Exercise Prescription

<中文版>

• Graded exercise program
• Proprioceptive training
• Core strengthening under real-time ultrasound guidance

Graded exercise program

Graded exercise is an exercise program that starts out slowly and adjusts in very small steps. Musculoskeletal physician will create a tailor-made exercise plan with the patient and require him/her to stay with it, even feeling like doing more. The physician will then carefully watch the patient’s progress so that the volume of exercise can be moved either upward or downward as needed. The principle of the exercise program is to increase the exercise very slowly and let the body to make the changes it needs to cope with activity and exercise. Such program is shown by studies especially helpful for patients with fibromyalgia and chronic fatigue syndrome.  

Proprioceptive training

Proprioception refers to a sense of joint position and balance.  It provides messages to the central nervous system (CNS) which then relays information to rest of the body on how to respond and with what amount of tension in what muscle groups so that the body can react by changing the centre of gravity to match the moves and stay in balance.

Bodies can be trained to improve the proprioception by creating balance challenges. The musculoskeletal physician can prescribe a proprioceptive training program to patients, sometimes with the help of training aids to assist them to attain better muscle balance, strength and responsiveness. Proprioceptive training is commonly used to rehabilitate of injured persons, but it can also be used to prevent injury for healthy persons who would like to engage in sports.

Core strengthening under real-time ultrasound guidance

In anatomy, the word “core” refers to the body minus the legs and arms. Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius. Core muscles stabilize the back and extend the entire length of the trunk and hip girdle. These muscles help in controlling movements, in transferring energy and in shifting the body weight when the body moves in any direction.

Sometimes chronic back pain can be attributed to weakness of core muscles of the abdomen and the low back. Clinical studies have proven that people who specifically re-train these core muscles can significantly reduce pain and reduce the risk of recurring back pain.

Real-time ultrasound imaging allows direct viewing of how the muscles are working. Actually seeing the muscle as it contracts and feeling the sensation of correct contraction technique is a powerful form of bio feedback and can speed up muscle training. Training of the transversus abdominis under real-time ultrasound guidance has been used quite extensively in back pain rehabilitation. The imaging can provide an accurate assessment of the quality, timing and endurance of patient’s abdominal muscle contraction, which in turn allows the musculoskeletal physician to organize individual tailor-made plans for different muscle groups to fine tune the rehabilitation.

Besides, such technique can be used in the area of Women's Health for rehabilitation of the support muscles of the pelvic floor. During pregnancy extreme pressure is placed on the abdomen and pelvic floor. It is vital that the core muscles are retrained correctly during and after pregnancy to prevent long term urinary incontinence, back pain and instability.

運動處方

• 漸進式運動鍛煉計劃
• 本體感覺訓練
• 實時超聲波掃描引導下的核心肌群訓練

漸進式運動鍛煉計劃

漸進式運動是一項運動鍛煉計劃，其特色就是循序漸進。肌骼科醫生會為病人度身設計一個運動計劃，並要求病人無論感覺好壞都要堅持遵守計劃的進度。 醫生會仔細觀察病人的進展，根據需要適時將運動量上下調整。這項運動計劃的原則是緩慢提升運動量，讓身體容易適應。根據研究，漸進式運動鍛煉計劃對患上纖維肌痛和慢性疲勞綜合症的病人特別有效。

本體感覺訓練

本體感覺是指人對於本身關節位置、姿勢與平衡的感覺。它為中樞神經系統提供信息，傳遞有關肌肉群組活動與其張力的資訊給身體其他部位，使身體能作出反應，改變重心，以相應動作配合並保持平衡。

我們可以透過平衡挑戰來訓練本體感覺。肌骼科醫生可以為病人設計一個訓練計劃，利用一些訓練工具來協助病人達到更好的肌肉平衡、力量和反應速度。本體感覺訓練一般用以幫助傷患者康復，但健康人士也可接受此訓練來預防運動傷害。

實時超聲波掃描引導下的核心肌群訓練

根據解剖學的定義，"核心身體"(core) 指的是雙腿和雙臂以外的軀體。主要肌肉包括盆底肌肉、腹橫肌、多裂肌、內側和外側斜肌、腹直肌、豎脊肌（骶棘肌），特別是胸背最長肌和橫隔膜。比較次要的核心肌肉包括背闊肌，臀大肌和斜方肌。核心肌肉負責背部的穩定性以及整個軀幹和腰帶的伸展。當我們的身體活動時，這些肌肉可以幫助控制身體動作，以及身體能量和重心的轉移。

有時腹部和腰部核心肌肉的軟弱可以導致慢性腰背痛。臨床研究證實，加強核心肌肉訓練可以顯著減輕腰背疼痛和減少背痛復發的風險。

實時超聲波掃描可以讓我們直接觀察到核心肌肉如何運作。讓病人直接觀察並感受正確的肌肉收縮，可以提供強大的生物反饋，有助加快病人的肌肉訓練。運用這種技術來訓練腹橫肌已經是腰背痛康復治療常用的方法了。利用實時超聲波掃描的影像可以準確評估病人腹部肌肉收縮的質素、時間和耐力，使肌骼科醫生能因應不同肌肉群組的狀態去度身訂造以及微調的病人的復康計劃。

此外，這種技術亦可應用於婦女盆底肌肉的復康訓練。在懷孕期間，女性的腹部和盆腔底要承受龐大的壓力。因此，在懷孕期間及生產後，正確訓練核心肌肉對防止婦女長期尿失禁、背部疼痛和不穩定是至關重要的。