基于肌筋膜链和经筋角度探讨针刀治疗菱形肌损伤思路

Exploring the Acupotomy Treatment Thoughts for Rhomboid Muscle Injury from the Perspective of Myofascial Chains and Meridian Sinews

摘要: 菱形肌损伤是临床常见的肩背部软组织疾患，多见于长期伏案人群，发病率呈逐年上升及年轻化趋势，但现有疗法多偏重局部对症或整体康复，尚缺乏精准高效的微创干预手段。文章基于肌筋膜链理论与中医经筋学说，从整体观与力学传导的视角，重新审视菱形肌损伤的发病机制与针刀治疗思路。肌筋膜链理论认为，本病是臂前深线与臂后深线力学失衡及螺旋线张力传导异常的结果，常与胸小肌短缩、前锯肌及头颈夹肌紧张等远隔环节的功能失调相关；中医经筋学说则以“筋结”、“横络”为核心病机，强调“不通则痛”、“不荣则痛”，以“解结通络”为治疗要旨。二者在解剖循行、病理产物及传变规律上存在功能和解剖上的平行关系，可相互借鉴与补充，整合应用可为针刀提供系统的理论指导与精准的靶点选择，即在松解C6~T4棘突旁起止点及肩胛间区肌腹局部筋结的同时，兼顾胸小肌喙突附着区、头颈夹肌及前锯肌等远程靶点，从源头阻断异常张力传导，恢复肩胛带前后力学平衡，以期为针刀治疗菱形肌损伤提供“局部–整体”兼顾的新思路。

Abstract: Rhomboid muscle injury is a common clinical soft tissue disorder of the shoulder and back, predominantly seen in people with long-term desk-bound work. Its incidence rises year by year, with a trend of affecting younger populations. Existing therapies mostly focus on local symptomatic relief or holistic rehabilitation, and there remains a lack of precise, efficient, and minimally invasive interventions. Based on the myofascial chain theory and the traditional Chinese medicine (TCM) doctrine of meridian sinews, this paper re-examines the pathogenesis of rhomboid muscle injury and the therapeutic strategies of acupotomy from the perspectives of holistic concept and biomechanical conduction. According to the myofascial chain theory, this disease results from the biomechanical imbalance of the Deep Front Arm Line and Deep Back Arm Line, as well as abnormal tension conduction along the Spiral Line. It is often associated with dysfunction of distant segments, including shortening of the pectoralis minor and hypertonicity of the serratus anterior, splenius capitis, and splenius cervicis. The TCM doctrine of meridian sinews regards “sinew nodules” and “transverse collaterals” as the core pathological changes, emphasizes that “obstruction leads to pain” and “deficient nourishment leads to pain”, and takes “resolving nodules and dredging collaterals” as the fundamental therapeutic principle. The two theories exhibit anatomical and functional parallels that can inform each other in clinical practice. Their integrated application can provide systematic theoretical guidance and precise target selection for acupotomy. Specifically, while releasing the origin and insertion points adjacent to the C6~T4 spinous processes and local sinew nodules in the muscle belly of the interscapular region, distant targets such as the coracoid process attachment of the pectoralis minor, splenius muscles, and serratus anterior should also be addressed. This approach can block abnormal tension conduction from the source and restore the anterior-posterior biomechanical balance of the shoulder girdle, so as to provide a new “local-holistic” integrated strategy for the acupotomy treatment of rhomboid muscle injury.