理学療法ジャーナル58巻3号

2024年03月発行

特集 骨盤底機能障害と運動器障害の連関

骨盤底機能と腰椎・骨盤帯疼痛

著者： 城内若菜¹

所属機関： ¹成尾整形外科病院

ページ範囲：P.285 - P.292

Point

●腰痛，骨盤帯疼痛は慢性化することで疼痛の原因が複雑化するため，識別は重要である

●骨盤底筋は腹横筋や多裂筋とともに働くことで腹圧を上昇させ，腰椎の安定化に関与している

●骨盤底筋は共同収縮により仙腸関節を安定させており，機能不全により仙腸関節痛の要因となり得る

参考文献

1）Hoy D, et al：The global burden of low back pain：estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014；73：968-974

2）Koes BW, et al：Diagnosis and treatment of low back pain. BMJ 2006；332：1430-1434

3）Verhagen AP, et al：Red flags presented in current low back pain guidelines：a review. Eur Spine J 2016；25：2788-2802

4）Vleeming A, et al：European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008；17：794-819

5）Ugur Tosun B, et al：Cause of non-specific low back in women：pelvic floor muscle weakness. Int Urogynecol J 2023；34：2317-2323

6）Arab AM, et al：Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Man Ther 2010；15：235-239

7）Fitzgerald CM, et al：The association between pelvic girdle pain and pelvic floor muscle function in pregnancy. Int Urogynecol J 2012；23：893-898

8）Stuge B, et al：Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Man Ther 2006；11：287-296

9）Bergmark A：Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 1989；230：1-54

10）Hodges PW：Core stability exercise in chronic low back pain. Orthop Clin North Am 2003；34：245-254

11）Barker PJ, et al：Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension：young investigator award winner. Spine（Phila Pa 1976） 2006；31：397-405

12）Lee D：胸郭の解剖．Lee D（原著），石井美和子（監訳）：胸郭—統合アプローチ．医歯薬出版，pp1-35，2020

13）Hodges PW：Is there a role for transversus abdominis in lumbo-pelvic stability? Man Ther 1999；4：74-86

14）Hodges P, et al：Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm：in vivo porcine studies. Spine（Phila Pa 1976） 2003；28：2594-2601

15）Bartelink DL：The role of abdominal pressure in relieving the pressure on the lumbar intervertebral discs. J Bone Joint Surg Br 1957；39-B：718-725

16）Hodges PW, et al：Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture 2000；11：92-101

17）Moseley GL, et al：Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine（Phila Pa 1976） 2002；27：E29-E36. doi：10.1097/00007632-200201150-00013

18）Hodges PW, et al：Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn 2007；26：362-371

19）Vleeming A, et al：The sacroiliac joint：an overview of its anatomy, function and potential clinical implications. J Anat 2012；221：537-567

20）Pool-Goudzwaard AL, et al：Insufficient lumbopelvic stability：a clinical, anatomical and biomechanical approach to ‘a-specific’ low back pain. Man Ther 1998；3：12-20

21）Dontigny RL：Sacroiliac 101：form and function：a biomechanical study. J Prolother 2011；3：561-567

22）Pool-Goudzwaard A, et al：Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clin Biomech（Bristol, Avon） 2004；19：564-571

23）Lee D：胸郭の解剖．Lee D（原著），石井美和子（監訳）：胸郭—統合アプローチ．医歯薬出版，pp59-145，2020

24）Laslett M：Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther 2008；16：142-152

25）村上栄一：仙腸関節由来の疼痛．日腰痛会誌2007；13：40-47

26）Beales DJ, et al：Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects, Spine（Phila Pa 1976） 2009；34：861-870

27）Lee D：腰椎骨盤股関節複合体の評価，そのテクニックと手法．Lee D（原著），石井美和子（監訳）：骨盤帯—臨床の専門的技術とリサーチの統合，第4版．pp169-248，医歯薬出版，2013

28）Lee DH, et al：Is abdominal hollowing exercise using real-time ultrasound imaging feedback helpful for selective strengthening of the transversus abdominis muscle? A prospective, randomized, parallel-group, comparative study. Medicine（Baltimore） 2018；97：e11369. doi：10.1097/MD.0000000000011369

29）Lin S, et al：Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects：a preliminary study. BMC Musculoskelet Disord 2021；22：142. doi：10.1186/s12891-021-04006-0

30）Vesentini G, et al：Pelvic floor muscle training for women with lumbopelvic pain：a systematic review and meta-analysis. Eur J Pain 2020；24：1865-1879

31）Bernard S, et al：Is adding pelvic floor muscle training to an exercise intervention more effective at improving pain in patients with non-specific low back pain? A systematic review of randomized controlled trials. Physiotherapy 2021；110：15-25

32）Abdel-Aziem AA, et al：The effects of stabilization exercise combined with pelvic floor exercise in women with nonspecific low back pain：a randomized clinical study. J Chiropr Med 2021；20：229-238