1) 측두하악관절장애 (TMD) 환자에게초음파와근막이완술이측두하악관절및경부의기능적회복에미치는영향, 1 The Effect of Ultrasound and Myofascial Release on a Functional Recovery of Neck in Patients

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1 1) 측두하악관절장애 (TMD) 환자에게초음파와근막이완술이측두하악관절및경부의기능적회복에미치는영향, 1 The Effect of Ultrasound and Myofascial Release on a Functional Recovery of Neck in Patients with Temporomandibular Disorder Soo-jin Kim PT, Sang-wook Hyun 1, PT, Byoung-gon Kim, PT, PhD, Hyun-kyu Seo, PT, PhD Department of Physical Therapy Daegu Health Collage 1 Rehabilitation Center, Best Rehabilitation Hospital <Abstract> Purpose The purpose of this study is to examine the effectiveness of ultrasound and myofascial release in patients who have opening mouth limitation and temporomandibular disorder. Methods Twenty students were randomly assigned to a myofascial release group(n=10) or an ultrasound group(n=7). Each group was treated for 15 minutes per a every treatment session for four weeks. Cervial range of motion(crom) was used to measure cervical R.O.M., and a mm(millimeter) graduated ruler was used to measure opening mouth limitation. Results Results of the follows : 1. The neck extension of range of motion of both groups was significantly increased in length of time (p<.05). 2. The neck flexion of range of motion of both groups was significantly increased (p<.05). 3. The quantity of opening mouth of temporomandibular joint of both groups was significantly increased (p<.05). Conclusion These data suggest that myofascial release and ultrasound are beneficial to increasing a functional recovery of neck(flexion and extension) and opening mouth. Key Words Temporomandibular disorder, Range of motion, Mouth limitation., shk8275@hanmail.net / /

2 Ⅰ.,., 1,500~2,000 (Paula, 1989).,,,, (, 1992).,,, (William, 1995).., (Dworkin, 1990).,,,.. (Travell Simons, 1988).,. (back),. (Travell Simons, 1988). (Wall Melzark, 2002).,.,,,,.,.(John Wright, 1962).. (Sarkey, 1993).,,,.,. Ⅱ , 4

D 10, 10 20. 21.9±1.77. 10, 10. 2.,., (, 1999). 10 15 1) (1).

3 D 10, ± , ,., (, 1999) ) (1). (Maximum comportable opening) mm.(, 2001). (2) Cervical Range of Motion(CROM) instrument,. 1, 1, 3, 6 4. Fig 1. CROM, starting position, flexion and extension measurement 2) (1). TMJ - (tempro-occipital), Fig 2. Application of myofascial release

(, 2008). (ramus of mandible)..,.. (Travell Simons, 1988)... (Travell Simons, 1988). 60 90. 3~5 (Barnes, 1995) 15 (, 2005). (2) 4 6, 15.

4 (, 2008). (ramus of mandible)..,.. (Travell Simons, 1988)... (Travell Simons, 1988) ~5 (Barnes, 1995) 15 (, 2005). (2) 4 6, % 2W/ 15 (Fig 3). (Lehmann, 1966; Kahn, 1987). Direct Fig 3. Application of ultrasound coupling. 3. SPSS 12.0 ver. for windows. 1 1, 3, 6,.,, (α) Ⅲ Table1. 20,

5 Table 1. General characteristics of subjects Myofascial release group Ultrasound group Gender Male n=10 Male n=10 Female n=10 Female n=10 Age ± ± 1.33 Height ± ± 9.86 Weight ± ± ±1.77, ±2.20, 62.90±12.26kg, ± 7.93cm ± 1.33, 62.60±13.69kg, ±9.86cm. 2. Table 2., Table 2. Comparison of CROM extension with treatment period on each group Myofascial release group (N=20) Ultrasound group (N=20) 1st treatment 3rd treatment Unit : 6th treatment ± ± ± ± ± ± ± ± Table 3. Results of effect within subjects for CROM extension * *Group Error() Table 4. Comparison of CROM extension within treatment period * Group * * *

6 Table 5. Results of effect between subjects for CROM extension Group * Error Fig 4. Variation of CROM extension (p<.05), (Table 3). 1 1, 1 3, 1 6 (p<.05)(table 4)(Fig 4). (p<.05)(table 5). Table 6., (p<.05), (p>.05)(table 7). 1 1, 1 3, (p<.05)(table 8) (Fig.5). 3. Fig 5. Variation of CROM flexion Table 6. Comparion of CROM flexion within treatment period on each group Myofascial release group (N=20) Ultrasound group (N=20) 1st treatment 3rd treatment 6th treatment ± ± ± ± ± ± ± ± Unit : Table 7. Results of effect within subjects for CROM flexion * *Group Error()

7 Table 8. Comparison of CROM flexion within treatment period * Group * * * * * Table 9. Results of effect between subjects for CROM flexion Group Error Table 10. Comparison of mouth opening within treatment period on each group Group Myofascial release group (N=20 Ultrasound group (N=20) 1st treatment 3rd treatment 6th treatment ± ± ± ± ± ± ± ± 5.73 (mm) (p>.05)(table 9). 4. (Table 10)., (p<.05) (p>.05)(table 11). Table 11. Results of effect within subjects for mouth opening * *Group Error()

8 Table 12. Comparison of mouth opening within treatment period * Group Type SS MS F p * * * * Table 13. Results of effect between subjects for mouth opening Group * Error , 1 3, 1 6 (p<.05)(table 12)(Fig 6). (p<.05)(table 13). Fig 6. Variation of mouth opening Ⅳ.,,,.,,,,. Von Korff (1988) 30.,, TMJ,,, TMJ., Zarb (1970) %., Dahlstrom(1992)

9 ., (John Wright, 1962)., (manual therapy) (, 2004), (, 2005). Wood(1927).., 3MHz 1MHz. 1MHz 2W/ 15., 78.10, 86.60, (2008) , , 3, 6.(p<.05), 49.40, 63.80, (2008) , , 3, 6 (p<.05)., 43.10mm, 47.40mm mm, 42.20mm. (2001) , 3, 6 (p<.05).. Wood (2001) 30. 1, 2 (atlas-axis),,,,,

10 ... Ⅴ. D 20 10, 10, 10. CROM, mm. 1, 1, 3, 6 4.,, (p<.05), (p<.05). 1 1, 3, 6, 3 6.,, (p<.05), (p>.05). 1 1, 3, 6, 3 6., (p<.05), (p<.05). 1 1, 3, , ; 18(4): ;11(3): , ,, ;11(2):2-10..,, , ;16(3): Barnes JF. PT Today. January. 1995;16. Dworkin SF, Huggins KH, LeResche L, et al. Epidermiology of signs and symtoms in temporomandibular disorder : Clinical signs in cases and control, J Am Dent Assoc, 1990;120: Dahlstrom L. Conseruative treatment methods in

11 craniomandibular disorder. Swed Dent J. 1992; 16: John RJ, Wright V. Relative importance of various tissues in joint stiffness. J physiology. 1962;17: Jordan A, Mehlsen J, Ostergaard K. A comparison of physical characteristics between patients seeking treatment for neck pain and matched healthy individuals. Journal of Manipulative and Physiological Therapeutics. 1997;20: Kahn J. Principles and Practice of electrothrapy New York. Churchill Livingstone Lehmann JF, Delateur BJ, Silverman DR. Selective heating effects of ultrasound in humanbeings, Arch Phys Med Rehabil. 1966;47: Maixner W, Fillingim R, Sigurdsson A, et. al. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. pain. 1998;76(1-2): Mackowiak P. Relief of pain from headaches and TMJ. Manhattan printing. 1989;1-49. Starkey C. Therapeautic Modalities, 2nd ed. philadelphia, FA. Davis. 1993; Travell JG, Simons DG. Myofascial pain and dysfunction-the trigger point manual. Baltimore. Williams & Willkins. 1988;260 Von Korff M, Dworkin SF, LeReshe S, et al. An epidemiologic comparison of pain complaints. Pain. 1988;32: Wood TG, Colloca CJ, Matthews RA. pilot randomized clinical trial on the relative effect of instrumental (MFLA) versus manual(hvla) manipulation on the treatment of cervical spine dysfunction. Journal of Manipulative Physiological Therapeutics. 2001;24: Zarb GA. Assessment of clinical treatment of patients with temporo- mandibular joint dysfunction. J Proshet Dent. 1970;24(5):

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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