Pathology muscle 2
病理肌肉 2

Muscle spasm / cramp (Rattray p.193) involuntary and sustained contraction of muscle; cause painful prolonged muscle spasm
肌肉痉挛/抽筋（Rattray 第 193 页）肌肉不自主和持续的收缩；导致疼痛的肌肉痉挛

clonic: alternation contracting & relax of the muscle
阵发性：肌肉收缩与放松交替

tonic: sustained period of hypertonicity and tension
强直性：持续的高张力状态和紧张

chronic: sustained spasm over a period, cause increase the tone of group of muscles or a muscle
慢性：持续一段时间的痉挛，导致一组肌肉或单块肌肉的张力增加

reflex muscle guarding: prolong contraction of muscle in response to muscle or ligament injury as splint (protective reflex muscle guarding period)
反射性肌肉保护：肌肉对肌肉或韧带损伤的反应性延长收缩，如同夹板（保护性反射性肌肉保护期）

**(We do not release this type of muscle spasm because the spasm is to protect and stabilize the injury structure)
**(我们不释放这种类型的肌肉痉挛，因为痉挛是为了保护并稳定损伤结构)**

cause of spasm:
痉挛的原因：

muscle too tight or stressful due to gamma nerve firing,
肌肉因伽马神经放电而过于紧张或压力过大，

vitamins or micromineral deficiency (vitamin B₁ or B complex, D₃, K (potassium) or calcium, magnesium);
维生素或微量矿物质缺乏（维生素 B ₁ 或 B 复合物、D ₃ 、K（钾）或钙、镁）;

over stretched;
过度拉伸;

injury the ligament (sprain) or muscle (strain);
韧带受伤（扭伤）或肌肉受伤（拉伤）；

cold or ischemia (due decrease the blood supply and hypoxia);
寒冷或缺血（由于血液供应减少和缺氧）；

Clinical manifestations: antalgic gait, posture, shallow breathing due to decrease the O₂ and ATP, hot muscle due to congestion or cold muscle due to ischemia (due to tonic muscle spasm)
临床表现：抗痛性步态、姿势、浅呼吸由于 O ₂ 和 ATP 减少，肌肉发热由于充血或因缺血寒冷肌肉（由于肌肉强直性痉挛）

If biceps brachii is agonist muscle, triceps brachii is antagonist muscle
如果肱二头肌是主动肌，肱三头肌是拮抗肌

Biceps and triceps are antagonist each other
肱二头肌和肱三头肌是相互拮抗的

Treatment:
治疗：

use reciprocal inhibition = agonist contraction; (PNF: contract- relax, agonist contraction, contraction-relax-contraction)
使用互抑制 = 促动肌收缩；（本体感觉神经肌肉促进法：收缩-放松，促动肌收缩，收缩-放松-收缩）

GTO technique (Rattray 38) (C or S bowing ------ let the Golgi tendon organ release),
GTO 技术（拉特雷 38）（C 或 S 弯曲 ------ 让高尔基腱器官释放）

origin & insertion technique (“+” plus /cross sign);
起点和止点技术（“+”加号/交叉符号）

muscle approximation (Rattray 39: to reduce tone or spasm in a muscle, bring the ends of the muscle closer together, lessens the stretch on the muscle spindle, decrease the Gamma firing and reduces muscle tone and spasm);
肌肉靠近（Rattray 39：为了减少肌肉的张力或痉挛，将肌肉的两端拉近，减少肌梭的拉伸，降低 Gamma 放电，从而减少肌肉的张力与痉挛）；

joint play
关节活动度

When the muscle belly is too much pain to touch, you can use GTO technique, origin insertion or muscle approximation to release the muscle tension or spasm
当肌肉腹触摸时疼痛过度时，可以使用 GTO 技术、起点插入或肌肉靠近来放松肌肉的紧张或痉挛

For example: gastrocnemius spasm, do the isometric resistant contraction of dorsiflexion (activate the antagonist muscle anterior tibialis contraction), right away relax the spasm of gastrocnemius
例如：腓肠肌痉挛，进行背屈等长抗阻收缩（激活拮抗肌前胫骨肌收缩），立即放松腓肠肌的痉挛

Hamstring spasm, do the isometric resistant contraction of extension of knee by quadriceps
腘绳肌痉挛，通过股四头肌进行等长抗阻力收缩以伸展膝盖

Never passive stretch on spasm muscle, no stripping on spasm muscle because the muscle is painful to direct massage on it!!
痉挛肌肉切勿被动拉伸，不要对痉挛肌肉进行撕脱治疗，因为直接按摩会引起肌肉疼痛！！

In muscle has proprioceptors: muscle spindle and Golgi tendon organ
肌肉中有本体感受器：肌梭和高尔基腱器官

Muscle spindle: intrinsic muscle fiber monitors the muscle lengthen; limited the muscle over stretched
肌梭：内在肌纤维监测肌肉的长度；限制肌肉过度拉伸

- Golgi tendon organ: monitor if over loaded the muscle (contraction)
- 高尔基腱器官：监测肌肉是否过载（收缩）

P.N.F. (standard
P.N.F.（标准

1. Contract relax: initial stretch affected muscle, isometric resistant contraction on this muscle for 6 seconds (three different joint ROM); final stretch this muscle
1. 收缩放松：初始拉伸受影响肌肉，在该肌肉上进行等长阻力收缩 6 秒（三种不同的关节活动范围）；最终拉伸该肌肉

2. agonist contraction = reciprocal inhibition, my purpose is due to the agonist muscle is affected/target muscle (gastrocnemius) is too tight and too much pain to contraction; isometric resistant contraction of antagonist muscle (contraction of tibialis anterior in three different ROM) to relax the affected muscle (agonist gastrocnemius); ---- (if no pain, you can choose do /or do not do passive stretch on affected muscle for 30 seconds)
2. 主动肌收缩=互抑制，我的目的是由于主动肌（受影响/目标肌肉，即腓肠肌）过于紧张和疼痛导致收缩；对拮抗肌（胫前肌在三种不同活动范围）进行等长阻力收缩，以放松受影响肌肉（主动肌腓肠肌）；----（如果无痛，可以选择/或不进行受影响肌肉的被动拉伸 30 秒）

For example: gastronomies spasm, isometric contraction on tibialis anterior
例如：胃痉挛，胫前肌等长收缩

Bicep spasm, isometric contraction of triceps
二头肌痉挛，肱三头肌等长收缩

Diaphragm and external intercostals muscle are primary inspiration/ inhale muscles (normal breathing: active inspiration: passive exhale---- not involved muscle contraction)
膈肌和肋间外肌是主要的吸气/呼吸肌（正常呼吸：主动吸气：被动呼气——不涉及肌肉收缩）

Use exhale forcefully by contraction of internal intercostals muscles
通过肋间内肌收缩用力呼气

3. Contract - relax- contract: isometric contract the agonist and antagonist muscle alternatively for three times for each muscle; stretch the agonist muscle, finally the purpose is increase ROM of motion
3. 收缩-放松-收缩：对每块肌肉交替进行等长收缩三次；拉伸主动肌，最终目的是增加活动范围

Remedial exercises:
康复锻炼：

Isometric strengthen: isometric resistant contraction, no joint movement only muscle contraction with weight bearing; to maintain the muscle strengthen
等长增强：等长阻力收缩，无关节运动只有肌肉收缩并负重；以维持肌肉增强

isotonic concentric strengthen: with weight bearing and joint moves and muscle contraction (the muscle is shortening); to improve the muscle strengthen
等张向心增强：负重且关节运动并肌肉收缩（肌肉缩短）；以改善肌肉增强

isotonic eccentric contraction strengthens: muscle contraction while the muscle lengthening:
等长收缩增强：肌肉收缩同时肌肉伸长：

such as: you put down the heavy books to the desk (biceps eccentric contraction)
例如：你把重书放到桌子上（肱二头肌等长收缩）

*From standing to sitting on chair, (from standing to squatting) using the quadriceps femoris eccentric;
*从站立到坐椅子上（从站立到下蹲）使用股四头肌等长收缩；

*When you hike on the mountain, your feet are trying to hold your body not slide by using gastrocnemius, plantaris and soleus eccentric
*当你爬山时，你的脚试图通过使用腓肠肌、跖长肌和小腿三头肌等长收缩来保持身体不滑落

* Prone on the table, passively bring the leg flexed, ask him slowly extend the leg (using the hamstring eccentric contraction)
* 俯卧在桌子上，被动地将腿屈曲，让他缓慢地伸直腿（使用腘绳肌离心收缩）

Gait:
步态：

stance phase= close kinetic (chain)
支撑相= 闭链运动

open phase= open kinetic chain: mid-swing: acceleration, mid-swing, deceleration
摆动相= 开链运动：中摆动：加速，中摆动，减速

(isotonic) open kinetic: quadriceps, gluteal max. gluteal medius and minimum, hip lateral rotation (hydrant posture), erector spinae (superman), external oblique and internal oblique (crunch with twist, Russian twist) , rectus abdomens (crunch, sit up only contraction upper portion of this muscle),
(isotonic) 开放动力学：股四头肌，最大臀肌，中臀肌和最小臀肌，髋关节外旋（狗伸姿势），竖脊肌（超级英雄姿势），腹外斜肌和腹内斜肌（扭转卷腹，俄罗斯转体），腹直肌（卷腹，仅收缩该肌肉上部）

Close kinetic: quadriceps (squatting), pec major (push up on wall or, erector spinae (cobra posture or mild on sphinx posture---- for gentle isometric contraction)
闭合动力学：股四头肌（深蹲），胸大肌（靠墙俯卧撑），竖脊肌（眼镜蛇姿势或温和的菱形姿势——用于温和的等长收缩）

Torticollis= wry neck: (Rattray 477) unilateral spasm of neck muscles (SCM, scalene, or posterior cervical muscles)
斜颈=歪脖子：（Rattray 477）颈部肌肉单侧痉挛（胸锁乳突肌，斜方肌或后颈肌）

The client has torticollis with neck left side flexion, counter lateral rotation, which muscle? Left SCM spasm
客户有斜颈，颈部左侧屈曲，对侧旋转，哪个肌肉？左侧胸锁乳突肌痉挛

Agonist contraction (PNF): right SCM muscle isometric contraction for three times; passively stretch the left SCM, see if you can release the spasm
拮抗收缩（PNF）：右胸锁乳突肌等长收缩三次；被动拉伸左胸锁乳突肌，观察是否可以缓解痉挛

Congenital torticollis: structure shortening of sternocleidomastoid (SCM), during delivery of baby in leg position (breach birth), this is need to be treated by medical doctor
先天性斜颈：胸锁乳突肌结构缩短，在胎儿足位分娩（臀位分娩）时，这需要由医生治疗

Acquired torticollis: due to common cold, overuse, scoliosis, occupational, posture deviation
获得性斜颈：由于普通感冒、过度使用、脊柱侧弯、职业因素、姿势异常

CM: head and neck tilt to one side, antalgic posture, inflammation, tenderness, increased tone, trigger point, adhesion, unilateral shortening the muscle, decrease ROM, pain, referral to headache, earache, TMJ pain (see TG study the referral pattern of SCM)
CM：头部和颈部向一侧倾斜，抗痛姿势，炎症，压痛，肌张力增高，触发点，粘连，单侧肌肉缩短，活动范围减少，疼痛，可放射至头痛、耳痛、颞下颌关节疼痛（参见 TG 研究胸锁乳突肌的放射模式）

Treatment: PNF (contract- relax, agonist- contraction/ reciprocal inhibition, contract-relax-contract; PNF techniques effect is reflex relaxation of muscle opposing the contracting muscle such as the affected muscle is tight, pain or spasm presented), S or C bowing, Golgi tendon techniques, origin and insertion technique, muscle approximation indicates for treating the acquired torticollis
治疗：PNF（收缩-放松，拮抗肌-收缩/互抑制，收缩-放松-收缩；PNF 技术效果是收缩肌群对侧肌群的反射性放松，如受影响肌群紧张、疼痛或痉挛），S 或 C 型弯曲，高尔基腱技术，起止点技术，肌肉逼近法适用于治疗获得性斜颈

(Rattray book p. 81) agonist contraction is work on reciprocal inhibition: the reflex relaxation of the muscle opposing the contracting muscle
（拉特雷书籍第 81 页）拮抗肌收缩作用于互抑制：收缩肌群对侧肌群的反射性放松

Polymyalgia rheumatic: common seen the old women age 60-80, abrupt onset, idiopathic, may be autoimmune disease;
风湿性多肌痛：常见于 60-80 岁老年女性，急性发作，病因不明，可能是自身免疫性疾病；

CM: muscle stiffness, gel-phenomenon (stiffness after prolonged inactivity), most effect on proximal muscle of limb joint (hip, or GH joint); giant cell arteritis = medium or large arteries inflammation, cell mediated injury to the elastic lamina in blood vessel ---- usually affect temporal arteritis----the client complain that headache, facial pain, blurred vision
肌腱炎：肌肉僵硬，凝胶现象（长时间不活动后的僵硬），主要影响肢体关节近端肌肉（髋关节或肩关节）；巨细胞动脉炎=中或大动脉炎症，细胞介导的血管弹性膜损伤——通常影响颞动脉炎——患者主诉头痛、面部疼痛、视力模糊

Treatment: anti-inflammatory drugs
治疗：抗炎药物

Massage: relaxation massage only, to reduce sympathetic nerve firing, do not do stimulate techniques, such as friction, tapotement, deep compression….
按摩：仅进行放松按摩，以减少交感神经放电，不要做刺激技术，如摩擦、拍打、深层按压……

Botulism: bacterial infection (clostridium botulinum), the bacteria release the toxin to inhibit the Ach at synaptic terminal cause the skeletal muscle paralysis;
肉毒杆菌中毒：细菌感染（肉毒杆菌），细菌释放毒素抑制突触末端的 Ach 导致骨骼肌麻痹；

CM: visual problems, blurred speech
CM：视力问题，言语模糊

Can’t walk or stand
不能行走或站立

Nausea, vomiting
恶心、呕吐

Recovery gradual (days, months or years)
恢复缓慢（数天、数月或数年）

10 % mortality, if involved primary respiratory muscles paralysis: diaphragm and external intercostal muscle
如果涉及原发性呼吸肌麻痹（膈肌和肋间外肌）：10%死亡率

BOTOX: use the diluted toxin of clostridium botulinum to injection on face (upper part); temporary paralysis the expression muscles to reduce wrinkles
BOTOX：使用稀释的肉毒杆菌毒素注射到面部（上半部分）；暂时麻痹表情肌肉以减少皱纹

Tetanus: bacterial infection (clostridium tetani)
破伤风：细菌感染（破伤风杆菌）

The bacteria clostridium tetani has spore to “protect” the bacteria can survive in very bad environment condition (very cold or very hot weather);
破伤风杆菌具有孢子，可以“保护”细菌在恶劣环境下生存（非常寒冷或非常炎热的天气）；

Acute infection, fatal disease; the bacteria enter at skin lesion, grow anaerobically and cause persistent painful tonic spasm of voluntary muscles
急性感染，致命疾病；细菌通过皮肤伤口进入，厌氧生长并引起持续性疼痛的强直性痉挛

PDT (pertussis, diphtheria, tetanus): vaccine in 2^nd, 4^th, 6^th, and 18-month-old; 4 years old; 14 years old (TD), every 10 years afterward you need to have booster injection (TD)
PDT（百日咳、白喉、破伤风）：在 2 个月、4 个月、6 个月和 18 个月大时接种；4 岁；14 岁（TD），之后每 10 年需要加强注射（TD）

Trichinosis: parasite worm in pork flesh; infected this parasite due ingestion uncooked pork meat (larvae), larvae mature in intestine then migrate to muscles
旋毛虫病：猪肉中的寄生虫虫卵；因食用未煮熟的猪肉（幼虫）而感染此寄生虫，幼虫在肠道成熟后迁移至肌肉
CM: ache, muscle and joint pain, edema, fever, diarrhea; muscle effected @ tongue, eyes, diaphragm, chest or legs
CM：疼痛、肌肉和关节疼痛、水肿、发烧、腹泻；受影响的肌肉包括舌头、眼睛、膈肌、胸部或腿部

Contracture: shortening and tightening of skin, fascia, muscle or joint capsule; affect the normal mobility, decrease ROM; most the contracture is happened in flexion
挛缩：皮肤、筋膜、肌肉或关节囊的缩短和紧张；影响正常活动能力，减少活动范围；大多数挛缩发生在屈曲状态

myostatic: muscular tendon union shortening cause decrease the ROM, relieved by PNF or stretching
肌紧张：肌肉肌腱联合缩短导致活动范围减少，可通过 PNF 或拉伸缓解

scar tissue adhesion: (Rattray 243) because scar tissue lies b/w two type of tissues, decrease ROM, develop adhesion b/w joint capsule, tendon, skin & tendon
瘢痕组织粘连：（Rattray 243）由于瘢痕组织位于两种组织之间，导致活动范围减少，并在关节囊、肌腱、皮肤与肌腱之间形成粘连

fibrotic adhesion: due to chronic inflammation occur irreversible fibrotic change --- decrease ROM----- difficult to recovery b/c fibrous is not muscle tissue, less elasticity
纤维性粘连：由于慢性炎症导致不可逆的纤维化改变——活动范围减少——难以恢复，因为纤维组织不是肌肉组织，弹性较低

irreversible contracture: permanent, treat with surgery, soft tissue is replaced by inextensible tissue (bone or fibrous tissue)
不可逆性挛缩：永久性，需手术治疗，软组织被不可伸缩组织（骨骼或纤维组织）取代

pseudomyostatic: occur lesion at central nerve system, usually involve the flexion muscle; reduced the ROM; such as post-stroke /CVA (cerebral vascular accident, if stroke happen right side brain, affected deformity @ left), Parkinson’s disease, spinal cord injury, multiple sclerosis, heart stroke;
假性肌强直：发生在中枢神经系统病变，通常影响屈肌；减少活动范围；例如中风后/CVA（脑血管意外，如果中风发生在右侧大脑，受影响的畸形在左侧）、帕金森病、脊髓损伤、多发性硬化、心梗；

CM: often occur in flexion; muscle is short, hard, unyielding, disuse atrophy or thickening the fascia
CM：常发生在屈肌；肌肉短、硬、不灵活、废用性萎缩或筋膜增厚

Sprain: ligament injury; ligament connect bone to bone
扭伤：韧带损伤；韧带连接骨头与骨头

Muscle strain: injury to musculotendinous unit, partial or total tear of muscle; often happen with athletes (common involved gastrocnemius, rotator cuff muscle (esp. supraspinatus), adductor group, iliopsoas (iliacus, psoas major and minor; action as hip flexor), hamstring (ischial tuberosity is origin of hamstring, is common seen strain injury, such as sprinter, runner)
肌肉拉伤：肌腱单位损伤，肌肉部分或完全撕裂；常发生在运动员（常见涉及腓肠肌、肩袖肌群（尤其是冈上肌）、内收肌群、髂腰肌（髂肌、腰大肌和小肌；作为髋屈肌起作用）、腘绳肌（坐骨结节是腘绳肌的起点，常见拉伤损伤，如短跑运动员、长跑运动员）

Polymetric exercises: running and jump combination, such as hurdle sport
多组训练：跑步和跳跃的组合，例如跨栏运动

Cause:
原因：

Overuse, over training
过度使用、过度训练

repeated micro-tearing, and micro wearing, always some inflammation
反复的微小撕裂和磨损，总是有些炎症

vitamin deficiency (calcium, Mg, vitamin C, vitamin B complex);
维生素缺乏（钙、镁、维生素 C、维生素 B 复合物）;

improperly stretching, forcefully stretch
不恰当拉伸，强力拉伸

damage the Golgi tendon organ
损伤高尔基腱器官

(Golgi tendon organ @ each tendon, this proprioceptor monitors if over loaded of muscle contraction)
（高尔基腱器官 @ 每条肌腱，这个本体感受器监测肌肉收缩是否过载）

Previous injury, may lead to repeat injured; have any injury, only 70% healed
之前的损伤，可能导致再次受伤；有任何损伤，只有 70%能愈合

3 degrees of strain:
3 度肌肉拉伤：

mild, 1^st degree ---- 20 % or less tear
轻度，1 级——20%或更少撕裂

muscle spasm, tenderness, weakness
肌肉痉挛，疼痛，无力

pain is not immediate, usually after 1-2 days of injury start the pain
疼痛不是立即发生的，通常在受伤后 1-2 天开始疼痛

**active ROM is not painful, but isometric resistant contraction is painful
**活动范围不受疼痛影响，但等长收缩时疼痛**

Moderate, 2^nd degree---- 20-75 % tears
中度，2 级 0 级---20-75%撕裂

extreme spasm, lot of tension, tenderness/ pain
严重痉挛，大量张力，压痛/疼痛

rapid inflammation, “hollow spot” due to muscle torn
快速炎症，肌肉撕裂导致的“空洞”

won’t able to activity because of pain
因疼痛无法活动

active ROM restricted and painful
活动范围受限且疼痛

resistant of ROM extremely painful and show sign of very weakness
活动范围抵抗极度疼痛，并显示非常虚弱的症状

Severe, 3^rd degree, 75-100% tear
严重，3 级撕裂，75-100%撕裂

extreme painful, but 100% tear / rupture muscle, no pain
极度疼痛，但肌肉完全撕裂/断裂，无痛

muscle splinting and muscle guarding to stabilize at injury area
肌肉固定和肌肉保护以稳定受伤部位

immediate lost function
立即丧失功能

inflammation, bruising, “Gap”
炎症、瘀伤、“间隙”

active motion not possible
无法进行主动活动

resistant of ROM is contraindication
ROM 阻力是禁忌

fibroblast secrete the collagen to form scar tissue to repair torn muscle fibers, which leads to a decrease in elastic quality, increase chance of re-injury as heals and adhesions cause tissue to stick to each other or other surrounding tissue
成纤维细胞分泌胶原蛋白形成瘢痕组织以修复撕裂的肌肉纤维，这会导致弹性质量下降，愈合时粘连增加，使组织相互粘附或粘附于周围组织，从而增加再次受伤的机会

Treatment: focus on try to make scar tissue fibers most parallel to regular muscle fibers in order to maximize flexibility----- by passive or active stretch, muscle stripping, effleurage, petrissage….
治疗：重点尝试使瘢痕组织纤维尽可能平行于正常肌肉纤维，以最大化柔韧性——通过被动或主动拉伸、肌肉剥离、 effleurage、petrissage 等方法……

The treatment: subacute: active ROM (pain free), passive ROM (pain free), slowing if muscle setting (very gentle isometric contraction) ……. Rattray 235
治疗：亚急性期：主动活动范围（无痛）、被动活动范围（无痛）、延缓肌肉设置（非常轻柔的等长收缩）…… Rattray 235

As massage therapist, do not disturb the healing process;
作为按摩师，不要干扰愈合过程；

Tendonitis: (tendinopathies)
腱炎：（腱病）

tendons are made up of dense connective tissue; do not stretch or contract, made up of collagen, the fiber are closely together packed and parallel; attach muscle to bone, lacking blood vessels; if dehydration causes decreased space between fibers and bound created;
肌腱由致密结缔组织构成；不能拉伸或收缩，由胶原纤维构成，纤维紧密地平行排列；连接肌肉与骨骼，缺乏血管；如果脱水导致纤维间空间减少和结合形成；

** Tendons have a limited blood supply so they take longer time to heal if tendon is injured
**肌腱的血供有限，因此如果肌腱受伤，需要更长时间才能愈合

Tendonitis is chronic inflammation of tendon due to repeated micro trauma, micro-tear of muscle fiber;
肌腱炎是由于反复微创伤、肌肉纤维微撕裂引起的肌腱慢性炎症；

Tendinosis is chronic degenerative processes of tendonitis, properly combination of intrinsic and extrinsic factors, repeated use, microtear, no enough time to recovery,
肌腱病是肌腱炎的慢性退行性过程，是内因和外因的适当组合，反复使用、微撕裂、恢复时间不足

Contributing factors:
促成因素：

immobilization: atrophy of muscle, once atrophy, use the muscle again cause micro-trauma --- cause tendonitis
制动：肌肉萎缩，一旦萎缩，再次使用肌肉会造成微创伤——进而导致腱鞘炎

endocrine factor: glucocorticoids (cortical) is stress response, cause more secretion of cortisol hormone; long term use corticosteroid medication, the side effect is tissue become fragile, easier to injured
内分泌因素：糖皮质激素（皮质）是应激反应，导致皮质醇激素分泌增多；长期使用皮质类固醇药物，副作用是组织变得脆弱，更容易受伤

nutrition: poor nutrition (amino acid contribute the collagen formation, vitamin C, E, copper & iron, zinc to repair the tissue)
营养：营养不良（氨基酸有助于胶原蛋白形成，维生素 C、E、铜和铁、锌有助于组织修复）

tendinosis -----Tendonitis usually is chronic ---- chronic ----- flare up (treat as subacute or acute) ----- chronic ----- chronic
肌腱病 -----肌腱炎通常是慢性的 ---- 慢性 ----- 突发（按亚急性或急性治疗） ----- 慢性 ----- 慢性

Massage and remedial exercises: always strengthen the weak muscle by active isometric or isotonic exercises; active or passive stretch the tight muscle
按摩和康复锻炼：始终通过主动等长或等张运动增强薄弱肌肉；主动或被动拉伸紧张肌肉

Active contraction of muscle and with weight bearing can strengthen the muscle
肌肉主动收缩并结合负重可以增强肌肉

Any joint pain or pathology, suggest the client walk or swim in swimming pool
任何关节疼痛或病理情况，建议客户在游泳池中行走或游泳

Multiple sclerosis: autoimmune disease; the myelin sheath damaged by abnormal auto-antibody. CI: jacuzzi pool, sauna, hot bath tub,
多发性硬化症：自身免疫性疾病；髓鞘受损，由异常自身抗体引起。CI：按摩浴缸，桑拿，热水浴缸，

Scoliosis: is the spine latera deviation (reverse “S” shape or “C” shape---- is neuromuscular condition cause the C shape scoliosis)
脊柱侧弯：是脊柱的侧向偏移（反向“S”形或“C”形——是神经肌肉条件引起的“C”形脊柱侧弯）

Intimate (client sexual abuse), intimidate
性侵犯，恐吓

Chronic tendonitis: / tendinosis
慢性腱炎：/ 腱病

due to repetitive use, muscle fatigue, partial rupture, failed (not enough time) healing, degenerative changes to fibrous tissue (which is connective tissue)
由于反复使用，肌肉疲劳，部分撕裂，愈合失败（时间不足），纤维组织发生退行性变（纤维组织是结缔组织）

gradual onset, sharp pain with contraction, dull ache or/ no pain at rest, pain may radiate, decrease muscle strength and ROM
逐渐发生，收缩时剧痛，休息时隐痛或无痛，疼痛可能放射，肌肉力量和活动范围减少

if not treated, muscles become weak, degeneration of tendon, adhesion, spasm in other muscle, possible tendon rupture; trigger point or acute inflammation episodes/ flare up
若不治疗，肌肉会变弱，肌腱退行性变，粘连，其他肌肉痉挛，可能发生肌腱撕裂；触发点或急性炎症发作/复发

Treatment: for reduce the adhesion, friction is indicated but make sure the client is not under anti inflammation medication (include NSAIDs, such as aspirin, ibuprofen, Advil, Tylenol and corticosteroid antiinflammation);
治疗：为减少粘连，需要摩擦，但需确保客户未服用抗炎药物（包括非甾体抗炎药，如阿司匹林、布洛芬、Advil、泰诺和皮质类固醇抗炎药）；

Before you do friction, prepare the tissue by Swedish massage techniques and follow the principles of massage
在实施摩擦疗法前，需通过瑞典按摩技术准备组织，并遵循按摩原则

cross fiber friction is “intentional inflammation” to reduce the adhesion; place the joint and tendon of limb in rest position/open pack position ---(remove the oil from skin of client and your hands), palpate the tendon to be treated do the cross-fiber friction for 1-2 minutes ----- effleurage and petrissage to flush away the “waste” ----- passive stretch---- ice compression (for 30 seconds- 1minutes)
交叉纤维摩擦是“有意引发炎症”以减少粘连；将肢体关节和肌腱置于休息位/打开包扎位——（去除客户和双手上的油），触摸要治疗的肌腱进行交叉纤维摩擦 1-2 分钟——（通过 effleurage 和 petrissage 清除“废物”）——被动拉伸——冰敷压缩（30 秒-1 分钟）

Common locations cause of tendonitis:
腱炎的常见部位：

common extensor tendonitis @ lateral epicondyle of humerus; tennis player/ (tennis elbow), worker on computer, musician, knitting
常见伸肌腱炎 @ 肱骨外上髁；网球运动员/（网球肘），电脑工作者，音乐家，编织者

Cozen’s test, Mills’s test
科赞试验，米尔斯试验

common extensor tendon: extensor digit minimums, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris
常见伸肌腱：伸指短肌，拇长伸肌，指伸肌，拇长展肌

common flexor tendonitis @ medial epicondyle of humerus; massager, golf player/ golf elbow, writing
常见屈肌腱炎 @ 肱骨内上髁；按摩师，高尔夫球运动员/高尔夫肘，书写

common flexor tendon: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor carpi ulnaris (reverse Cozen’s and reverse Mill’s)
常见屈肌腱：旋前圆肌，屈指浅肌，掌长肌，屈指深肌，尺侧屈腕肌（反向科赞试验和反向米尔斯试验）

subscapularis tendonitis: baseball pitcher, valley ball player, table tennis player, they all do lot of throwing movement/ medial rotation action; barber or hair dresser
肩胛下肌腱炎：棒球投手、垒球运动员、乒乓球运动员，他们都做大量投掷动作/内旋动作；理发师或美容师

supraspinatus tendonitis: carry heavy object (insertion @ superior facet of great tubercle of humerus; its action is initial abduction 0-25 degrees
冈上肌腱炎：搬运重物（插入点在肱骨大结节上缘；其作用是初始外展 0-25 度）

infraspinatus tendonitis: using movement lateral rotation of arm; plumber, mechanical technician, hair dresser;
冈下肌腱炎：使用手臂外旋动作；水管工、机械技师、美容师；

This muscle’s insertion @ middle facet of great tubercle
此肌肉的插入点在大结节中部

In rotator cuff muscles: Synergist muscles infraspinatus and teres minor
在肩袖肌群：协同肌小圆肌和肩胛下肌

The rotator cuff tendons: SITS are prone to tendinitis with sport such as swimming, tennis, golf or any throwing sport (baseball, valley ball….) or dry wall installation worker, installation the ceiling light; the shoulder muscle with the arms in an overhead position may cause the rotator cuff tendonitis
肩袖腱：SITS 肌群易因游泳、网球、高尔夫或任何投掷类运动（棒球、排球等）或干墙安装工、安装天花板灯等工作引发腱炎；手臂举过头顶时肩部肌肉可能导致肩袖腱炎

Achilles’ tendonitis: sustained or do planter flexion, runner, ballet dancer or high heel wear
跟腱炎：持续进行或进行跖屈动作，如跑步者、芭蕾舞演员或穿高跟鞋者

Over use Extensor pollicis longus and brevis, abductor pollicis longus to cause tenosynovitis (inflammation of tendon, tendon sheath and synovial fluid) ---- de Quervain’s tenosynovitis/ Hoffman disease (use the Finklestein test)
过度使用拇指长伸肌和短伸肌、拇长展肌，可引起腱鞘炎（肌腱、腱鞘和滑液的炎症）——德昆韦因腱鞘炎/霍夫曼病（使用费氏试验）

The jobs use lot of arm and elbow flexion, biceps tendonitis (Speed test and Yergason’s test)
工作需要大量使用手臂和肘部屈曲，肱二头肌腱炎（速度测试和耶尔加森测试）

j: Muscle tumors:
j: 肌肉肿瘤：

Desmoids tumor: benign, 1-3 cm diameter, like fibrous scar, usually seen this tumor at abdomen area after pregnancy; if compress on nerve or blood vessels, surgical removed
纤维瘤：良性，直径 1-3 厘米，类似纤维疤痕，通常在怀孕后腹部出现这种肿瘤；如果压迫神经或血管，需要手术切除

K: CREST syndrome: related scleroderma
K: CREST 综合征：与硬皮病相关

Scleroderma: it is an autoimmune disease of the connective tissue; the skin become thickening and hardening due to abnormal overproduction of collagen;
硬皮病：这是一种结缔组织自身免疫性疾病；由于胶原蛋白异常过度产生，皮肤变得增厚和硬化；

Idiopathic, but some researchers found some evidence that gene factors, or environmental factors (exposure to silica dust, vinyl chloride, epoxy resins and other organic solvent); there are many reported cases of scleroderma and other autoimmune disorders among women who have had breast implants by silicon
病因不明，但一些研究人员发现了一些证据表明基因因素或环境因素（如接触硅尘、氯乙烯、环氧树脂和其他有机溶剂）；据报道，许多接受硅乳腺植入的女性患有硬皮病和其他自身免疫性疾病

Thickening and hardening of the skin, the skin loses its elasticity and become shiny, numbness, pain or color changes in fingers, toes, cheeks, nose and ears (Raynaud’s phenomenon: cyanosis= bluish color)
皮肤增厚和硬化，皮肤失去弹性并变得有光泽，手指、脚趾、脸颊、鼻子和耳朵出现麻木、疼痛或颜色变化（雷诺现象：发绀=蓝色）

Stiffness or pain at joints, digestive problems, puffy hands and feet
关节僵硬或疼痛，消化问题，手脚浮肿

Gastrointestinal wasting, scarring of lungs and heart tissue,
胃肠道消耗，肺部和心脏组织瘢痕形成，

CREST syndrome:
CREST 综合征：

Calcinosis: small, white, chalky, lumps of calcium under skin (white chalky spots on the skin) ---- initial sign of this disease
钙化：皮肤下的小型、白色、石灰状钙质肿块（皮肤上的白色石灰状斑点）——该疾病的初始症状

Reynaud phenomenon: fingers or toes cyanosis (bluish) due to blood vessel spasm/ constriction, ischemia and hypoxia/lacking the oxygen
雷诺现象：由于血管痉挛/收缩、缺血和缺氧/缺乏氧气导致手指或脚趾发紫（呈蓝色）

Esophageal dysfunction: difficult to swallow
食管功能障碍：吞咽困难

Sclerodactyly: hardness of fingers
硬皮病：手指僵硬

Telangiectasis: distal/ peripheral red spots
毛细血管扩张：远端/周围红点

Treatment: no treatment to cure; Dr. prescription medication for relief and reduce the symptoms (improve blood flow, preserve kidney function and control high blood pressure); massage use moisturizers to temporary smooth and soften the skin, only palliative/ soothing care
治疗：无法治愈；医生处方药物缓解症状并减少（改善血流、保护肾功能和控制高血压）；按摩使用保湿剂暂时使皮肤平滑软化，仅作为姑息/舒缓护理

L: ITB (iliotibial band: from ASIS to tibia tubercle, it is continuing from Tensor fascia Lata to tubercle of tibia see GT 348); the ITB origin is from Tense fasciae latae and gluteus max.
L: ITB（髂胫束：从髂嵴到胫骨结节，它从阔筋膜张肌延续到胫骨结节，参见 GT 348）；ITB 的起点是阔筋膜张肌和臀大肌。

ITB friction syndrome: (use Noble compression test)
ITB 摩擦综合征：（使用诺布尔压迫试验）

inflammation & pain where the ITB cross the lateral femoral epicondyle due to long term overuse where knee flexion and hip flexion, abduction (runner, dancer, football player, bicyclist), also tensor fasciae latae contracture, dehydration, anterior pelvic tilt are the contribution factors
炎症和疼痛发生在 ITB 跨越股骨外侧髁处，由于长期过度使用导致膝关节屈曲和髋关节屈曲、外展（跑步者、舞者、足球运动员、骑自行车者），以及阔筋膜张肌挛缩、脱水、前倾骨盆是促成因素。

CM: pain along the ITB, tenderness at lateral epicondyle area or contracture entire ITB (Ober’s test)
CM：沿 ITB 的疼痛，外侧髁区域压痛或整个 ITB 挛缩（奥伯试验）

treatment: cryotherapy to affected tissue to decrease inflammation;
治疗：对受影响组织进行冷冻治疗以减少炎症；

cross fiber Friction technique to decrease adhesion; “J” sign stroke, C or S bowing; or contrast hydrotherapy to flushing away the waste
交叉纤维摩擦技术以减少粘连；“J”形标志划痕，C 形或 S 形弯曲；或对比水疗以冲洗掉废物

Prognosis: self-limited in 6 weeks if the aggravating factors are removed or reduced; if causes not removed, the condition is continuing
预后：如果加重因素被去除或减少，6 周内可自愈；如果原因未去除，病情会持续

(Timing ratio of contrast hydrotherapy: heat: cold =3:1, always end with cold, to restore the homeostasis)
（对比水疗的时间比例：热：冷=3:1，始终以冷结束，以恢复稳态）

Cold or cryotherapy cause Active hyperemia; increase WBC & RBC activity
冷疗或冷冻疗法引起主动充血；增加白细胞和红细胞活性

warm hydrotherapy causes passive hyperemia; increase WBC activity only; as a massage therapist, always end with brief cold compress
热湿疗引起被动充血；仅增加白细胞活性；作为按摩师，始终以短暂冷敷结束

Heat CI: inflammation, fever, diabetes, multiple sclerosis, (hyperthyroidism don’t do any hydrotherapy at all)
热疗禁忌症：炎症、发烧、糖尿病、多发性硬化（甲亢患者完全禁止水疗）

Myofascial Trigger point: a hyperirritable spot within a taut band (nodule) of skeletal muscle. Upon compression, pain at local and referral pattern, autonomic phenomenon (sweating, numbness, tingling, or tinnitus, sensation decreased…)
肌肉筋膜触发点：肌肉紧张带（结节）内的一个高反应性点。按压时，局部及放射痛、自主神经现象（出汗、麻木、刺痛或耳鸣、感觉减退……）

pain pattern helps location of trigger point; sarcomeres contracts & little small nodule/taut band in muscle when palpated
疼痛模式有助于定位触发点；当触诊时，肌节收缩，肌肉中出现微小结节或紧张带

active TP: pain @ rest or more pain use that muscle
活动性触发点：静止时疼痛或使用该肌肉时疼痛加剧

latent TP: palpable pain when palpated/ compressed
潜伏性触发点：触诊或压迫时能感知疼痛

primary TPs: pain activated directly by acute & chronic muscle strain (radiate to insertion direction or distally)
原发性触发点：由急性或慢性肌肉拉伤直接激活（疼痛向插入点方向或远端放射）

secondary TPs: appear in synergist & antagonist muscles
次级触发点：出现在协同肌和拮抗肌中

satellite TPs: found within muscle referral pattern if deltoid have a TP, it’s a referral from scalene
卫星触发点：若三角肌有触发点，则来自斜方肌的牵涉痛

SCM: clavicle head: referral pain, superior of eye brow of both sides; pain in side of ear, may compress the trigger point, cause tinnitus (noise in ear)
胸锁乳突肌：锁骨头：牵涉痛，双侧眉头上方；耳侧疼痛，可能压迫触发点，引起耳鸣（耳内噪音）

Sternal head: referral pain, at surround eye and cheek, top of head and occiput
胸骨头：牵涉痛，围绕眼睛和脸颊，头顶和枕部

Swallowing test: (to determine whether pain on swallowing is due to referred pain from SCM muscle trigger point
吞咽测试：（用于判断吞咽疼痛是否由胸锁乳突肌触发点引起的牵涉痛

Client in sitting position
患者坐姿

Examiner palpate the SCM in a pincer grasp; when the most tender point is found, maintain the pressure on the muscle belly while the client swallows
检查者以钳状手法按压胸锁乳突肌；当找到最痛点时，在患者吞咽时保持对肌肉腹部的按压

Positive: pain of muscle is diminished;
阳性：肌肉疼痛减轻；

Indicate: is the trigger point on SCM
标明：是胸锁乳突肌上的触发点吗？

(If pain without compress on SCM, sore throat pain may indicate some infection, should ask client see the medical diagnosis)
（如果胸锁乳突肌无压痛，喉咙疼痛可能提示某些感染，应建议客户就医诊断）

pathophysiology: 7 clinical features of Trigger point:
病理生理学：触发点的 7 个临床特征：

exquisite local tenderness of TP, sensation of nerve endings--- muscle have nociceptors (pain receptor)
触发点有明显的局部压痛，感觉神经末梢——肌肉中有痛觉感受器（疼痛受体）

referral pain or tenderness with autonomic phenomenon in area distant from trigger point; TP of SCM: tinnitus (noisy in ear), vertigo
转介疼痛或压痛伴随远离触发点的自主神经现象；胸锁乳突肌触发点：耳鸣（耳朵嘈杂）、眩晕

palpable taut band/ nodule in combination with resisted ROM / or stretch of the muscle---- the taut band is a ropy sensation,
可触及的紧张带/结节，结合阻力下活动范围受限/或肌肉拉伸——紧张带是一种绳索样感觉，

Palpable band, there is a local twitch response/ muscle local twitch (jump sign) bound involuntarily----- occurs when you palpate TP spasm of muscle. this confirms that you are on a TP
可触及的带状物，有局部抽搐反应/肌肉局部抽搐（跳跃征）非自愿地发生——当按压肌肉触发点痉挛时发生。这证实你正位于一个触发点上

perpetuating trigger point or increase susceptibility of trigger points, because of compromise of a muscle’s energy (ATP) supply & energy assistant (muscle more vulnerable to have trigger point) (constant to use the ATP) --- cause metabolic distress or may be compromises energy; or other factors such as
持续存在的触发点或增加触发点的易感性，因为肌肉的能量（ATP）供应和能量辅助（肌肉更容易出现触发点）受损（持续使用 ATP）——导致代谢紊乱或可能损害能量；或其他因素，例如

include vitamin D₃, vitamin B complex, or calcium, magnesium deficiency
包括维生素 D ₃ 、复合维生素 B 或钙、镁缺乏

anemia or inadequate thyroid function (hypothyroidism), endocrine factors
贫血或甲状腺功能不足（甲状腺功能减退），内分泌因素

therapeutic result because of stretching---- this is why stretching is so important immediate effective b/c
由于拉伸而产生的治疗效果——这就是拉伸如此重要的原因，立即有效，因为

use of ATP stopping;
使用 ATP 停止；

the tension release by myosin head returning to normal position;
肌球蛋白头部回到正常位置时释放张力；

muscle relaxed (the muscle length restored); to prevent bounce back pain post treatment
肌肉放松（肌肉长度恢复）；防止治疗后反弹疼痛

weakness without atrophy, fatigue quicker than other muscle / increase the fatigability--- lack of oxygen= hypoxia--- build- up of lactic acid due poor circulation
无萎缩的无力，比其他肌肉更容易疲劳/增加疲劳度---缺氧=缺氧---由于循环不良导致乳酸堆积

Explanation for these 7 clinical features:
这些 7 个临床特征的解释：

sensitization of nerve endings--- group III and IV muscle nociceptors (pain receptor) cause nerve to respond at a reduced threshold, to increase response to a given stimulus, needless stimulus to cause pain
神经末梢的敏感性——即 III 组和 IV 组肌肉痛觉感受器（疼痛受体）——会导致神经在降低的阈值下响应，增加对给定刺激的反应，无刺激也会引起疼痛

sensitization may induce spontaneous firing in a nerve that was not spontaneously active. These small nerve fibers are responsive to prostaglandin (a substance knows to sensitize nerves).
敏感性可能诱导原本非自发活跃的神经产生自发放电。这些小神经纤维对前列腺素（一种已知能引起神经敏感的物质）有反应。

prostaglandin inhibitor/ pain killer, pain may be reduced; NSAIDS (Tylenol, Advil….) these medications inhibit the prostaglandin
前列腺素抑制剂/止痛药，疼痛可能会减轻；非甾体抗炎药（泰诺、美林等）这些药物抑制前列腺素。

Nerve action potentials are misinterpreted by brain and projected as referred pain and tenderness. The source of pain is rarely where the client feels the pain. experience/ inexperienced pain such as follow common pain pathways = referral pattern
神经动作电位被大脑错误解读并投射为牵涉痛和压痛。疼痛的来源很少是客户感觉疼痛的地方。经验/无经验的疼痛通常遵循常见的疼痛通路=牵涉痛模式

Palpable band: severe condition, nodule in muscle. Important in identifying a trigger point. Define: shortening in region of TP at sarcomere. it is a unique characteristic to a Trigger point
可触及的条带：严重状况，肌肉中的结节。在识别触发点时非常重要。定义：触发点区域肌节缩短。这是触发点的独特特征。

It is a ropy sensation, feel ropy; there will be a “twitch response” but no electrical pain; muscle lengthen of other fibers to give contraction
这是一种绳索状的感觉，感觉像绳索；会有“抽搐反应”，但没有电击样疼痛；其他肌纤维的肌肉长度变化以产生收缩

local twitch response: occurs when you palpate TP, spasm of muscle this confirms that you have a TP or (coming from muscle fibers or reflex response)
局部抽搐反应：当你触诊触发点时发生，肌肉痉挛，这证实你有一个触发点或（来自肌纤维或反射反应）

metabolic distress: any compromise of muscle energy pathways appears to sensitize a muscle to the development of TP’s and to aggravate existing TP’s. Compromises include vitamins’ deficiency, anemia and inadequate thyroid function or endocrine factors
代谢失调：任何肌肉能量途径的损害似乎会使肌肉对触发点的发展敏感，并加剧现有的触发点。损害包括维生素缺乏、贫血和甲状腺功能不足或内分泌因素

or calcium, magnesium, vitamin D deficiency…
或钙、镁、维生素 D 缺乏……

value of stretch: this is why stretching is so important immediately effective b/c use of ATP stopping, the tension release by myosin head returning to normal position, muscle relaxes
拉伸的价值：这就是为什么拉伸如此重要，立即有效，因为 ATP 的使用停止，肌球蛋白头部回到正常位置，肌肉放松

Due to TP pain, the muscle is weakness / fatigability: cause the lacking of O₂ --- hypoxia, buildup of lactic acid due poor circulation
由于 TP 疼痛，肌肉无力/疲劳：原因是 O 缺乏---缺氧，乳酸堆积由于循环不良

Active TP revert to latent or remission, latent TP do not cause clinical pain complaints, but may have all other diagnostic signs of an active TP, but there is palpable taut band
活动性 TP 转为潜伏或缓解，潜伏性 TP 不会引起临床疼痛症状，但可能有所有其他活动性 TP 的诊断体征，但可以触及紧张带

Clinical manifestations:
临床症状：

pain with muscle contraction, stimulation of latent TP
肌肉收缩时疼痛，潜伏 TP 刺激

twitch upon palpation
触诊时肌肉抽搐

hypertonicity
肌肉紧张

decrease circulation & drainage
减少循环和引流

pain with passive stretching
被动拉伸时疼痛

contraction of affected muscle, inner range of contraction is painful
受影响肌肉收缩，收缩内范围疼痛

latent TP can become active if muscle in a shortened position for a long period of time
潜伏性 TP 如果肌肉长时间处于缩短位置可能会变为活跃

jump sign/ twitch sign --- it is involuntary sign
跳跃征/抽搐征 --- 这是非自主性征象

Autonomic phenomenon: itchy, numbness, tingling… with SCM or trapezius, tinnitus, vertigo, dizziness….
自主神经现象：瘙痒、麻木、针刺感……伴随胸锁乳突肌或斜方肌，耳鸣、眩晕、头晕……

The referred pattern is useful key to locate the trigger point. Have client describe and show their pain pattern by using one finger. You draw the pattern on a picture. Number the pain patterns in order of most irritability to least
牵涉模式是定位触发点的有用关键。让客户用一根手指描述并展示他们的疼痛模式。你在图片上画出该模式。按从最易受刺激到最不易受刺激的顺序给疼痛模式编号

Examination:
检查：

observation of posture & movement (gait)
姿势与运动观察（步态）

identify restricted movement
识别受限运动

compensating movement
代偿性运动

strength test /isometric resistant contraction result shaky (ratchet response) which means muscle weakness due to pain
力量测试/等长抵抗收缩结果颤抖（棘轮反应）这意味着由于疼痛导致的肌肉无力

palpation to find most painful site on the muscle
触诊以找到肌肉最疼痛的部位

see if twitch response
检查是否有抽搐反应

Reproduction of complaint by client. They should say “this is exactly what I am feeling.”
患者复述主诉。他们应该说“这正好是我感觉的。”

Treatment of TP:
TP 的治疗方法：

Use the Swedish massage techniques to warm up the area; (follow massage principles)
使用瑞典式按摩技术来热敷该区域；（遵循按摩原则）

Palpation the TP by muscle stripping, “I feel the taut band “; “I saw the twitch sign”
通过肌肉剥离法触诊 TP，"我感觉到紧张带"；"我看到抽搐征象"

ischemia compression for 1-2 minutes, until the pain diminished or relieved
进行 1-2 分钟的缺血性按压，直到疼痛减轻或缓解

Flushing away by effleurage, finger stripping, petrissage….,
通过轻抚、指剥离、揉捏等方式进行冲洗

Passive stretch and holding for 30 seconds, until client say “the tension is gone”;
被动拉伸并保持 30 秒，直到客户说“紧张感消失了”；

warm towel compression for 1-3 minutes;
热毛巾压迫 1-3 分钟；

The muscles with TP: need on side lying with gluteal area and thigh area treatment to TP treat and stretch
有 TP 问题的肌肉：需要侧卧进行臀部区域和大腿区域的 TP 治疗和拉伸

hamstring (biceps femoris, semimembranosus and semitendinosus), quadriceps (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius), latissimus dorsi, serratus anterior, gluteus maximum, quadratus lumborum,
腘绳肌（股二头肌、半膜肌和半腱肌）、股四头肌（股直肌、股内侧肌、股外侧肌、股中间肌）、背阔肌、前锯肌、臀大肌、腰方肌，

(Remember mention “I have already had your written consent to treat your gluteal muscle, can we start to the gluteus maximum muscle for massage?), then do the gluteal draping;
(记得提及“我已经获得您治疗臀部肌肉的书面同意，我们可以开始按摩最大臀肌了吗？”)，然后进行臀部遮盖；

Perpetuating factors: two common mechanical factors perpetuate TP:
持续因素：两种常见的机械因素持续导致 TP：

congenital leg length discrepancy
先天性腿长差异

small hemi pelvis (abnormal small)
小半骨盆（异常小）

anterior or posterior tilt pelvis, causing muscle strain of functional scoliosis
骨盆前倾或后倾，导致功能型脊柱侧弯肌肉拉伤

short upper arms, perpetuate QL trigger point
上臂短小，持续引发腰方肌触发点

Morton’s toe of foot (2^nd toe is longer than big toe due to longer 2^nd metatarsal bone), cause the gluteus Medius and low back with the Trigger points
足部莫顿趾（第 2 脚趾比大脚趾长，因为第 2 跖骨较长），导致臀中肌和下背部出现触发点

Vitamins’ deficiency of specific B complex, vitamin D, iron deficiency, low thyroid function, low calcium or potassium, hyperuricemia (high level of uric acid in blood, cause gout), chronic bacterial infection, emotional stress and respiratory viruses can all perpetuate trigger point
特定 B 族维生素缺乏、维生素 D 缺乏、铁缺乏、甲状腺功能减退、低钙或低钾、高尿酸（血液中尿酸水平高，引发痛风）、慢性细菌感染、情绪压力和呼吸道病毒均可持续引发触发点

Client education: educate on what a TP is and how theirs was caused. they must learn how to avoid overloading those muscles
客户教育：告知什么是肌肉痉挛以及他们是如何引起的。他们必须学习如何避免过度负荷这些肌肉

correct posture
正确姿势

self-care:
自我护理：

full active ROM to increase circulation
完全主动活动范围以增加循环

self-stretching
自拉伸

self-massage
自我按摩

heat to affected muscles, cool compression on referral zone
对受影响肌肉加热，对反射区进行冷敷

Prognosis: depending on state of TP; quick results in first section and slow progress after many sessions are common;
预后：取决于 TP 状态；第一部分效果迅速，多次治疗后进展缓慢是常见的；

Some information:
一些信息：

Pregnancy: CI & precaution: no reflexology foot massage, no massage on the area of inferior medial malleolus, avoid to massage at sacrum area; no passive force ROM, no passive stretches because during the pregnancy, the progesterone and relaxant the ligament
怀孕：禁忌与注意事项：禁止足部反射学按摩，禁止在胫骨内踝下方区域按摩，避免在骶骨区域按摩；禁止被动力范围活动，禁止被动拉伸，因为怀孕期间，孕酮和松弛激素会使韧带松弛

During the supine position for pregnancy women, you will put one pillow at right lumbar area to yield the compression on inferior vena cava;
对于怀孕的女性，在仰卧姿势时，你会在右侧腰椎区域放置一个枕头以减轻下腔静脉的压迫；

Left side lying first, then supine, right side lying; side lying need to put 4 pillows:
先左侧卧，然后仰卧，再右侧卧；侧卧时需要放置 4 个枕头：