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Schmerzen im Bereich des Steißbeins werden häufig unter dem Begriff Kokzygodynie zusammengefasst. Ursache der Beschwerden können hierbei lokal oder entfernt liegende Strukturen sein. Außerdem gibt es eine Reihe von inneren und psychischen Erkrankungen, die eine Kokzygodynie vortäuschen können und differenzialdiagnostisch abgeklärt werden müssen.
Dieser Artikel gibt eine Übersicht über Anatomie, Ätiopathologie, Diagnostik, Differenzialdiagnostik und Therapiemöglichkeiten bei Kokzygodynie. Der Schwerpunkt liegt dabei auf muskuloskeletaler Therapie. Es werden Techniken am Steißbein aus 4 manualtherapeutischen Konzepten vorgestellt.
Bericht über das 35. Symposium der Performing Arts Medicine Association in Snowmass, Colorado
(2018)
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1.understand and describe the basic principles of EMG
2.understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3.use EMG on performing artists in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1.Short presentation: introduction and understanding of EMG (educational objective 1)
2.Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3.Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control. The purpose of this workshop is to show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1. Short presentation: introduction and understanding of EMG (educational objective 1)
2. Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3. Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1. understand and describe the basic principles of EMG
2. understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3. use EMG on performing artists in the performance process
Für die Schmerzentstehung von Kokzygodynie können sowohl lokale als auch entfernte Strukturen verantwortlich sein. Deshalb gilt es, die Quellen der Symptome für jeden Einzelfall zu identifizieren und durch Clinical Reasoning zu untermauern. Da keine Korrelation zwischen den Symptomen und dem Grad der Steißbeinkrümmung besteht, lässt sich ein Behandlungserfolg nicht mit der Korrektur der Steißbeinstellung erklären. Der Therapieverlauf muss durch andere Parameter kontrolliert werden, wie z. B. Schmerzreduktion und Verbesserung der funktionalen Beeinträchtigungen. Da die Kokzygodynie eng mit psychosozialen Prozessen in Verbindung zu stehen scheint, ist bei Kindern und chronischen Schmerzgeschehen besondere Aufmerksamkeit geboten.
Eine gängige Behandlungsoption bei Kokzygodynie stellt die muskuloskeletale Therapie dar, über deren Wirksamkeit allerdings wenig bekannt ist. Aus diesem Grund ging dieser systematische Literaturreview der Forschungsfrage nach, ob sich Kokzygodynie mit muskuloskeletaler Therapie effektiv behandeln lässt. Obwohl die Validität der ausgewählten Studien eher gering ausfiel, waren ihre Ergebnisse durchweg positiv. Insgesamt erwies sich muskuloskeletale Therapie bei Kokzygodynie als effektive Behandlungsform.