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1 운동과학, 2014년, 제23권제4호 Exercise Science, 2014, Vol. 23, No. 4 원문 푸시업운동시위팔뼈벌림각도에따른어깨주변근육의활성도 홍용 김용권 * 전주대학교 Abstract Hong, Yong, Kim, Yong-Kweon. Peri-Scapular Muscle Activity during Push-Up Exercise with Different Angles of Humerus Abduction. Exercise Science, 23(4): The purpose of this study is to investigate peri-scapular muscle activity during push-up exercise with different angles (15 and 45 ) of the humerus abduction. Eight male college students were recruited without any history of shoulder injury or pathology. The subjects were instructed to perform three trials of a push-up exercise with the shoulders abducted to either 15 or 45 in a random order. EMG activity of 8 peri-scapular muscles was recorded during two phases of exercise: push-down and push-up. The 8 muscles were upper trapezius, lower trapezius, middle trapezius, serratus anterior, anterior deltoid, posterior deltoid, pectoralis major and infraspinatus. Separate independent t tests found that the exercise with the shoulders abducted to 15 significantly activate lower and middle trapezius muscles more than the other exercise with shoulders abducted to 45 in the push-up phase. However, these similar findings were not found in the phase of the push-down. These results suggest that the push-up exercise with shoulders abducted to 15 in the push-up phase would be more effective when considering strength of the lower and middle trapezius muscles. Key words:push-up, push-down, humerus abduction, periscapular muscle, EMG 초록홍용, 김용권. 푸시업운동시위팔뼈벌림각도에따른어깨주변근육의활성도. 운동과학, 제23권제4호, , 이연구는푸시업운동시위팔뼈의벌림각도에따라어깨주변근육의활성도에어떠한차이가있는지를알아보는데목적이있다. 어깨관절의통증이없는남자대학생 8명을대상으로하여위팔뼈를 15 와 45 벌린자세에서푸시다운과푸시업동작을각각하도록하였다. 어깨주변근육의활성도를알아보기위하여표면근전도를이용하여위등세모근, 아래등세모근, 중간등세모근, 앞톱니근, 앞세모근, 뒤세모근, 큰가슴근, 가시아래근의활성도를분석하였다. 자료분석은 PASW 18.0을이용하였으며, 집단간차이를알아보기위하여독립 t 검정을실시하였다. 푸시업동작에서는위팔뼈벌림각도 15 집단이 45 집단보다아래위세모근과중간위세모근이유의하게활성화되는것으로나타난반면푸시다운동작에서는유의한차이가없었다. 연구결과를토대로볼때푸시업동작시위팔뼈를몸에붙여서하는것 (15 위팔뼈벌림 ) 이 45 로자연스럽게벌려서하는것보다아래등세모근과중간등세모근의더큰활성도를보이기때문에이근육들만을활성화시키고자할때에는위팔뼈를몸에붙인자세에서푸시업운동을하는것이더효과적인것으로사료된다. 주요어 : 푸시업, 푸시다운, 위팔뼈벌림, 어깨주변근육, 근전도
2 324 푸시업운동시위팔뼈벌림각도에따른어깨주변근육의활성도 Ⅰ. 서론 푸시업운동은일상생활속에서상지근력을강화시킬수있는대표적인닫힌사슬운동이다 (Lehman et al., 2008). 또한푸시업운동은상지의근력평가를위해주로사용되고있으며 (Ebben et al., 2011), 어깨손상환자를위한재활운동프로그램에도사용이된다 (Lippit et al., 1993; Dillman et al., 1994; Rogol et al., 1998; Uhl et al., 2003). 푸시업운동은푸시다운과정 (Descending phase) 에서는편심성수축을하고푸시업과정 (Ascending phase) 에서는구심성수축을한다. 운동을하는동안구심성수축을할때보다편심성수축을할때더많은에너지가사용되어지기때문에훈련을하거나재활과정에서강도높은훈련을위해편심성수축을하는경우도있다 (Donkers et al., 1999; Park & Yoo, 2011). 선행연구를보면손을짚는부위가안정적인경우와불안정적인경우에어깨주변근활성화에어떠한차이가있는지에대해연구 (Martins et al., 2008; Park & Yoo, 2011) 와푸시업운동시발의높이를조절하여어깨주변근활성화에어떠한차이가있는지에대해연구 (Ebben et al., 2011), 어깨뼈익상여부와어깨주변근의관련성 ( 신윤아, 2013; Burkhart et al., 2003) 에관한연구등이보고된바있다. 푸시업운동은손의위치에의해동원되는근육의활성도가달라지기때문에위팔뼈의벌림각도를어떻게해야하는지의여부는매우중요한요소라할수있다. 그러나푸시업운동과관련한최근까지의연구들에서는이와관련한연구들은거의없는실정이다. Donkers et al.(1993) 은푸시업운동시손의위치를일반적인위치와벌려서짚는경우, 모아서짚는경우, 위쪽에짚는경우, 아래쪽에짚는경우를구분하여팔꿈치관절에미치는영향을연구한결과에서손을가슴보다아래쪽에짚는자세에서팔꿈치의부하가가장큰것으로보고하였지만, 위팔뼈의벌림각도에대해서는전혀언급을하지않고있다. 특히어깨관절환자를위한재활운동프로그램이나어깨주변근육을강화시키기위한훈련프로그램을제공할때위팔뼈의벌림각도가환자의재활기간이나경기력에매우중요하게작용할것이다. 이에본연구에서는어깨통증이없는대학생을대상으로푸시업운동시가장일반적으로실시하고있는위팔뼈를몸에붙인상태 ( 약 15 벌림 ) 와편안하게위팔뼈를벌린상태 ( 약 45 벌림 ) 에서어깨뼈주변근육의활성도에어떠한차이 가있는지를규명함으로써푸시업운동에대한효과적인위팔뼈의벌림각도를제시하고자하였다. 1. 연구대상 Ⅱ. 연구방법 이연구는최근 6개월이내에어깨관절의통증이없으며 (VAS 0), 수술병력이없는남자대학생 10명을대상으로하였다. 이들은선수경험이없는일반체육학과대학생으로사전에실험계획을설명한후참여동의서를작성하게하였다. 실험중통증발생을예방하기위해사전에어깨관절주변근육을 20분동안스트레칭하였으며, 검사순서는무작위로실시하였다. 그러나실험중 1명은가시위근부위에서통증을호소하여제외시켰으며, 또다른 1명은근피로를호소하였기에실험에서제외하였다. 따라서피검자는총 8명을대상으로하였으며, 피검자의신체적특징은 <Table 1> 에제시한바와같다. Table 1. Characteristics of subjects Variables Mean±SD Age (yrs) 20.5±1.77 Height (cm) ±3.88 Body weight (kg) 72.15±8.36 Percent body fat (%) 18.00± 실험설계및절차 모든연구대상자는무작위순서에의해위팔뼈를몸에붙인자세 (15 위팔뼈벌림 ) 에서푸시업과푸시다운운동을하면서어깨주변근육근전도실험을먼저실시하였으며, 피험자 1번부터 8번까지무작위로검사하였다. 그다음에는위팔뼈를 45 로자연스럽게벌린자세에서동일하게푸시업과푸시다운검사를실시하였다. 초기실험설계에서는위팔뼈를 90 벌린자세도푸시업과푸시다운검사를실시할계획이었지만, 사전검사에서피검자가어깨통증을호소하였기때문에푸시업과푸시다운운동은위팔뼈 15 와 45 벌린자세에서만실시하기로결정하였다.
3 홍용ㆍ김용권 측정항목및방법 1) 근전도검사 근전도검사를위해무선근전도 (Laxtha, Korea) 를이용하여측정하였으며, 전극은위등세모근, 아래등세모근, 중간등세모근, 앞톱니근, 앞세모근, 뒤세모근, 큰가슴근, 가시아래근에부착하였다. 먼저피부저항을줄이기위해피부를알코올솜으로깨끗하게닦은후알코올이마른후에전극을검사하고자하는근육의피부에부착하였다. 각측정근육의전극부착부위는 <Table 2> 와 <Fig. 1> 에제시하였다 (Hermens et al., 1999). 한편모든전극은근육의방향과일치되도록부착하였으며, 양극성이중전극을사용하였다. 전극을부착한후에는약간의움직임을통하여전극부착상태를확인하였다. 또한푸시업운동시근육의활성도를표준화하기위하여최대등척성수축을실시하였다. 측정하고자하는근육이최대로발휘할수있는등척성수축을시킨상태에서 maximal voluntary isometric contraction(mvic) 을측정하였다 (Cram et al., 1998). 등척성근력측정은총 5초동안실시하면서평균근전도신호량을 RMS 처리한후처음 1초값과 Table 2. Location of surface electrode Muscle Upper Trapezius (UT) Lower Trapezius (LT) Middle Trapezius (MT) Serratus Anterior (SA) Anterior Deltoid (AD) Posterior Deltoid (PD) Pectoralis Major (PM) Infraspinatus (IS) Electrode location at 50% on the line from the acromion to the spine on vertebra C7 at 2/3 on the line from the trigonum spinae to the 8th thoracic vertebra at 50% between the medial border of the scapula and the spine, at the level of T3 between 5-6th ribs and anterior axillary, parallel to the muscle fibers about one finger width distal and anterior to the acromion about two finger widths posterior of the acromion placed horizontally on the chest wall over the muscle mass that arise (about merely 2 cm out from the axillary fold) parallel to and approximately 4 cm below scapular spine, on the lateral aspect, over the infrascapular fossa of the scapula 마지막 1초값을제외한중간 3초동안의평균근전도신호량을 100% MVIC로정량화시켜평균값을통계분석에사용하였다. 총 3회를실시한후평균값을산출하였다. 2) 위팔뼈벌림각도및근육의활성도검사 푸시다운과푸시업자세에서위팔뼈를몸에붙인상태와위팔뼈를편안하게벌린상태를구분하여사전각도를측정한결과는 <Table 3> 에제시하였다. 측정결과위팔뼈를몸에붙인경우에는위팔뼈벌림각도가약 15 였으며, 자연스럽게벌린경우에는위팔뼈벌림각도가약 45 로나타났다. Table 3. Angles of humerus abduction by groups Group Angle (degree) Narrowing Humerus Abduction 14.9±2.49 Comfortable Humerus Abduction 44.3±2.76 Values are M±SD 측정자세에있어서푸시다운시위팔뼈벌림각도가 15 에서는위팔뼈가몸에서떨어지지않은상태에서푸시다운하도록하였으며, 위팔뼈벌림각도 45 의경우에는자연스럽게푸시다운이되도록하였다. 두동작모두팔꿈치가 90 굽혀진각도에서몸통과위팔뼈의벌림각도를측정하였으며, 이때등척성수축을하는동안근육의활성도값을채택하였다. 푸시업시위팔뼈벌림각도 15 의경우에는손의너비를어깨너비와동일하게지면을짚게한다음손바닥을몸의방향과일치되도록똑바로짚게하였다. 그러나위팔뼈벌림각도 45 의경우에는손의너비는동일하게적용한후손바닥을지면에댈때손목을약간안쪽돌림한상태에서지면을짚도록하였으며, 이때의근육의활성도값을채택하였다. 위팔뼈벌림각도 15 와 45 모두푸시다운단계에는날숨을쉬도록지시하였고, 푸시업단계에서는들숨을쉬도록하였다 (Fig. 2-5). Fig. 2. Push-down with 15 abduction of humerus. Fig. 3. Push-down with 45 abduction of humerus. Fig. 1. Surface electrode placement.
4 326 푸시업운동시위팔뼈벌림각도에따른어깨주변근육의활성도 2. 푸시업시위팔뼈벌림각도에따른근활성도 Fig. 4. Push-up with 15 abduction of humerus. 4. 자료처리방법 Fig. 5. Push-up with 45 abduction of humerus. 본연구의처리된자료는평균과표준편차로제시하였으며, 위팔뼈벌림각도에따른근활성도차이를비교분석하기위해독립표본 t 검정 (independent t test) 을실시하였다. 모든통계처리는 PASW 18.0 패키지를이용하였다. 통계적유의수준은 α=.05로하였다. Ⅲ. 연구결과 1. 푸시다운시위팔뼈벌림각도에따른근활성도 푸시다운자세에서위팔뼈벌림각도 15 집단과위팔뼈벌림각도 45 집단간연구결과는 <Table 4> 와같다. 위팔뼈의벌림각도에관계없이모든근육에서집단간유의한차이가없는것으로나타났다 (p>.05). 한편푸시다운동작시에는위팔뼈의벌림각도와관련없이어깨주변근육들의활성도에있어서는앞세모근의활성도가가장높았으며, 다음으로아래등세모근, 가시아래근, 앞톱니근순으로나타났다. 반면뒤세모근은근활성도가가장낮은것으로나타났다. Table 4. Muscle activation during push-down stage with different humerus abduction (unit: %MVC) Muscle 15 abduction 45 abduction t p UT 10.49± ± LT 21.90± ± MT 13.36± ± SA 19.99± ± AD 48.18± ± PD 4.81± ± PM 14.13± ± IS 20.20± ± Values are Mean±SD 푸시업자세에서위팔뼈벌림각도 15 집단과위팔뼈벌림각도 45 집단간연구결과는 <Table 5> 와같다. 먼저아래등세모근과중간등세모근은위팔뼈벌림각도 15 집단이 45 집단보다근활성도가유의하게높은것으로나타났다 (p<.05). 그러나다른근육들에서는푸시업운동시팔의몸통붙임각도에따라근활성도에통계적으로유의한차이가발견되지않았다 (p>.05). 한편푸시업동작시어깨주변근육들의활성도는앞톱니근이가장높았으며, 다음으로앞세모근, 가시아래근순으로나타났다. 반면에위등세모근은푸시업자세에서근활성도가가장낮은것으로나타났다. Table 5. Muscle activation during push-up stage with different humerus abduction (unit: %MVC) Muscle 15 abduction 45 abduction t p UT 3.25± ± LT 21.19± ± * MT 12.72± ± * SA 60.71± ± AD 56.56± ± PD 10.91± ± PM 11.54± ± IS 34.71± ± Values are Mean±SD. * p<.05 Ⅳ. 논의 이연구의목적은푸시업운동시위팔뼈의벌림각도에따라어깨뼈주변근활성도에어떠한차이가있는지를비교분석함으로써더효과적인푸시업운동을하기위한위팔뼈의벌림각도를알아보는데있다. 연구결과에서보듯이푸시업동작시위팔뼈를몸에붙였을때 ( 위팔뼈벌림 15 ) 가 45 로자연스럽게벌린경우보다아래등세모근과중간등세모근이유의하게활성화되는것으로나타났다. 그러나다른근육에서는위팔뼈의벌린각도로인한근활성도의유의한차이가없었다. 실험계획에서는위팔뼈를 90 벌린자세에서도푸시업검사를하려했지만일부피검자가가시위근부위에통증을호소하였기때문에본실험에서는제외를하였다. Cools et al.(2004) 에의하면
5 홍용ㆍ김용권 327 위팔뼈를벌리게되면어깨뼈가상방회전이되면서내밈 (protraction) 이되기때문에등세모근과함께앞톱니근과가시아래근, 뒤세모근등이함께수축을하게된다고하였다. 따라서위팔뼈의 90 벌린상태에서푸시업운동을하는것은어깨관절의충돌증후군을유발시키는위험요인이될수있는것으로사료된다. 푸시업동작시등척성수축을할경우에는위팔뼈를몸에붙인자세가자연스럽게벌린자세보다아래등세모근과중간등세모근을유의하게활성화하는것으로나타났다. Uhl et al.(2003) 은푸시업을할때최대등척성근수축 (MVIC) 에비해가시아래근은 44%, 앞세모근은 31%, 뒤세모근 18%, 큰가슴근 33% 정도가작용한다고보고하였다. 그러나본연구에서는위팔뼈를몸에붙인자세와 45 벌림시가시아래근이각각 34%, 24%, 앞세모근이 56%, 45%, 뒤세모근 10%, 9%, 큰가슴근 11%, 12% 가작용하는것으로나타나선행연구보다다소낮은것으로나타났다. 앞톱니근은어깨뼈움직임을조절하는주된역할을하는데 (Ludewig et al., 2004), 특히이근육은어깨등뼈의근육중하나로팔을들어올리는동안흉곽위에서어깨뼈를움직이도록기여한다 (Ludewig et al., 1996). 본연구에서는위팔뼈의벌림각도와상관없이푸시업운동시앞톱니근의활성도가높은것으로나타났다. 즉위팔뼈를몸에붙인경우아래등세모근의활성화 (21.19%) 보다앞톱니근은 60.71% 로약 3배정도가활성화되는것을알수있었다. 위팔뼈를 45 정도로벌린경우에는아래등세모근이 12.41%, 앞톱니근은 66.59% 로약 5배정도의활성화가되는것을알수있었다. 그러나푸시다운시에는앞톱니근의근활성도가아래등세모근수준과비슷한것으로나타났다. 최근어깨뼈와위팔뼈의리듬은매우중요한어깨관절의손상과매우밀접한것으로여겨지고있다 (Burkhart et al., 2003). 즉, 위팔뼈의벌림각도에따라서어깨뼈의움직임이작용을해야하지만, 어깨뼈주변근육의지나친경직이나위약감은어깨뼈의움직임을제어하지못하기때문에손상이유발되는것이다. 따라서어깨뼈주변근육을강화시키기위해서푸시업운동이강조되고있으며, 특히어깨뼈익상을예방하기위해서는푸시업플러스운동으로앞톱니근을활성화시키는것을권장하고있다 ( 신윤아, 2013; Ellenbecker & Cappel, 2000). 이렇듯어깨뼈주변근육과위팔뼈의움직임에서아래등세모근과중간등세모근, 앞톱니근은익상어깨뼈를예방하고어깨관절의충돌증후군및어깨뼈의정렬상태를유지할수 있는매우중요한역할을한다 ( 신윤아, 2013; Ludewig & Cook, 2000; Burkhart et al., 2003; Uhl et al., 2003; Cools et al., 2004; Ludewig et al., 2004). 그러나푸시업운동을할때위팔뼈의벌림각도를작게하는것은아래등세모근을더욱활성화시키기때문에어깨뼈안정화에더욱기여할수있을것으로사료된다. Ebben et al.(2011) 은다양한푸시업동작을하면서손바닥의지면반력을연구한결과발을 cm 위에올린상태에서푸시업운동을하는것의지면반력이가장컸으며, 다음은일반적인푸시업, cm 위에손을짚고실시하는푸시업, 그리고무릎을굽힌상태에서하는변형푸시업의순으로지면반력에차이가있음을보고하였다. 푸시업운동시손바닥에서의지면반력은일반적인푸시업동작이약 700 N일때무릎을굽힌자세에서의푸시업동작은 569 N으로약 80% 수준임을고려할때푸시업운동은자세에따라서어깨주변근육의활성화에영향을미칠수는있는것으로생각된다. 또한푸시업운동을하는동안팔꿈치관절에미치는힘은약 Nm로최대등척성수축력의 56% 수준이라고보고하였다 (Askew et al., 1987). 그러나두손으로푸시업운동을하는경우에는지면반력이 29% 이지만한손으로실시한경우에는 71% 로보고되고있다 (Donkers et al., 1993). 한편본연구결과위팔뼈의벌림각도에따라푸시업과푸시다운동작시어깨주변근육들의활성도에차이가있음을알수있었다. 이와관련하여 Lunden et al.(2010) 은벽을짚고푸시업을하는동안어깨뼈의움직임각도를연구한결과푸시다운시상방회전은 이지만푸시업작시에는 라고하였으며, 안쪽회전은푸시다운시 이고푸시업시 라고보고하였다. 즉, 이결과는푸시다운에비해푸시업동작시어깨뼈가상방회전은작고안쪽회전이더크다고것을제시하는것이다. 따라서어깨뼈의회전은어깨주변근육의신장성수축을유발시키기때문에근활성도와깊은관련이있을것으로생각할수있다. 즉, 위팔뼈를몸에붙이는경우에는어깨뼈의회전이적고뒤당김 (retraction) 이유발되기때문에어깨뼈의내측에위치하고있는위등세모근과중간등세모근, 아래등세모근의활성도가큰반면, 앞톱니근의활성도는낮게된다. 그러나위팔뼈를벌리게되면어깨뼈가상방회전이되면서내밈 (protraction) 이되기때문에등세모근과함께앞톱니근과가시아래근, 뒤세모근등이함께수축을하게되고이는선행연구 (Cools et al., 2004) 와일치하는것이다. Freeman et
6 328 푸시업운동시위팔뼈벌림각도에따른어깨주변근육의활성도 al.(2006) 은푸시업운동시손을지면이아닌볼위에서실시할경우에는배곧은근과내외복사근이활성화되어요통을예방할수있다고보고하였다. 푸시업운동은상지및척추주변의근력강화에깊이관여하고있기때문에그자세에따라서근활성도는큰차이가있는것으로보고되고있다 (Cogley, 2005; Gouvali & Boudolos, 2005; Freeman et al., 2006; Ebben et al., 2011). 이와관련하여 Cogley et al.(2005) 은푸시업시손을넓게벌린집단 (85.8 cm) 과손을좁게한집단 (66.3 cm) 간큰가슴근과위팔세갈래근의활성도를비교한결과좁게한집단에서두근육모두유의하게근활성도가높았다고보고하였으며, Gouvali & Boudolos (2005) 는손의위치를 6가지로구분한후손바닥에미치는지면반력과근활성도를연구한결과손을좁게할경우에는큰가슴근의활성화가크고, 손의위치를가슴보다더아래쪽으로위치시키면큰가슴근활성화는높은반면상대적으로위팔세갈래근의활성도는유의하게감소하였다고보고하였으며, 손을가슴보다위쪽으로위치시키면위팔세갈래근활성화가크고, 무릎을굽힌상태에서푸시업을할때에는큰가슴근과위팔세갈래근의활성화가낮은것으로보고하였다. 이렇듯푸시업운동시손의다양한위치에따라어깨주변근육이활성화에차이가있었으며, 본연구에서는푸시업운동을할때위팔뼈의벌림각도에따라어깨주변근육에서아래등세모근과중간등세모근의활성도에차이가있었음을알수있었다. Ⅴ. 결론 본연구에서는푸시업운동을할때위팔뼈의벌림각도에따른어깨주변근의활성화에어떠한차이가있는지를조사한결과, 등척성푸시업동작은위팔뼈를몸에붙인자세 (15 위팔뼈벌림 ) 에서실시하는것이위팔뼈를 45 자연스럽게벌린자세에서운동하는것보다아래등세모근과중간등세모근의활성도를유의하게높이는것으로나타났다. 따라서이근육만을선택적으로강화시키고자한다면위팔뼈를몸에붙인자세에서푸시업운동을하는것을권장한다. 참고문헌 신윤아 (2013). 어깨뼈익상여부에따른재활운동동작시근활성도비교. 운동학학술지, 15(4): Askew, L. J., An, K. N., Morrey, B. F., & Chao, E. Y. (1987). Isometric elbow strength in normal individuals. Clinical Orthopaedics and Related Research, (222): Burkhart, S. S., Morgan, C. D., & Kibler, W. B. (2003). The disabled throwing shoulder: spectrum of pathology Part Ⅲ: The SICK scapular, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy, 19(6): Cogley, R. M., Archambault, T. E., Fiberger, J. F., Koverman, M. M., Voudas, J. M. et al. (2005). Comparison of muscle activation using hand positions during the push-up exercise. Journal of Strength and Conditioning Research, 19(3): Cools, A. M., Witvrouw, E. E., Declercq, G. A., Vanderstraeten, G. G., & Cambier, D. C. (2004). Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction retraction movement in overhead athletes with impingement symptoms. British Journal of Sports Medicine, 38(1): Cram, J. R., Kasman, G. S., & Holtz, J. (1998). Introduction to surface electromyography. Gaithersburg, MD: Aspen Publishers Dillman, C. J., Murray, T. A., & Hintermeister, R. A. (1994). Biomechanical differences of open and closed chain exercises with respect to the shoulder. J. Sports Rehabilitation, 3(3): Donkers, M. J., An K. N., Chao, E. Y., & Morrey B. F. (1993). Hand position affects elbow joint load during push-up exercise. J. Biomechanics, 26(6): Donkers, M. J., Hintermeister, R. A., Faber, K. J., & Hawkins, R. J. (1999). Serratus anterior muscle activity during selected rehabilitation exercises. Am. J. Sports Med., 27(6): Ebben, W. P., Wurm, B., Vanderzanden, T. L., Spadavecchia, M. L., Durocher, J. J. et al. (2011). Kinetic analysis of several variations of push-ups. Journal of Strength and Conditioning Research, 25(10):
7 홍용ㆍ김용권 329 Ellenbecker T. S & Cappel K. (2000). Clinical application of closed kinetic chain exercises in the upper extremities. Orthopaedic Physical Therapy Clinics of North America, 9(2): Freeman, S., Karpowicz, A., Gray, J., & McGill, S. (2006). Quantifying muscle patterns and spine load during various forms of the push-up. Medicine and Science in Sports and Exercise, 38(3): Gouvali, M. K., & Boudolos, K. (2005). Dynamic and electromyographical analysis in variants of push-up exercise. Journal of Strength and Conditioning Research, 19(1): Hermens, H. J., Freriks, B., Merletti, R., Stegeman, D., Blok, J. et al. (1999). European Recommendations for surface Electromyography. Enschede, The Netherlands: Roessingh Research and Development. Lehman, G. J., Gilas, D., & Patel, U. (2008). An unstable support surface does not increase scapulothoracic stabilizing muscle activity during push up and push up plus exercises. Manual Therapy, 13(6): Lippit, S. B., Vanderhoof, J. E., Harris, S. L., Slides, J. A., Harryman, D. T. et al. (1993). Glenohumeral stability from concavity-compression: a quantitative analysis. Journal of Shoulder & Elbow Surgery, 2(1): Ludewig, P. M., & Cook, T. M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys. Ther., 80(3): Ludewig, P. M., Cook, T. M., & Nawoczenski, D. A. (1996). Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J. Orthop. Sports Phys. Ther., 24(2): Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J. (2004). Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercise. Am. J. Sports Med., 32(2): Lunden, J. B., Braman, J. P., LaPrade, R. F., & Ludewig, P. M. (2010). Shoulder kinematics during the wall push-up plus exercise. Journal of Shoulder & Elbow Surgery, 19(2): Martins, J., Tucci, H. T., Andrade, R., Araujo, R. C., Grossi, B. D. et al. (2008). Electromyographic amplitude ration of serratus anterior and upper trapezius muscle during modified push-ups and bench press exercises. J. Strength and Conditioning Research, 22(2): Park, S. Y., & Yoo, W. G. (2011). Differential activation of parts of the serratus anterior muscle during push-up variations on stable and unstable bases of support. J. Electromyogr. Kinesiol., 21(5): Rogol, I. M., Emst, G., & Perri,n D. H. (1998). Open and closed kinetic chain exercises improve shoulder joint reposition sense equally in healthy subjects. Journal of Athletic Training, 33(4): Uhl, T. L., Carver, T. J., Mattacola, C. G., Mair, S. D., & Nitz, A. J. (2003). Shoulder musculature activation during upper extremity weight-bearing exercise. J. Ortho. Sports Phys. Ther., 33(3): 논문투고일 : 심사일 : 심사완료일 : * 교신저자 : 김용권, 전주대학교, caliperkim@hanmail.net
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