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1 Journal of the Korea Academia-Industrial cooperation Society Vol. 16, No. 6 pp , ISSN / eissn 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 김정현 1, 오두환 1, 장석암 1, 이장규 1* 1 단국대학교대학원운동의과학과 Effects of Schroth 3-Dimensional Exercise on Cubb's Angle, Abdominal Endurance, Flexibility and Balance in Adolescents with Idiopathic Scoliosis Jung-Hyun Kim 1, Doo-Hwan Oh 1, Seok-Am Zhang 1, Jang-Kyu Lee 1* 1 Department of Sports Medicine Science, Graduate school, Dankook University 요약이연구는특발성척추측만증청소년을대상으로, Schroth 3차원운동처치와볼 슬링운동을수행하는재활운동프로그램의처치가콥스각의변화와근력및유연성, 평형성에어떠한영향을미치는지를구명하고자수행되었다. 특발성척추측만증을진단받은청소년 30명을대상으로, Schroth 3차원운동처치집단 (n=15) 과볼과슬링을수행하는재활운동처치집단 (n=15) 으로무선배정하였으며운동프로그램은 8주간, 주 3회, 90분으로구성하여실시하였다. 이연구의결과에서, 8주간의운동후 Schroth 3차원운동처치집단에서콥스각이유의하게감소되었으며 (p<.001), 복부근지구력 (p<.05) 및유연성 (p<.001) 과평형성 (p<.001) 모두운동후에유의한개선의효과가있는것으로나타났다. 또한 8주간의운동전 후 Schroth 3차원운동처치집단에서의콥스각변화율이재활운동처치집단의콥스각변화율보다유의하게높은것으로나타났다 (p<.05). 이상의결과에서 Schroth 처치집단과재활운동처치집단모두 8주간의처치후, 특발성척추측만증이있는청소년에게유의한개선의효과가있었으며, 그러나 Schroth 3차원운동처치가콥스각교정에보다더효과적인것으로나타났다. 따라서청소년들의특발성척추측만증예방과운동치료에 Schroth 3차원운동처치가보다효과적인것으로사료된다. Abstract The purpose of this study was to investigate the effects of 8-week schroth 3-dimensional exercise and ball-sling complex exercise treatment on cobb's angle, abdominal muscle endurance, flexibility and balance in adolescents with idiopathic scoliosis. Thirty subjects with scoliosis were random assignment into one of two experimental groups, either schroth treatment(n=15) or ball-sling complex exercise treatment(n=15). Exercise program was to perform for 8-week and 90min and 3 times per week. The results of this study were as follows; First, cobb's angle was significantly decreased after 8-weeks in schroth treatment(p<.001). And also abdominal muscle endurance(p<.05), flexibility(p<.001) and balance(p<.001) were significantly improve in pre vs. post treatment. Second, the ratio of cobb's angle change was significantly higher in schroth treatment compared to ball-sling complex exercise treatment following 8-weeks(p<.05). These results suggest that although both the schroth treatment and bal-sling complex exercise treatment in adolescents with idiopathic scoliosis can improve on cobb's angle, abdominal muscle endurance, flexibility and balance, but schroth treatment was better than ball-sling complex exercise treatment improving effect of cobb's angle. Therefore, we consider that schroth treatment has more effect of prevention and therapy in idiopathic scoliosis in adolescents. Key Words : Ball exercise, Cobb's angle, Idiopathic scoliosis, Schroth, Sling exercise * Corresponding Author : Jang-Kyu Lee(Dankook Univ.) Tel: kyu1216@hanmail.net Received April 14, 2015 Accepted June 11, 2015 Revised (1st May 14, 2015, 2nd May 20, 2015) Published June 30,

2 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 1. 서론입시위주의교육을하고있는우리나라에서는청소년들의신체활동시간은줄어든반면책상에앉아있는시간은증가한것으로보고되고있으며 [1], 이러한환경은잘못된자세습관으로인한척추변형의위험성을높이고있다. 다양한원인에의해척추와가슴이비틀리면서추체의수평면 (transverse plane) 과전두면 (frontal plane), 시상면 (sagittal plane) 에서의 3차원적기형현상을나타내는것을척추측만증 (Scoliosis) 이라고하며 [2,3], 전문가에따라측정방법및진단기준이상이하지만 [4,5] 미국의척추측만증연구학회 (The Scoliosis Research Society) 에서는콥스각 (Cobb s angle) 10 이상을척추측만증으로정의하고있다 [6]. 척추측만증은척추움직임의감소와척추주변근육의약화, 짧은호흡, 만성통증, 호흡기감염, 심폐기능저하, 그리고심리적고통등이나타나며이로인한근력약화와더불어유연성의감소, 체형의불균형등을초래한다 [7,8,9,10]. 대부분의측만증환자 (70~90%) 가원인을알수없는특발성측만증 (idiopathic scoliosis) 이며 [11], 이들중 10대청소년이 46.5% 를차지하고있다 [12]. 청소년기의척추측만증에가장영향을주는요인으로나이와성별, 그리고만곡정도등이보고되고있으며 [13], 척추만곡이어린나이에시작될수록척추측만증으로유병될확률은현저히높아진다고보고되고있다 [14,15]. 이는아동과청소년들에게서발생되는초기의만곡이심각한척추측만증으로발전될가능성이매우높을것으로예상되어그예방과치료의필요성이매우중요한것으로사료된다. 척추측만증의치료방법으로는크게외과적치료와보존적치료로나눌수있으며외과적치료인수술은측만각도가 40 이상의극심한경우에처방되지만조기에발견하여치료하면대부분수술적치료는필요하지않다. 대부분의전문가들은보존적치료의한방법으로척추의강직으로인한운동범위감소와척추주변근육의근력소실등을피하기위해특발성측만증치료의중요한단계로써특별한운동요법을권장하여왔으며, 이러한운동요법은만곡의진행을멈추거나개선하며 [16], 폐기능의개선과통증을치료하는것등을목적으로하고있다 [17]. 여러가지특별한운동요법중, Schroth는측만증의 3 차원적치료 (3-dimensional treatment) 방법으로서, 1932 년독일의카타리나슈로츠에의해소개되었으며역학과신경생리학적관점에근거하여자세의구성요소를교정하기위한호흡법인 rotational breathing 이개발되었고또한전통적인견인치료에서벗어나뒤틀린부위의근육강화와늑골을이용하여척추의위치를회복시키는 3차원적운동을실행하였다 [7]. Schroth의 rotational breathing 은찌그러진공에바람을넣으면공의모양이회복되는원리를측만증치료에적용하였으며호흡에의한흉곽내공간의변화를이용하여척추의위치를교정하였다 [7]. 또한 Schroth 3차원운동은환자가일상생활에서자신의변형된몸을인지하면서호흡법과운동을적용하는중요한특성을가지고있다 [7]. Negrini 등 [18] 과 Otman 등 [19] 의연구에서 Schroth 3차원운동이콥스각의개선과폐활량, 근력, 자세교정등에긍정적영향을미친다고보고하였으며, Borysov 등 [20] 의연구에서는 7일간의단기간치료에도콥스각의유의한변화를관찰하였고국내의이준호등 [21] 의연구에서도긍정적인효과가있음을보고하였다. Schroth 3차원운동은운동치료방법중에서가장오랜역사를가지고있으며여러운동치료요법의기초를제공하는치료방법이고이를토대로여러가지운동치료방법이개발되고있다. 국내의경우, 근력운동과스위스볼을이용한복합운동 [22] 과체간몸통운동을이용한치료법 [23] 의효과가보고되었으며, 외국의경우에서는 SEAS (Scientific Exercises Approach to Scoliosis, 능동적운동 ) 를이용한운동치료법의효과가보고되었다 [24]. 그러나이상의선행연구에서보듯 Schroth 3차원운동과다양한형태의운동요법의효과비교에대한검증이거의전무한실정이며 Schroth 3차원운동의효과에대한연구또한매우미비한실정이다. 따라서이연구의목적은특발성척추측만증청소년을대상으로 8주간의 Schroth 3차원운동프로그램의처치와볼 슬링운동을함께수행하는재활운동프로그램의처치가콥스각과근력및유연성, 평형성변화에어떠한영향을미치는지를구명하고그결과를청소년의특발성측만증예방과치료를위한프로그램의기초자료로제시하고자한다. 4099

3 한국산학기술학회논문지제 16 권제 6 호, 연구방법 2.1 연구대상이연구의대상자는천안시소재의 Y정형외과에내원한만13~18세사이의청소년중, Whole spine AP X-ray촬영을하여콥스각이 10 ~30 사이로정형외과전문의로부터척추측만증판정을받았으며, 보조기를착용하지않았고과거척추측만증으로인해운동치료를받은경험이없는 30명을대상으로선정하였다. 이들을다시 Schroth 처치집단 (n=15) 과볼과슬링운동을수행하는재활운동집단 (n=15) 으로무선배정하였으며, 실험에대해충분히설명하고실험참여를위한동의서를자발적으로받았다. 실험대상자의신체적특성은 Table 1에서보는바와같다. Table 1. The characteristics of subjects Age(yr) Height(cm) Weight(kg) Cobb'sangle( ) Schroth 15.04± ± ± ±4.29 Ball & sling 15.72± ± ± ±3.66 Values are means ± S.E.M. 2.2 운동프로그램실험대상자들은주 3회, 90분의운동을 8주간실시하 였으며, 운동프로그램은준비운동 (10분) 유산소운동 (20 분 ), 본운동 (50분), 그리고정리운동 (10분) 으로구성하였다. Schroth 3차원운동프로그램처치집단은 Otman 등 [19] 의연구에서사용되었던운동프로그램을바탕으로호흡 (breathing), 매달리기 (hanging), 가동 (mobilization), 모양 (shaping), 신전및강화 (stretch & strengthen) 등으로구성하여실시하였으며재활운동처치집단에서볼운동프로그램 [25] 과슬링운동프로그램 [26,27] 은선행연구들에서사용한것으로수정 보완하여실시하였다. 각집단의자세한운동프로그램은 Table 2에서보는바와같다. 2.3 방사선 X-ray 검사척추측만증검사는 GH-30X(Shimadzu, Japan) 를이용하여허리와가슴을펴고다리를가지런히모은후, 척추의전후면 (AnteroPosterior : AP) 을촬영하여측만증을확인하였으며, Cobb's method를이용하여방사선사진과각도기로콥스각을측정하였다 [28]. 콥스각은가장만곡이심한상단끝척추의위경계와하단끝척추의아래경계로부터수평선을그린후, 각수평선에수직선을그려그수직선이만나는각을측정하였다 [Fig. 1]. Table 2. Schroth, ball and sling exercise program warming-up(10min) aerobic exercise(20min) main exercise(50min) cool-down(10min) Schroth -Breathing exercise -Muscle cylinder -Hanging exercise -Mobilization exercise -Shaping exercise -Stretch & strengthen exercise -Elongating strengthening Ball and sling exercise static stretching exercise(10 times) treadmill walking <ball exercise> -raises counter arm and leg (10second, 15repetition, both) -push-up on ball (10repetition, 3set) -trunk extension -sit-up (15repetition, 3set) -hamstring curl (15repetition, 3set) <sling exercise> -supine bridge (10second, 15repetition, both) -side bridge (10second, 15repetition, both) -prone bridge (10second, 10repetition, 2set) -leaning forward (10second, 10repetition, 2set) static stretching exercise(10 times) 4100

특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 3. 연구결과 3.1 콥스각의변화 8주간의운동전 후콥스각의변화에서, 처치와시기간의유의한상호작용효과는나타나지않았으며주효과의검증결과, 시기에서유의한차이가나타나운동후, Schroth 처치집단에서유의하게감소된것으로나타났다 [Table 3]. Fig. 1.

4 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 3. 연구결과 3.1 콥스각의변화 8주간의운동전 후콥스각의변화에서, 처치와시기간의유의한상호작용효과는나타나지않았으며주효과의검증결과, 시기에서유의한차이가나타나운동후, Schroth 처치집단에서유의하게감소된것으로나타났다 [Table 3]. Fig. 1. Cobb's angle 2.4 복부근지구력측정복부근지구력은대상자가바닥에누운상태에서보조자가다리를고정하여무릎을직각으로구부린후, 상체를일으켜팔꿈치가무릎에닿고다시누운상태로되돌아가면 1회로간주하여그횟수를 30초간측정하였다. 2.5 유연성측정유연성측정은전방좌전굴장비 (mydi) 를이용하여 (Mymedical, Korea), 측정기구의수직면에발바닥을붙이고무릎을편상태로양손바닥을겹친후, 상체를굽히면서손끝으로측정대를천천히밀어서측정하였다. 2 회를측정하여좋은기록을채택하였다. 2.6 평형성측정평형성은안대와초시계를이용하여제자리에서양팔을벌린후, 관리자의시작구령에맞춰한쪽발을들어균형을잡고있는시간을측정하였다. 0.01초단위로기록하였으며양발을각 3회씩측정하여좋은기록을채택하였다. 2.7 자료처리수집된모든자료는 SPSS 18.0을이용하여평균 (M) 과표준오차 (SEM) 를산출하였으며처치방법 (Schroth vs. 재활운동 ) 과시기 (8주전 vs. 후 ) 간의상호작용효과를검증하기위하여 two-way ANOVA를실시하였다. 유의한상호작용효과가없었을경우, 주효과 (main effect) 를검증하였으며집단간콥스각의변화율 (%) 은독립 t-test 를실시하였다. 통계적유의수준은 α=.05로하였다. 3.2 유연성및복부근지구력, 평형성의변화 [Table 3] 에서보는바와같이유연성및복부근지구력과평형성모두처치와시기간의유의한상호작용효과는나타나지않았으며주효과의검증결과에서시기간두집단모두에서유의한차이가있는것으로나타났다. 그러나처치간에주효과는나타나지않았다. 3.3 척추교정율 (%) 8주간의운동전 후 Schroth 처치집단에서의콥스각변화율이 ±8.71% 로재활운동집단의콥스각변화율인 -7.43±6.32% 보다유의하게높은것으로나타났다 (p=.040). 4. 논의척추측만증의대부분을차지하는특발성측만증은지금까지정확한원인을알수없으며여러가지다양한요인들이복합적으로작용하여발생되는것으로알려져있다 [29]. Stokes 등 [30] 의 vicious cycle( 악순환 )" 이론에따르면측만증은평형성을상실하게하는다양한원인에의해척추안정화의요인들이붕괴되어초기의가지런함과안정성을잃게되며, 이렇게시작된척추의만곡은여러방면에서자세의변형을유도하여결국은뼈의기형을초래하게된다고주장하였다. 이러한척추측만증의치료방법으로수술과열치료, 전기치료, 견인치료, 보조기사용, 그리고운동치료등이있으며이중운동치료에대한관심이높아져있는추세이다. 운동치료의궁극적인목적은척추의안정화 (spinal stability) 이며이것에부정적영향을주는요인으로구조적기형 (structure deformation) 과자세요인 (postural components) 의기능상실등이보고되었으며자세요인은운동치료의예방적차원에서의중요한목적중하나이다 [31]. 4101

5 한국산학기술학회논문지제 16 권제 6 호, 2015 Table 3. The change of cobb's angle, abdominal muscle endurance, flexibility and balance in 8 weeks' pre vs. post. Cobb's angle Abdominal muscle endurance Flexibility pre post treatment time Schroth 18.01± ±1.90** Ball & sling 14.99± ±1.29 Schroth 13.73± ±1.73* Ball & sling 15.60± ±1.64* Schroth -0.37± ±3.50** Ball & sling 4.33± ±1.74** Schroth 5.87± ±3.43* treatment time p=.442 p=.028 p=.153 p=.580 p=.020 p=.606 p=.235 p=.011 p=.731 Balance Ball & sling 9.18± ±2.09** Values are means ± S.E.M. *significantly different from pre at p<.01, **significantly different from pre at p<.001. p=.075 p=000 p=.720 콥스각의개선에대한최근의 Kuru 등 [32] 과 Schreiber 등 [33] 의연구에서 Schroth 운동이콥스가개선에유의한효과가있음을보고하였으며, Otman 등 [19] 은 50명의청소년을대상으로 1년간 Schroth를실시한결과, 콥스각과근력, 자세교정, 폐활량등에긍정적영향을주었다고하였고, Herling 등 [34] 의연구에서도수술을권유받은소녀가 6개월간 Schroth를실시한결과콥스각이 52 에서 42 로, 몸통회전각이 14 에서 10 로, 축회전각이 22 에서 15 로감소되었다고보고하였다. 또한 Fusco 등 [35] 과 Weiss 등 [36] 의연구에서도유사한결과를보고하였다. 다른형태의운동치료효과를연구한이숙희와김종희 [37] 는척추와골반의근육강화운동을, 문훈기등 [23] 은체간몸통회전운동을실시하여콥스각의변화에유의한효과가있음을보고하였다. 또한볼과슬링을이용한연구에서도콥스각의개선에효과가있었음을보고하였으며 [38-40], 이외의다른형태의운동치료에서도콥스각에유의한효과가있음을나타내었다 [22,41]. 외국의선행연구에서도 Danneels 등 [42] 은 10주간의복합운동이측만각도를개선하였다고보고하였으며 Mooney 등 [43] 의연구에서도몸통회전운동이콥스각에유의한효과가있었다고보고하였다. 또한 Romano 등 [44] 은근신경생리학적으로접근한 Scientific Exercises Approach to Scoliosis(SEAS) 라는능동적인자가교정운동 (Active Self-Correction) 이척추측만증교정에효과가있음을보고하였다. 이상의선행연구결과와유사하게본연구의결과에서도 8주간의운동전 후콥스각은 Schroth처치집단에서유의하게감소하였으며 (p=.001), 또한 Schroth 처치집단에서의콥스각변화율이 ball -sling 재활운동집단보다유의하게 (p=.040) 큰것으로나타났다. 이연구에서콥 스각의유의한변화는 Schroth 3차원운동의회전호흡법 (rotation breathing) 이뒤틀어진횡경막이나호흡근을정상화시켜측만증개선에도움을주어, 단순히운동만수행한재활운동에비해호흡운동을추가적으로수행한 Schroth 3차원운동처치가보다효과적이라생각되어지며, 또한 Schroth 3차원운동처치는하나의동작이다른부분에영향을미치지않도록하고환자스스로가자신의상태를깨닫고변형된신체를구분하여치료할수있도록도와주기때문인것으로사료된다. 척추측만증은주변근육의경직과위축등으로인한근력및근지구력의감소를초래하게된다. 문훈기등 [23] 의연구에서 8주간의체간몸통회전운동이요부의근력을증가시켰으며조지훈등 [22] 의연구에서도 12주간의근력과유연성복합운동후, 요부근력이증가를보고하였고, 다른몇몇연구에서도비슷한결과를보고하였다 [25,26,45]. Mooney 등 [43] 의연구에서몸통회전운동후, 근력의불균형이회복되었다고하였으며, Zaina 등 [46] 도 68명을대상으로한장기간의연구에서브레이스착용에따른근력손실같은부수적인폐해를특수한운동을통해피할수있다고보고하였다. 또한 Schroth 3차원운동이근력변화에미치는영향을연구한 Otman 등 [19] 은 Schroth를실시한후근력이증가되었다고보고하였으며, 이러한결과는본연구의결과에서도동일하게나타나 8주간의처치후, 복부근지구력이두집단모두에서유의하게증가되었다 (Schroth, p=.005 & ball-sling p=.002). 이러한운동치료의근력및근지구력향상은척추의안정화에관련된근육들의중력에대한반응능력을향상시켜보다높은수준의척추안정화에도움을주는것으로생각된다. 그러나본연구에서다른형태의운동프로그램을사용하였음에도불구하고집단간복부근지구력의유의한차이가나타나지않은것은 4102

6 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 (p=.978) 두집단모두자신의체중을저항으로이용한비슷한형태의프로그램이기때문인것으로사료되며, Schroth 3차원운동처치집단이 ball-sling 처치집단보다통계적유의수준에는도달하지못하였지만약간높은수준을보인것은 Schroth 3차원운동이보다높은강도의 weight bearing 부하를준것으로사료된다. 척추측만증의대표적인징후는몸통의기형과경직으로나타나며이로인해체간의유연성은매우감소된다고보고하고있다 [7]. 따라서유연성감소의예방및개선은척추측만증운동치료의중요한목적중하나이다. 특발성척추측만증여고생을대상으로바 (barre) 운동을실시한전영남등 [41] 의연구에서운동치료후, 유연성이유의하게증가되었다고보고하였으며, 문형훈 [47] 의연구에서도교정운동후유연성이유의하게증가된것으로나타났고이외다른연구에서도유사한결과를보고하였다 [22,25]. 그러나대부분의선행연구에서운동치료후유연성의증가를보고한반면이준호등 [21] 의연구에서는슬링운동집단에서만유연성의증가가나타났으며 Schroth처치집단에서는약간증가하는경향만을보여통계적유의수준에도달하지못하였다. 본연구에서도 8주간의운동전 후두집단의유연성이모두유의하게증가한것으로나타났으며 (Schroth, p=.000 & ball-sling p=.001), Schroth 3차원운동집단에서약간높은향상을보였으나집단간의유의한차이에는도달하지못하였다 (p=.511). 이처럼이준호등 [21] 의연구와상반되는결과를보인것은실험대상자의연령 ( 성인 vs. 청소년 ) 및척추측만정도의차이와운동프로그램구성내용의차이에의한것으로사료되며, 이외의결과는대부분의선행연구와일치하였다. 본연구에서 Schroth 3차원운동집단에서의유연성이보다높게나타난것은 Schroth 3차원운동의회전호흡을통해일반호흡과는반대로뒤틀어진늑골을반대쪽으로보다많이회전시키며흉곽을최대한확장시켜유지하는방법과 ball-sling의복식호흡법과의차이로사료된다. Stokes 등 [30] 의 vicious cycle( 악순환 )" 이론에따르면측만증은평형성을상실하게하는다양한원인에의해뼈의기형을초래하며, Romano 등 [44] 의연구에서는병인학적요인들이평형성의부기능 (balance dyfunction) 과도상관관계가있다고보고하였다. 또한변성학 [48] 의연구에서척추측만증은동적평형감각이매우낮은상태이며, 이는척추의정렬과안정화를상실한것이고이로 인한근육의경직등이나타나인체의빠른움직임에어려움이있다고하였다. 따라서이러한선행연구의결과를토대로척추측만증운동치료의기본적목표중하나로평형성반응 (balance reaction) 의개선을들수있다. 김미숙등 [25] 의연구에서볼운동후, 평형성이증가된것으로나타났으며, 박선희 [27] 의연구에서도슬링을이용한요부안정화운동후, 균형능력이유의하게향상되었다고보고하였다. 이외의여러선행연구에서도같은동일한결과를보고하였으며 [41,49], 본연구의결과에서도운동치료전 후평형성이유의하게증가하였고 (Schroth, p=.010 & ball-sling p=.000), 이러한결과는 Schroth를포함한운동치료가척추측만증치료목표중의하나인평형성을개선하는데효과있는것으로사료된다. 또한 ball-sling 처치집단에서평형성이약간높은향상을보였으나집단간의차이는나타나지않았으며 (p=.228), 이는 ball-sling 운동에의한근력불균형의해소와근지구력의향상등이그원인으로생각된다. 카타리나슈로스는 Schroth방법이척추측만증의완벽한치료법이아니며척추측만증을유발하는이차적인요인을부분적으로회복시키는것이라고하였고또한 Schroth 3차원운동요법과 ball-sling 운동요법등다양한운동요법모두각각의효과로척추측만증에긍정적인도움을주는것으로생각된다. 따라서이러한운동요법들은치료의목적에따라다양하게적용하는것이보다효과적인치료법으로사료된다. 이연구에서는많은연구대상자를확보하지못하여연구결과를일반화하는데제한이있을것으로생각되며, 그러나측만증치료의다양한프로그램이미흡했던국내의실정에잘알려지지않은 Schroth 처치와다른운동처치의효과를검증하였고, 이연구를통해더욱다양한프로그램이개발되어특발성측만증치료의발전에기여할수있기를기대한다. 이후의연구에서는보다구체적이고객관적인측정도구를이용하여다양한프로그램으로, 보다많은척추측만환자를대상으로한후속연구가필요할것으로사료된다. 5. 결론특발성측만증이있는청소년 30명을대상으로 8주간의 Schroth 처치와볼 슬링운동을수행하는재활운동 4103

7 한국산학기술학회논문지제 16 권제 6 호, 2015 프로그램의처치가콥스각의변화와복부근지구력및유연성, 평형성에어떠한영향을미치는지를구명하고자실시되어다음과같은결론을얻었다. 8주간의운동후, Schroth 처치집단에서콥스각이유의하게감소되었으며 (p<.001), 복부근지구력 (p<.05) 및유연성 (p<.001) 과평형성 (p<.001) 모두운동후에유의한개선의효과가있는것으로나타났다. 또한 8주간의운동전 후 Schroth 처치집단에서의콥스각변화율이재활운동처치집단의콥스각변화율보다유의하게높은것으로나타났다 (p<.05). 이상의결과에서 Schroth 처치집단과재활운동처치집단모두특발성척추측만증이있는청소년의콥스각과복부근지구력, 유연성및평형성개선에유의한효과가있었으며, Schroth 처치가재활운동처치보다콥스각개선의효과가더큰것으로나타났다. 따라서 Schroth 처치가청소년들의특발성척추측만증예방및운동치료에보다효과적인방법으로사료되며, 추후다양한연령대와성별을대상으로하여 Schroth 처치를비롯한여러운동치료에대한장기간의지속적인연구가필요할것으로생각된다. Reference [1] Ministry of Culture, Sports and Tourism, "Survey on Citizens' sports participation". A periodical publication of Ministry of Culture, Sports and Tourism, [2] Heine J, Meister R, Quantitative analysis of the functions of the lungs and of blood-gases in young patients with scoliosis, using a functional diagnostic minimal program", Z Orthop Ihr Grenzgeb, Vol. 110, No. 1, pp , [3] Weinstein S. L, Idiopathic scoliosis in adolescence. Incidence and progression of untreated scoliosis, Orthopade, Vol. 18, No. 2, pp , [4] Brooks H. L, Azen S. P, Gerberg E, Brooks R, Chan L, Scoliosis: A prospective epidemiological study, J Bone Joint Surg Am, Vol. 57, No. 7, pp , [5] Rogala E. J, Drummond D. S, Gurr J, Scoliosis: incidence and natural history. A prospective epidemiological study, J Bone Joint Surg Am, Vol. 60, No. 2, pp , [6] Kane W. J, Scoliosis prevalence: a call for a statement of terms, Clin Orthop Relat Res, Vol. 126, pp. 43-6, DOI: [7] Lehnert-Schroth C, Introduction to the threedimensional scoliosis treatment according to schroth. Physiotherapy, Vol. 78, No. 11, pp , DOI: [8] McCool F. D, Rochester D. F, The lungs and the chest wall diseases, In: Murray J. F, and Nadel J. A(eds), Textbook of respiratory medicine, 3rd edition, WB saunder(philadelphia), pp , [9] Mayo N. E, Goldberg M. S, Poitras B, Scott S, Hanley J, The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: Back pain, Spine, Vol. 19, No. 14, pp , DOI: [10] Weinstein S. L, Dolan L. A, Spratt K. F, Peterson K. K, Spoonamore M. J, Ponseti I. V, Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study, JAMA, Vol. 289, No. 5, pp , DOI: [11] Moe J. H, Byrd J. A. Idiopathic scoliosis. In: Lonsteins J. E, Winter R. B, Bradford D. S, Olgivie J. W, editors. Moe's textbook of scoliosis and other spinal deformities. 2nd ed. Philadelphia: WB Saunders; p [12] Health Insurance Review & Assessment Servise. "The curved back of teenager waist-scoliosis caution" A press release, pp. 1-5, [13] Weinstein S. L, Natural history, Spine, Vol. 24, No. 24, pp , DOI: [14] Robinson C. M, McMaster M. J, Juvenile idiopathic scoliosis. Curve patterns and prognosis in one hundred and nine patients, J Bone Joint Surg Am, Vol. 78, No. 8, pp , [15] Lonstein J. E, Carlson J. M, The prediction of curve progression in untreated idiopathic scoliosis during growth, J Bone Joint Surg Am, Vol. 66, No. 7, pp , [16] Landauer F, Wimmer C, Therapieziel der Korsettbehandlung bei idiopathischer Adoleszentenskoliose, MOT, Vol. 123, pp , [17] Weiss H. R, Negrini S, Rigo M, Kotwicki T, Hawes M. C, Grivas T. B, Maruyama T, Landauer F, Indications for conservative management of scoliosis (guidelines), Scoliosis, Vol. 8, pp. 1-5, DOI: [18] Negrini S, Atanasio S, Zaina F, Romano M, Rehabilitation of adolescent idiopathic scoliosis: results 4104

8 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 of exercises and bracing from a series of clinical studies, Eur J Phys Rehabil Med, Vol. 44, No. 2, pp , [19] Otman S, Kose N, Yakut Y, The efficacy of Schroth`s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey, Neurosciences (Riyadh), Vol. 10, No. 4, pp , [20] Borysov M, Borysov A, "Scoliosis short-term rehabilitation(sstr) according to 'Best Pratice' standard are the results repeatable", Scoliosis, Vol. 7, No. 1, pp 1-17, DOI: [21] Lee J. H, Kim S. Y, Comparative Effectiveness of Schroth Therapeutic Exercise Versus Sling Therapeutic Exercise in Flexibility, Balance, Spine Angle and Chest Expansion in Patient with Scoliosis, J Korea Soc Phys Med, Vol. 9, No. 1, pp , DOI: [22] Cho J. H, Lee W. Y, Kim K. T, Choi, E. S, Lee D. T, The Effect of Regular Exercise Program on Cobb`s Angle and Fitness Parameters in Teenagers with Scoliosis, The Korea Journal of Physical Education, Vol. 43, No. 3, pp [23] Moon H. K, So J. M, Han K. S, The effect of torso rotation exercise on the alleviation of the curvature of the female adolescent idiopathic scoliosis, The Korea Journal of Physical Education, Vol. 46, No. 2, pp [24] Negrini S, Negrini A, Romano M, Verzini N, Negrini A, Parzini S, A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis, Stud Health Technol Inform, Vol. 123, pp , [25] Kim M. S, Yang J. H, The effects of scoliosis correction and swiss ball exercises on scoliosis in high school male students, The Korea Journal of Physical Education, Vol. 42, No. 2, pp [26] Kim S. Y, Kwon J, H, Lumbar stabilization exercises using the sling system, The Journal of Academy of Orthopedic Manual Therapy, Vol. 7, No. 2, pp [27] Park S. H, Effect of Sling Lumbar Stabilization Exercise on the Balance of Idiopathic Scoliosis Patients", Samyook university, master's dissertation, [28] Cailliet R, Scoliosis: Diagnosis and Management, F.A. Davis(Philadelphia), pp , [29] Harrington P. R, The etiology of idiopathic scoliosis, Clin Orthop Relat Res, Vol. 126, pp , DOI: [30] Stokes I. A. F, Burwell R. G, Dangerfield P. H, Biomechanical spinal growth modulation and progressive adolescent scoliosis a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE, Scoliosis, Vol. 1, pp. 16, DOI: [31] Duval-Beaupère G, Lespargot A, Grossiord A, Flexibility of scoliosis. What does it mean? Is this terminology appropriate?, Spine, Vol. 10, No. 5, pp , [32] Kuru T, Yeldan İ, Dereli E. E, Özdinçler A. R, Dikici F, Çolak İ, The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomised controlled clinical trial", Clin Rehabil. 16. pii: [Epub ahead of print], DOI: [33] Schreiber S, Parent E. C, Hedden D. M, Moreau M, Hill D, Lou E, Effect of Schroth exercises on curve characteristics and clinical outcomes in adolescent idiopathic scoliosis: protocol for a multicentre randomised controlled trial, J Physiother, 60(4):234, DOI: [34] Herling O, Clinical measurements, radiological and cosmetic improvements in a girl with adolescent idiopathic scoliosis treated with a Schroth rehabilitation program: a single case study, Scoliosis, Vol. 4(Suppl 2):O28, DOI: [35] Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S, "Physical exercise in the treatment of adolescent idiopathic scoliosis: An update systematic review", Physiotherapy Theory and Practice, Vol. 27, No. 1, pp , DOI: [36] Weiss H. R, Seibel S, "Scoliosis short-term rehabilitation(sstr)- A pilot investigation", The Internet Journal of Rehabilitation, Vol. 1, No. 1, pp. 1-17, [37] Lee S. H, Kim J. H, A Study on the Actual Conditions of Scoliosis in Fifth and Sixth Grade School children, The Journal of the korean society of school health, Vol. 12, No. 1, pp , [38] Kim K, Han J. T, Lee H. J, Effects of swiss ball exercise on scoliosis and flexibility in adults", Journal of Korea sport research, Vol. 18, No. 4, pp , [39] Kim S. H, Effect of Sling Exercise Program on the 4105

한국산학기술학회논문지제 16 권제 6 호, 2015 Body of Junior High School Girls with Idiopathic Scoliosis, Hanshin university, master's dissertation, 2010.

S, Park W. I, Kim H. T, The effects of barre exercise on flexibility, balance, and scoliosis improvement in high school female students with scoliosis", The Korea Journal of Physical Education, Vol.

H, Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain, Eur Spine J, Vol.

9 한국산학기술학회논문지제 16 권제 6 호, 2015 Body of Junior High School Girls with Idiopathic Scoliosis, Hanshin university, master's dissertation, [40] Park H, Effects of conditioning program by elastic band and ball on scoliosis correction in dancers, Dongduk women's university, master's dissertation, [41] Jeon Y. N, Yang J. H, Kim M. S, Park W. I, Kim H. T, The effects of barre exercise on flexibility, balance, and scoliosis improvement in high school female students with scoliosis", The Korea Journal of Physical Education, Vol. 44, No. 1, pp [42] Danneels L. A, Coorevits P. L, Cools A. M, Vanderstraeten G. G, Cambier D. C, Witvrouw E. E, De C. H, Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain, Eur Spine J, Vol. 11, No. 1, pp. 13-9, DOI: [43] Mooney V, Gulick J, Pozos R, A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis, J Spinal Disord, Vol. 13, No. 2, pp , DOI: [44] Romano M, Negrini A, Parzini S, Negrini S, Scientific Exercises Approach to Scoliosis (SEAS): efficacy, efficiency and innovation, Stud Health Technol Inform, Vol. 135, pp , [45] Choi B. C, Cho Y. H, Kim H, The effect of lumbar stabilization program using a swiss ball on lumbar strength and muscle activity in Ssireum players, The korean journal of physical education, Vol. 48, No. 4, pp , [46] Zaina F, Negrini S, Atanasio S, Fusco C, Romano M, Negrini A, Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients, Scoliosis, Vol. 7, pp. 4-8, [47] Moon H. H, Jang K. T, The Effect of Correction Exercise Program on Primary School Students with Idiopathic Scoliosis, Journal of Sport and Leisure Studies, Vol. 31, pp , [48] Byeon S. H, An effect of chiropractic and message scoliosis' cobb's angle and sense equilibrium", Pusan university of foreign studies, master's dissertation, [49] Park K. D, Joo S. B, Yoon S. D, The Effect of Chiropractic on ROM of Spine and Balance of Dynamic for Scoliosis Patients, The Korea Society of Sports Science, Vol. 15, No. 2, pp , 김정현 (Jung-Hyun Kim) [ 정회원 ] < 관심분야 > 의 생명공학, 스포츠의학, 운동생리학 2010 년 8 월 : 단국대학교대학원스포츠재활전공 ( 이학석사 ) 2013 년 5 월 ~ 현재 : 울산당당한의원운동치료실장 오두환 (Du-Hwan Oh) [ 정회원 ] < 관심분야 > 정형의학, 스포츠의학, 트레이닝방법 2012 년 3 월 : 단국대학교대학원스포츠의학전공 ( 박사수료 ) 2010 년 11 월 ~ 현재 : DH 웰리스스포츠클리닉대표 2010 년 11 월 ~ 현재 : 단국대학교운동처방재활학과강사 장석암 (Seok-Am Zhang) [ 정회원 ] < 관심분야 > 의 생명공학, 스포츠의학 2000 년 2 월 : 한국체육대학교대학원스포츠의학전공 ( 이학박사 ) 2000 년 9 월 ~ 현재 : 단국대학교대학원운동의과학과교수 4106

10 특발성측만증청소년의 Schroth 3 차원운동이콥스각과복부근지구력및유연성, 평형성에미치는영향 이장규 (Jang-Kyu Lee) [ 정회원 ] 2003 년 2 월 : 한국체육대학교대학원운동생리학전공 ( 이학박사 ) 2006 년 9 월 ~ 현재 : 단국대학교대학원운동의과학과강사 < 관심분야 > 의 생명공학, 스포츠의학, 운동생리학 4107

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar