JKPT pissn Vol. 27, No. 5, October 2015 J Kor Phys Ther 2015:27(5): eissn X Original Article

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1 pissn Vol. 27, No. 5, October eissn X Original Article Changes of Shoulder Muscles Activity during Maintaining and Lifting Shoulder Depending on Stretch Rate of Kinesio Tape Ju-Seung Kim 1, Min-Chull Park 2 1 Department of Physical Therapy, Graduate School, Catholic University of Pusan; 2 Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea Purpose: The objective of this study was to examine the changes in muscle activity on the anterior deltoid muscle depending on the stretch rate of kinesio tape when applying kinesio tape in healthy adult subjects. Methods: This study was a single-blind randomized controlled trial, including 22 healthy participants (male 15, female 7) with no pathology or past history of shoulder who participated voluntarily. Participants applied a different stretch rate of the kinesio tape, and the functional activity was tested. The stretch rate of kinesio tape was 0%, 10%, and 20%. Subjects lifted a weight (5% of their body weight) to their shoulder height. Subjects lifted a weight up to an angle of 90 degrees in the sagittal plane, and muscle activities (biceps brachii, anterior deltoid, middle deltoid, upper trapezius) were assessed using EMG (electromyography). Analysis of muscle activity was divided into two parts (lift weight and keep holding). The EMG activity of each muscle was normalized to the value of reference voluntary contraction (%RVC) and explored using repeated ANOVA. Results: There were no significant differences in muscle activity depending on the ratio of tape stretch when lifting a weight (p> 0.05). There were no significant differences in muscle activity depending on the ratio of tape stretch when holding a weight (p> 0.05). Conclusion: According to the results of this study, in the case of applying kinesio taping therapy for healthy people, it was found that the stretch rate of the tape does not have an effect on muscle activity. Keywords: Deltoid muscle, Electromyography, Muscle activity 서론일상생활수행을위해팔의역할은매우중요하며, 특히뻗기는손을이용한조작과결합되어팔기능에중요한역할을한다. 1 뻗기는어깨와팔꿈치의근육들이방향, 거리, 움직임에걸리는시간에따라적절한패턴을만들어활성화되고움직이는것이다. 2 이는일상생활에서필요한기본적인동작이며, 많은팔분절들의협응력이필요한움직임이다. 3 뻗기는과제및자세에따라서다르게나타날수있고, 4 과제의위치에따라분절들의움직임과근육의활성화정도가달라지는데, 대체적으로어깨세모근의앞섬유와가운데섬유그리고큰가슴근과위팔두갈래근, 부리위팔근등이중요한근육으로작용한다. 5,6 그중에서도어깨세모근앞섬유는전방뻗기시팔이시상면을따라움직일수있게작용하는근육으로, 전방으로뻗기에중요한역할을한다. 7,8 테이핑은주로비탄력테이프와탄력테이프를이용하는방법이 있는데, 비탄력테이프는대부분고정및보호를위해사용되고, 탄력테이프는혈액및림프액순환의촉진, 통증감소, 관절가동범위증진, 근력증진등을목적으로사용된다 키네시오테이핑은테이프의원래길이의약 % 까지늘어날수있는탄력테이프를사용하여근육에부착하는방법으로, Kase에의해고안되었다. 12 Park과 Bae 13 는목빗근의근막통증에키네시오테이핑적용이통증을감소시키고호흡기능에변화를일으킨다고하였으며, Lee 등 14 은근막통증후군에테이핑이효과가있다고하였다. 그러나 Akbas 등 15 은테이핑적용군과비적용군에서통증변화에차이가없다고하였다. Kuo와 Huang 16 은근활성도와근력증가에긍정적인효과가있다고하였고, Lee 등 17 은모지수근중수관절의관절가동범위와악력증진효과가있다고하였다. 그러나이와는반대로 Gómez-Soriano 등 18 은키네시오테이핑의적용이건강한사람의근력과유연성, 그리고근긴장도에영향을주지않는다고하였다. Received Sep 15, 2015 Revised Oct 6, 2015 Accepted Oct 11, 2015 Corresponding author Min-Chull Park mcpark@cup.ac.kr 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 The Journal of Korean Physical Therapy Ju-Seung Kim, et al. Huang 등 11 은장딴지근에탄력테이프를적용하였을때안쪽장딴지근의근전도신호가증가되었다고하였고 Kwon 등 19 은테이핑적용이근력과지구력의증진에효과가있다고하였다. 그러나 Poon 등 20 의연구에의하면탄력테이프를넙다리네갈래근에적용하였을때일량과최대회전력의변화가없었다고하였고, Vercelli 등 21 의연구에서도테이핑적용이넙다리네갈래근의근력과기능에유의한변화를이끌어내지못하였다고하였다. 이처럼키네시오테이핑은많은연구자들에의해통증, 관절가동범위, 기능, 근활성도등에미치는효과를확인하기위해활발하게연구되어왔으나연구자마다다양한결과들을제시하고있다. Hsu 등 22 은 17명의어깨충돌증후군이있는야구선수에게키네시오테이프를최소한신장한상태로적용하였을때근육의수축을지지하여근활성도와근력의증가를볼수있었다고하였다. 그리고 Mohammadi 등 23 은 40명의건강한성인에게키네시오테이프를 50% 늘려적용하여악력의증가를볼수있었다고하였다. 이처럼선행연구들에서테이프의적용길이를제시하고있지만신장정도를다르게하였을때의영향을본연구는거의없었다. 테이프를늘려서근육주행방향을따라적용하면피부를들어올리고압력을감소시켜혈액및림프액의순환을증가시키고, 통증완화및 2차적인손상예방과기능증진을이끌어낼수있는데, 12 테이프를신장할수록탄력테이프의줄어드는성질에의해지속적인기계적자극이가해질것이고피부에가해지는자극은일차감각, 운동피질을포함한뇌의다양한부위에활성도를증가시킬것이다. 24,25 이에본연구에서는어깨에손상이없는건강한성인남녀를대상으로전방으로팔을뻗는동작을수행할때어깨세모근앞섬유에신장정도를달리한테이프를적용하여근활성도의변화를확인해보고자하였다. 이를통해적절한테이핑의적용방법을위한기초자료를제공하고자수행되었다. 연구방법 1. 연구대상본연구대상자는뉘른베르크강령에따라실험의목적과방법에대해충분한설명을듣고이해한다음자발적으로참여에동의한 22명 ( 남자 15명, 여자 7명 ) 의건강한사람을대상으로하였다. 대상자의선정조건은최근 6개월이내에어깨의통증을경험하지않은자, 어깨의수동, 능동적관절가동범위에이상이없는자, 어깨의질환및수술받은적이없는자로하였다. 대상자의일반적특성은다음과같다 (Table 1). 2. 실험방법 1) 실험절차측정은실험에영향을미칠수있는환경적인영향을최소화하기위 Table 1. General characteristics of subjects n Age Height (cm) Weight (kg) 22 (M 15, F 7) 27.40± ± ±13.22 해소음이없는실험실에서실험에필요한것이외에다른전자기기의전원을끄고, 실내온도는 24 C로통일하여진행하였다. 대상자는의복을최소화하고, 등받이가없고높이조절이가능한의자에엉덩관절굽힘 90 와무릎관절굽힘 100 각도로유지하고앉아시작자세를취하였다. 앞팔은중립자세로어깨굽힘 0 에서시작하였고연구자의신호에따라어깨굽힘을시작하였다. 모든대상자들은실험방법의동질화를위해우세측팔을이용하여어깨관절의굽힘동안팔과어깨근육의근활성도를기록하였다. 대상자들은체중의 5% 가되는무게추를손목에달고어깨관절을굽힘시등세모근위섬유와어깨세모근가운데섬유의보상작용을최소화하기위해서 26 가능한시상면을따라움직임이일어날수있도록전방에기준봉을세우고어깨관절 90 가되는높이를봉에표시하여일정한높이까지팔을들어올리게하였다. 테이핑의적용을위해앞팔의중립과어깨굽힘 0 로하고어깨세모근거친면에서빗장뼈외측 1/3 지점까지길이를측정하여 5인치넓이의키네시오테이프 (M-TEX, mkorea, korea) 를길이에맞게준비하였다. 테이프의신장정도를달리하여적용하기위해원래준비한길이에서 10%, 20% 를자른길이의테이프를똑같은방법으로어깨세모근에늘려서부착하여근활성도측정을하였다. 한쪽끝에 20% 를남기고나머지부위를두갈래가되도록균등하게나누었다. 자르지않은부분을어깨세모근거친면부터붙이고측정하고자하는쪽엄지손가락을반대쪽무릎에두어어깨를굽힘, 모음, 안쪽돌림한상태에서잘린테이프의뒤쪽을어깨세모근뒤섬유를따라어깨뼈가시까지붙이고어깨를최대한신전, 가쪽돌림한상태에서잘린테이프의앞쪽을어깨세모근앞섬유를따라빗장뼈외측 1/3 지점까지늘려서붙였다. 테이프길이에따른적용순서는추첨을통해무작위로하고적용방식마다근활성도를측정하였으며각 5 분의간격을주어대상자에게충분한휴식을제공하였다. 팔을들어올릴때어깨에막대를대어어깨뼈의올림을통제하였다. 2) 측정도구및방법팔과어깨근육의수축시활성도를알아보기위해 4채널근전도를사용하였다. 전극을부착하기전에피부의저항을줄이기위해털을제거하고알코올로소독하였다. 은 / 연화은표면전극을사용하여수축이일어나는쪽의등세모근위섬유 (upper trapezius), 어깨세모근의앞섬유 (anterior deltoid) 와가운데섬유 (middle deltoid), 위팔두갈래근 (biceps brachii) 에부착하였다. 전극간의거리는 2 cm로유지하여근섬유방향에평행하게부착하였다. 근활성도의측정은표면무선근 300

3 Kinesio Tape and Muscle Activity 전도시스템 (Telemyo 2400T-G2 dynamic EMG, Noraxon Inc., USA) 을사용하였다. 근전도신호의표본추출률은 1,024 Hz로설정하였고주파수대역필터로 Hz를설정하여주파수대역을지정하였다. 근활성도는무게추를손목에달고연구자의신호에따라편안한속도로굽힘 90 로봉에표시한지점까지팔을올리고 7초간유지하기를 3회반복할때측정하였다. 뻗기 (2초) 와유지하기 (5초) 의두구간으로나누어제곱평균제곱근법 (root mean square) 으로처리하여분석하였다. 근활성도의정규화를위한기준수축역시같은방법으로테이핑을하지않은상태에서무게추를들고연구자의신호에따라팔을들어올릴때로정하였다. 기준수축은뻗어서 5초유지할때의근활성도로정하고비교하였다. 네개의근육에대한근활성도를정규화하기위해기준수축을하는동안수집된값으로정량화한 %RVC (reference voluntary contraction) 로기록하였다. 3) 자료분석본연구에서수집된자료들은 SPSS ver 프로그램을사용하여분석하였다. 대상자의일반적특성은평균값과표준편차로표시하였다. 테이핑의적용방식에따른근활성도의차이는반복측정분산분석 (repeated one-way ANOVA) 을이용하여비교하였으며통계적유의수준 α = 0.05로정하였다. 결과 1. 팔뻗기동안테이프신장비율에따른근활성도변화팔뻗기동안어깨세모근앞섬유와가운데섬유, 위팔두갈래근, 등세모근위섬유의근활성도는테이프신장비율에따라유의한차이가없었다 (p> 0.05) (Table 2). 2. 팔뻗기를유지하는동안테이프신장비율에따른근활성도변화팔뻗기를유지하는동안어깨세모근앞섬유와가운데섬유, 위팔두갈래근, 등세모근위섬유의근활성도는테이프신장비율에따라유의한차이가없었다 (p> 0.05) (Table 3). 고찰근전도를사용한연구에서는주로최대등척성수축을사용한 %MVIC (maximum voluntary contraction) 와기준이되는동작을사용한 %RVC 방법을통해근육의활성화정도를비교해왔다. 근전도신호의증가는근육의활성화정도를의미하는것으로신호의증가가항상근력이증가하였다거나근력이상대적으로크다는것을뜻하지는않는다. Arab 등 27 의연구에서처럼누운자세에서다리뒤로들기시요통이있는사람의척추세움근의근전도신호가정상인에비해크다는것은같은동작을할때요통이있는사람이그근육을더많이사용함을뜻한다. 테이핑으로인한몸감각자극은겉질운동표상영역의활성도를증가시켜운동수행력을향상시키고, 28 테이핑의지지력과탄성이관절의안정성과근골격계의좋은정렬상태를만들어신경근기능증진을이끌어낸다. 11 그러나근력, 20,29 관절가동범위, 30 통증, 15 부종의감소 31 에서테이핑이항상긍정적인효과만을볼수는없다는연구도최근에많이발표되고있다. Kase 12 에따르면관절완전가동범위를가능하게하기위해서키네시오테이프는 % 까지신장할수있다고하였다. 과사용, 급성손상시에는신장없이, 만성및급성약화가있을때는 15% 정도늘려서, 관절이나인대의손상에서는최대한테이프를늘려적용하라고제시하였다. 또한근력의증가를위해서는 35% 또는 50-75% 로테이프 Table 2. Comparison of shoulder muscle activity during lifting shoulder depending on kinesiotape stretching rate (mean±sd) (Unit: %RVC) Stretch rate 0% 10% 20% F p Biceps 98.66± ± ± Anterior deltoid ± ± ± Middle deltoid 99.36± ± ± Upper trapezius 96.19± ± ± RVC: Reference voluntary contraction. Table 3. Comparison of shoulder muscle activity during maintaining shoulder depending on kinesiotape stretching rate (mean±sd) (Unit: %RVC) Stretch rate 0% 10% 20% F p Biceps ± ± ± Anterior deltoid ± ± ± Middle deltoid 97.15± ± ± Upper trapezius 96.19± ± ± RVC: Reference voluntary contraction

4 The Journal of Korean Physical Therapy Ju-Seung Kim, et al. 를늘려야한다는등적용길이에대한여러주장들이있다. 20 Cai 등 32 에따르면건강한성인의손목신전근에테이핑을적용하고악력과근전도신호를분석한결과근력과근활성도의차이를볼수없었다. 그리고 Oliveria 등 33 의연구에서대퇴사두근에테이핑을하였을때최대근력과근활성도의변화가없었다. 본연구에서는신장정도를다르게한테이핑을어깨세모근앞섬유에적용하고팔들기시어깨세모근앞섬유와가운데섬유, 위팔두갈래근, 등세모근위섬유의근전도신호를 %RVC 방법을통해분석하였는데유의한차이를볼수없었다. 테이핑으로가해진긴장과자극으로움직임패턴의변화가생길수있는데, 이것이만들어지기위해서는충분한시간과반복이필요하다. 34 또한테이핑적용후일정시간후에근육의긴장도는점차증가하는데, 24시간이내에는긴장도에영향을주지못하며 24시간이후 72시간까지적용한다면근전도신호의증가를보일것이다. 35 본연구는정상성인을대상으로하였는데통증이있거나신체정렬에문제가있는사람에게테이핑의적용은잘못된위치를바로잡아역학적이득을얻고관문조절기전에의한통증감각의차단으로더욱큰근육의활동을만들수있지만, 정상인에게는그효과가미비하여근활성도에유의한차이가없었던것으로여겨진다. 36 신경전도검사는말초신경의전기자극에의해유발된전위를기록하여운동신경과감각신경의기능을평가하는것이다. 운동신경전도검사에서잠복시의감소, 진폭과속도의증가는운동신경원의흥분성증가를뜻한다. 운동신경원의흥분으로근육의신경근접합부로전달된신호를통해근육은활성화되고이때발생하는활동전위를근전도를통해기록할수있다. 37,38 그러나실험에서테이핑의적용이운동신경원의흥분성과근육세포의활동전위에변화를줄만큼강하지못해근전도신호의차이를볼수없었다고사료된다. 39 또한겉질척수로의흥분성을변화시키는데영향을미칠수있는테이핑으로인한자극의크기가충분하지못하였을것이다. 40 본연구에는다음의제한점이있다. 대상자의수가적어이를일반화하기에는어려움이있으며, 테이프의신장적용시과도한테이프의장력으로인한관절운동의보조적인역할을최소화하기위해 0%, 10%, 20% 로하였는데관절가동범위가허용하는범위까지몇단계를더추가하여적용해보았다면, 적용방식에따른차이를더욱세밀하게분석할수있었을것이다. 비록정상인을대상으로한본연구에서테이핑의적용으로근활성도에유의한차이를볼수는없었지만작은차이에의해서도많은영향을받는운동선수나환자에게키네시오테이프를적용하는추후연구도필요할것이다. 결론적으로정상인을대상으로키네시오테이프를어깨세모근의앞섬유에적용하고팔뻗기를수행하였을때 10%, 20% 로신장시킨테 이핑의적용은근활성도에영향을미치지않음을확인할수있었다. REFERENCES 1. Jeong JY, Lee HC, Shin HK. The effects of seat surface inclination on forward reaching in children with spastic cerebral palsy. J Kor Phys Ther. 2015;27(2): Buneo CA, Soechting JF, Flanders M. Muscle activation patterns for reaching: The representation of distance and time. J Neurophysiol. 1994;71(4): Flash T, Hogan N. The coordination of arm movements: An experimentally confirmed mathematical model. J Neurosci. 1985;5(7): Weon JH, Oh JS, Cynn HS et al. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. J Bodyw Mov Ther. 2010;14(4): Vandenberghe A, Levin O, De Schutter J et al. Three-dimensional reaching tasks: Effect of reaching height and width on upper limb kinematics and muscle activity. Gait Posture. 2010;32(4): Bonnefoy A, Louis N, Gorce P. Muscle activation during a reach-tograsp movement in sitting position: Influence of the distance. J Electromyogr Kinesiol. 2009;19(2): Park MC, Lee MH, Song MY et al. The comparison of muscle activation on low-reaching and high-reaching in patient with stroke. J Phys Ther Sci. 2010;22(3): Wagner JM, Dromerick AW, Sahrmann SA et al. Upper extremity muscle activation during recovery of reaching in subjects with post-stroke hemiparesis. Clin Neurophysiol. 2007;118(1): Choi JH, Lee JK. The effect of a kinesio taping on muscle power and muscular fatigue in quadriceps femoris. The Korean Academy of Physical Therapy Science. 2008;15(4): Campolo M, Babu J, Dmochowska K et al. A comparison of two taping techniques (kinesio and mcconnell) and their effect on anterior knee pain during functional activities. Int J Sports Phys Ther. 2013;8(2): Huang CY, Hsieh TH, Lu SC et al. Effect of the kinesio tape to muscle activity and vertical jump performance in healthy inactive people. Biomed Eng Online. 2011;10(1): Kase K, Wallis J, Kase T. Clinical therapeutic applications of the kinesio taping methods. 2nd ed. Kinesio Taping Assoc Park YN, Bae YS. Change of pain and breathing function following kinesio taping of myofascial pain in sternocleidomastoid muscle. J Kor Phys Ther. 2014;26(5): Lee JH, Hwang KO, Park YH. Comparing the effects of stability exercise, ESWT, and taping for patients with myofascial pain syndrome of upper trapezius. J Kor Phys Ther. 2012;24(2): Akbas E, Atay AO, Yuksel I. The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 2011;45(5): Kuo YL, Huang YC. Effects of the application direction of kinesio taping on isometric muscle strength of the wrist and fingers of healthy adults-a pilot study. J Phys Ther Sci. 2013;25(3): Lee MH, Kim EC, Lee SY et al. The effects of taping on metacarpophalangeal disorders of the thumb. J Kor Phys Ther. 2010;22(1): Gómez-Soriano J, Abián-Vicén J, Aparicio-García C et al. The effects of 302

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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