경부안정화운동방법에 따른 만성 경부통환자 경부의 최대근력과 근지구력 및 단면적에 미치는 영향 = Effects of cervical stabilization exercise type on muscle strength and endurance, cross sectional area of cervical in patients with chronic cervical pain

다국어 초록 (Multilingual Abstract)

The purpose of this study was to analyze potential effectiveness of different 8-week neck stabilization exercise programs applied to the adult cases of chronic neck pain in functional stability (pain scale, neck disability index, maximum cervical muscular strength and cervical muscular endurance) and structural stability (ROM, muscular cross- sectional area of cervical) of their necks, so that it could determine the most efficient way of neck stabilization exercise.
Pain scale, neck disability index and ROM of cervical joint were respectively measured (with flexion, extension, right/left flexion and right/left rotation of neck) using VAS, NDI and cervical gravity joint mobilizer. On each muscular region of neck (deep muscles such as longus capitis muscle, longus colli muscle and multifidus muscles, and superficial muscle such as musculus levator scapulae, musculus scalenus anterior and upper trapezius muscle), this study used pressure biofeedback unit to measure both maximum cervical muscular strength and cervical muscular endurance of subjects, and also employed magnetic resonance imaging (MRI) unit to measure muscular cross-sectional area of their cervical joint. In addition, this study sought to determine possible interactions among variables depending on exercise program and timing. Based on the comparison and analysis of all variables, this study could come to the following findings:

The results are listed as follows:

1. Potential variations in functional stability of neck depending upon neck stabilization exercise programs

1) According to measurement of pain scale depending on neck stabilization exercise programs, it was found that head-neck exercise group, Swiss ball exercise group and physical therapy group felt significantly relieved from chronic neck pain after exercise than before. In particular, Swiss ball exercise group experienced most significant efficacy of exercise in relief from chronic neck pain (p<.001).

2) According to analysis on neck disability index depending upon neck stabilization exercise programs, it was found that head-neck exercise group, Swiss ball exercise group and physical therapy group felt significantly relieved from chronic neck pain after exercise than before. In particular, Swiss ball exercise group experienced most significant efficacy of exercise in relief from chronic neck pain (p<.001).

3) According to measurement of maximum cervical muscular strength and cervical muscular endurance depending on neck stabilization exercise programs, it was found that both head-neck exercise group and Swiss ball exercise group showed significant improvement after exercise than before (p<.001). Particularly, it was found that Swiss ball exercise group showed most significant improvement among others after exercise, but physical therapy group didn't show any significant improvement even after exercise.

2. Potential variations in structural stability of neck depending on neck stabilization exercise programs

1) According to measurement of movable scope of neck joint depending on neck stabilization exercise programs, it was found that head-neck exercise group, Swiss ball exercise group and physical therapy group showed significant improvement in movable scope after exercise than before. Particularly, it was found that head-neck flexion exercise group showed most significant improvement in movable scope among others (p<.001).

2) According to measurement of cross-sectional area of cervical joint depending upon neck stabilization exercise programs, it was found that both head-neck exercise group and Swiss ball exercise group showed significant improvement in cross-sectional area after exercise than before (p<.001). Among others, Swiss ball exercise group showed most significant improvement in cross-sectional area, whereas physical therapy group showed no significant improvement.

Summing up, it was found that cranio-cervical flexion exercise, Swiss ball exercise and physical therapy contributed to significant improvement of cervical functional stability variables (such as pain scale, neck disability index, maximum cervical muscular strength and cervical muscular endurance) in terms of exercise program and timing, but Swiss ball exercise was most significantly effective in improving those variables. And it was found that cranio-cervical flexion exercise, Swiss ball exercise and physical therapy contributed to significant improvement contributed to significant improvement in the movable scope of cervical joint as a part of structural stability variables, but cranio-cervical flexion exercise was most significantly effective among others in improvement of those variables. On the other hand, it was found that cranio-cervical flexion exercise and Swiss ball exercise contributed to significant improvement in muscular cross-sectional area of cervical joint, but Swiss ball exercise was most significantly effective in improving cross-sectional area, while physical therapy showed no significant improvement.
Hence, it is concluded that neck stabilization exercise using Swiss ball is significantly effective in pain relief and functional recovery of chronic neck pain cases. Based on the findings of this study, it is required that follow-up studies should focus on development of rehabilitative exercise programs to improve a variety of proprioceptive senses.

목차 (Table of Contents)

• 목 차
• ABSTRACT
• I. 서론 1
• 1. 연구의 필요성 1
• 2. 연구의 목적 5
• 3. 연구의 가설 6
• 4. 연구의 제한점 7
• 5. 용어의 정의 8
• Ⅱ. 이론적 배경 11
• 1. 경추의 해부학적 구조와 기능 11
• 2. 경부통의 원인과 증상 14
• 3. 경부자세에 따른 불안정성의 특성 15
• 4. 경부 기능적 안정성의 특성 16
• 1) 경부기능장애 17
• 2) 경부근육의 불균형 18
• 3) 운동감각기능 19
• 5. 경부 구조적 안정성의 특성 21
• 1) 관절가동범위 21
• 2) 근단면적 22
• 6. 만성경부통의 치료 23
• 7. 경부안정화 운동 25
• 1) 경부안정화의 이론과 근육 26
• 2) 경부안정화운동의 효과 29
• 3) 두경부굴곡 운동 31
• 4) 스위스 볼 운동 32
• Ⅲ. 연구방법 35
• 1. 연구대상 35
• 2. 실험설계 36
• 3. 실험절차 37
• 4. 측정도구 39
• 5. 실험방법 39
• 1) 체격 39
• 2) 신체구성 39
• 3) 통증척도 40
• 4) 경부장애지수 40
• 5) 관절가동범위 41
• 6) 경부의 최대근력과 근지구력 41
• 7) 근단면적 43
• 6. 운동프로그램 44
• 7 자료처리 47
• Ⅳ. 연구결과 48
• 1. 경부안정화운동방법에 따른 경부 기능적 안정성의 변화 48
• 1) 통증척도의 변화 48
• 2) 경부장애지수의 변화 50
• 3) 경부의 최대근력과 근지구력의 변화 52
• (1) 최대근력의 변화 52
• (2) 근지구력의 변화 54
• 2. 경부안정화운동방법에 따른 경부 구조적 안정성의 변화 59
• 1) 관절가동범위의 변화 59
• (1) 경부굴곡의 변화 59
• (2) 경부신전의 변화 61
• (3) 우측굴곡의 변화 63
• (4) 좌측굴곡의 변화 65
• (5) 우측회전의 변화 67
• (6) 좌측회전의 변화 69
• 2) 경부 근단면적의 변화 71
• (1) 두장근의 변화 71
• (2) 경장근의 변화 75
• (3) 다열근의 변화 78
• (4) 전사각근의 변화 81
• (5) 견갑거근의 변화 84
• (6) 상부 승모근의 변화 87
• Ⅴ. 논의 91
• 1. 경부안정화운동방법에 따른 경부 기능적 안정성의 변화 91
• 1) 통증척도 91
• 2) 경부장애지수 93
• 3) 최대근력 및 근지구력 95
• 2. 경부안정화운동방법에 따른 경부 구조적 안정성의 변화 97
• 1) 관절가동범위 97
• 2) 근단면적 98
• Ⅵ. 결론 101
• Ⅶ. 참고문헌 104