タグ別アーカイブ: 腹診

Applied Abdominal Shiatsu

Michiko Kuroda
Japan Shiatsu CollegeShiatsu instructor

Report on Shiatsu Overseas

In order to promote the international spread of shiatsu, a therapy developed in Japan, the Namikoshi Academy • Japan Shiatsu College sends instructors to Vancouver, Canada once a year to provide practical guidance. In 2015, Japan Shiatsu College instructor Michiko Kuroda delivered a presentation to instructors of the Canadian College of Shiatsu Therapy and therapists at the Japan Shiatsu Clinic on the theme of applied abdominal shiatsu. Below is the report submitted by Ms. Kuroda on her presentation.


 On September 26, 2015 I delivered a lecture to the staff of the Japan Shiatsu Clinic. At the Japan Shiatsu Clinic, operated by Japan Shiatsu College graduate Kiyoshi Ikenaga, many students of different nationalities engage in study of anatomy, physiology, and the fundamentals of Namikoshi shiatsu. Although I attended as an instructor, I myself learned much from the experience. Following is the content of the lecture I delivered.

1.Introduction

 The abdomen is a region for which significant therapeutic effect can be expected from shiatsu, but which can be challenging to treat.

 Here, using standard Namikoshi abdominal shiatsu as a base, I would like to examine the topic from the perspective of both Western and Eastern medicine, with the hope of encouraging you to more actively employ abdominal shiatsu in your treatments.

2.Standard Namikoshi abdominal shiatsu

 Research by the Shiatsu Therapy Research Lab at the Namikoshi Institute has shown that abdominal shiatsu, a distinguishing characteristic of Namikoshi shiatsu, affects the autonomic nervous system to slow cardiac pulse, lower blood pressure, increase muscular blood flow, stimulate gastrointestinal peristalsis, and reduce pupil diameter, as well as having an effect on the musculoskeletal system (Fig. 1).

 In addition, the rectus abdominis and iliopsoas muscles can also be treated, making the abdominal region an extremely important area for treating lumbar pain.

Fig 1. Standard order of abdominal shiatsu
Fig 1. Standard order of abdominal shiatsu

Fig. 2. Effect of rectus abdominis and iliopsoas hypertonus on pelvic angle and lumbar spinal curvature
Fig. 2. Effect of rectus abdominis and iliopsoas hypertonus on pelvic angle and lumbar spinal curvature

3.Western medical perspective: an anatomical approach

 As mentioned previously, abdominal shiatsu can be highly effective for both regulating the autonomic nervous system and treating lumbar pain. Now let’s examine the effect of tension in the abdominal muscles on posture.

 As shown in Fig. 2, hypertonus in the rectus abdominis and iliopsoas has a significant effect on pelvic angle and lumbar spinal curvature.

 Next, I would like to consider how to approach the psoas major from the abdominal region. Whereas the rectus abdominis is a superficial muscle, the psoas major is deep. Therefore the key to treating the psoas major muscle is to have a clear image of its origin, insertion, and path.

Iliopsoas (Fig. 3)


Origin:
 Vertebral bodies and intervertebral discs, Th12-L5 (superficial head)
 Transverse processes of all lumbar vertebrae (deep head)
Insertion:Lesser trochanter of the femur
Innervation: Femoral nerve (L1~L4)
Actions: flexion of hip joint; anterior pelvic tilt
Test: Thomas test (flexion contracture of hip joint)

Fig. 3. Iliopsoas
Fig. 3. Iliopsoas

Actions of the iliopsoas (Fig. 4)

(1) When pelvis and lumbar vertebrae are fixed
 → Flexion of hip joint
(2) When femur is fixed
 → Lumbar lordosis; anterior pelvic tilt

Fig. 4. Actions of the iliopsoas
Fig. 4. Actions of the iliopsoas

Illustration of rectus abdominis and iliopsoas

Illustration of rectus abdominis and iliopsoas

Factors to consider during pressure application
(1) Recipient’s posture

  • Recipient’s hip and knee joints should be flexed, with thoracic breathing
  • (2) Have a clear objective

  • Apply shiatsu to 20 points and small intestine points using 2-thumb pressure
  • Have clear image of location of targeted muscles and adjust depth of pressure accordingly
  • 4.Eastern medical perspective: abdominal diagnosis

    What is abdominal diagnosis?
    Abdominal diagnosis involves assessing the patient’s physical condition through palpation of the abdomen to detect stiffness or tension in the abdominal wall, resistance or pain when pressure is applied, watery sounds in the organs, and so on.
    In Western medicine, the main objective of abdominal palpation is to determine the condition of the organs from outside the abdominal wall; but in Eastern medicine, abdominal diagnosis is used to determine the quantity of healthy ki, which provides resistance to disease, along with the qualities of ki, blood, and body fluids, based on tension, stiffness, and indurations in the abdominal skin and muscles.

    In abdominal diagnosis, responses specific to each area are examined

    In abdominal diagnosis, responses specific to each area are examined

    Typical responses

    Typical responses

    Incorporating abdominal diagnosis into abdominal shiatsu
    (1) Recipient’s posture

  • Recipient’s lower limbs should be extended, with abdominal breathing
  • (2) Objective

  • Perform abdominal diagnosis and treatment during the palm pressure series
  • Perform treatment and observe reactions while treating 20 points and small intestine points
  • 5.Conclusion

     For this lecture, my motivation for addressing abdominal shiatsu was to focus on treatment of lumbar pain via shiatsu to the rectus abdominis and psoas major muscles and also to introduce abdominal diagnosis. Of course, when treating an actual patient, it is necessary to evaluate not just the abdominal region, but the quadriceps femoris, hamstrings, and other muscles as well, and conduct a thorough diagnosis that includes listening, observation, and interview techniques in addition to abdominal diagnosis.
     It is my hope that you will keep these techniques in mind as another perspective from which you can assess your patients and as a means of understanding their condition.

    References

    1. Collected Reports of The Shiatsu Therapy Research Lab 1998-2012, Japan Shiatsu College (in Japanese)
    2. Purometeus kaibogaku atorasu kaibogaku soron undokikei. Igaku shoin (in Japanese)
    3. Toyoigaku kihonto shikumi. Seitosha (in Japanese)


    応用腹部指圧:黒田美稚子

    黒田美稚子
    日本指圧専門学校専任教員

    海外指圧レポート 

    学校法人浪越学園 日本指圧専門学校では、日本発祥の指圧療法を海外へ普及すべく、年に一度カナダ(バンクーバー)へ教員を派遣し、技術指導を行っている。  平成27年度は、日本指圧専門学校 常勤教員 黒田美稚子先生が派遣され「応用腹部指圧」というテーマでCanadian College of Shiatsu TherapyのインストラクターおよびJapan Shiatsu Clinicのセラピストに対して指導に当たった。  以下講師を務められた黒田美稚子先生よりご提出いただいたレポートを掲載する。


    1.はじめに

     腹部指圧は高い治療効果が期待できる一方で難易度の高い部位でもある。今回は、浪越式腹部基本指圧をベースに西洋医学、東洋医学それぞれにおけるひとつの視点を提示し、腹部指圧を積極的に治療に取り入れていただくきっかけを作ることができたら幸いである。

    2.浪越式腹部基本指圧

     浪越式指圧の特徴である腹部指圧は、自律神経への作用として心拍数の減少、血圧の低下、筋血流量の増加、消化管蠕動運動の促進、瞳孔直径の縮小、また、筋骨格への影響としては仙骨傾斜角度の増加が浪越学園指圧研究会の研究により明らかにされている(図1)。

     さらに、腹直筋および大腰筋へのアプローチも可能であることから腰痛治療に非常に効果の高い部位でもある。

    図1.腹部指圧基本手順図1.腹部指圧基本手順

    3.西洋医学的視点から結果
     ~解剖学的アプローチ~

     前述したように、腹部指圧は自律神経調整、また腰痛治療に高い効果が期待できる。そこで今回は腹部の筋緊張が姿勢に与える影響を考えたい。
    図2のように、腹直筋、腸腰筋の過緊張が骨盤の傾斜および腰椎の弯曲に与える影響は大きい。

    図2.腹直筋、腸腰筋の過緊張が骨盤の傾斜および腰椎の弯曲に与える影響図2.腹直筋、腸腰筋の過緊張が骨盤の傾斜および腰椎の弯曲に与える影響

     そこで次に、腹部からの大腰筋へのアプローチの仕方を考えたい。腹直筋が浅層にあるのに対し大腰筋は深部に存在する。そのため、起始停止や走行のイメージを明確に持って押圧することが大腰筋へのアプローチの鍵となる。

     腸腰筋(図3)

    vol4_07fig3図3.腸腰筋


    [起  始] (浅頭)Th12~L5の椎体ならびに椎間板
          (深頭)すべての腰椎の肋骨突起
    [停  止] 大腿骨小転子
    [支配神経] 大腿神経(L1〜L4)
    [作  用] 股関節の屈曲、骨盤の前頚
    [検  査] トーマステスト(股関節屈曲拘縮)

    腸腰筋の作用(図4)

    図4.腸腰筋の作用図4.腸腰筋の作用

    ①骨盤・腰椎を固定した時
     →股関節屈曲
    ②大腿骨を固定した時
     →腰椎前弯、骨盤前傾

    腹直筋および腸腰筋のイメージ

    vol4_07fig5図 5.腹直筋および腸腰筋のイメージ

    押圧時の注意点
    ①受け手の姿勢
     股関節膝関節を屈曲した仰臥位で胸式呼吸
    ②目的を明確にする
     ・ 腹部20点圧および小腸部において両母指圧で押圧する。
     ・ ターゲットとする筋を明確にし、それに応じた深さで圧を加える。

    4.東洋医学的視点から  ~腹診~

    腹診とは
    お腹を触って、腹壁の硬さや張り具合、押さえた時の抵抗や圧痛、内臓の水の音などの特徴を探って体の状態を調べる診断法。
    西洋医学では、腹壁の上から腹部の内臓の様子を探るのが主な目的だが、東洋医学の腹診では、腹部の皮膚や腹筋の張り、硬さ、しこりの有無などから、病気への抵抗力である正気の充実度や気・血・津液の状態を把握し、五臓の不調を推察することを目的とする。

    腹診では各部位特有の反応を診る

    vol4_07fig6図6.腹診では各部位特有の反応を診る

    代表的な反応

    vol4_07fig7図7.腹部の代表的な反応

    腹診を腹部指圧に取り入れる
    ①受け手の姿勢
    下肢を伸ばした仰臥位で胸式呼吸
    ②目的をもつ
    ・ 「の」の字型掌圧時に腹診及び治療
    ・ 腹部20点圧および小腸部において治療及び反応観察

    5.結論

     今回、腹部指圧を用いるきっかけとして腹直筋および腸腰筋への指圧による腰痛治療、また腹診の紹介をしたが、実際患者を診るにはもちろん腹部だけでなく大腿四頭筋やハムストリングスの評価、腹診のほかに聞診、望診、問診を行い総合的に診断する必要がある。
     身体を診るひとつの視点として頭の片隅に置いていただき、患者の状態を把握するための一つの手段にしてほしい。

    参考文献

    1) 指圧研究会論文集Ⅱ1998-2012,日本指圧専門学校
    2) プロメテウス解剖学アトラス 解剖学総論/運動器系,医学書院
    3) 東洋医学 基本としくみ,西東社