Comerford M J, Mottram S L
Kinetic Control, Salisbury Street, Mede House, Southampton SO15 2TZ, UK.
Man Ther. 2001 Feb;6(1):15-26. doi: 10.1054/math.2000.0388.
A good understanding of the control processes used to maintain stability in functional movements is essential for clinicians who attempt to treat or manage musculoskeletal pain problems. There is evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems is presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. Direction related restriction and compensation to maintain function is identified and related to pathology. The local stability muscles demonstrate evidence of failure of adequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology. Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction.
对于试图治疗或处理肌肉骨骼疼痛问题的临床医生而言，深入理解用于维持功能运动稳定性的控制过程至关重要。有证据表明肌肉功能障碍与运动系统的控制有关。本体感觉输入减少、慢运动单位募集改变与慢性疼痛状态的发展之间存在明确联系。阐述了整体和局部肌肉系统的功能障碍，以支持肌肉功能分类系统的发展以及与肌肉骨骼疼痛相关的功能障碍的发展。整体肌肉控制运动范围和排列，功能障碍的证据表现为整体稳定肌和整体活动肌之间募集和长度的不平衡。识别出与维持功能相关的方向限制和代偿，并将其与病理情况相关联。局部稳定肌表现出在允许过度不受控制的平移或病理部位横截面积特定损失方面，节段控制不足的证据。运动募集缺陷表现为募集时间和模式的改变。局部和整体功能障碍的证据有助于构建运动功能障碍的综合模型。
