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

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1 JKPT pissn Vol. 27, No. 5, October eissn X Original Article Effect of Various Leg-Crossing Positions on Muscle Activities of Rectus Femoris, Tensor Fascia Latae, and Hamstring in Healthy 20 s Adults Won-Hwee Lee, Tae-Hee Kang, Jeong-Ha Kim, Tri suryanti Department of Physical Therapy, College of Jeonju Vision, Jeonju, Korea Purpose: The purpose of this study was to investigate the effect of leg-crossing positions on muscle activities of rectus femoris, tensor fascia latae, and hamstring in healthy 20 s adults. Methods: Twenty healthy subjects were asked to perform three leg-crossing positions, leg crossing (LC), tailor crossing (TC), and ankle crossing (AC). Surface electromyography (EMG) was used to evaluate the activities of rectus femoris, tensor fascia latae, and hamstring during upright sit posture (UP) and three leg-crossing positions and UP was compared to three leg-crossing positions. Repeated one way ANOVA was used for data analysis. The alpha level was set at Results: The results showed significant difference in the muscle activities of rectus femoris, tensor fascia latae, and hamstring among leg-crossing positions. The muscle activity of the rectus femoris was significantly lower in LC and TC positions than UP. The muscle activity of tensor fascia latae was significantly higher in LC position than UP and other leg-crossing positions. The muscle activity of hamstring was significantly higher in LC and TC positions and significantly lower in AC position than in UP. Conclusion: Our study suggests that the activity of hip muscles was affected by pelvic and knee alignment in various leg-crossing positions. Keywords: Electromyography, Leg-crossing, Sitting 서론현대사회에는컴퓨터의대중화와컴퓨터업무의일반화로인해컴퓨터사용시간이증가하면서의자에앉아서하는형태의작업시간이늘어나고있으며안좋은자세로장시간앉은자세는전방머리자세, 둥근어깨및요통과같은근골격계질환을일으킬수있다. 1-4 그러므로올바르게앉은자세가필요하며올바르게앉기위해서는체간근육의균형적인작용과충분한엉덩관절굽힘관절가동범위가필요하다. 5 올바른앉은자세를인지하고유지하려고노력해도장시간앉아있을때에는허리를숙이거나다리를꼬는등자세의변화와이러한자세를지속적으로유지하고있다. 6 잘못된앉은자세들중대표적인것은다리꼬기자세가있다. 다리꼬기자세는일상생활이나컴퓨터작업을하는동안주로나타나는자세로이러한자세로인해허리가구부정하게되고골반의회전을 유발한다. 7,8 지금까지다리꼬기자세에대한많은연구들이보고되었지만다리꼬기자세를취하는이유에대해서는명확히밝혀지지는않았다. 대부분다리꼬기자세를하는이유는이자세가편하기때문에습관적으로다리꼬기자세를취한다고한다. 9 또한 Snijder 등 10 은짧은치마를입었을때미용적이유로다리꼬기자세를취한다고도제시하였다. 다리꼬기자세를통해신체의구조적불균형이나골반의불안정성등을보상한다고제시한연구들도있는데, Pinar 등 11 은외관상양쪽다리의길이가서로다른경우에골반의높이를맞추기위해서다리꼬기자세를하고, Snijder 등 12 은엉치엉덩관절 (sacroiliac joint) 의불안정성이있는사람이다리꼬기자세를통해엉덩관절모음 (adduction) 을발생시켜엉치엉덩관절에안정성을제공하므로다리꼬기자세를취한다고하였다. Takishita 등 13 은기립성저혈압이있는사람들에게다리꼬기자세가혈압을상승시키는효과도있다고도제시하였다. Received Sep 15, 2015 Revised Oct 19, 2015 Accepted Oct 25, 2015 Corresponding author Won-Hwee Lee wampus@naver.com Copylight 2015 The Korea Society of Physical Therapy This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License ( creativecommons.org/license/by-nc/3.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited

2 JKPT The Journal of Korean Physical Therapy Won-Hwee Lee, et al. 다리꼬기자세에대한연구들은주로체간의근활성도나척추의정렬과관련되어설명을하고있다. 6,14,15 Jung 6 과 Kim 등 15 은다리꼬기자세가체간의미치는영향들에대해보고하였으며주로다리꼬기자세는내복사근과외복사근의근활성도를감소시키고체간근육의비대칭적인근활성도를나타낸다고제시하였다. Kang 등 14 은다리꼬기자세는골반과척추의각도및양쪽볼기의압력을변화시킨다고보고하였다. 지금까지많은연구들이다리꼬기자세로인한복근이나척추세움근과같은체간근육의근활성도변화및척추의정렬상태에미치는영향에대해주로알아보고있었다. 하지만척추의정렬상태는엉덩관절주변근육들에의해서도영향을받을수있다. 5 엉덩관절주변근육들중넙다리곧은근, 넙다리근막긴장근, 뒤넙다리근은골반에서시작하여무릎관절을지나가는두관절근육으로골반의움직임과엉덩관절및무릎관절의움직임을일으킨다. 16 넙다리곧은근과넙다리근막긴장근은골반의아래앞엉덩뼈가시 (anteroinferior iliac spine) 와위앞엉덩뼈가시 (anterosuperior iliac spine) 에붙어있어수축시골반의앞쪽기울임을일으키고척추세움근과짝힘 (force-couple) 으로써작용한다. 뒤넙다리근은궁둥뼈결절에붙어있어수축시골반의뒤쪽기울임을일으켜복근과짝힘으로작용한다. 16 이러한협력근들은최적으로동원되어야되는데하나의근육이과도하게동원되면근육불균형이일어난다. 17 엉덩관절주변근육의근활성도및길이의변화는앉은자세에서골반의앞쪽또는뒤쪽기울임을유발하며이는요추의굽힘과폄움직임을일으켜요추의정렬상태에영향을줄수있다. 5,17 또한이근육들은정강뼈와종아리뼈에붙어있어서엉덩관절및무릎관절의움직임에관여를하여근육의근활성도및우세성의변화는엉덩관절과무릎관절의근골격계문제에도관여를할수있다. 16,17 지금까지대부분의연구에서는여러형태의다리꼬기자세로인해복근및척추세움근의근활성도가어떻게변하는지또는요추의정렬상태가어떻게변하는지에대해제시를하였지만여러형태의다리꼬기자세가엉덩관절주변의근육들에는어떠한영향을미치는지에대해서는알려지지않았다. 본연구에서는여러형태의다리꼬기자세에따라엉덩관절주변근육들에게어떠한영향을미치는지알아보고자한다. 본연구에서사용할여러형태의다리꼬기자세는사람들이주로취하는다리꼬기자세들이며 Kang 등 14 과 Kim 등 15 의연구에서사용했던다리꼬기자세인다리꼬기자세 (Leg-crossing, LC), 양반다리꼬기자세 (Taylor crossing, TC), 발목꼬기자세 (Ankle crossing, AC) 이다. 그래서본연구에서는이러한여러형태의다리꼬기자세들을바로앉은자세 (upright sit posture, UP) 와비교하여엉덩관절주변근육인넙다리곧은근, 넙다리근막긴장근, 뒤넙다리근의근활성도에어떠한영향을미치는지알아보았다. 연구방법 1. 연구대상자본연구대상자는실험전에본연구의목적과방법에대해충분히설명을듣고, 연구의목적에동의하는연구동의서를작성하고연구에참여의사를밝힌전라북도전주시에소재한 OO 대학교에재학중인건강한남녀대학생 20명 ( 남자 10명, 여자 10명 ) 을대상으로연구를실시하였다. 연구대상자의선정기준은요통이나다리의통증으로인한관절가동범위에제한이없는자로엉덩관절의굽힘범위가 90 도이상가능한대상자로선정하였으며지난 6개월동안골절, 관절염, 외상과같은정형외과적장애나통증을경험했던대상자는연구대상자에서제외하였다. 연구에참여한연구대상자의평균연령은 23.8 ± 4.8세, 평균신장은 ± 10.2 cm, 그리고평균체중은 66.5 ± 15.4 kg이었으며대상자의평균엉덩관절의굽힘범위는 ± 3.2도였다. 정규성검정을통해연령을제외한모든변수들이정규분포하였으며대상자의우세측다리는모두오른쪽이었다. 2. 실험방법 1) 측정도구 ⑴ 표면근전도시스템다양한다리꼬기자세에따른체간근육의활성도를알아보기위하여표면근전도시스템 (AP1180) 을사용하였으며, 표면근전도시스템에서디지털처리된근전도신호의분석은무선 EMG 시스템 (Wireless EMG System (100RT), BTS, Millan, Italy) 을이용해처리하였다. 표면근전도신호의표본추출률 (sampling rate) 은 1,000 Hz로설정하였다. 근육의근전도신호는제곱평균제곱근법 (Root Mean Square, RMS) 처리하여분석하였다. 표면전극의부착부위는피부저항을감소시키기위해털을제거하고, 가는사포로 3-4회문지른다음, 알코올솜으로피부각질층을제거하고전극을부착하였다. 전극을부착하는근육은오른쪽넙다리곧은근, 넙다리근막긴장근, 뒤넙다리근의가쪽근육으로전극부착부위는 Cram 등 18 에의해제시된부위를참고하여최대근수축이뚜렷이보이는힘살 (muscle belly) 에전극을부착하였다. 표면근전도신호의정규화 (normalization) 과정을위해자발적기준수축 (Reference Voluntary Contraction, RVC) 을사용하였다. 자발적기준수축의측정자세는등받이가있는의자에서다리를꼬지않고엉덩관절, 무릎관절, 발목관절은 90도로굽힘되고엉덩관절의회전이없는중립자세 (UP) 로이자세를 1분동안유지하였다. 이때각근육의근전도신호를 3회반복측정하였으며 3회반복하여구한값에서각각처음 10 초와마지막 10초를제외한중간 40초동안의평균값으로자발적기준수축을구해이를기준으로하였다. 이는 UP 자세에대한근활성 316

3 Effect of Leg-crossing Positions on Hip Muscles JKPT 도값으로각각자세에대한측정값을비교하였다. 2) 실험절차본연구에서는등받이가있는의자에서주로사용되는세가지형태의다리꼬기자세인다리꼬기자세 (LC), 양반다리꼬기자세 (TC), 발목꼬기자세 (AC) 에서근활성도를측정하고자발적기준수축자세인바로앉은자세 (UP) 와비교하였다 (Figure 1). 다리를꼬는방향은오른쪽다리를왼쪽다리위에올려놓은방법으로하였고, 왼쪽발은지면에닿아있는형태로하였다. 14,15 대상자들은먼저바로앉은자세에서자발적기준수축을측정하였고, 세가지의다리꼬기자세를 1분간 3회씩측정하였다. 측정자세의순서는무작위한순서로결정하였으며근피로등을방지하기위해측정간휴식시간을 5분으로하였다. 의한감소를보였으며, AC 자세에비해서도유의한감소를보였다 (p < 0.05). 넙다리근막긴장근은 LC 자세에서다른자세들보다근활성도의유의한증가를보였고 (p < 0.05), 나머지자세들사이에서는유의한차이가없었다 (p > 0.05). 뒤넙다리근은 UP 자세에비해 LC와 TC 자세에서근활성도에유의한증가를보였고, AC 자세에서는근활성도에유의한감소를보였다 (p < 0.05). AC 자세는 LC와 TC 자세에비해서도근활성도에유의한감소를보였다 (p < 0.05) (Table 1) (Figure 2). 고찰본연구에서는다양한다리꼬기자세가엉덩관절주변근육의근활성도에미치는영향을알아보고자주로다리꼬는형태로사용하는자세인 LC, TC, AC 자세에서 UP 자세를기준으로엉덩관절주변근 3) 통계방법세가지형태의다리꼬기자세와바로앉은자세에서근활성도의변화를비교하기위해반복측정된일요인분산분석 (repeated one-way ANOVA) 을사용하였다. 사후분석방법으로는 Bonferroni 검정을사용하였다. 통계적유의성을검증하기위한유의수준 (α) 은 0.05였고 SPSS 19.0 for Window (IBM Co, Armonk, NY, USA) 프로그램을이용하였다. Muscle activity (%RVC) LC TC AC UP 결과 1. 다리꼬기자세에따른근활성도비교다리꼬기자세에따라넙다리곧은근, 넙다리근막긴장근, 뒤넙다리근의근활성도는모두유의한차이를보였다 (p < 0.05). 사후검정결과넙다리곧은근은 LC 자세와 TC 자세는 UP 자세보다근활성도의유 0 RF TEL Ham Figure 2. Comparison of muscle activities according to leg-crossing positions (significant difference at p<0.05). RF: Rectus femoris, TFL: Tensor fascia latae, Ham: Hamstring, LC: Legcrossing, TC: Tailor-crossing, AC: Ankle-crossing, UP: Upright sit posture. A B C D Figure 1. Upright sit posture and three leg-crossing positions. (A) Upright sit posture, (B) Leg-crossing, (C) Tailor-crossing, (D) Ankle-crossing

4 JKPT The Journal of Korean Physical Therapy Won-Hwee Lee, et al. Table 1. Comparison of muscle activity of rectus femoris, tensor fascia latae, and hamstring according to leg crossing positions (%RVC) Muscle Posture Muscle activity Type III Sum of Squares df F p Rectus femoris LC 83.56± , < TC 83.06±22.36 AC 99.56±17.87 Tensor fascia latae LC ± , < TC 94.81±23.47 AC 89.91±22.89 Hamstring LC ± , < TC ±23.12 AC 79.58±17.61 LC: Leg crossing, TC: Tailor crossing, AC: Ankle crossing, UP: Upright sit posture. mean±standard deviation, p<0.05. 육인넙다리곧은근, 넙다리근막긴장근, 뒤넙다리근의근활성도에미치는영향을알아보았다. 연구결과모든근육이다리꼬기자세에따라유의한차이를보였다. UP 자세에서넙다리곧은근의근활성도를기준으로세가지다리꼬기자세와비교하였을때 LC 자세와 TC 자세에서는유의하게낮은근활성도를보였고, AC 자세는유의한차이가없었다. UP 자세에서넙다리근막긴장근의근활성도를기준으로세가지다리꼬기자세와비교하였을때 LC 자세에서는유의하게증가된근활성도를보였고, TC와 AC 자세에서유의한차이가없었다. UP 자세에서뒤넙다리근의근활성도를기준으로세가지다리꼬기자세와비교하였을때 LC와 TC 자세에서는유의하게증가된근활성도를보였고 AC 자세에서는유의하게감소된근활성도를보였다. 이러한결과를다리꼬기자세별로보면 UP 자세를기준으로 LC 자세에서는넙다리곧은근의근활성도는유의하게낮았고, 넙다리근막긴장근과뒤넙다리근의근활성도는유의하게높았다. UP 자세를기준으로 TC 자세에서는넙다리곧은근의근활성도는유의하게낮았고, 뒤넙다리근의근활성도는유의하게높았다. Kang 등 14 의연구에서 LC와 TC 자세는 UP 자세보다골반의후방경사가더일어난다고보고하였다. 앉은자세는선자세보다골반의후방경사를더일으키고다리꼬기자세는골반을더욱후방경사시켜척추의구부정한자세 (slumped position) 를일으킬수있다. 7,19,20 넙다리뒤근은복근과함께골반을후방경사시키는근육이다. 17 그러므로 UP 자세를기준으로 LC자세와 TC 자세에서뒤넙다리근의근활성도가유의하게증가하고넙다리곧은근의근활성도가유의하게감소한것은골반의후방경사로인해서나타났을것으로사료된다. 또한 UP 자세를기준으로비교하였을때 LC 자세에서만넙다리근막긴장근의근활성도가유의하게증가되어있었다. Sahrmann 17 은 LC 자세에서넙다리근막긴 장근이과도하게사용된다고하였고, 넙다리근막긴장근의단축을최소화하기위해서는 LC 자세를피해야만한다고하였다. UP 자세를기준으로 AC 자세에서뒤넙다리근의근활성도는유의하게낮았고, 넙다리곧은근과넙다리근막긴장도의근활성도는유의한차이가없었다. AC 자세는다른다리꼬기자세들보다골반의후방경사가덜일어나며무릎의각도가가장폄되어있는자세이다. 14 그러므로뒤넙다리근의근활성도가 UP 자세보다도유의하게낮게나왔고비록 AC 자세에서넙다리곧은근은 UP 자세와는유의한차이가없었지만다른다리꼬기자세들과는유의한차이를보였으므로무릎의폄된위치와관련이있다고사료된다. 이를통해각각의다리꼬기자세에따라엉덩관절주변근육들의근활성도변화는각각의다리꼬기자세에서골반및무릎의정렬상태와관련이있다고사료된다. Kang 등 14 의연구에서는동작분석을통해각각의다리꼬기자세를습관적으로장시간취하게되면척추에서나타나는근골격계질환인척추후만증이나측만증을일으킬수있다고제시하였다. 본연구에서알아본근육들은각각의다리꼬기자세에따라근활성도가유의하게증가되기도하고감소하기도하였다. 하지만넙다리근막긴장근은 UP 자세를기준으로비교했을때유의하게감소되는자세는없었고, LC 자세에서만유의하게증가되었다. UP 자세를기준으로했을때 LC 자세에서넙다리근막긴장근의근활성도가높았다는것은 UP 자세보다넙다리근막긴장근이많은수축을한다는것을의미하고 LC 자세를장시간습관적으로취하게되면넙다리근막긴장근의과사용이되며이는근육길이의단축이나뻣뻣함을일으킨다. 21 넙다리근막긴장근은무릎뼈가쪽에정지하는근육으로넙다리근막긴장근의과사용으로인한근육길이의단축은정강뼈의가쪽돌림과무릎뼈의가쪽활주에기여하여무릎통증을유발할수있다. 20,21 또한 Sahrmann 21 은넙다리근막긴장근이뻣뻣하고단축되는경우골 318

5 Effect of Leg-crossing Positions on Hip Muscles JKPT 반을회전시키며이러한골반의회전은요추의회전을유발한다고 하였다. 지금까지많은연구들에서다리꼬기자세시골반의회전이 일어나며이회전은복근의불균형으로인해일어난다고하였다. 6,10,15 하지만본연구를통해증가된넙다리근막긴장근의근활성도도장 시간습관적으로 LC 자세를취하게되면골반의회전에기여하는요 소가될수있다고생각한다. 본연구의제한점은젊은연령에대상자로국한되어있어일반화 하기힘들며, 요통이나다리의문제가없는정상인들로만대상으로 하였다. 또한단순히근활성도만측정하여다양한다리꼬기에따른 실제관절의정렬변화등은알수없었다. 그러므로추후연구에서는 다양한연령대의대상자를토대로연구와요통이나다리의통증이 있는대상자에게서는어떠한차이가있는지알아보는연구가필요하 다. 또한장시간다리를습관적으로꼬는대상자들을대상으로실제 적으로엉덩관절근육들의단축여부도알아보는연구도필요할것 이다. REFERENCES 1. Li G, Haslegrave CM. Seated work postures for manual, visual and combined tasks. Ergonomics. 1999;42(8): Ortiz-Hernandex L, Tamez-Gonzalez S, Martinez-Alcantara S et al. Computer use increase the risk of musculoskeletal disorders among newspaper office workers. Arch Med Res. 2003;34(4): Park YN, Bae YS. Comparison of muscle performance of the lumbar region and head alignment according to the length of sitting time. J Kor Phys Ther. 2013;25(6): Kwon JW, Nam SH, Choi YW et al. The effect of different head positions in sitting on head/shoulder posture and muscle activity. J Kor Phys Ther. 2013;25(4): Neumann DA. Kinesiology of the musculoskeletal system: Founcations for physical rehabilitation. St. Louis, Mosby, 2002: Jung YG. Effects of leg crossed sitting on the trunk muscle activities during the computer work. Yonsei university. Dissertation of Master s degree Lee JH, Park SY, Yoo WG. Change in craniocervical and trunk flexion angles and gluteal pressure during VDT work with continuous crosslegged sitting. J Occup Health. 2011;53: Watanabe S, Kobara K, Ishida H et al. Influence of trunk muscle co-contraction on spinal curvature during sitting cross-legged. Electromyogr Clin Neurophysiol. 2010;50: Jung WJ. Effects of a wallet in the back trouser pocket on paraspinal muscle activity in sitting. Yonsei university. Dissertation of Master s degree Snijders CJ, Slagter AH, van Strik R et al. Why leg crossing? The influence of common postures on abdominal muscle activity. Spine. 1995; 20(18): Pinar R, Sabuncu N, and Oksay A. Effects of crossed leg on blood pressure. Blood Press. 2004;13(4): Snijders CJ, Hermans PF, Neising R et al. The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clin Biomech (Bristol. Avon). 2004;19(4): Takishita S, Touma T, Kawazoe N et al. Usefulness of leg-crossing for maintaining blood pressure in a sitting position in patients with orthostatic hypotension - case reports. Angiology. 1991;42(5): Kang SY, Kim, SH, Ahn SJ et al. A comparison of pelvic, spine angle and buttock pressure in various cross-legged sitting postures. PTK. 2012; 19(1): Kim TH, Seo HK, Hong WT. The change of muscle activities of trunk muscles during various leg-crossing positions in low back pain patients. J Kor Phys Ther. 2007;19(5): Muscolino JE. Know the body: Muscle, bone, and palpation essentials. St Louis, Mosby, 2011: Sahrmann SA. Diagnosis and treatment of movement impairment syndromes. St Louis, Mosby, 2002: Cram J, Kasman G, Holtz J. Introduction of surface electromyography. Gaithersburg, MD: Aspen Publishers, 1998: Chae YW, Park JW, Park S. Effects of knee malalignment on static and dynamic postural stability. J Kor Phys Ther. 2015;27(1): Kang MH, Oh JS, Park BJ et al. Comparison of the lumbar flexion angle and EMG activity in trunk muscles in individuals with and without limited hip flexion range of motion during visual display terminal work with cross-legged sitting. J Phys Ther Sci. 2013;25: Sahrmann SA. Movement system impairment syndromes of the extremities, cervical and thoracic spines. St Louis, Elsevier, 2011:

제10강: 골관절과 골반대

제10강: 골관절과 골반대 제 10 강 고관절과골반대 SPORT & LEISURE STUDIES LEE CHAE SAN 엉덩관절의근육개요 작용과관련된다음의일반적인원칙들은엉덩관절의기능적근육군들을위해기술됨 근육의섬유방향이엉덩관절앞쪽에서수직방향으로가로지르면엉덩관절에서골반의앞면을향하여넙다리의앞면이움직임으로써넙다리를굽힘 ( 표준작용 : standard action). 또는넙다리의앞면을향하여골반의앞면이움직임으로써엉덩관절에서골반을앞쪽으로경사지게함