ＤＮＳ的肩胛骨穩定技巧

ＤＮＳ系列 ＤＮＳ的肩胛骨穩定技巧

Posted by Hans Lindgren DC on 20 November 2011 

當被問到哪些肌肉是提供肩胛骨穩定性最重要的時候，我相信大多數人會想到前鋸肌或中下斜方肌。在我開始研究Pavel Kolar的DNS之前，我可能會想到同樣的答案。

然而，我現在的答案會是橫隔膜！

肩胛骨的穩定肌，以及其他肩部肌肉，都需要一個固定的錨定點，肌肉群會往錨定點方向移動。在肩帶為例下，橫膈肌收縮穩定的肋骨和“核心”是錨定點。下側肋骨作為前鋸肌的錨定點，以提供完整的肩胛骨穩定機制。

在評估橫隔膜功能之前測試肩胛骨穩定測試可能會出現偽陽性的結果。

核心穩定性仰賴適當的橫膈功能以及整個腹壁和盆底的活動以增加的腹內壓力，由內向外產生。透過適當的核心活化來當作中心的錨定點，達到軀幹的穩定和連接上肢和下肢與軀幹之間的連結，並且最小化力量的損失。在肢體運動過程中沒有適當錨定點，中間將損失一些力量。

穩定的核心將整個身體連接成一整個功能單元。如果來自下半身的力不能透過穩定而且有彈性的核心傳遞，則不可能在上肢運動中產生完全有效的力量，反之亦然。

肩胛骨穩定性的DNS測試：

受試者四足跪姿（手、膝蓋支撐）。指示緩慢地將軀幹向前移動朝向頭端。不穩定的話將表現出翼狀肩胛骨（圖片來自DNS課程）。

橫隔對肩胛骨的穩定效果可以透過適當活化橫隔膜呼吸來證明，產生更多的腹內壓力，這將減少翼狀肩胛骨的發生。引導受試者將橫隔進一步向下推入腹腔，同時仍保持正常呼吸，這會強化提供肩胛骨穩定的固定點，肩胛的穩定性將得到改善。

透過增加腹內壓力來正確活化核心，施測者可以將手指放置在下腹外側；鼠蹊上方來評估。應在下腹部產生穩定的壓力，使整個腹壁均勻擴張。

為了達到最佳化穩定性，手部要有均勻的支撐（所有5個手指應都有支撐）。通過矯正手腕和手掌的重量分佈，肩胛骨穩定性將得到改善。 DNS強調支撐關節的中軸化，以促進良好的穩定模式。

不足的穩定性通常不是因為肌肉的虛弱，而是缺乏適當的活化。所以在強化肌力之前先適當地活化才能達到穩定模式。

如果受測者無法良好的在四足跪姿中穩定肩胛，甚至給予核心誘發及軸心化擺位仍無法良好穩定，，那麼在四足跪姿這個擺位的所有運動都應該要避免．

伏地挺身和在這個擺位下進行的所有其他運動都不會改善失能的穩定性。相反，受試者必須被放置在要求較低的擺位，才可能實現適當的穩定。

改變擺位（例如，支撐在手肘內髁而不是手上）是減少肩胛骨穩定的需求的一種方法。運動訓練必須在穩定性足夠的位置開始，並且隨著個體改善而緩慢地到功能需求較高的位置。

動作穩定的品質是決定訓練時可以使用什麼擺位和負重的因素。避免使用不足的穩定性動作來進行鍛煉，因為它不僅是無效的，而且還會加強錯誤的動作模式，並且通常會導致過度負荷的運動傷害。

所有的穩定性和運動模式的測試之前應該測試和活化適當的橫隔功能和發展足夠的腹內壓力。

DNS有幾種方式來活化理想穩定模式，主要是透過反射刺激或特定動作練習來達成．

這邊介紹DNS活化肩胛骨穩定的方法：

步驟說明：

1. 趴姿，手臂與肘關節成90度屈曲並與耳朵齊平。
2. 輕輕地將手肘壓床板，增加肘部的支撐，就像啟動提起身體一樣。不要太用力！
3. 下一個提示是非常聰明的：想像有人在你的肩膀的前面畫了點。現在慢慢轉動肩膀，使站在頭端前面的施測者可以看到那個點（肩胛骨透過這樣的指引會被往腳端方向推）。這是“把肩胛骨推入你的後面口袋”的提示的由來。
4. 上斜方肌和提肩胛肌應放鬆。檢查者可以觸摸這些肌肉的張力。腰部伸肌肌肉不應活化。試著脫離且單獨地穩定。
5. 這個位置的另一個好處是可以進行適當的頸部伸展。一旦肩胛骨穩定，頸部就以T4為固定點抬起。大多數人頸椎胸椎交界處常常過度負荷並且缺乏胸椎的適當活動度。下巴收，整個頸部作為一個功能單元緩慢地提升。

影片時間：

https://www.youtube.com/watch?v=dseNVjRJikQ

原文：

When asked which muscle is the most important in providing scapular stability I am sure most people would think of the Serratus anterior or the mid and lower Trapezius.  I would probably have done the same before I started to study with Pavel Kolar in the DNS program. 

My answer to that question would now be the Diaphragm.

The stabilizers of the scapula, as well as all other muscles, need a fixed anchor point to pull towards. That anchor point in this case is the ribcage and the “core” all stabilized by the diaphragmatic contraction. The lower lateral ribcage acts as an anchor point for the serratus anterior muscle when providing scapular stabilization. 

 Testing scapular stabilization prior to evaluating the diaphragm function would give a false positive result. 

Proper diaphragm function together with activity of the entire abdominal wall and the pelvic floor create core stability from the inside out through an increased Intra-abdominal pressure.  The stable trunk achieved by proper core activation acts as a central anchor point connecting the forces between upper and lower body and minimizes the loss of strength and power.  Without proper anchor points for the limb movements the force generated is lost in the middle.  The stable core connects the entire body into one functional unit.  It is not possible to generate full power in upper limb movements if the force from the lower body cannot be transferred through the stable yet flexible core and vice versa.

DNS test for scapular stabilization:

 The individual is positioned “on all fours” (on hands and knees). Instructions are given to slowly move the trunk further forward towards the head end. Insufficient stabilization will show up as of winging of the shoulder-blades (The picture is from the DNS program).

The Diaphragm’s stabilization effect on the scapula can be demonstrated by activation of proper diaphragm breathing, to develop an increased intra-abdominal pressure, which will decrease the winging of the shoulder blades.  By instructing the individual to push the diaphragm further down into the abdominal cavity while still maintaining normal breathing, the anchor points for the scapular stabilizers are further facilitated and the scapular stability will improve. 

Correct activation of the core by an increased intra-abdominal pressure can be assessed by placing fingers at the lower lateral abdomen, just above the groin. There should be an even expansion of the entire abdominal wall with a firm pressure generated in the lower abdomen.

To achieve the best possible stabilization it is also important that the supporting hands have an even distribution of load (all 5 fingers should be weight bearing). By correcting the weight distribution on the wrists and hands the scapular stabilization often improves.  DNS emphasizes proper centration of supporting joints to facilitate good stabilization patterns.

Insufficient stabilization is most often not due to weakness of the muscles but primarily a lack of proper activation. The stabilization patterns therefore have to be properly activated before strengthening of the muscles can be achieved.

If someone cannot stabilize their shoulder-blades properly in an all fours position even after the activation of the core and a proper centrated positioning of the support, all exercises in this position should be avoided.  

Push-ups and all other activities performed in this position will not improve the dysfunctional stabilization. Instead, the individual has to be placed in a less demanding position where proper stabilization can be achieved.  

Changing the position (so for example the support is on the inside of the elbows instead of the hands), is one method to decrease the demand of the scapular stabilizers. Exercising has to start in a position where the stabilization is sufficient and slowly progress back up towards positions with higher demand as the individual improves. 

The quality of stabilization is the limiting factor which determines what position and load can be used when training. No exercises should ever be performed with insufficient stabilization because it will not only be fruitless, but will also reinforce the faulty pattern and will often lead to over-load injuries.

All testing of stabilization and movement patterns should be preceded by testing and activation of proper diaphragm function and development of sufficient intra-abdominal pressure.

The DNS program contains several methods of activating ideal stabilization patterns either via reflex-stimulation or specific exercises.

Here is one easy yet very effective exercise from DNS to activate scapular stabilization:

Step by step instructions:

1. Place the person on the stomach with the arms positioned with the elbows in 90 degrees flexion and in level with the ears.

1. Increase the support on the elbows by gently pushing them into the surface as if to initiating lifting the body. Do not push too hard!
2.  Next cue is very clever: pretend that someone has painted dots at the front of your shoulders. Now slowly turn the shoulders so the examiner standing in front of the head end can see the dots (By doing this the scapulae have to be pushed down towards the foot end). This is where the cue of ‘push the shoulder-blades into your back-pockets’ originates.

1. The upper Trapezius and Levator Scapulae muscles should be relaxed. Examiner can palpate for tension in these muscles.
2. There should be no activation of the Lumbar extensor muscles. Try to isolate the stabilization.

1. An additional benefit in this position is that proper neck extension also can be exercised. Once the scapulae are stable the neck gets lifted with the pivot point around T4 area. Most individuals are over-loading the C/T junction and lack proper mobility of the thoracic spine.  The chin should remain in a tucked position and the entire neck slowly lifted as one functional unit.