柔韌性訓(xùn)練在心肺康復(fù)中的應(yīng)用課件

1、柔韌性訓(xùn)練在心肺康復(fù)中的應(yīng)用柔韌性訓(xùn)練 定義：柔韌性訓(xùn)練指的是通過牽伸肌肉 - 肌腱，使肌肉保持一定長(zhǎng)度，緩沖外界壓力。 關(guān)節(jié)柔韌性取決于關(guān)節(jié)附著肌肉的長(zhǎng)度及延展性。柔韌性越高，關(guān)節(jié)活動(dòng)范圍越大。 長(zhǎng)期缺乏柔韌性訓(xùn)練可導(dǎo)致肌肉變短變緊，關(guān)節(jié)活動(dòng)范圍減小，柔韌性下降。 牽伸是提高肢體柔韌性的主要途徑。牽伸的種類 主動(dòng)牽伸自己將身體部位保持在某一位置所進(jìn)行的牽伸。 被動(dòng)牽伸由他人將身體部位固定在某一位置并持續(xù)一定時(shí)間所進(jìn)行的牽伸。牽伸的種類 靜態(tài)牽伸通過保持牽伸一定時(shí)間來(lái)牽伸某一肌肉或某一肌肉群。由于開始靜態(tài)牽伸時(shí)，肌肉處于放松狀態(tài)，牽伸速度較慢，因此靜態(tài)牽伸不會(huì)激活牽張反射。靜態(tài)牽伸是最常用的牽

2、伸方法 PNF 牽伸 （本體感覺神經(jīng)肌肉促進(jìn)術(shù)）通過在關(guān)節(jié)活動(dòng)范圍內(nèi)牽伸已經(jīng)收縮的肌肉，嘗試更充分的吸收本體感受器的動(dòng)作。 肌肉收縮與肌肉牽伸相結(jié)合可以使緊張的肌肉放松，減少促使和阻止關(guān)節(jié)活動(dòng)肌肉的內(nèi)在壓力，放松肌肉可以增強(qiáng)柔韌性。牽伸的種類 彈震性牽伸 / 擺動(dòng)牽伸利用肌肉收縮迫使肌肉不停地?cái)[動(dòng)伸展，包括彈跳運(yùn)動(dòng)，而不要求牽伸時(shí)間?？赡軙?huì)激活牽張反射從而刺激肌肉群再收縮，因此常不被推薦。 動(dòng)態(tài)牽伸使用特定的運(yùn)動(dòng)方式在比平常更大的運(yùn)動(dòng)范圍內(nèi)活動(dòng)四肢，讓運(yùn)動(dòng)的動(dòng)量帶動(dòng)四肢達(dá)到超過正常運(yùn)動(dòng)范圍極限，并激活本體感受器反應(yīng)。動(dòng)態(tài)牽伸可提高肌肉溫度和本體感受器反應(yīng)性，通常用于運(yùn)動(dòng)員體育運(yùn)動(dòng)前的準(zhǔn)備活動(dòng)。

3、動(dòng)態(tài)牽伸與擺動(dòng)牽伸類似，都是利用肢體快速運(yùn)動(dòng)以達(dá)到牽伸的效果，但不同的是動(dòng)態(tài)牽伸中不使用晃動(dòng)或擺動(dòng)。長(zhǎng)期柔韌性訓(xùn)練的益處 提高肌肉柔韌性、耐力和力量。功效的大小取決于對(duì)肌肉施加的力度。初學(xué)者從小強(qiáng)度開始，逐漸提高牽伸強(qiáng)度和時(shí)間。 減少肌肉酸痛；肌肉酸痛時(shí)可進(jìn)行輕度牽伸。 改善肌肉和關(guān)節(jié)靈活性。 提高肌肉活動(dòng)的效率和動(dòng)作的流暢性。 能通過更大運(yùn)動(dòng)范圍發(fā)揮最大力量。 預(yù)防運(yùn)動(dòng)損傷。 改善體型和自我形象。 在運(yùn)動(dòng)中執(zhí)行更有效的熱身和整理運(yùn)動(dòng)。柔韌性訓(xùn)練在心臟康復(fù)中的應(yīng)用 柔韌性訓(xùn)練主要作為心臟康復(fù)整體訓(xùn)練中熱身運(yùn)動(dòng)和整理運(yùn)動(dòng)的一部分。 柔韌性訓(xùn)練和有氧訓(xùn)練、抗阻訓(xùn)練相結(jié)合提高患者的全身耐力水平和心肺

4、功能。 合并骨關(guān)節(jié)病的患者，可以通過柔韌性訓(xùn)練增加關(guān)節(jié)活動(dòng)范圍，減少運(yùn)動(dòng)中的關(guān)節(jié)疼痛和預(yù)防運(yùn)動(dòng)創(chuàng)傷。耐力訓(xùn)練熱身訓(xùn)練整理運(yùn)動(dòng)恢復(fù)心率最適目標(biāo)心率測(cè)定心率結(jié)束時(shí)開始時(shí)注）圖為年輕健康人的心率，某些中老年健康人心率會(huì)過度升高柔韌性訓(xùn)練是熱身運(yùn)動(dòng)和整理運(yùn)動(dòng)的重要組成部分熱身運(yùn)動(dòng)、耐力訓(xùn)練、整理運(yùn)動(dòng)等各運(yùn)動(dòng)訓(xùn)練時(shí)間和心率的關(guān)系運(yùn)動(dòng)前柔韌性訓(xùn)練目的 增加關(guān)節(jié)活動(dòng)范圍 促進(jìn)肌肉的血液循環(huán) 提高肌肉柔韌性，預(yù)防受傷 激活交感神經(jīng)，提高體溫、心率運(yùn)動(dòng)后柔韌性訓(xùn)練目的 促進(jìn)乳酸等疲勞物質(zhì)排泄 降低肌張力 促進(jìn)內(nèi)啡肽等內(nèi)源性疼痛物質(zhì)抑制物的分泌運(yùn)動(dòng)前后柔韌性訓(xùn)練方法 柔韌性訓(xùn)練前有 5 分鐘熱身運(yùn)動(dòng)如步行、踩車等

5、 主動(dòng)的全關(guān)節(jié)范圍的活動(dòng)牽伸肌肉 緩慢牽伸，時(shí)間約 10 分鐘 先靜態(tài)牽伸，然后可適當(dāng)結(jié)合動(dòng)態(tài)牽伸。 靜態(tài)牽伸動(dòng)作，每個(gè)動(dòng)作保持 1030 秒，重復(fù) 5-10次注意事項(xiàng) 柔韌性訓(xùn)練過程中注意放松，正常呼吸，不要憋氣。 動(dòng)作輕柔、緩慢，避免急速牽拉，以防運(yùn)動(dòng)損傷 訓(xùn)練中以感到舒適的程度進(jìn)行牽伸，如果出現(xiàn)疼痛表示牽伸過度 訓(xùn)練時(shí)手扶護(hù)欄，注意不要摔倒。 動(dòng)態(tài)牽伸訓(xùn)練時(shí)，避免過度牽伸。動(dòng)態(tài)牽伸訓(xùn)練前需配合靜態(tài)牽伸訓(xùn)練。柔韌性評(píng)定How Flexible Are You?1. 下肢柔韌性評(píng)定 Lower Body Flexibility 端坐位，挺胸拔背Sit on a chair with your

6、 back straight . 一側(cè)足底著地，另一側(cè)下肢上抬與地面平行Keep one foot on the floor and raise the other leg to be parallel to thefloor. 在一側(cè)足底不抬離地面，并且坐姿不變的情況下，另一側(cè)下肢可以上抬至大腿高度則代表下肢柔韌性良好If you can raise your leg to thigh height without shift position or raisingyour other foot you have a decent range of motion in your lower

7、body.2. 上肢柔韌性評(píng)定Upper Body Flexibility 右手越過肩部在背后向腰部牽伸Reach your right hand over your shoulder and behind yourback, stretching down to your waist. 左手從后背向頸部牽伸，兩手接觸或相握Place your left hand behind your back and reach toward yourneck trying to touch or overlap fingers with your hands. 如果能完成這個(gè)動(dòng)作代表上肢柔韌性良好If

8、you can touch/overlap fingers you have a decent level ofupper body flexibility.3. 全體柔韌性測(cè)定 Overall Flexibility 坐位雙腿前伸Sit on the floor with legs stretched out in front of you. 雙足下蹬固定物Place your feet against a solid box. 上身雙手前探，在雙膝伸直的情況下測(cè)量雙手超出固定面的長(zhǎng)度Lean forward and see how many inches you can reach wit

9、houtbending your knees.超過 8-9 inches ： excellent 極好超出 5-8 inches ： very good 好超出 1-5 inches ： fair 合格不能碰到： poor 不合格（ 1 英寸 (in)=2.54 厘米 (cm) ）軀干牽伸 Torso Stretch目的：牽伸腰腹部起始姿勢(shì)：高坐位，下肢平放于地，兩肩同寬動(dòng) 作 ： 雙 手 抱 頭 ， 或 雙 手 胸 前 交 叉 / 置 于 身體 兩 側(cè) 。 向 身 體 一 側(cè) 牽 伸 腰 部 ， 保 持 5 秒 。雙側(cè)交替，重復(fù) 6-8 次Purpose: Stretch the midse

10、ction (waist).Starting Position: Sit tall with your feet flat on the floor, shoulder-width apart.Action: Place hands behind your head, as shown, with elbows out to the side. You can also cross your arms overyour body or leave them at your sides, whichever is most comfortable. Bend your body to one s

11、ide, bending at the waist. Keep your head facing forward. Hold for 5 seconds. Return to starting position. Repeat on the other side.Repeat: 6 to 8 times on each side. Rest, then do a second set.軀干轉(zhuǎn)體 Torso Twist目的：牽伸腰腹部起始姿勢(shì)：高坐位，下肢平放于地與肩同寬動(dòng)作：雙手抱頭，或雙手胸前交叉 / 置于身體兩側(cè)。向身體一側(cè)緩慢扭轉(zhuǎn)腰部，頭部同向轉(zhuǎn)動(dòng)，注意是腰部旋轉(zhuǎn)髖部不動(dòng)。保持 10-3

12、0 秒。雙側(cè)交替，重復(fù) 6-8 次Purpose: Stretch the midsection (waist).Starting Position: Sit tall with your feet flat on the floor, shoulder-width apart.Action: Place hands behind your head, as shown, with elbows out to the side. You can also cross your arms over yourbody or leave them at your sides, whichever i

13、s most comfortable. Slowly twist your body to one side so you face the side wall. Your head should follow your body as you turn. Besure to twist from your waist without moving your hips. Hold the position for 10-30 seconds. Slowly return to starting position. Repeat on the other side.Repeat: 6 to 8

14、times on each side. Rest, then do a second set.頸部牽伸 Neck Stretch目的：增加頸部柔韌性起始姿勢(shì)：高坐位，下肢平放于地，兩肩同寬動(dòng)作：緩慢轉(zhuǎn)動(dòng)頭部向肩看齊，背部貼椅，雙肩部向前，保持 10-30 秒。雙側(cè)交替，重復(fù) 6-8 次Purpose: Improve neck flexibilityStarting Position: Sit tall, feet flat on the floor, shoulder-width apart.Action: Slowly turn your head to look over your sh

15、oulder. Keep your back against the chair and your shouldersfacing forward. Hold the position for 10-30 seconds. Return to starting position. Repeat on the other side.Repeat: 6 to 8 times on each side. Rest, then do a second set.坐位牽伸 Seated March目的：增加髖部柔韌性起始姿勢(shì)：高坐位，下肢平放于地，兩肩同寬動(dòng)作：一側(cè)膝盡量上抬后放下，雙側(cè)交替，重復(fù) 6-8

16、 次Purpose: Increase hip flexibility.Starting Position: Sit tall with your feet flat on the floor, shoulder-width apart.Action: Raise one knee as high as you comfortably can. Return to starting position. Repeat on the other side.Repeat: March 12 to 16 times (6 to 8 times per leg). Rest, then do a sec

17、ond set.股四頭肌牽伸 QuadricepsStretch目的：牽伸股四頭肌并且強(qiáng)化腘繩肌起始姿勢(shì)：左腿單腿站立，左手微屈扶墻，距墻12-18 英寸。動(dòng)作：右后跟向臀部上抬，右手觸碰右腳（足跟、腳踝或襪子）。如果不能觸到足部，也可以觸碰褲管或盡可能抬高足部。保持 2-3 秒，注意保持昂首站立，下肢呈一直線。雙側(cè)交替，重復(fù) 6-8 次。為了保持平衡并且避免創(chuàng)傷，站立的下肢可以微屈，但注意軀干挺直不能屈曲。Purpose: Stretch quadriceps muscle (front of thigh) and strengthen hamstring on back of thigh.

18、Starting position: Stand with your left side to the wall, 12 to 18 inches from the wall. Place your left hand againstthe wall for balance, keeping that arm slightly bent.Action: Raise your right heel towards your buttocks. Reach back with your right hand and grab your foot at the heel,ankle or sock.

19、 If you cant reach your foot, grab your pant leg or just raise your foot as high as you can and stillfeel comfortable. Hold for two to three seconds. Be sure youre standing tall and looking straight ahead. Your knee should bepointing toward the floor and your ankle should be in a straight line with

20、your leg, not twisted to the side. Let go of your foot and slowly return to starting position. Then repeat. Complete one set, then turn around and hold the wall with your right hand when working your left leg. Repeat: 6to 8 times with each foot. Rest, then do a second set.Note: Keep your standing le

21、g slightly bent for better balance and to avoid injury. Stand tall and avoid leaning over.腘繩肌牽伸 HamstringStretch目的：牽伸腘繩肌起始姿勢(shì)：左腿單腿站立，左手微屈扶墻，距墻12-18 英寸。動(dòng)作：左足向前邁，牽伸髖關(guān)節(jié)（而不是腰部）身體前探。右手向下觸碰足尖，足部可踝背伸或平放于地。肩背部保持直線。保持 2-3 秒，雙側(cè)交替，重復(fù) 6-8 次。Purpose: Stretch hamstring (back of thigh).Starting Position: Stand with

22、 your left side to the wall, 12 to 18 inches from the wall. Place your left handagainst the wall for balance, keeping that arm slightly bent.Action: Place your left heel on the floor in front of you. Lean forward from your hip (not your waist). Push your hip back and reach toward your toe with your

23、right hand. Your foot can be pointing up (as shown)or flat on the floor, whichever is more comfortable for you. Make sure to keep your shoulders and backstraight as you reach forward. Hold for two to three seconds. Return to starting position. Then repeat. Complete one set and then turn around and w

24、ork the other leg.Repeat: 6 to 8 times with each leg. Rest, then do a second set.腓腸肌牽伸 CalfStretch目的：牽伸腓腸肌起始姿勢(shì)：離墻距離略超過臂長(zhǎng)，雙手推墻動(dòng)作：彎曲一側(cè)下肢并且置于身體前側(cè)，另一側(cè)下肢微屈膝置于身體后側(cè)。雙足尖保持向前。緩慢做髖部前移，保持后背部平直，足后跟不離地，身體重心位于足后跟。保持10-30 秒，雙側(cè)交替，重復(fù) 3-5 次。Purpose: Stretch the calf (lower part of the back of the leg).Starting positi

25、on: Stand facing a wall slightly farther than arms length from the wall, feet shoulder-width apart. Lean against the wall, with both hands on the wall.Action: Bend one leg, and place the foot on the ground in front of you. The other leg extends behind youwith the knee slightly bent. Both feet point

26、straight ahead. Slowly move your hips forward, keeping your lower back flat. Be sure the heel of your back footis flat on the floor, and your weight is in your back heel. Hold for 10-30 seconds. Then return to starting position. Repeat with other leg. Continue alternating legs.Repeat: 3 to 5 times w

27、ith each leg. Rest, then do a second set.上肢，軀干，下肢代表性柔韌性訓(xùn)練動(dòng)作。（ a-f ） 站位訓(xùn)練用 （ g-i ）坐位訓(xùn)練用柔韌性訓(xùn)練在肺康復(fù)中的應(yīng)用 柔韌性訓(xùn)練可以通過增加胸廓活動(dòng)度和糾正不良姿勢(shì)，從而改善慢性肺疾病患者的肺功能。 影響呼吸功能的常見姿勢(shì)問題包括：胸椎后凸、胸部前后徑過大、肩部上提、頭部前伸和軀干屈曲。 姿勢(shì)問題同時(shí)可導(dǎo)致頸背部疼痛，從而進(jìn)一步影響呼吸功能KyphosisForward Head Posture上交叉綜合癥 Upper-crossed syndrome柔韌性訓(xùn)練在肺康復(fù)中的應(yīng)用訓(xùn)練方案 加強(qiáng)頸、肩、背、胸肌肉的牽

28、伸訓(xùn)練，改善關(guān)節(jié)活動(dòng)度 加強(qiáng)四肢主要大肌群的牽伸訓(xùn)練（腓腸肌、股四頭肌、腘繩肌、肱二頭肌） 柔韌性訓(xùn)練和有氧訓(xùn)練相結(jié)合有助于改善慢性肺疾病患者的心肺功能和全身耐力水平Although flexibility training is a component of many exercise regimens and is commonly provided in pulmonary rehabilitation,there are, to date, no clinical trials demonstrating its effectiveness in this particular set

29、ting. Improved thoracic mobility and posturemay increase the vital capacity in patients with chronic respiratory disease Because respiration and posture have a coupledrelationship, a thorough evaluation includes both the assessment and treatment of patients with chronic respiratory disease(Common po

30、stural impairments include thoracic kyphosis, increased chest anteriorposterior diameter, shoulder elevation andprotraction, and trunk flexion Postural abnormalities are associated with a decline in pulmonary function, decreased quality of life,poor bone mineral density, and increased work of breath

31、ing .Postural deviations are known to alter body mechanics, resulting inback pain, which in turn alters breathing mechanics (One appoach in pulmonary rehabilitation is to have patients perform bothupper and lower body flexibility exercises (including stretching of major muscle groups such as the cal

32、ves, hamstrings, quadriceps,and biceps, as well as range of motion exercises for the neck, shoulders, and trunk) at least 23 days/week頸部肌群解剖主要頸前肌群主要頸后肌群胸鎖乳突肌下固定時(shí)，一側(cè)作用頭 轉(zhuǎn)向?qū)?cè)，并向同側(cè)傾斜；合力使頭前屈。上固定時(shí)，上提胸廓幫助吸氣斜角肌頸部側(cè)屈、屈曲、上提胸廓斜方肌上部上提上回旋肩胛骨 ；中部使肩胛骨向脊柱靠攏；下部下降肩胛骨頭夾肌頸后伸、頭向同側(cè)轉(zhuǎn)動(dòng)頭半棘肌、頭最長(zhǎng)肌頸后伸、頭側(cè)屈頸伸肌牽伸 建議坐位下進(jìn)行，背部伸直 雙手交

33、叉置于腦后靠近頂部 輕緩向下牽拉頭部，讓下巴盡可能接觸胸部 牽伸中注意頸部伸直，不要聳肩 主要牽伸肌肉：斜方肌上部頸伸肌和旋轉(zhuǎn)牽伸 坐位，背部伸直 右手置于腦后靠近頂部 輕緩向下和向右牽拉頭部，使其朝向右肩部，下巴盡可能靠近右肩部 另一側(cè)重復(fù)此牽伸 頸伸肌柔韌后可以從兩側(cè)牽伸改為一側(cè)牽伸 主要牽伸肌肉：斜方肌上部、左側(cè)胸鎖乳突肌頸屈肌牽伸 坐位，背部伸直 雙手交叉，手掌置于前額 輕緩向后牽拉頭部，讓鼻子朝上 主要牽伸肌肉：胸鎖乳突肌頸屈肌和旋轉(zhuǎn)牽伸 坐位，背部伸直 右手置于腦后靠近頭頂位置 輕緩向下和向右牽拉頭部，使其朝向右肩 在另一側(cè)重復(fù)此牽伸 主要牽伸肌肉：斜方肌上部、左側(cè)胸鎖乳突肌肩、胸

34、、背部肌群解剖肩胛骨 上 提 ： 斜 方 肌 上 部 、 菱 形 肌 、 肩 胛 提 肌 下 降 ： 斜 方 肌 下 部 纖 維 、 前 鋸 肌 下 部 纖 維 、 胸 小 肌 前 伸 ： 前 鋸 肌 、 胸 小 肌 后 縮 ： 斜 方 肌 、 菱 形 肌 上 回 旋 ： 斜 方 肌 、 前 鋸 肌 下 回 旋 ： 胸 小 肌 、 菱 形 肌 、 肩 胛 提 肌肩關(guān)節(jié) 前屈：三角肌前束、胸大肌、喙肱肌、肱二頭肌長(zhǎng)頭 后伸：三角肌后部、肱三頭肌長(zhǎng)頭、背闊肌、岡下肌、大圓肌、小圓肌 外展：三角肌、岡上肌 內(nèi)收：胸大肌、背闊肌、肩胛下肌、岡下肌、小圓肌、大圓肌 內(nèi)旋：三角肌前束、胸大肌、背闊肌、大圓肌、肩胛下肌 外旋：三角肌后束、岡下肌、小圓肌初級(jí)肩屈肌牽伸 肩屈肌群緊張常伴隨頸伸肌緊張，從而出現(xiàn)肩部上抬，頭部向前的異常姿勢(shì)，加重呼吸障礙。 肩屈肌群緊張同時(shí)可導(dǎo)致肩部撞擊、肩周炎等問題訓(xùn)練步驟 站立，十指交叉 將雙手