Hyo uen Kim. The Graduate School. Yonsei University Department of Rehabilitation Therapy

Transcription

1 Effects of Contralateral Hip Adduction on Muscle Thickness, Activity of Lumbar Stabilizers and Pelvic Lateral Tilting During Hip Abduction in Sidelying Hyo uen Kim The Graduate School Yonsei University Department of Rehabilitation Therapy

2 Effects of Contralateral Hip Adduction on Muscle Thickness, Activity of Lumbar Stabilizers and Pelvic Lateral Tilting During Hip Abduction in Sidelying Hyo uen Kim The Graduate School Yonsei University Department of Rehabilitation Therapy

3 Effects of Contralateral Hip Adduction on Muscle Thickness, Activity of Lumbar Stabilizers and Pelvic Lateral Tilting During Hip Abduction in Sidelying A Masters Thesis Submitted to the Department of Rehabilitation Therapy and the Graduate School of Yonsei University in partial fulfillment of the requirements for the degree of Master of Science Hyo uen Kim December 2011

4 This certifies that the masters thesis of Hyo uen Kim is approved. Thesis Supervisor: Ohyun Kwon Chunghwi Yi Heonseock Cynn The Graduate School Yonsei University December 2011

5 Acknowledgements After the years of efforts, I am now able to complete graduate school. I would like to take this opportunity to express my gratitude to everyone who has helped me to graduate. First, I sincerely appreciate Profs. Ohyun Kwon. He provided me with direction. I could not have finished the course without his guidance. I deeply thank Profs. Chunghwi Yi and Heonseock Cynn. I have written a better graduate thesis as a result of your guide and advice. I also thank Profs. Sanghyun Cho, Hyeseon Jeon and Seunghyun Yoo. I have expanded my knowledge and perspective from interactions with you. I also give thanks to Mr. Byungkyu Lee, who always took care of administrative issues. I appreciate all my fellow students, especially Wonhwee Lee, Sujung Kim and Boram Choi. You gave me lots of help with my thesis and with school life generally. I also appreciate my co workers. You always tried to cheer me up and were a great comfort to me. Finally, I want to express my love for my parents, sister and Jinsu Lim. You always prayed for me from your hearts. I was able to finish the course with your support and encouragement. Thanks to all of you. I hope to be able to repay your favors someday.

6 Table of Contents List of Figures ⅲ List of Tables ⅳ Abstract ⅴ Introduction 1 Method 4 1. Subjects 4 2. Experimental Equipment Sonography System Electromyography System D Motion Analysis System 8 3. Experimental Procedure 9 4. Statistical Analysis 12 Results Muscle Thickness Muscle Activity Pelvic Lateral Tilting 17 Discussion 18 Conclusion 23 References 24 - i -

7 Abstract in Korean 29 - ii -

8 List of Figures Figure 1. Measurement of the muscle thickness 6 Figure 2. Test postures 11 Figure 3. Comparison of muscle thickness 15 - iii -

9 List of Tables Table 1. Characteristics of the subjects 4 Table 2. Means and standard deviations of muscle thickness 14 Table 3. Comparison of muscle thicknesses 14 Table 4. Comparison of the muscle activity 16 Table 5. Comparison of the angle pelvic lateral tilting 17 - iv -

10 ABSTRACT Effects of Contralateral Hip Adduction on Muscle Thickness, Activity of Lumbar Stabilizers and Pelvic Lateral Tilting During Hip Abduction in Sidelying Hyo uen Kim Dept. of Rehabilitation Therapy The Graduate School Yonsei University The purpose of this study was to determine the effects of contralateral hip adduction on muscle thickness, muscle activity of lumbar stabilizers, and the angle of pelvic lateral tilting during hip abduction in side lying. Twenty healthy male subjects with no medical history of lower extremity or lumbar spine disorders were recruited for this study. Subjects performed 35 preferred hip abduction (PHA) and 35 hip abduction with 10 contralateral hip adduction (CHA) during side lying. Thicknesses - v -

11 of the transverses abdominis (TrA), internal oblique (IO), and quadratus lumborum (QL) were measured in the rest position (RP) and during PHA and CHA using a sonography system. Muscle activities of the dominant side rectus abdominis (RA), external oblique (EO), IO, QL, gluteus medius (GM), and non dominant-side hip adductor longus (Add) were measured during PHA and CHA using a surface electromyography system (EMG). Kinematic data for pelvic lateral tilting were collected during PHA and CHA using a three dimensional (3 D) motion analysis system. One way repeated analysis of variance was used to compare the thickness of the muscles, and a paired t test was used to compare EMG activity and the angle of pelvic lateral tilting between the two exercises. Thicknesses of the TrA and IO were significantly increased in CHA versus PHA, but there was no significant difference between RP and PHA. Thickness of QL (anterio posterior, A P) was increased in CHA more than PHA, but QL (medio lateral, M L) was not significantly different between PHA and CHA. EMG activities of all muscles were increased significantly more in CHA versus PHA. Pelvic lateral tilting was decreased significantly more in CHA versus PHA. These results suggest that CHA could be recommended as a hip abduction exercise for activating lumbar stabilizers and decreasing compensatory pelvic tilting motion. Key Words: Electromyography, Hip abduction, Lumbar stabilizer, Sonography, Pelvic tilting. - vi -

12 Introduction Lumbar stabilization has been actively studied over the past decade (Cynn et al. 2006). The concept of lumbar stabilization involves maintaining lumbar stability through isometric contraction of lumbar and abdominal muscles during limb movement. Increasing lumbar stability is considered an effective method of preventing lumbar musculoskeletal disease and improving lumbar function (Kisner and Colby 2002). Increasing lumbar stabilization is also effective for patients with low back pain regardless of the cause or status (Luoto et al. 1998; O Sullivan et al. 1997). Previous studies have demonstrated that the activity of the lumbar stabilizers is decreased and delayed during limb movement in patients with low back pain compared with subjects without low back pain (Hodge and Richardson 1997; Sahrmann 2002). Decreased lumbar stability during limb movement causes compensatory movements. Excessive compensatory movement can causes micro trauma, and repeated micro trauma can lead to lumbar dysfunction (Sahrmann 1993). Hip abduction in side lying is commonly used clinically to evaluate movement patterns (Libenson 1996; Sahrmann 1993) and to improve gait and balance ability (Judge et al. 1993; Sashika et al. 1996). Many studies have investigated lumbar stabilization in the standing and supine lying position, whereas few have examined - 1 -

13 the side lying position (Hodges and Richardson 1999; Jull et al. 1993). Cynn et al. (2006) reported that an abdominal drawing in maneuver and using a pressure biofeedback unit increased lumbar stability and decreased pelvic lateral tilting during hip abduction in side lying. When a hip abduction exercise is performed in side lying, unwanted compensatory pelvic lateral tilting can appear (Norris 1995). The normal pattern of hip abduction has been described as about 40 abduction, with no hip flexion, external or internal rotation, hip elevation, or pelvic rotation. When the hip abduction is initiated by contraction of the quadratus lumborum before 20, hip abduction induces pelvic lateral tilt or hip hike. This altered movement pattern can cause excessive stress to lumbosacral segments during a hip abduction exercise (Libenson 2007). The function of TrA and IO in lumbar stability was investigated in previous studies (Hodges and Richardson 1997; Hodges and Richardson 1999; O Sullivan et al. 2002). QL can stabilize the lumbar region during isometric contraction (Cholewicki and Vanvliet 2002; McGill 1996). Page et al. (2010) stated that the role of the QL changed from pelvic stabilizer to the prime mover in hip abduction, resulting in a pelvic lateral tilt during hip abduction in side lying. During hip abduction, contraction of contralateral hip in adduction can stabilize the lumbar region (Lee 1999). Lee (1999) described four systems that contribute to lumbo pelvic stability: the anterior oblique, posterior oblique, longitudinal, and lateral systems. Among them, the lateral system consists of the hip abductor and the - 2 -

14 contralateral hip adductor. These muscles are related closely in the kinetic chain to make forces and co contract or release to optimize the function of the pelvis (Lee 1999). Root and Spero (1981) also demonstrated that enough force from the contralateral hip adductor can act against the force of hip abductor, maintaining pelvic stability. However, there has been no reported study on whether contralateral hip adduction can increase lumbar stability in hip abduction in side lying. The extent of lumbar stability had been measured through the activity of the lumbar stabilizers (Cholewicki and McGill 1996; Reeve and Dilley 2009). The quantity of muscle activity can be measured using electromyography. The increased thickness of lumbar stabilizers could reflect their increased activity (Hodges et al. 2003; McMeeken 2004) and the thickness of lumbar stabilizers can be measured using sonography (Ainscouph Potts et al. 2006). The purpose of this study was to investigate the effects of contralateral hip adduction on the thickness and activity of the lumbar stabilizers and pelvic lateral tilting during hip abduction in side lying. The hypothesis of the study was that thickness and activity of lumbar stabilizers would be increased and pelvic lateral tilting would be decreased in hip abduction with contralateral hip adduction (CHA) compared with preferred hip abduction (PHA)

15 Method 1. Subjects Twenty healthy male subjects were recruited from Yonsei University. Exclusion criteria were past or present neurological, musculoskeletal, or cardiopulmonary disease. Subjects with low back pain, knee pain, hip joint contracture, and gluteus medius strength below a grade of good on manual muscle testing were also excluded. All subjects were right leg dominant. Prior to the study, ethics approval was obtained from Yonsei University. All subjects were informed about the purpose and procedures of the study, and written informed consent was obtained. Characteristics of the subjects are presented in Table 1. Table 1. Characteristics of the subjects (N=20) Parameter Mean ± SD Age (yr) 21.8 ± 2.8 Body mass ( kg ) 71.9 ± 10.8 Height ( cm ) ±

16 2. Experimental Equipment 2.1 Sonography System The SONOACE X8 (Medison, Inc., Seoul, South Korea) was used to measure muscle thickness of the dominant side TrA, IO, and QL. A linear transducer (L5 12EC) 4.5 cm in size and with a frequency of 10 MHz was used (Richardson, Hodge and Hides 2004). TrA and IO were measured at a point 2.5 cm antero medial to the midpoint between the ribs and ilium on the mid axillary line (Critchley 2002; Mcmeeken et al. 2004). The thickness of TrA and IO were measured (vertical diameter) between the fascias at a point 1.5 cm from the aponeurotic attachment (Reeve and Dilley 2009) (Fig. 1). To measure the QL, the transducer was moved laterally from the transverses plane at the L3 level until an image was obtained (Desmoulin and Millner 2007). The thickness of the QL was measured (medio lateral (M L) diameter and anterio posterior (A P) diameter) at the widest point (Desmoulin and Milner 2007) (Fig. 1). Measurements were conducted by one expert and measured while the subject maintained end posture while holding his breath after expiration. The transducer was maintained vertical to the skin and in the same position during the measurements to reduce errors

17 Figure 1. Measurement of muscle thickness A: internal oblique, B: transverses abdominis, C: quadratus lumborum anterio posterior, D: quadratus lumborum medio lateral

18 2.2 Electromyography System The Noraxon Telemyo 2400T (Noraxon, Inc., Scottsdale, AZ, USA) was used to measure muscle activity The skin was shaved with a razor, rubbed with sand paper, and cleaned with alcohol. Pairs of surface electrodes and adhesive skin interfaces were separated by 2 cm. The reference electrode was placed on the anterior superior iliac spine (ASIS). EMG data were collected from the following muscles: dominant side rectus abdominis (RA; parallel and approximately 3 cm lateral and superior to the umbilicus, arranged along the longitudinal axis over the muscle belly); dominant side EO (half way between the ASIS of the pelvis and the inferior border of the rib cage at a slightly oblique angle, running parallel to the underlying muscle fibers); dominant side IO (half way between the ASIS of the pelvis and the midline, just superior to the inguinal ligament); dominant side gluteus medius (GM; over the proximal third of the distance between the iliac crest and the greater trochanter); dominant-side QL (approximately 4 cm lateral from the vertebra ridge and at a slightly oblique angle at half the distance between the 12 th rib and the iliac crest); and non-dominant side hip adductor longus (Add; medial aspect of the thigh in an oblique direction, 4 cm from the pubis). Raw data were rectified and filtered using a Lancosh FIR digital filter. The sampling rate was 1000 Hz. A band pass filter ( Hz) and a band stop (60 Hz) were used. EMG data were converted to root mean square (RMS) values. To - 7 -

19 normalize the EMG data, the mean RMS of three trials of 5 s maximal voluntary isometric contractions (MVICs) was calculated for each muscle at a manual muscle testing position, according to Kendall et al. (2005). The data were expressed as a percentage of the MVIC (%MVIC), and the mean value of three trials was used for data analysis D Motion Analysis System A three dimensional ultrasonic motion analysis system (CMS HS, Zebris, Medizintechnik, Isny, Germany) was used to measure pelvic lateral tilting during hip abduction in side lying. Three active markers were placed at the level of the dominant ASIS by fastening a belt. The markers faced the measuring sensor, which consisted of three microphones. The measuring sensor was placed in front of the subject and recorded the ultrasonic signals from the markers. The angle of the pelvic lateral tilt was calibrated to 0 at the rest position as a reference before the movement, and then the relative angle of the pelvic lateral tilt during hip abduction was calculated from this reference. The sampling rate was set at 20 Hz. A low pass filter with a cutoff frequency was set at 8 Hz. Kinematic data were analyzed using the Windata software (ver. 2.19). The mean angle of three trials was used in data analysis

20 3. Experimental Procedure The rest position (RP) was a side lying position with the non dominant lower extremity contacting a firm mattress. The upper trunk, pelvis, and dominant lower extremity were aligned in a straight line. PHA is a 35 abduction of the dominant hip during side lying (Cynn 2006). CHA is 10 adduction of the contralateral hip and then a 35 dominant hip abduction during side lying. The degree of contralateral hip adduction was set at the proper angle according to a pilot study. During PHA and CHA, subjects were required to maintain steady trunk alignment without hand support. Bars were placed at 35 hip abduction and 10 hip adduction positions (Fig. 2). Before testing, subjects were trained for approximately 15 min to familiarize them with PHA and CHA. Subjects performed RP, PHA, and CHA randomly. The subject was asked to maintain each posture for 5 s to allow image capture of TrA, IO, and QL using the sonography system. The principal investigator placed the transducer at a point 2.5 cm antero medial to the midpoint between the ribs and ilium on the mid axillary line for the TrA and IO muscles. After capturing TrA and IO images, the transducer was moved laterally at the L3 level to capture the QL image. Between the two conditions, a 5 min rest period was provided at the RP. After a 30 min rest, electrodes and the three markers were attached for collecting EMG and kinematic data. Subjects were asked to perform PHA and CHA in the same - 9 -

21 way. During the each test, muscle activity and the angle of pelvic lateral tilting were recorded using EMG and a 3 D motion analysis system. All examinations were conducted by the same researcher

22 Figure 2. Test postures A: rest Position, B: preferred hip abduction, C: hip abduction with contralateral hip adduction

23 4. Statistical Analysis Repeated measures one way analysis of variance (ANOVA) was used to determine significant differences in muscle thicknesses of the TrA, IO, and QL among RP, PHA, and CHA, and the least significant difference (LSD) was calculated post hoc. The paired t test was used to determine significant differences in muscle activity of the RA, IO, EO, QL, GM, and Add muscles and pelvic lateral tilting between PHA and CHA. The level of statistical significance was set at α =

24 Results 1. Muscle thickness The mean thickness of TrA and IO in each posture is presented in Table 2. The thickness of TrA and IO increased significantly in CHA compared with PHA and RP (F = 92.61, p = 0.000; F = 10.09, p = 0.000, respectively; Table 3; Fig. 3). The A P thickness of QL was increased significantly in CHA versus PHA (F = 86.63, p = 0.000; Table 3; Fig. 3). The M L thickness of QL decreased significantly (F = 16.54, p = 0.000; Table 3). The result from the post hoc analysis showed no significant difference between PHA and CHA (Fig. 3)

25 Table 2. Means and standard deviations of muscle thickness Muscle ( cm ) RP a PHA b CHA c TrA d 0.61 ± 0.14 h 0.73 ± ± 0.18 IO e 0.65 ± ± ± 0.20 QL (M-L) f 1.74 ± ± ± 0.21 QL (A-P) g 0.40 ± ± ± 0.14 RP a : rest position; PHA b : preferred hip abduction; CHA c : hip abduction with contralateral hip adduction; TrA d : transverses abdominis; IO e : internal oblique; QL (M-L) f : quadratus lumborum (medio lateral); QL (A-P) g : quadratus lumborum (anterio posterior). h mean±sd. Table 3. Comparison of muscle thicknesses Muscle Type Ⅲ Sum of Squares df Mean Square F p TrA a IO b QL (M-L) c QL (A-P) d TrA a : transverses abdominis; IO b : internal oblique; QL (M-L) c : quadratus lumborum (medio lateral); QL (A-P) d : quadratus lumborum (anterio posterior)

26 Figure 3. Comparison of the muscle thicknesses RP: rest position; PHA: preferred hip abduction; CHA: hip abduction with contralateral hip adduction; TrA: transverses abdominis; IO: internal oblique; QL (M L): quadratus lumborum (medio lateral); QL (A P): quadratus lumborum (anterio posterior); *p <

27 2. Muscle activity Mean values and standard deviations of EMG amplitude for each muscle are presented in Table 5. The activity of all muscles was statistically significantly increased in CHA versus PHA (Table 4). Table 4. Comparison of the muscle activity Muscle (%MVC) PHA a CHA b t p RA c 1.63±0.86 i 7.07± IO d 10.46± ± EO e 6.17± ± QL f 17.07± ± GM g 26.11± ± Add h 1.24± ± PHA a : preferred hip abduction; CHA b : hip abduction with contralateral hip adduction; RA c : rectus abdominis; IO d : internal oblique; EO e : external oblique; QL f : quadratus lumborum; GM g : gluteus medius; Add h : hip adductor longus. i mean±sd

28 3. Pelvic lateral tilting The angle of pelvic lateral tilting was significantly decreased in CHA versus PHA (p = 0.000) (Table 5). Table 5. Comparison of the angle of pelvic lateral tilting PHA a CHA b t p Pelvic lateral tilting ( ) 11.41±4.71 c 7.78± PHA a : Preferred hip abduction; CHA b : Hip abduction with contralateral hip adduction c mean±sd

29 Discussion This study was performed to determine whether contralateral hip adduction could improve lumbar stability, activate lumbar stabilizers and the gluteus medius muscle, and decrease unwanted compensatory pelvic lateral tilting during hip abduction in side lying. To compare changes in muscle thickness, real time ultrasound was used. The result of this study demonstrated that the thicknesses of TrA, IO, QL (A P) increased significantly in CHA versus PHA. Furthermore, activity in the dominant side RA, EO, IO, and QL increased significantly in CHA versus PHA. The observed increased muscle thickness in TrA, IO, and QL (A P) and increased muscle activity in RA, EO, IO, and QL under the CHA condition may have several explanations. First, the base of support (BOS) in CHA was less than that in PHA. In this study, subjects were asked to maintain the alignment without hand support during the tests. Under the CHA condition, the subject was asked to adduct his bottom leg. Thus, the contact area of the body on the floor, BOS, was markedly decreased in the CHA condition versus PHA. A previous study demonstrated that decreased BOS was more challenging and led to coactive muscle contraction (Santos and Aruin 2009). Ainscouph Potts et al. (2006) showed that TrA and IO thickness increased significantly in decreasing the stability and area of BOS in a sitting position and

30 lifting the foot off the floor on a gym ball compared with crooked lying and relaxed sitting on a gym ball with both feet on the ground. Kim et al. (2011) reported that single leg raising in hook laying position on a round foam roll, which provided a small BOS, induced more abdominal muscle activity than lying on the floor. Thus, TrA, IO, and QL (A-P) and the activity of RA, EO, IO, and QL are likely to contract synergistically, especially under the CHA condition when there is less BOS than under the PHA condition. Second, the load to the lumbar vertebrae was increased significantly in CHA versus PHA. Cholewicki et al. (2002) reported that 10 major trunk muscles (RA, EO, IO, latissimus dorsi, iliocostalis lumborum, longissimus thoracis, lumbar erector spinae, multifidus, psoas, QL) contributed to maintaining stability of the lumbar spine rather than single muscles of the trunk, according to the increased load to the lumbar vertebrae in a biomechanical model study. Cholewicki and McGill (1996) demonstrated that the relative stability index and muscle effort increased with increased moment demand or the joint compression force during the tasks in their study. Cholewicki, Simons, and Radebold (2000) reported that vertical and horizontal trunk load magnitude increased the activity of trunk muscles. In the present study, the load on the trunk may have been increased in CHA due to lifting both legs. This increased trunk load during CHA increased the demand for muscle contraction in the trunk. Thus, RA, EO, IO, and QL activity was significantly increased in CHA. In this study, activity in RA, EO, IO, and QL increased significantly in CHA versus PHA. Some authors have suggested that the activity of local muscles,

31 including TrA and the multifidus for lumbar segmental stability, is needed for lumbar stability (Hodge and Richardson 1997; Hodge and Richardson 1999). However, others have insisted that the activities of all muscles of the trunk are important for lumbar stability (Cholewicki and McGill 1996; Cholewicki and Vanvliet 2002). The results of this study support the latter conclusion: not only local muscles but all muscles of the trunk play an important role in lumbar stability. Although activity of the TrA was not included in this study, it seems possible that TrA activity is increased in CHA. EMG activities of TrA and IO have been shown to act together for all directions of rapid shoulder movement (Marshall and Murphy 2003). Thus, CHA would help to increase activity of the TrA. The hip abduction test can be used to evaluate the quality of the lateral muscular pelvic brace and lumbo pelvic stabilization. The poorest pattern of hip abduction is when the QL acts in pelvic tilting rather than pelvic stabilization (Libenson 1996). Alteration in hip abduction patterns may cause excessive stress to lumbo pelvic segments. Cynn et al. (2006) demonstrated that lumbar stabilization during hip abduction was useful to prevent excessive activation of the QL and excessive pelvic lateral tilting. In the present study, the activity of GM increased significantly in CHA compared with PHA. Kinematic data showed a significantly decreased angle of pelvic lateral tilting in CHA compared with PHA. Contraction of the contralateral hip adductor muscle during contraction of the hip abductor muscle may stabilize the pelvis in CHA (Lee 1999). A stabilized pelvis may result in increased GM activity

32 and a decreased angle of pelvic lateral tilting in CHA. Thus, the CHA exercise can be recommended to prevent unwanted compensatory pelvic lateral tilting during hip abduction in side lying. In this study, the thickness of QL (A P) increased significantly in CHA versus PHA. The thickness of the QL has not yet been thoroughly investigated. However, Desmoulin and Milner (2007) demonstrated that the thickness of the QL (A P) was significantly correlated with the isometric lateral flexion force of the trunk. McGill (1996) demonstrated that the quadratus lumborum appeared to be an important stabilizer of the lumbar column and acted primarily during isometric side support tasks. Consequently, QL functions as a stabilizer during the isometric side flexion force of the trunk. Although these studies did not use the same method as the present study, maintaining hip abduction in side lying produced isometric lateral flexion force on the trunk. Thus, the increased thickness of QL (A P) and activity of the QL demonstrated that the QL contracts isometrically and acts as a stabilizer of the pelvis during the CHA condition. This study has some limitations. First, the results were obtained only in young healthy male subjects. Older persons or those with injured spines may show different results. Second, the standard references for the thickness of the QL by sonography were insufficient. Although Desmoulin and Milner (2007) demonstrated that the A P thickness of the QL increased significantly during isometric lateral flexion of the trunk, it is necessary that the thickness of the QL using a sonography system also be

33 investigated. Third, this study was a cross sectional study that investigated the effects of CHA on muscle thickness, activity of lumbar stabilizers, and pelvic lateral tilting during CHA. The effects of long term training using CHA should be examined in further studies

34 Conclusion In this study, the effect of CHA on lumbar stabilizers and compensatory movement was determined. The results demonstrate that the thickness and activity of lumbar stabilizers were significantly increased in CHA compared with PHA. Furthermore, the angle of pelvic lateral tilting was decreased significantly in CHA versus PHA. Thus, a CHA exercise can be recommended to prevent unwanted compensatory pelvic lateral tilting during hip abduction exercises in side lying

35 References Ainscouph Potts AM, Morrissey MC, and Critchley D. The response of the transverse abdominis and internal oblique muscles to different postures. Man Ther. 2006;11(1): Cholewicki J, VanVliet JJ Ⅳ. Relative contribution of trunk muscles to the stability of the lumbar spine during isometric exertions. Clin Biomech (Bristol, Avon). 2002;17(2): Cholewicki J, and McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech (Bristol, Avon). 1996;11(1):1 15. Cholewicki J, Simons AP, and Radebold A. Effects of external trunk loads on lumbar spine stability. J biomech. 2000;33(11): Critchley D. Instructing pelvic floor contraction facilitates transverses abdominis thickness increase during low abdominal hollowing. Physiother Res Int. 2002;7(2):

36 Cynn HS, Oh JS, Kwon OY, and Yi CH. Effects of lumbar stabilization using a pressure biofeedback unit on muscle activity and lateral pelvic tilt during hip abduction in side-lying. Arch Phys Med Rehabil. 2006;87(11): Desmoulin G, and Milner T. Lumbar mechanics from ultrasound imaging. Canadian Acoustics. 2007;35(2):61 68 Hodges PW, and Richardson CA. Feedforward contraction of transverses abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114(2): Hodges PW, and Richardson CA. Altered trunk muscle recruitment in people with low back pain with limb movement at different speeds. Arch Phys Med Rehabil. 1999;80(9): Hodges PW, Pengel LHM, Herber RD, and Gandevia SC. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve. 2003;27(6): Judge JO, Lindsey C, Underwood M, and Winsemius D. Balance improvements in older women: Effects of exercise training. Phys Ther. 1993;73(4): Jull G, Richardson C, Toppenberg R, Comerford M, and Bui B. Towards a measurement of active muscle control for lumbar stabilization. Aust. J Physiother. 1993;39(3):

37 Kim SJ, Kwon OY, Yi CH, Jeon HS, Oh JS, Cynn HS, and Weon JH. Comparison of abdominal muscle activity during a single legged hold in the hook-lying position on the floor and on a round foam roll. J Athl Train. 2011:46(4): Kisner C and Colby LA. Theraeutic Exercise: Foundation and techniques. 4 th ed. Philadelphia F.A: Davis Lee D. The Pelvic Girdle. 2 nd ed. London: Churchill Livingstone Libenson C. Rehabilitation of the spine: a practitioner s manual. Baltimore: Williams & Wilkins Libenson C. Rehabilitation of the spine: a practitioner s manual. 2 nd ed. Baltimore: Williams & Wilkins Luoto S, Aalto H, Taimela S, Hurri H, Pyyo I, and Alaranta H. One footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy contol subjects: A controlled study with follow up. Spine (Phila Pa 1976). 1998;23(19): Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. J Electromyogr Kinesiol. 2003;13(5):

38 McGill SM. Quantitative intramuscular myoelectric activity of quadratus lumboum during a wide variety of tasks. Clin Biomech (Bristol, Avon). 1996:11(3): McMeeen JM, Beith ID, Newham DJ, and Milligan P. The relationship between emg and change in thickness of transverses abdominis. Clin Biomech (Bristol, Avon). 2004;19(4): Norris CM. Spinal stabilization: 4.muscle imbalance and the low back. Physiotherapy. 1995;81(3): O Sullivan PB, Phyty DG, Twomey LT, and Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low bac pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). 1997;22(24): O Sullivan PB, Grahamslaw KM, Kendell M, Lapenskie SC, Moller NE, and Richard KV. The effect of different standing and sitting postures on trunk muscle activity in pain-free population. Spine (Phila Pa 1976). 2002;27(11): Page P, Frank C, and Lardner R. Assessment and treatment of muscle imbalance: the Janda approach.united States of America: Human Kinetics Reeve A and Dilley A. Effects of posture on the thickness of transverses abdominis in pain free subjects. Man Ther. 2009;14(6):

39 Richardson CA, Hodges PW, and Hides J. Therapeutic exercise for lumbopelvic stabilization. 2nd Ed. Philadelphia: Churchill livingstone, Root L, and Spero CR. Hip adductor transfer compared with adductor tenotomy in cerebral palsy. J Bone Joint Surg Am. 1981;63(5): Sahrmann SA. Movement as a Cause of Musculoskeletal pain. Integrating. Sydney: Association of Australia Sahrmann S. Diagnosis and treatment of movement impairment syndrome. St. Louis: Mosby Santos MJ, Aruin AS. Effects of lateral perturbations and changing stance conditions on anticipatory postural adjustment. J Electromyogr Kinesiol. 2009;19(3): Sashika H, Matsuba Y, and Watanabe Y. Home program of physical therapy: Effect on disabilities of patients with total hip arthroplasty. Arch Phys Med Rehabil. 1996;77(3):

40 국문요약 옆으로누운자세에서고관절외전시반대측고관절 내전이요추안정화근육의두께, 근활성도와골반 외측경사에미치는영향 연세대학교대학원 재활학과 김효언 본연구는옆으로누운자세에서고관절외전시반대측고관절내전이요추안정화근육의두께와근활성도, 골반외측경사에미치는영향을알아보기위해시행되었다. 본연구는요추나하지의과거병력이없는 20명의건강한성인남성을대상으로하였다. 대상자는옆으로누운자세에서임의로고관절 35 외전 (preferred hip abduction; PHA) 과반대측고관절 10 내전후고관절 35 외전 (hip abduction with contralateral hip adduction; CHA) 을실시하였다. 대상자가동작을하는동안오른쪽복횡근, 내복사근과요방형근의두께, 오른쪽복직근,

41 외복사근, 내복사근, 요방형근, 중둔근과왼쪽고관절내전근의근활성도, 골반의외측경사를측정하였다. 휴식자세 (rest position), PHA와 CHA 시근육의두께를비교하기위해반복측정된일요인분산분석 (repeated one-way analysis of variance) 을, PHA와 CHA 시근활성도와골반외측경사를비교하기위해짝비교 t-검정 (paired t-test) 을사용하였다. 내복사근과복횡근의두께는 PHA시보다 CHA 시유의하게두꺼워졌다. 요방형근의안-밖두께는 CHA와 PHA사이유의한차이가없었으며앞- 뒤두께는 CHA 시 PHA보다유의하게두꺼워졌다. 근활성도는모든근육에서 CHA시 PHA보다유의하게증가하였다. 골반의외측경사는 CHA시 PHA보다유의하게감소하였다. 이러한결과들은옆으로누운자세에서고관절외전시반대측고관절을동시에내전하는것이요추의안정성을증가시키고골반의보상작용을줄일수있다고제안할수있을것이다. 핵심되는말 : 고관절외전, 골반경사, 근전도, 요부안정화, 초음파