교각운동 방법 차이에 의한 만성요통환자의 체간근 활성도, 근 두께 및 고유수용성감각에 미치는 영향 = The Effect of Activity,Thickness and Proprioception of Trunk muscles According to the Methods of Bridge exercises in Patients with Chronic Low Back Pain

다국어 초록 (Multilingual Abstract)

This study was conducted in order to find a method to improve trunk muscle activity, thickness, and proprioception in chronic low back pain patients using different bridge exercises. Seventy-five subjects (control group=30, patients group=45) participated in this study and the chronic low back pain groups were randomly divided into a supine bridge exercise (SBE) group, a supine bridge on Swiss ball exercise (SBSE) group, and a prone bridge exercise (PBE) group. The patients in each of the three exercise groups received the specified training for eight weeks and then the activity, thickness and proprioception of internal oblique, transverse abdominis, external oblique, and erector spinae were measured using surface electromyography, zebris and ultrasonograpy.
An independent t-test was conducted in order to compare the control group and the chronic low back pain patient group. A paired t-test was carried out to compare the results within the low back pain patient group prior to and after the exercises based on the different exercise methods. To compare the results between the three exercise groups, the pre-test was controlled as a covariate and analysis of the covariance was performed.
The study results were as followed.
First, IO, TrA and EO were significantly thinner in chronic low back pain group compared to control group. Second, the joint position senses of lumbar spine were significantly degraded in chronic low back pain group compared to control group. Third, the activities of IO, TrA, EO and ES were significantly higher in chronic low back pain group when performing bridge exercises compared to control group. Fourth, thicknesses of IO, TrA and EO were significantly increased in all 3 bridge exercises groups of chronic low back pain patients after training. Especially, thicknesses of IO, TrA and EO were the highest in PBE, followed by SBSE and then SBE. IO was significantly different between SBE and PBE as well as between SBSE and PBE. The differences of TrA thickness among three groups were significant. Fifth, all three bridge exercise groups showed significantly decreased joint position sense after training. There were significant difference of joint position sense with lumbar flexion between SBE and PBE. With lumbar extension, there were significant differences between SBE and PBE, as well as between SBSE and PBE. Sixth, EMG activity of IO was significantly reduced in all 3 bridge exercises after training. PBE showed significantly higher EMG activity of IO than both SBE and SBSE. There were significant difference between SBE and PBE as well as between SBSE and PBE. Only PBE made significantly decreased EMG activity of TrA after training compared to before training. EMG activity of EO was significantly different in both SBSE and PBE after training compared to before training. EMG activity of ES was significantly different in both SBSE and PBE after training compared to before training. There were significant difference between SBE and PBE as well as between SBSE and PBE. Especially, activity of IO, TrA and EO was the higest in PBE, followed by SBSE and SBE. Activity of ES was the lowest in PBE, followed by SBSE and SBE. Lastly Oswestry Disability Index was significantly reduced in all 3 bridge exercise groups after training compared to before training. There were significant difference between SBE and PBE as well as between SBSE and PBE.
To summarize the results presented above, the results of this study showed that thickness, activity and proprioception of trunk muscles declined in the chronic low back pain group compared to control group. In chronic low back pain groups, the activity of trunk muscle, proprioception, and muscle thickness increased more during the prone bridge exercise than it did during the traditional supine bridge exercise and the supine bridge on a Swiss ball exercise. Decrease of oswestry disability index is considered to be very helpful in ameliorating pain and activity disability in low back pain patients, thereby improving their quality of life. Thus, this study proposes that the prone bridge exercise is a more useful exercise method for enhancing chronic low back pain patients’ proprioception, improving their quality of life regarding pain and activity disability, and stabilizing and activating the trunk muscles than the supine bridge exercise and supine bridge on Swiss ball exercise that are currently used to treat patients with chronic low back pain.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구 배경 1
• 2. 연구의 목적 6
• 3. 연구 가설 7
• Ⅱ. 이론적 배경 8
• 1. 요부안정화운동 8
• 2. 근초음파영상 10
• 3. 고유수용성감각 11
• Ⅲ. 연구대상 및 방법 13
• 1. 연구 대상 13
• 2. 실험 절차 14
• 3. 실험 설계 15
• 4. 교각운동 실시 방법 16
• 5. 실험 도구 18
• 1) Surface electromyography 18
• 2) Ultra-sonograpy 19
• 3) Zebris 20
• 4) Oswestry 요통장애지수 21
• 6. 통계 방법 21
• Ⅳ. 연구결과 23
• 1. 연구 대상자의 일반적 특성 23
• 2. 정상군과 만성요통환자군의 근 두께 분석 26
• 1) 정상군과 만성요통환자군 간 배속빗근의 두께 비교 26
• 2) 정상군과 만성요통환자군 간 배가로근의 두께 비교 27
• 3) 정상군과 만성요통환자군 간 배바깥빗근의 두께 비교 28
• 3. 정상군과 만성요통환자군의 고유수용성감각 분석 29
• 1) 정상군과 만성요통환자군 간 요부굽힘시 관절위치감각 차이 비교 29
• 2) 정상군과 만성요통환자군 간 요부폄시 관절위치감각 차이 비교 30
• 3) 정상군과 만성요통환자군 간 요부가쪽굽힘시 관절위치감각 차이 비교 31
• 4) 정상군과 만성요통환자군 간 요부회전시 관절위치감각 차이 비교 32
• 4. 정상군과 만성요통환자군의 근활성도 분석 33
• 1) Supine bridge exercise 그룹의 근활성도 비교 33
• (1) 정상군과 만성요통환자군 간 배속빗근 비교 33
• (2) 정상군과 만성요통환자군 간 배가로근 비교 35
• (3) 정상군과 만성요통환자군 간 배바깥빗근 비교 36
• (4) 정상군과 만성요통환자군 간 척추세움근 비교 37
• 2) Supine bridge on swiss ball exercise 그룹의 근활성도 비교 38
• (1) 정상군과 만성요통환자군 간 배속빗근 비교 38
• (2) 정상군과 만성요통환자군 간 배가로근 비교 40
• (3) 정상군과 만성요통환자군 간 배바깥빗근 비교 41
• (4) 정상군과 만성요통환자군 간 척추세움근 비교 42
• 3) Prone bridge exercise 그룹의 근활성도 비교 43
• (1) 정상군과 만성요통환자군 간 배속빗근 비교 43
• (2) 정상군과 만성요통환자군 간 배가로근 비교 45
• (3) 정상군과 만성요통환자군 간 배바깥빗근의 비교 46
• (4) 정상군과 만성요통환자군 간 척추세움근의 비교 47
• 5. 만성요통환자군 간 교각운동 방법 차이에 의한 체간근육의
• 근 두께에 미치는 영향 48
• 1) 배속빗근의 근 두께 비교 48
• 2) 배가로근의 근 두께 비교 50
• 3) 배바깥빗근의 근 두께 비교 52
• 6. 만성요통환자군 간 교각운동 방법 차이에 의한 체간근육의
• 근활성도에 미치는 영향 54
• 1) 배속빗근의 근활성도에 미치는 영향 54
• 2) 배가로근의 근활성도에 미치는 영향 56
• 3) 배바깥빗근의 근활성도에 미치는 영향 58
• 4) 척추세움근의 근활성도에 미치는 영향 60
• 7. 만성요통환자군 간 교각운동 방법 차이에 의한 고유수용성감각에 미치는 영향 62
• 1) 요부굽힘시 관절위치감각 차이 비교 62
• 2) 요부폄시 관절위치감각 차이 비교 64
• 3) 요부가쪽굽힘시 관절위치감각 차이 비교 66
• 4) 요부회전시 관절위치감각 차이 비교 68
• 8. 교각운동 방법 차이에 의한 Oswestry 요통장애지수의 비교 70
• Ⅴ. 고찰 72
• Ⅵ. 결론 86
• 참고문헌 89
• 감사의 글 101