闭链运动概念,远端（手掌或脚掌）闭合，如接触地面、墙面或桌面，近端（躯干）运动，称之为闭链运动。这时所能做的肢体运动只能是多关节协调活动。例如蹲起时必须同时活动髋、膝、踝关节，不可能作单一关节的活动；两上肢撑地作俯卧撑时，也只能同时活动腕、肘、和肩关节。骑车训练也是典型的例子。,闭链运动图释,闭链运动-哑铃蹲举,闭链运动-引体向上,开链运动与闭链运动比较,开链运动(OKC) 闭链运动(CKC) 远端肢体在空间中运动 远端肢体保持固定 有单一的关节运动，附 多关节运动，附近关节有运动 近关节无活动 只有运动关节远端的躯体活动 运动关节的近端和远端的身体都有活动 只有主动肌收缩 运动关节的远端和近端多肌群收缩 较少出现身体重量作为负重参 很多时候有身体重量作为负重参与运动 与运动 阻力应用在运动肢体远端 阻力同时应用在多个运动关节 动作相对比较简单，容 动作相对不容易掌握，用于早期康复和功能 易掌握。 训练 针对性训练，孤立、刺激训练 参与活动关节和目标肌肉较多 目标肌肉,三运动特点,开链运动的运动特点：远端的运动范围大于近端，速度也快于近端。所以在强化肌力的训练中，肌肉爆发力的训练应选择开链运动训练。前交叉韧带损伤时，应多开链练习强化腘绳肌肌力，后交叉韧带损伤时，应多开链练习强化股四头肌肌力；以保护韧带再发损伤。,闭链运动特点：多关节、多块肌肉（主动肌与拮抗肌）参与的活动，因此运动时不增加关节的切力，可以增加保护作用，更接近于功能性康复。 所以对于某些疾患如前十字韧带(ACL)重建或松弛的关节，可以提供早期、安全、有效的康复手段。神经疾病后康复治疗中，也一般选择闭链运动，强调多关节的协同运动。但是如果有单一肌肉需要特别强调进行独立的训练，则选择开链运动。通常胫前肌肌是薄弱环节，有可能需要开链运动训练。,四开链和闭链运动的康复上的应用,开链运动和闭链运动有着各自的特点和作用，但它们在康复治疗中都具有重要的运动学与生物力学意义。 我们经常遇到骨折的病人，骨折或关节损伤后的病人，康复早期要尽力减少损伤部位的剪切力。,剪力分析,当我们由上往下蹲时，则需要股四头肌、腘绳肌、臀大肌共同离心收缩来控制着慢慢屈髋屈膝。另外股四头肌起点连接在髂骨上，而腘绳肌起点连接在坐骨上，它们的同步收缩可以帮助我们更好保持骨盆的中立位和稳定躯干。同时股四头肌的止点在小腿前面的胫骨结节，腘绳肌的止点在胫骨和腓骨后面，还有腓肠肌也有屈膝作用。他们的同步收缩也可以帮助我们提高膝关节的稳定。同样蹲起时，伸髋的腘绳肌、臀大肌和伸膝的股四头肌同时向心收缩来完成动作。,诊疗中心,研究室,二病区,一病区,名老中医工作室,三病区,3个病区外治室,在开链运动中，比如股四头肌训练器训练股四头肌时，由于身体重量完全由座椅支撑，因此当股四头肌收缩时，腘绳肌、臀大肌完全放松，此时股四头肌和腘绳肌失去拮抗关系；胫骨在股四头肌牵动下发生前移，前交叉韧带和膝关节的负荷就增大了。,因此， 闭链运动中，股四头肌和腘绳肌为同步收缩的关系。这种主动肌和拮抗肌同步收缩的方式对维持关节稳定,减少力矩，减少韧带的负荷受力有很好的作用。同时闭链运动（CKC）的训练方式，可使数个关节同时运动，刺激关节本体感受器，产生肢体的运动和保护性反射弧(Protective Reflex Arc）。这活动能充分训练关节整体的协调性和促进关节本体感受器功能恢复，从而促进关节的稳定性。,临床专病分化,膝关节的功能性和本体感受器通过闭链运动（CKC）得到了一定的加强后，我们可以采用开链运动（OKC）针对膝关节附近的稳定肌群加强针对性训练，例如：可以用股四头肌训练椅强化股四头肌、腘绳肌的肌力，保护膝关节。在康复的不同阶段选择性使用开链或闭链运动，对于促进组织修复、功能恢复和关节稳定来说至关重要。,上肢的开链与闭链,举例,患者某某，髌骨骨折内固定术后两个多月，开始利用股四头肌训练椅训练肌力，突然膝关节疼痛激烈，无法继续训练。疼痛肿胀几天才恢复入院时水平。之后，采用闭链运动训练肌力，再也没有出现类似情况，患者肌力恢复良好，疼痛明显减轻后出院。,蹲马步利于矫正膝过伸步态,膝过伸原因：1、股四头肌肌力不足，负重时膝关节过伸以将其锁住，以保持稳定。2、股四头肌张力过高。3、小腿三头肌张力过高/足下垂，把小腿推向后倾膝过伸。4、腘绳肌、股四头肌控制力低下，缺乏同步收缩，导致膝关节失稳。,蹲马步类似于闭链运动,1、可以训练下肢肌力，包括主动肌及拮抗肌。2、股四头肌及小腿三头肌得到牵伸，可以抑制其痉挛。3、训练下肢整体的协调性和促进关节本体感受器功能恢复，提高肌肉的控制能力。4、马步还是传统