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					編集：橋本雅至（奈良学園大学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評シリーズの第5弾．スポーツによる膝の外傷・障害に対する敏腕理学療法士の技術とコツを12テーマに分けて解説．前半では，触診による機能解剖や機能評価，疾患の特徴や病態，外科的治療について紹介．後半では，外科的治療前後での介入や障害発生のメカニズム，運動連鎖を応用したアプローチを解説．また，競技レベルでの復帰を導く手法，再発予防のための取り組みについても掲載．敏腕PTが現場で結果を出すための技術とコツを紹介する，集大成となる一冊．</section><section class="preface">［臨床実践　スポーツ傷害膝の理学療法］　序文<br><br>　本書は，「教科書にはない敏腕PTのテクニック」シリーズの第5弾として，実際にスポーツ現場や臨床場面で行われ，成果を出している膝関節のスポーツ傷害に対する理学療法テクニックを解説するという編集方針にて企画しました．臨床上よく経験する膝関節のスポーツ傷害に対する理学療法を例示するほか，工夫された膝関節の評価方法や運動療法に限らず，下肢全体から全身の機能に及ぶ運動連鎖の観点から，膝関節の機能をとらえ，スポーツ傷害の発生要因を考察し，アプローチする方法を数多く掲載しています．<br>　本書の前半は，評価において理学療法士が知っておくべき膝関節周辺の触診方法を具体的に紹介し，触診からとらえる機能解剖のポイントを説明しています．また，手術療法や保存療法にかかわらず，評価が必要である筋機能に対して臨床で工夫を凝らした下肢や体幹も含めた方法を紹介しています．さらに膝関節に多い靱帯損傷を取り上げ，医師の診断に基づく画像診断情報を把握することや，具体的な手術方法を詳細に理解することが大切であると考えており，これらの病態の理解を通じて読者の理学療法における創意工夫が発展することを期待しています．<br>　後半の各論では，治療の実践として前十字靱帯再建術の術前・術後のプロトコールから病期別アプローチの実践例を紹介しています．また術前・術後から問題となる関節可動域障害や筋機能障害に焦点を絞って解説しています．続いて外傷だけではなく，身体的要因の関与が多い膝関節のスポーツ障害であるオーバーユース，靱帯損傷以外に関節内の損傷に関して医師の診断，理学療法評価とアプローチを紹介しています．さらに，運動学の観点から，身体的要因の考察と具体的なアプローチを紹介し，術後スポーツ復帰を念頭に置いたパフォーマンスの評価について具体的な実践方法を紹介しています．最後に，多くの実践例の経験からスポーツ傷害の再発予防について具体的な方法が解説されています．<br>　理論的背景に基づいた理学療法実践に加えて，本書で執筆いただいた先生方は臨床で患者に向き合い，日頃の発想や感性を大事にし，現場で創意工夫されています．したがって，成果を上げる理学療法評価や治療のテクニックが大変重要であるという考えを読者と共有したいとの思いがあります．これまで紹介していない敏腕PTならではの技術のコツも要所に盛り込んでいます．本書が膝関節のスポーツ傷害に対する理学療法へ積極的に挑戦し，対象者の満足を得るための結果にこだわった理学療法の臨床実践に貢献しうることを心より願っています．<br><br>令和2年12月<br>奈良学園大学　橋本雅至</section><section class="indexes">解剖・病態・評価・治療方針の理解<br>　触診により膝関節の機能解剖を理解する<br>　　Ⅰ　膝関節を構成する関節構造および静的・動的制御機構<br>　　　1　膝関節の関節構造<br>　　　2　膝関節の靱帯と半月板<br>　　　3　膝関節周囲筋<br>　　Ⅱ　膝関節を構成する骨格構造および軟部組織の触診の実際<br>　　　1　骨の触診<br>　　　2　主要な骨格筋の触診<br>　　　3　主要な腱，靱帯，軟部組織の触診<br>　　Ⅲ　膝関節に多いスポーツ傷害の圧痛部位 <br>　膝関節の筋機能と下肢機能を評価する<br>　　Ⅰ　スポーツ傷害膝に求められる筋機能評価 <br>　　　1　等速性筋力評価<br>　　　2　筋持久力評価<br>　　　3　機器を使用しない評価<br>　　Ⅱ　スポーツ動作に近い荷重位での評価 <br>　　　1　スクワット<br>　　　2　フォワードランジ<br>　　　3　片脚スクワット<br>　膝関節靱帯損傷の特徴と病態を理解する<br>　　Ⅰ　靱帯損傷の概要<br>　　　1　靱帯損傷の程度と修復<br>　　　2　画像所見の診方<br>　　Ⅱ　各靱帯損傷の特徴をとらえる<br>　　　1　ACL損傷<br>　　　2　PCL損傷<br>　　　3　MCL損傷<br>　　　4　LCL損傷<br>　　　5　MPFL損傷<br>　膝前十字靱帯再建術を理解する<br>　　Ⅰ　前十字靱帯再建術の実際 <br>　　　1　体位<br>　　　2　移植腱の採取と再建靱帯の作成<br>　　　3　骨孔の作成<br>　　　4　再建靱帯の挿入と固定<br>　　Ⅱ　術後リハビリテーションにおける注意点 <br><br>実践と結果に基づく理学療法手技<br>　膝前十字靱帯再建術前・術後の状態を見極め介入する<br>　　Ⅰ　術前理学療法 <br>　　　1　RICE処置<br>　　　2　関節可動域<br>　　　3　筋力<br>　　Ⅱ　術後理学療法の概要 <br>　　　1　最大制限期（〜術後2週）<br>　　　2　制限時期（術後2〜6週）<br>　　　3　回復期（術後6週〜4カ月）<br>　　　4　増進期（術後4〜6カ月）<br>　　　5　復帰期（術後6カ月〜1年）<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　最大制限期（〜術後2週）<br>　　　2　制限時期（術後2〜6週）<br>　　　3　回復期（術後6週〜4カ月）<br>　　　4　増進期（術後4〜6カ月）<br>　　　5　復帰期（術後6カ月〜1年）<br>　　　［CT］大腿四頭筋セッティング<br>　半月板・関節軟骨損傷の手術療法を理解し術後理学療法に挑む<br>　　Ⅰ　関節内損傷に対する手術療法 <br>　　　1　半月板損傷に対する手術療法<br>　　　2　関節軟骨損傷に対する手術療法<br>　　Ⅱ　正常な関節包内運動の再構築<br>　　　1　膝関節屈曲-伸展時のバイオメカニクス<br>　　　［CT］下腿内旋誘導・自動膝屈曲エクササイズ<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　術式による術後理学療法の違い<br>　　　2　術後理学療法プログラム<br>　膝関節術前・術後の関節可動域に挑む<br>　　Ⅰ　6自由度で考える関節運動 <br>　　　1　関節運動の考え方<br>　　　2　関節運動としての6自由度<br>　　　［CT］徒手テストにおける把持の工夫<br>　　Ⅱ　関節不安定性と関節運動制限から考える関節可動域における障害<br>　　　1　関節不安定性<br>　　　2　関節運動制限<br>　　　［CT］徒手テストにおける知見の活用<br>　　Ⅲ　関節内で生じる問題 <br>　　　1　術前における問題<br>　　　2　観血術以降における問題<br>　　Ⅳ　理学療法プログラムの実際 <br>　　　1　関節可動域における障害に対する理学療法の前提<br>　　　2　受傷から術前までの関節可動域障害<br>　　　3　再建術後の関節可動域における障害<br>　膝関節術前・術後の筋機能に挑む<br>　　Ⅰ　術前および術後早期における疼痛や腫脹に着目した筋萎縮の予防と改善<br>　　　1　疼痛・腫脹と筋力<br>　　　2　NMESを併用した筋力トレーニング<br>　　Ⅱ　術後から競技復帰時期における筋と筋連結部の粘弾性改善 <br>　　　1　粘弾性体としての筋機能<br>　　　2　アプローチの基本的な選択<br>　　　［CT］マッスルコネクションアプローチ<br>　　　3　競技復帰における粘弾性の改善<br>　　Ⅲ　競技復帰に向けた筋肥大，特異性，基本動作の改善 <br>　　　1　筋肥大と神経筋の改善<br>　　　2　特異性の改善<br>　　　3　正しいダイナミックアライメントでの基本動作トレーニング<br>　　Ⅳ　理学療法プログラムの実際 <br>　　　1　形態的および神経筋の改善を目的としたレジスタンストレーニング<br>　　　2　特異性の改善を目的とした筋力トレーニング<br>　　　3　基本動作トレーニングとしてのスクワット動作とランジ動作<br>　膝関節のオーバーユース障害の要因を評価し改善に導く<br>　　Ⅰ　スクワット動作によるアライメントおよびメカニカルストレスの評価 <br>　　　1　矢状面からみた評価ポイント<br>　　　2　前額面からみた評価ポイント<br>　　　3　水平面からみた評価ポイント<br>　　Ⅱ　膝関節のオーバーユース障害の要因 <br>　　　1　膝前方の痛み<br>　　　2　膝外側の痛み<br>　　　3　膝内側の痛み<br>　　　［CT］足関節の可動域評価からとらえる膝関節オーバーユース障害の要因<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　AKPに対する評価とアプローチ<br>　　　2　膝外側の痛み（腸脛靱帯炎）に対する評価とアプローチ<br>　　　3　膝内側の痛み（鵞足炎）に対する評価とアプローチ<br>　　　4　膝前方の痛みに対するテーピング<br>　　　5　膝外側の痛みに対するテーピング<br>　　　6　膝内側の痛みに対するテーピング<br>　運動連鎖の観点から膝関節機能改善をねらう<br>　　Ⅰ　膝関節構成体への力学的ストレスとその要因 <br>　　　1　膝関節と力学的ストレス<br>　　　2　疼痛を発生させる力学的ストレスと機能評価の重要性<br>　　Ⅱ　姿勢・動作の観察と身体アライメント評価 <br>　　　［CT］脚長差と力学的ストレス<br>　　Ⅲ　足部・足関節による膝関節への力学的ストレスの把握 <br>　　　1　足部・足関節運動と上行性運動連鎖<br>　　　2　足関節背屈制限と膝関節への力学的ストレス<br>　　　3　過回内足と膝関節への力学的ストレス<br>　　Ⅳ　体幹・股関節による膝関節への力学的ストレスの把握 <br>　　　1　体幹・股関節運動と下行性運動連鎖<br>　　　2　体幹の可動域制限と膝関節への力学的ストレス<br>　　　3　股関節の可動域制限と膝関節への力学的ストレス<br>　　Ⅴ　理学療法プログラムの実際 <br>　　　1　足部・足関節からの上行性運動連鎖アプローチ<br>　　　2　体幹からの下行性運動連鎖アプローチ<br>　　　3　股関節からの下行性運動連鎖アプローチ<br>　競技レベルの復帰を想定してパフォーマンスを評価する<br>　　Ⅰ　競技復帰に向けたパフォーマンス評価 <br>　　　［CT］荷重負荷の可視化とトレーニングへの活用<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　テクノロジーを用いたトレーニングの実際<br>　　Ⅲ　競技の動きのなかでの評価 <br>　　　1　定量化できないパフォーマンスの評価ノウハウ<br>　　Ⅳ　動きを観る眼のためのトレーニング <br>　　　1　動きを観る眼を安定させるためのポイント<br>　スポーツ傷害膝の再発予防に向き合う<br>　　Ⅰ　良好な膝関節機能の維持<br>　　　1　膝関節可動域の評価<br>　　　［CT］最終伸展可動域評価での注意点<br>　　　2　軟部組織の評価<br>　　　3　筋機能の評価<br>　　Ⅱ　全身のアライメントを意識したアプローチ<br>　　　1　パワーポジション<br>　　　［CT］スポーツの特殊性を考慮したスクワット<br>　　　2　多関節の機能不全による障害<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　膝関節の可動域獲得のための理学療法<br>　　　2　内側広筋と内側ハムストリングスの筋機能の改善<br>　　　3　パワーポジションをとるための多関節への理学療法<br>　　　4　再発予防に対する動作練習の考え方<br>　　　5　患者教育に対する考え方<br><br>索　引 <br><br>［CT］＝クリニカル・テクニック</section></article>
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