カテゴリー別アーカイブ: 学会誌掲載論文

礫川マラソン指圧ボランティアアンケート報告:小松京介

小松 京介
日本指圧専門学校 指圧科
本多 剛
指導教員(日本指圧専門学校 専任教員)
金子 泰隆
指導教員(日本指圧専門学校 専任教員)
大木 慎平
指導教員(日本指圧専門学校 専任教員)

Volunteer Shiatsu at Rekisen Marathon : Survey Report

Kyosuke Komatsu / Tsuyoshi Honda, Yasutaka Kaneko, Shinpei Oki

 

Abstract :  The Forty-First Rekisen Marathon was held on November 29th, 2015 at Koishikawa, Bunkyo Ward. We participated as volunteer shiatsu therapists and surveyed 31 runners (24 males and 7 females) before and after treatment. The runners were asked to describe their level of fatigue and pain on a 100mm Visual Analog Scale (VAS) and circle the areas on abody diagram where they felt fatigue or pain. Volunteers from Japan Shiatsu College treated the runners with Namikoshi Standard Shiatsu for between 15 and 30 minutes depending on their chief complaint. All runners showed post-treatment improvement as measured by the Visual Analog Scale. Concerning the body area that the runners felt fatigue or pain, the top reply was the posterior region of the left thigh, and the second was the posterior region of the left lower leg. VAS improvement may have been due to increased muscle flexibility following shiatsu treatment.

Keywords: marathon, runner, survey, Visual Analog Scale, shiatsu


I.はじめに

 平成 27年 11月 29日に文京区青少年対策礫川地区委員会主催、第 41回礫川マラソンが文京区小石川において開催された。この催しには、本校も礫川地域に根づいた学校として協賛し、ランナーにレース後、指圧を受けていただくボランティアを毎年行っている。そこで今回、ランナーがレース後、身体のどの部位に痛みを生じるのか、また、その症状は指圧によってどの程度改善されたのかなどを調査するためのアンケートを併せて行った。その結果を集計したので報告する。

II. 対象および方法

日  時:2015年 11月 29日(日)

場  所:学校法人浪越学園日本指圧専門学校第3実技室

対  象:第 41回 礫川マラソン参加者中、指圧を受けかつアンケートで有効回答が得られた 10代~50代の男女(男性 23名、女性 7名)

評価方法:

 使用したアンケート用紙は、衞藤ら1)が第13回東京夢舞いマラソンボランティアアンケート報告で使用したものを用いた(図1、図競技終了後2)。A4版両面印刷のアンケート用紙を用い、施術前と施術後の疲労および痛みの度合いを 100mm(= 100ポイント)の長さの VAS(visual analogue scale)にて計測した。また、疲労を感じる部位並びに痛みを感じる部位を、身体イラストに丸印を記入するよう指示した。

施術方法:

 指圧は日本指圧専門学校学生有志が、ランナーの主訴に応じて 15~30分の間で浪越式基本指圧2)を行った。

図1.施術前アンケート用紙
図1.施術前アンケート用紙

図2.施術後アンケート用紙
図2.施術後アンケート用紙

III. 結果

 アンケートを集計した結果、VASにて疲労および痛みの度合いが減少したのは 30名中 30名(100%)であった。疲労および痛みの度合いが減少した平均ポイントは 40.9ポイントで、男性では 39.8ポイント、女性では 44.6ポイントであった。疲労および痛む部位でもっとも多かった回答は左大腿後面、次いで左下腿後面であった。尚、部位の回答は複数回答可のため、延べ 144箇所であった(表1)。

表1.左右の部位別主訴の件数
表1.左右の部位別主訴の件数

IV. 考察

 今回の疲労を感じる部位並びに痛みを感じる部位の結果は、衞藤ら1)の報告同様、右側と比較して左側に多かった。浅見ら3)は中・長距離の選手の脚力はほとんど左右差が認められないことを報告しており、加えて村田ら4)は、下肢では明らかな一側優位性が認められず、評価や治療の際、下肢の利き足を考慮する必要性が少ないことを示唆している。このことから、今回、左側の痛みを訴える件数が多かったのは、脚力の左右差や利き足の影響に由来するものとは考えづらい。しかし、本大会のマラソンコースは左回りであったことなど、左足に負荷をかける要素が見受けられたこともあり、それにより右側に比べて左側に疲労や痛みが多く出現した可能性が考えられる。

 また、今回すべての対象の自覚症状において改善が認められた。浅井ら5)の報告では、指圧により筋柔軟性の向上が認められており、15~ 30分の施術においても同様の効果が得られたと推察される。

 今回のボランティアにおいて、アンケート調査の重要性を再認識した。今後もさまざまな活動を通じて、アンケート調査を実施していきたい。また、アンケートの内容については今後、指圧学会において共通して使用できるものの作成を検討してはどうかと考える。

V. 結語

 第 41回礫川マラソン出場ランナーの 30名に対して指圧施術を行い、30名全てで疲労及び痛みの VASに改善が見られた。アンケートの結果、疲労及び痛みを感じる部位は左大腿後面が最も多かった。

参考文献

1)衞藤友親 他:東京夢舞いマラソン指圧ボランティア報告 ,日本指圧学会誌(1);p.31-34,2012
2)石塚寛:指圧療法学,p.78-126,国際医学出版,東京, 2008
3)浅見高明 他:スポーツ選手の一側優位性(左右差)の比較検討,筑波大学体育科学系紀要(4);p.99-109,1981
4)村田伸 他:上下肢の一側優位性に関する研究,西九州リハビリテーション研究(1);p.11-14, 2008
5)浅井宗一 他:指圧刺激による筋の柔軟性に対する効果,東洋療法学校協会学会誌(25);p.125-129, 2001


【要旨】

礫川マラソン指圧ボランティアアンケート報告
小松 京介/本多 剛,金子 泰隆,大木 慎平

  平成 27年 11月 29日に文京区小石川で第 41回礫川マラソンが開催された。我々は本大会において、出場した 31名 (男性 24名、女性7名)のランナーに対しボランティアとして指圧施術をし、施術前後にアンケートを実施した。アンケートの内容は、疲労及び痛みの度合い を 100mmの長さの VASに記入し、疲労及び痛みを感じる部位に身体イラスト上で印をつける形式で設定した。施術方法は日本指圧専門学校学生有志がランナーの主訴に応じて 15〜 30分の間で浪越式基本指圧を行った。その結果、全てのランナーにおいて、疲労及び痛みの度合いを示す VASが施術後に改善した。また、疲労及び痛みを感じる部位で最も多かった回答は左大腿後面、次いで左下腿後面だった。VASの改善は、指圧による筋柔軟性の向上によるものであると推察される。

キーワード:マラソン、ランナー、アンケート、VAS、指圧


指圧治療の患者立脚型評価法について:大木慎平

大木 慎平
日本指圧専門学校専任教員

Patient-based Assessment for Shiatsu Treatment

Shinpei Oki

 

Abstract : Patient-based assessment, which evaluates subjective complaints in daily life, is useful for evaluating the effects of shiatsu treatment. Various organizations and associations are offering such evaluation tools, an d this report examines practical evaluation tools for clinical practice among the free resources available.

Keywords: shiatsu, subjective evaluation, patient-based assessment


I.はじめに

 日々の臨床で行われる治療効果の評価法としては、画像による姿勢などの評価や、関節可動域の測定1)など様々であるが、患者の自覚症状を評価する方法として患者立脚型評価法が挙げられる。患者の自覚症状の評価法としてはVisual Analog Scale(以下 VAS)がよく知られている。これは左端を「全くなし」、右端を「想像できる最高の程度」と設定した長さ 10cmの線上に、患者がどの程度の痛みや不快度を抱えているかを示してもらうという評価法である。また、VASに類似したものとして Numerical Rating Scale(NRS)というものもあり、こちらは症状の程度を0~ 10の 11段階で回答してもらう手法をとる2)。患者立脚型評価法はこれらの評価法を応用したもので、患者の自覚症状について回答してもらうという点で共通であるが、主に日常生活に関する質問項目で構成されているのが特徴である。  今回、実際の臨床で遭遇するケースが多いと思われる症例について適用可能な評価票を、簡略な解説・ダウンロード方法と併せて紹介していく。今回取り上げる評価票については、運用の利便性を考え無料で使用できるものに限った。これにより、本学会への症例報告のきっかけが生じれば幸いである。  なお、監修団体により「評価表」「評価法」などの表記の異同があるが、各団体 HPの表記に従った。

Ⅱ.方法

Ⅰ.運動器系評価尺度

A.患者立脚上肢障害評価表

DL:日本手外科学会HP(http://www.jssh.or.jp/)⇒医療関係者の皆様⇒出版物・お知らせ⇒患者立脚型機能評価質問表

 日本手外科学会監修の、上肢(腕、肩、手)の ADLにおける不自由度と疼痛の評価票である。「ビンのフタを開ける」「背中を洗う」などの ADLや、「腕・肩・手に痛みがある」「腕・肩・手にこわばり感がある」などの疼痛・機能に関する質問の 30項目からなり、追加項目にスポーツ・演奏など芸術活動に関する質問もある。短縮版に Quick-DASHもあり、そちらは11項目の質問で構成される。

B.患者立脚手関節評価表(PRWE-J)

DL:日本手外科学会 HP⇒医療関係者の皆様⇒出版物・お知らせ⇒患者立脚型機能評価質問表

 日本手外科学会監修の、手関節の痛み、機能、ADLなどに関する評価票である。「休んでいる時の痛み」「重いものを持ち上げる時の痛み」などの痛みに関する質問や、「ワイシャツのボタンをかける」などの機能・「ドアの取手を回す」動作に関する質問の全 15項目からなる。

C.患者立脚肘関節評価法(PREE-J)

DL:日本肘関節学会HP(http://www.elbow-jp.org/)⇒機能評価⇒患者立脚肘関節評価法のご案内

 MacDermid JCが開発した Patient-Rated Elbow Evaluation(PREE)3)を基に、日本肘関節学会・機能評価委員会が日本語版として作成した、肘の 痛み、機能、ADLに関する評価表である。質問項目は 20項目で PRWE-Jと共通のものも多いが、機能の項目に「重いものを引っ張る」「テニスボールのような小さなものを投げる」などが追加されている。

D.患者立脚肩関節評価法(Shoulder 36)

DL:日本肩関節学会 HP(http://www.j-shoulder-s.jp/)⇒各種機能評価法ダウンロード

日本整形外科学会及び日本肩関節学会監修の、肩関節の評価票である。「エプロンのひもを後ろで結ぶ」「患側の手でバスや電車のつり革につかまる」などの ADLを主とした 36項目の質問で構成され、肩関節の疼痛、可動域、筋力、健康感、ADL、スポーツ能力という6因子を評価できる。

E.日本整形外科学会股関節疾患質問票(JHEQ)

DL:日本股関節学会HP(http://hip-society.jp/)⇒ JHEQ日本整形外科学会股関節疾患評価質問票

 日本整形外科学会監修4)の股関節の評価表である。股関節機能の不満度、痛みに関するVASに加え、「椅子に座っている時に股関節に痛みがある」「動き出すときに股関節に痛みがある」などの疼痛誘発動作や、「浴槽の出入りが困難である」「靴下をはくことが困難である」などの ADLの困難度、さらに「股関節の病気のために、イライラしたり、神経質になることがある」「自分の健康状態に股関節は深く関与していると感じる」などの精神面に関する質問の全 20項目で構成される。

F.変形性膝関節症患者機能評価尺度(JKOM)

DL:日本運動器科学会HP(http://www.jsmr.org/)⇒関連情報⇒ JKOM質問紙

 日本整形外科学会、日本運動器リハビリテーション学会、日本臨床整形外科学会が開発した膝関節の評価票である5)。変形性膝関節症患者の膝の痛みに関する VASに加え、「朝起きて動き出すとき膝がこわばりますか」「日用品の買い物はどの程度困難ですか」などの ADLに関する質問や、「膝の痛みのため、普段のお稽古ごとや友達付き合いを控えましたか」「ご自分の健康状態は人並に良いと思いますか」といった社会参加への不安感、精神面に関する質問の全 25項目で構成される。

G.患者立脚型慢性腰痛症患者機能評価尺度(JLEQ)

DL:日本運動器科学会 HP ⇒関連情報⇒ JLEQ質問紙

 日本運動器科学会、日本整形外科学会、日本臨床整形外科学会が開発した評価票である6)。腰痛症患者の腰の痛みに関する VASに加え、「あお向けで寝ているとき腰が痛みますか」「前かがみになるとき腰が痛みますか」などの増悪動作や、「寝返りはどの程度困難ですか」「椅子や洋式トイレからの立ち上がりはどの程度困難ですか」などの ADLの障害度に加え、「この数日間、腰痛のため横になって休みたいと思いましたか」「腰痛はあなたの精神状態に悪く影響していると思いますか」などの精神面に関する質問の全 30項目で構成される。

H.ロコモ25、ロコモ5

DL:日本運動器科学会 HP⇒関連情報⇒ロコモ判定ツール「ロコモ25」「ロコモ5」長寿科学総合研究事業により策定された、ロコモティブシンドローム診断ツールである。

 「背中・腰・おしりのどこかに痛みがありますか」「下肢のどこかに痛みがありますか」といった身体の疼痛や、「家の中を歩くのはどの程度困難ですか」「シャツを着たり脱いだりするのはどの程度困難ですか」などの ADLの困難度、「親しい人や友人とのおつき合いを控えていますか」「先行き歩けなくなるのではないかと不安ですか」などの社会参加への精神的な不安に関する質問の全 25項目の質問で構成される。

 患者立脚型評価法は患者自身による回答が原則だが、ロコモ 25は質問表の特性上、対象が高齢者に限られるため、25問の回答が完遂できないケースも考えられる。そのため、質問項目を5問まで絞った簡易版としてロコモ5が用意されている。

Ⅱ.不定愁訴系評価尺度

A.自覚症しらべ

DL:産業疲労研究会HP(http://square.umin.ac.jp/of/)⇒調査票ダウンロード⇒自覚症しらべ

 産業疲労研究会監修の疲労状況の測定指標である7)。質問内容は非常に簡素で、「ねむい」「あくびが出る」などのねむけ感、「不安な感じがする」といった不安定感、「考えがまとまらない」「頭がおもい」「気分が悪い」などの不快感、「腕がだるい」「足がだるい」などのだるさ感、「目がしょぼつく」「目がかわく」などのぼやけ感の計5因子が測定できる全 25項目で構成される。

B.起床時睡眠感調査票(OSA-MA)

DL:日本睡眠改善協議会HP(http://www.jobs.gr.jp/)⇒インフォメーション⇒ OSA睡眠調査票 MA版

 睡眠改善協議会監修の起床時の睡眠内省を評価する心理尺度である8)。「集中力がある」「頭がはっきりしている」などの起床時眠気、「寝付きがよかった」「睡眠中に目が覚めなかった」などの入眠と睡眠維持、「悪夢が多かった」「しょっちゅう夢を見た」などの夢み、「疲れが残っている」「身体がだるい」などの疲労回復に加え、睡眠時間の5因子が測定できる全 16項目の質問で構成される。スコアの算出には付属の睡眠内省特典変換用 MS-Excelシートを使用する。

C.ドライアイ QOL問診票(DEQS)

DL:ドライアイ研究会HP(http://www.dryeye.ne.jp/)⇒医師・医療従事者の方⇒研究⇒ドライアイ QOL問診票

 ドライアイ研究会と参天製薬株式会社により共同開発された質問票である9)。「目がゴロゴロする(異物感)」「目を開けているのがつらい」「目の症状のため気分が晴れない」など全 15項目の質問で構成され、ドライアイの症状、日常生活への影響、精神面を含めた QOLが評価可能である。

D.日本語版便秘評価尺度(CAS)

 様式はダウンロード出来る形式にないので、引用文献を参考にしていただきたい。

 これは、McMillanらが開発した便秘評価尺度10)をもとに、日本語版として深井らが作成した便秘評価尺度である11)。腹部膨満感、排ガス量、排便痛、便の量など8つの質問に0~2点の3段階で回答する形式になっており、16点満点で、点数が高いほど便秘傾向が強いことを示す。

Ⅲ.結語

 今回は入手が容易なものに限定して紹介したため、対象疾患によっては上述の評価票以外のものも無数に存在する。また、今回紹介した評価票は学術目的の使用は基本的に無料だが、制作者の許諾や引用文献の記載が必要となる場合もあるので、使用に際しては必ず手引や説明書を参照されたい。

 理学療法診療ガイドライン12)によると、運動器系の疾患では患者立脚型評価は高い推奨グレードが示されており、疼痛評価や健康関連QOLの指標として有効であることが示されている。日々の臨床では他覚的評価と自覚的評価の変動は必ずしも相関するとは限らず、角度計を用いた機能検査や、画像を用いたアライメント検査などの他覚的評価では拾いきれない、疼痛性状や ADLなど患者の自覚的評価の改善を認知できる患者立脚型評価法は、非常に有用であると考える。

 また、治療データを数値化して残しておくことができ、症状の変化が視覚的にわかりやすくなるのも大きな利点である。私見ではあるが、臨床で蓄積したデータを元に、一人でも多くの指圧師が症例報告を発表していけるようになればと願うばかりである。

参考文献

1)黒澤一弘:フリーウェアを用いた姿勢分析並びに関節可動域測定 ,日本指圧学会誌(1);14-20,2012
2)日本ペインクリニック学会HP:痛みの評価法 http://www.jspc.gr.jp/gakusei/gakusei_rank.html
3) MacDermid JC:Outcome evaluation in patients with elbow pathology: Issues in instrument development and evaluation, J Hand Ther(14), p.105-114, 2001
4) Tadami Matsumoto, Ayumi Kaneuji, Yoshimitsu Hiejima, etal:Japanese Orthopaedic Association Hip -Disease Evaluation Questionnaire(JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association, J Orthop Sci 17(1), p.25-38, 2012
5)赤居正美、岩谷力、黒澤尚 他:疾患特異的・患者立脚型変形性膝関節症患者機能評価尺度:JKOM(Japanese Knee Osteoarthritis Measure),日本整形外科学会誌(80),p.307-315,2006
6)白土修,土肥徳秀,赤居正美 他:疾患特異的・患者立脚型慢性腰痛症患者機能評価尺度;JLEQ(Japan Low back pain Evaluation Questionnaire),日本腰痛会13,p.225-235, 2007
7)酒井一博:日本産業衛生学会産業疲労研究会撰「自覚症しらべ」の改訂作業2002,労働の科学(57),p.295-298,2002
8)山本由華吏, 田中秀樹 , 高瀬美紀 他 :中高年・高齢者を対象とした OSA睡眠感調査票(MA版)の開発と標準化 ,脳と精神の医学(10),p.401-409, 1999
9) Yuri Sakane, Masahiko Yamaguchi, Norihiko Yokoi, et al:JAMA Ophthalmol,131(10), p.1331-1338, 2013
10)McMillan, et al:Validity and reliability of the constipation assessment scale, Cancer Nursing, 12(3),p.183-188, 1989
11)深井喜代子 他:日本語版便秘評価尺度の検討 ,看護研究28(3),p.209-216,199512)日本理学療法士協会:理学療法診療ガイドライン第1版(2011),p.38-45,p.296-298  http://jspt.japanpt.or.jp/upload/jspt/obj/files/ guideline/00_ver_all.pdf


【要旨】

指圧治療の患者立脚型評価法について
大木 慎平

 治療効果の評価法として、日常生活上での自覚症状を評価する患者立脚型評価法がある。評価に用いる尺度は様々な団体から提供されているが、ここでは無料で使用できるものに限定し、日々の臨床に応用可能と思われるものを紹介する。

キーワード:指圧、自覚的評価、患者立脚型評価法


乳がんに対する左乳房切除術(全摘手術)後の疼痛とそれに伴う肩関節可動域の制限に対する指圧治療の一例報告:宮下雅俊

宮下 雅俊
株式会社日本指圧研究所世田谷指圧治療院てのひら 院長

Shiatsu Therapy for a Patient with Post-mastectomy Pain and Limited Shoulder Joint Range of Motion Caused by Total Mastectomy

Masatoshi Miyashita

 

Abstract : This report examines the case of a patient who received shiatsu treatments following total mastectomy of the left breast in the treatment of breast cancer. Following treatment, relief of postsurgical pain and improvement in the shoulder joint’s range of motion were observed. Pain was treated using standard Namikoshi shiatsu techniques such as fluid pressure and suction pressure applied to the skin, and the shoulder joint was treated using a combination of pressure applications and mobilizations. We conclude that in this patient, these shiatsu techniques helped to relieve postsurgical pain and improve the shoulder joint’s range of motion.

Keywords: breast cancer, skin, scar, shoulder joint range of motion, mastectomy, post-mastectomy neurogenic pain, shiatsu, mobilization


Ⅰ.はじめに

 国立がん研究センターの「2015年のがん罹患数、死亡数予測」の統計データによると1)、わが国では女性の癌の中で一番患者数が多いのが乳がんである。乳がんの患者は年々増加傾向にあり、罹患数が増加するのに比例して死亡数も増加しているのが現状である。

 今回、乳がんに対する左乳房切除術(全摘手術)後の左胸部の疼痛と、処置部位の瘢痕拘縮が原因と考えられる肩関節可動域の制限が現れている患者に対し、まず左胸部の指圧は皮膚の柔軟性、伸張性を改善することを重点において施術、それから全身指圧を施した。

 指圧療法は、世間一般的には、筋肉にアプローチするものとイメージされていることが多い。しかし、指圧は筋肉、神経、血管、骨、腱、内臓、皮下組織など、身体のあらゆる箇所を対象に、皮膚の上から押圧または運動操作を施し、人体のあらゆる反射を利用する手技療法と言える。

 皮膚は身体の全表面を覆い、内部の諸器官を外部からの刺激、衝撃から保護するとともに、独自の生理機能を持って身体全体の調和に関係している器官である。皮膚は薄いながらも表面積が広いので、その重さは体重の約8%にもあたり、内臓の中で最も重い肝臓の約3倍になる。いわば、皮膚は身体の最大の器官ということができる2)

 マイスナー小体やパチニ小体といった、皮膚の感覚受容器に働きかける指圧療法は、皮膚とは密接な関係にあるが、皮膚の柔軟性、伸張性に着目した指圧の症例報告は少ないので、この度は、乳房切除術後の患者に対し、特に胸部、腹部、肩周囲の皮膚の柔軟性、伸張性を改善するよう指圧してから全身の指圧施術をし、その前後で写真撮影を行い、肩関節前方挙上(肩関節屈曲)可動域の変化を確認したのでここに報告する。

Ⅱ .対象

施術対象:44歳 女性 個人事業主

場  所:世田谷指圧治療院てのひら

期  間:平成 27年9月 11日

主  訴:乳がんに対する左乳房切除術(全摘手術)後の左胸部瘢痕(図1)の疼痛と左上肢の動作痛、またそれに伴う関節可動域の制限

治 療 法:基本指圧を応用し、仰臥位で瘢痕の創傷部離解が起きないように、瘢痕に直接片手掌圧を加えて皮膚移動を抑えながら、もう片方の手で瘢痕の周りを片手掌圧し、瘢痕を中心とした八方の遠位方向に、流動圧法を加える二点圧を使用した。左胸部の瘢痕への指圧は、瘢痕周辺の皮膚の柔軟性、伸張性を向上させることを目的に指圧を行った。

 その後、全身の調整として、仰臥位にて、胸部、腹部、肩周囲部、上肢帯、頸部、頭部の指圧を行った。

 横臥位にて、頸部、肩上部、肩甲間部、肩甲下部、上肢帯への指圧と肩関節、肘関節の運動操作を行った。

 伏臥位にて、仙骨部掌圧・股関節伸展操作による骨盤調整を行い、臀部、大腿後側部、下腿後側部、足底部の指圧を行った。

 圧法の種類は、通常圧法、持続圧法、吸引圧法、流動圧法、振動圧法を適宜に使い分けた3)

図1 患者の乳がん乳房切除術後の瘢痕
図1 患者の乳がん乳房切除術後の瘢痕

Ⅲ .結果

[現病歴]

 平成 27年8月 19日、乳がんにより左乳房切除(全摘手術)を行ってから、左胸部の疼痛と動作痛が現れた。それに伴い、肩関節前方挙上(肩関節屈曲)可動域の制限も現れた。

[既往歴]

27歳 局所性左乳がん発症 ステージⅠ

温存手術 +化学療法 +放射線治療を受けた

[家族歴]

なし

[術前所見]

自覚所見

  • 乳房切除術後からある肩こり
  • 乳房切除術後からある背中の張り
  • 乳房切除術後の左胸部(瘢痕)の疼痛
  • 乳房切除術後からある左胸部(瘢痕)の上肢の動作痛
  • 乳房切除術後からある肩関節の前方挙上(肩関節屈曲)可動域の制限
  • 乳房切除術後からある胸部の皮膚の突っ張り感(瘢痕拘縮と考えられる)
  • 便秘
  • 倦怠感

他覚所見

  • 発汗
  • 両上肢の周径に顕著な左右差は見られない
  • 肩関節の前方挙上(肩関節屈曲)の可動域の制限あり(図2)
  • 触診により胸部の皮膚の柔軟性、伸張性の低下を感じる
  • 仰臥位時に肩関節の自動運動、他動運動をすると左胸部(瘢痕)に痛みを訴える
  • 瘢痕に直接片手掌圧を加え、瘢痕の移動を抑えながら肩関節の他動運動、自動運動をすると痛みが減少することを確認した

[術後所見]

自覚所見

  • 肩こりが軽減した
  • 背中の張りが軽減した
  • 術後の瘢痕の疼痛が軽減した
  • 術後からある瘢痕部の上肢動作痛が軽減した
  • 術後からある肩関節前方挙上(肩関節屈曲)の可動域が向上した
  • 胸部の皮膚の突っ張り感が軽減した(瘢痕拘縮と考えられる)

他覚所見

  • 肩関節前方挙上(肩関節屈曲)の可動域が向上した(図3)
  • 触診により胸部の皮膚の柔軟性、伸張性が向上した
  • 肩関節の運動痛が軽減した

図2 指圧施術前
図2 指圧施術前

図3 指圧施術後
図3 指圧施術後

Ⅳ .考察

 本症例の施術前後の画像(図2、3)を比較したところ、指圧による押圧操作と運動操作により、肩関節前方挙上(肩関節屈曲)の関節可動域が改善したのを確認できた。これは、福井4)が提唱する皮膚運動の5つの原則と照らし合わせると、瘢痕の影響により肩関節挙上運動に生じていた制限が、指圧による瘢痕周囲の皮膚の柔軟性、伸張性の向上により改善され、肩関節の可動域に変化が起きたためと考えられる。

 また、今回治療で使用した、流動圧法、吸引圧法、また基本指圧にもある撫で下ろしなどの圧法は、筆者の臨床上の経験から、皮膚を誘導する方法として非常に効果の高い手技であると考えている。福井4)は、皮膚を適切な方向に誘導することで関節運動が楽に行えるように感じるのは、浅筋膜で隔てられた浅層部と深層部が、互いに反対方向に移動する滑走状態を作り上げているからではないかと推測しており、上記の手技はこれと同じ効果を出しているとも考えられる。

 もちろん、指圧刺激が筋の柔軟性に及ぼす効果についての報告が複数存在する5~7)ことからも、皮膚、筋、両方の相乗効果とも推察できる。また、指圧施術後に、胸部の皮膚の突っ張り感の軽減と、瘢痕の疼痛が軽減したとの患者の報告から、左乳房切除術後の神経障害性疼痛と思われる症状にも効果があったと推察される。

 乳癌術後の症例として真っ先に頭に浮かぶのはリンパ浮腫であろう。2006年日本乳癌学会研究班の北村らによるリンパ浮腫の発症率の調査によれば、1379例の一側性乳癌術後のうち、平均術後観察年数は 3.9年、全体のリンパ浮腫発症率は50.9%、うち重症が 46.6%と報告されている8)

 本症例では、左乳房切除術後 23日後に指圧治療を行った。その際の所見では、両上肢の周径に大きな左右差は見られなかったが、術後から左胸部の疼痛、皮膚の突っ張り感があり、術後の左胸部は感覚低下があるとのことだった。また、左上肢を自動・他動運動で動かすと痛みが増強し、肩関節の可動域制限もみられ、QOLの低下を訴えていた。これらの症状は、日本緩和医療学会が発表している、がん疼痛の薬物療法のガイドライン 2010年版9)の乳房切除後疼痛症候群(post-mastectomy pain syndrome:PMPS)の特徴である。『上腕後面、腋窩や前胸壁部などにおける、感覚低下を伴う締め付け感や灼熱感などが多い』、『術後痛の強さや腋窩郭清が発現率に関連する』、『しばしば上肢運動によって痛みが増強するため、有痛性肩拘縮症となる』、『術直後~半年までに発症することが多い』と重なる部分が多く、本患者は乳房切除後疼痛症候群を発症していたのではないかと考えられる。乳房切除後疼痛症候群は、手術、放射線療法、化学療法による肋間上腕神経障害が関与すると言われており10)、約 20%の患者は術後 10年経過しても症状が残存するとの報告もある11)。今回は一症例のみの紹介であるが、本症例における症状の改善は、指圧治療が乳房切除後疼痛症候群に有効である可能性を示唆するものと考える。

 日本リハビリテーション医学会の発行する、がんのリハビリテーションガイドラインでは、肩関節可動域の改善、上肢機能の改善、リンパ浮腫の発症リスクを減少させるなどの目的で、包括的リハビリテーションを行うように強くすすめられている12)

 しかしながら、根岸ら13)が近年、乳がん術後の入院日数が短縮傾向にあり、リハビリテーションとその指導が十分に行われないままに退院する患者が増加していることを挙げており、指圧師が包括的なリハビリテーションの知識と、それに対応しうる施術技術を持つことで、医療機関を退院した乳がん術後の患者に対してその役割を十分果たせると考えられる。

 今回疼痛の程度を評価していなかったため、今後の課題としてNRS(Numerical Rating Scale)や、VAS(Visual Analogue Scale)などの評価スケールを用いた、乳房切除術後の痛みの程度の変化も評価検討したい。

Ⅴ .結論

 指圧治療により、乳がんに対する乳房切除術(全摘手術)後の患者に対し、指圧の押圧操作と運動操作を併用することで、肩関節可動域の制限が改善できる可能性がある。また、乳がんに対する乳房切除術(全摘手術)後の疼痛を緩和させ、上肢の動作痛も軽減される可能性がある。しかし、今回は1例のみの報告であるため、さらに症例を重ね検討したいと考えている。

参考文献

1)国立がん研究センター:2015年のがん罹患数、死亡数予測,http://www.ncc.go.jp/jp/information/ press_release_20150428.html
2)朝田康夫:美容皮膚科学事典 ,中央書院,p.4, 2002
3)浪越徹:完全図解指圧療法,日貿出版社,p.58-59, 1979
4)福井勉:皮膚運動学 ,三和書店,2010
5)浅井宗一 他:指圧刺激による筋の柔軟性に体する効果,(社)東洋療法学校協会学会誌(25);p.125-129,2001
6)菅田直紀 他:指圧刺激による筋の柔軟性に体する効果(第2報),(社)東洋療法学校協会学会誌(26);p.35-39,2002
7)衛藤友親 他:指圧刺激による筋の柔軟性に体する効果(第3報),(社)東洋療法学校協会学会誌(27);p.97-100,2001
8)北村薫 他:乳癌術後のリンパ浮腫に関する他施設実態調査と今後の課題 ,日本脈管学会機関誌50;P.715-720,2010
9)日本緩和医療学会:がん疼痛の薬物療法に関するガイドライン 2010年版,http://www.jspm.ne.jp/ guidelines/pain/2010/chapter02/02_01_03. php#top
10)Vecht CJ et al: Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve, Pain 38(2) ; p.171-176, 1989
11)Macdonald L et al: Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome, Br J Cancer 92(2); p.225-230, 2005
12)日本リハビリテーション医学会:がんのリハビリテーションガイドライン,金原出版,p.54-75, 2013
13)根岸智美 他:乳癌術後リハビリテーションにおける肩関節可動域運動の開始時期の検討,理学療法学第 13巻第1号,p.18-21,2016


【要旨】

乳がんに対する左乳房切除術(全摘手術)後の疼痛とそれに伴う肩関節可動域の制限に対する指圧治療の一例報告
宮下 雅俊

 本症例では、乳がんに対する左乳房切除術(全摘手術)後の左胸部疼痛と、肩関節可動域の制限がある患者に対し、指圧治療を行い、疼痛の緩和、肩関節可動域の改善が見られた。疼痛に対するアプローチとしては、皮膚に対して流動圧法、吸引圧法などの基本指圧の応用操作を行い、肩関節に対しては押圧操作と運動操作を併用して治療することで、効果を得られたものと推察する。

キーワード:乳がん、皮膚、瘢痕、肩関節可動域、乳房切除術、乳房切除後神経性疼痛、指圧、運動操作


20代女性の側弯症に対する指圧治療によるCobb角の変化:作田早苗

作田 早苗
りんでんマニピ指圧治療院

Effects of Shiatsu Therapy on the Cobb Angle of a Female Patient in Her Twenties with Scoliosis

Sanae Sakuta

 

Abstract : This report examines the case of a female patient in her twenties diagnosed with lumbar idiopathic levoscoliosis who received 93 shiatsu treatments between 2013 and 2016. Following treatment, the Cobb angle was improved from 69.6. to 62.3.Relief of subjective symptoms such as back pain and severe menstrual cramps was also observed. We concluded that reducing muscle tension with shiatsu treatment resulted in improved spinal mobility leading to correction of leg length difference, asymmetric pelvis, tilted ribs, and unaligned spine.

Keywords: shiatsu, scoliosis, Cobb angle, spine


Ⅰ.はじめに

 側弯症とは、脊柱がねじれを伴って左右に曲がってしまう症状であり、それに伴い胸郭の変形、肩甲骨の出っ張りに加え、前屈時の高さ、肩の高さ、骨盤の高さの左右差などが生じる。また、肺などの臓器の圧迫や位置のズレに伴う背腰部痛、生理痛、胃腸障害が生じたり、好きな服が着られない、水着になれないなどの外見上の問題による精神的ストレスを受けるなど、心身ともに影響が及ぼされるといわれる1)

 側弯症の分類はおおまかに機能性側弯症と構築性側弯症があり、構築性側弯症に分類される特発性側弯症が側弯症全体の 70~ 80%を占める2)。特発性側弯症の原因はわかっておらず、思春期側弯症が最も多く、症例の 85%が女性と言われている3)。予防法は未だ確立されていないが、早期発見が手術適用のリスクを軽減するため、現在は学校での検診が行われている1)

 側弯の程度を表すための方法としては、立位でのレントゲン写真から測定する Cobb法 (脊柱の前後から見て、最も傾いた椎体間の角度を計測する方法 )が用いられている2)(図1)。

 日本側弯症学会によると、側弯症に対する手技療法では、痛みの緩和はあっても症状の改善には効果がないとされてきた1)。しかし、今回、指圧施術により患者の Cobb角に改善がみられた症例が得られたので、ここに報告する。

図1.Cobb角の計測法
図1.Cobb角の計測法
X線において、脊柱カーブの上下端で水平面に対して最も傾いている頭側終椎の上縁と、尾側終椎の下縁を結ぶ線のなす角度を Cobb角とする。

Ⅱ.対象および方法

日時及び回数:

2013年2月 28日~ 2016年3月 24日 全93回(表1)

対象:20歳 女性 身長 162.8cm

現病歴:11歳の時に歯ぎしりがひどく、顎関節を治すために行った整体院で脊柱の側弯を指摘された。その時点では自覚症状はなかったが、その後 13歳のときから背腰部痛が発生するようになり、15歳で側弯症専門の整形外科を受診し腰部左凸の特発性側弯症と診断される。手術を勧められたが、なるべく手術はしたくないという考えもあり体操や装具などで改善を図りつつ、現在に至る。装具は着けているのが辛く、ほとんど使用していない。

自覚所見:

  • 背腰部痛…痛みのため、椅子に座っていることができず、在宅時は寝転びながら勉強をする
  • 生理痛…重症時は痛み止めを服用する。痛みのため学校を休むことも多い
  • 軟便傾向である
  • 開口時、顎関節がズレる

他覚所見:

  • 視診
     静止時の姿勢では、反り腰、体幹の右回旋、腰部の左回旋がみられる。右肋骨は張り出し、左肩が上がった状態である。右の肩甲骨は挙上し、内縁は胸郭から浮いている。下肢長は右のほうが長い。
  • 触診
     右肩甲骨周り、右鼠径部、左背腰部に顕著な硬結がみられる。右腸腰筋の短縮が認められる。両下肢外側に張りがある。右腰部は筋量が少ない。

施術方法:

 石塚4)、田之倉5)を参考に、以下のような施術を行った。

  • 2013年~ 2014年
     顔面部・頭部・背部・腰部・殿部・腹部・下肢への指圧
  • 2015年~
     顔面部・頭部・頸部・背部・腹部・殿部・腹部・下肢への指圧・棘突起調整・座骨掌圧・背部調整・下肢長の調整・肋間筋への指圧

Ⅲ.結果

・Cobb角について

 整形外科で撮影されたレントゲン写真からTh10~ L3の Cobb角を計測した。2012年Cobb角は 69.6°だったが、2016年には 62.3°まで改善された(表2)。

・自覚症状について

 2013.3.7 腰の痛みが緩和した。

 4.24 座っていても、背腰部が痛くなくなってきた。

 6.23 生理痛はあったが、寝込むほどではなくなった。

 10.13 開口時の顎関節のズレが改善した。

 12.16 生理痛があり、薬を飲むほど痛かった。

 2015.5 生理痛が緩和した。これ以降、本人の自覚症状の訴えは出ていない。

表1.各月ごとの施術回数
表1.各月ごとの施術回数

表2.施術期間中のTh10 ~ L3 のCobb 角
表2.施術期間中のTh10 ~ L3 のCobb 角

Ⅳ.考察

 本患者の診察所見では、右腰部の筋量低下がみられたため、立位において左腰部筋力とのアンバランスが生じ、側弯が増強されていたと考えられる。藤川6)は手技療法による Cobb角の改善を成人で4例報告しており、脊椎アライメントの調整と筋硬直の解消の重要性を示唆している。田附ら7)、宮地ら8)は指圧により脊柱可動性が向上することを報告しており、本症例において Cobb角の改善がみられたのは、指圧により筋硬直が改善し脊柱の可動性が高まり、それに伴い下肢長、骨盤、肋骨の高さ、脊柱のアライメントが矯正されたことによるものと推察する。今後は今の可動性を保ちながら、筋肉を増強させることが更なる改善に重要であると考える。また、2013~ 2014年にかけて Cobb角の変化に停滞がみられたが、これは患者の受験期間などと重なることで、施術頻度がやや減少したことに起因すると推察される。また、受験等のストレスにより筋の柔軟性が低下し、脊柱のアライメントの不整につながった可能性も考えられる。大木9)は定期的な指圧施術で患者の精神的ストレスが改善された症例を報告しており、なるべく間隔をあけず定期的に施術を行うことが治療において重要であると考える。

 日本側弯症学会1)によると、手技療法は側弯に伴う痛みなどの緩和には効果が期待されても、改善、進行を防ぐ効果はないとされ、経過観察、運動療法、装具着用、手術が推奨されており、16歳以降の側弯の改善は難しいとされてきた。しかし、本症例により、成人における指圧療法による改善の可能性が示唆されたと考える。また、医療関係者と連携し、装具療法や運動療法を併用して治療を始め、早期から姿勢、筋バランスを整えることがより良い治療効果を得るために重要であると考える。

Ⅴ.結語

 側弯症患者に対する全 93回の指圧治療により、Cobb角の改善がみられた。

参考文献

1)日本側弯症学会:知っておきたい脊柱側弯症,p.1-63,インテルナ出版,東京,2003
2)奈良信雄 他:臨床医学各論 第 2版,p.151-154,医歯薬出版株式会社,東京,2004
3)国分正一,鳥巣岳彦:標準整形外科学 第 10版,医学書院,東京,2008
4)石塚寛:指圧療法学 改訂第1版,国際医学出版,東京,2008
5)田野倉快泉:無薬医術指圧療法復刻,p.50,八幡書店,東京 ,2002
6)藤川勝正:脊柱側弯症の保存療法,整形外科と災害外科39(1);p.349-358,1990
7)田附正光 他:指圧刺激による脊柱の可動性及び筋の硬さに対する効果,東洋療法学校協会学会誌(28);p.29-32,2005
8)宮地愛美 他:腹部指圧刺激による脊柱の可動性に対する効果,東洋療法学校協会学会誌(29);p.60-64,2006
9)大木慎平:全身指圧による心理的影響を測定した一例,日本指圧学会誌(4);p.7-10,2015


【要旨】

20代女性の側弯症に対する指圧治療によるCobb角の変化
作田 早苗

 今回、専門医により腰部左凸の特発性側弯症と診断された 20代女性に対し、2013年~ 2016年まで計 93回の指圧治療を行った。その結果、初診時点では69.6°であった Cobb角が、62.3°まで改善した。また、背腰部痛や重い生理痛などの自覚症状にも改善がみられた。本症例の改善は、指圧により筋硬直が解消して脊柱可動性が向上し、下肢長、骨盤、肋骨の高さ、脊柱のアライメントが矯正されたことにより生じたと推察する。

キーワード:指圧、側弯症、Cobb角、脊柱


Effects of Shiatsu to the Plantar Region on Center of Gravity Sway (Part 1)

Koichi Hoshino,Munetaka Hibi
Japan Shiatsu CollegeShiatsu Department
Hiroyuki Ishizuka
Japan Shiatsu CollegeShiatsu instructor

Abstract : There are few studies on the effects of plantar region shiatsu treatment on the locomotor system. In this study, we examined the effects of shiatsu stimulation of the plantar region on standing balance, based on measurements obtained using a stabilograph. Four healthy subjects received shiatsu treatment to the plantar region for 1 min 42 sec per session. Results showed no significant differences between the stimulation group and the non-stimulation group with respect to total trajectory length, outer circumference area, rectangle area, or effective value area. Further research is required using different test subjects and research methodology.

Keywords: Shiatsu, plantar region, variance of center of gravity, balance in the upright position


I.Introduction

In shiatsu therapy, the plantar region is approached based on a variety of interpretations depending on the symptoms involved, with numerous accounts of its perceived efficacy based on experience.

However, few studies have been conducted on the effects on the locomotor system of Japanese manual therapies to this region.

In this study, as an initial step in clarifying the effects of shiatsu therapy on the muscles and structure of the plantar region and the consequent effect on locomotor function, we progressed to the pre-experimental stage in the measurement and analysis of changes to standing balance using a stabilograph. This is an interim report on the results obtained and summary of our ongoing research.

Ⅱ.Methods

1.Subjects

Research was conducted on four healthy males (mean age: 30 ± 10.68 years old) who were students at the Japan Shiatsu College. Test procedures were fully explained to each test subject and their consent obtained.

2.Test location and period

Testing was conducted in the lounge space at Japan Shiatsu College between January 29 and February 5, 2015.

3.Measurement procedure

Center of gravity sway was measured using a stabilograph (Gravicorder GS-10 Type C; Anima Corp.). Each measurement was recorded for 1 minute while subjects stood with the medial borders of their feet together, arms crossed over their chests, and eyes closed. Results were obtained for 10 measurement criteria (total trajectory length, unit trajectory length, unit area trajectory length, outer circumference area, rectangle area, effective value area, sway mean center deviation X-axis, sway center deviation X-axis, sway mean center deviation Y-axis, and sway center deviation Y-axis).

4.Stimulation

(1)Area stimulated

In accordance with the basic treatment points employed in Namikoshi shiatsu, 4 points were stimulated between Point 1, located in the plantar region between the bases of the second and third digits, and the edge of the heel, using 2-thumb pressure with the test subject in the prone position (Fig. 1).

4 points of plantar region
Fig. 1. 4 points of plantar region

(2)Duration and method of stimulation

Pressure was applied for 3 seconds to each of the 4 points, repeated 3 times, then single-point pressure was applied to Point 3 for 3 seconds, repeated 3 times, with a total duration of approx. 1 min 42 sec for both feet. Treatment was applied using standard pressure (pressure gradually increased, sustained, and gradually decreased), with pressure regulated so as to be pleasurable for the test subject (standard pressure) 1.

5.Test procedure

In order to average the test subjects’ learned behavior, they were randomly divided into two groups of two, Group A and Group B. Group A was scheduled to act as the non-stimulation group first, then as the stimulation group, while Group B acted first as the stimulation group, then as the non-stimulation group (Fig. 2).

Test schedule and learned behavior averaging
Fig. 2. Test schedule and learned behavior averaging

(1)Stimulation group  

The procedure was performed as follows:
1) 3 min rest in seated position
2) 1st stabilograph measurement
3) 3 min rest in seated position
4) 2nd stabilograph measurement
5) Shiatsu stimulation to plantar region
6) 3 min rest in seated position
7) 3rd stabilograph measurement

(2)Non-stimulation group

The procedure was performed as follows:
1) 3 min rest in seated position
2) 1st stabilograph measurement
3) 3 min rest in seated position
4) 2nd stabilograph measurement
5) 1 min 42 sec rest in prone position
6) 3 min rest in seated position
7) 3rd stabilograph measurement

Test procedure

6.Statistical processing

Of the data obtained from the stabilograph, measurements for total trajectory length, outer circumference area, rectangle area, and effective value area were compared between the non-stimulation group and the stimulation group by subjecting data on change rates between the 2nd and 3rd stabilograph measurements to t-testing.

Ⅲ.Results

1.Total trajectory length (Fig. 3)

Compared to the non-stimulation group, which had a change rate of 85.5 ± 7.2% (mean ± SE), the stimulation group had a change rate of 92.9 ± 7.0%, which was not statistically significant (p<0.595).

Total trajectory length
Fig. 3. Total trajectory length

2.Outer circumference area (Fig. 4)

Compared to the non-stimulation group, which had a change rate of 90.6 ± 17.8%, the stimulation group had a change rate of 79.6 ± 13.3%, which was not statistically significant (p<0.744).

Outer circumference area
Fig. 4. Outer circumference area

3.Rectangle area (Fig. 5)

Compared to the non-stimulation group, which had a change rate of 79.3 ± 14.9%, the stimulation group had a change rate of 79.4 ± 13.9%, which was not statistically significant (p<0.996).

Rectangle area
Fig. 5. Rectangle area

4.Effective value area (Fig. 6)

Compared to the non-stimulation group, which had a change rate of 92.0 ± 23.8%, the stimulation group had a change rate of 90.6 ±17.6%, which was not statistically significant (p<0.975).

Effective value area
Fig. 6. Effective value area

Ⅳ.Discussion

The purpose of this study was to examine the effect of shiatsu stimulation to the plantar region on standing balance. This was based on the hypothesis that shiatsu stimulation would have a similar effect to that reported in existing research showing the effect on standing balance of sensory stimulation to the plantar region 2~6.

In this study, which was still at the preexperimental stage, we were not able to obtain data or statistical results to substantiate the effect on balance of shiatsu to the plantar region. However, each sample observed suggested a trend in the effect of shiatsu stimulation, so there is a chance that a different result will be obtained when testing is conducted with a larger sample size.

On the other hand, all measurement values obtained from this sample were from healthy test subjects considered to be within the standard range 7. It was assumed that, for test subjects within such a range, measurement values would be easily variable based on physical condition, a factor which cannot be averaged out through uniform test procedure. For this reason, it is difficult to fully investigate the effect of shiatsu stimulation on standing balance using the measurement data obtained from a stabilograph alone.

In future study, it will be necessary to consider an experimental method that includes examination of test subjects and the use of other measurement criteria in addition to the stabilograph, with integrated analysis of the results obtained.

Ⅴ.Conclusion

Shiatsu stimulation of the plantar region in four healthy test subjects did not produce a statistically significant change in measurement values using a stabilograph.

Testing of the effect of plantar region shiatsu on standing balance was insufficient due to the limitations of the test procedure employed at this stage, necessitating a reexamination of the methods employed in testing.

VI.References

1. Ishizuka H et al: Shiatsu ryohogaku: 96, International Medical Publishers, Ltd. Tokyo, 2008 (in Japanese)
2. Okubo J et al: Sokuseki atsujuyouki ga jushin doyo ni oyobosu eikyo ni tsuite. Jibirinsho 72: 1553-1562, 1979 (in Japanese)
3. Ito A et al: Sokutei sokuakkaku ga ritsui shisei no jushin doyo ni ataeru eikyo. Nihon rigaku ryoho gakujutsu taikai 2004: A1113-A1113, 2005 (in Japanese)
4. Utsunomiya Y et al: Kankaku shigeki ga seiteki ritsui ni oyobosu eikyo. Nihon rigaku ryoho gakujutsu taikai 2005: A0853-A0853, 2006 (in Japanese)
5. Kamei S et al: Sokutei no kankaku shigeki ga jushin doyo ni ataeru eikyo ni tsuite. Aino gakuin kiyo 20: 27-40, 2006 (in Japanese)
6. Nose T et al: Boshi sokuteibu he no shokuatsu shigeki ga shisei seigyo ni oyobosu eikyo. Nihon rigaku ryoho gakujutsu taikai 2009: A4P2047-A4P2047, 2010 (in Japanese)
7. Imamura K et al: Jushin doyo kensa ni okeru kenjosha data no shukei. Equilibrium research, supplement 12: 15-23, 1997 (in Japanese)


Measurement of the Psychological Effect of Full Body Shiatsu Therapy: a Case Report

Shinpei Oki
Representative, Nekonote Shiatsu

Abstract : This report examines the case of a female patient in her 20s who received three full body shiatsu treatments between May 24 and June 7 2015, with the objective of reducing psychological stress. The psychological effect was evaluated using the Profile of Mood States (POMS) index. Following treatment, improvements in the t-scores of all six POMS factors were observed. This suggests that full body shiatsu therapy has a stress-relief effect, which may be verified through further studies.

Keywords: shiatsu, stress, POMS


I.Introduction

 So many people are feeling the effects of psychological stress in modern society that stress can be considered endemic 1. In Japan, many people look to alternative therapies, including anma, massage, and shiatsu, for treatment of stress.

 Multiple studies have been conducted into the effects of manual therapy on stress relief 2~5, confirming its effectiveness. Research has also been conducted into the use of shiatsu for treating stress 6, but insufficient data exists on the effects of general shiatsu carried out by a therapist on a patient. In this paper, we report on a case in which full body shiatsu used to alleviate stress with psychological stress measured using a mood profile, which will serve as a springboard for future investigation.

Ⅱ.Methods

Test subject

 Female office worker in her 20s

Period

 May 24 to June 7, 2015 (3 sessions)

Location

 Patient’s home

Treatment method

 Namikoshi-style full body shiatsu, starting in lateral position

Evaluation method

 In order to evaluate psychological effects, a Japanese-language POMS™ test (Kaneko Shobo) was administered immediately before and after treatment. POMS is a mood profile test developed by McNair et al in the U.S., which employs answers to 65 questions to enable simultaneous measurement of six factors: tension-anxiety, depression, anger-hostility, vigor, fatigue, and confusion 7. The POMS results for this report were converted from raw data to t-scores and totaled. POMS has been implemented on large groups of healthy adult males and females and standardized, with t-scores calculated for mean value and standard deviation by age and sex. The t-score is calculated as 50 + 10 x (raw score – average score) / standard deviation. If the raw score is equal to the average score, the t-score will be 50. The lower the t-score, the lower the tension-anxiety, depression, anger-hostility, vigor, fatigue, or confusion. Thus, for vigor, a higher t-score indicates a more favorable condition 7.

 The goal and measurement procedure for POMS was fully explained to the patient and her consent obtained.

Ⅲ.Results

History of present illness

 The patient was transferred to a new department at work in April 2015 and, still unaccustomed to the new workplace and job responsibilities, was experiencing high daily stress levels. Work mainly involved VDT (video display terminal) operation, with over 7 hours per day spent engaging in computer input.

Medical history

 Inguinal hernia (surgery completed in 2013)

Family history

 No relevant items

Subjective findings

  • Sleep disorder
    On some days, the patient had difficulty getting to sleep because she was unable to relax emotionally. The harder she tried to sleep, the more difficult it would become.
  • Neck, shoulder, and lumbar pain
    The patient experienced chronic neck and shoulder stiffness. Perhaps because she assumed the same posture for extended periods, she experienced a grinding pain when she extended her back.

Examination findings

  • Observation
    The patient’s complexion was poor, with bags under her eyes and numerous pimples around her jaw. Head-forward poster with exaggerated lumbar kyphosis was observed.
  • Palpation
    Cervical region: Hypertonus was confirmed in anterior and middle scalenus, splenius capitis, rectus capitis posterior major and minor, and semispinalis capitis. Misalignment of the lower cervical vertebrae was also observed.
    Shoulder, dorsal, and lumbar regions: Hypertonus was confirmed in the upper trapezius, levator scapulae, and quadratus lumborum.
    Abdomen: The lower abdomen was flaccid and induration was observed in the descending colon region (left umbilical region).

Treatment #1 (May 24, 2015)

  • Rigidity in the dorsal region was alleviated.
  • Post-treatment, the patient reported fullbody relaxation and mild drowsiness.

Treatment #2 (May 30, 2015)

  • Patient reported that she slept well after the previous treatment and that she awoke the next morning with no feelings of lethargy.
  • She also stated that her neck and shoulders felt lighter than usual.

Treatment #3 (June 7, 2015)

  • Patient reported that she slept well for several days after treatment and that she felt comparatively fresh on waking.
  • She still felt stiffness in the neck and shoulders, but it was not severe. Her lumbar region was still slightly stiff, but not painfully so.
  • She felt that her stress level was lower as well.

 Table 1 shows the POMS t-scores measured before and after all three treatments. Aside from the anxiety factor on May 24 and the vigor factor on May 30, the values for all factors showed improvement posttreatment, with a general trend toward improvement as the treatments progressed (Fig. 1).

Table 1. T-scores for six POMS factors
Table 1. T-scores for six POMS factors

Fig. 1. Changes in t-scores for six POMS factors
Fig. 1. Changes in t-scores for six POMS factors

Ⅳ.Discussion

 In the case presented in this report, the patient showed improvement in all six POMS factors over the course of three treatments. Kamohara et al and Asai et al demonstrated the possibility for suppression of sympathetic nervous system activity using shiatsu to the abdominal region and the dorsal region, respectively 8-9. Also, Yokota, Watanabe, and Tadaka et al reported miotic (pupil contraction) response to shiatsu to the anterior cervical, lower leg, sacral, and head regions, respectively, possibly due to either suppression of the sympathetic nervous system or stimulation of the parasympathetic nervous system 10~12. The patient in this case report received full body shiatsu, including comprehensive shiatsu stimulation to all of the above-mentioned regions, so it is probable that a relaxation effect was achieved due to both suppression of the sympathetic nervous system and stimulation of the parasympathetic nervous system. In addition, Kato reported that, in restraint-stressed rats, acupuncture electrostimulation lead to normalization of secretion of monamines including dopamine and serotonin in all areas of the brain 13, so one might consider the possibility that a similar mechanism occurs with shiatsu stimulation as well.

 A single case such as this is insufficient evidence to argue for the effectiveness of shiatsu therapy for treatment of stress. Verification of the effectiveness of shiatsu as a means of stress alleviation will require a study employing statistical methodology, which I hope to pursue as a research topic in the future.

Ⅴ.Conclusion

 Improvement was observed in all six POMS factors over the course of three full body shiatsu treatments.

References

1. Govt. of Japan Cabinet Office website: Heisei 20 nendo-ban kokumin seikatsu akusho, 2008 (in Japanese)
2. Kober A, Scheck T, et al: Auricular acupressure as a treatment for anxiety i prehospital transport setting. Anesthesiology 98: 1328-1332, 2003
3. Sato T: Kenko na seijin josei ni okeru hando massaji no jiritsu shinkei katsudo oyobi kibun he no eikyo. Yamanashi daigaku kango gakkaishi 4(2): 25-32, 2006(in Japanese)
4. Fujita K: Haibu massaji ni yoru seijin dansei no shintaiteki • sinnriteki eikyo. Ube furontia diagaku kangogaku janaru 4(1): 37-43, 2011 (in Japanese)
5. Sakai K et al: Kenko na josei ni taisuru takutiru kea no seiriteki • shinriteki koka. Nippon kango kenkyu gakkaishi 35(1): 145-152, 2012 (in Japanese)
6. Honda Y et al: Serufu keiraku shiatsu ga kibun ni oyobosu kyusei koka to sono yuzabiriti ni kan suru kenkyu. Kenko Shien 15(1): 49-54, 2013 (in Japanese)
7. Yokoyama K: Nihongoban POMS tebiki, 1-7. Kaneko Shobo, Tokyo, 1994 (in Japanese)
8. Kamohara H et al: Effects of Shiatsu Stimulation on Peripheral Circulation. Toyo ryoho gakko kyokaishi(24): 51-56, 2002 (in Japanese)
9. Asai S et al: Effects of Shiatsu StimuIation on Muscle PIiability. Toyo ryoho gakko kyokaishi (25): 125-129, 2001 (in Japanese)
10. Yokota M et al: Effect on Pupil Diameter of Shiatsu Stimulation to the Anterior Cervical and Lateral Crural Regions. Toyo ryoho gakko kyokaishi (35): 77-80, 2011 (in Japanese)
11. Watanabe T et al: Effect on Pupil Diameter,Pulse Rate, and Blood Pressure of Shiatsu Stimulation to the Sacral Region. Toyo ryoho gakko kyokaishi (36): 15-19, 2012 (in Japanese)
12. Tadaka S et al: Tobu he no shiatsu shigeki ga doko chokkei • myakuhakusu• ketsuatsu ni oyobosu koka. Toyo ryoho gakko kyokaishi (37): 154-158, 2013 (in Japanese)
13. Kato M: Kosoku sutoresu ratto he no hari tsuden shigeki no nonai monoamin ni oyobosu eikyo. Meiji shinkyu igaku (27): 27-45, 2000 (in Japanese)


Shiatsu Therapy for a Patient with Suspected Peripheral Neuropathy while Diagnosed with Traumatic Cervical Spinal Cord Injury

Ichiro Maruyama
Graduated Japan Shiatsu College in 2012

Abstract : This report examines the case of a patient diagnosed with traumatic cervical spinal cord injury and suspected peripheral neuropathy (flaccid paralysis of the lower extremities) who was treated with shiatsu therapy for the alleviation of dorsal muscle tension. After 29 treatments, lower-limb motor function recovered. This suggests that hypertonicity in paraspinal muscles was significantly related to the motor dysfunction due to peripheral neuropathy. Considering other reports on the effect of shiatsu stimulation in improvement of muscle pliability, we conclude that in this patient the decrease in muscle hypertonicity due to shiatsu therapy resulted in improved blood circulation and increased spinal range of motion, leading to a recovery of motor function.

Keywords: flaccid paralysis of the lower extremities, shiatsu therapy, dorsal muscle tension


I.Introduction

 Spinal cord injury refers to injury of the spinal cord where it is protected within the spinal canal. Depending on the level of the spinal cord injury, symptoms presented may include motor, respiratory, circulatory, urinary, digestive, or other dysfunctions. Treatment is divided between initial phase treatment and chronic phase treatment, with initial phase treatment including pharmacotherapy, localized rest, cranial traction, and surgery, while chronic phase treatment centers on rehabilitation. Here, we report on a case in which the symptoms of a patient diagnosed with traumatic cervical spinal cord injury virtually disappeared following therapy.

Ⅱ.Methods

Location

 Patient’s home

Period

 August 25 to December 1, 2014 (Number of treatments: 29)

Test subject

 82 year old female

History of present illness

 The patient sustained a traumatic cervical spinal cord injury 46 years previously. Rehabilitation restored motor function in the upper limbs, but paralysis (paraplegia) of the lower limbs remained and she had been confined to a wheelchair ever since. Six years previously she sustained a fracture to her right humerus, and later required amputation of the arm due to pyogenic osteomyelitis. Two years previously she was diagnosed with tuberculosis and admitted to a tuberculosis ward, after which she became bedridden. After discharge from the hospital, she developed pain in her upper limb and dorsal regions, and it was arranged for her to received homecare massage for alleviation of the pain.

Medical history

 Paraplegia (circulatory organ, urinary, and digestive organ dysfunction) due to spinal cord injury; gallbladder cancer; pancreatic cancer; tuberculosis; amputation of right arm due to pyogenic osteomyelitis

Treatment

  • Shiatsu to cervical, dorsal, sacral, and gluteal regions in lateral position
  • Shiatsu to left upper limb and lower limbs in supine position (emphasis on treatment of lower limbs)

Evaluation

  • Pain evaluated using 10-step VAS
  • Manual muscle testing (MMT)

III.Results

August 25 (Treatment #1)
Pre-treatment findings
 Subjective findings

  • Motor paralysis and sensory dysfunction inferior to lumbar region
  • Numbness below knees
  • Bladder and rectal dysfunction
  • Pain in upper limb and dorsal regions
  • Hot and cold flashes (excessive sweating from neck up)

 Objective findings

  • Limited range of motion in left shoulder joint
  • Flaccid paralysis and sensory dysfunction of lower limbs
  • Pain in dorsal and gluteal regions

 Post-treatment findings

  • Hot and cold flashes alleviated due to improved circulation
  • Pain reduced

September 4 (Treatment #4)
 Post-treatment findings

  • Dorsal region muscle tension reduced (thoracolumbar junction)
  • Pain in medial femoral region absent
  • Slight return of sensory function in femoral region (femoral nerve, obturator nerve)
  • Muscle contraction observed in femoralregion (adductor muscles)

September 8 (Treatment #5)
 Post-treatment findings

  • Plantar pain absent
  • Patient found shiatsu to sacral region pleasurable

September 18 (Treatment #8)
 Post-treatment findings

  • Patient felt urinary and bowel sensations (improvement of bladder and rectal dysfunction)
  • Return of sensory function to femoral region

October 2 (Treatment #12)
 Post-treatment findings

  • Muscle contraction observed in femoral region (femoral nerve, obturator nerve)

October 30 (Treatment #20)
 Post-treatment findings

  • Muscle contraction observed in femoral region (sciatic nerve)

November 6 (Treatment #22)
 Post-treatment findings

  • Movement observed in hip joint (flexion, extension, external rotation, internal rotation)
  • Movement observed in knee joint (flexion, extension)
  • Left shoulder joint more stable; pain absent
  • Changed sensation distal to knee

November 17 (Treatment #25)
 Post-treatment findings

  • Movement observed in ankle joint and toes (flexion, extension) with patient lying in lateral position
  • Patient able to form slight bridge (elevation of gluteal region)

December 1 (Treatment #29)
 Post-treatment findings

 Subjective findings

  • Patient experiences numbness in calcaneal region
  • Pain eliminated

 Objective findings

  • Return of motor function inferior to lumbar region
  • Improvement to bladder and rectal dysfunction

Table 1. 10-step VAS pain scale values (post-treatment)
Table 1. 10-step VAS pain scale values (post-treatment)

Table 2. Manual muscle testing (MMT) of lower limbs
Table 2. Manual muscle testing (MMT) of lower limbs

IV.Discussion

 In most cases of spinal cord injury, the vertebrae undergo dislocation fracture due to an external force, with concomitant damage to the spinal cord. Characteristics vary depending on the level and degree of spinal cord injury (complete or incomplete paralysis), but immediately after the injury spinal shock occurs and autonomy is lost in the spinal cord inferior to the injury. Specifically, flaccid paralysis occurs, with loss of all motor, sensory, and deep tendon reflex function, while at the same time autonomic nervous function is also impaired. Following the recovery period, reflex functions in the spinal cord inferior to the injury are recovered, resulting in spastic paralysis, characterized by hyperreflexia of the deep tendon reflexes 1.
 In this case, since the patient exhibited flaccid paralysis from post-injury to the present, it is likely that this was a case not of spinal cord injury, but rather of spinal cord compression. In other words, assuming lower motor neuron damage and comparing spinal cord injury level with ADL levels, since T1 ADLs (upper limbs normal, full wheelchair mobility) were possible and T6 functions (circulatory organ stability) were unstable, it was determined that there was an irregularity in the upper thoracic vertebrae. Clinical findings indicated that the thoracic spine was straight, with almost no curve in the thoracic vertebrae. We may hypothesize that this caused hypertonus in the dorsal musculature, causing lower motor neuron damage, pain, and motor dysfunction.
 Based on the above determination of peripheral neuropathy due to spinal cord compression, shiatsu therapy was carried out with the objective of alleviating pain and restoring motor function in the patient. As a result, after 29 treatments, decrease in VAS values as an indicator of pain (Table 1) and recovery of muscle strength as determined by manual muscle testing (Table 2) were observed, although numbness remained in the calcaneal region. If this were a case of spinal cord injury, such rapid return of function would be unlikely 2-3. It is therefore reasonable to assume that recovery was due to shiatsu treatment of peripheral neuropathy caused by nerve entrapment due to hypertonic muscles.
 At the very least, in this case it is highly likely that hypertonicity in paraspinal muscles was significantly related to the motor dysfunction due to peripheral neuropathy. Considering other reports on the effect of shiatsu stimulation in improvement of muscle pliability 4~6, we conclude that in this patient the decrease in muscle hypertonicity due to shiatsu therapy resulted in improved blood circulation and increased spinal range of motion, leading to a recovery of motor function.

V.Conclusion

 Even in patients afflicted by long-term peripheral neuropathy (pain and motor dysfunction), recovery through shiatsu therapy is possible.

VI.References

1. Nara N et al: Toyo ryoho gakko kyokai rinsho igakukakuron (dai 2 han) sekizui sonsho. Ishiyaku shuppan KK: 171-173, 2010 (in Japanese)
2. Shinno Y: Massho shinkei shogai no rihabiriteshon. Nihon rihabiriteshon igakukaishi 28 (6): 453-458 (in Japanese)
3. Nishiwaki K et al: Massho shinkei sonshogo no shinkeisaisei to rihabiriteshon. Nihon rihabiriteshon igakukaishi 39 (5): 257-266, 2002 (in Japanese)
4. Asai S et al: Effects of Shiatsu Stimulation on Muscle Pliability. Toyo ryoho gakko kyokai gakkaishi (25): 125-129, 2001 (in Japanese)
5. Sugata N et al: Effects of Shiatsu Stimulation on Muscle Pliability(Part2). Toyo ryoho gakko kyokai gakkaishi (26): 35-39, 2002 (in Japanese)
6. Eto T et al: Effects of Shiatsu Stimulation on Muscle Pliability(Part3). Toyo ryoho gakko kyokai gakkaishi (27): 97-100, 2003 (in Japanese)


A Case of Posture Correction with a Combination of Pressure Application and Mobilization

Genta Niikura
Clinic Director, Genta Chiryoin

Abstract : In clinical practice, one encounters many patients presenting subjective symptoms of shoulder stiffness or back pain. Here we examine a case in which symptoms were alleviated through posture and joint correction, in addition to using shiatsu therapy to reduce muscle tension. By combining the pressure applications of shiatsu therapy with mobilization, it was possible to achieve an effect on both muscles and joints.

Keywords: shiatsu therapy, pressure application, exercise therapy, posture correction


I.Introduction

 In clinical practice, one often encounters patients for whom, even though muscle tension is alleviated through shiatsu therapy consisting of pressure application to muscles and soft tissues, similar symptoms return after several days or weeks.

 It was our opinion that these symptoms could be more effectively treated with a combination of shiatsu therapy and ongoing posture correction and joint adjustment.

 Here, we report on a case in which significant therapeutic effect was achieved through joint adjustment and posture correction via the use of pressure applications combined with mobilization.

Ⅱ.Methods

Subject

 Female child care worker in her 30s

Location

 This clinic (Genta Chiroin)

Period

 March 30 to April 12, 2014

Primary complaint

 Work involves frequent crouching, leading to lumbar pain, stooped posture, and severe shoulder stiffness; patient told by coworkers that she has poor posture

Treatment method

 Full body shiatsu 1 combined with mobilization for shoulder, hip, and sacroiliac joints

  • For rounded back:
    Prone position: Palmar pressure to spine, spinous process adjustment
  • For internal rotation of shoulder joints:
    Lateral position:
    Pressure applications to superior angle of scapula, sub-clavicular region, and coracoid process, plus adjustment procedure to scapula
  • For Lumbar kyphosis:
    Supine position: Palmar pressure to abdomen and inguinal region
    Prone position: Adjustment of hip and sacroiliac joints
  • For posterior pelvic tilt:
    Supine position: Palmar pressure to abdomen and inguinal region
    Prone position: Adjustment of hip and sacroiliac joints

III.Results

Treatment #1 (March 30, 2014)
Pre-treatment findings
 Subjective findings

  • Work involves frequent crouching, leading to lumbar pain, stooped posture, and severe shoulder stiffness; patient told by coworkers that she has poor posture Objective findings
  • Exaggerated posterior pelvic tilt, rounded back, exaggerated internal rotation of shoulders (Fig. 1)

Post-treatment findings
 Subjective findings

  • Reduced sensations of shoulder stiffness and lumbar pain; reduced discomfort at work, even after maintaining same posture for a prolonged period

 Objective findings

  • Tension in lumbar musculature reduced due to creation of anterior pelvic tilt and lumbar lordotic curve; reduced internal rotation of shoulders due to improved shoulder posture (Fig. 2)

treatment #1

Treatment #2 (April 12, 2014)
Pre-treatment findings
 Subjective findings

  • Patient told by those around her that her posture had improved; alleviation of lumber pain

 Objective findings

  • Anterior pelvic tilt maintained; exaggerated internal rotation of shoulders observed (Fig. 3)

Post-treatment findings
 Subjective findings

  • Alleviation of symptoms of shoulder stiffness and lumbar pain; reduced discomfort, even after maintaining same posture for a prolonged period

 Objective findings

  • Improvement of exaggerated internal rotation of shoulders (Fig. 4); alleviation of muscle tension due to adjustment of joint position

treatment #2

IV.Discussion

 According to the Comprehensive Survey of Living Conditions by the Japanese Ministry of Health, Labour and Welfare 2, the two most common symptoms experienced by both men and women in Japan are, in order, stiff shoulders and lumbar pain. Little has changed in this situation, and a comparatively large number of patients visiting our clinic list stiff shoulders or lumbar pain as their primary complaint.

 It is my experience in a clinical setting that, in order to alleviate shoulder stiffness or lumbar pain, effects are longer lasting if reduction of excess muscle tension is used in combination with joint adjustment.

 The reason is that, as humans are bipedal, they must continually maintain posture in opposition to gravity. The extensors, trunk muscles, and other antigravity muscles must maintain contraction in order to resist gravity and maintain proper posture, which when disrupted is corrected by postural reflexes 3. It follows that a greater load is placed on these muscles when proper posture and skeletal alignment are regularly disrupted during routine daily activities. For this reason, correction of chronically disrupted postural and skeletal alignment should help alleviate symptoms of shoulder stiffness and lumbar pain.

 In this case, initial examination revealed marked postural disruption from the line of gravity (Fig. 1), indicating probable hypertonus in the pectoralis major and other shoulder internal rotator muscles along with reduced tonus of the antigravity muscles. Also, hypertension in the gluteus maximus and hamstring muscles were likely responsible for the posterior pelvic tilt.

 In the initial treatment, hypertonus in the gluteus maximus and hamstrings was improved, along with overextension of the quadratus lumborum and erector spinae muscles, as was evidenced by the reductions in posterior pelvic tilt and lumbar kyphosis. Also, concerning the shoulder joints, changes to the position of the scapula were likely due to reduced hypertonus in the internal rotators, including the pectoralis major, latissimus dorsi, and subscapularis (Fig. 2).

 Prior to treatment #2, a slight internal rotation of the shoulder joints was observed, though no major postural disruption from the line of gravity compared to post-treatment #1 was apparent (Figs. 2, 3). In treatment #2, further improvements to pliability in hypertoned muscles improved balance with over-extended muscles, causing positional changes to the shoulder joint and humerus that likely resulted in reduced tension in the trapezius, sternocleidomastoid, and other neck muscles that led to improvements in head position.

 It is difficult to determine whether disrupted posture due to routine daily activities led to muscular hypertonus and hypotonus or whether the problem was due to irregularities in joint alignment, but since multiple reports have shown that shiatsu stimulation effectively increases muscle pliability 4-6, in this case it is likely that pressure application relaxed hypertoned muscles that were the cause of postural disruption while mobilization improved joint positioning, resulting in alleviation of symptoms.

V.Conclusions

 When the pressure applications of shiatsu therapy are combined with mobilization, there is a tendency for symptoms of stiff shoulders and lumbar pain to be alleviated due to elimination of muscle hypertension and improved joint positioning. However, because this report only contains one example, it will be necessary to study a larger number of cases.

VI.References

1. Ishizuka H: Shiatsu ryohogaku, first revised edition, International Medical Publishers, Ltd. Tokyo, 2008 (in Japanese)
2) 2. Japanese Ministry of Health, Labour and Welfare: Kokumin seikatsu kiso chosa. 2013, http://www.mhlw.go.jp/toukei/list/20-21.html (in Japanese)
3. Toyo ryoho gakko kyokai: Seirigaku. Ishiyaku shuppan KK, 1990 (in Japanese)
4. Asai S et al: Effects of Shiatsu Stimulation on Muscle Pliability. Toyo ryoho gakko kyokai gakkaishi (25): 125-129, 2001 (in Japanese)
5. Sugata N et al: Effects of Shiatsu Stimulation on Muscle Pliability(Part2). Toyo ryoho gakko kyokai gakkaishi (26): 35-39, 2002 (in Japanese)
6. Eto T et al: Effects of Shiatsu Stimulation on Muscle Pliability(Part3). Toyo ryoho gakko kyokai gakkaishi (27): 97-100, 2003 (in Japanese)


Effects of Inguinal Region Shiatsu on Walking Ability

Hiroki Koizumi
Shiatsu Department, Japan Shiatsu College
Yasutaka Kaneko
Shiatsu instructor, Japan Shiatsu College; Clinic director, MTA Shiatsu Chiryoin

Abstract : The Timed Up and Go (TUG) test was employed to determine the effect of inguinal region shiatsu on walking ability. The post-treatment time was shorter than the pre-treatment time, suggesting that shiatsu stimulation may improve walking ability at least temporarily.

Keywords: Timed Up and Go Test, iliopsoas muscle, inguinal region, shiatsu


I.Introduction

 Yoshinari et al have reported on the possibility that shiatsu stimulation to the inguinal region increases range of motion for hip extension and lumbar vertebrae retroflexion in standing automatic trunk retroflexion 1, postulating that shiatsu stimulation to the inguinal region reduced tension in the iliopsoas muscles, increasing range of motion in the lumbar vertebrae and hip joints. However, there was no reference to functional changes. In this comparatively simple study, we observe changes to walking ability after inguinal region shiatsu using the highly reliable TUG test as an evaluative tool. The TUG test, devised by Podsiadlo et al in 1991 2, is a widely used evaluation index for walking ability in the elderly.

Ⅱ.Methods

Location

 8th floor classroom, Namikoshi Institute • Japan Shiatsu College

Test subject

 66-year-old male (no history of central nervous system dysfunction, bone fractures, muscle rupture, degenerative arthritis, or other disorders that may affect lower limb function)

Period

 September 4, 12, 19, October 3, 2015 (4 treatments over 30 days)

Stimulation

 The subject was placed in a relaxed supine position with all four limbs extended. The therapist stimulated three points over the inguinal ligament, extending medioinferiorly from the anterior superior iliac spine to the lateral border of the pubic bone 3. Stimulation consisted of (1) palmar pressure (pressure using the thenar eminence) and (2) shiatsu using the therapist’s thumbs of both hands, held for approximately 5 seconds per point, applied for 5 minutes each on the left and right sides. Strength of pressure was such that, when the therapist’s palm and thumbs sank into the skin and subcutaneous tissue, he was able to feel the inguinal ligament and femoral pulse, at a pressure that was comfortable for the subject.

Evaluation

 The TUG test was used to evaluate pre- and post-treatment times required. An armless chair was used, with a red cone placed 3 meters directly in front of the leading edge of the front leg as a marker. Responding to a verbal signal, the subject was required to stand up from the chair, walk around the cone, and return to sit in the chair. The time required to complete this task was measured with a stopwatch. The task was performed immediately before and immediately after stimulation, (1) at regular walking speed; and (2) at maximum walking speed, once for each. The times were measured and the time for walking speed at (2) maximum effort was used as the measurement value.

III.Results

 Post-stimulation times were reduced compared to pre-stimulation for all four sessions. No overall time reduction was seen for pre-stimulation or post-stimulation times over the entire period. (Table 1, Fig. 1)

Table 1. TUG times (sec)
Table 1. TUG times (sec)

Fig. 1. TUG time changes
Fig. 1. TUG time changes

IV.Discussion

 The iliopsoas is comprised of two muscles, the iliacus and the psoas major, which come together in the pelvic cavity to form the iliopsoas before passing through the muscular lacuna below the inguinal ligament and inserting onto the lesser trochanter of the femur. Shiatsu of the inguinal region targets pressure to the inguinal ligament, with pressure directed more or less perpendicularly to the skin’s surface on points along the inguinal ligament from the anterior superior iliac spine to the lateral border of the pubic bone. The pressure therefore should penetrate to the iliopsoas muscle.

 When walking at a moderate pace, after reaching extension at the end of the stance phase the lower limb swings forward like a pendulum, allowing the foot to move forward without employing the iliopsoas muscle. However, in effortful walking, the iliopsoas contracts powerfully during the initial-to-mid swing phase, flexing the extended leg to swing it forward 4. According to research conducted by Anderson et al using an electromyograph, the effect of these muscles on walking is greater the faster the pace 5. It is also likely that iliopsoas functionality also plays a role in pelvic stability while walking, as well as emergency postural control when balance is lost.

 Eto reported on the probability that shiatsu stimulation improves regulation of muscle output 6, hypothesizing that this may be due to its effect on kinetic and sustained neuromuscular units along with increase in local blood supply. Similarly, the reduced post-treatment times recorded in this study were likely due to changes in the condition of the iliopsoas muscles due to shiatsu stimulation of the inguinal region, affecting their function during effortful walking to result in increased walking speed.

 Regarding the fact that no cumulative time reduction was observed during the overall test period, this was likely because shiatsu stimulation to the iliopsoas in isolation did not result in a fixed change to the condition of the muscle. We hypothesize that, in order to achieve a more lasting change, it would be necessary to effect changes in hip flexors other than the iliopsoas, including the rectus femoris and tensor fasciae latae, along with antagonists such as the gluteus maximus and hamstrings, leading to changes of alignment in the sagittal plane for the hip joint and pelvis.

 In this case, because no control was used, we cannot rule out the possibility that the reduced times were due to a learning effect in the test subject. Further research employing test methodology that includes a control is required in order to verify the effect of shiatsu stimulation in isolation.

V.Conclusion

 Shiatsu stimulation to the inguinal region resulted in a tendency for TUG times to be shorter post-stimulation than pre-stimulation.

VI.References

1. Yoshinari K et al: Effect on Spinal Mobility of Shiatsu Stimulation to the Inguinal Region. Toyo ryoho gakko kyokai gakkaishi 32: 18-22, 2008 (in Japanese)
2. Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39.2: 142-148, 1991
3. Ishizuka H et al: Shiatsu ryohogaku. International Medical Publishers, Ltd. Tokyo: 102, 2008 (in Japanese)
4. Neumann D, Shimada T, Hirata S:Kinkokkakukei no kineshioroji. Ishiyaku Shuppan, Tokyo: 573-574, 2005 (in Japanese)
5. Andersson EA et al: Intramuscular EMG from the hop flexor muscles during human locomotion. Acta Physiologica Scandinavica Vol. 161, Issue 3: 361-370, 1997
6. Eto T: Shiatsu ni yoru teihaikutsuryoku no henka ni tsuite. Nihon shiatsu gakkai (2): 10-12, 2013 (in Japanese)


The Effect of Standard Namikoshi Abdominal Region Shiatsu on Shortdistance Sprint Performance

Keisuke Okubo, Maho Nakano
Japan Shiatsu CollegeShiatsu Department
Hiroyuki Ishizuka
Japan Shiatsu CollegeShiatsu instructor

Abstract : Sports are receiving increasing attention in Japan ahead of the 2020 Tokyo Olympic Games. The goal of this study was to verify the effect of standard Namikoshi shiatsu therapy on sports performance.
After adequate warm-up, the test subject performed five 50-meter sprints separated by 5-minute rest intervals. The sprints were timed and photographed using a fixed camera to facilitate running posture analysis. Abdominal shiatsu, consisting of the standard 20 points on the abdomen, repeated 3 times, was applied before the initial run and during each 5-minute interval. During control testing, the subject spent the same time resting in supine position. Testing was performed on different days for shiatsu and control sessions.
On average, sprint times were shorter when shiatsu had been applied. Comparison of photographic images also showed changes in trunk rotation, knee flexion, and stride length. These results suggest that Namikoshi standard abdominal shiatsu consisting of pressure to 20 points on the abdomen may have positive effects on sprint performance.

Keywords: Shiatsu, run, sprint, abdominal region, abdominal pressure, trunk, exercise, time, 50m, track and field, manipulative therapy, angular motion, image, rectus abdominis, obliquus externus abdominis muscle, obliquus internus abdominis muscle, Olympic, length of stride, twist, motion, ROM, range of joint motion, joint, load, track, race, performance, massage, start, dash, run, crouch start, running motion, abdominal region shiatsu based on Namikoshi shiatsu therapy’s standard procedures


I.Introduction

 In this study, we examined the effect of standard Namikoshi 20-point abdominal shiatsu 1 applied to a runner prior to running a 50-meter sprint on ankle, knee, trunk, and shoulder joint ROM, hip flexion speed, and starting hip position, and verified the accompanying changes to stride length and run time.

 Measurements were taken after applying shiatsu stimulation to the test subject on August 15, with control measurements taken on August 2 when the test subject had received no shiatsu stimulation. Shiatsu stimulation consisted of standard Namikoshi 20-point abdominal shiatsu, repeated 3 times, before the initial run and during the 5-minute rest interval prior to each of 5 runs. Adequate stretching was carried out prior to running 2.

Ⅱ.Methods

Dates

 August 2 and 15, 2015

Location

 Komazawa Olympic Park athletic field, straight track

Test subject

 27-year-old male Weight: 52 kg Height: 161 cm
 Played soccer from elementary school to university

Equipment

 CASIO Digital Sports Stop Watch HS-70W

Imaging equipment

 SONY HANDYCAM HDR-CX420
 iPhone 6plus

Editing application

 Adobe premiere pro CC 2015
 Adobe photoshop CC 2015

Fig. 1. Experiment protocol
Fig. 1. Experiment protocol

III.Results

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Table 1. Comparison of times (sec) with and without abdominal shiatsu
Table 1. Comparison of times (sec) with and without abdominal shiatsu

Table 2
Table 2.

 

IV.Discussion

 The short-distance running cycle can be divided into two phases: (1) the support phase (when the sole of the foot is in contact with the ground); and (2) the recovery phase (when the sole of the foot is not in contact with the ground). Phases (1) and (2) can each be further divided into three sub-phases. The (1) support phase includes (1)-1 foot strike (the period when a portion of the sole of the foot is in contact with the ground); (1)-2 mid support (The period from when the sole of the foot is in full contact with the ground, supporting the body’s weight, to immediately before the heel loses contact with the ground); and (1)-3 takeoff (the period from when the heel loses contact with the ground to when the toes leave the ground). The (2) recovery phase includes (2)-1 follow-through (the period from when the sole of the foot leaves the ground to when rearward motion of the lower leg ends); (2)-2 forward swing (the period when the lower leg is moving from back to front); and (2)-3 foot descent (the period immediately prior to when the sole of the foot makes contact with the ground). Specific muscles are active during each of these phases, which may vary depending on running speed. When observing the muscles active while running, the abdominal muscles are strongly active only when running 100 m at an average speed of 36 km/h, as compared to 1 km at an average speed of 12 km/h or 16 km/h. During the running cycle, strong abdominal muscle activity is observed from (1)-2 to (2)-2 3.

 The reason abdominal muscle activity is only observed in short-distance running is due to the strong angular momentum generated between arm swinging and the pelvis. While running, the pelvis produces rotational motion on a vertical axis, generating angular momentum around the vertical axis. Arm swinging is important for reducing trunk deflection due to this motion; in practice, the angular momentum produced by arm swinging eliminates the trunk deflection due to pelvic angular momentum. This is a distinguishing characteristic of short-distance running 4.

 In running there is an ideal leg trajectory. According to research conducted using a sprint training machine, leg motion effectively utilizes flexible twisting and rotational motions in the pelvis and trunk and is also necessary to adroitly maintain balance. Also important is that this motion originates in the epigastric fossa, around the level of the upper lumbar and lower thoracic vertebrae 5.

 Muscles thought to be affected by abdominal region shiatsu include the muscles related to maintaining abdominal pressure (diaphragm, rectus abdominis, external abdominal obliques, internal abdominal obliques). When these abdominal wall muscles contract in coordination with the pelvic floor muscles, intra-abdominal pressure rises. It is known that increased intraabdominal pressure significantly reduces the load placed on upper and lower lumbar intervertebral discs 6.

 Based on the above discussion, one possible explanation for improved running performance and shorter times recorded in this study is that abdominal shiatsu resulted in more coordinated performance of muscles involved in maintaining intraabdominal pressure and improved trunk stability. It is also possible that improved response time from the start of the sprint to the first step resulted in faster running times, but analysis would be problematic at this stage.

Ⅴ.Conclusions

 Abdominal shiatsu does not directly affect the lower limbs, which are the focus of running. However, it may have an effect on the trunk, from where such motion originates, contributing to more ideal motion in the upper and lower limbs.

 Nevertheless, many points in this study remain unclear, and it is possible that there would be no effect on middle or long distance running times, where abdominal muscle activity is less apparent. More specialized testing and analysis is required.

References

1 Ishizuka H: Shiatsu ryohogaku, first revised edition, International Medical Publishers, Ltd. Tokyo, 2008 (in Japanese)
2 Sugiura S: Sutoretchingu & womuappu buibetsu tekunikku to kyogibetsu purogruramu. Oizumi shoten, 2008 (in Japanese)
3 Kawano I, Tsukuba Daigaku et al editorial supervision: Konin asuretikku torena senmon kamoku teksuto, dai 6 suri. Bunkodo, 2011 (in Japanese)
4 Shikakura J et al editors, Kawano I et al editorial supervision: Konin asuretikku torena senmon kamoku tekisuto, dai 7 kan asuretikku rehabiriteshon. Bunkodo, 2011 (in Japanese)
5 Kobayashi K: Ranningu pafomansu wo takameru supotsu dosa no sozo. Kyorin shoin: 42, 2001 (in Japanese)
6 Sakai T et al translator: Purometeus kaibogaku atorasu kaibogaku soron undokikei dai 2 ban. Igaku shoin, 2013 (in Japanese)

Additional reference

Saito H: Undogaku. Ishiyaku Shuppan, 2003

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