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					編集：橋本雅至（奈良学園大学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評シリーズの第4弾．体幹に対する敏腕理学療法士の技術とコツを11テーマに分けて解説．前半では，触診による機能解剖や疾患の特徴から見た運動連鎖の観点からの運動機能障害，機能評価を紹介．後半では，動作分析からみた腰痛発生のメカニズムや外科的治療とその術後理学療法を解説．また，成長期スポーツ選手の腰痛や非特異的腰痛の特徴，運動連鎖・隣接関節を理解したうえでの介入方法，産業医学の立場から見た腰痛対策についても紹介．敏腕PTが現場で結果を出すための技術とコツを紹介する，集大成となる一冊．</section><section class="preface">［臨床実践　体幹の理学療法］　序文<br><br>　本書は，「教科書にはない敏腕PTのテクニック」シリーズの第4弾として，実際に臨床現場で行われ，結果を出している体幹に対する理学療法テクニックを解説するという編集方針にて企画しました．臨床上よく経験する腰痛に対する理学療法を例示するほか，臨床上工夫された体幹機能の評価方法や運動療法に限らず，姿勢調整や運動連鎖の観点から体幹の機能をとらえ，アプローチする方法を多く掲載しました．<br>　本書の前半は，評価において理学療法士が知っておくべき体幹の触察方法を具体的に紹介し，触診からとらえる機能解剖のポイントを説明しています．また，腰痛をはじめとする腰部障害を体幹の機能障害としてとらえ，体幹機能障害の特徴を理解することは大切です．このように，機能障害としてとらえるための理学療法評価方法について臨床からスポーツ現場での創意工夫を例示し，体幹機能をとらえる客観的評価に挑む実践例を紹介し，下肢機能との関連性にも展開し，その重要性を述べています．<br>　後半の各論では，最初に身体動作と腰痛発生のメカニズムをバイオメカニクスの観点から日常の動作を例にあげて説明しています．次に，治療の実践では腰痛などの体幹の障害に対する徒手的アプローチとその効果を具体的に説明し，さらに最新知見を含めた手術方法の解説とその後の理学療法の工夫と観点を紹介しています．また，腰痛発生の特徴として成長期のスポーツ選手の観点を取り上げ，腰痛発生予防やトレーニング，コンディショニング方法について具体的に掲載しています．さらに，非特異的腰痛に的を絞り，運動療法による改善の実践を紹介し，加えて運動連鎖の観点から体幹と下肢機能をとらえ，運動療法との併用に有効なテープやインソール療法について具体的に紹介しています．また，腰痛発生について職業・労働状況の観点からとらえ，腰痛予防に貢献している産業医学の立場から，個人に必要なアプローチと職場へのかかわりの実践例を交えて掲載しています．<br>　理論的背景を優先した理学療法実践に加えて，本書で執筆いただいた先生方は臨床で患者に向き合い，日頃の発想や感性を大事にし，現場で創意工夫しておられます．したがって，成果を上げる理学療法評価や治療のテクニックが大変重要であるという考えを読者と共有したいとの思いがあります．これまで紹介されていない敏腕PTならではの技術のコツも要所に盛り込まれています．本書が体幹に対する理学療法へ積極的に挑戦し，対象者の満足を得るための結果にこだわった理学療法の臨床実践に貢献し得ることを心より願っています．<br><br>令和元年8月<br>奈良学園大学　橋本雅至</section><section class="indexes">解剖・病態・評価・治療方針の理解<br>　触診により体幹の機能解剖を理解する<br>　　Ⅰ　体幹を構成する構造と機能<br>　　　1　体幹の基本骨格<br>　　　2　体幹の関節・靱帯（静的安定機構）<br>　　　3　体幹の筋・筋膜（動的安定機構）<br>　　Ⅱ　体幹の骨指標と圧痛点<br>　　　1　体幹の骨指標<br>　　　2　体表からみる圧痛点<br>　　Ⅲ　背部・胸部・腹部・骨盤周囲の主要な筋の触察<br>　　　1　背部の筋<br>　　　2　胸部の筋<br>　　　3　腹部の筋<br>　　　4　骨盤周囲の筋<br>　疾患の特徴から腰部の運動機能障害を理解する<br>　　Ⅰ　器質的疾患によるアライメント異常<br>　　　1　腰椎椎間板ヘルニア<br>　　　2　腰部脊柱管狭窄症<br>　　　3　腰椎圧迫骨折<br>　　Ⅱ　非特異的腰痛の原因<br>　　　1　バイオメカニクス<br>　　　2　運動のバイオメカニクスと理学療法<br>　　　3　問題点の把握<br>　　Ⅲ　再発予防<br>　コアスタビリティを評価し結果を介入に活かす<br>　　Ⅰ　体幹機能とコアスタビリティ<br>　　　1　腰痛とコアスタビリティの関係<br>　　　2　コアスタビリティの評価は重要<br>　　Ⅱ　コアスタビリティの評価方法<br>　　　1　体幹筋力の評価は必要か？<br>　　　2　体幹筋持久力を評価することは有用なのか？<br>　　Ⅲ　体幹の筋持久力を評価する有用な方法<br>　　　1　core stability test<br>　　　2　実際の測定例<br>　運動連鎖の観点から体幹と下肢の機能の関連を評価する<br>　　Ⅰ　体幹機能の評価について<br>　　Ⅱ　直立二足移動に必要な体幹機能<br>　　　1　四足動物と二足動物との違い<br>　　　2　二足動物に求められる体幹機能<br>　　Ⅲ　“動的安定性”と“荷重支持”の評価方法<br>　　　1　体幹機能における“動的安定性”の評価<br>　　　2　体幹機能における“荷重支持”の評価<br>　　　［CT］TRTにおけるいくつかの興味深い知見<br><br>実践と結果に基づく理学療法手技<br>　動作分析から腰痛発生のメカニズムを理解し介入する<br>　　Ⅰ　脊柱ニュートラルゾーンの安定化<br>　　　1　ローカルマッスルによる脊柱の安定<br>　　　2　腰椎構造体の脆弱から生じる腰痛のメカニズム<br>　　　［CT］立位保持における姿勢制御戦略<br>　　Ⅱ　腰痛患者への介入は，腰部のみ行うものか？<br>　　　　─腰椎部以外の要因から生じる腰痛の出現メカニズム─<br>　　　1　逸脱した立位姿勢で引き起こされる腰痛の要因<br>　　　2　逸脱した歩行動作で引き起こされる腰痛の要因<br>　　　3　日常生活の諸動作で生じる腰痛の要因<br>　　　［CT］腰椎骨盤リズム<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　立位時のニュートラルゾーンの調整<br>　徒手療法を評価に用いて腰痛に挑む<br>　　Ⅰ　腰痛に徒手療法を用いる際のクリニカルリーズニング<br>　　　1　問診，脊柱所見，動作時痛時の仮説について<br>　　　2　疼痛除去テスト<br>　　Ⅱ　椎間板性腰痛に対する徒手療法<br>　　　1　椎間板性腰痛の病態<br>　　　2　椎間板性腰痛に対する徒手療法の実際<br>　　　［CT］ホームエクササイズへの導入<br>　　Ⅲ　椎間関節性腰痛に対する徒手療法<br>　　　1　椎間関節性腰痛の病態<br>　　　2　椎間関節性腰痛に対する徒手療法の実際<br>　　Ⅳ　仙腸関節性腰痛に対する徒手療法<br>　　　1　仙腸関節性腰痛の病態<br>　　　2　仙腸関節障害に対する徒手療法の実際<br>　　　［CT］組織間の滑走性<br>　腰痛の外科的治療を理解し術後理学療法に挑む<br>　　Ⅰ　腰椎疾患に対する手術療法の適応と術式<br>　　　1　手術適応<br>　　　2　腰椎後方除圧術<br>　　　3　腰椎後方除圧固定術<br>　　　4　術後の理学療法<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　術前評価と術翌日の理学療法<br>　　　2　離　床<br>　　　3　ストレッチ<br>　　　［CT］術後特有の症状を見極めよう！<br>　　　4　ドローイン・エクササイズ<br>　　　5　ブリッジ・エクササイズ<br>　　　6　筋力強化トレーニング<br>　　　7　ADLトレーニング<br>　　　8　術後理学療法のまとめ<br>　　Ⅲ　腰椎手術の経過<br>　　　1　症例提示と術前計画<br>　　　2　手術と術後経過<br>　　　3　術後の理学療法<br>　成長期スポーツ選手の腰痛の特徴を踏まえ介入する<br>　　Ⅰ　スポーツ現場で起きやすい腰痛症に対する運動機能の評価方法<br>　　　1　スポーツ選手に多い腰痛症の特徴<br>　　　2　スポーツ選手の腰痛評価<br>　　　［CT］回旋運動の評価とアプローチ<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　股関節の可動域に対するアプローチ<br>　　　2　腰背部筋の柔軟性改善<br>　　　3　筋機能の改善<br>　　　4　パフォーマンスエクササイズ<br>　　　5　腰痛症に対するテーピング<br>　　　6　スポーツ復帰<br>　非特異的腰痛の特徴を踏まえ介入する<br>　　Ⅰ　非特異的腰痛と運動療法<br>　　Ⅱ　腰痛を引き起こすマルアライメントと脊柱-骨盤アライメント制御に働くアウターマッスル<br>　　　［CT］脊柱-骨盤アライメントの制御機能の評価<br>　　Ⅲ　インナーユニットの賦活化と脊柱-骨盤アライメントの安定化<br>　　Ⅳ　下部腰椎の局所的な運動とメカニカルストレスの関係<br>　　Ⅴ　股関節の柔軟性低下と動作や歩行時のメカニカルストレスの関係<br>　　Ⅵ　理学療法プログラムの実際<br>　　　1　ストレッチの考え方<br>　　　2　腰部の局所的なメカニカルストレス軽減を目指した脊柱全体の可動性改善へのアプローチ<br>　　　3　腰部のメカニカルストレス軽減を目指した股関節筋群の柔軟性改善へのアプローチ<br>　　　4　腰痛患者の筋力トレーニングの考え方<br>　　　5　インナーユニットとアウターマッスルの筋機能改善による脊柱-骨盤アライメント制御の適正化<br>　身体アライメントと隣接関節の運動連鎖を理解し腰痛に介入する<br>　　Ⅰ　姿勢と運動連鎖<br>　　　1　姿勢と腰部障害<br>　　　［CT］脚長差と動的姿勢制御の関連<br>　　　2　上行性および下行性運動連鎖と腰部<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　足部からの上行性運動連鎖を考慮したアライメント調整<br>　　　2　呼吸機能・胸郭アライメント調整による下行性運動連鎖アプローチ<br>　　　［CT］下部体幹のアライメント調整<br>　　　3　骨盤アライメント調整および股関節機能による上行性運動連鎖アプローチ<br>　産業医学の立場から腰痛対策を実践する<br>　　Ⅰ　ダイナミック運動療法のさまざまな評価やエクササイズの根拠となる成績<br>　　　1　ダイナミック運動療法とは？<br>　　　2　KWテストとは？<br>　　　3　ダイナミック運動療法の臨床成績<br>　　　4　産業医学的成果：労災件数の推移と経済効果<br>　　Ⅱ　当科の外来での取り組み<br>　　　1　腰痛評価<br>　　　2　KWテストによる体幹筋力の評価<br>　　　3　ダイナミック運動療法のランク設定<br>　　　4　重労働復帰やスポーツ復帰の判定<br>　　　5　症　例<br>　　　［CT］患者教育としての作業姿勢指導<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　腰痛体操<br>　　　2　体幹筋力トレーニング<br>　　　3　サーキット・トレーニング<br>　　　4　職場体操<br><br>索　引<br><br>［CT］＝クリニカル・テクニック</section></article>
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