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慢性非特異的腰痛症例に対する腹部引き込み運動が体幹筋筋活動に与える影響

大須賀, 聡 北海道大学

2020.03.25

概要

1.緒言
慢性非特異的腰痛(Non-specific low back pain: NS-CLBP)症例は外乱動揺課題において,体幹筋群の反応が遅延し,この体幹筋群の機能障害は非特異的腰痛症の慢性化に寄与すると報告されている.NS-CLBP症例に対して推奨される保存療法の一つに運動療法が挙げられており,中でも腹部引き込み運動(Abdominal draw-in maneuver: ADIM)は体幹深層筋の機能障害を改善することが,多くの先行研究において報告されている.しかしながら,NSCLBPの症状の改善,慢性化予防には深層筋のみならず表層筋群を含めた体幹筋群の機能改善が重要である.NS-CLBP症例を対象にADIMが体幹表層筋群を含めた体幹筋群の活動性に与える影響を検討した先行研究は少なく,外乱動揺課題に対する体幹筋群の活動性を検討した先行研究はない.また,ADIMによる介入が体幹深層筋の活動性に変化を生じさせたか検討することは,ADIMの効果発現機序を解明する上で必須と考えられる.本研究の目的は1)外乱動揺課題における体幹筋群の活動性へのADIMによる介入効果を検討すること,2)上肢挙上課題における体幹深層筋の活動性へのADIMによる介入効果を検討することである.

2.方法
対象はNS-CLBP症例17例とし,ADIMによる介入を4週間実施した.介入前後にて被験者は下肢と骨盤を固定したSemi-seated positionをとり,体幹屈曲方向および体幹伸展方向への外乱動揺課題と上肢挙上課題を実施した.筋活動の測定には表面筋電計を使用し,外乱動揺課題においては右側の内腹斜筋/腹横筋,外腹斜筋,腹直筋,腰部脊柱起立筋,胸部脊柱起立筋,広背筋の6筋を被検筋とした.上肢挙上課題においては左右の内腹斜筋/腹横筋,右側三角筋前部線維の3筋を被検筋とした.外乱動揺課題においては活動開始時点(onset),活動停止時点(offset),体幹屈曲筋群と体幹伸展筋群が同時に活動していた時間であるco-contraction timeを算出した.また,上肢挙上課題においては内腹斜筋/腹横筋のonset,筋活動量を算出した.統計解析においては検討項目の正規性を確認した後に,介入前後での比較を行った.

3.結果
ADIMによる介入後,体幹伸展方向への外乱動揺課題では体幹屈曲筋群のonsetが,体幹屈曲方向への外乱動揺課題では体幹屈曲筋群のoffsetが,介入後,有意に早期に生じた.また,外乱動揺課題におけるco-contraction timeはADIMによる介入後,有意に低値を示した.上肢挙上課題においては,左側の内腹斜筋/腹横筋のonsetが介入前と比較して有意に早期に生じた.また,右側の内腹斜筋/腹横筋の筋活動量に有意な増加が認められた.

4.考察および結論
本研究はADIMによる介入が,NS-CLBP症例の外乱動揺に対する体幹筋群の筋活動に変化を生じさせることを初めて明らかにした.ADIMの介入後,外乱動揺に対する体幹屈曲筋群の筋活動が介入前と比較して早期に生じたが,体幹伸展筋群の活動性に変化は認められなかった.また,上肢挙上課題では,内腹斜筋/腹横筋の活動性に変化が認められた.したがって,本研究に認められた腹部の体幹表層筋群に認められた変化は,ADIMの介入を通して体幹深層筋の活動性が賦活されたたため生じた変化である可能性がある.

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