스포츠손상에따른물리치료 근골격계스포츠손상의분류 접촉성스포츠 신기문 비접촉성스포츠 근골격계스포츠손상의원인 Macrotrauma : 급성의큰외력 Microtrauma : 반복동작, 스트레스, 견인력만성과사용 (overuse) 미세손상 경기력 향상 작 용 지속적반복성최대스트레스 반작용 병리학적미세상해 ( 건, 근육접합부위및골격 ) 반 복 염증성반응 ( 부종및출혈 ) 유착및상흔조직의형성 상해정도의분류 경도상해 ( 75-80 % ) ; 타박, 염좌 ( 근, 건상해 ) 중등도상해 (15-20 % ) ; 인대, 연골상해, 작은골절 중증상해 ( 5-8 % ) ; 큰골격의골절, 내장및신경계손상 치료를위한개념정리 HOLISM ( 전체성 ) Manual Therapy ( 맨손치료 ) Musculo - Skeletal Therapy ( 근골격계치료 ) Somatic Dysfunction ( 체성기능부전 ) 1
Structural vs Functional Dichotomy Symptomatic vs Asymptomatic Circulatory (Hyperemic vs Ischemic) Motility (Hyper mobility vs Hypo-mobility) Asymmetry (Static vs dynamic) (Wt. Bearing + vs -) ROM (Translatory vs. Angular) (Quality vs Quantity) Tissue Texture (Contractile vs. Non-Contractile) - endfeel Concentric vs Eccentric Contraction (cf. Contracture) Normal vs. Abnormal (cf. WNL) Assessment ( 보는과정 ) Inspection- see vs. look( 눈으로 ) History taking( 귀로 ) Palpation( 손으로 ) Movement test (P. A. R.)( 움직임으로 ) Differential Dx.( 비교해서 ) Special Tests ( 자세히 ) Tome -tomy Zone 영역구분 Derma 피부 Connective Tissue 결체조직 Myo 근육 Ot Osteo 뼈 Sclero 경부조직 Manu 손 Pedo 발 Auricle - 귀 2
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근육의손상과출혈고관절내전근파열과건의신장정상견관절의연부조직견관절의완전탈구인대손상의형태 5
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완이두근장두건파열상완골의과상골절과합병증주두점액액낭염견관절극상근건의침해 대흉근파열상과봉합수술 상8
팔꿈치주두돌기골절과정복수술 손목의요골골절 손의수근골골절 스키선수들의엄지손가락손상 척추추간판수핵탈출로인한신경압박 무릎내측에가해진스트레스의한손상 9
릎외측부에가해진스트레스무릎바깥쪽에가해진스트레스 개대퇴관절의연골연화증무릎관절주위의활액낭분포무릎관절불안정손상 무슬전슬개활액낭염 10
하퇴정강이 종아리구획 후종골 점액낭염 발목관절의굴곡, 신전, 외반상해 후경골근건의지시부 족저근막과족궁 Head injury a. contusion ( emergency care ) b. lacerations c. fractures d. hematomas 11
Facial injuries a. jaw : laceration, dislocation, TMJ b. nose : fracture, epistasis, narsal septum c. eye : contusion, laceration, foreign body d. ear : contusion, foreign body, hematoma auris, swimmer's ear neck a. spinal cord transection - paraplegia / quadriplegia ( emergency care ) b. laceration, contusions, fractures, subluxation / dislocation c. whiplash injury, torticollis e. mouth : tooth fracture, loss, tongue & cheek Shoulder & Upper arm a. sterno - clavicular joint : sprain, disc injury b. acromio - clavicular joint : contusion, sprain c. clavicle : fracture d.rotator cuff : strain / rupture, inpingement syndrome e. glenohumeral joint fracture : humeral head / neck, labum subluxation / dislocation : anterior, posterior, inferior, recurrent tendinitis : long head of biceps, supraspinatus bursitis : subdeltoid, subacromia f. sports shoulder : little league shoulder, pitcher's shoulder, trapshooter's shoulder, tennis shoulder, shouler - hand syndrome, blocker's extosis elbow & forearm a. fracture, dislocation, hyperextension bli b. ligament tij injury : valgus / varus, annular c. olecranon bursitis d. tennis elbow, golfer's elbow little league elbow e. volkmann' s ischemia wrist & hand a. fractures : colle's, bennett, boxer's/street fighter's, mallet finger, scaphoid, lunate b. tendinitis, tenosynovitis, tenovaginitis, De Quarvain's, trigger /snapping finger c. sprains : skier's thumb, gamekeeper's thumb, lunate dislocation d. meniscal injuries, contusion, nail bed hematoma e. nerve palsy : ulnar, radial, median f. contractures : Dupuytren's g. ganglion, Herbenden's nodes h. circulatory complication : Raynaud's disease i. deformity : finger clubbing, claw finger, swan neck, Boutonniere j. Sudeck's atrophy ( sympathetic nerve dystrophy ) k. carpal tunnel syndrome Thoracic & Lumbar spines a. Fractures : spondylosis, spondylolisthesis, SP & TP, vertebral body b. contusions, subluxation, dislocation, sprain c. spinal stenosis, spondylolysis d. disc injuries i & degenerative disc diseases e. nerve root impingement f. facet syndromes g. scoliosis, kyposis, lordosis h. vertebral osteochondritis i. soft tissue injuries : dura stretch 12
Thorax Abdomen a. fractures : rib, sternal b. separation/dislocation : costochondral, sternocostal c. hemothorax, pneumothorax, hemopneumo thorax d. traumatic asphyxia, frail chest e. heart contusion a. internal organ contusion : kidney, spleen, stomach, pancreas b. internal organ rupture : bladder, urethra, spleen c. solar plexus contusion d. abdominal muscle contusion Pelvis a. fracture : ilium b. contusion : hip pp pointer, scrotum c. hernia : inguinal, femoral d. varicocele e. over use syndrome : symphysis pubis separation, inguinal region hip thigh, groin a. fracture, dislocation, contusion, sprain b. strain : quadriceps, hamstring, adductor, abductor hip pointer(iliac spine), satorius traction(a.s.i.s.), rectus femoris pull(p.s.i.s.), sis) c. hamstring pull (ischial tuberosity) d. synovitis, bursitis, tendinitis e. snapping hip f. congenital anteversion / retroversion of the hip g. traumatic great trochanter Knee a. fracture : femoral condyle,bumper's fracture b. sprain : MCL, LCL, ACL, coronary ligament c. meniscus injury : tear, congenital anormalities (discoid meniscus) d. synovitis, bursitis(infra, supra, prepatella, pes anserinus), tendinitis (patella, popliteal) e. patella subluxation / dislocation acute & chronic f. chondromalacia patellae - acute & chronic (Patello-Femoral Mal-alignment syndrome) g. Osgood - Schlatter's disease, Backer's cyst h. jumper's knee, iliotibial band friction syndrome, lower leg a. fracture : traumatic, stress b. shin splints, overuse syndromes c. compartment syndromes d. muscle cramps f. contusion, laceration 13
Ankle & Foot a. fracture : lat./med. malleolus, bimalleolar, tarus, calcaneus, phalanges, metatarsal b. sprain (inversion / eversion) strains c. tendinitis (achilles, tibialis anterior), bursitis (retro-calcaneal), fasciitis d. contusion, bruises( heel l) ), laceration e. extosis : pump bumps f. nerve palsy : tibial, superficial / deep peroneal g. deformity : hammer toe, mallet toe, claw toe, pes cavus, planus, Morton's foot h. Morton's neuroma / metatarsalgia, march fracture i. nail bed hematoma, ingrown toe nail j. circulatory complications : Raynaud's disease 여러가지감염, 질환, 병변 (1) viral infections (2) bacterial infections (3) fungus infections (4) parasitic infections (5) mechanical, physical & thermal reactions (6) allergic skin conditions (7) problems of the resperatory system (8) problems of digestive system (9) problems of uro-genital system (10) wounds (11) infectious diseases Soft Tissue Injury Emergency Care ICE + S2 의원칙 Ice ( 냉적용 ), Compression( 압박 ), Elevation ( 거상 ) S2 = Stabilization ( 추가적상해로부터상해부위보호 ) = Stretch ( 가능하다면환부에가벼운스트레칭시행 ) Physical + Therapy + Education Physical Therapy vs. Physical Education Physical Therapy Physical Education 물리치료적용 수동적방법 ; 냉온의적용, 전기자극, 광선요법등 능동적방법 ; 각종운동요법, 안정화, 근에너지기법등 14
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수고하셨습니다. 신기문 21