临床诊疗技术新进展周维金悬吊

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,临床诊疗技术新进展周维金悬吊,3D Newton-Box,初级教程,Basic Tutorial,悬吊运动治疗（,S-E-T,）,Suspension movement therapy,神经肌肉激活技术 （,Neurac,）,Neuromuscular activation technology,3D Newton-Box,2,发展史（,5,步）,History,特点（,5,项）,Features,适用对象（,5,种）,Suitable Users,重要概念（,8,个）,Important concepts,治疗系统（,8,个方面）,TreatmentSystematic,讨论,Discussion,3,德国,汤姆森,German Thomson,英国,-,史密斯,British Smith,一、发展史,History,1,4,2,摄于某三甲医院康复医学科,Department of Rehabilitation Medicine,5,3,6,Neurac,Newton Sling,4,7,3D Newton-Box,5,8,二、特 点,1.,丰富,的训练手段，强化康复训练内容，康复效果更加明显。,利用固定绳站立，自信感,增,加,消,、,除恐惧,并预防跌伤,套装,利用弹性稳定性,保持,安全,姿势,通过,弹性,绳找,平衡,感。,Rich means of training. Removetheir fears by using fixed ropes. Keep a safe position by elastic ropes.To find a sense of balance by elastic ropes.,2.,使徒手训练无法完成的动作得以实现，如闭链运动、有效增强深浅肌群的肌力与肌耐力,Complete the actions which can not be done by empty-handed training.,3.,可以采用各种体位进行训练,Do throughvariouspostures,4.,摆脱了重力的影响,Slip the gravity,5.,既解放了治疗师又因为一个手臂或双手臂都自由了而使得操作起来更容易。这个系统易于调整，能用于家庭运动,Liberated the therapists hands.,Newton,3D Sling,有很多组件，可供整形界、神经系统成人和儿童患者、健身运动、残疾人及老年人的健康保健选用,Many components for various types of people,Newton Sliding,组件,9,三、适用对象,Suitable Users,5,4,3,2,1,骨骼肌疾病，肌筋膜功能障碍,Skeletal muscle disease, dysfunction of muscular fascia,脑卒中和其他神经病,Stroke, and other neuropathy,儿童发展训练,Child development training,健康体能运动,Healthy physical activity,小儿脑瘫,Children cerebral palsy,10,（,1,）本体感觉：从肌肉、肌腱、韧带、关节囊和皮肤上的机械感受器传入中枢神经系统的所有,神经输入信号,a. Proprioception: All the input signals from the mechanical sensors of muscle, tendon, ligament, joint capsule, and skin to the central nervous system.,（,2,）运动觉：关节运动及其方向和速度的感知,b. Motion perception : Perception of joint movement and its direction and speed.,（,3,）感觉和运动的协调功能：包括本体感觉（传入信号线路）、这些信号的感知能力（运动觉）和向肌肉传出的纠正姿势和保持稳定性的冲动,c. The coordination function of sensation and movement : Including proprioception (the incoming signal line), the perception (motion perception), and the impulse came to the muscles to correct posture and maintain the stability.,四、,8,个,重要概念,Important concepts,11,（,4,）,“,薄弱环节,”,：在一个动作中，某肌肉和其他肌肉一起工作时，它太弱以至于不能发挥它应有的那部分作用,d. Weak point: In an action, when a muscle and others work together, because it is too weak to play its due part of the role.,（,5,）开放式动力链：肢体远端不固定，且不受重（远端在固定的近端基础上移动）。比如不负重的长凳仰卧推举练习,e. Open type kinetic chain: distal limb no fixation, and no weight(the distal limb movement based on proximal fixed limb),（,6,）闭锁式动力链：肢体远端固定，且负重（近端在固定的远端基础上移动），比如屈膝运动,f. Locking type kinetic chain: distal limb fixation, and weight(the proximal limb movement based on fixed distal limb),12,（,7,）稳定肌,（,stabilisor,）,与运动肌,（,mobilisor,）,局部肌肉,（,Local,）,与全局肌肉,（,Global,）,Rood(1972),根据功能的不同，将背部肌肉区分为稳定肌和运动肌两类,Rood (1972) according to the different functions of muscles, divided the back muscles into stability muscles and motor muscles .,稳定肌,通常位于深部、具有单关节或者单一节段分布、通过离心收缩控制椎体活动和具有静态保持能力,The,stability muscles,are usually located in the deep part, which are single joint or single segment distribution, to control the vertebral body movement through the centrifugal contraction, and have the static holding capacity.,运动肌,一般位于表层、具有双关节或者多关节分布、通过向心收缩控制身体的运动和产生功率,The,motor muscles,are generally located in the surface, which are double joint or multi joint distribution, to control the movement and generate power through the concentric contraction.,13,稳定肌与运动肌比较,Comparison of stabilisor and mobilisor,位于背部深层,Located in the deep part of back,腱膜状,Aponeurotic,慢肌为主,Slow muscle as the main,耐力活动时激活,Activation when endurance activities,选择性弱化,Selective weakening,募集较差，可以被抑制,Recruitment is bad, can be suppressed,在,30%,40,MVC,条件下激活,Activation under the 30%-40%MVC condition,位于背部浅层,Located in the surface of back,梭状,Fusiform,快肌为主,Fast muscle as the main,爆发性活动时激活,Activation when explosive activities,优先募集,Preferential recruitment,缩短和紧张,Shorten and tension,在大于,40,MVC,条件下激活,Activation under the condition of more than 40% MVC,稳定肌,stabilisor,运动肌,mobilisor,14,Bergmark,（,1989,）还根据肌肉解剖位置的差异，将背部肌肉分为局部肌肉和全局肌肉,Bergmark (1989) according to the difference position of the muscle, divided the back muscles into local muscles and global muscles.,局部肌肉通常均起源于脊椎，它们的活动控制脊柱的弯曲度和维持脊柱的机械稳定性；多裂肌是最重要的局部肌肉,Local muscle is usually derived from the spine, which controls the curvature of spine and maintains the mechanical stability of spine. Multifidus are the most important local muscles.,全局肌肉一般连接胸廓和骨盆，这些肌肉收缩通常可以产生较大的力量,Global muscles are generally connected to the thorax and pelvis, which usually produce a larger force when contraction.,腰大肌、最长肌胸段会对腰椎施加强大的拉力，可能是某些患者腰痛的原因 之一,Musculi psoas major, longissimus thoracic segment will exert a strong pull on the lumbar spine, may be one of the reasons for the low back pain in some patients.,腘绳肌过度紧张在提高髋关节稳定性的同时，可能通过改变骨盆前倾角对腰椎受力产生影响,Hamstring strains can improve the stability of the hip joint , also impact on lumbar spine through change the pelvic anteversion.,15,腰椎的稳定机制,Stable mechanism of lumbar spine,Global musc,les,Local musc,les,腹直肌,Rectus abdominis,腹内外斜肌,Musculi obliquus internus abdominis, Musculus obliquus externus abdominis,竖脊肌,Erector muscle of spine,腰方肌,Musculi quadratus lumborum,腹横肌,Transversus abdominis,多裂肌,Multifidus,腰大肌,Musculi psoas major,膈肌,diaphragm,The Pelvic floor,16,（,8,）自主神经肌肉系统,Autonomic nerve muscle system,内层肌肉系统（局部稳定肌）为神经网络所控制，意识无法直接控制。在外层运动肌开始收缩前和收缩时，神经网络按照自己收集的信息（本体感觉等）制定工作计划，控制和协调内层肌肉为运动服务，意识不能持续干预这一过程,Inner muscle system (local stability muscles) be controlled by neural network, consciousness cannot control directly. Before the outer motor muscles contraction, the neural network according to their collection of information (such as proprioception) work plan, control and coordinate the inner muscles to sports, consciousness cant intervene this process,神经网络的兴奋度依赖于大量传入的神经冲动，当人体站立时，此一系统时刻感知着外界环境和人体运动系统的各种情况并作出反应。所以卧床,48,小时（或失重）后内层肌（多裂肌）开始萎缩，原因在于神经网络系统活性的下降,The excitement of the neural network is dependent on a large number of afferent nerve impulses, when the human body standing, this system is always aware of the various situations of external environment and the human body movement system, and make a response. So after 48 hours in bed (or weightlessness), the inner muscles (,multifidus,) began to shrink due to the decrease of the activity of neural network system.,17,神经网络活性下降甚至关闭后，关节稳定性必然下降并带,来疼痛。,Neural network activity decline or even shut down, the joint stability decreases and the patients can feel pain.,快速大重量牵引、长期卧床、剧烈疼痛等都可能会导致核心肌群（多裂肌）萎缩、失活；运动肌群（竖脊肌、腘绳肌、腰大肌、梨状肌）过度紧张、短缩。,Rapid weight traction, long-term in bed, severe pain may lead to core muscle group (,multifidus),atrophy and inactivation. Exercise muscle (erector muscle of spine, hamstring muscles, musculi psoas major, musculi piriformis) tension and shortening.,18,意识无法重新激活这一系统,Consciousness cannot reactivate this system,由于神经网络系统的兴奋依赖于大量的感觉传入信息，因此针灸、悬吊运动训练、本体感觉训练等治疗的机制之一可能在于创造了大量的传入冲动,Because the neural network system excited depend on the sensory information, so the one of mechanism of acupuncture, suspension training, proprioception training is likely to be created a large number of afferent impulses.,在不稳定平面上作训练是治疗的基本原则。同样，快走、骑车、自由泳、倒走等运动会使躯干产生扭转动作，导致腰椎的旋转，对腰椎周围感受器的刺激较强，也会产生治疗作用，并可同时锻炼内层肌肉。,Training in the unstable plane is the basic principle of the treatment. Brisk walking, cycling, swimming, backward walking can make the trunk produce torsion action, cause lumbar rotation, stimulation the lumbar peripheral receptor, have a therapeutic effect, and can also exercise the inner muscles.,研究显示，每天骑自行车半小时腰痛发病率较低,Research shows that half an hour by bike every day can reduce the incidence of low back pain,19,与运动组织慢性病有关的改变,Changes related to the motor tissue chronic diseases,感觉和运动的控制能力失调,Sensory and motor control disorders,稳定肌的力量和耐力降低,Strength and endurance of stability muscles decreased,运动肌的力量和耐力降低,Strength and endurance of motor muscles decreased,肌肉萎缩,Muscle atrophy,心血管功能减退,Cardiovascular dysfunction,20,五、,3D Newton-Box,运动治疗观念,The concept of 3D Newton-Box exercise therapy,包括诊断系统和治疗系统,including the diagnosis and treatment system,诊断系统,diagnosis system,涉及肌肉耐力的测定,involves the determination of muscular endurance,通过不断增加开链和闭链运动的负荷来实现,To achieve by increasing the open chain and closed chain kinetic load,21,独立诊断系统,Independent diagnostic system,用于诊断所谓的,“,薄弱环节,”,Used to diagnose the so-called weak link,先,在,闭链,运动中使用渐进式阶梯系统筛查进行检测。负荷逐渐增大直至病人不能正确做运动或者感到疼痛为止。如果在负荷较低时就发生上述这种情况或者左右两边的负荷量有明显差别时，就有理由,猜测,存在一个或更多个,“,薄弱环节,”,。用闭链运动进行检测要求治疗师严密检测，因为机体会尽量让其它肌肉去代偿,“,薄弱环节,”,First,used,incremental step screening system to test,in the,closed chain,motion . The load gradually increased until the patient was unable to exercise or feel pain. If above situation happens when the load is low , there is reason,to guess,there are one or more weak link.,接着,用,开链,运动检测各块肌肉以确定薄弱处。,Then use the open chain motion to detect each muscle to determine the weakness.,22,在闭链运动中检测背部的肩胛肌,In the closed chain motion to detect the scapula muscle,23,治疗系统,Treatment system,肌肉松弛,Muscle relaxation,增加关节活动范围,Increase joint range of motion(ROM),牵引,Traction,训练稳定肌系统、感觉运动的协调训练,Train stability muscles system, sensory and motor coordination training,开链运动和闭链运动,The open chain motion and closed chain motion,肌力训练,Muscle strength training,健康体能运动,Health physical exercise,团体运动,Team exercise,伴有长期随访的家庭个别化运动,Family individualized exercise with long-term follow-up,24,1.,肌肉松弛,Muscle relaxation,把身体需要放松的部分做到悬吊装置中要求的姿势，然后缓缓移动这部分身体。病人通常会感到很舒服，得到抚慰，这个操作在治疗前后都可以用。,Relax the body and do position that suspension device requires, and then slowly move the part of the body. Patients often feel comfortable, the patients can do this before or after treatment.,2.,增加活动度的运动,Exercise to increase ROM,通过悬吊系统来实施增加活动度的运动。由于重力的影响已基本消除，病人感到受控制和保护，于是肌肉和关节就能逐渐移动到最大范围，最终能再往前伸一点,Exercise to increase ROM through the suspension device, due to the impact of gravity has been basically eliminated, the patient feels controlled and protected, so the muscles and joints will be able to gradually move to the maximum extent, and ultimately a little farther forward.,25,3.,牵引,Traction,背部牵引：通过泰洛比皮带将病人的双臂悬挂起来，双脚放在地板上。慢慢屈膝并把体重转移至手臂，产生牵引的效果。,Back traction: hang up the patients arms with a belt, and put the feet on the floor. Slowly bend the knee and put the weight transfer to the arms, produce the effect of traction.,仰卧姿势牵引：把吊带包绕脚踝，将双下肢悬吊在空中，臀部就从支撑面上抬起来了。,Supination traction: wrapped the ankle with belt and suspended the lower limbs, and the hips are raised from the support.,牵引还可以在颈部、肩部和髋关节处实施，在这些情况下，物理治疗师应担任主要的角色。,Traction can also be used in the neck, shoulder and hip joints, in these cases, the physical therapist should serve as the main role.,26,4.,稳定肌的训练,Train stability muscles system,“,局部,”,肌肉位于关节附近，并有大量的兴奋肌纤维。主要负责局部的稳定性。运动由,“,广泛,”,肌肉实施。,Local muscles are located near the joint, and there are a lot of exciting muscle fiber. Mainly responsible for local stability. Exercise is implemented by the wide muscles.,与稳定外周关节有关的肌肉：肩关节的,肌腱袖,、膝关节的,股内侧斜肌,和髋关节的,臀中肌后部,。腰椎最重要的稳定肌是,腹横肌和多裂肌,，颈椎的稳定肌则是,颈长肌、头长肌、多裂肌以及半棘肌。,Muscle stabilized the peripheral joints:,musculotendinous cuff,of shoulder joint,VMO,of knee joint,posterior part of mesoglutaeus,. The most important stability muscle of lumbar spine is,transversus abdominis,and,multifidus,. The stability muscle of cervical spine is,musculus longus colli,musculus longus capitis,multifidus, and,semispinalis,.,在训练稳定肌时，强调使用,低负荷的等长收缩,（,30,40,的最大收缩阻力）。训练,时间逐渐延长,而不是负荷重量增加。对腰背痛患者的腹横肌进行低负荷训练是有效的。,When training the stability muscles,emphasizes to,use low load isometric contraction,(the largest contraction resistance of 30% - 40% ). Training,time prolonged,rather than weight load increases. Training transverse abdominal muscle with low weight pain of in patients with low back training is effective.,27,在躯干或四肢突然移动的情况下，身体会以,“,前反馈,”,的机制尽量稳定腰椎。,“,局部,”,的稳定肌接到传出信号并在,“,广泛,”,的运动肌兴奋之前收缩。参与这种,“,前反馈,”,机制肌肉：腹横肌、膈肌、盆壁的肌肉及颈肌。,Under the condition of trunk or limbs move suddenly, the body will stabilize the lumbar by front feedback mechanism. The local stable muscle receives the outgoing signal and contracts before the wide motor muscle excitement. Related muscles: musculus trasversus abdominis, diaphragm, muscles of the pelvic cavity, and cervical muscle.,慢性背痛患者失去腹横肌的,“,前反馈,”,机制。 当身体处于非常紧张的状态时，就会启动兴奋肌和相位肌保持稳定，所以训练这两者的重要性已显而易见。,Patients with chronic back pain lost transversus abdominis front feedback mechanism. When the body is very stressful, will start the phasic and tonic muscle to remain stable, so it is important to train them.,28,稳定肌的分级训练,。起初，很强调,“,局部,”,稳定肌的低负荷等长收缩。图,3,展示的就是这种运动的一个例子。渐渐地，运动增加了要兴奋,“,广泛,”,的肌肉作为稳定因子（,“,平衡,”,效果）和动力移动因子。但是，这要求,“,局部,”,肌有维持满意稳定性的能力。图,4,和图,5,就是这种运动的示例。,Graded training of,stability muscles: at first, emphasize the low load isometric contraction of local stability muscles(figure 3). Gradually, exercise adds to excite wide muscle as a stabilizing factor (balance effect) and the power factor. However, this requires the “local muscle has the ability to maintain stability (figure 4, figure 5).,29,“,局部,”,稳定肌的低负荷等长收缩,Low load isometric contraction of local stability muscle,30,兴奋,“,广泛,”,的肌肉作为稳定因子（,“,平衡,”,效果）和动力移动因子,excite wide muscle as a stabilizing factor,(balance effect) and the power factor,31,5.,感觉和运动的协调能力训练,Sensory and motor coordination training,恰当的感觉和运动控制能力对维持正常水平功能非常必要。早就知道，如果脚踝和膝盖有慢性疾病，感觉和运动的控制能力就会失调。这些疾病的治疗原则如感觉和运动协调的训练已经使用了好多年，并且在大多数康复计划中已成为标准。对下肢进行这种训练的疗效现在已得到证实。,Appropriate sensory and motor control ability is necessary to maintain normal function. If you have any chronic disease of ankle and knee, sensory and motor control ability will disorder. Treatment principles of these diseases have been used for many years, and have become a standard in most of the rehabilitation program. The effect of this training on the lower limb has now been confirmed.,32,5.,感觉和运动的协调能力训练,Sensory and motor coordination training,最近研究表明，慢性背痛与感觉运动的协调能力减退有关。,Recent studies show that chronic back pain associated with decreased sensorimotor coordination.,在下肢、肩以及背部的肌疲劳使得感觉和运动的控制能力失调。,Muscle fatigue of lower limbs, shoulder and back make the control ability of sensory and motor disorders.,少数研究指出，对患有慢性背痛和慢性颈部疾病患者进行感觉和运动协调训练是有成效的。,A few research suggests that sensory and motor coordination training for patients with chronic low back pain and chronic cervical disease is effective.,33,5.,感觉和运动的协调能力训练,Sensory and motor coordination training,在不平稳的地面上进行闭链运动对感觉运动器官达到最佳诱发效果。在悬吊器械上进行训练非常适于这个目的。,Do closed chain motion on the not smooth ground can achieve the best effect of sensorimotor organs.,通常用海绵橡胶垫、平衡板以及充气的橡胶垫枕。见图,6,和图,7,Usually use a sponge rubber mat, balance board and,inflatable rubber pad (,figure 6, figure 7,).,图,6,感觉和运动协调的训练,34,6.,开链训练：肢体远端不固定，且不负重（远端在固定的近端基础上移动）。这种训练涉及到主动肌和协同肌的分开兴奋，而拮抗肌不同时收缩。,Open chain training: distal limb not fixation, and no weight(the distal limb movement based on fixed proximal limb). This kind of training involves the separation of the active muscle and the coordinated muscle, while the antagonistic muscle does not shrink at the same time.,开链运动,开链运动,在悬吊系统做肌肉松弛运动及不负重的肌力训练和,/,或用滑轮系统进行肌力训练时实施。这种情况下采用一个可移动的、可伸缩的滑轮装置。,图,8,是开链运动的一个例子。,Open chain training:,Do muscle relaxation exercise and muscle strength training with no weight under the suspension system and/or the implementation of muscle strength training with pulley system. Adopting a movable and retractable pulley device.(figure 8),35,闭链训练：肢体远端固定，并负重（近端在固定的远端基础上移动）。 这种训练涉及到主动肌、协同肌和拮抗肌同时兴奋，非常适于完成,ADL,和体育活动。,Locking chain training: distal limb fixation, and weight(the proximal limb movement based on fixed distal limb). This training involves the active muscle, synergistic muscles and antagonistic muscles excited simultaneously, it is vary suitable for the completion of ADL and sports activities.,36,使用肌肉,Muscles,-,臀大肌,(gluteus maximus),-,腘绳肌腱,(hamstring),-,竖脊肌,(erector spine),使用设备,Equipment,-,治疗用床,Treatment bed,- Middle Sling,- Extend Short cord,HP,-,膝关节,Knee joint,SP,-,膝关节,Knee joint,Progression,增加运动范围,Increase the ROM,弹力绳的阻抗控制,Impedance control of elastic rope,开始姿势,Start position,结束姿势,End position,Supine Position Hip extension,OKC,37,使用肌肉,Muscles,- (gluteus maximus),- (hamstring),- (transversus abdominin),- (internal/external oblique),- (multifidus),- (erector spine),使用设备,Equipment,-,治疗用床,Treatment bed,- Large Sling,HP,-,小腿,Calf,SP,-,小腿肌,Calf muscles,Progression,增加运动范围,Increase the ROM,调节杠杆长度,Adjusting lever length,调节悬挂点的位置,Adjust the position of the suspension point,开始姿势,Start position,结束姿势,End position,Supine Position Hip extension,CKC,38,使用肌肉,Muscles,- (hamstring),使用设备,Equipment,-,治疗用床,Treatment bed,- Middle Sling,- AW Red grip,HP,-,膝关节,Knee joint,SP,-,小腿与足,Calf and feet,Progression,逐渐增加运动范围,Increase the ROM gradually,开始姿势,Start position,结束姿势,End position,Side-lying Position Knee flexion,OKC,39,使用肌肉,Muscles,- (hamstring),- (transversus abdominin),- (internal/external oblique),- (multifidus),- (ercetor spine),使用设备,Equipment,-,治疗用床,Treatment bed,- AW Red grip,HP,-,膝关节,Knee joint,SP,-,足跟,Ankle,Progression,逐渐增加弯曲的运动范围,Increase the ROM gradually,调节杠杆的长度,Adjusting lever length,-,调节悬挂点,Regulating suspension point,结束姿势,End position,Supine Positio,CKC,开始姿势,Start position,40,使用肌肉,Muscles,- (transversus abdominin),- (internal/external oblique),- (multifidus),- (ercetor spine),- (quadriceps),- (rectus abdominis),使用设备,Equipment,-,治疗用床,Treatment bed,- Large Sling,HP,-,膝关节,Knee joint,SP,-,小腿,Calf,Progression,-,增加运动范围,Increase the ROM,-,调节杠杆长度,Adjusting lever length,开始姿势,Start position,结束姿势,End position,Prone Position Knee extension,CKC,41,闭链运动,Locking chain motion,原先就使用了悬吊系统。通过改变肌肉的扭力来逐级增加负荷。,The suspension system was originally used. By changing the muscle torque to increase the load.,可以通过改变吊带置于身体的,位置,或改变绳子的,长度,或根据自吊带的悬挂点的垂直线移动身体。,The body can be moved by changing,the position,of the sling on the body or by changing,the length,of the rope or by the vertical line of the hanging point of the sling.,42,43,悬挂点调整,Suspension point adjustment,44,Example of Progression,力臂的变化,Arm changes,45,7.,肌力训练,Muscle strength training,一旦,“,局部,”,肌肉有了满意的稳定作用，,“,广泛,”,的肌肉的渐进式训练就可以开始了。开链运动和闭链运动都可以用作此目的。,Once the local muscle has a stabilizing effect, the progressive training of the wide muscle can begin. The open chain motions and closed chain motions both can be used.,对于肌力训练，要用相对较大的负荷。运动分为,3,4,组，每组重复,5,6,次，每组之间要有休息。,For muscle strength training, should use a relatively large load. Exercise is divided into 3-4 groups, each repeat 5 - 6 times, have a rest between each group.,46,大负荷的运动可达到改善肌肉耐力的目的。肌肉做,3,组强力收缩，重复,5,6,次，每组间休息,1,2,分钟。,Heavy load exercise can achieve the purpose of improving muscle endurance. Do 3 groups of strong contraction, repeat 5-6 times, have a 1 - 2 minutes rest between each group.,当患者用这种方法进行运动时，治疗师必须考虑到正确运动的能力和带来的疼痛。在运动疗法中使用小负荷的、重复,30,50,次的,3,4,组动作来训练肌肉耐力也很常见,When patients exercise in this way, the therapist must consider the ability of the right exercise and pain. The use of a small load and 3-4 group action repeated 30-50 times to train the muscle endurance is also very common.,47,8.,渐进式阶梯系统中的运动的分级,Classification of motion in progressive ladder systems,训练应遵循渐进式的阶梯系统，这用在开链运动和闭链运动中。,Training should follow the step-by-step system, which be used in the open chain motion and closed chain motion.,最低水平时，运动一般在吊带的帮助下或采用无重量的形式降低等级。弹力绳、滑轮系统或自由重量被用来减少重力的影响。,At the lowest level, exercise is generally reduced by the aid of a sling or by a weight - free form. Elastic rope, pulley systems, or free weights are used to reduce the influence of gravity.,48,渐进式阶梯系统的最高水平通常是在高扭力的闭链运动中实施。这些水平层次是按运动员来衡量的。,The highest level of progressive ladder system is usually impl