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1 Journal of the Korea Academia-Industrial cooperation Society Vol. 17, No. 3 pp , ISSN / eissn 구두굽의높이가한다리서기자세에서배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도에미치는영향 이원휘 1*, 이현준 1 1 전주비전대학교물리치료학과 Effects of Height of the Shoe Heel in a Static Posture on Muscle Activity of the Rectus Abdominis, Erector Spinae, Rectus Femoris and Hamstring Won-Hwee Lee 1*, Hyeon-Jun Lee 1 1 Department of Physical Therapy, Jeonju Vision College 요약본연구의목적은젊은여성을대상으로구두굽높이에따라한다리서기자세를수행하는동안배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도를비교하기위해연구를실시하였다. 본연구는건강한 20대여성 20명을대상으로,, 의각각다른높이의굽이있는구두를착용하고안정한지지면위에서정적균형검사중하나인오른쪽다리로한다리서기를하는동안표면근전도장비를이용하여오른쪽배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도를측정하여비교분석하였으며연구결과척추세움근과넙다리곧은근의근활성도는굽높이가증가함에따라유의한증가가있었고 (p<0.05), 배곧은근, 뒤넙다리근의근활성도는유의한차이가없었다 (p>0.05). 구두굽높이의증가는척추세움근및넙다리곧은근의근활성도를증가시키며이로인한허리앞굽음과골반의앞쪽기울임증가는신체분절의위치나무게중심의변화를일으켜허리골반부위및엉덩관절, 무릎관절에근골격계통증과같은문제를일으킬수있을것이다. Abstract The purpose of this study was to examine the effects of height of the shoe heel in a one leg standing posture on the muscle activity of the rectus abdominis, erector spinae, hamstring, and rectus femoris. Twenty healthy female subjects were asked to perform a one leg standing posture with three types of shoes, which had different heights of shoe heel,,, and. Surface electromyography was used to evaluate the activities of the right rectus abdominis, erector spinae, hamstring, and rectus femoris muscles. The data was analyzed by repeated one-way ANOVA and the muscle activities among three heights of shoe heel were compared. The results showed that the muscle activities of the erector spinae and rectus femoris increased significantly according to increase height of shoe heel (p<0.05). The activity of the rectus abdominis and hamstring were not significantly different among the three height of shoe heel (p>0.05). These results suggest that the height of shoe heel affects the lumbo-pelvic alignment and center of mass; therefore, high-heeled shoes lead to musculoskeletal pain in the lumbopelvic, hip, and knee areas. Keywords : Electromyography, High-heeled shoes, Hip muscle, Static standing balance, Trunk muscle 1. 서론 의효율을증진시키는것이다 [1]. 많은종류의신발들중구두는인간이사회생활을하면서시대와문화의변화에신발의일반적인기능은여러형태의지면, 날씨및의해발전해왔으며처음에는단순히발을보호하여이환경에서발을보호하고, 보행시발을지지함으로보행동을편하게하기위한기능적인측면에맞춰구두를신 * Corresponding Author : Won-Hwee Lee(Jeonju Vision College) Tel: wampus@naver.com Received December 8, 2015 Revised (1st December 29, 2015, 2nd January 4, 2016) Accepted March 3, 2016 Published March 31,

2 구두굽의높이가한다리서기자세에서배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도에미치는영향 었으나문화가발전하면서특히여성의경우매력과아름다움을더욱증대시킬수있는패션의조형물로서기능적인측면보다는미용적인측면을강조한구두를신는다 [2, 3, 4]. 그러므로현대사회에서여성들의 37 69% 가높은굽의구두를선택하고있다 [5]. 이러한구두의형태는구두의앞은뾰족하고높은굽은가늘고높아장시간신으면발의변형을가져오고허리통증을포함한많은장애를유발할수있다 [6, 7]. 그러므로높은굽의구두를신고일상의대부분을보내는사회생활을하는여성들에게는근골격계통증과같은문제를일으킬수있다 [1]. 높은굽의구두에대해서많은연구들이있으며이러한많은연구들은높은굽의구두를신고서있거나보행을하면운동역학적으로불리한변화를유발하여인체에좋지않은영향을미친다고보고하고있다 [8, 9, 10, 11, 12]. Lee 등에의한연구에서는구두굽의높이가다른세가지의구두를신고서있을때와보행을할때허리뼈만곡, 허리와다리근육의근활성도, 신체중심의이동범위등을비교하였는데, 굽의높이가높은신발을신었을경우신체에스트레스를많이주어높은굽의신발은피해야한다고보고하였다 [12]. 또한높은굽의신발을 2년이상신어온여성을대상으로근피로도와안정성을측정한연구에서는대상자들이장딴지근의높은피로도로인해다리의안정성이많이떨어졌다고하였지만 [9], 높은굽의신발을신고보행할때몸통근육의근활성도는낮은굽을신었을때보다더증가한다는보고도있었다 [8]. 균형능력을평가하는방법으로는여러가지방법이있지만대표적으로는정적서기자세에서의균형능력이있다 [13]. 서기균형은일상생활과목적있는활동을위한기본적인요소이며, 선자세에서의안정성유지, 체중부하조절, 보행과같은동작수행에중요한영향을미친다 [14]. 정적서기자세에서균형능력을알아보는방법들중의한다리서기가있다 [15]. 한다리서기는일상생활에서많이요구되는자세이며한다리서기검사는허리엉치부위의안정성과움직임의질을평가하기위해주로사용된다 [16]. 지금까지구두굽에따른균형능력을알아본연구들은대부분구두굽높이에따른동적균형능력이나보행에미치는영향등을알아보았다 [8,12]. 또한구두굽에따른정적균형능력을알아보는연구들도있었으나, 이는발목관절에대해서만국한되고엉덩관절과 몸통의움직임에영향을주는근육들에대한연구는많이되어있지않다 [17]. 따라서본연구는젊은여성을대상으로굽의높이가다른구두를착용하고정적서기자세에서균형을유지하는동안나타나는엉덩관절과몸통의움직임에영향을주는근육들의근활성도를측정하여비교하고이로인해나타날수있는근골격계장애에대해알아보고자한다. 본연구의가설은구두굽의높이가증가할수록척추세움근 (Erector spinae), 넙다리곧은근 (Rectus femoris) 의근활성도는증가할것이고, 배곧은근 (Rectus abdominis), 뒤넙다리근 (Hamstring) 은근활성도에차이가없을것이라고설정하고본연구를실시하였다. 2.1 연구대상자 2. 연구방법 본연구는 J시거주하는건강한 20대여성 20명을대상으로실시하였으며본연구의대상자는실험전에본연구의목적과방법에대해충분히설명을듣고, 연구의목적에동의하는연구동의서를작성하고연구에참여의사를밝힌후실험에참여하였다. 연구대상자의선정기준은내과적질환이나허리통증및발목의염좌등과같은근골격계관련질환을경험하지않고, 이로인한관절가동범위에제한이없으며지난 6개월동안정형외과적또는수술과거력이없으며사지의선천적기형이없는자로하였다. 최근 6개월동안하지에골절, 관절염, 외상과같은정형외과적장애나통증을경험했던대상자는연구대상자에서제외하였다. 모든대상자들의우세손 (dominant hand) 과우세발은오른쪽이었으며이들의일반적인특성은 Table 1과같다. Table 1. General characteristics of subjects Age(year) Height (cm) Weight (kg) 2.2 측정장비및방법 구두 Mean ± Standard deviation 21.8± ± ±4.9 실험에사용되는구두는 20대여성의평균발길이를토대로 230mm, 240mm와 250mm의구두로구두굽의 225

3 한국산학기술학회논문지제 17 권제 3 호, 2016 높이는각각, 와 의세가지높이로설정하였다 (Figure 1). 구두굽의높이를,, 그리고 로정한이유는일반적으로단화라고도하는낮은굽구두의굽높이는보통 정도이고젊은여성들이즐겨신는높은굽구두의굽높이가일반적으로 정도인점과 Kim 등의선행연구에서도,, 그리고 의구두굽의높이에따라비교한것을착안하여본연구에서도,, 그리고 의구두굽높이로결정하였다 [1]. 또한구두굽과지면과의접촉면적을동일하게하기위해 와 구두굽의접촉면적은약 2cm 2 이하로하였다. Fig. 1. Shoes with,, and 7 cm height of shoe heel 표면근전도시스템 (Surface electromyogram) 구두굽의높이에따라엉덩관절과몸통의움직임에영향을주는근육들의근활성도에미치는영향을알아보기위하여표면근전도시스템 (AP1180) 을사용하였으며, 표면근전도시스템에서디지털처리된표면근전도신호의분석은무선 EMG 시스템 (Wireless EMG System(100RT), BTS, Millan, Italy) 을이용해처리하였다. 표면근전도신호의표본추출률 (sampling rate) 은 1,000Hz로설정하였다. 근육의근전도신호는제곱평균제곱근법 (Root Mean Square: RMS) 처리하여분석하였다. 표면전극의부착부위는피부저항을감소시키기위해털을제거하고, 가는사포로 3 4회문지른다음, 알코올솜으로피부각질층을제거하고전극을부착하였다. 전극을부착하는근육은오른쪽배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근으로 Cram등에의해제시된부위를참고하여최대근수축이뚜렷이보이는힘살 (muscle belly) 에전극을부착하였다 [18]. 표면근전도신호의정규화 (normalization) 과정을위해근육최대수축 (Maximal voluntary contraction: MVC) 을사용하였으며 10초씩 3번측정하여평균값을사용하였다. 근육최대검사는각근육의맨손근력검사방법을토대로측 정하였으며근육최대수축값을기준으로각각높이에따른근육의근활성도값을정규화 (%) 하였다. 2.3 실험방법실험을실시하기전에각대상자들에게과제수행에대한설명을하였으며, 대상자들에게구두는각개개인의발크기에최대한맞게신도록하였으며세가지구두굽높이의적용순서는무작위로결정하였다. 구두의불편함을없애기위하여대상자들에게실험에사용되는구두를신고각구두높이에따라실험실주위를 2분씩걷도록하였다. 본실험에서는구두굽에따라 30초동안한다리서기자세를수행하였고이때의근활성도를수집하였고 30초동안의자료에서시작과끝시점의 10초를제외하고가운데 10초의값을데이터로수집하였으며 3번측정한값의평균값을사용하였다. 한다리서기자세는양팔을몸통옆에나란히위치시키고, 시선은정면을바라보도록하고, 한쪽발로 30초간서있었다 ( 그림 2)[19]. 본실험방법은서있는쪽의발은우세발로하였고균형을유지하지못하고 30초이전에들고있는발이지면에닿으면 3분간휴식한후다시측정하였다. 구두높이에따라 3회씩측정하였고측정간휴식은 3분으로하였고구두가바뀔때마다 5분간의휴식시간을제공하였다. Fig. 2. One leg standing position 2.4 자료분석구두굽에따른배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도를비교하기위해반복측정된일요인분산분석 (repeated one-way ANOVA) 을사용하였다. 사후분석방법으로는 Bonferroni 검정을사용하였다. 통계적유의성을검증하기위한유의수준 (a) 은.05 하였고 SPSS 18.0 for window 프로그램을이용하였다. 226

4 구두굽의높이가한다리서기자세에서배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도에미치는영향 Table 2. Comparison of muscle activities during one leg standing position according to difference of height of shoe heel Muscle Rectus Abdominis Erector Spinae Rectus Femoris Hamstring a Mean±Standard deviation * p<0.05 height of shoe heel Muscle activity Type III Sum of Squares df F p 8.18±5.43 a 9.19± ± ± ± ± ± ± ± ± ± ± * * 연구결과 3.1 한다리서기동안구두굽에따른근활성도비교한다리서기를유지하는동안측정된엉덩관절과몸통의움직임에영향을주는근육들의근활성도에대한결과는구두굽높이가증가할수록넙다리곧은근과척추세움근의근활성도의유의한차이가있었으며 (p<.05) 배곧은근과뒤넙다리근은유의한차이가없었다 (p>.05) (Table 2). 사후분석결과척추세움근은 와 사이에서유의한차이가있었고넙다리곧은근은,, 모두에서유의한차이가있었다 (Figure 3). Fig. 3. Comparison of muscle activities during one leg standing position according to difference of height of shoe heel RA: Rectus Abdominis, ES: Erector Spinae, RF: Rectus Femoris, HS: Hamstring 4. 논의본연구는젊은여성을대상으로굽의높이가다른구두를착용하고한다리서기자세를유지하는동안나타나는엉덩관절과몸통의움직임에영향을주는근육들의근활성도를측정하여비교하였다. 연구결과한다리서기를유지하는동안구두굽의높이가증가할수록넙다리곧은근과척추세움근의근활성도는유의하게증가하였고배곧은근과뒤넙다리근의근활성도는유의한차이가없었다. 또한사후분석결과척추세움근은 와 사이에서유의한차이가있었고넙다리곧은근은,, 모두에서유의한차이가있었다. Kim 등의연구에서도 20대여성을대상으로보행시구두굽높이에따라배곧은근과척추세움근의근활성도변화를알아보았는데, 굽의높이가증가할수록척추세움근의근활성도증가율이배곧은근의증가율보다높게나타나본연구와유사한결과를보였으며사공우원과안덕현의연구에서도불안정지지면에서구두굽높이에따른정적서기동안에근활성도변화를알아보았는데이연구에서도척추세움근과넙다리곧은근의근활성도는유의하게증가하였다 [19, 20]. 또한 Barton 등은 15명의건강한젊은여성을대상으로깔창을이용하여굽의높이를변화시키고보행을실시한연구에서굽의높이가증가함에따라척추세움근의근활성도가증가하였다고보고하였고, Mika 등은성인여성을대상으로보행하는동안구두굽높이가증가할수록넙다리곧은근의근활성도가증가한다고보고하였다 [8, 21]. 구두굽의높이에증가에따라척추세움근과넙다리곧은근의근활성도가 227

5 한국산학기술학회논문지제 17 권제 3 호, 2016 증가하면척추세움근과넙다리곧은근의짝힘 (force couple) 에의해허리의앞굽음을발생시킨다 [8, 22]. Lee 등도높은굽의구두의착용은허리의앞굽음을야기하며, 하부허리뼈의압박력을증가시켜요통을유발시킨다고하였다 [12]. 그러므로본연구에서도구두굽의높이가증가함에따라배곧은근과뒤넙다리근의근활성도는유의한차이가없었고, 넙다리곧은근과척추세움근의근활성도만유의하게증가되었을것이라고사료된다. 이러한결과는구두굽높이의증가로인해균형유지시뒤넙다리근과배곧은근보다넙다리곧은근과척추세움근의사용이더욱증가하였다고할수있으며, 균형을유지하기위해엉덩관절전략을주로사용했다고볼수있다. Gribble 등은발목관절전략을사용하지않고엉덩관절전략을사용하는자세조절은낙상의원인이될수있다고보고하였다 [23]. 또한높은굽의신발을신고서있는동안의무게중심선은바깥귀길과넙다리뼈의큰돌기에서는앞쪽으로, 넙다리뼈의위관절융기와가쪽복사뼈에서는뒤쪽으로이동되어신체분절의위치, 무게중심에변화가생기게되고이를보상하기위한운동학적및동력학적변화가허리부에서가장먼저일어나허리의곡선이증가되어앞굽음자세와골반의경사각도를증가시킨다고하였다 [24, 25]. 본연구결과에서척추세움근은 와 에서유의한차이가있었지만넙다리곧은근은구두굽의높이가,, 모든조건에서유의하게증가하였다. 이는신체의중심선이위쪽에서는앞쪽으로이동하고허리의앞굽음자세와골반의경사각도를증가시키는데큰역할을하는것이척추세움근보다는넙다리곧은근이라는것을알수있었다. 이러한자세는엉덩관절굽힘근인엉덩허리근, 넙다리근막긴장근, 넙다리곧은근과허리폄근의가동성을감소시키고배곧은근과배속빗근, 배바깥빗근의근육수행력이손상되어앞세로인대의스트레스, 척추사이구멍이좁아지는척추협착증과척추사이관절의압박으로척추사이관절및윤활막의염증을만든다 [26]. Park과 Kim도높은굽의신발은발목관절의과도한발바닥굽힘을시키고이는정상적인발목기능에변화를주어골반, 엉덩관절과무릎관절의보상작용을일으켜통증, 낮은안정성과관절의손상을일으킨다고보고하였다 [27]. 그러므로 Ebbeling 등은여성들이구두를신을때안정성을유지하고부상의위험을감소시키기위해서는 5cm 이상굽높이의구두를착용해서는안된다고보고하였다 [28]. 그러므로자신의개성과패션의미적아름다움을추구하기위한수단으로높은굽의구두는균형능력에영향을주고신체분절의위치나무게중심의변화를일으켜허리골반부위및엉덩관절, 무릎관절에근골격계문제를일으킬수있으므로피해야된다고사료한다. 본연구는몇가지제한점을가지고있다. 첫번째로연구대상자의연령대가 20대여성이라는점과건강한사람들을대상으로연구를하여일반화하기가어렵다. 두번째로실험에사용한구두의사이즈가 230mm 에서 250mm 이므로이보다발이작은대상자들이나큰대상자들에게는구두의착용감이불편하여연구결과에영향을주었을수있다. 세번째로본연구는근활성도만알아보았으므로체간정렬의변화를직접적으로알수가없었다. 그러므로추후에는좀더다양한연령대의대상자들이나발목의염좌등을경험하거나하이힐을즐겨신는사람들을대상으로하는연구도필요하며동작분석기등을사용하여한다리서기자세를하는동안골반및허리의정렬의변화를알아보는연구도필요할것이다. 5. 결론 본연구는건강한 20대여성 20명을대상으로, 와 의각각다른높이의굽이있는구두를착용하여안정한지지면위에서한다리서기를통해배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도를측정하여비교분석하였다. 연구결과척추세움근과넙다리곧은근의근활성도는굽높이가증가함에따라유의한차이가있었으며 (p<0.05), 배곧은근과뒤넙다리근은유의한차이가없었다 (p>0.05). 이러한결과는굽높이가증가할수록골반의앞쪽기울임및엉덩관절굽힘이증가되고이로인해허리의앞굽음이증가되어나타난결과로사료되며높은굽의구두는균형능력에도영향을주고신체분절의위치나무게중심의변화를일으켜허리골반부위및엉덩관절과무릎관절에근골격계통증과같은문제를일으킬수있을것이다. References [1] B. K. Kim, W. T. Gong, H. S. Kim, "The Effect of Heel-height on the Lumbosacral Region Angle of Young 228

6 구두굽의높이가한다리서기자세에서배곧은근, 척추세움근, 넙다리곧은근, 뒤넙다리근의근활성도에미치는영향 Ladies", Journal of the Korean Society of Physical Medicine, vol. 2, no. 1, pp , [2] M. H. Lee, J. S Chang, S. Y. Lee, J. Y. Ju, S. S. Bae, "The Effects of High-heeled Shoes on Static Balance and EMG Activity of Lower Extremity Muscles for Young Women", Journal of the Korean Society of Physical Medicine, vol. 4, no. 1, pp , [3] D. Y. Lee, "The Study of the Impact of Body Alignment of Height Shoe in a Womans", The Korea Academia-industrial cooperation Society Semianaual, pp , [4] M. S. Jang, "Research on the emotional response to the design factors of women's shoes", Dissertation of Master degree, Ulsan University, [5] C. Frey, F. Thompson, J. Smith, M. Sanders, H. Horstman. "American Orthopaedic Foot and Ankle Society women's shoe survey", Foot Ankle, vol. 14, no. 2, pp , DOI: [6] Y. H. Bae, M. S. Ko, Y. S. Park. 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3 월 ~ 현재 : 전주비전대학교물리치료학과교수 < 관심분야 > 근골격계물리치료, 물리치료진단평가 이현준

7 한국산학기술학회논문지제 17 권제 3 호, 2016 이원휘 (Won-Hwee Lee) [ 정회원 ] 2009 년 8 월 : 연세대학교일반대학원재활학과 ( 이학석사 ) 2012 년 2 월 : 연세대학교일반대학원재활학과 ( 이학박사 ) 2012 년 3 월 ~ 현재 : 전주비전대학교물리치료학과교수 < 관심분야 > 근골격계물리치료, 물리치료진단평가 이현준 (Hyeon-Jun Lee) [ 정회원 ] 2016 년 2 월 : 전주비전대학교물리치료학과 ( 전문학사 ) < 관심분야 > 신경계물리치료 230

JKPT The Journal of Korean Physical Therapy Won-Hwee Lee, et al. 다리꼬기자세에대한연구들은주로체간의근활성도나척추의정렬과관련되어설명을하고있다. 6,14,15 Jung 6 과 Kim 등 15 은다리꼬기자세가체간의미치는영향들

JKPT The Journal of Korean Physical Therapy Won-Hwee Lee, et al. 다리꼬기자세에대한연구들은주로체간의근활성도나척추의정렬과관련되어설명을하고있다. 6,14,15 Jung 6 과 Kim 등 15 은다리꼬기자세가체간의미치는영향들 JKPT pissn Vol. 27, No. 5, October 2015 1229-0475 eissn 2287-156X Original Article http://dx.doi.org/10.18857/jkpt.2015.27.5.315 Effect of Various Leg-Crossing Positions on Muscle Activities of Rectus