精品项背肌筋膜炎 湖北中医学院课件

项背肌筋膜炎 湖北中医药大学湖北中医药大学推拿教研室推拿教研室 推拿系列多媒体课件之 项背肌筋膜炎又称项背纤维织炎或肌 肉风湿症，一般是指筋膜、肌肉、肌腱和 韧带等软组织的无菌性炎症，引起项背部 疼痛、僵硬、运动受限及软弱无力等症状 。常累及斜方肌、菱形肌和提肩胛肌等。 n本病的确切病因尚不十分明了，临床观察认为本 病与轻微外伤、劳累及受寒等有关。 n项背部急性损伤后，使肌筋膜组织产生炎症、水 肿、粘连、变性，以后逐渐纤维化，形成瘢痕， 使经络气血运行不畅而发为本病。长期的慢性劳 损，如伏案低头作业，使肌肉长时间过度紧张、 痉挛，虽损伤轻微，病变部位小，但在肌肉筋膜 组织中产生变性、肥厚，形成纤维小结而引起较 广泛的疼痛。 n久卧湿地、贪凉或劳累后复感寒邪，寒凝 血滞，使肌筋气血运行不畅，经络痹阻不 通，可导致项背肌筋膜炎发生，故项背肌 筋膜炎患者对天气变化较敏感。 【诊断】 n1临床症状：项背部酸痛不适，肌肉僵硬 板滞，或有重压感，向一侧或两侧背部与 肩胛之间放射。晨起或天气变化及受凉后 症状加重，活动后则疼痛减轻，常反复发 作。急性发作时，局部肌肉紧张、痉挛， 项背部活动受限。 n 2检查： n (1)项背部及肩胛内缘有广泛压痛，皮下可触 及变性的肌筋膜及纤维小结，并可触及筋膜摩擦 音。 n (2)项背部活动受限，尤以屈伸颈项为主。 n (3)一般无神经根性放射痛，故各种神经挤压 试验均正常。 n (4)X线检查：一般无阳性体征。偶可见项韧带 钙化或项背肌筋膜增厚，颈椎生理弧度轻度变直 等。 【治疗】 目的：减轻疼痛，缓解肌肉痉挛，防止肌筋 膜粘连形成。 n n治则：舒筋通络，行气活血，解痉止痛。 n部位及取穴：项背及风池、风府、肩井、 风门、肺俞、心俞、膈俞等。 n手法：一指禅推法、拿揉、掖法、点压、 弹拨、叩击等。 n操作： n (1)松解手法：患者坐位，医者站于患者背后 ，先用一指禅推法推颈项督脉及膀胱经，从上至 下35遍，然后再拿揉项部肌筋23分钟，并配 合颈项屈伸及旋转运动。 n (2)解痉止痛法：接上式，先用拇指点压、按 揉风府、风池、肩井、风门、肺俞、心俞等穴及 痛点，以酸胀感为度，可解痉止痛。然后施拇指 弹拨手法于肌痉挛处或痛点，每处弹拨35次， 力达病所，可松解粘连，缓解肌痉挛，有良好的 止痛效果。 n(3)理筋整复法：先活动颈椎，颈椎屈伸、左右侧 屈及旋转等运动，使关节滑利。然后采用颈胸椎 微调手法，如斜扳、侧扳及胸椎对抗扳法和旋转 扳法，力度要求轻巧灵活，无任何不适感，从而 达到理筋整复的目的。 n (4)整理手法：掖揉项背部，重点在斜方肌和菱 形肌，反复35遍，然后拿揉斜方肌，提拿肩井 23分钟，最后用小鱼际或空拳拳眼轻轻叩击项 背部，直擦督脉和膀胱经，结束治疗。 【预后】 n 推拿治疗可明显改善症状，尤其是早期 见效更显著，配合功能锻炼可增强疗效。 【附注】 1加强项背部功能锻炼，积极参加体育活动 ，如体操、打太极拳等，增强项背部的肌 力和身体素质。 2避免过度疲劳，适当劳逸结合，注意局部 保暖，防止受凉、感冒。 jRgOdL9I6E3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z- 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