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非常感谢 非常荣幸
thank you very much i'm honored to be

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也非常高兴受邀来参加此次论坛
here and delighted to have been

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但是有一点
invited i um the only problem for me is

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就是我感觉自己真的很愚笨啊
i feel so dumb compared to you all

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因为在座各位可以说四五种语言
you don't need a translator you speak

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不需要翻译帮忙
four or five languages

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很多人说我需要一个翻译协助
most people think i need a translator

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翻译熟悉我的语言
and they speak my language

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那么来看看今天我们的内容吧
so um we'll see what we can do from here

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关于本次论坛，我发现自己收到的标题
so uh i was actually given the title for

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实际上有些难度的
this talk which i found challenging

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因为回顾过往30年
to think over the last uh 30 years

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事实上我已经在这个领域
uh i actually have been in the

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从业55年
profession for 55 years

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所以要在40分钟时间内完成自己的陈述
and then to do it in 40 minutes so um

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我们需要抓紧时间啊
we're going to have a quick run through

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那么
here

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我的计划表中
um so there's several things that are

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有几项非常重要
really important on my agenda and one of

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而其中一项是
them is

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物理治疗的转型
this transition in in physiotherapy

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30年前
uh so going back 30 years which is about

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也就是1980年
1980

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当时我所了解的
the identity as i saw it of

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物理治疗的身份得以确立
physiotherapy at that time was the

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是由于
emergence of

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手法治疗开始作为
manual therapy to an important part of

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肌骨管理方法的一个重要组成部分
musculoskeletal management

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而这件事之所以这么重要
and i think what was so important about

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就是因为
it is that

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这是首次
really for the first time

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物理治疗师开始寻求
physiotherapists were figuring something

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弄明白一些问题
out

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而在此之前，他们多侧重于
rather than just doing something to

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病患治疗
treat patients

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另外，手法治疗还有一个重要方面是
and but the the other side of manual

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这种治疗起初
therapy was that the time

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非常被动
initially it was pretty much passive

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并不重视
without any emphasis

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身体运动或肌肉功能
on exercise or muscle function and i had

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我在其他治疗师之前已经了解到
already learned that that muscles move

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肌肉推动关节移动
joints long before therapists knew how

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也正是这个工作原理
to move joints because that's the way it

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标志着我在这个领域研究的开始
was when i started

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除此之外，还有麦肯基疗法
there was also the McKenzie method which

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我个人对其疗法的综合理解是
was sort of a self-manipulation i'm

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它是一直自我操作的方法
paraphrasing of course all of this and

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而我所了解到的
then the only person that i knew of that

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对肌肉问题有所论及的
was somewhat talking about muscles was

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是Vladimir Yonda
vladimir yonda and he had his sort of

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他研究的是肌肉协同
muscle synergy things

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和肌肉训练
and sort of a little bit of muscle

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而我认为
training

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从这些研究可以看出我们正处于转型中
where i think we are the big transition

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而且关于这个行业
and this has been a

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我最感兴趣的方面
major part of my interest for the

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也正是形成身份认同
profession is developing an identity

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2013年
and in night in 2013 the american

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美国物理治疗协会（APTA）宣布
physical therapy association declared 

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人体运动系统的
the human movement system as the

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物理治疗身份
identity of physical therapy

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我认为这一点非常重要
and i think this is just really critical

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因为对我们来说其重要性
because i think what what's so important

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在于它关注的
for us is to be in charge of a body

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不仅仅是完成某项活动的人
system not just people that do things

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而是整个
but have responsibility for a system of

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人体系统
the body

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我们已经了解
and what we have is knowledge of its

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人体系统的功能
functions and the other part that i

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而关于其重要性
think is so important about this and

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特别是诸位对运动的理解
particularly you people related to

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是
sports

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将其视为全生命周期从业者
is that we should be life span

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我们要协助
practitioners we should be helping to

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提高
shape

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身体效能
the performance of a body from the time

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从人体开始能活动一直到
people start to move until they

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生命不支持任何活动
can't move anymore and my analogy is

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我的比喻是牙颌模型
with the dental model people go to the

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人们有牙齿的时候会去看牙医
dentist when they get their teeth and

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而即使后来牙齿掉光了
then they keep going even after they

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还是要去看牙医
don't have teeth

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所以生命不支持时
so uh it's much harder to get people to

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再让人去动就很难了
move when they can't move but

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我们如果早点开始动
if if we start out early then i really

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相信就可以降低
believe we can reduce the incidence of

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肌骨痛的发病率
musculoskeletal pain or

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或者可以推迟发病时间
or put it off for a while and the other

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我认为还有一点至关重要
thing that i believe is absolutely

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就是我们要
critical is that we have to have

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确定症状和诊断类别
defined syndromes and diagnostic

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在你贴上标签之前
categories no one will ever think you

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人们并不会了解
figure anything out until you put a

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你是否弄明白任何问题
label on it

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所以我们要
and we've got to get in the habit of

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养成归类的习惯
having labels

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另外 我认为
so i think the other thing that we're in

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我们正处于重大的转型过程中
the major transition of and maybe this

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而或许这只是我一厢情愿的看法
is wishful thinking but there's

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但诸多迹象表明
many indications of this is that instead

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转型并非侧重病理解剖问题
of a big focus on patho anatomical

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而是
problems

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聚焦在
is a focus on the whether you call it

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运动损伤（不知道您是否这样称呼）
it's movement impairments and one form

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它探讨的是病理运动学
is to talk about pathokinesiology

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即某种形式的病理诱发
how some form of pathology induces

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运动障碍
movement faults

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而我认为我们应该关注的是
but what i think we should be really in

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我所谓的
charge of is what i call kinesio

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运动病理学
pathology

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即运动如何诱发身体问题
which is how movement induces problems

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那么这是一份
so this is a diagram developed at

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华盛顿大学
washington university

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为运动系统制作的图表
uh for the movement system and of course

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它比较显著的一点是
what's so wonderful about it it takes in

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其囊括的内容非常全面
everything as you all know so well the

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包括肌骨系统和神经系统
musculoskeletal and nervous systems

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肌骨系统主要负责
musculoskeletal being the primarily

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操作执行运动
effector of movement

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而神经系统发挥调节功能
and the nervous system the regulator and

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当然
of course

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还有心肺和内分泌
the cardiopulmonary and endocrine

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系统
systems

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心肺系统用于
cardiovascular systems which you need to

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保持其他系统健康
keep the other systems healthy but

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但是这些系统都受到运动影响
they're also affected by movement

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在美国我一直说
i kind of keep saying in america we're

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我们做这个实验
doing this this experiment

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产生的数据非常乐观
the data's coming in good the experiment

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实验目的是将运动限定于
is to lift limit our movement to elbow

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通常使用勺子或餐叉时
flexion and extension usually with a

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肘部的屈曲和外展
spoon or a fork

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而且实验结果的确显示变胖
and it does show out that you get obese

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罹患心脏疾病
and then you get heart disease and

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和糖尿病
diabetes

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因此数据真的很有参考价值
so that data is coming in really good

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无论如何
anyway

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我们面临的一个突出问题
one of our big problems the definition

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即华盛顿大学开发的运动系统
of the movement system developed at

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是一套
washington university is a system of

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生理器官系统
physiological organ systems

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这些系统交互产生且支持
that interact to produce and support

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机体和其组成部分的
movement of the body and its component

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运动
parts

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而且我认为
and i believe that the diagnosis that

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物理治疗师
physical therapists physiotherapists

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应做出的诊断
should make

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属于运动系统诊断
are movement system diagnosis they

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这些诊断就像是
should be ones of this system just as

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神经科医生进行神经学诊断
the neurologist makes neurological

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心脏病专家进行心脏诊断 
diagnosis the cardiologist makes cardiac

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等等
diagnosis etc okay and and i think it

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Paula Ludwig的一篇社论里
was explained well in an editorial by

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很好地阐释了这一点
paula ludwig

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她是一位肩部研究员
who's a investigator on the shoulder

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非常优秀
very very good one

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关于物理治疗师做出的诊断
and she said regarding diagnosis by

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她认为
physical therapists

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物理治疗师针对的是运动相关的损伤
that pts treat movement related

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而非
impairments rather than structural

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结构解剖问题
anatomical problems and using anatomical

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使用解剖标签造成
labels creates a disconnect between the

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标签和治疗的脱节
label and our treatment

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而运动系统标签的好处是
and the advantage of a movement system

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它与我们的身份认同
label is it's consistent with our

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是一致的
identity

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我们的专业知识培训 我们的执照
our expertise training our license and

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我们的疗法
our treatment

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侧重于动作检查
it prioritizes the movement exam which

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而这一点目前是欠缺的
is where i think things are deficient

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而对于评估
and evaluation and it uses standard

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则采用我们这个领域的
kinesiology terminology within our scope

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运动机能学术语
of practice

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所以我希望诸位可以认识到
so i i'm hoping you'll see the rest of

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接下来的材料与
this material falls in line with that

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我们的认知
so what do we know now well i think

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或者说我们将要认识到的情况相一致
we're beginning to know

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我们逐渐认识到运动的关键性
that movement is really key and can

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运动可能引发损伤
become impaired and cause

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运动可能造成肌骨痛
musculoskeletal pain this is what i

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以上就是我所谓的主要变化和观念
consider the main

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这种理解是基于
changes and concepts at least as i've

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我在该领域50多年的积累
been around for these 50 odd years

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肌骨痛并非
that musculoskeletal pain is not a

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短时间内形成的
short-term problem with

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通过治疗让相关身体组织
tissues fully restored to normal with

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完全恢复正常
treatment

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病理结构问题
that the patho anatomical problem is

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产生的原因是
induced by progressive

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生活方式
micro trauma related to degenerative

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和个人特质的
changes in lifestyle

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退化病变相关的轻伤
and personal characteristics that

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运动损伤是
movement impairments induced are induced

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由于
by

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神经肌肉骨骼适应性产生的
neuromusculoskeletal adaptations

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继而导致
and they result in changes in the

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关节内和关节间运动精准度的变化
precision of intra and inter-joint

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而这些运动会引发
motions that creates this micro trauma

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导致重大创伤的微小创伤
that leads to macro trauma

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00:06:33,360 --> 00:06:34,880
我想对我来说
and then i guess the really prevailing

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非常普遍的一个问题是
question for me and i i hope this is uh

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我希望这个理论是合理的
the theory the theory will turn out to

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原因是该理论会
be right because it will increase the

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增加物理治疗师角色的重要性
importance of your roles

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而且这些时间的演化
is that is this really the progression

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最终会引发
of events that eventually results in

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骨关节炎
osteoarthritis

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因此我们创建了这样一个小模型
so we have this little model called a

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叫做运动病理模型
kinesio pathological model

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这里包含肌骨神经系统
and musculoskeletal nervous system

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心肺系统
cardiopulmonary

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内分泌系统 等等
endocrine systems etc and i think

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我想生物力学
biomechanics is the critical interface

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对于这些系统的互相作用非常关键
in the interaction of these systems the

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这些问题的诱因
inducers

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是重复动作和
of the problem are the repeated

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日常活动的持续比对
movements and sustained alignments of

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实际上
everyday activities and of course the

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修改的是
modifiers are your own personal

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个人特征
characteristics

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出现肌肉性能的
you get tissue adaptations in muscle

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身体组织适应性
performance

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肌平衡失调 相对劲度
imbalanced muscle relative stiffness and

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和我所谓的相对柔性
what i call relative flexibility

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以及由此引发的脊柱附属动作
and then this leads to hypermobility of

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运动过度
spinal accessory motions

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也很可能引发某种微不稳定性
and probably a form of micro instability

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继而导致大的创伤 等等
and then the micro trauma etc so

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所以这张图比较宏观
this is

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如果我们补充
the big picture and if we fill in a

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一些细节的话
little bit of the details

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就很显然
just to make it hopefully even more

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正是由于
clear that it's

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日常活动
everyday activities that give the

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引发了
problem

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肌骨系统问题
you get the musculoskeletal changes and

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和神经系统问题
the nervous system i think

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要是还能工作50年
if i had 50 more years i'd be so focused

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我会全力
on

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研究如何达到训练效果
understanding more about how you get

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研究是哪种操作方式
what you train the way you do things you

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让你陷入困境
get stuck with

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研究哪些地方难以改变
and that's what's hard to change around

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这些正是
and of course that's what we have to

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我们需要改变的地方
change around

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这些个体特点
these individual characteristics

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结构变化 性别
structural variations sex

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系统性的过度活动
generalized hypermobility how active you

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运动量的大小
are inactive you are

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这些都能采用运动
all lead to these adoption of movement

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和
movement

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这些活动的比对模型
and alignment patterns with these

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而后将遍及
activities and then it gets generalized

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其他所以的活动
across all activities whether you're

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不管坐于桌前还是做运动
sitting at a desk or playing a sport

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你都拥有一种基本的运动模式
you have a basic pattern of movement

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你会固定在这种运动模式中
that you are stuck with

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在关节和比对运动中
you get this specific alteration in

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你可以获得某些改变
joint and alignment movement

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有些身体部位比其他部位更灵活柔韧
some parts become more flexible than

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因此
other parts and therefore move too

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更容易活动
readily

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同时也改变了负荷
and you get altered loading and

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积累了压力
accumulation of stress

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那么我尝试为大家提供一些
so i'm going to try to give you some of

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这些理念背后的
the the research support

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研究支持
behind these ideas and i've tried to put

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我一直致力于我所谓的
my focus on what i think are the two key

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两个关键概念
concepts

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即 相对柔性和
which are relative flexibility and

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相对劲度
relative stiffness

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那么我们对这两者了解有多少呢？
so what do we know about these well we

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我们有非常可靠的
have a movement exam

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动作检查
with good reliability this is what what

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而这是 Linda Van Dillon 的研究
uh linda's van dillon's research has put

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为所做的贡献
in place for us

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00:08:59,839 --> 00:09:02,480
也就是动作检查
so this movement exam and and we i'll

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00:09:02,480 --> 00:09:04,320
这部分是参考文献
have some references here

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00:09:04,320 --> 00:09:06,560
这些都非常可靠
is we we have pretty good reliability on

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我们可以将
that we can classify patients with low

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下背痛患者
back pain

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进行分组
into groups based on the direction of

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这种分组主要是依据患者症状方向
their symptoms

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00:09:13,920 --> 00:09:16,240
那么我们有患者通过脊椎活动
so we have patients move their spine as

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和四肢活动
well as move their limbs

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00:09:17,680 --> 00:09:20,080
来看看这些活动是如何引发疼痛
see how that causes pain we let them

287
00:09:20,080 --> 00:09:22,320
我们让患者以患者喜欢的方式活动
move in their preferred way we see that

288
00:09:22,320 --> 00:09:23,680
我们发现患者其动作不对时
they're not doing it right

289
00:09:23,680 --> 00:09:25,760
会帮助纠正
we correct it and look at the effect on

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00:09:25,760 --> 00:09:27,120
然后看对症状有没有改善
their symptoms

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00:09:27,120 --> 00:09:28,640
我们根据诊断类别
we've also characterized different

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00:09:28,640 --> 00:09:30,959
来描述不同的
features according to this diagnostic

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特征
category

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而后再检查模型的特征
and then examine some features of the

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正如我上述提到的
model as i say

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相对柔性和
relative flexibility and relative

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相对劲度
stiffness

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所以物理检查往往
so the physical examination always

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00:09:41,120 --> 00:09:42,240
始于
starts with

300
00:09:42,240 --> 00:09:44,880
站立 坐下 钩躺 侧卧
standing sitting hook lying side lying

301
00:09:44,880 --> 00:09:45,519
俯卧
prone

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00:09:45,519 --> 00:09:47,360
四足跪 
quadruped and the exam is the same

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00:09:47,360 --> 00:09:49,279
不管我们是针对背痛
whether you're looking at a back pain

304
00:09:49,279 --> 00:09:51,600
髋痛 
hip pain or even hallux valgus of the

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00:09:51,600 --> 00:09:52,720
还是大拇脚指外翻
big toe

306
00:09:52,720 --> 00:09:54,000
检查都是一样的
you you because these are

307
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因为身体各部分在生物力学上属于相互作用
biomechanically interacting segments and

308
00:09:56,160 --> 00:09:57,680
我们无法在不受其他部分的影响下
you can't take one out

309
00:09:57,680 --> 00:10:00,160
单独考虑其中一部分
without being affected by the others and

310
00:10:00,160 --> 00:10:01,440
而后我也列出了
then i've just listed

311
00:10:01,440 --> 00:10:03,760
一些相关研究
how some of the studies that have put

312
00:10:03,760 --> 00:10:05,200
它们在体格检查和分类方面
reliability behind

313
00:10:05,200 --> 00:10:07,680
都非常重视可靠性
these examinations and the

314
00:10:07,680 --> 00:10:09,360
另外
classifications and again

315
00:10:09,360 --> 00:10:12,720
还有一些参考文献
a a list of references

316
00:10:12,720 --> 00:10:14,800
来支持这一理念
that support the idea that we can

317
00:10:14,800 --> 00:10:16,240
该理念认为
classify people with

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我们可以根据引起症状的原因
low back pain according to the direction

319
00:10:18,640 --> 00:10:22,000
来对后背部疼痛进行分类
that causes their symptoms

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00:10:22,000 --> 00:10:24,240
那么相对灵活和
so what about relative flexibility and

321
00:10:24,240 --> 00:10:26,079
相对劲度是什么呢？
relative stiffness and i think

322
00:10:26,079 --> 00:10:28,079
个人认为，两者非常关键
these are really key and that's why i

323
00:10:28,079 --> 00:10:29,920
所以我曾想要重点研究这一模块
wanted to kind of focus on them

324
00:10:29,920 --> 00:10:32,160
我认为这一理念
i believe that they're generic to

325
00:10:32,160 --> 00:10:33,760
可以广泛应用于理解各个关节的运动损伤
movement impairments at all joints

326
00:10:33,760 --> 00:10:36,240
而非仅仅停留在后背部
not just in the low back but all joints

327
00:10:36,240 --> 00:10:37,040
也要包含如肩 髋 shoulder hip

328
00:10:37,040 --> 00:10:40,240
颈 等关节 相对灵活
neck etc and that relative flexibility

329
00:10:40,240 --> 00:10:41,279
和
and

330
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我们一直在说
as we were saying before we started one

331
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在开始理疗新难题
of our challenges in physiotherapy is

332
00:10:45,120 --> 00:10:45,519
之前
that

333
00:10:45,519 --> 00:10:47,920
很多人会使用不同的术语
so many people use different terminology

334
00:10:47,920 --> 00:10:49,440
来描述同一现象
for the same phenomena

335
00:10:49,440 --> 00:10:51,040
很可能我就是
and i'm probably you know one of the bad

336
00:10:51,040 --> 00:10:53,360
其中个负面案例
ones as well but

337
00:10:53,360 --> 00:10:54,640
但是相信我们可以解决其中的某个问题
hopefully we'll get it all worked out

338
00:10:54,640 --> 00:10:57,279
那么相对柔性
one of these days so relative flex

339
00:10:57,279 --> 00:10:59,360
在我看来指的是
flexibility to me means the intrinsic

340
00:10:59,360 --> 00:11:00,959
关节本身的内在运动
movement of the joint itself

341
00:11:00,959 --> 00:11:03,839
这些是附属运动
these accessory motions and that what

342
00:11:03,839 --> 00:11:05,440
我想说的是我认为
i'll try to show you is that i believe

343
00:11:05,440 --> 00:11:07,200
关节内活动
that intra-joint motion

344
00:11:07,200 --> 00:11:10,000
可能不那么精确
can become imprecise and that one of the

345
00:11:10,000 --> 00:11:11,680
其中一种附属运动
accessory motions

346
00:11:11,680 --> 00:11:13,680
可能比其他运动更容易做到
occurs too readily than the others for

347
00:11:13,680 --> 00:11:15,440
例如滑动
example glide

348
00:11:15,440 --> 00:11:19,120
就比卷起或旋动更容易
rather than roll or spin and that

349
00:11:19,120 --> 00:11:22,079
也可能出现过度运动
that motion also becomes excessive so

350
00:11:22,079 --> 00:11:24,240
有可能是动作幅度的增加
it's increased in its range and it's

351
00:11:24,240 --> 00:11:25,760
也有可能是
increased in the frequency of its

352
00:11:25,760 --> 00:11:27,360
动作发生频率的增加
occurrence

353
00:11:27,360 --> 00:11:29,040
关节内运动指
interjoint movement means when you put

354
00:11:29,040 --> 00:11:30,640
将两个关键放在一起
it together with another joint

355
00:11:30,640 --> 00:11:33,440
如背和髋 如果弯腰
like back and hip if you bend over and

356
00:11:33,440 --> 00:11:35,200
那么背部的屈曲就超过髋部
your back flex is more than your hips

357
00:11:35,200 --> 00:11:35,839
那么
then you got

358
00:11:35,839 --> 00:11:37,839
就呈现出关节内相对灵活
inter-joint relative flexible

359
00:11:37,839 --> 00:11:39,040
即 关节内
inter-joint

360
00:11:39,040 --> 00:11:42,320
相对灵活性
relative flexibility okay and then so

361
00:11:42,320 --> 00:11:43,040
那么这就是一个
that's one

362
00:11:43,040 --> 00:11:45,200
显著的现象
big phenomenon the joint moves too

363
00:11:45,200 --> 00:11:47,519
关节活动太灵活 可以进行附属动作readily using accessory motion

364
00:11:47,519 --> 00:11:49,279
那么其中一个有帮助的因素是
and then one of the contributing factors

365
00:11:49,279 --> 00:11:50,639
我所说的
is what i call relative

366
00:11:50,639 --> 00:11:53,200
相对劲度 而这基本上
stiffness and this is basically the

367
00:11:53,200 --> 00:11:55,519
是肌肉和连接组织的
passive tension of muscle and connective

368
00:11:55,519 --> 00:11:56,560
被动张力
tissue

369
00:11:56,560 --> 00:11:58,639
可以称之为
and it's defined as a change in tension

370
00:11:58,639 --> 00:12:00,240
每单位长度的变化所带来的张力变化
per unit change in length at least this

371
00:12:00,240 --> 00:12:02,240
这部分不是我杜撰
part i didn't make up

372
00:12:02,240 --> 00:12:05,200
而是合情合理
this is legitimate and and i think it's

373
00:12:05,200 --> 00:12:07,440
我想描述这一点最好的方法是
best depicted by having a couple uh

374
00:12:07,440 --> 00:12:10,000
使用一组弹簧
springs and what they never took me when

375
00:12:10,000 --> 00:12:11,839
我在上肌肉生理学课时
i was told me when i was taking muscle

376
00:12:11,839 --> 00:12:13,040
从没听到过这种说法
physiology i

377
00:12:13,040 --> 00:12:15,040
我意识到这些优美的弧线
i got the idea of those nice curves and

378
00:12:15,040 --> 00:12:16,720
并且说这是
said this is the passive tension of a

379
00:12:16,720 --> 00:12:17,360
肌肉的被动张力
muscle

380
00:12:17,360 --> 00:12:19,760
但是他们并没有这么告诉我
but they didn't tell me it changed that

381
00:12:19,760 --> 00:12:21,600
这种认知变迁花费了20年 我动作还是很快的
took 20 years because i'm swift

382
00:12:21,600 --> 00:12:24,399
无论如何 
anyway so if you get a muscle that's

383
00:12:24,399 --> 00:12:25,200
你的肌肉是这种大块的
this big

384
00:12:25,200 --> 00:12:27,040
那它就比这种小块的更坚硬
it's a lot stiffer than one that's this

385
00:12:27,040 --> 00:12:30,079
如果把这些都放在一起
big and if you put these in series

386
00:12:30,079 --> 00:12:32,959
刚度最小的弹簧就可以给出
the least stiff spring gives and i

387
00:12:32,959 --> 00:12:34,079
我真的相信
really believe that what we've

388
00:12:34,079 --> 00:12:35,839
我们被打断了那么久
interpreted for so long as muscle

389
00:12:35,839 --> 00:12:37,120
实际上肌肉缩短
shortness is not

390
00:12:37,120 --> 00:12:40,560
并非相对刚度的问题
it's a relative stiffness problem okay

391
00:12:40,560 --> 00:12:44,000
那么这就是基本理念
so that's the underlying idea here

392
00:12:44,000 --> 00:12:47,040
另外还有一些
and it was little things like during

393
00:12:47,040 --> 00:12:48,880
临床检查期间的小问题让我
clinical exams that would always bother

394
00:12:48,880 --> 00:12:49,519
很困扰
me

395
00:12:49,519 --> 00:12:52,480
例如 这位女士
for example this woman is sliding her

396
00:12:52,480 --> 00:12:54,240
将髋关节滑入外展姿势
hip into extension
 
397
00:12:54,240 --> 00:12:55,839
那么我们可以看到她只活动了
and you can see she's only moved about

398
00:12:55,839 --> 00:12:58,160
30度就出现了
30 degrees before her pelvis is going

399
00:12:58,160 --> 00:12:58,639
骨盆前倾
into an

400
00:12:58,639 --> 00:13:02,160
其指症是
anterior tilt as indicated by the 

401
00:13:02,160 --> 00:13:06,160
我的拇指到她髂前上棘时
movement of my thumb on her asis well

402
00:13:06,160 --> 00:13:08,240
并没有出现肌肉缩短
that cannot be muscle shortness because

403
00:13:08,240 --> 00:13:10,160
她的肌肉并没有
you have not come close to the end of a

404
00:13:10,160 --> 00:13:11,200
完全展开
muscle length

405
00:13:11,200 --> 00:13:14,399
她这个姿势做的特别容易
it's happening much too readily so i

406
00:13:14,399 --> 00:13:15,760
所以我想了解
wanted to know why

407
00:13:15,760 --> 00:13:18,320
如果她有肌肉缩短
would her pelvis tilt with such little

408
00:13:18,320 --> 00:13:19,040
那么
movement

409
00:13:19,040 --> 00:13:21,440
为何她髋部这么小幅度的动作就发生了骨盆前倾
of her hip if this was muscle shortness

410
00:13:21,440 --> 00:13:23,200
这完全讲不通啊
it didn't make any sense

411
00:13:23,200 --> 00:13:25,120
那么这就是一个
so i this is an example to me of

412
00:13:25,120 --> 00:13:27,120
相对灵活的典例
relative flexibility

413
00:13:27,120 --> 00:13:30,160
她背部随骨盆活动
her back moved much too easily with her

414
00:13:30,160 --> 00:13:32,720
的移动过于灵活
pelvis and then i would also be confused

415
00:13:32,720 --> 00:13:34,800
那我就是很困惑了 
because i would test other people

416
00:13:34,800 --> 00:13:36,800
因为我测试了哪些髋屈肌比较短的人
who actually had a short hip flexor but

417
00:13:36,800 --> 00:13:38,000
而他们并没有
they didn't have an

418
00:13:38,000 --> 00:13:40,880
骨盆前倾
anterior pelvic tilt so it didn't make

419
00:13:40,880 --> 00:13:42,160
所以这讲不通啊
sense

420
00:13:42,160 --> 00:13:43,920
另外我还发现
this kind of person then what i also

421
00:13:43,920 --> 00:13:45,760
这位并没有背痛
realized is this person did not have

422
00:13:45,760 --> 00:13:48,079
但是这位有发生背痛
back pain but this person did

423
00:13:48,079 --> 00:13:49,839
所以背部活动
so it was the back moving that was the

424
00:13:49,839 --> 00:13:51,760
才是关键问题
critical issue not how short a muscle

425
00:13:51,760 --> 00:13:52,240
而不是肌肉缩短
was

426
00:13:52,240 --> 00:13:54,639
后者与之关联不大
that didn't have that much to do with it

427
00:13:54,639 --> 00:13:57,360
这是另一种
okay and this was another way in which i

428
00:13:57,360 --> 00:13:59,440
我用以切换这个问题描述的方法
cut on to trying to depict this this

429
00:13:59,440 --> 00:14:02,160
因此在这种情况下
issue so in this case if someone flexes

430
00:14:02,160 --> 00:14:03,199
如果有人屈膝
their knee

431
00:14:03,199 --> 00:14:05,120
且一切正常
and nothing happens here it's because

432
00:14:05,120 --> 00:14:06,480
那就是因为弹簧
this spring

433
00:14:06,480 --> 00:14:09,040
我们又称之为
we'll call it the rectus femoris tensor

434
00:14:09,040 --> 00:14:09,920
股直肌阔筋膜张肌
fasciae latae

435
00:14:09,920 --> 00:14:13,519
比这三类结构的伸展性更好
is more extensible than these structures

436
00:14:13,519 --> 00:14:16,160
在这个案例李屈膝
well in this case flexing the knee

437
00:14:16,160 --> 00:14:18,320
引发骨盆前倾
causes anterior pelvic tilt because the

438
00:14:18,320 --> 00:14:19,920
是因为其腹部和
support from the abdominals

439
00:14:19,920 --> 00:14:22,800
背部的支撑不如
and the back is not as great it's not as

440
00:14:22,800 --> 00:14:23,440
这个部位的肌肉
stiff

441
00:14:23,440 --> 00:14:26,800
力量更强大
as this muscle right here so

442
00:14:26,800 --> 00:14:28,399
那么这里是一个视频
this is a video if you'll play that

443
00:14:28,399 --> 00:14:30,720
播放视频就可以发现它展示了个体发生
video to just depict this happening in

444
00:14:30,720 --> 00:14:32,000
发生的这种情况
an individual

445
00:14:32,000 --> 00:14:34,000
它为我们所做工作的
and it's formed the basis of some of the

446
00:14:34,000 --> 00:14:36,000
某些实验室分析提供了依据
laboratory analysis that we're doing

447
00:14:36,000 --> 00:14:39,040
那么髋外旋会引发
so hip lateral rotation is causing

448
00:14:39,040 --> 00:14:42,639
腰骨盆旋转
lumbar pelvic rotation

449
00:14:42,639 --> 00:14:44,959
所以只要她做内旋
so as soon as she moves with both medial

450
00:14:44,959 --> 00:14:46,240
和外旋的动作
and lateral rotation

451
00:14:46,240 --> 00:14:49,360
她就会有腰骨盆旋转
she gets lumbo pelvic rotation well and

452
00:14:49,360 --> 00:14:50,959
那么如果我们仔细观察
then if we take a look and play this

453
00:14:50,959 --> 00:14:52,399
请播放视频
video please

454
00:14:52,399 --> 00:14:55,199
我们所能看到的是当她行走时
what do we see is that when she walks

455
00:14:55,199 --> 00:14:57,040
各位猜一下
guess what she gets

456
00:14:57,040 --> 00:15:00,800
是什么原因导致她的腰骨盆旋转
lumbo pelvic rotation so the the fact

457
00:15:00,800 --> 00:15:02,800
实际上她的走路姿势
that she walks that way

458
00:15:02,800 --> 00:15:06,079
导致其腰椎松动
mobilizes her lumbar spine and it's so

459
00:15:06,079 --> 00:15:08,320
从而导致如膝部屈曲或者髋关节旋转这样的
mobile that something as benign as knee

460
00:15:08,320 --> 00:15:08,880
良性现象
flexion

461
00:15:08,880 --> 00:15:11,440
引发同意的活动
or hip rotation causes the same motion

462
00:15:11,440 --> 00:15:12,720
的出现
to occur

463
00:15:12,720 --> 00:15:14,240
那么这对于我们的意义是什么呢
so what does this mean to us it means

464
00:15:14,240 --> 00:15:16,480
要制止她的这种走路姿势
you got to stop the way she walks

465
00:15:16,480 --> 00:15:18,800
严格来讲这并没有任何作用
it won't matter i'm serious so she rides

466
00:15:18,800 --> 00:15:20,240
他随时随地都是这种步态
everywhere now no no no

467
00:15:20,240 --> 00:15:24,639
我们要做的是教她
no no so we had to teach her how to walk

468
00:15:24,639 --> 00:15:25,440
重新学习走路
again

469
00:15:25,440 --> 00:15:27,839
这样就可以预防她恶化为腰骨盆
so that she didn't get lumbo pelvic

470
00:15:27,839 --> 00:15:28,880
旋转
rotation

471
00:15:28,880 --> 00:15:31,120
另外还想之处一点
and and just to point out about personal

472
00:15:31,120 --> 00:15:33,040
个人特征而言 她存在明显的
characteristics she's obviously has very

473
00:15:33,040 --> 00:15:34,240
骨盆宽大
broad pelvis

474
00:15:34,240 --> 00:15:35,600
原因并非仅仅是
well it's not just because she's

475
00:15:35,600 --> 00:15:36,959
她的肥胖
overweight but i'm sure she has

476
00:15:36,959 --> 00:15:38,560
相信还有髋部coccyvera的问题
coccyvera hips

477
00:15:38,560 --> 00:15:40,560
这种步态出现的原因是
and the reason why this plays into it is

478
00:15:40,560 --> 00:15:42,480
她睡觉时采取的是侧卧位
that when she's sleeping on her side

479
00:15:42,480 --> 00:15:44,240
那么由于她骨盆宽大
she goes into a marked side bend because

480
00:15:44,240 --> 00:15:45,839
就导致明显的侧弯
her pelvis is so wide

481
00:15:45,839 --> 00:15:47,440
那么一晚又一晚的重复之后
well you do that night after night and

482
00:15:47,440 --> 00:15:49,600
就诱发腰椎
that mobilizes your lumbar spine into

483
00:15:49,600 --> 00:15:50,560
出现侧屈
side flexion

484
00:15:50,560 --> 00:15:53,120
那么因为持续这样的旋转
so it keeps getting more rotation and

485
00:15:53,120 --> 00:15:54,240
其髋部也变得
her hips keep getting

486
00:15:54,240 --> 00:15:57,600
越来越僵硬
stiffer and stiffer okay

487
00:15:57,600 --> 00:16:00,480
这里显示的是活动的整个流程
so here's the whole flow of activity as

488
00:16:00,480 --> 00:16:01,040
可以看到
we see it

489
00:16:01,040 --> 00:16:03,519
早期的腰骨盆活动
early lumbo pelvic motion increased

490
00:16:03,519 --> 00:16:04,240
频率增加
frequency

491
00:16:04,240 --> 00:16:06,639
组织压力的积累
accumulation of tissue stress low back

492
00:16:06,639 --> 00:16:07,279
后背痛
pain

493
00:16:07,279 --> 00:16:09,519
问题持续或复发
persistence or reoccurrence so all of

494
00:16:09,519 --> 00:16:10,720
那么我们所有的研究
our studies have been done

495
00:16:10,720 --> 00:16:12,880
都是针对慢性腰痛
in people with chronic low back pain not

496
00:16:12,880 --> 00:16:14,160
而非急性腰痛
acute low back pain

497
00:16:14,160 --> 00:16:15,600
实际上也了解
and of course we know everybody that's

498
00:16:15,600 --> 00:16:18,000
急性痛疼终有一天会转化为慢性疼痛
acute will someday become chronic

499
00:16:18,000 --> 00:16:21,600
而且疼痛会复发
we know they'll be back yes okay

500
00:16:21,600 --> 00:16:23,199
那么我们看待这些问题直接关系的方式
so one of the ways we've looked at these

501
00:16:23,199 --> 00:16:25,519
也就是说
relationships is to say well if if

502
00:16:25,519 --> 00:16:27,839
如果因为背部非常灵活，
moving the limbs causes the back to move

503
00:16:27,839 --> 00:16:29,839
导致活动四肢引发背部活动
because it's become so flexible

504
00:16:29,839 --> 00:16:32,800
那么要是我们引活动四肢时
what if we just make them not move their

505
00:16:32,800 --> 00:16:34,560
保持背部不动会怎样呢
back when moving their limbs and see

506
00:16:34,560 --> 00:16:36,639
来看看疼痛是否消失
does the pain go away so these are some

507
00:16:36,639 --> 00:16:38,880
那么这些是Linda发表的研究报告
of the studies that linda has published

508
00:16:38,880 --> 00:16:41,680
其结果显示如果我们修改
showing that if we modified how they

509
00:16:41,680 --> 00:16:42,399
其运动方式
move

510
00:16:42,399 --> 00:16:45,600
他们的症状就会减轻
their symptoms decrease so if we look at

511
00:16:45,600 --> 00:16:48,880
那么如果我们来看一下这个测试
uh our tests these are examples of the

512
00:16:48,880 --> 00:16:51,839
他们是一些检查的示例 
examination test knee ex they're really

513
00:16:51,839 --> 00:16:53,040
属于非常复杂的
kind of complicated

514
00:16:53,040 --> 00:16:56,240
膝关节外展和髋关节外旋
knee extension and sitting hip abduction

515
00:16:56,240 --> 00:16:57,839
屈膝平躺以及
lateral rotation and hook lying knee

516
00:16:57,839 --> 00:16:58,959
俯卧位膝关节屈曲
flexion and prone

517
00:16:58,959 --> 00:17:00,320
我相信在座诸位如果能说四国语言的话
but i think you're smart enough to get

518
00:17:00,320 --> 00:17:01,920
也一定能够无障碍理解这些
it if you can speak four languages you

519
00:17:01,920 --> 00:17:04,079
可以做这次动作
can do these things

520
00:17:04,079 --> 00:17:06,319
俯卧位髋关节旋转 俯卧位髋关节外展
hip rotation in prone hip extension in

521
00:17:06,319 --> 00:17:08,240
这里显示的症状增加的
prone and these are the numbers of

522
00:17:08,240 --> 00:17:08,959
人数
people that had

523
00:17:08,959 --> 00:17:11,039
可以看到数目大的这个是
increased symptoms as you can see a big

524
00:17:11,039 --> 00:17:13,439
俯卧位髋关节旋转
one is hip rotation in prone and hip

525
00:17:13,439 --> 00:17:14,640
俯卧位髋关节外展
extension in prone

526
00:17:14,640 --> 00:17:16,959
而这一点已经成为我们研究的核心
and this became the focus of our studies

527
00:17:16,959 --> 00:17:18,480
这时如果说
now if we say

528
00:17:18,480 --> 00:17:21,599
让你在进行这些运动的时候
okay let's make you not move your back

529
00:17:21,599 --> 00:17:23,599
保持背部不动
while you perform these motions

530
00:17:23,599 --> 00:17:26,480
就可以看到
you can see the percentages of people

531
00:17:26,480 --> 00:17:27,839
阳性测试结果（即显示症状减轻）的
with positive tests

532
00:17:27,839 --> 00:17:29,360
人数比重的情况
that all showed a decrease in their

533
00:17:29,360 --> 00:17:31,919
在四肢活动时
symptoms so stop the back from moving

534
00:17:31,919 --> 00:17:33,360
保持背部固定不动时
when you're moving your limbs and you

535
00:17:33,360 --> 00:17:34,400
患者症状就会减轻
get a decrease

536
00:17:34,400 --> 00:17:37,120
就是这么简单
in your symptoms it's like that simple

537
00:17:37,120 --> 00:17:37,840
好吧
okay

538
00:17:37,840 --> 00:17:39,200
实际上我们目前进展已经非常深入
so now we've gone on to get more

539
00:17:39,200 --> 00:17:41,840
动作捕捉
sophisticated and do motion capture

540
00:17:41,840 --> 00:17:43,440
咱们来更审慎地
to look at some of these tests more

541
00:17:43,440 --> 00:17:45,600
看看这些测试
critically

542
00:17:45,600 --> 00:17:47,520
这是一位准备好的患者
and so this is a person all dressed up

543
00:17:47,520 --> 00:17:49,200
作为我们动作捕捉 分析的模特
for motion capture

544
00:17:49,200 --> 00:17:52,400
这里我想要强调的是
analysis and what i want to

545
00:17:52,400 --> 00:17:54,720
髋关节运动
stress to you here is what is the timing

546
00:17:54,720 --> 00:17:56,480
和腰椎骨盆运动
differences between

547
00:17:56,480 --> 00:17:59,919
之间的
movement of the hip versus lumbar pelvic

548
00:17:59,919 --> 00:18:00,960
时间差
motion

549
00:18:00,960 --> 00:18:04,320
Linda和其同事
okay so one of the studies that linda

550
00:18:04,320 --> 00:18:05,760
所做的其中一项研究是
and her colleagues did

551
00:18:05,760 --> 00:18:08,320
针对背痛和
was to have people with back pain people

552
00:18:08,320 --> 00:18:09,679
不存在背痛的两组人群
without back pain

553
00:18:09,679 --> 00:18:11,440
指导他们做这些小动作
and they did this little simple two

554
00:18:11,440 --> 00:18:13,679
比如俯卧
simple movements they were prone

555
00:18:13,679 --> 00:18:16,320
膝关节屈曲
they did knee flexion and then they did

556
00:18:16,320 --> 00:18:16,880
而后是髋关节旋转
hip

557
00:18:16,880 --> 00:18:20,240
我们发现
rotation okay and what did we find and

558
00:18:20,240 --> 00:18:22,480
这就是分析所采用的方法
this is the way it was analyzed

559
00:18:22,480 --> 00:18:25,120
我们可以以这个视角来观察
we might looked at this angle to see

560
00:18:25,120 --> 00:18:27,280
他们什么时间开始做髋关节运动
when did they start to move their hip

561
00:18:27,280 --> 00:18:30,320
以及多久后
and then how soon did the pelvis

562
00:18:30,320 --> 00:18:34,799
腰椎骨盆开始随即旋转
start to to rotate lumbo pelvic rotation

563
00:18:34,799 --> 00:18:36,880
这是一份
and this is the diagram of how the data

564
00:18:36,880 --> 00:18:37,919
数据采集方式的图表
was taken

565
00:18:37,919 --> 00:18:40,080
低幅度动作是腰椎骨盆旋转
the low amplitude movement of course is

566
00:18:40,080 --> 00:18:42,559
而高幅度动作是
lumbo pelvic rotation the high amplitude

567
00:18:42,559 --> 00:18:43,200
髋关节外旋
is hip

568
00:18:43,200 --> 00:18:45,440
那么我们观察的
lateral rotation and what we're looking

569
00:18:45,440 --> 00:18:46,799
是
at is the

570
00:18:46,799 --> 00:18:49,840
一个动作开始的时间
time difference between when one started

571
00:18:49,840 --> 00:18:52,160
和另一个动作随之发生的时间差
and the other one followed now the idea

572
00:18:52,160 --> 00:18:52,880
背后的逻辑是
being that

573
00:18:52,880 --> 00:18:55,520
这个时间差越大
the bigger this time difference the less

574
00:18:55,520 --> 00:18:57,039
他们做下肢运动时
likely they are to be

575
00:18:57,039 --> 00:18:58,880
背部损伤的
injuring their back when they move their

576
00:18:58,880 --> 00:19:00,559
可能性就越小
lower extremity

577
00:19:00,559 --> 00:19:03,039
他们的相对灵活性能少
are how much less relative flexibility

578
00:19:03,039 --> 00:19:04,720
多少呢
they have

579
00:19:04,720 --> 00:19:07,360
这就是运作原理
so this is the way it works out that if

580
00:19:07,360 --> 00:19:09,520
如果患者不存在腰痛
you do not have low back pain

581
00:19:09,520 --> 00:19:12,720
此处数据是0.3
it's like 0.3 before your

582
00:19:12,720 --> 00:19:15,520
腰椎骨盆旋转之前
lumbar pelvic rotation starts after your

583
00:19:15,520 --> 00:19:16,000
髋关节开始外旋之后
hip

584
00:19:16,000 --> 00:19:18,640
如果
starts to laterally rotate well if you

585
00:19:18,640 --> 00:19:19,840
存在腰痛
have low back pain

586
00:19:19,840 --> 00:19:24,160
那么腰痛就会提早出现
this starts earlier

587
00:19:24,160 --> 00:19:26,000
另外需要
the the other things that to look to

588
00:19:26,000 --> 00:19:27,600
确认
make sure is how much

589
00:19:27,600 --> 00:19:29,679
存在多大的动作幅度
range of motion there was well actually

590
00:19:29,679 --> 00:19:31,200
实际上 如果患者存在腰痛情况
there was slightly more

591
00:19:31,200 --> 00:19:34,320
那么其髋关节外展的
hip lateral rotation range of motion

592
00:19:34,320 --> 00:19:36,400
动作幅度就会稍大一些
if you didn't if you had back pain than

593
00:19:36,400 --> 00:19:38,720
如果患者不存在腰痛情况
if you did not have back pain

594
00:19:38,720 --> 00:19:40,799
那么相信
and we made sure that they weren't

595
00:19:40,799 --> 00:19:42,000
要想做到这个姿势
moving faster

596
00:19:42,000 --> 00:19:43,840
他们动作就会慢很多
that would cause this so the velocity

597
00:19:43,840 --> 00:19:47,600
所以其速度就受到限制
was controlled and that was similar

598
00:19:47,600 --> 00:19:50,960
此处的腰关节骨盆旋转也是同样的原理
here's lumbo pelvic rotation and again

599
00:19:50,960 --> 00:19:54,080
实际上腰关节骨盆旋转
the maximum lumbo-pelvic rotation

600
00:19:54,080 --> 00:19:56,480
这个动作
was actually a little bit greater in

601
00:19:56,480 --> 00:19:58,240
存在腰痛的患者
people that had low back pain

602
00:19:58,240 --> 00:20:00,160
往往比腰不痛的患者动作幅度更大
than in the other people this is just

603
00:20:00,160 --> 00:20:02,000
而这里是此前跟大家提及的时间维度
the time that i showed you before

604
00:20:02,000 --> 00:20:04,240
那么对于膝关节屈曲这个动作呢？
now what about with knee flexion and

605
00:20:04,240 --> 00:20:06,240
这里展示的是膝关节屈曲做得比较灵活的一个
this was a knee flexion performed

606
00:20:06,240 --> 00:20:08,000
此处比较值得思考的一点是
actively and i think what's interesting

607
00:20:08,000 --> 00:20:10,400
在膝屈曲期间
is there was no difference

608
00:20:10,400 --> 00:20:12,559
骨盆前倾患者并没有表现出
in anterior pelvic tilt during knee

609
00:20:12,559 --> 00:20:13,520
有任何不同
flexion

610
00:20:13,520 --> 00:20:16,240
但是在髋关节旋转这个动作上
but there was a difference in pelvic

611
00:20:16,240 --> 00:20:17,679
却存在差异
rotation

612
00:20:17,679 --> 00:20:20,000
所以我再一次推测
now i think again that points out to me

613
00:20:20,000 --> 00:20:20,960
这就暗示捣乱的动作是
the evil motion

614
00:20:20,960 --> 00:20:23,200
旋转 我相信一定是这个动作
is rotation and i believe the evil

615
00:20:23,200 --> 00:20:24,799
因为
motion is rotation because it's

616
00:20:24,799 --> 00:20:26,480
它与另外一个动作偏离相关
associated with shear

617
00:20:26,480 --> 00:20:28,720
它是最具破坏性的因素
and that's the most destructive force

618
00:20:28,720 --> 00:20:30,960
同时也是最难控制的
and also it's the hardest to control

619
00:20:30,960 --> 00:20:33,679
绝对是最难控制的
absolutely the hardest to control so in

620
00:20:33,679 --> 00:20:34,640
所以
people that

621
00:20:34,640 --> 00:20:37,280
不存在腰痛的患者
did not have back pain they had knee

622
00:20:37,280 --> 00:20:38,240
膝关节屈曲这个动作上
flexion

623
00:20:38,240 --> 00:20:40,159
能够停留的时间会更久一点
for a longer period of time before

624
00:20:40,159 --> 00:20:42,240
而后才发生腰椎骨盆旋转
getting lumbo pelvic rotation

625
00:20:42,240 --> 00:20:45,679
而存在腰痛的患者
than people who had back pain

626
00:20:45,679 --> 00:20:48,159
不存在腰痛的患者
and again the maximum knee flexion was

627
00:20:48,159 --> 00:20:50,400
膝关节屈曲的动作幅度
actually a little bit greater in the non

628
00:20:50,400 --> 00:20:52,159
要比腰痛患者更大一些
back pain people than in the back pain

629
00:20:52,159 --> 00:20:54,320
人群差异巨大
people significantly different but

630
00:20:54,320 --> 00:20:57,120
而动作幅度差异是10度
only 10 degrees the velocity again was

631
00:20:57,120 --> 00:20:58,960
速度没有差异
no different

632
00:20:58,960 --> 00:21:01,600
那么从度数这个维度看，情况如何呢？
so what about degrees well we this is

633
00:21:01,600 --> 00:21:02,159
那么这个显示的是
sort of a

634
00:21:02,159 --> 00:21:04,320
膝屈曲时
during knee flexion the lumbar pelvic

635
00:21:04,320 --> 00:21:05,840
如果存在腰痛，腰椎骨盆旋转动作幅度更大
rotation was greater

636
00:21:05,840 --> 00:21:09,360
如果存在骨盆前倾，幅度则比较小
you had back pain the anterior tilt

637
00:21:09,360 --> 00:21:11,440
关于时间差异
was not and then we've already talked

638
00:21:11,440 --> 00:21:13,039
此前已经谈过
about time differences

639
00:21:13,039 --> 00:21:16,000
所以总结一下
so in summary people with low back pain

640
00:21:16,000 --> 00:21:17,919
腰痛患者下肢运动的动作上
在move the lumbo-pelvic region

641
00:21:17,919 --> 00:21:21,840
停留时间更短
early during lower limb movements

642
00:21:21,840 --> 00:21:24,000
我们认为这可能是由于
that and we consider that this may be an

643
00:21:24,000 --> 00:21:26,080
日常活动期间运动模式的指数
index of the movement pattern during

644
00:21:26,080 --> 00:21:28,080
这些看似很小的
everyday activities these little simple

645
00:21:28,080 --> 00:21:28,880
因素
things

646
00:21:28,880 --> 00:21:30,799
可能就造成了患者做运动是
could be an index of what's really going

647
00:21:30,799 --> 00:21:34,320
很大的差异性
on when you're out there performing

648
00:21:34,320 --> 00:21:36,880
髋关节外旋会迅速带动
hip lateral rotation produces early

649
00:21:36,880 --> 00:21:38,400
腰椎骨盆旋转
lumbar pelvic rotation

650
00:21:38,400 --> 00:21:40,640
膝关节屈曲也会
knee flexion early lumbar pelvic

651
00:21:40,640 --> 00:21:42,240
在肌肉力量到达极限之前
rotation

652
00:21:42,240 --> 00:21:44,240
更快带动
much earlier than reaching the limit of

653
00:21:44,240 --> 00:21:45,360
腰椎骨盆旋转
muscle length that

654
00:21:45,360 --> 00:21:47,919
所以说在开始前一个动作时 后面动作发生的非常非常早
so this occurs very very early when you

655
00:21:47,919 --> 00:21:49,360
而不是非常晚
start to move not late

656
00:21:49,360 --> 00:21:52,799
非常早
very very early now

657
00:21:52,799 --> 00:21:54,720
the maximum knee flexion is less in low

658
00:21:54,720 --> 00:21:56,400
back pain there's no difference in

659
00:21:56,400 --> 00:21:57,840
velocity

660
00:21:57,840 --> 00:22:00,080
maximum lumbo pelvic rotation during

661
00:22:00,080 --> 00:22:00,880
knee flexion

662
00:22:00,880 --> 00:22:02,880
is about and this is what i think

663
00:22:02,880 --> 00:22:04,159
supports the idea

664
00:22:04,159 --> 00:22:07,120
of relative flexibility about one degree

665
00:22:07,120 --> 00:22:08,960
more

666
00:22:08,960 --> 00:22:12,159
the timing is about one second earlier

667
00:22:12,159 --> 00:22:13,919
so we're talking about little little

668
00:22:13,919 --> 00:22:15,280
bitty differences

669
00:22:15,280 --> 00:22:17,679
no difference for anterior pelvic tilt

670
00:22:17,679 --> 00:22:18,320
and

671
00:22:18,320 --> 00:22:20,159
the lateral rotation angle is only about

672
00:22:20,159 --> 00:22:22,000
2.5 degrees

673
00:22:22,000 --> 00:22:24,080
maximum lumbar pelvic rotation during

674
00:22:24,080 --> 00:22:26,080
hip bladder rotation is about 1.5

675
00:22:26,080 --> 00:22:28,480
degrees greater so we're talking about

676
00:22:28,480 --> 00:22:30,080
many aspects of things

677
00:22:30,080 --> 00:22:33,440
not maxi aspects of things okay

678
00:22:33,440 --> 00:22:36,240
so the lumbo pelvic motion occurs very

679
00:22:36,240 --> 00:22:36,880
readily

680
00:22:36,880 --> 00:22:39,200
a limit elicited by lower extremity

681
00:22:39,200 --> 00:22:40,000
movement

682
00:22:40,000 --> 00:22:43,039
and it's not primarily inter it's not

683
00:22:43,039 --> 00:22:45,039
caused by short muscles i think that's

684
00:22:45,039 --> 00:22:46,559
what's so important to realize

685
00:22:46,559 --> 00:22:48,240
stretching a muscle will never

686
00:22:48,240 --> 00:22:50,799
stop these movements stopping these

687
00:22:50,799 --> 00:22:53,200
movements will stretch a muscle

688
00:22:53,200 --> 00:22:55,200
but stretching a muscle will never stop

689
00:22:55,200 --> 00:22:56,400
them

690
00:22:56,400 --> 00:23:00,000
okay and that all this is very minimal

691
00:23:00,000 --> 00:23:01,919
which to me i think is the is sort of

692
00:23:01,919 --> 00:23:04,720
the fun yet the challenging part

693
00:23:04,720 --> 00:23:07,760
all right now another aspect is looking

694
00:23:07,760 --> 00:23:08,000
at

695
00:23:08,000 --> 00:23:10,320
variations in relative flexibility with

696
00:23:10,320 --> 00:23:12,240
the different syndromes

697
00:23:12,240 --> 00:23:14,240
so the syndromes that we're going to

698
00:23:14,240 --> 00:23:15,679
just talk about for a minute

699
00:23:15,679 --> 00:23:18,400
are people classified as rotation that

700
00:23:18,400 --> 00:23:20,080
means they have pain with rotational

701
00:23:20,080 --> 00:23:21,120
type movements

702
00:23:21,120 --> 00:23:23,120
are they have pain with both flexion and

703
00:23:23,120 --> 00:23:24,400
extension

704
00:23:24,400 --> 00:23:27,280
extension rotation patients have pain

705
00:23:27,280 --> 00:23:28,799
when the back is extended

706
00:23:28,799 --> 00:23:31,280
or when rotation is occurring and these

707
00:23:31,280 --> 00:23:32,720
are often people that do

708
00:23:32,720 --> 00:23:35,360
asymmetrical sports that involve

709
00:23:35,360 --> 00:23:37,600
rotation to one side or another

710
00:23:37,600 --> 00:23:40,400
and so again the test is hip rotation

711
00:23:40,400 --> 00:23:41,279
and looking to see

712
00:23:41,279 --> 00:23:43,840
at lumbo pelvic rotation and now we're

713
00:23:43,840 --> 00:23:45,520
going to compare what happens

714
00:23:45,520 --> 00:23:48,640
to the pelvis when you rotate your right

715
00:23:48,640 --> 00:23:49,039
hip

716
00:23:49,039 --> 00:23:52,799
versus your left hip so

717
00:23:52,799 --> 00:23:54,080
these are just to give you an idea of

718
00:23:54,080 --> 00:23:56,080
what we're looking for if you

719
00:23:56,080 --> 00:23:59,520
look at the onset of pelvic motion

720
00:23:59,520 --> 00:24:01,360
with right hip i'm sorry left hip

721
00:24:01,360 --> 00:24:02,559
lateral rotation

722
00:24:02,559 --> 00:24:04,480
and right hip lateral rotation this

723
00:24:04,480 --> 00:24:06,080
would be a late onset

724
00:24:06,080 --> 00:24:07,760
but there would be a high correlation

725
00:24:07,760 --> 00:24:10,720
between left and right

726
00:24:10,720 --> 00:24:12,720
early onset would mean they're really

727
00:24:12,720 --> 00:24:13,840
locked together

728
00:24:13,840 --> 00:24:15,520
but there's would be a correlation

729
00:24:15,520 --> 00:24:17,039
between left and right because

730
00:24:17,039 --> 00:24:19,440
they're both showing the same change

731
00:24:19,440 --> 00:24:20,320
okay

732
00:24:20,320 --> 00:24:22,880
now this is the way it came out also if

733
00:24:22,880 --> 00:24:24,480
it's symmetric

734
00:24:24,480 --> 00:24:27,039
it means that there's a high correlation

735
00:24:27,039 --> 00:24:29,039
the time that the pelvis starts to move

736
00:24:29,039 --> 00:24:30,640
when moving the left is the same as when

737
00:24:30,640 --> 00:24:32,000
you're moving the right

738
00:24:32,000 --> 00:24:33,440
if it's like this and there's no

739
00:24:33,440 --> 00:24:35,919
correlation there's asymmetry

740
00:24:35,919 --> 00:24:37,440
between what happens moving the right

741
00:24:37,440 --> 00:24:40,000
leg and moving the left leg

742
00:24:40,000 --> 00:24:42,640
okay well how did it come out

743
00:24:42,640 --> 00:24:43,600
beautifully

744
00:24:43,600 --> 00:24:45,440
meaning the patients that were

745
00:24:45,440 --> 00:24:48,320
classified as rotation patients

746
00:24:48,320 --> 00:24:50,880
when they moved their left leg and their

747
00:24:50,880 --> 00:24:51,840
right leg

748
00:24:51,840 --> 00:24:54,080
the onset of lumbo-pelvic rotation was

749
00:24:54,080 --> 00:24:55,360
highly correlated

750
00:24:55,360 --> 00:24:58,640
poor 0.94 if they were extension

751
00:24:58,640 --> 00:25:00,240
rotation patients

752
00:25:00,240 --> 00:25:02,240
asymmetric when they moved their right

753
00:25:02,240 --> 00:25:04,320
leg and they moved their left leg they

754
00:25:04,320 --> 00:25:05,440
had very differences

755
00:25:05,440 --> 00:25:08,000
in the timing of their lumbo pelvic

756
00:25:08,000 --> 00:25:09,039
rotation

757
00:25:09,039 --> 00:25:10,559
so the people that we had categorized

758
00:25:10,559 --> 00:25:13,039
clinically according to the

759
00:25:13,039 --> 00:25:15,039
different performances of their symptoms

760
00:25:15,039 --> 00:25:16,799
turned out to have these very high

761
00:25:16,799 --> 00:25:19,279
correlations

762
00:25:19,279 --> 00:25:21,440
okay then the other part that we wanted

763
00:25:21,440 --> 00:25:22,559
to look at was

764
00:25:22,559 --> 00:25:25,360
what about the relative stiffness issue

765
00:25:25,360 --> 00:25:26,880
so we looked at

766
00:25:26,880 --> 00:25:29,200
side bending and we looked at lateral

767
00:25:29,200 --> 00:25:30,320
side bending

768
00:25:30,320 --> 00:25:32,799
in standing and we saw different

769
00:25:32,799 --> 00:25:33,520
patterns

770
00:25:33,520 --> 00:25:35,039
again according to the different

771
00:25:35,039 --> 00:25:38,240
classifications and they paralleled

772
00:25:38,240 --> 00:25:41,600
the hip lateral rotation findings

773
00:25:41,600 --> 00:25:43,120
which which really means that the

774
00:25:43,120 --> 00:25:45,600
problem is in the back

775
00:25:45,600 --> 00:25:47,840
and that asymmetry is from the relative

776
00:25:47,840 --> 00:25:49,600
flexibility

777
00:25:49,600 --> 00:25:53,039
okay so let me just go on to to kind of

778
00:25:53,039 --> 00:25:55,279
show you we had 44 people in this

779
00:25:55,279 --> 00:25:58,080
and with chronic recurrent low back pain

780
00:25:58,080 --> 00:26:00,240
they regularly participated in rotation

781
00:26:00,240 --> 00:26:01,679
related sports

782
00:26:01,679 --> 00:26:04,080
and their symptoms were associated with

783
00:26:04,080 --> 00:26:07,520
these rotation related sports

784
00:26:07,520 --> 00:26:10,080
so again here comes the motion capture

785
00:26:10,080 --> 00:26:10,640
system

786
00:26:10,640 --> 00:26:12,320
they're all dressed up they do side

787
00:26:12,320 --> 00:26:14,720
bending and we look at the change in the

788
00:26:14,720 --> 00:26:15,440
angle

789
00:26:15,440 --> 00:26:18,559
in their lumbar spine

790
00:26:18,799 --> 00:26:22,159
isn't that cute okay

791
00:26:22,240 --> 00:26:25,360
so specifically they we're looking at

792
00:26:25,360 --> 00:26:26,159
what happens

793
00:26:26,159 --> 00:26:29,520
in lumbar motion compared to thoracic uh

794
00:26:29,520 --> 00:26:32,080
and uh and lower thoracic and upper

795
00:26:32,080 --> 00:26:33,039
thoracic

796
00:26:33,039 --> 00:26:35,120
so this is the way the data looked we

797
00:26:35,120 --> 00:26:37,520
looked at the onset of lumbar spine

798
00:26:37,520 --> 00:26:38,400
motion

799
00:26:38,400 --> 00:26:40,640
the movement here at l1 compared to down

800
00:26:40,640 --> 00:26:41,440
here

801
00:26:41,440 --> 00:26:43,760
then the lower thoracic segment and

802
00:26:43,760 --> 00:26:45,279
upper thoracic segment

803
00:26:45,279 --> 00:26:47,600
and compare that to total lateral

804
00:26:47,600 --> 00:26:49,919
bending

805
00:26:49,919 --> 00:26:52,320
and this is again the this uh to give

806
00:26:52,320 --> 00:26:53,919
you an idea of what we're looking for

807
00:26:53,919 --> 00:26:56,799
here's total lateral bending and this is

808
00:26:56,799 --> 00:26:59,039
what's happening in the lumbar region

809
00:26:59,039 --> 00:27:01,039
during different phases so what happened

810
00:27:01,039 --> 00:27:03,200
to 25 percent of the movement

811
00:27:03,200 --> 00:27:06,000
50 percent of the movement 75 percent of

812
00:27:06,000 --> 00:27:06,799
the movement

813
00:27:06,799 --> 00:27:09,919
and 100 percent of the movement

814
00:27:09,919 --> 00:27:12,159
and if the pattern was symmetric it

815
00:27:12,159 --> 00:27:14,000
would look the same whether you're going

816
00:27:14,000 --> 00:27:14,559
to

817
00:27:14,559 --> 00:27:16,400
the right or the left in the lumbar

818
00:27:16,400 --> 00:27:18,159
spine but

819
00:27:18,159 --> 00:27:20,960
how did it turn out it turned out no let

820
00:27:20,960 --> 00:27:21,679
me first see

821
00:27:21,679 --> 00:27:23,919
an asymmetric pattern is that when

822
00:27:23,919 --> 00:27:25,760
you're going to the left

823
00:27:25,760 --> 00:27:27,760
the lumbar motion is not the same as

824
00:27:27,760 --> 00:27:29,600
when you're going to the right

825
00:27:29,600 --> 00:27:32,880
okay so we looked at the percent of

826
00:27:32,880 --> 00:27:36,159
contribution of the lumbar region

827
00:27:36,159 --> 00:27:38,399
at various increments just as i told you

828
00:27:38,399 --> 00:27:41,520
and then set up this little formula

829
00:27:41,520 --> 00:27:43,440
and this is the way it turned out would

830
00:27:43,440 --> 00:27:45,039
you believe that in the rotation

831
00:27:45,039 --> 00:27:46,480
subgroup

832
00:27:46,480 --> 00:27:49,200
that it was the same going to the right

833
00:27:49,200 --> 00:27:51,440
and going to the left

834
00:27:51,440 --> 00:27:54,080
in the rotation extension subgroup there

835
00:27:54,080 --> 00:27:55,840
was much more

836
00:27:55,840 --> 00:27:59,279
lumbar lower lumbar motion in the first

837
00:27:59,279 --> 00:28:00,320
part of the range

838
00:28:00,320 --> 00:28:02,720
and then it became symmetric and this

839
00:28:02,720 --> 00:28:04,399
was asymmetrical

840
00:28:04,399 --> 00:28:06,320
so just like with the hip when you went

841
00:28:06,320 --> 00:28:08,399
to the left you got more motion

842
00:28:08,399 --> 00:28:10,399
in your lumbar spine if you were

843
00:28:10,399 --> 00:28:12,080
extension rotation

844
00:28:12,080 --> 00:28:14,480
if you were rotation that movement was

845
00:28:14,480 --> 00:28:15,360
the same

846
00:28:15,360 --> 00:28:18,720
in both directions okay and what about

847
00:28:18,720 --> 00:28:20,240
stiffness well

848
00:28:20,240 --> 00:28:23,760
the uh we developed a uh

849
00:28:23,760 --> 00:28:26,799
basically like a gravity free table and

850
00:28:26,799 --> 00:28:28,480
people were put on this table

851
00:28:28,480 --> 00:28:30,880
and we measured their passive tension

852
00:28:30,880 --> 00:28:33,279
properties

853
00:28:33,279 --> 00:28:34,799
and this is the way it looked and again

854
00:28:34,799 --> 00:28:37,440
it's the same kind of calculations

855
00:28:37,440 --> 00:28:40,000
and we've looked at the passive elastic

856
00:28:40,000 --> 00:28:40,720
energy

857
00:28:40,720 --> 00:28:43,279
as they were pulled from one side are to

858
00:28:43,279 --> 00:28:45,279
the other side

859
00:28:45,279 --> 00:28:48,559
and this was to their end range and this

860
00:28:48,559 --> 00:28:49,520
area was

861
00:28:49,520 --> 00:28:52,640
calculated and what did we find

862
00:28:52,640 --> 00:28:54,559
is that we looked at looking at group

863
00:28:54,559 --> 00:28:56,720
differences first people with no low

864
00:28:56,720 --> 00:28:58,480
back pain compared to people

865
00:28:58,480 --> 00:29:01,679
with extension low back pain and there

866
00:29:01,679 --> 00:29:02,559
was

867
00:29:02,559 --> 00:29:05,440
asymmetry to a certain extent one side

868
00:29:05,440 --> 00:29:07,840
had more passive elastic energy

869
00:29:07,840 --> 00:29:10,880
than the other side but in no low back

870
00:29:10,880 --> 00:29:11,520
pain people

871
00:29:11,520 --> 00:29:14,240
this was not significant but when we

872
00:29:14,240 --> 00:29:16,159
looked at people with back pain

873
00:29:16,159 --> 00:29:18,799
extension back pain there was an a

874
00:29:18,799 --> 00:29:20,480
significant difference

875
00:29:20,480 --> 00:29:22,880
between the passive elastic energy on

876
00:29:22,880 --> 00:29:27,120
one side compared to the other side

877
00:29:27,120 --> 00:29:31,600
i should have had those fly in okay and

878
00:29:31,600 --> 00:29:34,880
the end range of lumbar motion again

879
00:29:34,880 --> 00:29:36,960
there was a little bit of difference the

880
00:29:36,960 --> 00:29:38,399
side of greater motion

881
00:29:38,399 --> 00:29:40,640
compared to the side of lesser motion in

882
00:29:40,640 --> 00:29:42,399
both people with low back pain

883
00:29:42,399 --> 00:29:44,559
than no low back pain so the range of

884
00:29:44,559 --> 00:29:46,480
motion was not what was important

885
00:29:46,480 --> 00:29:49,760
it was the passive stiffness that was

886
00:29:49,760 --> 00:29:50,240
the most

887
00:29:50,240 --> 00:29:53,600
important factor okay so

888
00:29:53,600 --> 00:29:56,960
the increment of total lumbo

889
00:29:56,960 --> 00:29:59,760
uh total low back pain motion to the

890
00:29:59,760 --> 00:30:00,559
left

891
00:30:00,559 --> 00:30:03,200
total lumbar motion to the left the

892
00:30:03,200 --> 00:30:03,760
condition

893
00:30:03,760 --> 00:30:07,039
at 25 50 75

894
00:30:07,039 --> 00:30:09,200
in a hundred percent so the this is

895
00:30:09,200 --> 00:30:10,880
after treatment

896
00:30:10,880 --> 00:30:14,080
initially they had 75 percent

897
00:30:14,080 --> 00:30:17,120
motion in their lumbar spine at 25 and

898
00:30:17,120 --> 00:30:19,120
then it decreased as you went to the

899
00:30:19,120 --> 00:30:20,399
total motion

900
00:30:20,399 --> 00:30:23,520
after they were treated just taught

901
00:30:23,520 --> 00:30:27,279
not to move that way it went down to 25

902
00:30:27,279 --> 00:30:29,440
so that we could teach people and get a

903
00:30:29,440 --> 00:30:31,600
change in how much their lumbar spine

904
00:30:31,600 --> 00:30:35,279
was moving okay so summaries of these

905
00:30:35,279 --> 00:30:36,000
studies of

906
00:30:36,000 --> 00:30:39,919
relative flexibility that

907
00:30:39,919 --> 00:30:42,640
spinal hypermobility most reasonably

908
00:30:42,640 --> 00:30:43,440
accessory

909
00:30:43,440 --> 00:30:45,679
motion hypermobility and i think we can

910
00:30:45,679 --> 00:30:47,440
start to call it micro instability

911
00:30:47,440 --> 00:30:48,720
though i've been adverse to that for a

912
00:30:48,720 --> 00:30:49,520
long time

913
00:30:49,520 --> 00:30:51,760
is evident in our clinical exam and in

914
00:30:51,760 --> 00:30:53,200
laboratory measures

915
00:30:53,200 --> 00:30:54,559
but what we can do in laboratory

916
00:30:54,559 --> 00:30:56,399
measures is look at the

917
00:30:56,399 --> 00:30:58,720
the amount and and we can look at the

918
00:30:58,720 --> 00:31:00,000
timing

919
00:31:00,000 --> 00:31:02,480
the lumbo pelvic motion occurs earlier

920
00:31:02,480 --> 00:31:04,080
and with greater range of motion

921
00:31:04,080 --> 00:31:06,399
in patients with low back pain compared

922
00:31:06,399 --> 00:31:07,679
to controls

923
00:31:07,679 --> 00:31:09,919
but these differences are in tenths of a

924
00:31:09,919 --> 00:31:12,399
second and just a few degrees

925
00:31:12,399 --> 00:31:14,480
so this suggests that small but frequent

926
00:31:14,480 --> 00:31:16,640
motion is a source of stress

927
00:31:16,640 --> 00:31:18,880
on spinal segments and causes micro

928
00:31:18,880 --> 00:31:21,120
trauma to become macro trauma

929
00:31:21,120 --> 00:31:23,279
and that a contributing factor is the

930
00:31:23,279 --> 00:31:25,760
relative passive stiffness of muscles

931
00:31:25,760 --> 00:31:28,559
about a joint is the is a contributing

932
00:31:28,559 --> 00:31:30,159
factor

933
00:31:30,159 --> 00:31:32,320
now i wanted to tell you one other thing

934
00:31:32,320 --> 00:31:34,480
that this is in the process of being

935
00:31:34,480 --> 00:31:36,080
published and this is a randomized

936
00:31:36,080 --> 00:31:37,360
control trial that

937
00:31:37,360 --> 00:31:40,480
uh linda van dillen uh did

938
00:31:40,480 --> 00:31:43,519
and um it was sort of a good news bad

939
00:31:43,519 --> 00:31:45,200
news thing so she got people with low

940
00:31:45,200 --> 00:31:46,880
back pain

941
00:31:46,880 --> 00:31:50,480
and they were all examined

942
00:31:50,480 --> 00:31:53,760
both clinically and with motion capture

943
00:31:53,760 --> 00:31:56,320
they were then divided up into a

944
00:31:56,320 --> 00:31:59,039
category specific exercise program

945
00:31:59,039 --> 00:32:02,880
and into a generalized exercise program

946
00:32:02,880 --> 00:32:06,480
the uh people were seen once a week for

947
00:32:06,480 --> 00:32:08,720
six weeks now seeing what that means is

948
00:32:08,720 --> 00:32:09,919
treatment is

949
00:32:09,919 --> 00:32:13,039
they were shown exercises to do again

950
00:32:13,039 --> 00:32:15,279
whether category specific or general

951
00:32:15,279 --> 00:32:18,399
and they were also taught to keep their

952
00:32:18,399 --> 00:32:19,919
spine neutral

953
00:32:19,919 --> 00:32:21,679
during functional activities now

954
00:32:21,679 --> 00:32:23,440
functional activities means how do you

955
00:32:23,440 --> 00:32:24,240
roll

956
00:32:24,240 --> 00:32:26,480
how do you go from supine to sitting how

957
00:32:26,480 --> 00:32:28,159
do you walk how do you get up and down

958
00:32:28,159 --> 00:32:29,440
out of a chair

959
00:32:29,440 --> 00:32:33,039
basic keep it neutral things so

960
00:32:33,039 --> 00:32:35,279
what was the good news everybody got

961
00:32:35,279 --> 00:32:36,880
better for six months

962
00:32:36,880 --> 00:32:39,120
they were seen six times once a week and

963
00:32:39,120 --> 00:32:40,799
their pain scores went down for six

964
00:32:40,799 --> 00:32:41,440
months

965
00:32:41,440 --> 00:32:43,760
then there was a little upswing the bad

966
00:32:43,760 --> 00:32:44,480
news was

967
00:32:44,480 --> 00:32:46,940
everybody got better

968
00:32:46,940 --> 00:32:49,120
[Laughter]

969
00:32:49,120 --> 00:32:52,080
meaning how much i wanted the people

970
00:32:52,080 --> 00:32:54,480
that got category specific exercises to

971
00:32:54,480 --> 00:32:56,000
do better than people that got general

972
00:32:56,000 --> 00:32:59,200
exercises but what was the fatal flaw

973
00:32:59,200 --> 00:33:01,279
the fatal flaw is that both groups were

974
00:33:01,279 --> 00:33:02,720
taught to keep their spine

975
00:33:02,720 --> 00:33:05,919
in neutral during all functional

976
00:33:05,919 --> 00:33:09,600
activities the uh other thing that i

977
00:33:09,600 --> 00:33:11,360
think is a really big take-home message

978
00:33:11,360 --> 00:33:11,840
on this

979
00:33:11,840 --> 00:33:15,200
is that linda

980
00:33:15,200 --> 00:33:17,919
has a wonderful case of ocd obsessive

981
00:33:17,919 --> 00:33:19,679
compulsive disorder which i think every

982
00:33:19,679 --> 00:33:21,279
good researcher needs

983
00:33:21,279 --> 00:33:24,320
so what she also did was monitor their

984
00:33:24,320 --> 00:33:25,279
adherence

985
00:33:25,279 --> 00:33:27,519
to their exercise program or to their

986
00:33:27,519 --> 00:33:29,200
functional activities

987
00:33:29,200 --> 00:33:32,080
and what do you think people did longer

988
00:33:32,080 --> 00:33:32,799
modify

989
00:33:32,799 --> 00:33:35,039
continue with their exercises or modify

990
00:33:35,039 --> 00:33:38,720
their their functional activities

991
00:33:38,720 --> 00:33:40,960
functional activities and there was a

992
00:33:40,960 --> 00:33:42,960
very high relationship the longer they

993
00:33:42,960 --> 00:33:43,440
kept

994
00:33:43,440 --> 00:33:44,880
doing their functional activities

995
00:33:44,880 --> 00:33:47,440
correctly the better they did

996
00:33:47,440 --> 00:33:49,519
so now i do believe and i think linda

997
00:33:49,519 --> 00:33:51,120
shares this belief that it's going to

998
00:33:51,120 --> 00:33:53,120
take about four weeks at least

999
00:33:53,120 --> 00:33:54,880
to get people to change their functional

1000
00:33:54,880 --> 00:33:57,120
activities in my clinical experience

1001
00:33:57,120 --> 00:33:58,000
once people's

1002
00:33:58,000 --> 00:33:59,360
pain goes away they don't think they

1003
00:33:59,360 --> 00:34:00,960
need to do their exercises anymore

1004
00:34:00,960 --> 00:34:01,840
because

1005
00:34:01,840 --> 00:34:05,360
that's over with yeah it's like

1006
00:34:05,360 --> 00:34:06,720
that's good because then you'll be back

1007
00:34:06,720 --> 00:34:08,639
so good keep it up

1008
00:34:08,639 --> 00:34:10,239
anyway so i think i think the important

1009
00:34:10,239 --> 00:34:11,839
messages are we know people will get

1010
00:34:11,839 --> 00:34:12,480
better

1011
00:34:12,480 --> 00:34:14,079
if they keep their spines still during

1012
00:34:14,079 --> 00:34:16,079
functional activities we know

1013
00:34:16,079 --> 00:34:18,000
that people will modify their functional

1014
00:34:18,000 --> 00:34:19,520
activities once they've been carefully

1015
00:34:19,520 --> 00:34:20,320
instructed

1016
00:34:20,320 --> 00:34:21,839
more so than they'll keep up with an

1017
00:34:21,839 --> 00:34:23,760
exercise program so

1018
00:34:23,760 --> 00:34:27,040
that's what had the greatest effect okay

1019
00:34:27,040 --> 00:34:29,679
so spinal stabilization is an

1020
00:34:29,679 --> 00:34:30,960
appropriate treatment

1021
00:34:30,960 --> 00:34:32,719
and i think because the spine is

1022
00:34:32,719 --> 00:34:34,000
basically hypermobile

1023
00:34:34,000 --> 00:34:35,918
that's what all these little tests show

1024
00:34:35,918 --> 00:34:38,239
and that symptoms are elicited by spinal

1025
00:34:38,239 --> 00:34:39,679
motion

1026
00:34:39,679 --> 00:34:41,839
when you move your limbs it makes your

1027
00:34:41,839 --> 00:34:43,839
spine move which it shouldn't do

1028
00:34:43,839 --> 00:34:45,839
and then we decrease their symptoms if

1029
00:34:45,839 --> 00:34:47,760
we prevent that motion

1030
00:34:47,760 --> 00:34:50,320
and that this imbalance in relative

1031
00:34:50,320 --> 00:34:51,440
muscle stiffness

1032
00:34:51,440 --> 00:34:53,839
is a big contributing factor and the

1033
00:34:53,839 --> 00:34:55,679
bottom line on that is it means you need

1034
00:34:55,679 --> 00:34:57,119
to stiffen what

1035
00:34:57,119 --> 00:34:59,760
elongates too easily not stretch what

1036
00:34:59,760 --> 00:35:01,359
doesn't seem to elongate

1037
00:35:01,359 --> 00:35:05,200
well enough and stretching a muscle just

1038
00:35:05,200 --> 00:35:05,760
to say

1039
00:35:05,760 --> 00:35:07,599
to make this so important will never

1040
00:35:07,599 --> 00:35:09,040
stop this motion

1041
00:35:09,040 --> 00:35:11,839
it occurs too readily too easily and

1042
00:35:11,839 --> 00:35:13,680
that the patient needs to be instructed

1043
00:35:13,680 --> 00:35:15,359
in moving the appropriate joint

1044
00:35:15,359 --> 00:35:19,599
the hip while not moving in the back

1045
00:35:19,599 --> 00:35:21,119
now these are all the people that have

1046
00:35:21,119 --> 00:35:22,880
worked with linda on this and

1047
00:35:22,880 --> 00:35:25,520
and i thought since i've sped through

1048
00:35:25,520 --> 00:35:25,920
this

1049
00:35:25,920 --> 00:35:29,200
and i still have five minutes to go uh

1050
00:35:29,200 --> 00:35:31,090
right

1051
00:35:31,090 --> 00:35:33,040
[Laughter]

1052
00:35:33,040 --> 00:35:34,960
i i thought that i would show you a

1053
00:35:34,960 --> 00:35:37,280
little bit of of what we're looking at

1054
00:35:37,280 --> 00:35:40,720
in other joints so that that

1055
00:35:40,720 --> 00:35:42,160
we're not doing with there's some

1056
00:35:42,160 --> 00:35:43,760
research in process but we don't have

1057
00:35:43,760 --> 00:35:44,160
all the

1058
00:35:44,160 --> 00:35:46,000
the data like i've shown you for for the

1059
00:35:46,000 --> 00:35:47,599
low back and

1060
00:35:47,599 --> 00:35:50,079
for the hip we've put people also into

1061
00:35:50,079 --> 00:35:51,440
categories

1062
00:35:51,440 --> 00:35:53,520
one category is called anterior glide

1063
00:35:53,520 --> 00:35:55,760
with medial rotation

1064
00:35:55,760 --> 00:35:58,400
posterior glide and and these again are

1065
00:35:58,400 --> 00:36:00,960
the offending motions and they reflect

1066
00:36:00,960 --> 00:36:03,920
joint hyper mobility not hypo but

1067
00:36:03,920 --> 00:36:05,359
hypermobility

1068
00:36:05,359 --> 00:36:06,800
and as you know if you've worked with

1069
00:36:06,800 --> 00:36:08,240
people with a frozen shoulder you can

1070
00:36:08,240 --> 00:36:10,320
have accessory motion hypermobility when

1071
00:36:10,320 --> 00:36:12,160
you have physiological motion

1072
00:36:12,160 --> 00:36:15,839
hypo mobility if you didn't you wouldn't

1073
00:36:15,839 --> 00:36:17,839
have pain

1074
00:36:17,839 --> 00:36:21,040
yeah okay i'll show you

1075
00:36:21,040 --> 00:36:24,400
so here's here's the idea

1076
00:36:24,800 --> 00:36:28,160
if you did precise hip flexion

1077
00:36:28,160 --> 00:36:29,839
you would be able to drive an axle

1078
00:36:29,839 --> 00:36:31,680
through the through the head of the

1079
00:36:31,680 --> 00:36:33,280
femur and you would just spin

1080
00:36:33,280 --> 00:36:35,599
in the joint and that one of the

1081
00:36:35,599 --> 00:36:36,960
observations that we made

1082
00:36:36,960 --> 00:36:39,440
early is that if you don't flex your hip

1083
00:36:39,440 --> 00:36:40,720
precisely

1084
00:36:40,720 --> 00:36:42,960
instead of the perfect spinning you get

1085
00:36:42,960 --> 00:36:44,720
an anterior glide

1086
00:36:44,720 --> 00:36:46,160
and when the head of the femur

1087
00:36:46,160 --> 00:36:47,920
anteriorly glides it hits

1088
00:36:47,920 --> 00:36:50,880
on the edge of the acetabulum and that

1089
00:36:50,880 --> 00:36:51,359
means

1090
00:36:51,359 --> 00:36:53,680
you could injure that structure there

1091
00:36:53,680 --> 00:36:54,720
now not only i

1092
00:36:54,720 --> 00:36:57,040
i'm well aware of the large heads of the

1093
00:36:57,040 --> 00:36:58,720
femurs and all the rest of it

1094
00:36:58,720 --> 00:37:01,839
but this is another factor oh it's so

1095
00:37:01,839 --> 00:37:02,480
scary

1096
00:37:02,480 --> 00:37:05,040
anyway uh

1097
00:37:05,599 --> 00:37:07,040
you know and halloween is over but we

1098
00:37:07,040 --> 00:37:08,720
still put that up there anyway

1099
00:37:08,720 --> 00:37:12,720
so video so what i want to show you here

1100
00:37:12,720 --> 00:37:13,200
is

1101
00:37:13,200 --> 00:37:15,440
is the anterior glide sign that we look

1102
00:37:15,440 --> 00:37:16,880
for in people that have hip

1103
00:37:16,880 --> 00:37:20,720
joint problems so again

1104
00:37:20,720 --> 00:37:23,040
with the idea that i should be my thumb

1105
00:37:23,040 --> 00:37:24,240
should be a parallel

1106
00:37:24,240 --> 00:37:26,800
axle so that when i flex the hip my

1107
00:37:26,800 --> 00:37:28,160
thumb should stay still

1108
00:37:28,160 --> 00:37:31,359
if this hip is perfectly spinning but as

1109
00:37:31,359 --> 00:37:32,720
you can see

1110
00:37:32,720 --> 00:37:36,160
this femur is translating anteriorly

1111
00:37:36,160 --> 00:37:37,599
it's kind of a combination of what we

1112
00:37:37,599 --> 00:37:41,520
call anterior glide with medial rotation

1113
00:37:41,520 --> 00:37:43,440
now this young woman was having hip pain

1114
00:37:43,440 --> 00:37:45,440
she's actually a professional

1115
00:37:45,440 --> 00:37:47,599
was a professional dancer she's a physio

1116
00:37:47,599 --> 00:37:48,480
now

1117
00:37:48,480 --> 00:37:51,440
taking care of professional dancers and

1118
00:37:51,440 --> 00:37:52,800
and she's also

1119
00:37:52,800 --> 00:37:54,560
asian so she's very flexible so there

1120
00:37:54,560 --> 00:37:57,200
was absolutely no hamstring resistance

1121
00:37:57,200 --> 00:37:59,119
now i'm doing what i call a correction

1122
00:37:59,119 --> 00:38:00,960
which just means keep my thumb still

1123
00:38:00,960 --> 00:38:03,440
nothing complicated and then i flex her

1124
00:38:03,440 --> 00:38:04,720
hip the way it should flex

1125
00:38:04,720 --> 00:38:06,320
now i'm going to ask her to take hold of

1126
00:38:06,320 --> 00:38:08,160
it and watch what happens when she takes

1127
00:38:08,160 --> 00:38:10,000
hold of it

1128
00:38:10,000 --> 00:38:13,119
actively contracts her muscles there

1129
00:38:13,119 --> 00:38:14,320
goes all that motion

1130
00:38:14,320 --> 00:38:17,119
that shouldn't go so it's flexion with

1131
00:38:17,119 --> 00:38:18,160
medial rotation

1132
00:38:18,160 --> 00:38:20,000
now it tells you the iliopsoas is not

1133
00:38:20,000 --> 00:38:21,359
working correctly or would never

1134
00:38:21,359 --> 00:38:23,359
immediately rotate

1135
00:38:23,359 --> 00:38:26,000
that's what that tells you and the hip

1136
00:38:26,000 --> 00:38:27,040
has become

1137
00:38:27,040 --> 00:38:30,240
hyper mobile okay

1138
00:38:30,240 --> 00:38:33,520
now let me go on another uh

1139
00:38:33,520 --> 00:38:36,160
aspect that we that we found too and and

1140
00:38:36,160 --> 00:38:38,000
people do these incredible things like

1141
00:38:38,000 --> 00:38:40,480
try to posteriorly dislocate their hip

1142
00:38:40,480 --> 00:38:42,720
um

1143
00:38:45,359 --> 00:38:47,280
i know they're on to the happy life now

1144
00:38:47,280 --> 00:38:49,359
they put their chest on their thighs

1145
00:38:49,359 --> 00:38:50,880
and then and then they rotate

1146
00:38:50,880 --> 00:38:52,160
immediately and they rotate laterally

1147
00:38:52,160 --> 00:38:53,599
that is a good way to posteriorly

1148
00:38:53,599 --> 00:38:54,960
dislocate their hip

1149
00:38:54,960 --> 00:38:57,760
so um we have this posterior glide

1150
00:38:57,760 --> 00:38:59,520
problem

1151
00:38:59,520 --> 00:39:02,480
so this is the same girl doesn't get any

1152
00:39:02,480 --> 00:39:05,119
does not get any better but anyway

1153
00:39:05,119 --> 00:39:08,240
you played the video here

1154
00:39:08,640 --> 00:39:10,800
she talks and talks it never stops

1155
00:39:10,800 --> 00:39:12,079
anyway

1156
00:39:12,079 --> 00:39:14,240
so what i want to show you is that with

1157
00:39:14,240 --> 00:39:15,359
this hip

1158
00:39:15,359 --> 00:39:17,920
that in her right buttock there was

1159
00:39:17,920 --> 00:39:19,440
something sticking out that wasn't

1160
00:39:19,440 --> 00:39:21,200
sticking out her left buttock

1161
00:39:21,200 --> 00:39:22,960
so if i put the stick on there and i put

1162
00:39:22,960 --> 00:39:24,560
my fingers behind there

1163
00:39:24,560 --> 00:39:26,880
my that's a half an inch of difference

1164
00:39:26,880 --> 00:39:28,880
between something prominent in her right

1165
00:39:28,880 --> 00:39:29,520
buttock

1166
00:39:29,520 --> 00:39:32,160
versus her left buttock okay and then if

1167
00:39:32,160 --> 00:39:33,520
i have her rock back

1168
00:39:33,520 --> 00:39:35,599
and see if i'm sorry take my hands i i

1169
00:39:35,599 --> 00:39:38,400
know my fingers are half an inch thick

1170
00:39:38,400 --> 00:39:40,240
there's something going on on the right

1171
00:39:40,240 --> 00:39:41,440
side that's not there

1172
00:39:41,440 --> 00:39:44,400
on the left side now if i put my hands

1173
00:39:44,400 --> 00:39:44,960
on her

1174
00:39:44,960 --> 00:39:48,560
sacrum as she rocks back you'll see that

1175
00:39:48,560 --> 00:39:50,960
as she rocks back the right side goes

1176
00:39:50,960 --> 00:39:52,000
low

1177
00:39:52,000 --> 00:39:54,000
compared to the left side so there's

1178
00:39:54,000 --> 00:39:55,359
something different

1179
00:39:55,359 --> 00:39:57,280
in the way her hip is flexing this is

1180
00:39:57,280 --> 00:40:00,800
going low compared to the other side

1181
00:40:00,800 --> 00:40:04,880
okay once more

1182
00:40:04,880 --> 00:40:10,640
rock back and this goes low now if i put

1183
00:40:10,640 --> 00:40:12,000
my thumb

1184
00:40:12,000 --> 00:40:13,920
right there on this i think it's the

1185
00:40:13,920 --> 00:40:15,200
head of the femur do you see how it's

1186
00:40:15,200 --> 00:40:16,640
medially rotating

1187
00:40:16,640 --> 00:40:18,160
and what it's also doing is coming out

1188
00:40:18,160 --> 00:40:20,560
at me so as she goes back

1189
00:40:20,560 --> 00:40:22,720
the head of the femur is going posterior

1190
00:40:22,720 --> 00:40:23,839
and medially

1191
00:40:23,839 --> 00:40:26,560
rotating it shouldn't do that it should

1192
00:40:26,560 --> 00:40:28,079
be like on the left side

1193
00:40:28,079 --> 00:40:31,280
where nothing happens as you rock back

1194
00:40:31,280 --> 00:40:33,520
now if i put my fingers on either side

1195
00:40:33,520 --> 00:40:35,440
of the greater trochanter you can

1196
00:40:35,440 --> 00:40:38,800
see the same kind of thing so again i'm

1197
00:40:38,800 --> 00:40:40,000
explaining that there's something

1198
00:40:40,000 --> 00:40:41,359
prominent on this side

1199
00:40:41,359 --> 00:40:44,640
as compared to the other side

1200
00:40:45,280 --> 00:40:47,119
so we'll hold on here and then i'll stop

1201
00:40:47,119 --> 00:40:49,200
it after this

1202
00:40:49,200 --> 00:40:52,319
have her rock back and there goes the

1203
00:40:52,319 --> 00:40:53,839
medial rotation on the right

1204
00:40:53,839 --> 00:40:56,160
that's not on the left so we call this a

1205
00:40:56,160 --> 00:40:58,240
posterior glide with medial rotation

1206
00:40:58,240 --> 00:40:59,599
now you can have anterior glide with

1207
00:40:59,599 --> 00:41:01,280
medial rotation or you can have both and

1208
00:41:01,280 --> 00:41:02,640
then it's hypermobility

1209
00:41:02,640 --> 00:41:05,520
accessory motion hypermobility let's

1210
00:41:05,520 --> 00:41:07,040
okay

1211
00:41:07,040 --> 00:41:08,720
so what and i think the other part

1212
00:41:08,720 --> 00:41:10,160
that's interesting is she's already had

1213
00:41:10,160 --> 00:41:11,440
an acl

1214
00:41:11,440 --> 00:41:13,599
now that's a solid bone that means if

1215
00:41:13,599 --> 00:41:15,440
it's rotating up at the top end

1216
00:41:15,440 --> 00:41:17,599
it's rotating at the bottom end yeah

1217
00:41:17,599 --> 00:41:18,880
five minutes okay

1218
00:41:18,880 --> 00:41:22,560
and and then i i'm

1219
00:41:22,560 --> 00:41:24,240
not bad not bad i didn't think i'd get

1220
00:41:24,240 --> 00:41:26,240
to this so but i did want to show you

1221
00:41:26,240 --> 00:41:28,800
because i think observing these movement

1222
00:41:28,800 --> 00:41:30,160
impairments is what's what's the

1223
00:41:30,160 --> 00:41:31,680
critical issue people can be high

1224
00:41:31,680 --> 00:41:32,640
performance

1225
00:41:32,640 --> 00:41:35,119
let me show you these shoulder things i

1226
00:41:35,119 --> 00:41:37,280
call these the big three of scapular

1227
00:41:37,280 --> 00:41:38,160
problems

1228
00:41:38,160 --> 00:41:40,640
decrease scapular posterior tilting

1229
00:41:40,640 --> 00:41:42,800
decreased scapular upward rotation

1230
00:41:42,800 --> 00:41:45,680
and increased scapular internal rotation

1231
00:41:45,680 --> 00:41:46,240
and

1232
00:41:46,240 --> 00:41:47,520
these are all the studies that have

1233
00:41:47,520 --> 00:41:49,599
shown that if you have shoulder pain

1234
00:41:49,599 --> 00:41:52,319
this is these are the the faults that

1235
00:41:52,319 --> 00:41:54,319
have been identified

1236
00:41:54,319 --> 00:41:56,480
okay and the humeral same thing

1237
00:41:56,480 --> 00:41:58,400
excessive superior translation

1238
00:41:58,400 --> 00:42:00,640
inferior anterior these are all the

1239
00:42:00,640 --> 00:42:02,480
things we look for during our exam

1240
00:42:02,480 --> 00:42:06,000
and let me just show you this is a video

1241
00:42:06,000 --> 00:42:08,079
so when this girl does shoulder flexion

1242
00:42:08,079 --> 00:42:10,240
she has it all bad

1243
00:42:10,240 --> 00:42:12,640
meaning that's internal rotation not

1244
00:42:12,640 --> 00:42:14,720
enough posterior tilt

1245
00:42:14,720 --> 00:42:17,920
not not enough external rotation uh

1246
00:42:17,920 --> 00:42:20,640
not enough upward rotation and what

1247
00:42:20,640 --> 00:42:22,079
happens is she still has

1248
00:42:22,079 --> 00:42:24,480
180 degrees of shoulder flexion which

1249
00:42:24,480 --> 00:42:26,480
means her glenohumeral joint is hyper

1250
00:42:26,480 --> 00:42:27,200
mobile

1251
00:42:27,200 --> 00:42:29,359
because her scapula isn't moving enough

1252
00:42:29,359 --> 00:42:31,599
and it's not moving in the right place

1253
00:42:31,599 --> 00:42:35,040
okay in this fellow this video

1254
00:42:35,040 --> 00:42:38,480
you play the one on the left please

1255
00:42:39,760 --> 00:42:42,800
okay now most of the most often

1256
00:42:42,800 --> 00:42:45,920
you see these faults on return

1257
00:42:45,920 --> 00:42:50,160
like that you got it right you got it

1258
00:42:50,160 --> 00:42:52,000
that is internal rotation with

1259
00:42:52,000 --> 00:42:53,920
insufficient upward rotation

1260
00:42:53,920 --> 00:42:56,400
now since it happened on return it's not

1261
00:42:56,400 --> 00:42:58,640
a weakness problem

1262
00:42:58,640 --> 00:43:01,599
because eccentric is much stronger than

1263
00:43:01,599 --> 00:43:03,200
than concentric

1264
00:43:03,200 --> 00:43:04,960
so we shouldn't have a problem on return

1265
00:43:04,960 --> 00:43:07,839
play the one on the right

1266
00:43:07,839 --> 00:43:10,240
now so what we do is teach them how not

1267
00:43:10,240 --> 00:43:10,960
to do that

1268
00:43:10,960 --> 00:43:12,480
there's a whole lot of don't do that in

1269
00:43:12,480 --> 00:43:14,960
this system

1270
00:43:14,960 --> 00:43:17,280
did it play already when you saw it that

1271
00:43:17,280 --> 00:43:18,560
we cured him

1272
00:43:18,560 --> 00:43:20,960
here's here's another one i think this

1273
00:43:20,960 --> 00:43:23,040
is so so wonderfully dramatic

1274
00:43:23,040 --> 00:43:27,839
look at that

1275
00:43:31,520 --> 00:43:34,319
okay here over here on this side oh

1276
00:43:34,319 --> 00:43:35,520
she's going to do it once more just to

1277
00:43:35,520 --> 00:43:38,319
show that it really does happen

1278
00:43:38,319 --> 00:43:41,200
here she goes now this is all in the

1279
00:43:41,200 --> 00:43:43,839
same session

1280
00:43:49,200 --> 00:43:50,720
see what what does it mean it means that

1281
00:43:50,720 --> 00:43:52,640
when she contracts her scapulohumeral

1282
00:43:52,640 --> 00:43:53,440
muscles

1283
00:43:53,440 --> 00:43:55,359
it causes the scapula to move because

1284
00:43:55,359 --> 00:43:57,200
the axial scapular muscles

1285
00:43:57,200 --> 00:43:59,280
don't control the scapula they don't

1286
00:43:59,280 --> 00:44:01,359
have as much effect on the scapula

1287
00:44:01,359 --> 00:44:04,240
as the scapulohumeral muscles so the

1288
00:44:04,240 --> 00:44:06,240
tail wags the dog as i see it

1289
00:44:06,240 --> 00:44:08,560
instead of enough stiffness and control

1290
00:44:08,560 --> 00:44:10,160
from those muscles but it's a training

1291
00:44:10,160 --> 00:44:10,960
thing it's not

1292
00:44:10,960 --> 00:44:13,200
a strength thing it's a training thing

1293
00:44:13,200 --> 00:44:14,000
the staff the

1294
00:44:14,000 --> 00:44:15,920
the stiffness has to be changed that's

1295
00:44:15,920 --> 00:44:17,839
why they can modify it right away that's

1296
00:44:17,839 --> 00:44:19,599
what we try and teach them to do so

1297
00:44:19,599 --> 00:44:21,440
i just wanted to show you examples of

1298
00:44:21,440 --> 00:44:23,040
these movement faults that can be

1299
00:44:23,040 --> 00:44:24,960
categorized we can put people into

1300
00:44:24,960 --> 00:44:26,000
syndromes

1301
00:44:26,000 --> 00:44:28,560
explain the significant factors and

1302
00:44:28,560 --> 00:44:29,200
believe me

1303
00:44:29,200 --> 00:44:30,880
our profession will move on so much

1304
00:44:30,880 --> 00:44:33,040
better if we put labels on conditions so

1305
00:44:33,040 --> 00:44:35,280
people know we figure things out

1306
00:44:35,280 --> 00:44:36,900
thank you very much

1307
00:44:36,900 --> 00:44:50,260
[Applause]