いつまでもアウトドアスポーツを楽しむために-オーバーユースシンドロームの評価と処置-

歳をとると、特に外傷はないのに、関節が痛いなあとか、力を入れると痛みがあるなあとか感じたことはありませんか?なんか、運動するのがおっくうになっちゃいますよね。それらはもしかしたら、使いすぎや、加齢によるオーバーユースシンドローム(使い過ぎ症候群)かもしません。

原因がわからないからと言って軽視されがちですが、筋、腱、靭帯、神経などの軟組織にダメージを与えるだけでなく、疲労性骨折を起こすこともあります。今回は、全てではありませんが、一般的なオーバーユースシンドロームを紹介します。早めに問題を同定して、治療と動きを改善し、いつまでもアウトドアスポーツを楽しみましょう。


目次
・危険因子
・原因
・予防
・一般的な処置
・オーバーユースシンドロームによる外傷


危険因子
・成長期:幼少期、青年期は、筋骨格系が発達するため、オーバーユースシンドロームになりやすいです。中学時代私はオスグッドで、息子は腰椎分離で泣きました。スポーツをやっている子供を対象とした時に気をつけなければなりませんね。
・加齢:40才以上は、腱、靭帯、軟骨における水分やコラーゲンが減少し、関節組織で様々な障害のリスクが高まります。私は痛風が膝に出て、念のためにMRI をとったら、右大腿骨の関節軟骨が一部なくなっているのが見つかってガーンです。おかげで膝をいたわった動きを意識するようになりました。
・クローズドスポーツ:同じ動き、左右一方の動きのみを行う運動も、オーバーユースシンドロームのリスクを高めます。痛みを訴える人のSAMPLEで運動歴を聞く必要もあるかもしれませんね。


原因
・長時間の繰り返しの使用、同じ動き
・不自然な動き(手首、腕の捻れ)
・使いすぎ
・筋疲労
・体に合っていない道具(足に合わない靴、体の動きに合っていないパドル、スキーのポールなど)
・道具、機械による振動(チェーンソーなど)
・強度な運動
・長時間同じ姿勢を維持する
・重いものを運ぶ
・一般的な疲労


予防
・使用部位の定期的なトレーニングを行う。
・姿勢をよくする。首、背中、骨盤を真っ直ぐにする。
・正しい動きを意識し、訓練する。
・インナーマッスルを鍛える。
・目的とする運動とできるだけ近い動きで筋力トレーニングする(スキー、パドリング、クライミング、ローリングなど)
・拮抗筋(運動に使用する筋と反対の動きをする筋)を鍛える。
・クロストレーニング(複合的、包括的な運動)
・水分補給


一般的なTx
・炎症が治るまで安静にする。
・症状が出た後6時間は冷却をする。
・動きを変える。
・テーピングやサポーターをする。
・パッドを当てる。
・足の裏のインナーソールや、足首、膝、腰、肩、肘などの矯正器具を使う。
・繰り返しの使用を避ける。
・ボールやローラーを使って、筋、腱をマッサージする。
・痛み止め、鎮痛剤を検討する。
・痛みが治ったら、徐々に可動域を広げ、負荷をあげる。


オーバーユース症候群による外傷

滑液包炎:膝、肘、肩関節などの滑液で満たされた滑液包が炎症を起こす最も一般的なオーバーユース症候群。関節の腫れ、鈍痛。過度の使い過ぎだけでなく、痛風、リュウマチ、感染などで起こることもある。
腱鞘炎:手、指の使い過ぎが原因となり、腱を覆い、腱が滑らかに動くための腱鞘と、中を通る腱が擦れ合って起こる炎症。手首の腫れ、痛み。40歳以上より発症率が高まる。スマホの使い過ぎにで起こることも。
手根管症候群:手のひらにある手根管(神経が通る管)が、繰り返しの手首の屈曲などにより、横手根靭帯により圧迫され起こる障害。手の痺れ、痛み。スキー、クライミング、パドリングなどの、手首の繰り返しの屈曲によって起こる。
肘管症候群:肘の長時間の繰り返しの圧迫や、長時間の伸展により、尺骨神経が圧迫されて起こる。小指側の痺れ、進行すると小指が曲がったままになる(環指)。ノルディックスキー、クライミング、パドリングなどで起こりやすい。
デュピュイトラン拘縮:手掌腱膜が硬くなることにより起こる。指が恒久的に曲がったままになる。クライミングやパドリングで起こることがある。連続的な振動もリスクを高める。
手指屈筋腱障害:指を屈曲させる屈筋腱は、骨に鞘状の滑車状靭帯で固定されている。屈筋腱に強い力がかかり、この靭帯が破断し、腱が骨から離れてしまうと、指が曲がらなくなる。クライミング中に、指1本か2本に体重をのせた時に、ポップ音を聞いたら、靭帯が破断したサイン。部分的な極小な破断や炎症は、クライミング中に常に起きている。指の第一関節を反らしてホールドするなど、靭帯に与えるストレスをできるだけ少なくする。
腸脛靭帯症候群(ランナーズニー):腸脛靭帯は上は大腿筋膜張筋(臀部)から、下は膝の外側を通って脛骨上部につながっている。膝の曲げ伸ばしを繰り返すことより、腸頸靭帯が、膝の外側に隆起する大腿骨外顆に擦れて炎症を起こす。
インターセクション症候群:手首に力が加わりながら、激しい曲げの伸ばしを繰り返すと、親指につながる腱と人差し指につながる腱の交差する部分に炎症が起こる。パドリング、乗馬、スキーなどで起こりやすい。パドラーは、強いパドリングやリカバリーの時など、できるだけ手首をリラックスさせ、手首の屈曲は15度以内に抑える。
上腕骨外側上顆炎(テニス肘):手首を伸ばす橈側手根伸筋の上腕筋への付け根である上腕骨外側上顆で起こる炎症。30-50才かつ女性の方が起こりやすい。

上腕骨内側上顆炎(ゴルフ肘):手首を曲げる橈側手根屈筋の上腕筋への付け根である上腕骨内側上顆で起こる炎症。ねじれを伴う腕の動きで起こりやすい。

橈骨神経管症候群:腕の押したり引いたりや、手首や指の使いすぎにより、前腕の外側を通る橈骨神経管に炎症が起こり、痛みが生じる。パドリングやローリングで起こりやすい。
回旋筋腱板(ローテーターカフ)症候群:肩甲骨と上腕骨を繋ぐ4つの筋肉群を回旋筋腱板といい、肘が肩より後ろに行ったり上がるような強度な動き(ピッチングなど)で、これらの接続が破断する。クライマーやパドラーは、肘が肩より前で下になるように動きを意識して予防する。
膝蓋大腿関節障害:オーバーユースや加齢により、膝蓋骨裏側及び大腿骨と脛骨の関節面の軟骨が劣化し、可動制限や痛みが起こる。大腿四頭筋のアンバランスな発達や、O脚、X脚の人に起こりやすい。
足底筋膜炎:踵から爪先まで足の裏を走っている帯状の筋、腱の炎症。多くは踵骨の近くで痛みが起こる。処置は足底筋、腱のストレッチと下腿の筋力アップであり、足首や踵の安定化、足底のアーチの回復につながる。痛みを和らげようと不自然な歩き方をすると、足、膝、臀部、背中の二次的な障害になる。
種子骨炎:種子骨は腱の中にある小さな骨片で、腱の摩擦に抵抗する役割がある。特に足の親指の付け根にある2つの種子骨が炎症が起こったり、位置が動いたりすることにより痛みが生じる。トレイルランナー、ハイカー、ノルディックスキーヤーなどに起こりやすい。整形インナーソールやクッション性の高いインナーソールにより、予防と治療をする。
狭窄性腱鞘炎(ドケルバン病):手首の親指側の腱鞘炎の一つ。親指の使いすぎにより、母指伸筋腱鞘が肥大し炎症が起こる。親指側の手首の腫れ、痛みを伴う。ノルディックスキー、パドリング、ラフティングなどで起こりやすい。
胸郭出口症候群:腕神経叢、鎖骨下動脈、鎖骨下静脈が、胸郭出口で鎖骨、第一肋骨、前斜角筋、中斜角筋、小胸筋な、肩甲骨の烏口突起などに圧迫されることで起きる症状の総称。悪い姿勢や、長い間同じ姿勢をすることが原因となり、肩こり、腕の痺れが起こる。
疲労骨折:脛骨などの長骨の長期間の使い過ぎにより発生する。シンスプリント(脛骨過労性骨膜炎)は警告のサインである。女性で生理不順がある人や、摂食障害がある人は、骨粗しょう症のリスクが高いため、発症する可能性が高い。

オーバーユースシンドロームの評価と処置は原則的には、四肢のケガに従います。正しい四肢のケガの理解にはデジタルハンドブックを参照してくだい。また、正しく四肢のケガを評価し、処置(固定)を行うためにはWFA/WFRコースに参加してトレーニングを受ける必要があります。

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