흔히 발생하는 노인에서의 운동 손상
이 규 훈
한양대학교 의과대학 재활의학교실
• 60세 이상의 노인 100명을 대상, 운동
• 조깅이나 걷기 ; 32명
• 게이트볼 ; 28명
• 기공체조 ; 15명
• 배드민턴 ; 3명
• 에어로빅, 수영
• 60세 이상의 노인 100명을 대상, 여가시간
• 경로당이나 노인정에 다닌다 ; 37명
• 등산, 춤, 하이킹과 여행, 애완 동물 돌보기, 사
우나 이용 등
Impingement syndrome
• Rotator cuff disease, painful arc syndrome
• Subdeltoid bursitis, subacromial bursitis
• shoulder stabilizer: static & dynamic
• subacromial space:
① superiorly acromion, subacromial bursa coracoacromial lig
② medially coracoid process
③ inferiorly humeral head
Shoulder impingement
Primary impingement
Primary impingement
Secondary impingement
Function of Rotator cuff
• contain humeral head into glenoid socket in abduction
• control humeral head within 1mm movement on glenoid at the normal range
(post displacement 4-6mm at maxE/R)
Secondary impingement
Secondary impingement
Impingement syndrome
Impingement tet
Impingement syndrome
Hawkins-Kennedy test
Impingement syndrome
supraspinatus test
Diagnosis
• stage I: point tenderness over the greater tuberosity & anterior acromion & CAL classic impingement test
Hawkins-Kennedy test
injection of 10mL of 1% lidocain
• stage II: worse at night, painful ROM
• stage III: weakness of abduction & external rotation, muscle wasting due to tear
• imaging study: plain film, ultrasonography, arthrography, MRI
Treatment
• stage I
- ice massage, US - alteration of activity - anti-inflammatory medication - intra-articular steroid: controversial - proprioceptive neuromuscular
facilitation(PNF)
- therapeutic exercise for strenthening the dynamic stabilizers
• stage II, III
- conservative protocol
- anterior acromioplasty, CAL release
Therapeutic exercise
Adhesive capsulitis
• Frozen shoulder
• pain & limited motion
~internal & external rotation, abduction
• classic three phases - pain
- progressive stiffness
- phase of gradual improvement with return
of motion
Stages of Adhesive Capsulitis
Stage I Stage II Stage III
Pain at rest no yes
Pain below elbow no transition stage yes Can lie on affect yes a: pain at end of movement no
side at night
End-feel elastic b: pain before end of move hard or
m spasm
Duration (month) 3-6 3-18 3-6
Diagnosis
• insidious onset, stiff & painful shoulder
• abnormal scapulohumeral rhythm
~ codman’s ratio: 2:1 =humerus:scapular
• arthrography
- reduction of volume - irregular outline
- incomplete filling
Treatment
• NSAIDs, analgesics, heat modalities
• home exercise program
~passive stretching of the shoulder capsular contracture
~Codman’s exercise
• limited efficacy-TENS, pulley traction, ice, heat, steroid injection(beneficially early)
• distension arthrography
~combination of local anesthetic & saline
• manipulation
• positioning in bed
~maintain abduction & external rotation
Schedules in glenohumeral joint
1st injection : 0 day
2nd injection : after 1 wk : 7 days 3rd : 10 ds after 2nd injection : 17 ds 4th : 2 wks after 3rd one : 31 ds 5th : 3 wks later : 52 ds 6th : 4 wks later on 80 ds 7th : 5 wks later : 115 ds 8th : 6 wks later : 157 ds 9th : 6 wks later : 199 ds In general, 5 times injection
Therapeutic exercises
Pes anserinus syndrome
• Pes anserine bursitis + tenosynovitis
• Sartorius, gracilis, semitendinosus
• Overuse friction, direct contusion
• Pain, tenderness over the anteromedial aspect of the knee, 4 to 5 cm below the joint line
• Exacerbation of symptoms in ascending
or descending stairs
Pes anserinus syndrome
• Over weight, middle aged women
• Osteoarthritis
• Runnig, basketball, racquet sports
• Patellar malalignment, poor flexibility
• DDx : medial meniscal injury, MCL injury
• Steroid injection
• Stretching Ex. (hamstring, quadriceps)
Iliotibial band friction syndrome
• Running, cycling
• Overuse injury
• Friction of the distal portion of the iliotibial band over the lateral femoral epicondyle
• Impingiment zone ; knee flexion 300
• Lateral knee pain and pain is aggravated while runnign
down hills
• Rest
• Friction massage
• Phonophoresis
• NSAIDs
• Steroid injection
• Stretching Ex
Iliotibial band friction syndrome
Patellar tendinitis
• Jumper’s knee
• Etiology
• Stress on the patellar tendon ; training frequency, intensity, surface
• Tight leg muscles
• muscular imbalance
• Misalignment of the leg
• Patellar alta
Patellar tendinitis
• Anterior knee pain
• Squat test
• Tx.
• Rest
• Stretching Ex., strengthening Ex.
• Adjusting body mechanics
• Patellar tendon strap
• Massage
• injection
• overuse condition
• maximal plantar flexion of the ankle and simultaneous dorsiflexion of the metatarsophalangeal(MTP) joints (eg. running, dancing)
• Pain in the heel worse in the morning improves during the day
Plantar fasciitis
• Diagnosis
Tenderness of medial process of the calcaneal tuberosity
Excessive pronation, or calf tightness - increasing the strain on the plantar fascia
X-ray --- calcaneal spur
• Treatment
Insertion of a heel cup or cushion Use of shoes with longitudinal arch support NSAIDs, Corticosteroid injection
Night splint, Taping, Surgery
Plantar fasciitis
장단지근과 가자미근의 스트레칭 운동
어깨너비
가자미근
장단지근
앞쪽 무릎은 구부리고
뒤쪽 무릎은 편다
양발의 발가락을 안쪽으로 향하게 함.
양발의 발뒤축을 바깥쪽으로 향하게 함.
잠자기 전에 5분씩 다리를 번갈아가며 한다.
운동중에는 몸을 흔들지 않는다.
