1 Frontal bone 2 Superciliary arch 3 Supraorbital notch 4 Glabella 5 Nasion 6 Maxilla 7 Nasal bone 8 Zygomatic bone 9 Frontozygomatic suture 10 Promin

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1 1. 1교시가. 10시 ~11시 1) 건강이란? 가 ) 정신적, 화학적, 육체적밸런스 2) 질병의원인가 ) 정신적, 화학적, 육체적스트레스에의하여우리몸에발생하는불편감에서부터치료를해야하는상황 3) 치료란? 가 ) 정신적, 화학적, 육체적스트레스를제거하는것 4) 라이브워크샵진행가 ) 화학적밸런스를맞추어주는방법에대한이론과실습을진행 5) 왜주사치료가효과가있는지가 ) 근거중심의이론강의 6) 표면해부학가 ) 상지해부학 (1) head ( 가 ) Anterior aspect of the face: bones - 1 -

2 1 Frontal bone 2 Superciliary arch 3 Supraorbital notch 4 Glabella 5 Nasion 6 Maxilla 7 Nasal bone 8 Zygomatic bone 9 Frontozygomatic suture 10 Prominence of cheek 11 Zygomatic arch 12 Infraorbital foramen 13 Mandible - 2 -

3 14 Mental foramen ( 나 ) Anterior aspect of the face: muscles and incisions 1 Frontalis 2 Orbicularis oculi 3 Corrugator 4 Levator labii superioris 5 Zygomaticus major 6 Zygomaticus minor 7 Orbicularis oris 8 Buccinator 9 Mentalis 10 Depressor labii inferioris 11 Depressor anguli oris - 3 -

12 Platysma 13 Medial orbital incision 14 Infranasal incision 15 Levator anguli oris 16 Levator labii superioris aleque nasi 17 Nales 18 Sublabial

4 12 Platysma 13 Medial orbital incision 14 Infranasal incision 15 Levator anguli oris 16 Levator labii superioris aleque nasi 17 Nales 18 Sublabial incision ( 다 ) Temporomandibular joint 1 Zygomatic arch 2 Temporomandibular joint 3 Body of mandible 4 Angle of mandible 5 Ramus of mandible - 4 -

6 Condyle of mandible 7 Coronoid process of mandible 8 External acoustic meatus 9 Mastoid process (2) neck ( 가 ) Carotid arteries, internal jugular vein and

5 6 Condyle of mandible 7 Coronoid process of mandible 8 External acoustic meatus 9 Mastoid process (2) neck ( 가 ) Carotid arteries, internal jugular vein and applied anatomy 1 Common carotid artery 2 Internal carotid artery 3 External carotid artery 4 Point of access to common carotid artery 5 Internal jugular vein - 5 -

6 Point of access to internal jugular vein above sternocleidomastoid muscle 7 Point of access to internal jugular vein between the heads of the sternocleidomastoid muscle 8 Collar incision 9

6 6 Point of access to internal jugular vein above sternocleidomastoid muscle 7 Point of access to internal jugular vein between the heads of the sternocleidomastoid muscle 8 Collar incision 9 Cricothyroid puncture site ( 나 ) Lateral aspect of neck: bones and attachments of shoulder girdle muscle 1 Angle of mandible 2 Body of mandible 3 Ramus of mandible 4 Temporomandibular joint 5 External acoustic meatus - 6 -

7 6 Mastoid process 7 Tip of transverse process of atlas vertebra 8 Clavicle 9 Acromion 10 Acromioclavicular joint 11 Sternocleidomastoid 12 Trapezius 13 Pectoralis major 14 Deltoid ( 다 ) Lateral aspect of the neck: palpable structures 1 Mastoid process 2 Angle of mandible 3 Hyoid bone - 7 -

8 4 Laryngeal prominence of thyroid cartilage 5 Cricoid cartilage 6 Tracheal ring 7 Manubrium sterni 8 Manubriosternal joint (angle of Louis) 9 Second costal cartilage 10 Clavicle 11 Acromion 12 Spine of scapula (3) thorax ( 가 ) Anterior chest wall: palpable structures 1 Clavicle - 8 -

2 Coracoid process of scapula 3 Manubrium sterni 4 Manubriosternal joint (angle of Louis) 5 Second costal cartilage 6 Body of sternum 7 Xiphisternum 8 Fifth, 6th and 7th

9 2 Coracoid process of scapula 3 Manubrium sterni 4 Manubriosternal joint (angle of Louis) 5 Second costal cartilage 6 Body of sternum 7 Xiphisternum 8 Fifth, 6th and 7th costal cartilage (true ribs) 9 Eighth, 9th and 10th (false) ribs ( 나 ) Anterior chest wall: bones 1 Clavicle 2 Suprasternal notch 3 Manubrium 4 Sternoclavicular joint - 9 -

10 5 Body of sternum 6 Xiphisternum 7 Coracoid process 8 True ribs (1 7) 9 False ribs (8 10) 10 Costal cartilages 11 Costal margin ( 다 ) Posterior chest wall: muscle attachments 1 Letvator scapulae 2 and 12 Supraspinatus 3 Trapezius 4 Deltoid 5 Rhomboideus minor

11 6 Rhomboideus major 7 Long head of triceps 8 and 14 Teres minor 9 Teres major 10 Latissimus dorsi 11 and 13 Infraspinatus 나 ) 하지해부학 (1) Anterior abdominal wall: palpable structures 1 Body of sternum 2 Xiphisternum 3 Costal margin 4 Tubercle of ilium

5 Anterior superior iliac spine 6 Upper border of two pubic bones, united by midline symphysis pubis (2) Posterior abdominal wall: bones and soft tissues 1 Fourth

12 5 Anterior superior iliac spine 6 Upper border of two pubic bones, united by midline symphysis pubis (2) Posterior abdominal wall: bones and soft tissues 1 Fourth lumbar spine 2 Iliac crest 3 Posterior superior iliac spine 4 Intercristal plane 5 Spleen 6 Suprarenal glands 7 Right kidney 8 Right ureter 9 Nephrectomy incision

13 10 Lumbotomy incision (this provides a limited exposure to the kidney and suprarenal gland) (3) Posterior abdominal wall: palpable structures 1 Spine of 7th cervical vertebra (vertebra prominens) 2 Upper medial border of scapula 3 Acromion 4 Spine of scapula 5 Lower medial border of scapula 6 Inferior angle of scapula 7 Twelfth rib 8 Spine of 5th lumbar vertebra 9 Sacrum 10 Posterior superior iliac spine

14 11 Iliac crest (4) Posterior trunk: sacrospinalis 1 Iliocostalis A Cervicis B Thoracis C Lumborum 2 Longissimus A Capitis B Cervicis C Thoracis 3 Spinalis A Cervicis B Thoracis

15 4 Semispinalis capitis 5 Rotatores and levator costae 6 Quadratus lumborum 7 Multifi dus (5) Gluteal region and posterior aspect of the thigh: bones 1 Fourth lumbar spine 2 Sacrum 3 Coccyx 4 Iliac crest 5 Posterior superior iliac spine 6 Posterior inferior iliac spine

7 Greater sciatic notch 8 Ischial spine 9 Lesser sciatic notch 10 Ischial tuberosity 11 Head of femur 12 Greater trochanter 13 Lesser trochanter 14 Gluteal tuberosity 15 Linea aspera 16

16 7 Greater sciatic notch 8 Ischial spine 9 Lesser sciatic notch 10 Ischial tuberosity 11 Head of femur 12 Greater trochanter 13 Lesser trochanter 14 Gluteal tuberosity 15 Linea aspera 16 Adductor tubercle 17 Medial femoral condyle 18 Lateral femoral condyle 19 Medial and lateral supracondylar ridges (6) Gluteal region and posterior aspect of thigh: palpable structures

1 Posterior superior iliac spine 2 Coccyx 3 Ischial tuberosity 4 Greater trochanter 5 Medial and lateral femoral condyles 6 Medial and lateral tibial condyles (7) Gluteal region

17 1 Posterior superior iliac spine 2 Coccyx 3 Ischial tuberosity 4 Greater trochanter 5 Medial and lateral femoral condyles 6 Medial and lateral tibial condyles (7) Gluteal region and posterior aspect of the thigh: superficial (left limb) and deep (right limb) muscles 1 Tensor fascia lata 2 Gluteus maximus 3 Long head of biceps femoris 4 Semitendinosus

5 Semimembranosus 6 Adductor magnus 7 Gracilis 8 Adductor hiatus 9 Sacrotuberous ligament 10 Sacrospinous ligament 11 Gluteus medius 12 Gluteus minimus (deep to

18 5 Semimembranosus 6 Adductor magnus 7 Gracilis 8 Adductor hiatus 9 Sacrotuberous ligament 10 Sacrospinous ligament 11 Gluteus medius 12 Gluteus minimus (deep to medius) 13 Piriformis 14 Quadratus femoris 15 Sciatic nerve 16 Short head of biceps femoris (8) Gluteal region and posterior thigh: superficial structures

19 1 Gluteus medius 2 Tensor fascia lata 3 Gluteus maximus 4 Iliotibial tract 5 Gracilis 6 Biceps 7 Semitendinosus overlying semimembranosus (9) Hip joint: posterior aspect 1 Sacrum 2 Coccyx 3 Ischial spine 4 Ischial tuberosity 5 Ischiofemoral ligament

20 6 Neck of femur 7 Greater trochanter 8 Lesser trochanter 9 Gluteal tuberosity 7) 24 개의 Balance needling points(bnps)

21 (1) 1 ( 가 ) Deep radial 1 terminal branches from the posterior cord of the brachial plexus 2 상지의신전근에분포 3 about 4cm distal to the lateral epicondyle (2) 2 ( 가 ) Great auricular 1 just behind the ear role on the anterior border of the SCM muscle 2 mechanical posture 와 systemic physiology 의항상성과연관 3 tender in almost every patient 4 출혈의가능성 external jugular vein venous air embolism 에주의 5 36게이지 5~8미리 (3) 3 ( 가 ) Spinal accessary 1 Muscular over the shoulder bridge in the midline of the front edge of the upper trpezius muscle 깊게찌르지말라 lung apex 기흉

22 혈종 2 over the shoulder bridge 3 trapezius 와 SCM 지배 (4) 7 ( 가 ) Greater occipital 1 at the base of the occipital region, 2 to 3cm from midline 2 dorsal rami of the C2 3 depth 2 to 4cm (5) 8 ( 가 ) Infraspinatus 1 Suprascapular(Infrascapular) (6) 9 ( 가 ) Lateral antebrachial cutaneous 1 at the lateral end of the skin crest at the elbow joint (7) 10 ( 가 ) Sural 1 around the middle of the posterior aspect of the leg (8) 11 ( 가 ) Lateral poppliteal 1 lateral side of the tendon of the semitendinous muscle (9) 12 ( 가 ) Superficial radial

23 1 between the thumb and the index finger (10) 13 ( 가 ) Dorsal scapular 1 located about 1 cm superior to the base of the spine of the scapula (11) 14 ( 가 ) Superior cluneal 1 the highest point of the iliac crest (12) 15 ( 가 ) Posterior cutaneous of L2 1 about 3cm from the SP of L2 (13) 16 ( 가 ) Inferior gluteal 1 center of the gluteal region (14) 18 ( 가 ) Iliotibial 1 about halfway between the hip and the knee (15) 20 ( 가 ) Spinous process of T7 1 right on the spinous process of T7 (16) 21 ( 가 ) Posterior cutaneous of T6 1 about 3 cm lateral from the sp. of T6-23 -

24 (17) 22 ( 가 ) Posterior cutaneous of L5 1 about 3cm from the SP of L5 (18) 4 ( 가 ) Saphenous

25 1 medial side of the knee below the medial condyle of the tibia (19) 5 ( 가 ) Deep fibular(peroneal) 1 2cm proximal to the web between the great and second toes (20) 6 ( 가 ) Tibial 1 about 6 to 8 cm above the medial malleolus (21) 17 ( 가 ) Lateral pectoral 1 lateral pectoral nerve 2 C5~C7 3 about 4 to 5cm inferior to the midline point of the clavicular bone (22) 19 ( 가 ) Infraorbital 1 infraorbital foramen 2 infraorbital n trigeminal n. 의 maxillary branch(v2) 3 first tender acupoint on the face 4 facial skin에분포 5 이곳주사시혈종이생기지않도록주의할것 6 36게이지니들

26 7 깊이는 2~5미리 8 증상의만성도및심한정도와관련 9 cranial neuralgias 10 all kinds od headache 11 facial,myofacial,and temporomandibular disorders 12 dental intraoral pain 13 ocular and periocular pain 14 pain in the ear 15 sinusitis 16 cold 17 allergy 18 facial paralysis 19 pain caused by cancer of the head and neck (23) 23 ( 가 ) Supraorbital 1 supraorbital notch 2 trigeminal nerve 의 ophtalmic branch(v1) 3 TMJ pain 4 chronic sinus pain (24) 24 ( 가 ) Common fibular (peroneal) 1 just anterior inferior to the head of the fibular 8) 증식주사가 ) Mechanisms of Prolotherapy

27 (1) Proliferants are injected which initiated a local inflammatory reaction (2) The inflammation launches a wound healing cascade (3) Depossion of new collagen occurs and results in a hypertrophied ligament 나 ) Prolotherapy agents (1) Osmotics; cause cell dehydration; dextrose, glycerin, zinc sulfate (2) Chemotactics; attract inflammatory cells directly; sodium morrhuate (3) Irritants; alkylating proteins on the cell surface; phenol, quaiacol, tannic acid (4) Particulates; attracts macrophages pumice 다 ) Basic formula (1) Lidocain 2% 1cc or 2.5 cc (2) Sterile water 6cc or 4.5 cc (3) 50% Dextrose 3cc (4) Total 10cc 라 ) 증식주사방법의비교

28 마 ) 증식주사방법 (1) 항상바늘이뼈에접촉하도록주사 (2) 주사부위당약 0.5cc 정도씩주사 (3) 치료간격은약 4~6 주간격으로실시 (4) 주사시환자의자세는매우중요 (5) 척추중심부를주사시 caudal needle 방향으로주사 (6) 해부학책을다시보고주사하는습관을드려라 (7) 자신의한계 ( 자신의교육정도 / 의학지식등 ) 바 ) Advice after Prolotherapy (1) Ice / Tyrenol or Codeine

29 (2) Avoid NSAID and steroid (3) Activity as tolerated but avoid vigorous exercise ( 주사후 2~3 일정도 ) (4) 약물이퍼질때까지몇시간누워있는것이좋다. (5) 주사후 2~3 일간은통증이심하게나타날수있다. (6) 금연이좋다 (7) 영양처방병행하면더욱효과적 ( 비타민 C) 사 ) 증식주사치료설명서 (1) " 프롤로테라피 " 란 ( 가 ) 증식 (prolo) + 치료 (therapy) 의합성어 ( 나 ) 인대, 건, 연골같은뼈및관절주위조직이약화되고그기능이손상 ( 다 ) 손상부위에세포의증식을유도하는약제를주사 ( 라 ) 약해진조직을강하게하는치료 (2) 방법 ( 가 ) 인대나건또는관절내에인체에무해한약물을주사 1 주사부위에염증반응 ( 나 ) 인대와건 ( 힘줄 ) 의주요성분인콜라겐생성을촉진 1 조직재생유도 ( 다 ) 관절과그주위조직의강화 1 질병치료 ( 라 ) 일반적으로알고있는뼈주사 ( 스테로이드 ) 가아님 (3) 적응증

30 ( 가 ) 허리디스크, 만성허리통증및좌골신경통 ( 나 ) 목디스크, 뻐근한목 ( 다 ) 퇴행성관절염 ( 무릎, 고관절 ) 등 ( 라 ) 어깨통증 ( 오십견 ) ( 마 ) 스포츠손상이나교통사고후만성통증 ( 바 ) 두통 (4) 치료기간 ( 가 ) 1주일간격 1 6회주사 ( 나 ) 6회주사후 6주에추가주사 ( 다 ) 3개월후 1 추가주사 (5) 부작용 ( 가 ) 특별한부작용은없음 ( 나 ) 다만, 치료초기에조직의재생과정에서통증이유발될수도있으나, 며칠후그통증은사라지게된다 (6) 주의점 ( 가 ) 의사가지시한대로따른다 ( 나 ) 치료를받으면초기에통증이더심해질수있다이때는담당주치의와상의한다 ( 다 ) 주사맞은당일목욕은하지않는다. 9) Placental Functions 가 ) metabolism

(1) synthesizes glycogen, cholesterol and fatty acids ( 가 ) serve as sources of nutrients and energy for the embryo and fetus 나 ) transport (1) The transfer of maternal antibodies (mainly IgG) ( 가 )

31 (1) synthesizes glycogen, cholesterol and fatty acids ( 가 ) serve as sources of nutrients and energy for the embryo and fetus 나 ) transport (1) The transfer of maternal antibodies (mainly IgG) ( 가 ) providing passive immunity to the newborn. (2) The syncytiotrophoblast is an important endocrine organ for much of the pregnancy 다 ) It produces both protein and steroid hormones 라 ) Placental hormone synthesis (1) Human chorionic gonadotropin (hcg) ( 가 ) Synthesis of hcg begins before implantation, and is responsible for maintaining the maternal corpus luteum

32 that secretes progesterone and estrogens. ( 나 ) It is the basis for early pregnancy tests. Production peaks at eight weeks and then gradually declines. ( 다 ) Structurally, this glycoprotein resembles LH. (2) Estrogens and progesterone ( 가 ) The placenta can produce progesterone independently from cholesterol precursors, and estrogen in concert with the fetal adrenal gland, as it does not contain all the necessary enzymes itself. ( 나 ) By the end of the first trimester, the placenta produces enough of these steroids to maintain the pregnancy and the corpus luteum is no longer needed. (3) Human placental lactogen (hpl) or human chorionic somatomammotropin (hcs) ( 가 ) This hormone is similar to growth hormone and influences growth, maternal mammary duct proliferation, and lipid and carbohydrate metabolism (4) Human placental growth hormone ( 가 ) This hormone differs from pituitary GH by 13 amino acids. ( 나 ) From 15 weeks until the end of pregnancy, this hormone gradually replaces maternal pituitary GH

33 ( 다 ) Its major function is the regulation of maternal blood glucose levels so that the fetus is ensured of an adequate nutrient supply. ( 라 ) Its secretion is stimulated by low maternal blood glucose levels; in turn, it stimulates gluconeogenesis in the maternal liver. (5) Human chorionic thyrotropin (hct) ( 가 ) Small amounts produced, functions similar to pituitary hormone. (6) Human chorionic adrenocorticotropin (hacth) ( 가 ) Small amounts produced, functions similar to pituitary hormone. (7) Insulin-like growth factors ( 가 ) Stimulates proliferation and differentiation of the cytotrophoblast. (8) Endothelial growth factor ( 가 ) First produced by 4 to 5-week-old placenta; stimulates proliferation of the trophoblast (9) Relaxin ( 가 ) Produced by decidua cells; softens the cervix and pelvic ligaments in preparation for childbirth. (10) In addition, the placenta produces dozens of proteins that have been identified immunologically

34 but whose function is poorly understood. 마 ) 라이넥 (1) 태반추출물 10) 신경간내주사가 ) 마6 신경간내주사의정의 (1) 신경인접부위에스테로이드제제, 국소마취제등을주입하는행위 (2) 1일 1회정도시행할수있음 (3) 고시제 호, 2008 년 6월 1일시행 (4) KK061 ( 가 ) 마 교시가. 11시 ~12시 1) Needling 가 ) Balance point (1) Trigger points ( 가 ) painful or tender points ( 나 ) Types 1 Central TP tender, localized hardening in a skeletal muscle palpably tense band of muscle fibers tender spot을누르면 pain 인식

35 2 Attachment TP taut band 가있는 muscle 의지속적 tension 에의해근육이붙는부위에서 tenderness 골격근에만존재 ( 다 ) active TP의진단기준 1 taut band (+) 2 tenderness in a nodule 3 tender spot을누르면 pain 인식 ( 라 ) Latent TP 1 no clinical pain (2) Motor points (3) Dermopoints (4) balance point = trigger points (5) chronicity 에따라 size가커진다 (6) 병태생리적으로 dynamic structure 나 ) Nervous system (1) 해부학적분류 ( 가 ) Central nervous system 1 brain 2 spinal cord 3 needling 에반응 ( 나 ) Peripheral nervous system 1 complex 2 12 pairs of cranial nerves

36 3 33 pairs of spinal cord 8 cervical 12 thoracic 5 lumbar 5 sacral 3 coccygeal 4 ganglion spinal cord 밖의 nerve cells group 5 기능적구성 sensory neurons motor neurons sympathetic ganglion neurons needling 에모두 activates 6 구심성신경섬유 수용체에서 signal 을 CNS로전달 4 types of sensations superficial pain touch temperature deep deep muscle pain muscle and joint position sense vibration sense visceral visceral pain

37 hunger nausea special smell vision hearing taste equilibrium needling 직접자극 superficial deep 간접자극 visceral 7 원심성신경섬유 8 3 types of sensory fiber A-beta gentle pressure, vibration 에 sensitive TENS에반응 3~6미터길이 15~30m/s 찌르면 numbness A-delta heavy pressure, temperature sensitive needling 에반응 2~5미터

38 12~30m/s 찌르면 aching, distension,heaviness C-fibers very thin unmyelinated pressure,chemicals, temperature needling 에반응 0.4~1.2m 0.5~2m/s 찌르면 soreness ( 다 ) Autonomic nervous system (2) 기능적분류 ( 가 ) Somatic NS 1 muscle controls 2 정보를뇌에전달 3 PNS와유사 4 muscle, skin, mucous membrane 에분포 ( 나 ) Autonomic(Visceral) NS 1 무의식적 controls respiration heartbeat 2 body의 caretaker 3 viceral organs 를 controls 4 종류 CNS

39 PNS 5 심장근, 장에있는 smooth muscle(blood vessel) 을 control 6 glands control 7 target organ --> brain까지 sensory information 을전달 8 efferent pathway(motor) two neuron chains primary neuron preganglionic neuron secondary neuron postganglionic neuron out flow pathway 9 afferent pathway(sensory) 10 groups of neurons in the brain and spinal cord 11 sympathetic C8~L2 maintain a constant internal body environment adrenaline 분비증가 blood sugar levels 조절 체온조절 혈관의수축성유지 교감신경이기능항진 energy consuming process 오래지속 저장에너지고갈 면역계억제 병에걸리고

항상성저하 sensitive to pain In rest, 교감신경기능이 calm 부교감신경이 active 12 parasympathetic inside the brainstem sacral segment of the spinal cord 13 needling

40 항상성저하 sensitive to pain In rest, 교감신경기능이 calm 부교감신경이 active 12 parasympathetic inside the brainstem sacral segment of the spinal cord 13 needling 교감신경과부교감신경의기능을정상화 최적의항상성회복 즉, 교감신경의기능을 calm 부교감신경의기능을 activates 골격근을자극 이완 근육에 tiny lesions brain and spinal cord를자극 endorphins 을분비 (3) 신경계의기본단위 ( 가 ) Neuron 1 nerve cell

41 (4) Vagus nerve ( 가 ) restore 1 homeostasis ( 나 ) antiinflammatory immune reaction 다 ) 감각신경 (1) 신체모든부위에존재 (2) 예외 ( 가 ) 손발톱, 머리카락라 ) Dr. Ronald Melzack (1) 경혈의 70% 와 trigger points 가일치마 ) 근육에서의정상에너지대사과정 (1) 전기신호를척수로부터근육이받게되면 (2) 근육세포는 Ca을저장소 (Sarcoplasmic reticulum) 로부터 cytoplasm 으로분비 (3) Ca의농도가세포질내에증가하게되면세포성수축활동이촉진된다. (4) 세포성수축후 Ca은다시세포질에서 SR로들어가고세포질내 Ca농도가감소 (5) 근육은즉시 relax (6) 다음수축을기다린다. (7) 이때 Ca의이동에에너지가필요함 (ATP) (8) 즉, 근섬유가손상되고, 에너지공급이감소

42 ( 가 ) Ca 이온이세포질내에서 SR로돌아가지못하고세포질내 Ca이온의농도가지속적으로높아짐 ( 나 ) muscle fibers 의 sustained contracture 1 에너지를더많이필요로함 energy crises 2 nutrition 과 oxygen 을공급하는말초혈관에혈류가감소 low oxygen environment(hypoxia) ( 다 ) acupoints 의 tenderness (9) 결국근육이손상되면 Ca pump 작동이정상적으로일어나지않아세포질내에 Ca 이온이증가, 지속적으로근육수축이일어나게됨 (10) 손상된근육에에너지고갈상태초래 ( 가 ) 만성염증으로진행바 ) needling (1) muscle ( 가 ) tiny lesion bleeding 1 in 수축된근육과주위조직 (2) tight contracted muscle 이즉시 relaxes (3) blood circulation 이 improve (4) needled lesion ( 가 ) lesion current 발생 1 500mA/cm 이상의 small electrical current ( 나 ) local bleeding

43 1 numerous Growth factors 의분비되도록자극 neurotrophic factors platelet derived growth factors 사 ) low back pain (1) H15 ( 가 ) Posterior cutaneous of L2 (2) H14 ( 가 ) Superior cluneal (3) H16 ( 가 ) Inferior gluteal (4) H18 ( 가 ) Iliotibial (5) H22 ( 가 ) Posterior cutaneous of L5 (6) H10 ( 가 ) Sural 아 ) mechanical force sustained at the SI joint to balance the body is about 3 to 6 times the weight of the luggage if the spine is bent to pick up luggage

44 자 ) SI joint

45 차 ) Shortened paraspinal muscles across an intervertebral space compress the disc and nerve root

46 카 ) A fatigued, tight, and shortened muscle can cause tendinitis 2) needling mechanism 가 ) 전제 (1) 주사로손상된세포는반흔형성없이같은종류의새로운세포로바뀐다. 나 ) Optimal homeostasis 최적의항상성 (1) 근골격계의밸런스 (2) 유효한기계적운동

47 (3) 신경, 심혈관, 내분비, 면역계의생리적조화 (4) 신체와정신의조화로운상호작용 (5) 기계적운동을최적화다 ) 근막통의 4가지형태와그들의다른병리 (1) The majority of clinical pain ( 가 ) myofascial. ( 나 ) 연구에의하면요통의 85%, 경부통과만성두통의 54.6% 가근막통이다. (2) 근막통의 4가지형태 ( 가 ) Trigger points 유발통 ( 나 ) Muscle spasm 근수축 ( 다 ) Muscle tension 근긴장 ( 라 ) Muscle deficiency 근결핍 (3) 연부조직통분석을해보면다음병리현상을수반 ( 가 ) Tissue inflammation 조직염증 ( 나 ) Tissue contracture 조직구축 ( 다 ) Microcirculatory deficiency, which includes blood and lymphatic circulation, ischemia and/or edema 미세순환결핍, 혈액과림프순환결핍, 허혈, 부종 ( 라 ) Trophic deficiency, including tissue degeneration 조직퇴화를포함하는영양결핍 ( 마 ) Tissue adhesion 조직유착 ( 바 ) Scarring of tissue 조직반흔

48 ( 사 ) Biomechanical imbalance of the musculoskeletal system, including improper posture. 근골격계통의생역학불균형, 자세불균형라 ) Lesion mechanisms of dry needling (1) The physical movement and manipulation of the needles in deep tissues (2) increases the tension of the muscle fibers and connective tissue (3) creates the effect of mechanical signal transduction (4) leads to self-healing (5) 바늘을수직으로 1센티깊이로찌르면적어도 1000 개의근섬유를손상하게된다. (6) 바늘을근육까지깊게찌르면수천개의근섬유와약간의모세혈관, 신경종말부에손상을초래 (7) 뇌는연부조직과생물학적시스템 ( 심혈관계. 면역계, 내분비계 ) 의외상손상을인식하게된다. 손상을입은조직은수일내로같은종류의새로운조직으로대체 (8) 이방법으로자연치유가바늘로찔린부위에서시작 (9) 국소치유효과에더불어손상은중추신경계에서일어나는여러반사작용을통해항상성회복에관여 (10) 니들링은자연치유를돕고원하지않는고통을감소 (11) 이것은만성병태로의발전을예방하는데도움

49 마 ) 효과 (1) Local skin reaction and cutaneous microcurrent mechanism (2) Local interaction between needle shaft and connective tissues (3) Local relaxation of current muscle shortening and contracture ( 가 ) -> improves local blood circulation through the autonomic reflex (4) Neural mechanism ( 가 ) nociceptive and motor neuronal activation ( 나 ) CNS-mediated neuroendocrine activity ( 다 ) segmental and nonsegmental pathways (5) Blood coagulation and lymphatic circulation (6) Local immune responses (7) DNA synthesis to replace the injured tissues and repair the lesions 손상된조직대체와병소치료를위한 DNA 합성 (8) Needling is a process of nociceptive stimulation with both mechanical and biochemical effects. ( 가 ) Needling 은기계적, 생화학적효과가지는통각자극과정 ( 나 ) 기계적효과는물리적압력과감각신경말단에서통각을

방해하는것을포함 1 생화학적효과는바늘로유도되는신경원성염증과통각신경말단과조직에서분비되는 substance P, bradykinin, prostaglandins, serotonin, somatostatin, and calcitonin gene related peptide (CGRP) 등의신경단백의분비 ( 다 ) needling-induced lesion

50 방해하는것을포함 1 생화학적효과는바늘로유도되는신경원성염증과통각신경말단과조직에서분비되는 substance P, bradykinin, prostaglandins, serotonin, somatostatin, and calcitonin gene related peptide (CGRP) 등의신경단백의분비 ( 다 ) needling-induced lesion 은표피, 진피, 기저결체조직 ( 탄력섬유, 콜라겐, 기저판, 심부근막 ), 근육조직 ( 골격근, 혈관의평활근 ), 신경조직 ( 감각신경의신경섬유, 신경절후신경세포 ) 를자극한다. 바 ) TYPES OF SOFT TISSUE INJURY (1) Violent physical injuries (2) Cumulative injuries (3) Emotional stress

51 (4) Unconscious injuries (5) Overloading fatigue ( 가 ) overexertion ( 나 ) overeating ( 다 ) overexercising (6) Injuries from chemical toxins (7) Injuries caused by excess weight and obesity (8) Postsurgical injuries (9) Disease-related injuries (10) Environmentally related injuries (11) Injuries caused by abnormal physiology 사 ) HISTOLOGIC FEATURES OF SOFT TISSUE INJURIES (1) Contracture 구축 ( 가 ) 가역적또는비가역적 1 조직의단축이생리적한계내에있고, 과사용, 과부하, 오사용, 물리적가해에의해야기되었을때이런구축은가역적이다 2 상당한양의조직이파괴된심한손상에의한구축은비가역적이다. 물리적손상이나수술의결과로발생한다. 수술후자가치유과정동안, 유착과상처가형성되고, 이과정에서발생한구축은비가역적이다. (2) Adhesion 유착

52 ( 가 ) 급성또는만성손상후자가치유과정중, 조직재생은인근조직과유착을발생시킬수있다. ( 나 ) 유착은근외막, 근내막, 힘줄과인접조직, 인대, 관절피막사이에발생한다. ( 다 ) 골막과신경, 인접조직, 기관사이, 연관된조직사이에발견되기도한다. ( 라 ) 치유과정에서유착생성을예방하는것은매우중요하다. ( 마 ) 국소미세순환, 혈액과림프, 를방해하고, 허혈, 저산소증, 수분저류와불순물의축적을발생아 ) PATHOLOGIC PROCESS OF SOFT TISSUE DYSFUNCTION AND INJURY (1) Soft tissue dysfunctions (2) inflammation (3) contracture (4) adhesion (5) scarring (6) blockage of circulation (7) atrophy (8) musculoskeletal imbalance 자 ) THREE STAGES OF SELF-HEALING OF SOFT TISSUE AFTER INJURY (1) Inflammation and immune reaction

( 가 ) release active biologic factors 1 platelet factors 2 activated immune cells white blood cells macrophages digest the injured tissues (2) Cellular regeneration

53 ( 가 ) release active biologic factors 1 platelet factors 2 activated immune cells white blood cells macrophages digest the injured tissues (2) Cellular regeneration and differentiation ( 가 ) Primordial cells( 원시세포 ) 는손상조직과같은종류의세포를재생하고분화 (3) Reconstruction of the injured tissues ( 가 ) 내피세포는조직과모세혈관을형성하기위해손상부분으로이동차 ) fmri 영상

54 3. 3교시가. 13시 ~14시 1) 증식주사실습 2) 라이넥주사실습 3) 신경간내주사실습 4. 4교시가. 14시 ~15시 1) 통증에필요한영양요법 가 ) 강사 (1) 김동환박사

55 5. 5교시가. 15시 ~16시 1) 영양요법체험 2) 질의응답

Thieme: Color Atlas of Acupuncture

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