FAISの保存療法
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年々増え続ける股関節の手術。私の担当させていただいた方も股関節の痛みを抱えている方､手術を考えている方が､肌感ですが結構多いのです。
今回のタフツ大学のAlexis Wright 先生は、「保存療法は手術と同レベルの効果がある」と言います。手術の前にまだやれることがある。そんな一筋の光をみた気がした講義でした。
ノートテキスト
ページ1:
Early promising Pain is sports The most Common treatment. Chl Surgery vs. Conservative Treat. Hip arthroscopy to reshape impingement lesions. 25x 2006 2013 However, the shape - pain relationship" = unsure Surgery results -Pain \- ^^ self-reported function. I hip α-angle. - No change in ROM B 760° = Cam-type -V satisfied (eventhough function ) Conservative care = Surgery, "1 In terms of pain function; QOL, There is no significant difference. "Can we predict who will respond to what treatment? No. (so for)
ページ2:
Too broad too global. Ch2 Current Evidence Regarding Conservative Treat. for FAIS Supporting te PT as the first line of FAIS treatment However, lack of detailed treatment protcols.... " "Zurich Consensus Statement" -Exercise: • Individualized/focused on the impairment. Including hip, trunk, and functional strengthening. • Gentle ROM . Retraining of movement pattern. The type and dose : . Unknown. Duration: >3m.o. •Poor postoperative rehab. needed more goal-oriented Specific, functional, focus. • Single-plane & NWB es sagittal plane Emore more triplanar single leg WB. exs are needed. 50% る Prevent flex. + IR × prevent knee valgus of all exs Prescribed.
ページ3:
relationship b/w the hip, knee, ankle, trunk... Ch3. Better Exercise Prescription • Sports require: -quick acceleration/deceleration kicking - Cutting twisting those are S pathomechanics. · change of direction (COD) • Axial & rotational loads. = ~ 12x Body Wt. • Biomechanical segmental coordination if loose it, intrinsic to an athlete's ability to control COD, produce power to execute that movement. • Load absorption eg) glut & iliopsoas activation & during hip ext. ant. hip force eg). lumbo pelvic control during ant pelvic tilt acetabular impingement... - load across the pubic symphysis. Tissue Linjury exceed the tolerance g) over stretching leg abduction D Inability to absorb load. (2 ECC control)
ページ4:
eg) √ During SL loading, I hip add, IR, & contralateral pelvic drop pelvifemoral rhythm In SL position, Pelvis moves over the femur." Exercises should (Top ·bottom.) replicate this. = FADIR in Ckc eg) Pelvic pronation • - Contralateral pelvic drop. + ant. pelvic tilt. + forward pelvic rotation (hip IR) In ability to ECC Control dynamic knee valgus. abd add post ant ext. flex. ER Top view. IR K If not, Uncoupling" Consider Trunk position D • Dynamic coupling - A The relationship b/w interdependent body segments. - Trunk, hip, knee, or ankle, all working together in unison. Q: Is there dominant strategy, or not? may lead to... over load. (athletic groin pain: AGP)
ページ5:
Global Intersegmental Control complex relationship throughout the kinetic chain, • not evenly distributed b/w the trunk, hip, knee, ankle. •Cannot simply be controlled by targeting muscles in isolation. ↓ So, exercises should be combined with Compound movements: • Deadlifts Squats • Lunges etc.. } In cutting task, COM (Center of mass) COP (Center of pressure) COM After Before COP COP Before After COM How can we approach? Pg6 of distance 2-axis D SL-OHSQ Whether rotation Dornot. ④ Compensation (L. E. weakness ④)
ページ6:
counter trunk rotation Traplanar pelvifemoral motion (SL) A band I Use the trunk as aprox. lever and point of prox Control/resistance, creating a longer lever around the Z-axis. Bridge with arm movements 22 band engage band latissimus • Upper body & trunk rotation keep Stable ✓ performing get the lower abs Working rowing Clam shell Feep stable ← rotate the trunk Stabilize the hip.
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