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1、开链运动与闭链运动,康复中心张廷峰,目 录,概念,比较,在康复中的应用,运动特点,1,2,3,4,总结,5,运动链,人体若干环节借助关节按一定顺序衔接起来,称运动链。在人体上,上肢由肩带、上臂、肘关节、前臂、腕关节、手等形成上肢运动链;下肢由髋关节、大腿、膝关节、小腿、踝关节、足等形成下肢运动链。 人们通常将一侧上下肢视为一条长链，每个关节均为链扣。,In open kinetic chain (OKC) exercise, the terminal segment of the extremity moves freely without any external resistance. T
2、he sequential activation of muscles in OKC exercise from proximal to distal allows rapid acceleration and speed of the distal segment. In closed kinetic chain (CKC) exercise, the distal segment of the extremity is fixed, and proximal motion takes place in multiple planes. A common error in developin
3、g an exercise program is failure to assess the proximal and distal segments of the entire extremity, or kinetic chain. A kinematic chain is a series of interrelated joints that constitute a complex motor unit, constructed so that motion at one joint will produce motion at the other joints in a predi
4、ctable manner. Whereas kinematics describes the appearance of motion, kinetics involves the forces, whether internal (e.g., muscle contractions or connective tissue restraints) or external (e.g., gravity, inertia, or segmental masses) that affect motion. Initially, a closed kinetic chain (CKC) was c
5、haracterized as the distal segment of the extremity in an erect, weight-bearing position, such as the lower extremity when a person is weight bearing. Subsequently, when the distal segment of the extremity is free to move without causing motion at another joint, such as when non-weight bearing, the
6、system was referred to as an open kinetic chain (OKC). When force is applied, the distal segment may function independently or in unison with the other joints. Movements of the more proximal joints are affected by OKC and CKC positions. For example, the rotational components of the ankle, knee, and
7、hip reverse direction when moving from an OKC to CKC position. Because of incongruities between the lower and upper extremity, particularly in the shoulder region, several authors have challenged the traditional definition of OKC and CKC positions. Stabilizing muscles in the scapulothoracic region p
8、roduces a joint compression force that stabilizes the glenohumeral joint much in the same manner as a CKC in the lower extremity. Although debate continues on defining CKC and OKC relative to the upper extremity, there remains general agreement that both CKC and OKC exercises should be incorporated
9、into an upper and lower extremity rehabilitation program. Injury and subsequent immobilization can affect the proprioceptors in the skeletal muscles, tendons, and joints. In rehabilitation, it is critical that CKC activities be used to retrain joints and muscle proprioceptors to respond to sensory i
10、nput. Closed kinetic chain exercises are recommended for several reasons. Closed kinetic chain exercises stimulate the proprioceptors, increase joint stability, increase muscle coactivation, allow better utilization of the SAID (Specific Adaptations to Imposed Demands) principle, and permit more fun
11、ctional patterns of movement and greater specificity for athletic activities. In contrast, OKC exercises can isolate a specific muscle group for intense strength and endurance exercises. In addition, they can develop strength in very weak muscles that may not function properly in a CKC system becaus
12、e of muscle substitution. Although OKC exercises may produce great gains in peak force production, the exercises are usually limited to one joint in a single plane (uniplanar), have greater potential for joint shear, have limited functional application, and have limited eccentric and proprioceptive
13、retraining. However, OKC exercises can assist in developing a patient-athletic trainer rapport through uniplanar and multiplanar manual therapeutic techniques. When ROM has been achieved, repetition of motion through actual skill movements can improve coordination and joint mechanics as the individu
14、al progresses into phase three of the program. For example, a pitcher may begin throwing without resistance or force application in front of a mirror to visualize the action. This also can motivate the individual to continue to progress in the therapeutic exercise program.,英语原文,梯队成员23人;主任医师7人，副主任医师8
15、人,一.开链运动概念,近端固定，远端游离的活动即为开链运动。如股四头肌椅训练、使用哑铃进行肱二头肌训练是典型的例子。此时多为单关节的活动。,开链运动图释,股四头肌训练,颈前下拉,二.闭链运动概念,远端（手掌或脚掌）闭合，如接触地面、墙面或桌面，近端（躯干）运动，称之为闭链运动。这时所能做的肢体运动只能是多关节协调活动。例如蹲起时必须同时活动髋、膝、踝关节，不可能作单一关节的活动；两上肢撑地作俯卧撑时，也只能同时活动腕、肘、和肩关节。骑车训练也是典型的例子。,闭链运动图释,闭链运动-哑铃蹲举,闭链运动-引体向上,开链运动与闭链运动比较,开链运动(OKC) 闭链运动(CKC) 远端肢体在空间中运动
16、 远端肢体保持固定 有单一的关节运动，附 多关节运动，附近关节有运动 近关节无活动 只有运动关节远端的躯体活动 运动关节的近端和远端的身体都有活动 只有主动肌收缩 运动关节的远端和近端多肌群收缩 较少出现身体重量作为负重参 很多时候有身体重量作为负重参与运动 与运动 阻力应用在运动肢体远端 阻力同时应用在多个运动关节 动作相对比较简单，容 动作相对不容易掌握，用于早期康复和功能 易掌握。 训练 针对性训练，孤立、刺激训练 参与活动关节和目标肌肉较多 目标肌肉,三运动特点,开链运动的运动特点：远端的运动范围大于近端，速度也快于近端。所以在强化肌力的训练中，肌肉爆发力的训练应选择开链运动训练。前交叉韧带损伤时，应多开链练习强化腘绳肌肌力，后交叉韧带损伤时，应多开链练习强化股四头肌肌力；以保护韧带再发损伤。,闭链运动特点：多关节、多块肌肉（主动肌与拮抗肌）参与的活动，因此运动时不增加关节的切力，可以增加保护作用，更接近于功能性康复。 所以对于某些疾患如前十字韧带(ACL)重建或松弛的关节，可以提供早期
