icon fsr

文献詳細

雑誌文献

理学療法ジャーナル52巻4号

2018年04月発行

文献概要

特集 変形性膝関節症に対する最新の保存療法

変形性膝関節症の保存療法における筋力

著者: 德田一貫1 阿南雅也2 高橋真34 新小田幸一34

所属機関: 1社会医療法人敬和会大分岡病院 2大分大学福祉健康科学部理学療法コース 3広島大学大学院医歯薬保健学研究科生体運動・動作解析学 4広島大学大学院医歯薬保健学研究科附属先駆的リハビリテーション実践支援センター

ページ範囲:P.309 - P.316

文献購入ページに移動
はじめに

 変形性膝関節症(knee osteoarthritis:以下,膝OA)患者の病態と筋力の関連性については,現在まで数多くの報告がある.膝OAの理学療法において,大腿四頭筋の筋力トレーニングとして,大腿四頭筋セッティングやstraight leg raising(SLR)練習などが求められる機会は少なくない.また,近年では膝OAの膝関節内反変形が前額面における変形の特徴であることから,大腿四頭筋の筋力に加えて,前額面の運動に関与する股関節外転筋群の筋力に着目した報告も散見する.

 しかしながら,膝OA患者の大腿四頭筋や股関節外転筋群の筋力と臨床症状やメカニカルストレスとの関連や,筋力トレーニングによって得られる効果について明確にした報告はほとんどない.そこで,本稿では膝OA患者の筋力トレーニングとメカニカルストレス,疼痛や身体機能の改善にかかわる報告について紹介し,保存療法における筋力トレーニングの意義と限界について述べる.

参考文献

1)Palmieri-Smith RM, et al:Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil 89:541-548, 2010
2)Bennell KL, et al:Update on the role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am 39:145-176, 2013
3)Slemenda C, et al:Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 127:97-104, 1997
4)Messier SP, et al:Osteoarthritis of the knee:Effects on gait, strength, and flexibility. Arch Phys Med Rehabil 73:29-36, 1992
5)Liikavainio T, et al:Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Arch Phys Med Rehabil 89:2185-2194, 2008
6)Jan MH, et al:Isokinetic study of muscle strength in osteoarthritic knees of females. J Formos Med Assoc 89:873-879, 1990
7)Thomas AC, et al:Lack of quadriceps dysfunction in women with early knee osteoarthritis. J Orthop Res 28:595-599, 2010
8)Costa RA, et al:Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee. Clinics 65:1253-1259, 2010
9)Hinman RS, et al:Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res 62:1190-1193, 2010
10)Zhang W, et al:OARSI recommendations for the management of hip and knee osteoarthritis, part I:critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 15:981-1000, 2007
11)Zhang W, et al:OARSI recommendations for the management of hip and knee osteoarthritis, Part II:OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16:137-162, 2008
12)Zhang W, et al:OARSI recommendations for the management of hip and knee osteoarthritis:part III:Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 18:476-499, 2010
13)American Academy of Orthopaedic Surgeons:Guideline on the Treatment of Osteoarthritis(OA)of the Knee, 2nd ed. http://www.aaos.org/Research/guidelines/GuidelineOAKnee.asp(2017年11月8日閲覧)
14)日本理学療法士協会:変形性膝関節症 理学療法診療ガイドライン.http://www.japanpt.or.jp/upload/jspt/obj/files/guideline/11_gonarthrosis.pdf(2017年11月8日閲覧)
15)Schipplein OD, et al:Interaction between active and passive knee stabilizers during level walking. J Orthop Res 9:113-119, 1991
16)Andriacchi TP, et al:The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol 18:514-518, 2006
17)Andriacchi TP, et al:Methods for evaluating the progression of osteoarthritis. J Rehabil Res Dev 37:163-170, 2000
18)Hunt MA, et al:Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis. J Biomech 39:2213-2220, 2006
19)徳田一貫,他:歩行のバイオメカニカルな解析に基づく変形性膝関節症患者の理学療法アプローチ.福井勉,他(編):バイオメカニクスと動作分析.pp61-67,ヒューマンプレス,2016
20)Miyazaki T, et al:Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61:617-622, 2002
21)Perry J, et al:Gait Analysis:Normal and pathological function, 2nd ed. pp85-102, Slack, Thorofare, 2010
22)阿南雅也,他:膝関節内転モーメントに着目した変形性膝関節症の運動療法—筋力トレーニングを中心に.理学療法32:1097-1108,2015
23)Segal NA, et al:Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort. Arthritis Care Res 61:1210-1217, 2009
24)Øiestad BE, et al:Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis Cartilage 23:171-177, 2015
25)Takagi S, et al:Quadriceps muscle weakness is related to increased risk of radiographic knee OA but not its progression in both women and men:the Matsudai Knee Osteoarthritis Survey. Knee Surg Sports Traumatol Arthrosc, 2017. doi:10.1007/s00167-017-4551-5 [Epub ahead of print]
26)Lim BW, et al:The association of quadriceps strength with the knee adduction moment in medial knee osteoarthritis. Arthritis Rheum 61:451-458, 2009
27)Lim BW, et al:Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum 59:943-951, 2009
28)Foroughi N, et al:Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis:A randomized controlled trial. Clin Biomech 26:167-174, 2011
29)Lewinson RT, et al:The relationship between maximal hip abductor strength and resultant loading at the knee during walking. Proc Inst Mech Eng H 228:1258-1263, 2014
30)Rutherford DJ, et al:Hip abductor function in individuals with medial knee osteoarthritis Implications for medial compartment loading during gait. Clin Biomech 29:545-550, 2014
31)Kean CO, et al:Relationship between hip abductor strength and external hip and knee adduction moments in medial knee osteoarthritis. Clin Biomech 30:226-230, 2015
32)Bennell KL, et al:Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment:a randomised controlled trial. Osteoarthritis Cartilage 18:621-628, 2010
33)Sled EA, et al:Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis:a clinical trial. Phys Ther 90:895-904, 2010
34)Pohl MB, et al:Experimentally reduced hip-abductor muscle strength and frontal-plane biomechanics during walking. J Athl Train 50:385-391, 2015
35)Takacs J, et al:The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing. J Biomech 45:2791-2796, 2012
36)Mundermann A, et al:Implications of increased medio-lateral trunk sway for ambulatory mechanics. J Biomech 41:165-170, 2008
37)Simic M, et al:Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis:the effect of varying trunk lean angles. Arthritis Care Res 64:1545-1553, 2012
38)Clark RA, et al:Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining. Gait posture 38:1064-1066, 2013
39)大森 豪:変形性膝関節症.臨床リハ24:344-351,2015
40)山田英司:膝関節内転モーメントに着目した変形性膝関節症の理学療法評価.理学療法32:1068-1076,2015
41)Muraki S, et al:Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain:the ROAD study. BMC Muscuoskelet Disord 16:305, 2015. doi:10.1186/s12891-015-0737-5
42)Kemnitz J, et al:Longitudinal change in thigh muscle strength prior to and concurrent with symptomatic and radiographic knee osteoarthritis progression:data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 25:1633-1640, 2017
43)Iles JF, et al:Reflex actions of knee joint afferents during contraction of the human quadriceps. Clin Physiol 10:489-500, 1990
44)Fitzgerald GK, et al:Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum 51:40-48, 2004
45)Ruhdorfer A, et al:Longitudinal change in thigh muscle strength prior to and concurrent with minimum clinically important worsening or improvement in knee function:data from the osteoarthritis initiative. Arthritis Rheumatol 68:826-836, 2016
46)Foroughi N, et al:Progressive resistance training and dynamic alignment in osteoarthritis:A single-blind randomised controlled trial. Clin Biomech 26:71-77, 2011
47)Park SK, et al:Relationship between lower limb muscle strength, self-reported pain and function, and frontal plane gait kinematic in knee osteoarthritis. Clin Biomech 38:68-74, 2016

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1359

印刷版ISSN:0915-0552

雑誌購入ページに移動
icon up
あなたは医療従事者ですか?