姿势训练

姿势训练,陈建,姿势的定义,构成身体的各个组织器官,尤其是骨骼、肌肉、内脏、神经系统互相关联所构成的自然姿态，其中尤以脊柱最为重要一般说来姿势主要指站立位姿势、坐位姿势和卧位姿势Posture is a “position or attitude of the body, the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing ones body,What is posture?,The position of the body in space Upright position Hold your body upright against gravity while standing, sitting or lying down.The chain-link concept of body mechanics Dominos多米诺骨牌,Optimal posture,State of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or rest. 良好姿势：从身体侧面观察重心线，是从耳垂经过肩关节、胸廓和腹部的中央、股骨大转子、膝关节前方、外踝的前方,Natural posture, Slightly anterior to centre of the knee膝关节前方 Greater trochanter of the hip股骨大转子 Level with the glenohumeral joint (shoulder)盂肱关节 Through the central mass of the neck颈部中央 Through the earlobe耳垂,Faulty posture不良姿势,Increases stress on the joints, which is compensated for by strong muscles关节压力增大,被强壮的肌肉所代偿,如果有关节僵硬、肌肉无力或缩短拉长，导致不良姿势的产生,影响姿势的因素,骨骼形态（如半椎体）韧带松弛肌筋膜或肌腱紧张或挛缩（如阔筋膜张肌、胸大肌、屈髋肌等）肌张力（如臀大肌、腹肌、竖脊肌等）骨盆角（正常为30）关节位置和活动度神经性输出或输入,Introduction,头颈部重量约为4-5 kg，颈部肌肉起着固定作用，肌肉越强壮，更多的力量经过脊柱传递当头部重心位于脊柱中部下段时最小的压力作用在脊柱，此时需要最小的肌肉张力保持头部，当人体处于自然的良好姿势时即为最佳的生物机械位置,Proper, Optimally Efficient Posture,Proper posture occurs when: The shoulders are held back and down肩部保持向背部和下方Thoracic spine curves forward only slightly胸椎轻微向前弯曲Scapulae are flat, do not “wing out”肩胛平面恰当，不能向外外展The chest curves out - forward tips of the shoulders would not touch a yardstick placed across the upper chest胸部前凸，双肩关节最前端不宜有交叉The collar bones are level or slope only slightly upwards锁骨仅轻度向上倾斜From the front, the chin is at least 5 cm, if not 8 or 10 cm, above the clavicular notch.下巴在锁骨上最少5cm,Proper, Optimally Efficient Upper Body Flexibility,Rotate arms forward and upward to vertical, without leaning back.向前上旋转上臂到垂直，身体没有向后倾Rotate head left and right 90, without tilting head back.左右旋转头部90没有向后倾斜Sit and reach to mid-calf.坐位能触到小腿中部Press elbows inward behind back, often touching.双手在背后可触及Arm overhead, pull elbow behind head without ducking.上臂举过头，向头后拉肘，没有低头Throw with full shoulder range of motion.投掷时肩关节能保持全范围,保持头部向前2-3 cm的位置需要7-14 kg的额外肌肉张力，意味着更少的肌力来承受外界负荷，此额外的肌肉张力传递到脊柱增加了椎间盘的负荷,Forward Head Posture头部前伸chin-in,上位颈椎后伸，下位颈椎屈曲；常伴随肩胛前伸、胸椎后凸增加In the general population, the incidence of forward head posture is very high. One study of 88 healthy subjects, ages 20-50, found forward head posture in 66%, kyphosis in 38%, right rounded shoulder in 73%, and left rounded shoulder in 66%.,Chin-out,上位颈椎屈曲，下位颈椎后伸,头部前伸姿势和背部的安全,头、颈和上背部的不良排列导致调节和代偿下腰部动作以保持髋部的平衡胸部过度后凸导致腰部前凸增加，从而增加腰部慢性扭伤，降低腰部负荷耐力,不良姿势对肌肉和脊柱的影响,肌肉习惯性保持在拉长的位置从而导致力量下降称为牵张性无力肌肉习惯性保持在缩短的位置而使弹性下降，虽然在缩短的位置下肌力足够，但当拉长时力量也下降，称为紧张性无力,“Aged” Posture,Head forward头部前伸 from years of forward reaching and leaningShoulders rolled forward肩部前滚 from years of forward reaching and leaningSunken chest胸部凹陷 because of loss of abdominal support (“bottom has dropped out”) and tightened chest musclesProtruding abdomen腹部凸起 from loss of abdominal muscle toneThicker waist腰部增粗 from sunken chest pushing viscera outwards,Functional Effects Of “Aged” Posture,由于增加了肌肉负荷而容易疲劳更多的体重远离中线有效的肌肉角度和长度减少当骨密度下降时增加了脊柱负荷而易骨折心肺系统效率下降：肺的扩张性下降（尤其是肺尖）肌肉效率、力量、弹性下降而降低了工作能力（躯体活动和运动中）,Training Methods For Maintaining Normal Upper Body Flexibility And Posture,Daily stretching and strengthening exercises specifically designed to maintain proper posture and flexibility. Takes 10 30 min/day, depending upon profession and lifestyle habits. Can make postural correction a subconscious response, reducing corrective needs. Weight training designed with postural considerations.General stretching programs like yoga, Alexander Technique, Pilates. (Cost and time factors; do not focus on upper torso enough to cure forward head posture or cure pain and fatigue in all cases),A stretching and strengthening program which will reestablish normal upper body muscle flexibilities and muscle strength balances is the following:,Elbow lift behind the back肘部举到背后StretchesStomach crunchesStrengthenSide of chest and outer back stretchStretchesNeck stretching颈部牵伸StretchesChin glides下颌前后伸Stretch and strengthenShoulder rolls滚肩Stretch and strengthenElbow press behind the backStretchesStanding stomach strengthenerStrengthensBack flattening平背Stretches and strengthensSit and reach坐位上肢前伸StretchesUpper spine straightener伸直上部脊柱Stretches and strengthensAir rowing空划船Stretches and strengthens,Stretching and strengthening program, continued:,Doing exercises 1-6 and 7-12 on alternate days, this program:Takes 10 min/day on average,Anyone of any fitness level can do it.Can be done virtually anywhere with no additional equipment.Will relieve acute pain in the office.Will prevent, reduce, or cure neck, shoulder, and back pain and fatigue.Should reduce the risk of permanent spine and shoulder injuries.Can increase height, flatten stomach, reduce waist, increase fatigue resistance, and improve performance in virtually all physical activities and sports.Is available on video - The PowerPosture Program,导致不良姿势的原因,解剖结构原因导致永久性变形（先天性畸形、发育问题、创伤或疾病等）位置原因 不良姿势习惯 心理因素，尤其是自卑心理 正常的发育和退化过程 疼痛导致自我保护机制而避免某些姿势如腰痛致侧弯 肌肉不平衡、痉挛或挛缩，如紧张的髂腰肌增加腰椎前凸 呼吸状态 一般性的乏力 体重过大 本体感觉丧失,ASSESSMENT,ObservationsGeneral postural,骨盆倾斜角,髂后上棘与耻骨联合连线与水平线之间的夹角髂后上棘应比髂前上棘略高角度增大骨盆前倾,角度减小骨盆后倾,骨盆前倾时脊柱后伸,髋关节屈曲骨盆后倾时脊柱前屈,髋关节伸展,骨盆前倾肌肉,屈髋肌：髂腰肌、股直肌脊柱伸肌：骶棘肌,骨盆后倾肌肉,腹肌：腹直肌伸髋肌：腘绳肌、臀大肌,矢状面影响骨盆稳定性因素,骨外形结构韧带及其他结缔组织的张力（髂腰韧带、骶棘韧带、骶结韧带、骶髂韧带）动态稳定性（挛缩、无力、适应性缩短等）,额状面影响骨盆稳定性因素,骨盆周围肌肉力量平衡性,常见的脊柱变形,脊柱前凸,常见于颈椎和腰椎前凸增大原因：畸形、腹肌松弛合并屈髋肌和腰椎伸肌紧张或挛缩、大腹便便（体重过大或怀孕）、胸椎过度后凸导致代偿性腰椎前凸、先天性髋关节脱位、穿时髦高跟鞋、脊柱滑脱等,Sway back,骨盆倾斜角增大，约40，胸椎后凸增大导致骨盆前倾，髋关节后伸为保持重心在正常位置，胸椎相对于腰椎屈曲合并有伸髋肌、下腰段伸肌和上部腹肌紧张，以及屈髋肌、下腹肌和下胸段伸肌无力,脊柱后凸,常见于胸椎常见原因：结核、脊椎压缩性骨折、强直性脊柱炎、老年性关节炎、肿瘤、脊柱前凸代偿性、先天性畸形（部分节段缺陷）、截瘫等常见脊柱后凸有以下四种,Round back,骨盆倾斜角减小(30)，胸椎后凸增大，脊柱呈长圆形躯干呈现前屈，腰椎屈度减小伸髋肌及躯干屈肌紧张，屈髋肌和腰段伸肌无力,Hump back,表现为胸段脊柱局部急剧向后呈角畸形,Flat back,骨盆倾斜角减小至20，腰段脊柱生理弯曲度减小,脊柱侧凸,非结构性脊柱侧凸：常见于姿势问题、癔病、神经根受刺激、炎症、双下肢不等长代偿性等结构性脊柱侧凸：常见于骨畸形、椎体缘或半椎体、神经肌肉性（上下运动神经原损伤）、关节挛缩。此类脊柱侧凸表现为进行性（因有骨畸形）特发性脊柱侧凸：约占75%-85%,Upper & Lower cross syndrome,Poor postures不良姿势Pain, inefficient or dysfunction of movements.疼痛、运动功能障碍或效率差Most commonly seen of the postural distortion patterns (office workers and drivers)最常见的姿势变形（司机和办公人员）Chronicholding patterns & Flexion Addicts,Upper Cross System (UCS),When a chain reaction evolved muscle shortening and reciprocal weakening in predictable patterns causing predictable imbalances or “syndromes”,UCS Imbalances,紧张或兴奋性的肌肉：胸大肌、斜方肌上部肌纤维、肩胛提肌、胸锁乳突肌、前斜角肌、小圆肌、背阔肌、三角肌前部肌无力或抑制：头最长肌、前锯肌、菱形肌、斜方肌中下部肌纤维、肩袖肌后部原因：头部向前、胸骨柄下降、肩胛带前移、胸椎后凸增加、肱骨内旋常见损伤：头痛、肩部撞击综合征、胸廓出口综合征、肩部不稳定,Changes due to Upper Cross System,Occiput and C1/2 hyperextend with the head pushed forward枕骨及C1/2过伸将头推向前Lower cervical to 4th thoracic vertebrae are stressed through posture下位颈椎到胸4被挤压Rotation and abduction of the scapulae肩胛旋转并外展Altered direction of the glenoid fossa肩胛盂的方向改变 Results i