1) pectoralis minor strech

▷ It may indicate that humeral elevation and external rotation to 90 are important components of pectoralis minor stretching

▷ performed bilaterally streching, which may be more effective prevent trunk rotation toward the side of the stretch, because of this mechanical block

2) posterior capsule stretch (sleeper strech)

3) Latissimus dorsi strech

4) Thoracic mobility exercise

# Effect of posture on pain and ROM

Thoracic kyphosis may not be an important contributor to the devepopment of shoulder pain. While there is evidence that reducing thoracic kyphosis facilitates greater shoudler ROM

5) Shoulder muscle exercise

▷ Conservative, Post OP treatment

large to massive tear, delay postop treatment

Impingement, early postop strengthening

6) Deltoid, Pectoralis, and Latissimus dorsi in large and massive RC tear

▷ in mRCT, The PM and LD muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures

▷ Increased activation of the latissimus dorsi and teres major muscles is an attempt to compensate for the deficient rotator cuff

▷ Humeral head deprssor exercises (pectoralis major and latissimus dorsi)

▷ Deltoid rehabilitation program is suitable for elderly patients with massive rotator cuff tears

7) OKC strengthening exercise

8)  more effect isolates position of supra from deltoid

▷ 30 of abduction, mild ER, and 30 of flexion

9) posterior capsular stretch VS capsular stretch + mobilization

 

10) Posterior mobilization

11) Effective position in inferior mobilization

▷ Maximal inferior translation with minimal force was found when a grade 3 mobilization was performed in the OPP

12) Mobilization with movement (MWM)

▷ Effects of Mobilization With Movement on Pain and Range of Motion in Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Controlled Trial

1) ROM test

2) Pain area

○ Motion pain was significantly more common than was rest pain or night pain

○ Anterior & lateral area

○ suff tendinitis (P < .0119)

○ shoudlers with torn rotator cuffs ( P < .0183)

3) NIP(negative intra-articular pressure)

○ Important role in limiting ingerior translation

(when muscle and ligament are relax)

>However, negative intra-articular pressuer is not a major contributor to shoudler stability during weight-bearing

4) Alignment

Humeral head relative to acromion - no more than 1/3 of humeral head anterior to anterolateral corner of acromion

Resting position of glenohumeral joint - 0 flexion or extension

 

 

5) Latissmus dorsi tightness test

6) Painful arc 

7) Provocation test

○ Neer test

○ Hawkins kennedy test

○ Yergason test

○ Empty can test

 

8) Postural dysfunction

 

○ setting of a subject for measuring shoulder range of motion with a controller lightly touching the subject's sternum during (a) erect, (b) comfortable slouched, and (c) maximum slouched postures.

○ Increased kyphosis , scapular internal rotation

○ Decreased shoulder flexion, abduction, external rotation

9) Forward neck posture

10) Posterior capsular tightness (GIRD)

 

 

○ Side to side differences > 20

○ Total rotation motion deficit > 5

 

Reference

 

The lat length test ELEATE SPORTS ACADEMY

 

Musculoskeletal Evidence based Treatment

 

Morrey BF, An KN (1990) Biomechanics of the shoulder. In: Rockwood CR, Matsen FA (ed) The shoulder. Saunders, Philadelphia, pp 208–245Google Scholar.

 

lippitt. clin orthop relat res (1993) Rotator Cuff Tears: causes of shoulder pain: Stabilizing effect of negative intraarticular pressure

 

L. Kessel, M. Watson Published 1 May 1977 Medicine The Journal of bone and joint surgery. British volume The painful arc syndrome. Clinical classification as a guide to management.

 

Rotsalai Kanlayanaphotporn, Ph.D. (Health Sciences), M.Appl.Sc. (Physiotherapy), B.Sc. (Physical Therapy) Published:November 04, 2013 Changes in sitting posture affect shoulder range of motion

 

Sally Raine, PhD, Lance T. Twomey, PhD Head and Shoulder Posture Variations in 160 Asymptomatic Women and Men

 

Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil 1997;78:1215-23.

 

 

Journal of Orthopaedic & Sports Physical Therapy Published Online:July 1, 2004 Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises

 

P. Chalmers, G. Cvetanovich, +5 authors G. Nicholson Published 1 February 2016 Medicine Journal of shoulder and elbow surgery. The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests.

 

 

Andrea J Johnson 1, Joseph J Godges, Grenith J Zimmerman, Leroy L Ounanian The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis DOI: 10.2519/jospt.2007.2307

 

Robert C. Manske, PT, DPT*, Matt Meschke, DO, Andrew Porter, DO, Barbara Smith, PhD, PT, Michael Reiman, PT, DPTFirst Published December 22, 2009 A Randomized Controlled Single-Blinded Comparison of Stretching Versus Stretching and Joint Mobilization for Posterior Shoulder Tightness Measured by Internal Rotation Motion Loss

 

Choo Yeonki, PT, Ph.D Dept. of Rehabilitation Therapy, Guposungshim Hospital, Manager Effects of Mobilization with Movement Combined with Exercise(EMWM) on ADH, ROM and Functional Performance in Patients with Impingement Syndrome of the Shoulder

 

The effect of shoulder position on inferior glenohumeral mobilization Dexter W. Witt DHS, DPT, MHS, PT, OCS, FAAOMPT *, Nancy R. Talbott PhD, MS, PT, RMSK

 

Effects of Mobilization With Movement on Pain and Range of Motion in Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Controlled Trial

Author links open overlay panelJosé A.Delgado-GilPTaEvaPrado-RoblesOTbDaiana P.Rodrigues-de-SouzaPT, MsCcJoshua A.ClelandPT, PhDdCésarFernández-de-las-PeñasPT, PhDeFranciscoAlburquerque-SendínPT, PhDf

 

1) Factor of internal impingement

▷ Anterior capsular laxity

▷ Posterior capsular tightness

▷ Scapular dyskinesis

▷ Hyperangulation & hyperexternal rotation

=> but internal impingement is a normal physiological phenomenon

2) Factors of SAIS(subacromial impingement syndrom)

○ Intrinsic mechanics

overuse

tension overload

trauma of the tendons

○ Extrinsic mechanisc

dysfunctional rotator cuff musculature

weak or dysfunctional scapular musculature

posterior gleno-humeral capsule tightness

postural dysfunctions of the spinal column

○ SASI may lead th a full-thickness tear of the rotator cuff tendons & tendinopathy

3) Extrinsic acromial length

○ Acromial index (ratio), positive correlation in impingement and RCT

>Greater in East Asian than North American

4) Dysfunction of rotator cuff

○ Supraspinatus weakness

○ Fatigue of the infraspinatus and teres minor

less scapular posterior tilit (scapular retraction)

○ During the 30 to 90

Subcaupualris & infraspinatus was the only muscles with decreased activity

5) Role of subscapularis

○ Subscapularis is the “hidden culprit” of the rotator cuff

○ Fibrosis or scarring of the subcaupularis

○ Primary restrict passive external rotation at AB 90 and 0, limiting ER in the adducted position.

6) Weakness & dysfunction trapezius

○ Excessive upper trapezius activation

between 40 to 100

increased anterior tilt scapulo-thoracic joint

○ Lack of activity in the middle & lower trapezius & serratus anteror

7) abnormal posture

○ Forward postuer

Abduction and elevation of the scapula

Appear winging scaupular and medial rotationof humerus

Increase thoracic khyposis angle

Relatively more elevation, protraction, anterior tilt and a downwardly rotated posture

○ Cause

Tightness of pectoralis minor, biceps short head, levator scapular, upper trapezius

Weakness of middle, lower trapezius, serratus anterior

Leading th subacromial impingement syndrome

8) Role of latissimus dorsi

○ Teres major and latissimus dorsi can also provide humeral depression forces secondary to their anatomical alignment.

○ Tight latissimus dorsi

cause of chronic shoudler pain

▷ tendinous fascia connecting the latissimus dorsi th the thoracic and lumbar spine.

9) Functionally tightened muscles

○ Pectoralis minor & biceps short head

○ Levator scapulae & upper trapezius

○ Latissimus dorsi & subscapularis

○ Superficial cervical flexor muscles

10) Inhibited or weakened functionally

○ Rhombiodeus & mid and lower trapezius & serratus anterior

○ Teres minor & infraspinatus & posterior deltoid

○ Deep flexor cervical muscles

○ Especially, lower stabilizers of the scapula (serratus anterior, middle trapezius, and lower trapezius)

Reference

The lat length test ELEATE SPORTS ACADEMY

Musculoskeletal Evidence based Treatment

Morrey BF, An KN (1990) Biomechanics of the shoulder. In: Rockwood CR, Matsen FA (ed) The shoulder. Saunders, Philadelphia, pp 208–245Google Scholar.

lippitt. clin orthop relat res (1993) Rotator Cuff Tears: causes of shoulder pain: Stabilizing effect of negative intraarticular pressure

L. Kessel, M. Watson Published 1 May 1977 Medicine The Journal of bone and joint surgery. British volume The painful arc syndrome. Clinical classification as a guide to management.

Rotsalai Kanlayanaphotporn, Ph.D. (Health Sciences), M.Appl.Sc. (Physiotherapy), B.Sc. (Physical Therapy) Published:November 04, 2013 Changes in sitting posture affect shoulder range of motion

Sally Raine, PhD, Lance T. Twomey, PhD Head and Shoulder Posture Variations in 160 Asymptomatic Women and Men

Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil 1997;78:1215-23.

Journal of Orthopaedic & Sports Physical Therapy Published Online:July 1, 2004 Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises

P. Chalmers, G. Cvetanovich, +5 authors G. Nicholson Published 1 February 2016 Medicine Journal of shoulder and elbow surgery. The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests.

Andrea J Johnson 1, Joseph J Godges, Grenith J Zimmerman, Leroy L Ounanian The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis DOI: 10.2519/jospt.2007.2307

Robert C. Manske, PT, DPT*, Matt Meschke, DO, Andrew Porter, DO, Barbara Smith, PhD, PT, Michael Reiman, PT, DPTFirst Published December 22, 2009 A Randomized Controlled Single-Blinded Comparison of Stretching Versus Stretching and Joint Mobilization for Posterior Shoulder Tightness Measured by Internal Rotation Motion Loss

Choo Yeonki, PT, Ph.D Dept. of Rehabilitation Therapy, Guposungshim Hospital, Manager Effects of Mobilization with Movement Combined with Exercise(EMWM) on ADH, ROM and Functional Performance in Patients with Impingement Syndrome of the Shoulder

The effect of shoulder position on inferior glenohumeral mobilization Dexter W. Witt DHS, DPT, MHS, PT, OCS, FAAOMPT *, Nancy R. Talbott PhD, MS, PT, RMSK

1) Subacromial impinegment (External impingement)

● Exccssive superior translations with rotator cuff weakness during arm elevation

● Bursitis sid

● Severe pain

2) Internal impingement

● At ABER position(90-90 position)

Intra- articular impingemetn

● Posterio-superior rotator cuff contacts the postero-superior glenoid labrum and pinched between the labrum and GT

● Articular side layer is more vulnerable to a tensile load than the bursal side layer.

● Especially, tear of posterior supraspinatus and anterior infraspinatus tendon.

Classification of patial tears

FTRCT (full thickness rotator cuff tear)

▷ Rotator cuff full thickness tear(supraspinatus complete tear)

▷ Concomitant infraspinatus tear 40%

▷ Concomitant subscapularis tear 30~70%

Reference

CBD Wellness Centre Feb 1, 2019

Difference between Rotator Cuff Tear and Sub Acromial Impingement Syndrome

Arthroscopic classification of partialthickness rotator cuff tears according to Ellman [32 Last Updated on Wed, 16 Dec 2020 | Rotator Cuff

Musculoskeletal Evidence based Treatment

현대사회에서 팔이 아프다고하면 굽은어깨와 어깨충돌증후군을 많이들 이야기한다. 이 어깨충돌증후군은 팔을 올릴때 견갑골의 견봉과 상완골의 대결절부의 마찰이 발생하여 염증이 유발되는 병적인 상태를 어깨의 충돌증후군이라 한다. 이러한 마찰은 견봉과 대결절부 사이에 위치하는 회전근개 힘줄(극상건, 극하건의 일부), 견봉하 점액낭 등에 염증 및 손상을 초래하며 이는 어깨의 통증 및 불안정성을 야기한다. 이러한 염증은 중년에게는 흔한 어깨 통증의 원인 중 하나이다.

충돌 증후군 대표증상은 통증이다. 삼각근 부위가 아프며, 경우에 따라 상완부가 아프기도 한다. 심하지 않은 경우에는 특정한 자세나 과격한 움직임에서 통증이 유발되지만 심해지면 지속적인 통증이 발생하기도 한다. 특히 팔을 전방 거상 할 때나 외전할 때 통증이 흔히 발생하며 60도에서 120도 까지 거상 시 통증이 나타나고 120도 이상 거상 시 통증이 줄어드는 동통 궁 증후군 현상이 나타나기도 한다. 또한 야간통으로 표현되는 바와 같이 밤에 누워 자려고 하면 통증이 심해져서 잠을 못 이룰 정도록 심해지기도 하여 수면장애를 일으키기도 한다. 간혹 견봉하 조직들의 충동에 따른 염발음이 나타나기도 한다. 특정한 움직임에서 소리가 나는 것은 환자가 인식하기도 하며 심한 경우 외부에서 들릴 정도로 크게 나기도 한다.

Reference

서울대학교병원 의학정보, 서울대학교병원

shoulder impingement syndrome: symptoms, cause, diagnosis & treatmet

이번에는 코어 운동에 대해서 게시하겠습니다.

Core exercise

Breathing

-breathing has on core stability and chronic neck and shoulder pain

-current literature suggests that the diaphragm, transversus abdominis, multifidius and pelvic floor work in unison to create the ideal intra-abodminal pressure for spinal stabilization

-these “inner core” muscles fire in an anticipatory manner milliseconds before the prime movers in an effort to stabilize the spine at the segmental level

High – low breathing

-Ideally, the hand on the belly should rise before the hand on the chest.

-The hand on the chest should move slightly forward (not toward the chin)

-If it moves significantly more than the hand on the abdomen, there is a suggestion of dysfunctional breathing

Breathing exercise

Diaphragm test(lateral expansion)

Both the fingers and thumbs should be moving apart form each other, ideally 1.5-2 inches apart

Bracing maneuver

-This is the practice of activating muscles surrounding the trunk in order to protect the spine, safely transfer power between upper and lower body, and stand ground against contact.

-Breathe in and out. Gently and slowly push out your waist without drawing your abdomen inward or moving your back or pelvis.

As multifidii contract, it pushes into the thoracolumbar fascia and along with contraction of the transversus abdominis, provides intersegmental stability.

a) The relaxed multifidi muscle in transverse section; b) Co-contraction of the transversus abdominis and multifidi creates a stiffening tension on the thoracolumbar fascia thereby providing intersegmental stability.

Bracing exersise

This is the practice of activating muscles surrounding the trunk in order to protect the spine, safely transfer power between upper and lower body, and stand ground against contact.

bracing + moment arm (UE>LE) >> theraband >> change of posture

supine bracing

1. Supine Core Bracing

2. Supine Core Bracing with Arms Extended Toward Floor

3. Supine Core Bracing with One Leg Up (hold 10-15 seconds each side)

4. Supine Core Bracing with One Leg Up and Arms Extended Toward Floor

5. Band Resisted Supine Core Bracing

6. Partner Resisted Supine Core Bracing

DEAD BUG (+ bracing)

1. Dead Bug

2. Dead Bug with Arms Extended Toward Floor

3. Dead Bug with One Leg Toward Floor

4. Dead Bug with Opposite Arm and Leg Toward Floor

5. Band Resisted Dead Bug

6. Partner Resisted Dead Bug

SIDE PLANK

PALLOF PRESS

SUPER HERO and HALF-AIRPLANE (from hands and knees or stability ball)

Caution during breathing

Co-activation of the multifidus

Common substitution patterns or faults

asymmetry of contraction

breath-holding

bracing and increasing intra-abdominal pressure with overactivation of the abdominal muscles

results in movement of the trunk or pelvis out of a neutral position, and into spinal flexion or posterior tilt.

Reference

co-activation of muscle in spinal column craig 2004

kibler et al. sports med 2003

Mcgill. Exerc Sport Sci Rev 2001

Paul Hodge. Intervertebral Stiffness of the Spine Is Increased byEvoked Contraction of Transversus Abdominis and theDiaphragm:In VivoPorcine Studies

Musculoskeletal Evidence based Treatment

Paul W. Hodges. 1.5 Low Back Pain and the Pelvic Floor

Jessica Reale, PT Yoga Anatomy: 6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

faries&greenwood. streng & condit j 2007

C. Frank, A. Kobesová, P. Kolář Published 2013 Medicine International journal of sports physical therapy Dynamic neuromuscular stabilization & sports rehabilitation.

Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380.

Arnold Fomo on Aug 23, 2018 Trigger Point Therapy - Understanding and Treating Multifidus

McGill, PhD J Can Chiropr Assoc 1999 (Jun); 43 (2): 75–88 ~ FULL TEXT Stability: from biomechanical concept to chiropractic practice

Leon Turetsky (NASM-CPT, NASM-CES), Last Updated: March 5, 2020 Abdominal Bracing VS Drawing In – For Core Exercises

Kristen Gostomski, B.S. Sports & Health Science, HSSCS, INHC Best and Worst Core Exercises for Athletes

https://youthsportstrainer.com/

https://www.muscleandmotion.com/abdominal-bracing/

https://youthsportstrainer.com/best-and-worst-core-exercises-for-athletes/

Core

Abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the roof, and the pelvic floor and hip girdle musculature as the bottom

The core is particularly important in sports because it provides "proximal stability for distal mobility".

* Provide mechanical stability of spine

* Increase functional mobility (N-M control)

* Decrease pain

Spinal stability

spinal stability is a prerequisite element that enables movement of the limbs by maintaining the spine upright in postural changes

Innor core – TRA, Diaphragm, Pelvic floor musculature, MF

TRA

The transversus abdominis has large attachments to the middle and posterior layers of the thoracolumbar fascia

Thoraco-lumbar fascia, provides a connection between the lower limb and the upper limb

Thoraco-lumbar fascia also functions as a proprioceptor, providing feedback about trunk positioning

Creating a belt around the abdomen. “hollowing in” of the abdomen creates isolated activation of the transversus abdominis

The transversus abdominis and multifidius habe been shown to contract 30ms before movement of the U/E and 110ms before movement of the L/E in healthy people

Theoretically to stabilize the lumbar spine

Delayed activation of transversus abdominis in patients with low back pain may be more related to the lack of trunk rotation used in the arm raise by these subjects

Re-establishes a normal asymmetrical transversus abdominis action during rotation tasks within a complex muscle synergy rather than correcting a single dysfunctional muscle.

Paul Hodge 실험

Electrical stimulation of the diaphragm increased IAP without abdominal or paraspincal activity

IAP produces an extensor moment.

IAP may influence intervertebral stiffness directly by tensioning the spine or indirectly by increasing the hoop tension in the abdominal muscles and their fascias.

Diaphragm

Contraction of the diaphragm increases intra-abdominal pressure, thus adding to spinal stability.

Abnormal position and recruitment of the diaphragm resulted in subsequent reduced intra-abdominal pressure conducive to low back pain

Pelvic floor musculature

Pelvic floor musculature is co-activated with transversus avdominis contraction

people with sacroiliac pain have impaired recruitment of the diaphragm and pelvic floor.

Abdominal muscle activity is a normal response th PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles

in healthy subjects, voluntary activity in the abdominal muscles results in increased pelvic floor muscle activity

The increase in pelvic floor pressure before the increase in the abdomen pressure indicates that this response is preprogrammed

The diaphragm, pelvic floor and transversus abdominis regulate IAP and provide anterior lumbo-pelvic postural stability.

Multifidus

Multifidus attachment to the spinous process, the multifidus has a longer lever arm for producing extension than do the erector spinea muscles that attach to the transverse process

The most important action of the multifidus is controlling the flexion and anterior shear of the spine during forward bending via its eccentric contraction

Reference

Musculoskeletal Evidence based Treatment

co-activation of muscle in spinal column craig 2004

kibler et al. sports med 2003

Mcgill. Exerc Sport Sci Rev 2001

Paul Hodge. Intervertebral Stiffness of the Spine Is Increased byEvoked Contraction of Transversus Abdominis and theDiaphragm:In VivoPorcine Studies

Paul W. Hodges. 1.5 Low Back Pain and the Pelvic Floor

Jessica Reale, PT Yoga Anatomy: 6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

faries&greenwood. streng & condit j 2007

C. Frank, A. Kobesová, P. Kolář Published 2013 Medicine International journal of sports physical therapy Dynamic neuromuscular stabilization & sports rehabilitation.

Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380.

Arnold Fomo on Aug 23, 2018 Trigger Point Therapy - Understanding and Treating Multifidus

Musculoskeletal Evidence based Treatment

McGill, PhD J Can Chiropr Assoc 1999 (Jun); 43 (2): 75–88 ~ FULL TEXT Stability: from biomechanical concept to chiropractic practice

척추 분리증(spondylolysis) 들어보셨나요?

생각보다는 흔한 질병입니다. 

척추 분리증은 정상적인 사람은 하나로 연결돼있는 척추뼈의 척추 후궁의 관절 간부 부분이 한쪽 또는 양쪽 모두 결손이나 골절이 된 상태를 말합니다.  만약 이 척추 분리증이 더 진행되어 골절된 부위의 위, 아래 부분이 서로 어긋나 움직이면 척추 전방 전위증(Spondylolisthesis)이 됩니다.

척추 분리증의 원인은 아직 정확하게 밝혀져있지 않다고 합니다. 선천적으로 척추의 결손 부분의 형성 기형 때문이라고 주장하는 사람도 있고, 발육부전, 외상에 의한 골절 등 다양한 의견이 제시되고 있습니다.

척추 분리증의 특징

척추 분리증은 5번 허리뼈에서 83%로 가장 많이 발생하며 4번 허리뼈가 약 15%로 두 번째로 많이 발생합니다.

전 인구의 4~5% 정도에서 발견되는 질병으로 어렵지 않게 발견할 수 있습니다.

남녀 간의 발생빈도는 비슷합니다.

연령별로는 5세 이전에서는 드물며 20세 전후까지 발생빈도가 증가합니다.

보통 사춘기까지는 증상이 없는 경우가 많고 성장이 촉진되는 시지에 통증이 시작되는 것이 일반적입니다.

통증은 느끼는 사람도 있고 활동 후 통증을 느끼는 사람도 있습니다.

대부분의 환자들은 허리를 무리하게 사용했을 대만 허리 통증을 느낍니다.

허리 통증은 척추가 불안정하기 때문에 생기는 증상입니다.

운동이나 노동, 장시간 같은 자세를 취할 때, 앉아 있다가 일어날 때, 허리를 뒤로 젖힐 때, 오래 서 있거나 많이 걸을 때 발생합니다.

소아의 경우 허리 통증보다는 자세 변화나 보행 이상을 보입니다.

대부분 허리에서 엉덩이 정도 부분에 통증이 있고 극히 일부만 다리의 통증과 마비가 있습니다.

변위가 없는 한 허리 통증 및 다리 방사 통증을 일으킬 만큼 심한  경우는 드뭅니다.

진단

진단은 방사선영상을 통해서 쉽게 알아볼 수 있습니다. 

척추 분리증이 있을 경우 빗면 방사선소견에서 테리어개( terrier dog) 혹은 스코트개(scotty dog)라고 부르는 음영이 나타납니다. 목부분에 개가 목걸이를 한 것 같은 결손음영이 보이면 척추분리증이 있음을 알 수 있습니다.

치료

척추 분리증으로 인한 통증은 대부분 지나친 허리 사용 후에 나타납니다. 때문에 통증이 있을 경우 안정과 함께 통증 완화를 위한 물리적 인자 치료를 실시하면 좋은 효과를 볼 수 있습니다.

염증성 질환이 아니기 때문에 초기에도 온열치료를 사용할 수 있고, 경피신경 전기자극이나 은침형 전극 치료, 간섭 전류 치료 등 효과가 있습니다. 간섭 전류 치료 시에는 지나친 근수축이 일어나지 않도록 해야 합니다.

운동치료

통증 시에는 심한 운동보다는 가벼운 스트레칭을 통해 척추근육과 인대를 풀어주는 운동을 하며 통증이 없거나 척추 전방 전위증으로 진행이 없는 경우에는 허리 근육의 강화를 통해 척추분리증 진행을 방지하는 것이 중요한 치료입니다. 특히 배근육과 허리근육의 강화 운동이 필요합니다. 허리 강화 운동을 충분히 해보지 않고 수술적인 방법을 허리를 강하게 만들려는 것은 바람직하지 않습니다.

reference

근골격계 물리치료중재학

radiologykey.com/axial-skeletal-trauma/