关节松动术实操指南：
缓解疼痛、改善关节活动受限、提升运动功能
［英］罗伯特·C. 曼斯克（Robert C. Manske）
B.J. 莱哈卡（B.J. Lehecka）
迈克尔·P. 雷曼（Michael P. Reiman）
珍妮丝·K. 劳登（Janice K. Loudon） 著
王悦 韩照岐 译
人民邮电出版社
北京
图书在版编目（CIP）数据
关节松动术实操指南：缓解疼痛、改善关节活动受限、提升运动功能 / （英）罗伯特·C. 曼斯克（Robert C. Manske）等著；王悦，韩照岐译．--北京：人民邮电出版社，2023.6
ISBN 978-7-115-55740-7
Ⅰ．①关… Ⅱ．①罗… ②王… ③韩… Ⅲ．①关节疾病-物理疗法-指南②关节-运动训练-指南 Ⅳ．①R684.05-62②G804.32-62
中国版本图书馆CIP数据核字（2020）第267778号
著 ［英］罗伯特·C. 曼斯克（Robert C. Manske）
B.J. 莱哈卡（B.J. Lehecka）
迈克尔·P. 雷曼（Michael P. Reiman）
珍妮丝·K. 劳登（Janice K. Loudon）
译 王悦 韩照岐
责任编辑 裴倩
责任印制 周昇亮
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字数：409千字
2023年6月第1版
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内容提要
对于物理治疗师和运动康复专业的学生和相关从业人员来说，本书是一本全面的关节松动术操作指南。全书共有4部分，第1部分系统介绍了关节松动术的基础理论知识，第2至第4部分则分别介绍了颅下颌复合体、脊柱、上肢和下肢等部位的关节松动术操作方法。本书以解剖图覆盖在真人实拍图之上的形式，清晰地展示了人体骨骼位置，通过指示性箭头细致地标注了手法位置和施力方向。此外，本书还提供了患者姿势、临床师姿势、稳定机制、松动术和技术目标等详细指导。书中讲授的关节松动术易于在教室、实验室、诊所和其他专业工作场所中使用，可以有效解决与疼痛、功能障碍和关节活动受限相关的各种肌肉骨骼问题。
版权声明
Copyright © 2019 by Robert C. Manske, B.J. Lehecka, Michael P. Reiman, Janice K. Loudon
All rights reserved. Except for use in a review, the reproduction or utilization of this work in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, and in any information storage and retrieval system, is forbidden without the written permission of the publisher
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免责声明
本书内容旨在为大众提供有用的信息。所有材料（包括文本、图形和图像）仅供参考，不能用于对特定疾病或症状的医疗诊断、建议或治疗。所有读者在针对任何一般性或特定的健康问题开始某项锻炼之前，均应向专业的医疗保健机构或医生进行咨询。作者和出版商都已尽可能确保本书技术上的准确性以及合理性，且并不特别推崇任何治疗方法、方案、建议或本书中的其他信息，并特别声明，不会承担由于使用本出版物中的材料而遭受的任何损伤所直接或间接产生的与个人或团体相关的一切责任、损失或风险。
本书旨在就关节短幅冲刺动作与非短幅冲刺动作，为物理治疗预科课程和整骨医疗课程的教育工作者和学生，提供一本有据可依的综合性教材。本书是专门为那些想治疗患有肌肉、骨骼、关节疼痛和功能紊乱的患者，而学习物理治疗预科课程与整骨医疗课程的物理治疗师、整骨医生、教育工作者和学生编写的。本书讲授的相关技术都易于在教室、实验室或专业的工作场所使用。本书为读者提供了对正在经历疼痛、关节活动受限、关节功能紊乱等各种肌肉骨骼病症的患者，在临床应用中开展关节短幅冲刺动作与非短幅冲刺动作的证据和理论。关节松动术与操作治疗术已经践行40多年了。这种关节松动术与操作治疗术是一种被美国大多数理疗项目采用的治疗术，也是在临床实践中最易得到理解和应用的技术之一。本书为读者呈现了一种直接的方法，其依据是传统的解剖结构与功能，还有目前的研究证据。
本书提供了支持使用关节松动术、操作治疗术以及徒手治疗的各种文献的综合概览，还对相关文献、概念和理论做了补充说明，以帮助读者理解关节短幅冲刺动作与非短幅冲刺动作是如何减轻病痛，并令患者重获正常的关节功能的。本书将向读者介绍如何确认关节运动学性质的关节功能失常，以便使用关节松动术/操作治疗术加以治疗。此外，本书还为渴望有所作为的物理治疗师讲解了各种可用于治疗常见肌肉骨骼病症的易于应用的方法。
这本书的独特之处在于解剖图覆盖在展示临床技术的图片上。它们可以更好地为读者呈现技术目标的视觉化效果，还可以指导临床师手的摆放与操作流程。大部分章节都配有相关的临床小贴士，以加深读者对技术的领会。
第1部分介绍了关节松动术与操作治疗术背后的科学常识，包括各种适应证、关节运动学概述和其他信息。第2部分描述了针对整段脊柱和颞下颌关节的松动术与操作治疗术。第3部分详述了针对上肢的松动术与操作治疗术。第4部分阐述了针对下肢的松动术与操作治疗术。最后，附录展现了26种自主松动术。我们希望通过对这些技术进行清楚、富有条理的描述，令所有读者及其所治疗的患者获益。
本书起初是几位作者为各自的理疗课程所写的讲义资料，多亏了人类运动出版社的乔希·斯通（Josh Stone）和阿曼达·尤因（Amanda Ewing）给予的帮助与指导，使本书成为更有价值的教材。没有他们提供的编辑工作，就根本不可能有现在展现在我们面前的这本书。我们还想感谢海迪·里克特（Heidi Richter），她出色地绘制了这本书中相关图片的解剖学图解。这些图解是本书非常关键的组成部分，因为读者能够通过它们更好地领会关节松动术与操作治疗术。
我们还想感谢所有帮助我们开发出编写本书所必需的技术的导师、学生和管理人员。
最后，还感谢我们的家人和朋友，他们允许我们牺牲一部分陪伴他们的时间来编写本书。
本书的第1部分包括第1章和第2章。第1章描述了关节松动术与操作治疗术的常识，第2章介绍了相关的应用指导。第1章详细地介绍了该领域中普遍采用的关节松动术与操作治疗技术的原理，包括临床师对患者应用关节松动术与操作治疗术时的原理。理解这些基本原理是读者应用后续各章概述的各种技术的关键。第1章总结了各种针对关节松动术与操作治疗术提出的机制。
第2章提供了与关节松动术和操作治疗术的应用相关的总体指导意见。这些指导意见主要包括以下各方面的细则：关节行为（关节运动学）评估、关节末端感觉评估、关节囊模式描述以及相对的非关节囊模式的描述。本章还涉及关节松动术的指标、变量以及应用时长。最后，本章为读者描述了各种注意事项、适应证与禁忌证。
完成本章的学习后，你将能够做到以下几点。
为了给患者提供适当的治疗，临床师们必须要理解关节松动术与操作治疗术的基本概念与原则。本章介绍了临床师所需要的基本信息，以便他们能够确定因关节囊结构受限而导致关节活动受限的患者并采用合适的治疗措施。因此，本章就充当了本书的导论，本书的主旨是展示并描述用于恢复关节的被动附属运动的各种松动术。
健康的关节可以在固有的活动度下进行运动。发生在滑膜关节表面的运动造成了一种刺激从而产生了滑液，这种滑液滋养了关节盘、半月板、软骨等关节结构。关节的正常运动让各种关节囊结构得以滑动起来，从而有助于维持其形态与结构。关节僵硬或关节的正常运动减少会导致各种负面生理效应的出现。这些负面生理效应包括脂肪浸润、关节粘连以及关节囊、韧带和肌腱等组织发生生理变化。
徒手治疗方法的起源可能早于现有历史记载。人类曾寻求过涉及牵引、关节松动术、关节操作治疗术，或是以上方法的结合等多种肌肉骨骼治疗方法。过去，物理治疗师将关节牵引和松动术纳入其常规临床实践的一部分。随着基础医学科学和有关肌肉骨骼系统知识的发展，这些病症的治疗方法也在不断发展。
在美国，关于支持使用（关节）松动术，特别是操作治疗术方面的立法正在发生转变。目前，相关立法是因州而异的，要求物理治疗师们要始终跟上其所在州对关节松动术和操作治疗术方面的指示，以确保其操作符合规定。在几个州，目前的立法正受到挑战。
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罗伯特·C. 曼斯克（Robert C. Manske），PT，DPT，MPT，MEd，SCS，ATC，CSCS，是在堪萨斯州威奇托市威奇托州立大学教授博士理疗课程的一名教授。1991年，他从威奇托州立大学毕业，获得体育学学士学位。1994年，他获得理疗学硕士学位。2000年，他又获得了体育教育学硕士学位。2006年，他获得了马萨诸塞州健康职业总局颁发的高级私人教练资格。
自2002年以来，曼斯克陆续成为美国理疗协会理事会认证的运动理疗师，美国国家体能协会认证的体能训练专家，以及运动员教练认证委员会认可的认证运动员教练。他担任过两届美国理疗协会运动理疗部的副主席。由于他对当地、州和国家作出的卓越教育贡献，他被授予了不计其数的奖项，其中包括2007年美国理疗协会运动理疗部颁发的杰出教育奖，以及2018年的荣·佩顿奖（RonPeyton Award）。
曼斯克出版和发表过多本（篇）与矫形和运动康复有关的书、文章和家庭学习课程，他还参与了9本涉及矫形和运动各方面内容的书的编辑工作。他是《国际运动理疗杂志》（International Journal of Sports Physical Therapy）的副编辑，是《矫形与运动理疗期刊》（Journal of Orthopedic and Sports Physical Therapy）《运动健康、体育训练与运动保健》（Sports Health, Athletic Training and Sports Health Care）《运动中的理疗》（Physical Therapy in Sports），以及《美国运动医学杂志》（American Journal of Sports Medicine, AJSM）的审稿专家。在2005～2007年和2011～2017年，他是《美国运动医学杂志》的主要评审员。
在美国理疗协会、美国国家运动员教练协会和美国国家体能协会的全国和州级大会上，曼斯克曾经多次发表演讲。他除了完成在校教学工作，还在维亚·克里斯提健康机构担任理疗师和运动员教练，堪萨斯大学医学中心康复科学系担任助教，并为维亚·克里斯提家庭实践运动医学住院医师实习计划提供助教服务。
B. J. 莱哈卡（B. J. Lehecka），DPT，是堪萨斯州威奇托市威奇托州立大学健康职业学院理疗系的一名助理教授。在威奇托州立大学，莱哈卡所教授的课程涉及髋部和脊柱的姿势、步态、本体感受神经肌肉功能、肌肉骨骼评估，以及对肌肉骨骼病变的治疗。2016年，鉴于他在教学上的杰出贡献，威奇托州立大学授予他罗登伯格杰出教学奖。
莱哈卡在期刊上发表过多篇经过同行评审的文章，参与了多本书与多篇文章的写作和编辑工作，还出席过各种州级、国家级和国际会议。2006年，他在堪萨斯州立大学获得人体运动学学士学位。2009年，他又在威奇托州立大学获得了理疗学博士学位。莱哈卡在自己所在的社区担任理疗师，他还是落基山运动职业大学的博士生。
迈克尔·P. 雷曼（Michael P. Reiman），PT，DPT，MEd，DCS，SCS，ATC，FAAOMPT，CSCS，是位于北卡罗来纳州达勒姆的杜克大学医学中心社区与家庭实践系的副教授。他同时也是杜克大学医学中心手动疗法研究生课程的临床教学组人员之一。雷曼发表了50多篇论文在经过同行评审的期刊上，还出版了10本书和3套家庭学习课程。他和罗伯特·C. 曼斯克合著了《人类（运动）表现功能测试》（Functional Testing in Human Performance）（人类运动出版社，2009年）一书。许多国家级、地区级会议都曾邀请他出席。
雷曼是下列组织的成员：美国理疗协会、美国矫形手动理疗师协会、堪萨斯州理疗协会、美国国家运动员教练协会、美国国家体能协会，以及阿尔法·埃塔协会。他是《理疗杂志》（Journal of Physical Therapy）的副编辑，还是《国际运动理疗杂志》（International Journal of Sports Physical Therapy）和《运动康复期刊》（Journal of Sport Rehabilitation）的编辑委员会成员。他还担任下列杂志（期刊）的评审工作：《英国运动医学杂志》（British Journal of Sports Medicine）《运动学与医学期刊》（Journal of Sports Science and Medicine）《物理治疗理论与实践》（Physiotherapy Theory and Practice）《运动康复期刊》（Journal of Sport Rehabilitation）《手动与推拿疗法期刊》（Journal of Manual and Manipulative Therapy）《矫形与运动理疗杂志》（Journal of Orthopaedic and Sports Physical Therapy）《临床解剖学》（Clinical Anatomy），以及《体育训练杂志》（Journal of Athletic Training）。
雷曼是一级田径教练和一级奥林匹克举重俱乐部教练。他还在堪萨斯州威奇托的弗兰兹大学女子排球队，以及威奇托的纽曼大学男女排球队担任体能训练专家。
雷曼居住在希尔斯伯勒（Hillsborough）。他享受与家人共度良辰，喜欢在附近的山上远足，与孩子们一起开展水上滑板运动。
珍妮丝·K. 劳登（Janice K. Loudon），PT，PhD，SCS，ATC，CSCS。她在临床运动医学方面有超过30年的经验，并担任了20多年的理疗导师。劳登博士之前曾经是杜克大学和堪萨斯城堪萨斯大学医学中心的副教授。
劳登博士是得到委员会认证的运动理疗师、经过认证的运动员教练，还是得到认证的体能训练专家。她是美国国家运动员教练协会和美国理疗协会的成员。她还担任美国理疗协会运动理疗部家庭学习课程的副主编一职。
劳登在经过同行评审的期刊上发表过多篇论文，在多本书中撰写过内容，还是《临床机制与人体运动学》（Clinical Mechanics and Kinesiology）（人类运动出版社，2013年）和两个版本《临床矫形评估指导》（The Clinical Orthopedic Assessment Guide）（人类运动出版社，1998年与2008年）的作者之一。她经常出席各种相关的国家级、州级和地区级会议。
劳登住在堪萨斯州的奥弗兰帕克。在业余时间，她喜欢远足、骑车、干园艺活儿，以及为堪萨斯捷鹰（篮球）队助威。
王悦，北京体育大学运动康复系学士，清华大学教育学硕士，美国南加州大学运动机能学硕士与物理治疗博士；获得2020年度美国南加州大学Joanne Gronley物理治疗系研究奖；被授予美国南加州大学2021年物理治疗系金手杖勋章；获得2021年美国杰出物理治疗博士生荣誉奖。
韩照岐，主任医师，中国游泳协会科研委员会委员，中国健康促进基金会骨病专项基金运动损伤康复工作委员会委员，中国营养学会注册营养师，浙江省“十三五”重大科技研发攻关和成果转化应用咨询专家；2005年被评为“全国体育科学先进工作者”，2012年获浙江省体育局“伦敦奥运会突出贡献”奖，分别于2013年、2016年、2017年荣立浙江省人民政府个人二等功3次；从事运动医学工作36年余，积累了丰富的临床和实践经验，在游泳专项训练伤病防治和科研攻关方面尤为突出，深受运动员及教练员的好评与信任；任职以来主持国家级科研项目1项，作为主要成员参与国家级科研项目3项，主持省部级课题5项；公开发表学术论文10余篇；正式出版本专业学术专著1部、编著2部，译著2部。
