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Onvoldoende lumbosacrale stabiliteit: een klinisch-anatomische en biomechanische benadering van aspecifieke lage-rugpijn

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Stimulus

Samenvatting

In dit artikel wordt een klinisch, anatomisch en biomechanisch model voorgesteld dat uitgaat van het concept dat onder houdingsbelasting specifieke ligamenteuze en spierkrachten nodig zijn voor intrinsieke bekkenstabilisering. Aangezien belastingsverplaatsing van de wervelkolom naar het bekken via de sacro-iliacale (si-)gewrichten plaatsvindt, is effectieve stabilisatie van deze gewrichten essentieel.

De stabilisatie van de si-gewrichten kan op twee manieren worden vergroot: 1 door het in elkaar grijpen van de richels en groeven op de gewrichtsoppervlakken (vormsluiting), en 2 door comprimerende krachten of structuren zoals spieren, ligamenten en fascia (krachtsluiting). Spierzwakte en onvoldoende spanning van ligamenten kunnen leiden tot verminderde compressie, hetgeen een negatief effect heeft op de belastingsverplaatsing. Langdurige spanning van bekkenligamenten kan hiervan een gevolg zijn hetgeen weer tot pijnklachten kan leiden.

Voor behandelingsdoelstellingen zijn stabiliserende technieken gevolgd door specifieke spierversterkende programma's geïndiceerd. Als er sprake is van verlies van vormsluiting, bijvoorbeeld bij bekkeninstabiliteit rondom de partus, kan het dragen van een bekkengordel worden geadviseerd.

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    A. L. Pool-Goudzwaard

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  1. A. L. Pool-Goudzwaard
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  2. A. Vleeming
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Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ‘a-specific’ low back pain [Manual Therapy 1998;3(1):12-20]

Department of anatomy, Department of Biomedical Physics and Technology, Department of Rehabilitation Medicine, Erasmus Universiteit, Rotterdam

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Pool-Goudzwaard, A.L., Vleeming, A. Onvoldoende lumbosacrale stabiliteit: een klinisch-anatomische en biomechanische benadering van aspecifieke lage-rugpijn. STIM 18, 161–172 (1999). https://doi.org/10.1007/BF03062695

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