肌肉不平衡的评估与治疗：JANDA方法.pdf

PhilPagePhD,PT,ATC,CSCS,FACSMBatonRouge,Louisiana静态姿势StaticPosture平衡Balance步态Gait肌肉长度MuscleLength运动模式MovementPatterns扳机点TriggerPoints检查感觉运动系统的状态&建立假设Examinestatusofsensorimotor system&formulatehypothesis对于感觉运动系统状态来说尤为重要尤为重要MOSTIMPORTANTMOSTIMPORTANT viewofthestatusofthemotorsystem为恰当的肌肉长度测试和力量测试提供线索，以确认在静态姿势中所见Cuestoappropriatemusclelengthorstrengthteststoconfirmwhatisobservedinstaticposture寻求姿势链中系统性适应Lookforsystematicadaptationsinchain优势眼在正中线上Dominanteyeinthemidline使用平衡、阴影&“想象”Usesymmetry,shadows,&“visualize”过度生长圆隆形，凸起Hypertrophy rounded,convex生长不足 平，凹陷Hypotrophy flat,hollow,concave站立位，脱衣拖鞋站立位，脱衣拖鞋Standing,clothesoff,noshoes侧面观LATERAL VIEW后面观POSTERIOR VIEW前面观ANTERIOR VIEW12345678936294213578110头前伸颈椎前凸增加圆肩胸椎后凸增加A型（髋）TypeA(hip)B型（背部）TypeB(back)髋轻度屈曲膝轻度屈曲胸腰段后凸腰椎前凸骨盆前倾头前伸胸椎后凸腰椎曲度减小膝过伸感觉运动系统功能状态的指标Indicatoroffunctionalstatusofsensorimotorsystem基本原理 Rationale观察功能稳定性控制中的骨盆控制Observepelviccontrolforfunctionalstability平衡策略的指标Indicatorofbalancestrategies说明站立中期的单腿站立Singlelegstanceindicativeofmidstance臀中肌功能Functionofgluteusmedius观察足部外形和功能Observationoffootformandfunction定量&定性Quantitative&QualitativeDiscriminates LBP vs.Controls(Byl&Sinnot,1991)测试 Test手臂置于体侧；将一足抬离地面Armsatside;raise1legoffthefloor髋屈曲45，膝屈曲90Hipflexedto45 andkneeto90睁眼平衡练习510秒Practicebalancewitheyesopenfor510sec双目直视前方并闭眼Thenfixgazestraightaheadandcloseeyes尝试保持此姿势30秒2次机会Trytomaintainfor30seconds 2chances失败出现Failureoccurs若脚碰到支撑腿或地面ifthefoottouchesthelegonthesupportlegorthefloor出现跳跃动作hoppingoccurs手臂触碰某物以达到支撑目的thearmstouchsomethingforsupport在多平面评估肌肉功能稳定性Evaluatesfunctionalstabilityofmusclesinmultipleplanes将姿势评估和单腿站立测试中得到的信息进行综合考虑Combineinformationfrompostureandsinglelegstancetest步态模式Gaitpattern病理原因PathologyTrendelenburg臀中肌无力G.Mediusweakness“Lurch”臀大肌无力G.Maximusweakness膝过伸KneeHyperextension股四头肌无力Quadricepsweakness足拍地FootSlap胫骨肌无力Tibialisweakness跳跃步态VaultingGait腰方肌紧张Quadratustightness 运动的质量Qualityofmovement肌肉放电顺序和速度Musclefiringorderandspeed收缩强度Intensityofcontraction大脑中所想为运动，而非肌肉Brainthinksintermsofmovement,notmuscle徒手肌力测试不能给予我们以激活速度、放电模式或关节稳定性方面的信息Manualmuscletesting(MMT)doesnotgiveusinformationonspeedofactivation,firingpatternsorjointstabilization在测试中很强壮的肌肉可能会在功能性运动中受到抑制AmusclethattestsstrongmaybeinhibitedwithfunctionalmovementMMT只能用来量化力弱MMTusedonlytoquantifyaweakness1.1.髋伸展髋伸展 HipextensionHipextension主要作用于步态周期的站立相末期essentialinterminalstanceofthegaitcycle2.2.髋外展髋外展HipabductionHipabduction主要作用于单腿支撑相维持骨盆侧方稳定性essentialforlateralpelvicstabilityinsinglelimbstance3.3.屈膝两头起屈膝两头起CurlCurl upup评估髂腰肌&腹肌间的关系estimatestherelationshipbetweentheiliopsoas&abdominals4.4.头屈曲头屈曲HeadflexionHeadflexion决定了SCM&颈深屈肌群的关系DeterminesrelationshipbetweenSCM&deepneckflexors5.5.俯卧撑俯卧撑PushPush upup评估前锯肌肌力&肩胛骨稳定性assessesserratusstrength&scapulastability6.6.肩部外展肩部外展ShoulderabductionShoulderabduction评估肩胛提肌、上斜方肌、三角肌、冈上肌&前锯肌前组间的关系estimatestheinterplaybetweenlevator,uppertraps,deltoid,supraspinatus&serratusanterior不需要碰触患者。只需触摸局部的肌肉Donottouchthepatient.Touchfacilitateslocalmuscles观察肌肉外形、速度、时序、体积和运动的平滑程度Observecontourofmuscles,speed,timing,amount,andsmoothnessofmovement所有的运动都必须缓慢地进行（重复三次）Allmovementsmustbeperformedslowly(3repetitions)尽量少用语言提示Useasfewverbalcuesaspossible患者无需将这六种运动模式都完成需要完成的项目将取决于姿势&平衡评估结果Patientsdontneedtoperformall6 useposture&balanceassessmenttodecide观察中应重点注意代偿性运动的出现Themostimportantthingtoobserveiscompensatorymovement从临床的观点上看，肌肉放电的顺序并不是非常重要。许多研究都发现个体之间存在放电顺序的差异Firingorderisnotasclinicallyimportant.Severalstudiesshowvariationinfiringbetweenindividuals俯卧Pronelying足离开桌面Feetoffthetable头中立位Headcentered股骨中立位，双臂置体侧Femurinneutralrotation,armsatside正常顺序 Normalsequence1.腘绳肌 Hamstrings2.臀大肌 GluteusMaximus3.(C)腰伸肌群lumbarextensors4.(I)腰伸肌群lumbarextensors5.(C)胸腰部伸肌群thoracolumbarextensors6.(I)胸腰部伸肌群thoracolumbarextensors阳性发现 PositiveFindings放电模式改变（早期腰椎PVM）Alteredfiringpattern(earlylumbarPVM)肌肉颤抖 Tremblingofmuscles骨盆前倾 Anteriorpelvictilt腰椎过伸Hyperextensionoflumbarspine上斜方肌活动显著增加Significantincreaseduppertrapeziusactivity患者侧卧Patientsidelying下方腿取屈膝屈髋位Lowerlegflexedathipandknee上方腿伸直，骨盆轻微向前Upperlegfullyextended,pelvisslightlyforwardoranterior正常顺序 Normalsequence1.臀中肌&臀小肌G.medius&minimus2.阔筋膜张肌 TFL3.腰方肌Quadratuslumborum4.髋屈肌群Hipflexors5.腹肌群Abdominals阳性发现 PositiveFindings放电顺序改变（TFL&腰方肌提前放电）Alteredfiringpattern(earlyTFLorQuadratus)肌肉颤动Tremblingofmuscles骨盆后旋Posteriorrotationofpelvis髋屈曲/外旋Hipflexion/externalrotation骨盆上提（髋移位）Elevationofpelvis(hiphike)患者屈膝仰卧Patientsupinewithkneesbent医生将手置于患者足部以便施加压力Clinicianshandunderpatientsheelstomonitorpressureoftheheelsonthehand出现以下情况时测试结束：Testendswhen:足跟离开手部（髂腰肌）heelsliftfromhands(iliopsoas)肩胛下角离开桌面3秒inferiorangleraised3”offtable正常顺序 Normalsequence1.头部 Head2.颈部 Neck3.肩部 Shoulders阳性发现 PositiveFindings手部来自足跟压力消失Lossofheelpressurefromhands骨盆前倾Anteriorpelvictilt肌肉颤动Tremblingofmuscles患者仰卧，髋&膝屈曲Patientsupinewithhips&kneesflexed患者抬起头部Havepatientraisethehead阳性发现 PositiveFindings在前10度时下颌前伸Earlychinjuttingduringthefirst10degrees肌肉颤动Tremblingofmuscles正常顺序 NormalsequenceOA点头OAnodding颈部屈曲Cervicalflexion男性俯卧，膝离地Men prone,kneesoffthetable妇女&儿童俯卧，膝着地Women&childrenprone,kneesonthetable保持身体正直，手臂分开与肩同宽Keepwholebodystraight,armsshoulderwidthapartandbeneathshoulders阳性发现 PositiveFindings肩胛骨内收Scapulaadduction肩胛骨上提Scapulaelevation翼状Winging正常顺序 Normalsequenc直至整个动作完成前肩胛骨都不应该出现活动（肩胛骨外展）Nomovementofscapulaeuntiltheendofthepushup(scapulaabduction)患者坐位，手肘屈曲90来控制旋转Patientsitting,withelbowsflexedto90odegreestocontrolrotation医生站于患者身后，观察肩外展情况Clinicianstandsbehindpatientandobservesshoulderabduction运动进行至90或肩部上提止Movementendsat90oorwithshoulderelevation阳性发现 PositiveFindings外展60时出现由(I)上斜方肌激活引起的肩带上提Shouldergirdleelevationinitiatedby(I)activationofuppertrapsat60腰方肌引起的躯干侧屈Lateraltrunkflexioninitiatedbyquadratuslumborum肩胛骨呈翼状Wingingofscapula正常顺序 Normalsequence1.三角肌/冈上肌Deltoid/supraspinatus2.(C)and(I)上斜方肌（稳定作用）uppertraps(forstabilization)3.(C)腰方肌quadratuslumborum评估被动运动阻力 Assessresistancetopassivemovement量化末端感觉 QuantifyEndfeel双侧对比 ComparebilaterallySherrington的交互抑制法则SherringtonsLawofReciprocalInhibition一块紧张并过度活动的肌肉将直接抑制其拮抗肌Atightoveractivemuscledirectlyinhibitsitsantagonist由于兴奋性阈值降低，肌肉紧张的出现会影响运动模式反应Presenceoftightmuscleinfluencesmotorpatterningresponsebecauseofloweredirritabilitythreshold应保证近端、远端附着点之间的长度最大Ensuremaximumlengtheningbetweenproximalanddistalattachments牢牢固定肌肉的一端Firmlystabilizeoneendofthemuscle缓慢延长肌肉并避免出现猛力牵拉Slowlylengthenmuscleandavoidjerkingthemuscle维持姿势稳定性和/或评估末端感觉Relyonmaintainingpositionalstabilityand/orassessmentofendfeel谨记：不是评估关节活动度！Remember:NOTassessingROM!髂腰肌 ILIOPSOAS伸髋0，过压100 hipextension,10 withoverpressure股直肌 RECTUS屈膝90，过压12590 kneeflexion,125 withoverpressure阔筋膜张肌/髂胫束TFL/ITBAND髋外旋0时内收15201520 adductionat0 hipext髋内收肌群 HIPADDUCTORS髋外旋0时外展20252025 abductionat0 hipext对侧膝屈曲以放松髂腰肌Oppositekneeflexedtorelaxiliopsoas测试者将患者足跟置于其肘部，前臂放于胫骨上。触诊髂前上棘以检测骨盆运动Patientsheelinthecrookofelbow,forearmovershin.PalpateASIStodetectpelvicmovement维持矢状面&控制选择Maintainsagittalplane&controlrotation将腿抬高直至膝弯曲、骨盆移动或末端感觉出现Raiseuntilkneebends,pelvismoves,orendfeel对侧膝伸直情况下可抬高80屈曲情况下可抬高9080 with opposite knee extended90 with opposite knee bent正常：有弹性、无痛的末端感觉Norm:springy,painfreeendfeel紧张：困难并伴有痛感Tight:Hard,painfulbarrier1.仰卧，屈颈Supine,flexneck2.颈侧屈；之后转向被测试侧Sidebendaway;thenrotatetowardtestedside3.将手掌置于肩胛骨上缘&加压Placepalmoversuperiorscapulaborder&depress4.记录末端感觉Noteendfeel1.仰卧，屈颈Supine,flexneck2.颈屈曲，并转向被测试侧对侧Flexcervicalspineandrotateawayfromtestedside.2.将手掌置于肩胛骨上缘&加压Placepalmoversuperiorscapulaborder&depress4.记录末端感觉Noteendfeel正常：有弹性、无痛的末端感觉Norm:springy,painfreeendfeel紧张：困难并伴有痛感Tight:Hard,painfulbarrier通常都需要用另一手协助固定肋骨和胸廓，并触诊肌肉紧张和发紧感觉Alwaysstabilizeribsandthoraxwithoppositehandandpalpatemusclefortenderness&tightness下部纤维LowerFibers外展150，外旋abductto150externalrotation中部纤维MiddleFibers屈肘90，外旋Flexelbowto90externalrotation锁骨纤维&胸小肌ClavicularFibers&PecMinor前臂指向地面Lowerarmtowardsfloor水平面下30/过压Horizontal30 w/overpressure触诊第二肋间隙Palpateat2ndribinterspace水平面下10151015 belowhorizonal触诊肌腹Palpatebellyofmuscle有弹性的末端感觉Springyendfeel触诊锁骨下区域Palpateatsubclaviculararea对比双侧硬度&位置Compareintensity&locationbilaterally作为肌肉病变的指征指征Useasanindicator ofmuscularpathology&CNSinvolvement扳机点不一定是治疗的重点TrPmaynotbefocusoftreatment评估扳机点以获得有效的治疗EvaluateTrPsforeffectivenessoftreatment腰方肌QuadratusLumborum骨盆后部肌肉（阔筋膜张肌）PosteriorPelvicCrest(TLFascia)髂腰肌Iliopsoas犁状肌Piriformis股内收肌群AdductorMagnus内侧小腿三头肌MedialGastrocSoleus足底肌Soleoffoot在不平衡侧的点疼痛可能更加明显在不平衡侧的点疼痛可能更加明显Points tend to be more painful on side of imbalancePoints tend to be more painful on side of imbalance枕骨下/C2区域Suboccipital/C2region胸锁乳突肌/斜角肌SCM/Scalene上斜方肌/肩胛提肌UpperTrapezius/Levator胸廓（T4区域）Thoracic(T4region)胸肌（第二肋骨处）Pectoralis(2ndrib)外侧腕伸肌群lateralwristextensors上上&下部的点可能位于相反侧下部的点可能位于相反侧Upper&Lower Points may be ContralateralUpper&Lower Points may be Contralateral!病史&主观检查结果History&SubjectiveFindings姿势Posture平衡&步态Balance&Gait运动模式MovementPatterns肌肉长度（作为指示物）MuscleLength(asindicated)扳机点检查TrPexamination其它骨骼肌肉系统评估（作为指示物）Othermusculoskeletalassessments(asindicated)ROM，MMT，关节活动情况等ROM,MMT,JointPlay,etc.结构缺乏病理性异常Lackofstructuralpathology慢性症状Chronicityofsymptoms姿势异常Posturalabnormality变紧或力弱的特征模式出现Characteristicpatternsoftightnessandweakness运动模式改变Alteredmovementpatterns在6种基本运动模式中出现代偿运动Lookforcompensatedmovementin6patterns变弱：颈屈肌群变紧：胸肌变弱：菱形肌、下斜方肌变紧：枕骨下肌群上斜方肌/肩胛提肌变弱：腹肌变弱：臀大肌变紧：髋屈肌群变紧：胸腰部伸肌群变弱的肌肉变紧的肌肉肩胛骨下方稳定肌群腰骶部竖脊肌臀大肌腘绳肌胸腰段竖脊肌颈部竖脊肌、上斜方肌肩胛提肌单纯的肌肉不平衡或运动损害通常都没有无法建立原因&影响，并且我们尚缺乏科学证据支持Themerepresenceofmuscleimbalanceormovementimpairmentdoesnotestablishcause&effect,andwelackscientificevidence医师必须要找出导致这种功能障碍的原因，或是这种功能障碍会带来什么样的问题Theclinicianmustestablishwhethertheimpairmentscontributetothedysfunctionoraresecondarytothedysfunction(copingmechanism)全身方法 Globalapproach中枢神经系统激活CNSactivation慢性疼痛可能由中枢神经系统介导ChronicpainismediatedbyCNS运动程序改变AlteredMotorProgram神经可塑性NeuralPlasticity神经适应性NeuralAdaptation运动学习的两个阶段2stagesofmotorlearning自发Voluntary自动Automatic1.使外周和本体感觉输入正常化Normalizeperipheryandproprioceptiveinput2.重建肌肉平衡Restoremusclebalance3.易化本体感觉通道并运动模式自动化Facilitateproprioceptivepathwaysandautomaticmovementpatterns4.增加协调运动中的耐力Increaseenduranceincoordinatedmovement本体感觉是姿势和运动重要的信息来源Proprioceptorsprovideimportantinformationforpostureandmovement必须使结构正常化以便为系统提供恰当的信息Structuresmustbenormalizedtosendappropriateinformationintosystem谨记：入=出Remember:IN=OUT变紧的肌肉将会反射性的抑制主动肌Tightmuscleswillreflexivelyinhibitagonists通常先牵伸变紧的肌肉Alwaysstretchtightmusclefirst牵伸技术的选择取决于导致肌肉变紧的原因Stretchingtechniquedependsoncauseoftightness从易化被抑制的肌肉开始，之后进阶到增强力量Beginbyfacilitatinginhibitedmuscle,thenworktowardstrengthening使用能够促进肌肉平衡的练习Useexercisesthatpromotemusclebalance运动由感觉运动系统控制SensorimotorSystemcontrolsmovement自发收缩的速度不足以预防伤害发生；运动必须是自动和协调的Voluntarycontractiondoesntoccurfastenoughtopreventinjury;movementmustbeautomaticandcoordinated下意识的反应&收缩速度（而非力量而非力量）是维持功能性稳定最重要的成分Unconsciousreaction&speedofcontractionaremostimportantcomponentsoffunctionalstability(notstrength)使放电模式&顺序正常化Normalfiringpatterns&sequence无代偿运动Nocompensatedmovement增强相位拮抗肌的离心控制Increaseeccentriccontrolofphasicagainsttonic增强耐力Improveendurance准确的本体感觉信息是协调运动&保护关节所必须的Accurateinformationfromproprioceptorsnecessarytocoordinatemovement&protectjoints颈椎颈椎Cervicalspine(Abrahams1977)使头部位置正常化normalizeheadposition骶髂关节骶髂关节SIjoint(Hinoki,1975)易化运动链facilitatekineticchain足底足底Soleoffoot(Freeman&Wyke,1964)使足部位置正常化normalizefootposition重建正常本体感觉输入重建正常本体感觉输入Restorenormalproprioceptiveinput关节整复/松动/METJointmobilization/manipulation/MET支具，提踵 Orthotics,heellift软组织松动术SoftTissueMobilization(Graston,ASTYM,etc)喷雾&牵伸Spray&Stretch水肿/渗出控制Edema/effusioncontrolSNAGs,NAGs,MWMsetc.姿势Posture重点调整3个关键区域的本体感觉输入Emphasize correction of 3 vital areas of proprioceptive input骨盆姿势会对其他链造成影响Pelvicpositioninfluencesotherchains应首先调整肌肉长度CorrectmusclelengthFIRST易化被抑制的肌肉Facilitateinhibitedmuscles下四分之一下四分之一LOWERQUARTER小腿三头肌gastrocsoleus胫骨后肌tibialisposterior髋内收肌群hipadductors腘绳肌hamstrings股直肌rectusfemoris髂腰肌iliopsosas阔筋膜张肌Tensorfascialata犁状肌piriformis腰方肌quadratuslumborum上四分之一上四分之一 UPPERQUARTER胸段伸肌thoracolumbarextensor胸大肌/胸小肌pectoralismajor/minor上斜方肌uppertrapezius肩胛提肌levatorscapula咀嚼肌/翼状肌masseter/latpterygoid胸锁乳突肌sternocleidomastoid斜角肌Scalenes枕骨下肌suboccipitals上肢屈肌群Upperextremityflexors 运动都是以一种最省力的方式进行运动都是以一种最省力的方式进行MovementtakesthepathofleastresistanceMovementtakesthepathofleastresistance紧张的肌肉将在运动中持续激活，从而变得更加紧张&改变运动程序Tightmuscleswillcontinuetobeactivatedwithmovement,facilitatingfurthertightness&alteringmotorprogram 前伸紧张的肌肉常可以使主动肌的肌力增加前伸紧张的肌肉常可以使主动肌的肌力增加StretchingtightmusclesfirstoftenresultsinStretchingtightmusclesfirstoftenresultsinimprovedstrengthoftheagonistimprovedstrengthoftheagonistSherrington交互抑制法则SherringtonsLawofreciprocalinnvervation阻力最小MinimalresistancePIR对于扳机点最有效PIRparticularlyusefulinTrPLewit&Simons(1984)指出，PIR可以降低94%的MFP扳机点疼痛Lewit&Simons(1984)notedPIRdecreasedTrPpainin94%ofMFP家庭运动计划最为有效最为有效HomeExerciseProgrammosteffective使用最小阻力将会激活特定的纤维。改变阻力与否取决于扳机点的数量Byusingminimalresistance,specificfibersareactivated.VaryresistancedependingonnumberofTrPsinvolved技术Technique通过“让其放松戒备”方式，轻柔缓慢延长肌肉至其首个受阻滞处（静息长度）Gentlyandslowlylengthenmuscletoitsfirstbarrier(restinglength)by“takingupitsslack”让患者轻微抵抗进行等长收缩（1020%）Havethepatientgentlypushagainstisometricresistance(1020%)让患者在吸气同时维持收缩58秒Havepatientholdthecontractionwhilebreathing in for 58 seconds技术，续Technique,cont.呼气时，医师缓慢移动到下一阻滞处Uponexhalation,cliniciantakesupslacktothenewbarrier重复35次Repeat35times在末端时可以辅以拮抗肌收缩Mayaddcontractionofantagonistinendposition“不是牵伸”“NOTASTRETCH”离心牵伸EccentricStretching1.使肌肉缩短&附加带ShortenMuscle&attachband2.拉紧带子以维持肌肉缩短状态TensionBandwhilekeepingmuscleshort3.缓慢地使肌肉延长以对抗张力Slowlyallowmuscletolengthenagainsttension4.在活动范围末端牵伸肌肉Stretchmuscleatendrange(Nelson 2004,2006)激活受抑制&力弱的肌肉Activateinhibited&weakmuscles神经肌肉再激活技术NeuromuscularReactivationTechniques下四分之一下四分之一 LOWERQUARTER腓骨肌peroneals胫前肌tibialisanterior股内/外侧肌vastusmedialis/lateralis臀中/小肌gluteusmedius/minimus臀大肌gluteusmaximus腹横肌transverseabdominus上四分之一上四分之一 UPPERQUARTER前锯肌serratusanterior菱形肌rhomboids中/下斜方肌middle/lowertrapezius颈深屈肌群deepneckflexors上肢伸肌群upperlimbextensors相位肌趋向于受到抑制Phasicmusclespronetoinhibition许多时候这种抑制来源于被易化的拮抗肌Sometimesinhibitedbyfacilitatedantagonist首先必须要从神经学方面的观点来了解肌肉功能Firstunderstandthetruefunctionofmusclefromneurologicalperspective在运动中不强调重力Deemphasize gravityinexercise用阻力来易化肌梭Useresistancetofacilitatemusclespindle促进离心收缩相Promoteeccentricphase在量中求质Promotequalityoverquantity使用TheraBand向量提供阻力TheraBandVectorsofResistance利用带子或管子在期望的运动方向上产生一个“向量”Usebandortubingtocreateavectorinthedirectionofdesired(orundesired)motion可以用来刺激特定的肌纤维Usedtostimulatespecificmusclefibers7979 2008.TheHygenicCorporation2008.TheHygenicCorporationTheraBand的隐秘动作练习TheraBandStealthExercise这个练习可以用来易化下意识的和自动/反射性动作，从而增进功能Performanexercisethatfacilitatesunconsciousandautomatic/reflexiveactionstopromotefunction其真正功能为回缩（非屈曲）颈椎TruefunctionistoretractCspine(notflexion)维持姿势（颈椎前凸）以及平衡；它们并不提供动态稳定性Maintainposture(cervicallordosis)andequilibrium;theydonotprovidedynamicmovement(Abrahams1997)其功能为将肩胛骨维持在肋骨上，而非前伸Truefunctionistomaintainscapulaonribs,NOTprotraction注意肌纤维方向：向量！Notemusclefiberorientation:Vector!前锯肌前冲？Serratuspunch?向前击前锯肌前冲动态拥抱Forward Punch Serratus Punch*Dynamic Hug其功能为维持盂肱关节稳定性Truefunctionisglenohumeralstabilization对关节盂形成压迫力Compressiveforcetoglenoid预防前方和向下移位Preventanteriorandupwardtranslation在肩关节运动之前最重要的是“设置”肱骨以应对来自于肩袖/三角肌的力偶Mostimpo