著者

野崎 結 安井 重男 池田 幸司 藤本 将志 赤松 圭介 大沼 俊博 渡邊 裕文

出版者

関西理学療法学会

雑誌

関西理学療法 (ISSN:13469606)

巻号頁・発行日

vol.10, pp.85-92, 2010 (Released:2011-01-13)

参考文献数

6

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We conducted physical therapy for a patient who experienced pain in the right gluteal and lateral femoral regions during walking following right hip replacement. Pain appeared due to flexion, adduction, and internal rotation of the right hip joint accompanied by exaggerated anterior inclination and right rotation of the pelvis on right heel contact through to right mid-stance. Physical therapy was conducted for the limited range of right hip joint motion and muscle weakness around this joint, which was assumed to be the cause of the abnormal gait and pain. Following this, standing step practice (Physical Therapy A) was conduced. After 6 weeks of Physical Therapy A, the limited range of right hip joint motion and muscle weakness around the joint had improved; however, the gait and pain had not improved. Thus, the therapy was re-evaluated, and bridge exercise was added to Physical Therapy A (Physical Therapy B). Physical Therapy B enabled induction of muscle activity and contractile patterns similar to those occurring during walking with respect to the muscle activity around the right hip joint that is necessary for right heel contact through to right mid-stance. A single session of Physical Therapy B improved the gait and reduced pain. Therefore, we concluded that the promotion of complex muscle activity, not in a single direction, and improvement of the muscle strength and contractile pattern are necessary in physical therapy for problematic muscle weakness.

著者

池田 幸司 藤本 将志 安井 重男 渡邊 裕文 大沼 俊博 赤松 圭介 鈴木 俊明

出版者

関西理学療法学会

雑誌

関西理学療法 (ISSN:13469606)

巻号頁・発行日

vol.9, pp.83-88, 2009 (Released:2010-01-16)

参考文献数

3

被引用文献数

4

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In the clinical field, we have provided physical therapy for cases presenting with Trendelenburg sign on walking caused by reduced muscle strength of the abductor muscle group of the hip joint on the weighted side. The Trendelenburg sign can occur in the early stage or after the middle stage of the stance phase, showing various patterns. In this study, we focused on the relationship between Trendelenburg sign occurring in the early stage or after the middle stage of the stance phase and the abductor muscle group of the hip joint on the weighted side. The subjects were asked to flex their hip joint and bend the body forward with 95% of the body weight loaded on one side of the body in an upright position, and remain in this position with the angle from the initial position at 5, 10, 15, 20, and 25 degrees. We evaluated the influence of changes in the angle of the hip joint on integration values of electromyograms of the abductor muscle group of the hip joint (the tensor fascia lata muscle, gluteus medius muscle, and superior part of the gluteus maximus muscle) on the weighted side, using surface electromyograms. As a result, the relative integration value of the electromyograms of the tensor fasciae lata muscle and gluteus medius muscle on the weighted side significantly decreased as the angle of the hip joint increased. On the other hand, the relative integration value of electromyograms of superior part of the gluteus maximus muscle on the weighted side significantly elevated as the angle of the hip joint increased. The hip joint on the weighted side underwent flexion, and was subjected to an abduction force, as the angle of hip joint changed when one of the lower extremities was loaded. It was considered that superior part of the gluteus maximus muscle, which also belongs to the extensor muscle group of the hip joint, was primarily involved as a braking force. The results of this study suggest that the evaluation and treatment of superior part of the gluteus maximus muscle is important in controlling the dropping of the pelvis toward the non-weighted side (adduction of the hip joint of the standing leg) and its anterior inclination (flexion of the hip joint of the standing leg) in cases presenting with Trendelenburg sign.

著者

安井 重男 藤本 将志 渡邊 裕文 大沼 俊博 赤松 圭介 中道 哲朗 鈴木 俊明

出版者

関西理学療法学会

雑誌

関西理学療法 (ISSN:13469606)

巻号頁・発行日

vol.8, pp.69-73, 2008 (Released:2009-01-15)

参考文献数

5

被引用文献数

3

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We have experimented with physical therapy for patients with difficulty of body weight transfer due to hyperactivity of the latissimus dorsi and muscular contractions. For lateral body weight transfer, training changed the distance of lateral transfer in the sitting position. Recent electromyographic (EMG) studies on the latissimus dorsi reported activities in its upper and lower fibers in the scapular brachial joint during trunk exercise. However, the activities of this muscle on lateral transfer in the sitting position have not been analyzed. In this study, we examined the influence of changes in the distance of lateral transfer in the sitting position using the EMG of the upper and lower fibers of the latissimus dorsi. Initially, in the end-sitting position (starting limb position), in which the bilateral arms were folded, we measured integrated EMG (iEMG) for the upper and lower fibers of the bilateral latissimus dorsi. Subsequently, the shoulder girdle was transferred in the lateral direction at distances of 5, 10, 15, and 20 cm without inclining or rotating the line between the bilateral acromions, while maintaining the head in the vertical position, with both feet placed on the ground from the starting limb position. We determined the respective iEMGs. There were no significant lateral transfer distance-related changes in the relative iEMG for the upper and lower fibers of the mobile side latissimus dorsi. Furthermore, the value for the upper fibers of the non-mobile side increased with the distance of lateral transfer. In addition, the value for the lower fibers of the non-mobile side also elevated with the lateral transfer distance; at a distance of 20 cm, the value was significantly higher than those at distances of 5 and 10 cm. Based on the results of this study, it may be important to evaluate the abdominal oblique muscles, dorsolumbar muscles, and latissimus dorsi in performing lateral body weight transfer. Training chang the distance of lateral transfer in the sitting position of patients with difficulty of lateral transfer . In addition, the actions of the upper fibers of the latissimus dorsi differed from those of the lower fibers, suggesting the necessity of assessing these fibers individually.