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1 J Korean Soc Phys Med, 2018; 13(2): htts://doi.org/ /ksm Online ISSN: Print ISSN: X Research Article Oen Access 운동과관절가동술을혼합한중재가어깨관절내적충돌증후군을가진청소년기야구선수의관절가동범위, 통증정도, 기능수행정도에미치는효과 오태영 추연기 1 유일영 1 신라대학교물리치료학과, 1 구포성심병원물리치료실 Effects of Joint Mobilization Intervention Combined with Exercise on Range of Motion, Pain Intensity, and Functional Performance in Adolescent Baseball Players with Internal Imingement of the Shoulder Tae-Young Oh, PhD, PT Yeon-Ki Choo, PT 1 Il-Young Yoo, PT 1 Deartment of Physical Theray, Silla University 1 Deartment of Physical Theray, Guo SungShim Hosital Received: January 22, 2018 / Revised: February 6, 2018 / Acceted: March 26, 2018 c 2018 J Korean Soc Phys Med Abstract 1) PURPOSE: The aim of this study was to identify the effects of joint mobilization intervention combined with exercise on range of motion (ROM), ain intensity, and functional erformance in adolescent baseball layers with internal imingement syndrome of the shoulder. METHODS: The subjects were 30 adolescent baseball layers diagnosed with internal imingement. Ten subjects were randomly assigned to each of 3 grous: Grou 1 (exercise only), Grou 2 (joint mobilization combined with exercise), and Grou 3 (rest-only control grou). Three weekly interventions were given for 4 weeks (the control Corresonding Author : Yeon-Ki Choo romise1221@nate.com, htts://orcid.org/ This is an Oen Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (htt://creativecommons.org/licenses/by-nc/3.0) which ermits unrestricted non-commercial use, distribution, and reroduction in any medium, rovided the original work is roerly cited. grou rested for 4 weeks). The main outcome measures were goniometer, visual analogue scale (VAS), and Korean Kerlan Jobe shoulder-elbow (K-KJOC) scores. The ROM (external and internal rotation), ain intensity (at the moment of throwing), and functional erformance were comared among the grous. RESULTS: No significant difference was observed among the grous in the range of external rotation of the shoulder before and after the intervention, but the range of internal rotation was significantly increased in Grou 2 comared to Grous 1 and 3. Pain intensity was significantly lower in Grou 2 than in Grou 1 and 3, and functional erformance was significantly increased in Grou 2 comared to Grou 1 and 3. CONCLUSION: An intervention that combined joint mobilization with exercise was more effective than resting or exercise alone for raid recovery from sorts injury and imrovement in athletic erformance.

2 12 J Korean Soc Phys Med Vol. 13, No. 2 Key Words: Adolescent baseball layers, Exercise, Internal imingement of the shoulder, Joint mobilization Ⅰ. 서론프로야구선수라는부푼꿈을안고있는약 9000여명의청소년기야구선수들은현재리틀또는초등학교, 중학교, 고등학교의아마추어야구리그에소속되어연간지역리그및전국대회등의다수의경기를통해실력을겨루고있다 (Korea Baseball Softball Association, 2016). 하지만우려스럽게도, 청소년들에서발생할수있는손상은신체적미성숙과발달이관련되어있어성인과는또다른양상으로나타나기때문에더욱더세심한관리와주의가필요함에도불구하고현재우리나라의많은청소년야구선수들은경쟁심고취와과도한훈련, 그리고빈번한시합으로경기력향상에만주력하고있는반면에연습이나시합중발생하는선수들의신체적상해는소홀히하는경우가대부분이다. 이와같이야구는전통적으로무리한과사용으로인해어깨관절을포함한상지손상이많이발생되는종목으로, 특히성장기에있는청소년선수들의손상은뼈와연골손상및관절운동등에많은장애를줄수있으며, 심지어는영구적인변형이발생하여선수생활에지장을주거나생명을단축시킬수있다 (Choi와 Eum, 2002). 청소년기야구선수들은건병증, 근건이음부염좌, 돌림근띠파열등을포함한다양한돌림근띠과사용손상때문에어려움을겪는경우가많으며, 이런손상들은주로누적된인장과부하, 외적충돌증후군, 어깨관절의불안정성과연관된내적충돌증후군에의해발생한다 (Chen 등, 2005). 실제로청소년기선수들에서발생할수있는어깨통증은외적충돌증후군보다는어깨관절의다방향불안정성에기인한내적충돌증후군이좀더주된원인이다 (Gómez, 2002). 또한내적충돌증후군은비교적젊고활동적이며오버헤드동작을반복적으로취하는청소년기야구선수와같은운동선수들에게주로발생되는손상이며 (Drakos 등, 2009), 어깨관절의벌림과가쪽돌림이최대화된상태에서큰결절과뒤쪽및위쪽오목테두리그리고관절오목사이에돌림근띠의 아래면접촉으로발생하며 (Walch 등, 1992; Jobe, 1995), 이는늦은코킹과초기가속동작간의전환시발생한다. 현재까지보고된내적충돌증후군의원인은반복적인투구동작으로인한앞쪽관절주머니이완과, 뒤쪽관절주머니구축및어깨뼈운동이상이대표적이며 (Jobe, 1989; Burkhart 등, 2003), 만성적으로돌림근띠압박과충돌증후군이진행되면가시위근과가시아래근힘줄의닳아짐또는파열과함께위쪽오목테두리병변을야기시킬수있으므로적절한중재방법및관리를통해더욱심각한손상을예방하고선수들의조속하고도효율적인복귀를도모하는것이필수적이다 (Burkhart 등, 2003; Manske 등, 2013). 청소년기야구선수의어깨관절손상중내적충돌증후군은이렇게빈번히발생하고있음에도불구하고국내스포츠물리치료분야에서는이에대한명확한치료방법및관리기준에관한선행연구가크게부족한실정이며일반적으로많이소개되어시행되어온운동처방에만의존하는방법에서벗어난더욱효과적인중재방법제시를위한전문치료사의개입이포함된물리치료적접근법의필요성이요구되고있다. 따라서본연구에서는청소년기야구선수에게효과적인중재방법을제시하기위해어깨관절내적충돌증후군으로진단받은청소년기야구선수를대상으로 4주동안의운동과관절가동술을혼합한중재가어깨관절의관절가동범위, 통증정도, 경기력과관련된기능수행정도에미치는효과를규명하는데있다. Ⅱ. 연구방법 1. 연구대상자및절차본연구는부산시소재의종합병원스포츠의학정형외과전문의로부터자기공명영상 (magnetic resonance imaging; MRI) 과이학적검사를통해내적충돌증후군의진단을받고물리치료가필요한청소년기 ( 중학생, 고등학생 ) 야구선수 30명을대상으로하였으며어깨관절에내적충돌증후군을제외한다른질환에의한심각한손상이나신경학적질환을가지고있는자, 수술을받은경험자, 최근 3개월이내어깨관절의치료이력이

3 운동과관절가동술을혼합한중재가어깨관절내적충돌증후군을가진청소년기야구선수의관절가동범위, 통증정도, 기능수행정도에미치는효과 13 Table 1. Exercise rograms for adolescent baseball layers with internal imingement syndrome Tye Exercise Intensity Warm-u Treadmill 10~15 min Stretching Strengthening (Rotator cuff) Stabilizing (Scaula) Cool-down Sleeer stretch Cross arm stretch (suine osition) Cross arm stretch with ball 90 /90 rhythmic stabilization Shoulder external rotation Shoulder internal rotation Prone Blackburn exercise (thumb u) Scaular retraction Push-u lus Hugging / Punching exercise Restorator / Ice-ack 30 sec/5 res 15 res/3 sets 15res/3sets 10~15 min / 10~15 min 있는대상자는연구에서제외하였다. 모든대상자는실험중재에앞서참여동의서를자발적으로작성하였으며, 중재기간동안다른약물이나치료를받지않을것을약속하였다. 실험에참여할대상자총 30명을무작위로각그룹당 10명씩배정하였으며, 각그룹의중재방법에따라실험군 2개와대조군 1개로나누었다. 중재적용전검사로는어깨관절가동범위, 통증, 기능수행정도를측정했으며실험군에대해주 3회씩 4주간의중재적용후검사역시같은측정방법을통해실시하였다. 2. 중재방법 Fig. 1. Joint mobilization. 등, 2003; Manske 등, 2013) 를바탕으로하여물리치료적운동프로그램초안을작성후야구선수치료경력이 2 년이상인의사 1명, 물리치료사 4명으로구성된전문가회의와청소년기야구선수가주로방문하는물리치료센터에서실질적인적용을통해수정보완한후최종운동프로그램을구성하였다. 운동기간은 4주간주 3회씩일정한시간에실시하도록하였고각각의운동에대해정확한동작, 횟수가실시될수있도록담당치료사와의 1:1 지도 감독하에이루어졌다 (Table 1). 2) 그룹 2. 운동과관절가동술을혼합한중재군 (combined joint mobilization with exercise, Mobilization Grou) 그룹 2는그룹 1과같은운동프로그램을수행함과함께관절가동술을적용하였다. 관절가동술은등급 3 과 4의해당방법으로 4주에걸쳐주 3회씩 1회에 10분동안실시되었으며, 안쪽돌림관절가동범위제한이있는끝지점에서관절면을따라뒤쪽및가쪽면으로위팔뼈을병진운동시키는활주기법을적용하였다 (Cyriax, 1975; Edmond, 2006)(Fig. 1). 이기법의목적은내적충돌증후군의주된원인으로밝혀지고있는구축이발생된뒤쪽관절주머니의운동성을증가시켜어깨관절의통증완화, 관절가동범위증진그리고내적충돌증후군증상을완화시키는것이다 (Cyriax, 1975; Edmond, 2006; Heyworth and Williams, 2009). 1) 그룹 1. 운동군 (exercise only, Exercise Grou) 그룹 1을위한운동프로그램은어깨관절내적충돌증후군대상자의보존적중재방법의사전연구 (Burkhart 3) 그룹 3. 투구중단후휴식을취한대조군 (resting, Control Grou) 그룹 3의경우전문의로부터내적충돌증후군으로

4 14 J Korean Soc Phys Med Vol. 13, No. 2 Table 2. Demograhic characteristics of subjects in each grou (Unit: degree) Mean±SD Grou 1 (n=10) Grou 2 (n=10) Grou 3 (n=10) Age (years) 16.90± ± ± Height (cm) ± ± ± Weight (kg) 71.00± ± ± Career (years) 6.20± ± ± Pain term (week) 2.80± ± ± Dominant hand Rt.(8), Lt.(2) Rt.(7), Lt.(3) Rt.(8), Lt.(2).845 Position P(6), I(2), O(1),C(1) P(4), I(3), O(2),C(1) P(6), I(2), O(1),C(1).767 Rt.=right hand; Lt.=left hand P=itcher; I=infielder; O=outfielder; C=catcher 진단받아물리치료가필요하나개인여건상센터방문이불가능한그룹으로물리치료사는어떠한운동및치료에대한개입없이실험에필요한사전 사후검사만을실시하였으며투구중단후휴식을권고받고이를지킬것과 4주후다시방문할것에동의하였다. 3. 측정도구및방법 1) 관절가동범위 (1) 어깨관절바깥돌림, 안쪽돌림, 전체돌림어깨관절의관절가동범위를측정하기위해표준화된관절각도계 (Universal Goniometer, Baseline, USA) 를사용하였다. 어깨관절의바깥돌림과안쪽돌림의관절가동범위를일반화된방법으로측정하였으며 (Weir, 2005), 바깥돌림과안쪽돌림각도를더한전체돌림또한자료화하였다 (McClure 등, 2007). 2) 통증정도통증을측정하고자시각적상사척도 (visual analogue scale; VAS) 를사용하였다. 본연구에서는눈금이없는수평형태의시각적상사척도을이용하여사전 사후검사를통해어깨관절의투구동작을행할때통증정도의변화를측정하였다. 3) 기능수행정도 (1) 한국어판케를란조브어깨-팔꿈치점수케를란조브어깨- 팔꿈치점수는 2010년 Alberta 등에의해미국스포츠의학저널에최초소개되었으며일반적인대상자의어깨관절기능수행정도를측정하는다른도구와는달리오버헤드동작을자주취하는야구선수등의기능적상태를측정하기위한상태구체적측정도구로알려졌다 (Alberta 등, 2010). 케를란조브어깨-팔꿈치점수는운동선수의수행능력 (athletic erformance), 증상 (symtoms), 선수를둘러싼상호관계 (interersonal relationshis) 3가지의큰요소로나누어측정하게되며, 측정은시각적상사척도 (VAS) 을이용한방법과같다. Choo 등 (2014) 에연구에의하면원본과동일한측정방법과총점을가지는한국어판케를란조브어깨- 팔꿈치점수 (Korean Kerlan-Jobe orthoaedic clinic shoulder & elbow score; K-KJOC score) 는급간내상관계수가.95로우수한신뢰도를가진다. 대상자의이해를돕기위해본연구에서는한국어판케를란조브어깨- 팔꿈치점수를사용하였으며사전 사후검사를통해 4주후의어깨관절기능수행정도의변화를측정하였다. 4. 분석방법그룹 1, 그룹2, 그룹3과시간 ( 중재전, 중재후 ) 에대한관절가동범위, 통증정도, 기능수행정도의변수들

5 운동과관절가동술을혼합한중재가어깨관절내적충돌증후군을가진청소년기야구선수의관절가동범위, 통증정도, 기능수행정도에미치는효과 15 Table 3. Results of changes in the external rotation range of motion (Unit : degree) Grou 1 (n=10) ±3.69 ( ) ±2.84 ( ) Grou.821 Grou 2 (n=10) ±5.27 ( ) ±3.69 ( ) Time.550 Grou 3 (n=10) ±3.94 ( ) ±4.12 ( ) Grou* Time.913 Table 4. Results of changes in the internal rotation range of motion (Unit : degree) Grou 1 A (n=10) 34.50±4.38 ( ) 48.00±4.22 ( ) Grou.000* Grou 2 B (n=10) 34.00±4.60 ( ) 54.50±2.84 ( ) Time.000* Grou 3 C (n=10) 34.50±3.69 ( ) 35.00±4.08 ( ) Grou* Time.000*.000** B>A>C *<.05; **<.01 을확인하기위해서혼합모형반복측정분산분석 (Mixed-model reeated measures ANOVA) 을실시하였으며, 유의수준은 α=.05로하였다. 상호작용이있을경우, 사후검정으로그룹간의차이를알아보기위하여중재적용전과후의변화량 (%) 을구하여일원배치분산분석 (One-way ANOVA) 을실시하였다. 또한사후검정에서 Ⅰ종오류를줄이기위해본페로니교정 (Bonferroni correction) 을시행하였으며유의수준 α=.01로하였다. 통계처리는 SPSS for windows (ver. 22.0) 을사용하였다. Ⅲ. 연구결과 서그룹간유의한차이는없었다 (Table 2). 2. 어깨관절관절가동범위의차이그룹 1, 그룹 2, 그룹 3 간의우세측어깨관절의바깥돌림관절가동범위차이에대한분석결과집단간, 측정시점간주효과와집단과측정시점간의상호작용효과모두유의한차이가없었으나 (>.05)(Table 3), 안쪽돌림과전체돌림에서는모두유의한차이가있었고 (<.05) 이에대한그룹간사후검정에서그룹 2가그룹 1과그룹 3보다안쪽돌림과전체돌림관절가동범위의유의하게증가되었다 (<.01)(Table 4, 5). 1. 연구대상자의특성연구대상자의특성은다음과같았으며, 실험전대상자특성의사전동질성을분석한결과모든측정치에 3. 통증정도의차이그룹 1,2와그룹 3 간의우세측어깨관절의통증정도차이에대한분산분석결과집단간, 측정시점간의

6 16 J Korean Soc Phys Med Vol. 13, No. 2 Table 5. Results of changes in the total rotation range of motion (Unit : degree) Grou 1 A (n=10) Grou 2 B (n=10) Grou 3 C (n=10) ±4.08 ( ) ±8.43 ( ) ±5.50 ( ) ±4.74 ( ) ±5.27 ( ) ±6.69 ( ) Grou.000* Time.000* Grou* Time.000*.000** B>A>C *<.05; **<.01 Table 6. Results of changes in the ain intensity (Unit: score) Grou 1 A (n=10) Grou 2 B (n=10) Grou 3 C (n=10) 7.47±.59 ( ) 8.01±.60 ( ) 7.15±1.33 ( ) 4.69±.84 ( ) 2.75±.75 ( ) 5.24±.89 ( ) Grou.000* Time.000* Grou* Time.000* P.000** B>A=C *<.05; **<.01 주효과, 집단과측정시점간의상호작용효과모두유의한차이가있었다 (<.05). 그룹간사후검정에서그룹 2가그룹 1과그룹 3보다통증이유의하게감소되었으나 (<.01) 그룹 1과 3에서는유의한차이가없었다 (>.01)(Table 6). 4. 기능수행정도차이 ( 한국어판케를란조브어깨-팔꿈치점수 ) 그룹 1, 그룹 2, 그룹 3 간의우세측어깨관절의기능수행정도차이에대한분산분석결과집단간, 측정시점간의주효과, 집단과측정시점간의상호작용효과모두유의한차이가있었다 (<.05). 그룹간사후검정에서그룹 2가그룹 1과그룹 3보다한국판케를란 조브어깨-팔꿈치점수가유의하게증가되었다 (<.01) (Table 7). Ⅳ. 고찰본연구는내적충돌증후군을가진청소년기야구선수대상자에게 4주간에걸쳐실험군 ( 그룹 1, 2) 에는운동또는운동과관절가동술을혼합한중재를시행하고, 대조군 ( 그룹 3) 에는의사와의상담을통한투구중지후휴식을시행하여우세측어깨관절의관절가동범위, 통증정도, 기능수행정도에미치는효과를알아보고자하였다. Shanley와 Thigen 등 (2013) 의연구에서청소년기야

7 운동과관절가동술을혼합한중재가어깨관절내적충돌증후군을가진청소년기야구선수의관절가동범위, 통증정도, 기능수행정도에미치는효과 17 Table 7. Results of changes in the functional erformance(k-kjoc score) (Unit: score) Grou 1 A (n=10) Grou 2 B (n=10) Grou 3 C (n=10) 39.17±6.44 ( ) 38.93±6.86 ( ) 38.77±7.42 ( ) 67.25±4.86 ( ) 83.00±4.75 ( ) 47.50±5.52 ( ) Grou.000* Time.000* Grou* Time.000* P.000** B>A>C *<.05; **<.01 구선수에게있어적절한어깨관절관절가동범위의확보는초기코킹동작에서부터팔로우스로우까지연결되는투구동작메커니즘에있어부드럽고자연스러운연결동작을만들수있지만, 가동범위의제한은경기력과같은기능적저하뿐만아니라심각한부상을야기할수있는확률을증가시켰다. 야구선수의다양한어깨관절부상과관련된바깥돌림, 안쪽돌림관절가동범위비교연구에서어깨부상야구선수들의바깥돌림범위는증가된반면안쪽돌림범위는감소되었다 (Grossman 등, 2005). 이와같이내적충돌증후군을가진야구선수에게는구축된뒤쪽및아래쪽관절주머니신장을통한안쪽돌림관절가동범위회복이특히중요하며 (Manske 등, 2013), Manske 등 (2010) 의연구에서도뒤쪽및아래쪽관절주머니의구축에따른안쪽돌림관절가동범위제한을가진대상자에대한스트레칭군과스트레칭에관절가동술을혼합한군의효과를비교한결과두가지중재방법모두에서전과후의바깥돌림관절가동범위의변화는없었으나, 안쪽돌림관절가동범위와바깥돌림과안쪽돌림범위를더한전체회전관절가동범위는증가가되었고, 평균값변화에서스트레칭에관절가동술을더한군이스트레칭만을실시한군에비해더욱효과적이라하였다. 본연구의결과에서도실험군과대조군모두에서내적충돌증후군의원인으로작용하는뒤쪽관절주머니의구축에부정적영향을크게받지않는바깥돌림관절가동범위의중재전 후의유의한차이가없었으나, 안쪽돌림그리고전체돌림관절가동 범위에서는운동과관절가동술을혼합한중재를시행한군이운동만을실시한운동군과휴식을취한대조군에비해유의한증가를보여선행연구들과유사한결과가나타났다. 이는운동과관절가동술을혼합한중재가어깨관절바깥돌림근길이연장과안쪽돌림근근력강화뿐만아니라견관절주변연부조직특히구축된관절낭주머니의신장성을증가시켜오목위팔관절의잠재적결함 (ositional fault) 을교정함으로써정상적인관절운동학을회복시킨것으로보인다. 내적충돌증후군을가진야구선수에게어깨운동프로그램만을 8주이상실시한결과통증지수가유의하게감소하였다는연구도있지만 (Han 등, 2014), Kachingwe 등 (2008) 에따르면어깨관절충돌증후군을가진대상자에게중재전 후의통증을비교한결과운동과함께관절가동술등을중재한군이운동만을한군과휴식만을취한군에비해유의한통증정도감소를보였다. 또한관절가동술은다양한관절들의통증감소에효과적이다 (Sim 등, 2017; Lee 등, 2015; Hwang 등, 2012). 본연구의결과역시운동과관절가동술을혼합한중재를시행한군에서운동군과대조군에비해유의한통증감소를보였고, 이는관절가동술과같은도수치료의통증억제효과로, 관문조절기전 (gate-control mechanism) 을통해유해자극을억제하는기계적수용기 (mechanorecetor) 의활성화와관절의유동성을증가시켜주는윤활액 (synovial fluid) 영양의증가에의한것으로생각된다 (Wall, 1979; Threlkeld, 1992).

8 18 J Korean Soc Phys Med Vol. 13, No. 2 어깨관절의기능을객관적으로표시하려는시도는 1980년대부터시작되었는데, Han 등 (2014) 의연구에서내적충돌증후군을가진야구선수에게어깨운동프로그램만을 8주이상실시한결과기능점수가유의하게증가하였지만, 야구선수의경기력과관련된기능수행을구체적으로평가가능한측정도구를사용하지않은점을고려하여본연구에서는오버헤드동작이자주요구되는선수들의구체적어깨관절기능수행정도측정을위한한국어판케를란조브어깨-팔꿈치점수 (K-KJOC score) 를사용하였다. 연구결과에따르면운동과관절가동술을혼합한중재를시행한군이운동군과대조군보다유의한기능수행능력증가를보이며, 운동군또한대조군에비해좋은효과가있는것으로나타났는데, 이는어깨관절의관절유연성증가, 정상적인오목위팔관절의관절운동학회복및통증완화에유의한차이를보였던관절가동술이라는물리치료적중재의효과에대한결과라생각되어진다. 다만, 본연구의대상자수가비교적적으며, 케를란조브어깨-팔꿈치점수를사용하여중재방법간기능수행정도를비교한선행연구가현재까지미비하기에본연구의결과를당장일반화시키는것이어렵다고생각되며앞으로더욱많은비교연구를통해관절가동술을포함한물리치료적중재의효과를규명하기위한노력이필요할것으로사료된다. Ⅴ. 결론본연구의결과는앞으로내적충돌증후군과같은어깨관절손상을가지고있는청소년기야구선수를대상으로도수치료를접목하는연구에대해이론적근거를제시하여스포츠물리치료저변확대에기여할것이며, 임상적으로운동에도수치료기법을더한중재방법이일반적으로현장에서많이적용되어왔던운동만의중재방법과투구중지후복귀전까지휴식만을취한방법에비해손상으로부터의빠른회복과기능수행능력증가에따른경기력향상에좀더효과적인중재방법이라제언할수있다. References Alberta FG, ElAttrache NS, Bissell S, et al. The develoment and validation of a functional assessment tool for the uer extremity in the overhead athlete. Am J Sorts Med. 2010;38(5): Burkhart SS, Morgan CD, Ben Kibler WB. The disabled throwing shoulder: sectrum of athology Part III: The SICK scaula, scaular dyskinesis, the kinetic chain, and rehabilitation. Arthroscoy. 2003;19(6): Chen FS, Diaz VA, Loebenberg M, et al. Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Ortho Surg. 2005;13(3): Choi CH, Eum DH. Radiograhic changes of the medial eicondyle in little league baseball layer. J Korean Ortho Sort Med. 2002;1(1):43-8. Choo YK, Song JM, Lee EJ, et al. Cross-cultural adation for shoulder ain and functional measures into Korean. Korea-Jaan Physical Theray Joint Conference. 2014;83:123. Cyriax J. Textbook of orthoedic medicine: Diagnosis of soft tissue lesions. 6th ed Williams&Wilkins Drakos MC, Rudzki JR, Allen AA, et al. Internal imingement of the shoulder in the overhead athlete. J Bone Joint Surg Am. 2009;91(11): Edmond SL. Joint mobilization / maniulation: Extremity and sinal techniques. 2nd ed Elsevier Mosby Gómez JE. Uer extremity injuries in youth sorts. Pediatr Clin North Am. 2002;49(3): Grossman MG, Tibone JE, McGarry MH, et al. A cadaveric model of the throwing shoulder: a ossible etiology of suerior labrum anterior-to-osterior lesions. J Bone Joint Surg Am. 2005;87(4): Han KJ, Lee DB, Kim SH. Effects of rehabilitative exercise rogram on VAS and Constant Score in baseball layer with internal imingement. J Korean Soc Sorts Sci. 2014;23(4):

9 운동과관절가동술을혼합한중재가어깨관절내적충돌증후군을가진청소년기야구선수의관절가동범위, 통증정도, 기능수행정도에미치는효과 19 Heyworth BE, Williams RJ. Internal imingement of the shoulder. Am J Sorts Medicine. 2009;37: Hwang BK, Kim GC, Park YK. Effects of self-stretching exercise and uer thoracic joint mobilization on range of motion and ain of the atients with chronic neck ain. J Korean Soc Phys Med. 2012;7(4): Jobe CM. Posterior suerior glenoid imingement: exanded sectrum. Arthroscoy: The Journal of Arthroscoic & Related Surgery. 1995;11(5): Jobe FW. Imingement roblems in the athlete. Instr Course Lect. 1989;38: Kachingwe AF, Phillis B, Sletten E, et al. Comarison of manual theray techniques with theraeutic exercise in the treatment of shoulder imingement: a randomized controlled ilot clinical trial. J Maniulative Physiol Ther. 2008;16(4): Kibler WB, Sciascia A, Dome D. Evaluation of aarent and absolute surasinatus strength in atients with shoulder injury using the scaular retraction test. Am J Sorts Med. 2006;34(10): Korea Baseball Softball Association : htt://korea-baseball. com.accessed November 23, Lee NY, Kwon CS, Song HS. The effect of manual joint mobilization on ain, ROM, body function and balance in atients with knee osteoarthritis. J Korean Soc Phys Med. 2015;10(4):91-9. Manske RC, Grant-Nierman M, Lucas B. Shoulder osterior internal imingement in the overhead athlete. Int J Sorts Phys Ther. 2013;8(2): Manske RC, Meschke M, Porter A, et al. A randomized controlled single-blinded comarison of stretching versus stretching and joint mobilization for osterior shoulder tightness measured by internal rotation motion loss. Sorts Health. 2010;2(2): McClure P, Balaicuis J, Heiland D, et al. A randomized controlled comarison of stretching rocedures for osterior shoulder tightness. J Ortho Sorts Phys Ther. 2007;37(3): Shanley E, Thigen C. Throwing injuries in the adolescent athlete. Int J Sorts Phys Ther. 2013;8(5): Sim JH, Jeong UC, Choi HY, et al. The Immediately Effects of thoracic Mobilization by segment on ain and range of motion in chronic low back ain atients. J Korean Soc Phys Med. 2017;12(2): Threlkeld AJ. The effects of manual theray on connective tissue. Physical Theray. 1992;72(12): Walch G, Boileau P, Noel E, et al. Imingement of the dee surface of the surasinatus tendon on the osterosuerior glenoid rim: an arthroscoic study. J Shoulder Elbow Surg. 1992;1(5): Wall PD. The gate control theory of ain mechanisms a re-examination and re-statement. Brain. 1979;101(1): Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical