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出張報告2012横浜リアライン
1.
変形性膝関節症に対する理学療法 ~リアラインコンセプトに基づく治療により確実 に即時効果を得て正常歩行を獲得する方法~ 日時:平成24年7月16日(月) 会場:ウィリング横浜 研修室(神奈川県) 講師:蒲田 和芳 先生 (広島国際大学 准教授 株式会社 GLAB 代表取締 役) 主催:療法士
.COM
2.
コンセプト誕生の背景 □ACL 再建術後の不良成績 –下腿外旋位 –伸展制限 –腫張 –大腿四頭筋機能低下 ↓ □OA 膝と同様のアライメントパター ン
3.
下腿外旋位 ① 正常なスクリュー ホームムーブメン トの消失 ② 脛骨の外方偏位 ③
脛骨粗面の外旋
4.
下腿外旋 脛骨外方偏位により大腿骨外側顆が脛骨隆起 外側部に乗り上げることにより、膝内反モー メントが発生する可能性がある
5.
マルアライメントを放置すると 1. マルアライメント(異常なアライメン ト)が進行 2. 関節周囲の軟部組織や筋が緊張 3.
関節周囲の軟部組織に炎症・損傷 4. 関節軟骨変性・半月板損傷 5. 変形性関節症
6.
リハビリテーションと マルアライ
メント 1. 軟部組織の過緊張が持続 2. 異常運動が持続 3. 疼痛・機能異常が持続 マルアライメントの早期の矯正が必要!
7.
マルアライメント症候群の疾患概
念
8.
一般的なリハビリテーションの進
行 理想 現実
9.
リアラインコンセプトの進行
10.
11.
リアラインコンセプト
12.
13.
エクササイズ
下腿内旋の自動運動および抵抗運動ができ、 また内旋位でのレッグプレスを行うことで、 上記に示した異常回旋運動を改善する効果がある。 研究成果では LP 運動前後で 膝屈曲可動域拡大 伸展可動域低下 -angle 低下 立位大腿骨内側顆間距離減少 10段階ペインスケールの減少 が有意( P<0.001 )にみられた。
14.
HTO への LP
の効果 HTO 術後患者に用いた短期成績例では、 術後1ヵ月後の独歩獲得 コントロール群( CL 群) 21人中4 人独 歩獲得 レッグプレス導入群( LP 群)21人中13人独歩 獲得 ( P<0.005 ) WOMAC の痛みでは LP 群平均189点改善 CL 群平均64点改善 WOMAC 活動では LP 群平均627点改善 CL 群平均218点改善 良好項目において LP 群の改善値が高く、治療効果 が認められた。
15.
まとめ リアラインコンセプトにも基づく運動療法 は膝 OA の治療に変化をもたらし、学術的 にも有用な治療方法である。 当院リハビリでも膝
OA 、 ACL 患者など に採用し治療効果を高めていきたいと思い ます。 この度は講習会に参加させていただきあり
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