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1 Journal of The Korean Society of Physical Medicine, 2013; 8(3): Online ISSN: Print ISSN: X Research Article Open Access 슬괵근단축이있는대학생에대한유지 - 이완기법의효과 오영택 마산대학교물리치료과 Effect of Hold-Relax Technique for College Students with Hamstring Shortening Yeong-Taek Oh Department of Physical Therapy, Masan University Received: June 28, 2013 / Revised: July 17, 2013 / Accepted: August 2, 2013 c 2013 Journal of the Korean Society of Physical Medicine Abstract PURPOSE: The purpose of this study was to determine the effectiveness of three PNF stretching techniques for improving hamstring flexibility and to compare the effectiveness of three PNF stretching techniques(direct and indirect and mix(direct&indirect) of hold-relax technique). METHODS: The subjects were randomly assigned into three groups: group1-direct-hold-relax technique(n=10); group2-indirect-hold-relax technique(n=8); group3-mix(direct&indirect)-hold-relax technique(n=10). For each group, stretch was performed three times a week for a period of three weeks. Hamstring flexibility for each group was measured using the ASLR and PSLR. RESULTS: The results showed significant improvement in hamstring flexibility for all subjects of three groups. However, were not significantly different between the three groups. CONCLUSION: In conclusion, three PNF stretching techniques are confirmed to be useful for improving hamstring flexibility. The choice for a qualified technique has to be made individually according to patient and therapist. Corresponding Author : oilpali@hanmail.net Key Words: Hamstring flexibility, Hold-relax technique, ASLR, PSLR Ⅰ. 서론유연성 (flexibility) 은바른자세유지와개선, 적절하고우아한동작의증진, 운동기능의촉진과발달, 일상생활이나운동수행중의상해예방에필수적이라고할수있지만 (Ogura 등, 2007), 현대인들은산업화로인한생활환경의변화, 신체활동의감소및비가동성, 노화등이근육의탄성성분및근섬유를감소시켜근육의신장성에문제를야기한다 (Faulkner 등, 2007). 그중에학생들은학업문제나취업스트레스에노출되어신체건강과정신건강이낮아져있으며 (Lee와 Cho, 2011), 일례로의자에앉아서보내는시간이거의모든일상생활을차지하므로슬괵근의단축 (shortening) 이일어나유연성이감소되고나아가요통이나나쁜자세, 보행이상등의기능장애를초래하게된다 (Kisner와 Colby, 2007). Fox(2006) 는슬괵근의유연성, 고관절굴곡, 천장관절의기능부전과요통과의연관성이어느정도는확립되어있다고하였고, 많은연구에서슬괵근의단축 (Shortening) 과강한근경도 (Stiffness) 는요추의전만을감소시킨다고보고하였다 (Johnson과 Thomas, 2010).

2 434 대한물리의학회지제 8 권제 3 호 Kim과 Hwang(2012) 은슬괵근이정상인그룹보다슬괵근이단축된그룹의하부요추 (L4-5, L5-S1) 에서상대적으로이동거리가증가되는것을확인함으로써척추퇴행의중요한원인으로작용하게될것이라고보고하였고, Oh와 Choi(2012) 는슬괵근단축유무에따른요통환자에대한능동적움직임조절검사에서슬괵근단축이비특이성요통환자의움직임에영향을미친다고보고하였다. 따라서비록연구자들이요통과슬괵근의유연성사이의원인및결과에따른결정적인연결고리는찾지못하였다하여도차후에발생될수있는요통을미리예방하기위해서는단축된슬괵근의유연성증진을위한처치가필요할것이다 (Kwon과 Jung, 2009; Lee 와 Jung, 2006). 한편근육을이완하는기법에는신장기법과운동요법, 코어프로그램 (Lee와 Jung, 2007), 균형조절치료 (Oh, 2011) 등이있으며, 최근에는고유수용성신경근촉진법 (proprioceptive neuromuscular facilitation; PNF) 이많이이용되고있다. PNF의근이완기법으로수축 -이완기법 (contract-relax; CR) 과유지-이완기법 (hold-relax; HR) 그리고수축-이완-길항근수축기법 (contract-relax antagonist-contract; CRAC) 이주로사용되며 (Feland 등, 2001), 특히, 유지-이완기법은효과적인근이완법으로등척성수축시최대의저항을가하는것을기본으로하고있으며, 피로와통증감소, 안정성촉진등다양한치료목적을위해사용되고있다 (Adler 등, 2008). Kim(2009) 은전화안내원을대상으로자발적으로실시한유지-이완기법이통증및유연성에미치는효과를알아보았고, Davis 등 (2005) 과 Sady 등 (1982) 은자발적신장, 정적신장, 탄성신장 (ballistic stretch) 과 PNF 신장기법이슬괵근유연성에미치는효과를비교, 연구하였다. Nagarwal 등 (2010) 은유지-이완기법과수축-이완- 길항근수축기법의효과를비교하였다. 하지만이러한연구들은유지-이완기법의효과만을연구하거나 PNF 의신장기법간에효과를비교하는연구, 다른신장기법들과비교하여유지-이완기법이더효과적이라는연구가대부분이며, 유지-이완기법 (HR) 에서직접적 (direct) 방법과간접적 (indirect) 방법으로구분하여효과의차이를검증한연구는거의없는실정이다. 직접 적방법과간접적방법의적용시에근이완이일어나는신경학적기전 (physiological mechanism) 을보면전자는자가억제 (autogenic inhibition) 에의해근이완이일어나고, 후자는상호억제 (reciprocal inhibition) 에의해근이완이일어나는것으로구분이되므로 (Adler 등, 2008; Chaitow, 2001) 두방법간의효과에도차이가있을것이다. 이에본연구는슬괵근단축이있는대학생을대상으로유지-이완기법의직접적방법과간접적방법, 그리고혼합된방법의효과를규명하고나아가방법들간에효과에차이가있는지를알아보고자하였다. Ⅱ. 연구방법 1. 연구대상본연구의대상자는 C시의 M대학교에재학중인자로다음과같은기준으로선정되었다. 1) 선자세에서허리를앞으로굽혔을때대퇴후부에당김을호소하였고, 슬괵근구축검사 (hamstring contracture test) 에서양성 (positive) 반응을나타낸자 (Magee, 2008)(Fig 1). 2) 현재어떠한치료나진통제및기타약물도복용하고있지않은자 3) 본연구의취지와목적에관한설명을듣고자발적으로연구참여에동의한자위사항에적합한대상자는 30명으로연구의목적달성을위해서무작위로각 10명씩세집단으로구분하였으며, 집단1(group1) 은유지-이완기법의직접적방법, 집단2(group2) 는유지-이완기법의간접적방법, 집단3(group3) 은직접적방법과간접적방법을혼합하여적용하였다. 연구과정중에집단2 에서 2명이개인사정으로탈락되어최종결과분석에서제외되었으며, 나이와슬괵근단축이심한비우세다리 (non-dominant leg) 의특성은 Table1과같다.

70±5.52 weight(kg) 67.4±10.37 62.13±7.75 65.80±8.63 non-dominant leg right 7(70%) 4(50%) 5(50%) left 3(30%) 4(50%) 5(50%) HR: hold-relax, Mean±SD, % 2. 연구수행을위한연구자훈련본연구는연구자훈련을통해서수행되었다.

3 슬괵근단축이있는대학생에대한유지 - 이완기법의효과 435 positive negative Fig 1. Hamstring contracture test Table 1. General characteristics of subjects Groups HR(direct) HR(indirect) HR(direct&indirect) Characteristics (n=10) (n=8) (n=10) age(yrs) 21.6± ± ±2.32 height(cm) 170± ± ±5.52 weight(kg) 67.4± ± ±8.63 non-dominant leg right 7(70%) 4(50%) 5(50%) left 3(30%) 4(50%) 5(50%) HR: hold-relax, Mean±SD, % 2. 연구수행을위한연구자훈련본연구는연구자훈련을통해서수행되었다. 연구자훈련에참가한자들은해부학적지식을겸비한 M대학교물리치료학과에재학중인 9명의학생으로이미수업을통해서유지- 이완기법의이론과실습을경험하였으나보다정확한시술과숙련도를높이기위해서 3명씩 3개조로나누어본연구자가재교육하였다. 3명중에 1명은유지-이완기법의시술자로강한등척성근수축을유도하기위해남자로정하여훈련하였고, 1명은측정시에필요한측정자훈련을하였으며, 나머지 1명은측정시에기록과대상자의안정된자세유지및고정을위한보조자로교육하였다. 교육참가자간에모의실험을통해서충분한기술을습득하였다고판단되었을때각조에연구대상자들을집단별로 3-4명씩무작위로배치하여연구를진행하였다. 3. 측정도구및측정방법슬괵근의유연성은처치전과처치후에평가하였고, 측정기구는디지털듀얼경사계 (Dualer IQ Digital Inclinometer, J-Tech, 미국 ) 를이용하였다. 경사계의측정센서는외과 (lateral malleolus) 의비골 (fibula) 하단에스트랩 (strap) 으로고정하였으며, 무릎을완전히신전한상태에서고관절의굴곡각도를측정하였다 (Kim, 1999; Azevedo 등, 2013). 측정은훈련된 3명의연구원이 1조가되어 1도단위로유연성을측정하였으며, 1회측정후에 5초간휴식을하고, 재측정하였다. 총 3회를측정하여평균값을기록하였으며, 측정자간신뢰도를알아보기위해실험전에동일한대상자를대상으로 3명의측정자가측정한값을분석한결과, 능동하지직거상법 (ASLR) 은.962, 수동하지직거상법 (PSLR) 은.977의높은급간내상관계수를나타내었다. ASLR과 PSLR의측정사이에미치는영향을최소화하기위해 1시간의휴식을하였다.

대상자에게무릎을완전히신전한상태에서고관절을능동적으로굴곡시킬때대퇴후부에서통증이느껴지는지점을말로표현하게하였고, 검사자는그지점에서최종굴곡각도를측정하였다 (Fig 2). Fig 3. PSLR 4.

4 436 대한물리의학회지제 8 권제 3 호 슬괵근유연성을검사하는방법은여러가지가있으나본연구에서는다음과같은두가지의방법을사용하였다 (Kim, 1999). 1) 능동하지직거상법 (active straight leg raising; ASLR) 대상자를바로눕힌자세 (spine) 에서스트랩으로반대편의우세다리 (dominant leg) 를고정하였고, 골반은보조자에게고정하게하여비정상적인움직임이없도록하였다. 대상자에게무릎을완전히신전한상태에서고관절을능동적으로굴곡시킬때대퇴후부에서통증이느껴지는지점을말로표현하게하였고, 검사자는그지점에서최종굴곡각도를측정하였다 (Fig 2). Fig 3. PSLR 4. 유지-이완기법 (hold-relax; HR) 유지- 이완기법은주 3회 2주간실시하였으며, 1회에집단1과집단2는 6번반복하여실시하였고, 집단3은직접적방법 3회, 간접적방법 3회를실시하였다. Fig 2. ASLR 2) 수동하지직거상법 (passive straight leg raising; PSLR) 대상자를바로눕힌자세 (spine) 에서스트랩으로반대편의우세다리 (dominant leg) 를고정하였고, 골반은보조자에게고정하게하여비정상적인움직임이없도록하였다. 검사자의왼손은대상자비우세다리의대퇴원위부전방에놓고, 발목뒤를잡은오른손으로고관절을수동으로최대한굴곡시킨다. 이때대퇴후부에서통증이느껴지는지점을대상자에게말로표현하게하였고, 검사자는그지점에서최종굴곡각도를측정하였다 (Fig 3). 1) 직접적방법 (direct) 본연구에서실시하는직접적방법은대상자가단축된슬괵근을수축시킬때연구자가반대방향으로저항을주는것이다. 대상자는바로누운자세에서슬괵근단축이심한것으로판명된비우세다리를치료자의어깨위에올린다. 치료자의한손은대퇴원위부를잡고서고관절을 90도까지굴곡한상태를유지하고, 다른한손은발목뒤를잡고서무릎을천천히펴면서대상자가통증을느끼는지점까지슬괵근을신장시킨다. 통증을느끼는지점에서대상자의슬괵근이수축되도록고관절의신전과함께슬관절의굴곡을지시한다. 동시에치료자는발목뒤를잡은손으로대상자의힘과반대로저항을제공하여등척성수축의상태를 7초간유지한다. 수축후에 5초간이완을한다음, 치료사의어깨를이용해새로획득된범위까지천천히슬괵근을신장시킨다. 휴식과안정을위해 2 3회호흡을실시한후이러한과정을반복하였으며, 치료를하는동안대상자의골반과우세다리의대퇴원위부는보조자에의해고정되었다 (Adler 등, 2008; Nagarwal 등, 2010) (Fig 4).

5 슬괵근단축이있는대학생에대한유지 - 이완기법의효과 437 Fig 4. HR(direct) 2) 간접적방법 (indirect) 본연구에서실시하는간접적방법은대상자가단축된슬괵근의길항근인대퇴사두근을수축시킬때연구자가반대방향으로저항을주는것이다. 간접적방법은직접적방법과동일한자세에서대상자의대퇴사두근 (quadriceps) 이수축되도록슬관절의신전을지시한다. 동시에치료자는발등을잡은손으로대상자의힘과반대로저항을제공하여등척성수축의상태를 7초간유지한다. 수축후에 5초간이완을한다음, 치료사의어깨를이용해새로획득된범위까지천천히슬괵근을신장시킨다. 휴식과안정을위해 2 3회호흡을실시한후이러한과정을반복하였으며, 치료를하는동안대상자의골반과우세다리의대퇴원위부는보조자에의해고정되었다 (Adler 등, 2008)(Fig 5). 3) 직접적방법과간접적방법의혼합 (mix of direct & indirect) 혼합방법은위에설명한것과동일한방법으로먼저직접적방법을시행한후에간접적방법을시행한다. 두방법간에수축하는근육과저항의방향이달라서대상자가혼란을겪을수있으므로이를방지하기위해약 10초간의준비시간을주었다. 5. 자료분석수집된자료는 SPSS/PC + (Ver 12.0) 을이용하여다음과같이분석하였다. 연구대상자의일반적특성과처치결과는백분율과평균 (M) 과표준편차 (SD) 로산출하였으며, 집단내는대응 t-검정으로하였다. 집단간의실험전 후변화량의차이에대해서는일원분산분석 (one-way ANOVA) 을실시하였으며, 모든유의수준은 α =.05로하였다. Ⅲ. 연구결과 1. 실험전ㆍ후에각군 (group) 의 ASLR 변화실험전ㆍ후에세군의 ASLR 변화에대한분석결과는다음과같다 (Table 2). 직접적방법의경우, 실험전 59.46±9.49에서실험후 73.73±8,04로증가하였고 (p<0.001), 간접적방법은실험전 57.82±10.00에서실험후 68.05±7.47로증가하였다 (p<0.01). 그리고직접적방법과간접적방법을혼합하여적용한경우에도실험전 57.88±8.63에서실험후 72.55±12.71로유의하게증가하였다 (p<0.001). Fig 5. HR(indirect) Table 2. Comparison of ASLR among the groups of pre and post-test (unit: ) ASLR Groups pre-test post-test t p HR(direct)(n=10) 59.46± ±8, *** HR(indirect)(n=8) 57.82± ± ** HR(direct&indirect)(n=10) 57.88± ± *** date are Mean±SD, ** : p<0.01, *** : p<0.001

6 438 대한물리의학회지제 8 권제 3 호 2. 실험전ㆍ후에각군 (group) 의 PSLR 변화실험전ㆍ후에세군의 PSLR 변화에대한분석결과는다음과같다 (Table 3). 직접적방법의경우, 실험전 61.54±8.03에서실험후 80.79±5.99로증가하였고 (p<0.001), 간접적방법은실험전 55.74±8.28에서실험후 71.20±10.32로증가하였다 (p<0.001). 그리고직접적방법과간접적방법을혼합하여적용한경우에도실험전 58.32±7.77에서실험후 78.90±12.75로유의하게증가하였다 (p<0.01). 3. 실험전ㆍ후에각군 (group) 간의변화량차이실험전ㆍ후에세군간의 ASLR과 PSLR의변화량차이를분석한결과세군모두유의한차이가없었다 (Table 4). Ⅳ. 논의유지-이완기법의직접적방법은자가억제기전 (autogenic inhibition mechanism) 에의해근이완이일어나고, 간접적방법은상호억제기전 (reciprocal inhibition mechanism) 에의해근이완이일어난다 (Adler 등, 2008, Chaitow, 2001). Heyward(1991) 는수축-이완기법을이 용한신장은주동근을 7 8초간등척성수축하고, 2 5 초간이완한후길항근을 7 8초간수축하는방법을 4 6회실시할것을권하였지만일반적으로수축시간과이완시간이정형화되어있지않으므로본연구는 7초동안등척성수축, 5초이완, 그리고새로획득된범위까지천천히슬괵근을신장하는것을 1회로하여 6회의유지-이완기법을적용하였다 (Chaitow, 2001). 실험기간과관련하여 Spernoga 등 (2001) 은 30명의건강한군생도를대상으로 1회의유지-이완기법을적용하였을때슬괵근의유연성이뚜렷하게증진되었다고하였으므로본연구에서는 2주동안총 6회의유지-이완기법을적용하였다. 슬괵근의신장을측정하는방법으로 SLR(straight leg raise) 검사, SA(sacral angle) 검사, SR(sit and reach) 검사가있으며 (Davis 등, 2008), 본연구에서는흔히사용되는 SLR 검사중에서 ASLR과 PSLR를이용하여측정하였다 (Kim, 1999) 그결과, ASLR과 PSLR 측정에서직접적방법과간접적방법그리고직접적방법과간접적방법을혼합한세집단모두처치전에비해서처치후에유의한증가를나타내었으며, 집단간에는차이가없었다. 유지-이완기법의직접적방법은단축된근육 (agonist) 인슬괵근을등척성수축하여유연성을증가시키는것이고, 간접적방법은슬괵근의길항근인대퇴사 Table 3. Comparison of PSLR among the groups of pre and post-test (unit: ) PSLR Groups pre-test post-test t p HR(direct)(n=10) 61.54± ± *** HR(indirect)(n=8) 55.74± ± *** HR(direct&indirect)(n=10) 58.32± ± ** date are Mean±SD, ** : p<0.01, *** : p<0.001 Table 4. Comparison of variation differences of ASLR and PSLR (unit: ) HR(direct) (n=10) HR(indirect) (n=8) HR(direct&indirect) (n=10) ASLR 14.27± ± ± PSLR 19.25± ± ± date are Mean±SD F p

7 슬괵근단축이있는대학생에대한유지 - 이완기법의효과 439 두근을등척성수축하는것이다. 이러한방법이외에주동근수축을동반한유지- 이완 (hold-relax with agonist contraction: HR-AC) 기법은단축된근육 (antagonist) 이통증을느끼는지점에서등척성수축을함으로써단축된근육에이완을유발한후, 다시반대편근육 (agonist) 을수축시켜단축된근육 (antagonist) 을이완시키는것으로직접적방법과간접적방법을모두적용한것 (Adler 등, 2008) 이지만본연구에서는직접적방법과간접적방법을각각 3회씩적용하는변형된방법을적용하였다. Nachtwey와 Stricker(2003) 는슬괵근의유연성증진을위해유지-이완기법에서슬괵근을등척성수축하는직접적방법과대퇴사두근을등척성수축하는간접적방법을적용하였을때두방법모두에서유의한증가가있었으며, 두방법간에는차이가없었다고하여본연구와동일한결과를나타내었다. Nagarwal 등 (2010) 은슬괵근이단축된 15명의대학생에게유지- 이완기법을 3초등척성수축, 5초이완, 그리고 7초동안천천히슬괵근을신장하는것을 1회로하여주 3회 3주동안적용하였고, 다른 15명에게는유지-이완기법의수축후이완이나수동적신장대신에대퇴사두근을 7초간구심성으로 (concentrically) 수축을하는주동근수축을동반한수축-이완 (Contract Relax-Agonist Contract: CRAC) 기법을적용하였을때두방법모두아무런처치를하지않은대조군에비해슬괵근이유의한증가를나타내었으며, 두방법의효과는거의동등하였다고하여집단간에차이가없었다고보고하였다. 하지만 Osterig 등 (1990) 은운동선수를대상으로 PNF 신장기법인신장-이완기법 (SR), 수축-이완기법 (CR), 주동근수축- 이완기법 (ACR) 을적용한결과, ACR 기법이 CR과 SR 기법보다슬괵근의 EMG 활동이 % 정도더높았고, 관절가동범위도 9 13% 더증가되어효과에차이가있었다고하였다. Ferber 등 (2002) 은 50 75세사이의성인을대상으로슬관절굴곡근의근활성도를관찰하였을때정적신장과 CR 기법보다수축- 이완길항근수축 (contract-relax antagonist contract: CRAC) 기법이더효과적이었다고하였고, Etnyre와 Abraham(1986) 은관절가동범위에미치는효과를알아보기위해서정적스트레칭, CR 기법, 그리고수축- 이완 길항근수축 (contract-relax antagonist contract: CRAC) 기법을비교한결과, CRAC 기법이가장효과적이었다고하여 CR기법과 CRAC기법간에는차이가있었다고보고하였다. 이러한결과에대해일부의연구는자가억제와상반억제의복합적작용에의한것으로이해하였지만 (Smith, 1994; Etnyre와 Abraham, 1986) 자가억제와상반억제를혼합적용한본연구의결과와상반된것이며, 일부의연구는 EMG와 H-반사연구를통해서 PNF 의신장적용동안에자율억제및상호억제의역할에대해의문을제기하고있다 (Sharman 등, 2006). 따라서특정연구의결과만으로차이가있다고확정할수는없으며, 차후에연구기간, 대상자의수, 대상자간에제한된근육길이의차이와같이연구결과에영향을미칠수있는다양한요소 (Nagarwal. 등, 2010) 들이고려된많은연구들이이루어져야할것으로생각한다. Ⅴ. 결론본연구는슬괵근단축이있는대학생을대상으로유지-이완기법의직접적방법과간접적방법, 그리고혼합된방법을적용하였을때치료효과와적용방법들간에효과의차이가있는지를알아보았다. 치료는주 3회 2주간실시하였으며, 직접적방법과간접적방법은 1회에 6번반복하여실시하였고, 혼합방법은각 3회씩실시하였다. 그결과능동하지직거상 (ASLR) 과수동하지직거상 (PSLR) 검사에서세가지방법모두처치전에비해서처치후에유의한증가를나타내었다. 하지만집단간에는차이가없는것으로나타났는데선행연구에서도서로상반된결과들을보고하고있어더복잡하고다양한요소들이치료효과에개입될것으로짐작할수있었다. 결론적으로근육의유연성을증진시키고자할때유지-이완기법의세가지방법이모두효과적이라는것을확인할수있었고, 적용방법간에는차이가없었으므로어떤방법이든지전문가의판단과환자의상황에따라적합한것이선택될것이다.

8 440 대한물리의학회지제 8 권제 3 호 References Adler SS, Beckers D, Buck M. PNF in Practice: An illustrated guide. 3rd ed. Berlin: Springer-Verlag Azevedo DC, Lauria AC, Pereira AR et al. Intraexaminer and interexaminer reliability of pressure biofeedback unit for assessing lumbopelvic stability during 6 lower limb movement tests. Journal of Manipulative and Physiological Therapeutics. 2013;36(1): Chaitow L. Muscle energy techniques, Oxford, UK : Elsevier Davis DS, Ashby PE, McCale KL et al. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. Journal of Strength and Conditioning Research. 2005;19(1): Davis DS, Quinn RO, Whiteman CT et al. Concurrent validity of four clinical tests used to measure hamstring flexibility. Journal of Strength and Conditioning Research. 2008;22(2): Etnyre BR & Abraham LD. Gains in Range of Ankle Dorsiflexion Using Three Popular Stretching Techniques. American Journal of Physical Medicine. 1986;65(4): Faulkner JA, Larkin LM, Claflin DR et al. Age-related changes in the structure and function of skeletal muscles. Clinical and Experimental Pharmacology and Physiology. 2007;34(11): Feland JB, Myrer JW, Merrill RM. Acute changes in hamstring flexibility: PNF versus static stretch in senior athletes. Physical Therapy in Sports. 2, 2001; Ferber R, Ostering L, Gravelle D. Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. Journal of Electromyography Kinesiology. 2002;12(5): Fox M. Effect on hamstring flexibility of hamstring stretching compared to hamstring stretching and sacroiliac joint manipulation. Clinical Chiropractic. 2006;9(1): Heyward VH. Advanced fitness assessment and exercise prescription. 2nd ed. Champaign Illinois: Human Kinetics Books Johnson EN & Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward reaching tasks in individuals with and without low back pain. Archives of Physical Medicine and Rehabilitation. 2010;91(7): Kim GC, Hwang BG. Research Article: Kinetic Analysis on the Lumbar at the Trunk Flexion according to the Degree of Hamstring Flexibility of Healthy Adult. Journal of the Korean Society of Physical Medicine. 2012;7(4): Kim SY. Comparison of Six Tests for Assessing Hamstring Muscle Length. The Journal Korean Academy of Orthopaedic Manual Physical Therapy. 1999:5(1): Kim YM. Effects of the Use of the Hold Relax Technique to Treat Female VDT Workers with Work-related Neck-shoulder Complaints. The Korean Journal of Occupational and Environmental Medicine. 2009; 21(1): Kisner C & Colby LA. Therapeutic exercise: foundations and techniques. 5th ed. Philadelphia: F. A. Davis Kwon HK, Jung HM. Effect of Strengthening Program for Nurses in Relation to Back Pain, Flexibility and Muscle Strength. Journal of the Korean Data Analysis Society. 2009;11(1): Lee IS, Cho JY. Employment Stress, Physical Health, and Mental Health among College Students. Journal of the Korean Data Analysis Society, 2011;13(2): Lee JW, Jung HM. The Relationship among Health Promoting Lifestyle, self-efficacy, perceived health status in college women. Journal of the Korean Data Analysis Society. 2006;8(5): Lee KH, Jung HM. The Effect of Core Program on Back Pain, Back Strength and Flexibility to Nurses. Journal of the Korean Data Analysis Society. 2007;9(4):

9 슬괵근단축이있는대학생에대한유지 - 이완기법의효과 Magee DJ. Orthopedic Physical Assessment. 5th ed. St. Louis: Saunders Elsevier Nagarwal AK, Zutshi K, Ram CS et al. Improvement of Hamstring Flexibility: A Comparison between Two PNF Stretching Techniques. International Journal of Sports Science and Engineering. 2010;4(1): Nachtwey MN & Stricker K. Effects of the PNF-hold-relaxtechnique, direct and indirect, on hamstring muscle flexibility. International Proprioceptive Neuromuscular Facilitation Association; IPNFA Report Ogura Y, Miyahara Y, Naito H et al. Duration of static stretching influences muscle force production in hamstring muscles, Journal of Strength and Conditioning Research. 2007;21(3): Oh SJ. & Choi JD. The Study of Validity in Active Movement Control test for Low Back Pain Patients with or without Hamstring Shortening, Journal of The Korean Society of Physical Medicine. 2012;7(4): Oh YT. Effect of Balance Control Therapy on Low Back Pain on University Students, Journal of the Korean Data Analysis Society, 2011;13(4): Osterig LR, Robertson RN, Troxel RK, Hansen P. Differential responses to proprioceptive neuromuscular facilitation (PNF) stretching techniques, Medicine & Science in Sports & Exercise, 1990;22: Sharman MJ, Cresswell AG, Riek S. Proprioceptive Neuromuscular Facilitation Stretching Mechanisms and Clinical Implications, Sports Medicine, 2006; 36(11): Smith CA. The warm-up procedure: To stretch or not to stretch. A brief review, Journal of Orthopaedic & Sports Physical Therapy, 1994;19:12-7. Spernoga SG, Uhl TL, Arnold BL et al. Duration of Maintained Hamstring Flexibility After a One-Time, Modified Hold-Relax Stretching Protocol. Journal of Athletic Training. 2001;36(1):44-8.

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