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有痛性筋痙攣の対処法(こむら返りの対処法)を多くの人に周知啓蒙したい

　日本人の50歳以上の高齢者は、おおよそ5000万人以上とされていますが、このうち、推定、50パーセント以上の人たちがこむら返りに悩んでいるとされています。しかも、若年者で健常者でも、少数ながらおこるのがこむら返りです。こむら返りを専門用語でいうと、有痛性腓腹筋痙攣と難解な単語になります。この病態の解明は、不明なところもおおく実態解明が期待されているところです。ところで、現在の歯科補綴では、噛む事の重要性が重視されてきましたが、ようやく嚥下する事や睡眠に対する影響が聞かれてきました。また、噛むという動作、開くという動作すなわち開閉動作が重要であることの一例として、アイウベ体操をあげることができます。そんな最中、最大開口により、痛みの下降性抑制や筋肉の自己抑制を発動させる考えができたのは、私自身糖尿病で昨年頻繁に腓返りがおきたことにより、以前からＴＰを使用したら効果があるのではと考えていたからに他ありません。特に昨年は、筋痙攣が頻発し、腓腹筋、ハムストリングス、大腿四頭筋、腹直筋、足底筋、指の筋肉まで痙攣に悩まされました。おそらく、持病の糖尿病による血液循環の不良が背景にあるものと思われます。痙攣発症の度に、堪えて待つか、ストレッチか、芍薬甘草湯（ツムラの68番）を飲むかの選択でしたが、ある時、チャレンジする機会が到来しました。就寝中でしたが午前4時頃に、ＴＰを装着する機会が訪れたのです。装着して何秒後かは測定してませんが、鮮明に驚きの記憶を振り返ることができます。痛みと痙攣が去っていったのです。やはり下降性疼痛抑制は、本物だ。また、自己抑制も期待でき、さらに、TPを持たない人でも、最大開口の動作によって、同様の効果が期待できる事を経験し、確信しました。その後、歯科治療時の患者への問診により痙攣対処法を指導し、その効果を確認するとやはり、その有効ケースが増えて行きました。ある人は、自動車の運転中に足が攣り、指導されたとうり、最大開口を実施、難を回避したそうです。このような場面では、服薬もストレッチもできません。とっさの判断で、痙攣には、最大開口という知識があったからこそできた、回避行動であると思います。もし、このような知識がなかったら最悪、大事故につながったかもしれません。
　是非『こむら返りには、最大開口を！』記憶してトライしてください。もう一つ、スポーツ歯科への提言です。スポーツ時のこむら返りは、とくにサッカー競技で多くみられます。その理由は、サッカー競技自体ハードなスポーツであることの他、気温により、脱水状態になりやすいことです。また、決定的なことは、キック時のボールの捉え方にあります。ボールを蹴る時、足の甲で捉える蹴り方をインステップキックといいますが、このような足位を尖足位といいます。この位置は丁度腓腹筋が収縮しているこむら返りがおきる位置関係になるのです。サッカーの試合中に選手が突然転倒し、苦しむ光景がほとんど、腓腹筋のトラブルのこむら返りのようです。これが起きるとフィールドから外にだされ、（ピッチアウト）トレーナーによるストレッチをする光景がよくみられます。こんな時、プレーヤーは、最大開口をする時なのです。また、最大開口のタイミングですがこむら返りが発症して時間が経つ程筋肉は疲弊して回復が遅れます。こむら返りがおきる感覚は、実は、経験からこれから起こるぞという自覚する感覚があります。この感覚が感じられたときすぐに最大開口を実行してください。事前に回避できる可能性があるのです。また、ストレッチプラス最大開口のダブル対応も効果的と考えます。
　また、こむら返りが起きやすい状況で妊婦のかたがあげられます。医学的な説明では、母体も胎児もタウリンを必要としタウリン不足が原因だとされています。タウリンは、イカやタコなどに含まれるため、食品から補給できるようですが、妊婦さんへの対応にも最大開口を取り入れてほしいと考えています。芍薬甘草湯の使用も漢方薬といえども頻回の服薬は、胎児への影響も配慮して避けた方が良いとかんがえます。実際、偽アルドステロン症なる問題もあるようです。妊婦の方でこむら返りに苦しまれているかたは、最大開口を是非トライしてみましょう。


Raising Awareness of How to Manage Painful Muscle Cramps It is estimated that there are more than 50 million Japanese people aged 50 and over, and that more than 50% of them are troubled by calf cramps, commonly known as “charley horses.” Such cramps can also occur, although less frequently, in younger and otherwise healthy people.
In medical terminology, a calf cramp is referred to as a painful gastrocnemius muscle spasm, which is a rather difficult term for the general public to understand. Although the mechanisms underlying this condition have been studied, many aspects remain unclear and further elucidation is still awaited.
Meanwhile, in modern dental prosthodontics, increasing importance has been placed on the act of chewing. More recently, attention has also been drawn to the effects of oral function on swallowing and sleep. The importance of the opening and closing movements of the mouth can also be illustrated by exercises such as the “A-I-U-Be” exercise.
It was in this context that I came to consider the possibility that maximum mouth opening might activate descending pain inhibition and muscle autoinhibition. This idea was also strongly influenced by my own experience. I have diabetes, and last year I frequently suffered from muscle cramps. I had previously wondered whether TP might be effective in relieving such cramps.
In particular, last year I experienced frequent spasms affecting not only my gastrocnemius muscles but also my hamstrings, quadriceps, rectus abdominis, plantar muscles, and even the muscles of my fingers. I assumed that impaired blood circulation associated with my diabetes might have been a contributing factor. Whenever a cramp occurred, my options were essentially to endure it until it subsided, perform stretching exercises, or take Shakuyaku-Kanzo-To (Tsumura No. 68). Then, one night, I had an opportunity to put my idea to the test.
At approximately 4:00 a.m., while I was asleep, I developed a cramp and had an opportunity to apply TP. I did not measure exactly how many seconds passed after applying it, but I have a vivid memory of what happened: the pain and the muscle spasm subsided.
At that moment, I felt that descending pain inhibition was indeed real. I also came to believe that muscle autoinhibition might contribute to the effect. Furthermore, I experienced that even people who do not have TP may potentially obtain a similar effect simply by performing maximum mouth opening. This led me to become convinced of its potential usefulness. Subsequently, during dental treatment, I began asking patients about their experiences with muscle cramps and teaching them this method. As I followed up with these patients, I found an increasing number of cases in which they reported that it had been effective.
One person told me that his or her leg cramped while driving a car. Following the instructions previously given, the person immediately performed maximum mouth opening and was able to avoid further difficulty. In such a situation, neither medication nor stretching can readily be performed. The fact that the person knew that maximum mouth opening could be used for a muscle cramp made it possible to take immediate action. Without this knowledge, the incident might potentially have resulted in a serious traffic accident.
Please remember: “For a calf cramp, try maximum mouth opening!”
I encourage people to remember this and try it when appropriate.

A Proposal for Sports Dentistry
I would also like to make a proposal concerning sports dentistry.
Muscle cramps during sports are particularly common in soccer. One reason is that soccer is a physically demanding sport, and players can also become dehydrated depending on the temperature and environmental conditions.
There is another important factor: the position of the foot when striking the ball.
When a player strikes the ball with the instep, this is called an instep kick. The foot is positioned in what is known as plantar flexion (equinus position). In this position, the gastrocnemius muscle is already contracted, creating a positional relationship in which a calf cramp can occur.
During soccer matches, we often see players suddenly fall to the ground and suffer from severe pain. These episodes appear, in many cases, to be problems involving the gastrocnemius muscle, such as calf cramps. When this happens, the player is often taken off the field and a trainer performs stretching exercises.
At such a moment, the player should also try maximum mouth opening.
The timing of maximum mouth opening is also important. The longer a cramp continues after it begins, the more fatigued the muscle becomes, and the longer recovery may take.
In fact, based on experience, people who have previously suffered from cramps often recognize a characteristic sensation that tells them, “A cramp is about to start.” When this sensation is detected, I recommend performing maximum mouth opening immediately. There may be a possibility of preventing the cramp before it fully develops.
A combined approach of stretching plus maximum mouth opening may also be effective.

Calf Cramps During Pregnancy
Pregnant women are another group in whom calf cramps are frequently experienced.
One medical explanation is that both the mother and fetus require taurine, and that taurine deficiency may contribute to muscle cramps. Taurine is found in foods such as squid and octopus, so it can be obtained through dietary sources.
I would also like to propose incorporating maximum mouth opening into the management of calf cramps during pregnancy.
Although Shakuyaku-Kanzo-To is a traditional herbal medicine, I believe that frequent use should be avoided when possible, taking into consideration potential effects on the fetus.
There are also concerns regarding the development of pseudoaldosteronismassociated with excessive or prolonged use of preparations containing licorice.
For pregnant women who are suffering from calf cramps, please consider trying maximum mouth opening.

Important medical note for an English-language publication The above is a faithful translation of your original text. However, if you intend to publish this as a medical, dental, sports-medicine, or public-health article, I recommend revising several statements?particularly the claims that maximum mouth opening relieves cramps through descending pain inhibition or muscle autoinhibition, that taurine deficiency causes pregnancy-related cramps, and that maximum mouth opening can prevent cramps during driving or sports?so that personal observations are clearly distinguished from scientifically established evidence. These claims would ideally be supported by appropriate clinical or physiological studies before being presented as established medical advice.

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