等速肌力测定

UptoDateDynamometry肌力测定新进展:ClinicalApplicationsandResearch临床应用与研究Dr.phil.SteffenMüllerUniversityOutpatientClinic.SportsMedicineandSportsOrthopaedicsUniversityofPotsdam.Germany德国波茨坦大学运动医学与康复专业医院introductionclin.appl.researchContent目录•introduction介绍•clinicalapplication(patients/athletes)临床应用（病人/运动员）•strengthdiagnostics力量诊断•treatmentevaluation治疗评估•rehabilitation康复•strengthtraining力量训练•research研究•strengthdiagnostics力量诊断•standardizedtestsituations标准测试方式•standardizedstrengthtraining标准力量训练•uptodate最新•„ballisticmode“弹道模式•„sensorimotor“testing感觉运动测试•speed„profile“(+perturbation)速度情况扰动•special/functionalmovementsituations特别的/功能性运动状况•examples(videoclip)例子（视频剪辑）J.Perrine1967uptodateIsokineticsinLiterature等速文献•PubMedsearch检索(isokinetic等速/torque力矩):1980:81990:482000:702010:11468–knee膝11–ankle踝9–hip髋7–trunk躯干9–shoulder肩5–elbow肘5–other其他introductionclin.appl.researchuptodateintroductionclin.appl.researchuptodate感谢德国菲兹曼医用电子公司提供设备支持!introductionclin.appl.researchuptodateintroductionclin.appl.researchuptodateeverydaypractice:patients每天训练：病人•strengthdiagnostics力量诊断•femaleathlete女性运动员;8weeksaftertornmusclefibers在肌纤维损伤8周后(M.rectusfemoris,left左侧股直肌)fullrecovery?真的康复了吗？isthereastrengthdeficit?有无力量缺失？•sidedifferences;agonistvs.antagonist;conentricvs.eccentric;referencevalues?两侧差异；收缩肌，对抗肌；向心，离心；参考值？decision:besttreatment/training?决定：最佳的治疗/训练introductionclin.appl.researchuptodateadditionalexamples:举例•LBP-patients下腰痛病人•strokepatients中风病人everydaypractice:athletes每天训练：运动员•treatment/trainingevaluation治疗/训练评估•elitemaleathlete(nopain)优秀男性运动员（无疼痛）strengthgainaftertrainingintervention?在训练之后力量的增加restorationofstrengthlevelaftertherapy?治疗之后力量水平的恢复情况？everydaypractice:patients/athletes每天训练：病人/运动员•rehabilitation(trainigmode–biofeedback)康复（训练模式-生物反馈）introductionclin.appl.researchuptodateeverydaypractice:patients/athletes每天训练：病人/运动员•diagnosticsandtreatmentevaluationandrehabilitation诊断治疗评估康复•maleathleteafterACLinjury•男性运动员在前交叉韧带损伤之后3month,6month,9month3,6,9个月restorationofstrengthlevelaftertherapy?治疗之后力量水平的恢复FlexreFlexliExtreExtliEccentricIsoconcentricintroductionclin.appl.researchuptodateResearch研究:•strengthdiagnostics力量诊断forexample举例:•differencesinstrengthoftheplantarflexorsbetweenhealthyrunnersandrunnerswithachillestendinopathy健康运动员与阿基里斯肌腱损伤运动员在跖屈力量上的差异•shoulderstrengthcapacityandsupraspinatustendinopathy肩关节力量能力和冈上肌肌腱病•istrunkstrengtharelevantfactorinlowbackpain躯干力量是下腰痛的一个相关因素•…Bauretal.Trunkextensorandflexorstrengthoflongdistanceracecardriverscomparedtophysicallyactivecontrols.JSportsSci.(2010)长距离驾车驾驶员的躯干伸肌与屈肌力量身体主动控制对比Bauretal.Reactivity,stability,andstrengthperformancecapacityinmotorsports.BrJSportsMed(2006)运动中的反应，稳定性，力量能力introductionclin.appl.researchuptodateResearch研究:•standardizedtestsituations标准测试状态•thicknessofAchilles/Patellatendonindifferentjointanglesandloadingsituations阿基里斯/髌骨肌腱在不同关节角度和负载状态下的厚度wellcontrolledposition,velocity,loading很好的控制姿势，速度，负载Aryaetal.2009•objectivity/reliability客观性/可靠性•themachinesareaccurate仪器准确性•variabilitycomesfromthesubjectinthespecifictestsituation目标特殊测试状态下的可变性Mülleretal.Reproducibilityofisokineticsingle-andmulti-jointstrengthmeasurementsinhealthyandinjuredathletes.IsokineticsandExerciseScience(2007)健康与损伤运动员单与多关节等速力量诊断的再现等速与训练科学2007introductionclin.appl.researchuptodateResearch研究:•standardizedstrengthtraining标准的力量训练•RCT;6weekstrainingintervention随机对照实验：6周的训练standardizedtraining标准训练introductionclin.appl.researchuptodate„ballisticmode““弹道模式”flexionextension0problemin„classicmode“经典模式“的问题:realspeedmaynotreachpresetspeedlimits:不能达到预设的速度reasons原因•physics(Newton´slaws)物理性:patients/athleteshavetoovercometwofactorstoreachspeedlimit:病人和运动员必须克服两个因素达到预设的速度•gravity(gravitationalforcethatoccursbetweenearthandotherbodies)重力（地球与身体之间的引力）•momentofinertia(dependingon:mass;radius)惯性（决定于：质量，半径）introductionclin.appl.researchuptodate„ballisticmode““弹道模式”Consequence(„classicmode“)结论（经典模式）•incorrectinterpretationofdata错误的数据解释:•ameasuredvalueiscorrelatedtoawrongvelocity测量值与错误的速度相关联•themeasuredvalueiseffectedthroughacceleration/decelerationmoments(noisokineticphase)诊断值受加速，减速运动的影响（无等速阶段）•patients:reasonablevelocitiesinactivemovementsnotalwayspossible(especiallyintheinitialphaseofrehabilitation)病人：在主动运动中，合理的速度不总是存在（尤其在康复的初期）•athletes:„highspeed“testing/trainingisnotpossible运动员：”高速“测试与训练不可能flexionextension1801800[°/s]0[Nm]introductionclin.appl.researchuptodate„ballisticmode“”弹道模式“naturalmovement自然运动naturalmovement自然运动isokineticmovement等速运动naturalmovementspeed自然运动速度:•walking步行:膝关节knee140-320°/s•running跑步:膝关节knee150-185°/s(8,0km/h)(Li1999)•pitching投掷:肩关节shoulder-8500°/s(internalrotation内旋)(Murray1999)•throwing投掷:肘关节elbow1000°/s(McNaughton2004)„ballisticmode““”弹道模式“:activecompensationofgravityandinertia重力和惯性主动补偿introductionclin.appl.researchuptodate„ballisticmode“弹道模式Method方法•subjects目标:N=25(healthy)健康•material材料:rotationalandlineardynamometer(Con-trexMJ/LP/TP/WS)旋转和线性测力计•Protocol方式:max.strengthmeasurements最大力量诊断(5rep.5次;60secondsrest60秒休息)inclassicandballisticmode(randomized)经典和弹道模式（随机）•4differentmovements4种不同的运动(kne