Comerford M J, Mottram S L
Kinetic Control, Salisbury Street, Mede House, Southampton SO15 2TZ, UK.
Man Ther. 2001 Feb;6(1):3-14. doi: 10.1054/math.2000.0389.
Functional stability is dependent on integrated local and global muscle function. Mechanical stability dysfunction presents as segmental (articular) and multi-segmental (myofascial) dysfunction. These dysfunctions present as combinations of restriction of normal motion and associated compensations (give) to maintain function. Stability dysfunction is diagnosed by the site and direction of give or compensation that relates to symptomatic pathology. Strategies to manage mechanical stabililty dysfunction require specific mobilization of articular and connective tissue restrictions, regaining myofascial extensibility, retraining global stability muscle control of myofascial compensations and local stability muscle recruitment to control segmental motion. Stability re-training targets both the local and global stability systems. Activation of the local stability system to increase muscle stiffness along with functional low-load integration in the neutral joint position controls segmental or articular give. Global muscle retraining is required to correct multisegmental or myofascial dysfunction in terms of controlling the site and direction of load that relates to provocation. The strategy here is to train low-load recruitment to control and limit motion at the site of pathology and then actively move the adjacent restriction, regain through range control of motion with the global stability muscles and regain sufficient extensibility in the global mobility muscles to allow normal function. Individual strategies for integrating local and global recruitment retraining back into normal function are suggested.
功能稳定性取决于局部和整体肌肉功能的整合。机械稳定性功能障碍表现为节段性（关节）和多节段性（肌筋膜）功能障碍。这些功能障碍表现为正常运动受限及相关代偿（给予）的组合，以维持功能。稳定性功能障碍通过与症状性病理相关的给予或代偿的部位和方向来诊断。管理机械稳定性功能障碍的策略需要对关节和结缔组织限制进行特定的松动，恢复肌筋膜的伸展性，重新训练对肌筋膜代偿的整体稳定性肌肉控制以及局部稳定性肌肉募集以控制节段性运动。稳定性再训练针对局部和整体稳定性系统。激活局部稳定性系统以增加肌肉僵硬度，并在关节中立位进行功能性低负荷整合，以控制节段性或关节给予。需要进行整体肌肉再训练，以在控制与激发相关的负荷部位和方向方面纠正多节段性或肌筋膜功能障碍。这里的策略是训练低负荷募集，以控制和限制病变部位的运动，然后主动活动相邻的受限部位，通过整体稳定性肌肉对运动进行全程控制来恢复，并在整体活动肌肉中恢复足够的伸展性以实现正常功能。文中还提出了将局部和整体募集再训练整合回正常功能的个体化策略。
