2000년 브뤼거가 제안한 개념.
mid-thoracic kyphosis, 흉곽움직임 제한, 폐활량 부족을 해결하는 가장 좋은 운동법
모든 노인환자에게 필수 운동법
Movements of the arm have similar effects on the intercostal spaces:
• Arm elevation with flexion raises the upper thorax in a more anterior direction and opens up the upper intercostal spaces.
• Arm elevation with abduction raises the lower thorax in a more lateral direction and opens up the lower intercostal spaces.
- 상지를 굴곡할때, 상부 흉곽이 좀더 앞으로 이동하고, 상부 늑골사이 공간을 넓힘.
- 상지를 외전할때, 하부 흉곽이 옆방향으로 이동하고 하부늑골사이 공간이 열림.
The rotation of the ribs around the longitudinal axis in the neck of the rib during deep inhalation and expiration results
in the inferior or superior edges of the ribs facing slightly outward.
- 심호흡동안 늑골경에서 종축 주위로 늑골의 회전은 늑골의 상부 또는 하부의 edge가 약간 outward됨.
panic bird....
Bruger relief 호흡
- 동영상으로 http://www.youtube.com/watch?v=Lgm3j66fpBA
The first step in treatment for musculoskeletal pain is advice. This precedes both manipulation and exercise. A very common postural syndrome in modern society involves excessive lumbar and thoracic kyphosis, a forward drawn head, and hyperlordosis of the cervicocranial junction. This is a natural result of prolonged sitting work, especially with computers. This posture is associated with increased muscular tension and faulty respiration habits.
- 현대사회 흔한 자세 문제는 과도한 요추전만, 흉추후만, 두부전방자세 등
- 이러한 자세의 원인은 컴퓨터에서 오래앉기
- 이러한 자세때문에 근육긴장 증가와 흉추 호흡이 안좋음 .
When the slumped posture is assumed for sustained periods of time, increased load is placed on the intervertebral disc. On examination, certain muscles are predictably found to have increased tension:
- 구부정한 자세(slumped posture)가 오랫동안 지속될때, 증가된 부하는 추간판에 놓여짐.
- 몇가지 근육은 증가된 긴장을 가짐.
- upper fixators of the shoulder girdle
- pectorals
- upper extremity flexors
- abdominals
- hip flexors
- adductors
- posterior calf muscles
This muscle tension is reversible by merely having the patient sit up straight.
- 근육긴장은 환자의 올바른 자세에 의해서 가역적으로 바뀜.
With the sternum approximating the pubic symphysis, diaphragmatic inhibition results in overactivation of scalene and upper trapezius musculature during respiration. Inspection reveals excessive shoulder girdle elevation during inhalation. The slumped posture should thus be considered a key perpetuating factor of faulty respiration, and of myofascial syndromes involving the upper trapezius or scalene muscles.
- 흉골이 pubic symphysis에 가까워질때, 흉곽근육 억제는 호흡동안 사각근과 상부승모근의 과활성을 유발함.
- 흡기시 시진상 과도한 견갑대 상승움직임이 보임. 구부정한 자세로 인한 사각근, 상부승모근과 관련된 근막통증 증후군은 잘못된 호흡의 중요 악화인자로 고려되어야 함.
Brugger's advice to individuals who work for long hours in a constrained, slumped posture is to learn to sit upright, or use supports which help maintain the lumbar lordosis. Repetitive "micro-breaks" every 20 minutes are a sensible approach. A "relief position" has been advocated incorporating the following components:
- 브뤼거는 구부정한 자세로 오랫동안 앉아서 일하는 사람들에게 올바른 앉기 자세, 운동자세를 제안함.
- 매 20분마다 실용적인 방법으로 반복적인 micro-breaks를 제안함. 이완자세는 아래와 같음.
- Sit at the edge of a chair.
- Abduct legs slightly.
- Externally rotate legs slightly.
- Rest weight on legs/feet & relax abdominal muscles.
- Tilt pelvis forward & lift sternum up thus increase lumbar lordosis to its maximum.
- Supinate forearms.
- Externally rotate arms.
With the patient in the "Brugger relief position" previous areas of palpable tenderness should be palpated again. They should be found to be much softer and less tender.
This postural advice can be recommended for 10 seconds every 20 minutes. It can be incorporated into sit to stand, walking, and lifting advice. Within a few weeks, patients usually experience the sensation of sitting and standing straighter naturally. When this occurs, conscious effort is not as necessary because a new skill has been learned on an automatic basis. This is ideal as long-term compliance with exercise is difficult to achieve, but a new postural habit once learned is unlikely to be broken.
- 이 자세는 매 20분마다 10초를 시행하도록 제안함.
- 몆주 이내에 환자는 앉는 자세 감각 그리고 선자세의 자연스러움을 경험할 수 있음.
References
- Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor System. 2nd ed. Oxford, Butterworth-Heinemann, 1991.
- Liebenson C. Rehabilitation of the Spine: A Practitioner's Manual. Baltimore. Williams and Wilkins, 1996.
Craig Liebenson, DC
Los Angeles, California