Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Figuur 1
Figuur 2
Figuur 3
Figuur 4
Figuur 5
Figuur 6
Figuur 7A
Figuur 7B

Literatuur

  • Anderson RL, Peterson VL 1944 Clinical use of the Chamberlain technique in sacroiliac conditions. JAMA 124:269-271

    Google Scholar 

  • Basmaijan JV 1976 Muscles Alive. Williams & Wilkins, Baltimore, Ch 13, 305-307

  • Bernard TN, Cassidy JD 1991 The sacroiliac joint syndrome: partophysiology, diagnosis and management. In: Frymoyer JW (ed). The Adult Spine: Principles and Practice. Raven Press, New York, 2107-2130

  • Bogdug N, MacIntosh JE 1984 The applied anatomy of the thoracolumbar fascia. Spine 9: 164-170

    Google Scholar 

  • Bodgyk N, Twomey LT 1987 Clinical Anatomy of the Lumbar Spine, Churchill Livingtone, Melbourne, Ch 8, 84-91

  • Bowen V, Cassidy JD 1981 Macroscopic and microscopic anatomy of the sacro-iliac joints from embryonic life until the eighth decade. Spine 6: 620-628

    Google Scholar 

  • Buyruk HM, Stam HJ, Vleeming A, Lameris JS, Holland WPJ, Snijders CJ 1995a Analysis of sacroiliac joint stiffness with colour doppler imaging on embalmed human pelvises. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 723-731

  • Buyruk HM, Snijders CJ, Vleeming A, Lameris JS, Holland WPJ, Stam HJ 19956b In vivo measurement of sacroiliac joint stiffness with colour doppler imaging. In: Vleeming A, Mooney V, Dorman T, Snhijders CJ (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 733-739

  • Dijkstra PF, Vleeming A, Stoeckart R 1992 Complex motion tomography of the sacroiliac joint; an anatomical and roentgenological stdy. In: Vleeming A, Mooney V, Snijders CJ, Dorman T (eds). First Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Integrated function of the lumbar spine and sacroiliac joint. Rotterdam ECO, 585-600

  • Don Tigny RL 1992 Sacroiliac dysfunction: recognition and treatment. In: Vleeming A, Mooney V, Snijders CJ, Dorman T (eds). First Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Integrated function of the lumbar spine and sacroiliac joint. Rotterdam ECO, 481-499

  • Egund N, Ollson TH, Schmid H, Selvik G 1978 Movements in the sacroiliac joints demonstrated with roentgen stereofotogrammetry. Acta Radiologica 19: 833-846

    Google Scholar 

  • Grob KR, Neuhuber WL, Kissling RO 1995 Die innervation des Sacroiliacaal gelenkes beim menschen. Zeitschrift fur Rheumatologie 54: 117-121

    Google Scholar 

  • Hides JA, Stokes NJ, Saide M, Jull GA 1994 Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19: 165-177

    Google Scholar 

  • Hodges PW, Richardson CA 1996 Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transverse abdominis. Spine 21: 2640-2650

    Google Scholar 

  • Kristianson P 1995 S-Relaxin: a marker for back pain during pregnancy. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 203-205

  • Laslett M 1995 The reliability of the selected pain tests for SI Joint pain pathology. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (Eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 484-499

  • Lavignolle B, Vital JM, Senegas J et al 1983 An approach to the functional anatomy of the sacroiliac joints in vivo. Anatomica Clinica 5: 169-176

    Google Scholar 

  • Mens JMA, Stam HJ, Vleeming A, Snijders CJ 1995 Active straight leg raising. A clinical approach to the load transfer function of the pelvic girdle. In: Vleeming A, Mooney V, Snijdes CJ, Dorman T (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 207-220.

  • Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ 1996 Understanding peripartum pelvi pain; implications of a patient survey. Spine 21: 1363-1370

    Google Scholar 

  • Miller JA, Schultz AB, Andersson GB 1987 Load displacement behaviour of sacro-iliac joint. Journal of Orthopaedic Research 5: 92-101

    Google Scholar 

  • Mooney V 1995 Evaluation and treatment of sacroiliac dysfunction. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 393-407

  • Njoo KH 1996 Nonspecific low back pain in general practice: a delicate point. Erasmus University Rotterdam dissertation

  • Richardson CA, Jull GA 1995 Muscle control - pain control. What exercise would you prescribe? Manual Therapy 1: 2-10

  • Schwarzer AC, April CN, Bogduk N 1995 The sacroiliac joint in chronic low back pain. Spine 20: 31-37

    Google Scholar 

  • Sashin D 1930 A critical analysis of the anatomy and the pathological changes of the sacroiliac joints. Journal of Bone and Joint Surgery 12: 891-910

    Google Scholar 

  • Snijders CJ, Vleeming A, Stoeckart R 199a Transfer of lumbosacral load to iliac bones and legs. Part 1: Biomechanics of selfbracing of the sacroiliac joints and its significance for treatment and exercise. Journal of Clinical Biomechanics 8: 285-294

  • Snijders CJ, Vleeming A, Stoeckart R 1993b Transfer of lumbosacral load to iliac bones and legs. Part 2: Loading of the sacroiliac joints when lifting in stooped posture. Journal of Clinical Biomechanics 8: 295-301

  • Snijders CJ, Slagter AHE, Strik van R, Vleeming A, Stoeckart R, Stam HJ 1995 Why leg crossing? The influence of common postures on abdominal activity. Spine 20: 1989-1993

  • Snijders CJ, Snijder JGN, Hoedt HTE 1984 Biomechanische modellen in het bestek van rugklachten tijdens de zwangerschap. Tijdschrift voor Sociale Gezondheidszorg 62: 141-147

  • Snijders CJ, Seroo JM, Snijder JGM, Hoedt HT 1977 Change in form of the spine as a consequence of pregnancy. Digest 1 1th ICMBE, Ottawa: 670-671

  • Sturesson B, Selvik G, Uden A 1989 Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine 14: 162-165

    Google Scholar 

  • US Department of Health and Human Services. Agency for Health Care Policy and Research 1994 Acute Low Back Problems in Adults. Publication 95-0642, Rockville, Maryland

  • Van Tulder M 1996 Diagnostics and treatment of chronic low back pain in primary care. Free University, Amsterdam

  • Vleeming A, Wingerden van JP, Dijkstra PF, Stoeckart R, Snijders SJ, Stijnen T 1992 Mobility of the SI joints in old people: A kinematic and radiological study. Clinical Biomechanics 7: 170-176

    Google Scholar 

  • Vleeming A 1990 The sacroiliac Joint. A clinical, biomechanical and radiological study (dissertation). Rotterdam Erasmus University

  • Vleeming A, Stockart R, Volkers ACW, Snijders CJ 1990a Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine 15(2): 130-132

  • Vleeming A, Volkers ACW, Snijders CJ, Stoeckart R 1990b Relation between form and function in the sacroiliac joint. Part 2: Biomechanical aspects. Spine 15(2): 133-136

  • Vleeming A, Wingerden van JP, Snijders CJ, Stoeckart R, Stijnen T 1989a Load application to the sacrotuberous ligament: influences on sacroiliac mechanics. Clinical Biomechanics 4: 204-209

  • Vleeming A, Stoeckart R, Snijders CJ 1989b The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint. Clinical Biomechanics 4: 201-203

  • Vleeming A, Pool-Goudzwaard AL, Stoeckart R, Wingerden van JP, Snijders CJ, Mens JMA 1995a The posterior layer of the thoracolumbar fascia: its function in load transfer from spine to legs. Spine 20(1): 753-758

  • Vleeming A, Pool-Goudzwaard AL, Hammudoghlu D, Stoeckart R, Snijders CJ, Mens JMA 1996 The function of the long dorsal ligament. Spine 21(5): 562-565

    Google Scholar 

  • Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ 1992 Towards an integrated therapy for peripartum pelvic instability. American Journal of Obstetrics and Gynaecology 166(4): 1243-1247

    Google Scholar 

  • Vleeming A, Pool-Goudzwaard AL, Stoeckart R, Wingerden van JP, Snijders CJ 1993 Towards a better understanding of the etiology of low back pain. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (eds). First Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 545-553

  • Vleeming A, Snijders CJ, Stoeckart R, Mens JMA 1995b A new light on low back pain. In: Vleeming A, Mooney V, Dorman T, Snijders CJ (eds). Second Interdisciplinary World Congress on Low Back Pain and its Relation to the SI Joint. Rotterdam ECO, 123-131

  • Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A 1995 Stability increase of the lumbar spine with different muscle groups: a biomechanical in vitro study. Spine 20(2): 192-198

    Google Scholar 

  • van Wingerden JP, Vleeming A, Snijders CJ, Stoeckart R 1993 A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the sacrotuberous ligament. European Spine Journal 2: 140-144

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

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

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03062695