理学療法ジャーナル52巻3号

2018年03月発行

特集 理学療法における動作のアセスメント

痛みと動作アセスメント

著者： 大住倫弘¹²

所属機関： ¹畿央大学ニューロリハビリテーション研究センター ²畿央大学大学院健康科学研究科

ページ範囲：P.225 - P.233

はじめに

　痛みは直接的に運動を阻害する要因になるため，動作パフォーマンスを低下させてしまう．そのため，臨床現場で腰を曲げられない症例を観察した際に「単なる腰部の筋の短縮だけでなく，腰に痛みが出現するのが恐くて曲げられないだけでは？」という迷いが生じてしまう．

　加えて，長期的な痛みシグナルは中枢神経システムでの体性感覚処理プロセスを歪めるため，痛みや恐怖心とは異なるメカニズムで協調運動障害が生じる．本稿では，疼痛患者が有する“痛み”“恐怖心”“体性感覚システム障害”が動作をどのように阻害するのかについて概説し，上記のような動作アセスメントの迷いが少しでも解消されることを目的としている．

参考文献

1）Laird RA, et al：Comparing lumbo-pelvic kinematics in people with and without back pain：a systematic review and meta-analysis. BMC Musculoskelet Disord 15：229, 2014. doi：10.1186/1471-2474-15-229

2）Schilder JC, et al：Motor control in complex regional pain syndrome：a kinematic analysis. Pain 153：805-812, 2012

3）Osumi M, et al：Optimal control of reaching is disturbed in complex regional pain syndrome：a single-case study. J Pain Res 10：167-173, 2017

4）Deschamps T, et al：Influence of experimental pain on the perception of action capabilities and performance of a maximal single-leg hop. J Pain 15：e1-7, 2014. doi：10.1016/j.japan.2013.10.016

5）Hatton AL, et al：The effects of acute experimental hip muscle pain on dynamic single-limb balance performance in healthy middle-aged adults. Gait Posture 50：201-206, 2016

6）Schilder JC, et al：Pain relief is associated with improvement in motor function in complex regional pain syndrome type 1：secondary analysis of a placebo-controlled study on the effects of ketamine. J Pain 14：1514-1521, 2013

7）Thomas JS, et al：Pain-related fear is associated with avoidance of spinal motion during recovery from low back pain. Spine（Phila Pa 1976） 32：E460-466, 2007

8）Thomas JS, et al：Effects of fear of movement on spine velocity and acceleration after recovery from low back pain. Spine（Phila Pa 1976） 33：564-570, 2008

9）Sarig Bahat H, et al：Do neck kinematics correlate with pain intensity, neck disability or with fear of motion? Man Ther 19：252-258, 2014

10）de Jong JR, et al：Pain-related fear, perceived harmfulness of activities, and functional limitations in complex regional pain syndrome type I. J Pain 12：1209-1218, 2011

11）van Dieën JH, et al：Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol 13：333-351, 2003

12）Hodges PW：Pain and motor control：From the laboratory to rehabilitation. J Electromyogr Kinesiol 21：220-228, 2011

13）van Dieën JH, et al：Low-back pain patients learn to adapt motor behavior with adverse secondary consequences. Exerc Sport Sci Rev 45：223-229, 2017

14）Arendt-Nielsen L, et al：Muscle pain：sensory implications and interaction with motor control. Clin J Pain 24：291-298, 2008

15）Karayannis NV, et al：Fear of movement is related to trunk stiffness in low back pain. PLoS One 8：e67779, 2013. doi：10.1371/journal.pone.0067779.Print2013

16）Massé-Alarie H, et al：Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending. J Electromyogr Kinesiol 27：87-94, 2016

17）Leeuw M, et al：Measuring perceived harmfulness of physical activities in patients with chronic low back pain：the Photograph Series of Daily Activities--short electronic version. J Pain 8：840-849, 2007

18）Willigenburg NW, et al：Precision control of trunk movement in low back pain patients. Hum Mov Sci 32：228-239, 2013

19）Ebrahimi S, et al：Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain. Hum Mov Sci 52：55-66, 2017

20）Bauer CM, et al：Pain intensity attenuates movement control of the lumbar spine in low back pain. J Electromyogr Kinesiol 25：919-927, 2015

21）da Silva RA, et al：People with chronic low back pain have poorer balance than controls in challenging tasks. Disabil Rehabil 10：1-7, 2017. doi：10.1080/09638288.2017.1294627

22）Osumi M, et al：Kinematic evaluation for impairment of skilled hand function in chemotherapy-induced peripheral neuropathy. J Hand Ther, 2017. doi：10.1016/j.jht.2017.06.003.［Epub ahead of print］

23）Luomajoki H, et al：Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med 45：437-440, 2011

24）Silfies SP, et al：The effects of visual input on postural control of the lumbar spine in unstable sitting. Hum Mov Sci 22：237-252, 2003

25）Sung W, et al：Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement. Spine J 15：1772-1782, 2015

26）Maihöfner C, et al：The motor system shows adaptive changes in complex regional pain syndrome. Brain 130：2671-2687, 2007

27）Singh A, et al：A summary of assessment tools for patients suffering from cervical spondylotic myelopathy：a systematic review on validity, reliability and responsiveness. Eur Spine J 24：209-228, 2015

28）Reid EJ, et al：Spatially-defined motor deficits in people with unilateral complex regional pain syndrome. Cortex, 2017. doi：10.1016/j.contex.2017.06.024.［Epub ahead of print］