Journal of the Korea Academia-Industrial cooperation Society Vol. 18, No. 10 pp. 442-447, 2017 https://doi.org/10.5762/kais.2017.18.10.442 ISSN 1975-4701 / eissn 2288-4688 등속성장비를이용하여한국고교야구선수주관절근력평가기준치설정 : ( 서울및경기도중심으로 ) 김수현 1, 이진욱 2* 1 선수촌병원, 2 단국대학교대학원체육학과 Norm-referenced criteria for strength of the elbow joint for the korean high school baseball players using the isokinetic equipment : (Focusing on seoul and gyeonggi-do) Su-Hyun Kim 1, Jin-Wook Lee 2* 1 Sunsoochon Hospital 2 Department of physical education, Graduate School, Dankook University 요약이연구의목적은등속성장비를이용하여고등학교야구선수들을대상으로주관절근육의평가기준치를설정하는데있다. 상지에의학적으로문제가없는고등학교야구선수 201 명을대상으로하였다. 주관절검사는 HUMAC NORM (CSMI, USA) system 을이용하여굴곡, 신전운동을부하속도 60 /sec 에서 4 회를실시하였으며, 절대근력 (peak torque) 와상대근력 (peak torque % body weight) 을측정하였다. Cajori 의 5 단계 (6.06%, 24.17%, 38.30%, 24.17%, and 6.06%) 로구분한구간추정 (interval estimation) 방식에의해평가기준치를나타내었다. 이연구의결과에서각속도 60 /sec 에서주관절의절대근력 (peak torque) 굴근의평균은 37.88±8.14Nm 신근은 44.59±11.79Nm 으로나타났으며, 상대근력 (peak torque % body weight) 굴근의평균은 50.06±8.66Nm 신근은 58.28±12.84Nm 로나타났다. 각속도 60 /sec 에서주관절굴근 (flexer) 과신근 (extensor) 의절대근력 (peak torque) 과상대근력 (peak torque % body weight) 의평가기준치는설정하였다. 이연구에서분석된결과를토대로다음과같이결론을이끌어냈다. 주관절은야구선수들에게가장많이발생되는손상임에도불구하고국내외주관절근력에관한연구가미비한실정이다. 주관절손상을예방하고경기력향상을위해상대적근력수준과훈련효과를보다객관적으로평가할수있는근력척도가필요하다. 주관절의절대근력과상대근력의평가기준치를제시함으로서고교선수, 야구지도자, 선수트레이너, 재활전문가등에게손상회복및재활복귀시유용하게자료가될것으로생각되며, 객관적인임상평가데이터로활용하는데매우유용한정보라고사료된다. Abstract The purpose of this study was to establish norm-referenced criteria for the isokinetic strength of the elbow joint inkorean high school baseball players. Two hundred and one high school baseball players participated in this study,none of whom had any medical problem withtheir upper limbs. The elbow flexion/extension test was conducted four times at a speed of 60 /sec. The HUMAC NORM (CSMI, USA) system was used to obtain the values of the peak torque and peak torque per body weight. The results were presented as norm-referenced criterion valuesusing the5-point scale of Cajori which consists of five stages (6.06%, 24.17%, 38.30%, 24.17%, and 6.06%). In the results of this study, the peak torques of the elbow (flexor and extensor?) at an angular velocity of 60 / sec were37.88 ± 8.14Nm and 44.59 ± 11.79Nm, and the peak torque per body weight of the elbow (flexor and extensor?) were50.06 ± 8.66 Nm and 58.28 ± 12.84 Nm, respectively. The reference values of the peak torque and peak torque per body weight of the elbow flexor and extensor were setat an angular velocity of 60 / sec. On the basis of the results analyzed in this study, the following conclusions were drawn. There is a lack of proper studies on the elbow joint strength, even though the most common injury in baseball players occurs in the elbow joint. Therefore, we need to establish a standard muscle strength in order to prevent elbow joint injuries and improve their performance. The criteriaforthe peak torque and peak torque per body weight establishedherein will provideuseful information for high school baseball players, baseball coaches, athletic trainers and sports injury rehabilitation specialists in injury recovery and return to rehabilitation, which can beutilized as objective clinical assessment data. Keywords : Baseball, Elbow joints, Isokinetic equipment, Norm-referenced criteria, Strength * Corresponding Author : Jin-Wook Lee(Graduate School, Dankook University) Tel: +82-80-8813-5674 email: rugby14@hanmail.net Received July 28, 2017 Revised (1st August 25, 2017, 2nd September 4, 2017) Accepted October 13, 2017 Published October 31, 2017 442
등속성장비를이용하여한국고교야구선수주관절근력평가기준치설정 : ( 서울및경기도중심으로 ) 1. 서론고교야구에서시작된우리나라의야구는사랑받는스포츠로자리잡고있다. 2017년대한야구소프트협회에등록된고교야구는 73개팀과 2763명의선수로매년증가하고있으며, 대학진학과프로야구입단을위하여치열하게경쟁하고있다 [1]. 야구는포지션구분없이공을던지는운동으로투구및송구동작으로인해신체여러부위에손상을가져올수있다. 이중주관절은상완골, 요골그리고척골로구성되어있으며, 경첩관절 (hinge) 과차축관절 (pivot joint) 로이루어져있다. 손에힘을전달하는복합관절로굴곡과신전, 회내와회외의운동이발생되고, 관절막, 근육과건및인대에의해안정성을이루고있다 [2]. 그러나주관절의외반력을발생시키는과도한투구훈련과송구동작은주관절의내측구조물에신장력을증가시켜외측구조물에과도한압박력을유발시켜통증을야기하고나아가인대와골손상을발생한다고보고하고있다 [3]. 주관절통증의발생빈도를줄이기위한많은연구가수행되었지만, 부상의유병률은여전히 높은것으로보고되고있다 [4-9]. Magra 등 [10] 은 9~19사이의야구선수중 18~69% 가내측주관절통증경험을가지고있으며, 통증은연령의증가와체중증가, 중량운동시무게증가, 투구폼의불만족, 어깨가피로한상태에서의투구, 투구수 (300미만또는 600이상 ) 와도관련이있다고보고하고있다 [5]. 아마추어및프로야구선수들에게주관절손상은가장빈번하게발생하며, 경기력저하의결정적요인이기도하다 [11]. 선행연구에의하면야구선수의손상이많이나타나는부위로는주관절 50.4%, 견관절 28.1%, 슬관절 8.1% 고관절 7.6% 순으로나타났으며, 투수, 내야수, 외야수모든집단에서주관절손상의발생률이가장높았다고보고하고있다 [12-13]. 주관절골변화는중학교선수 82%, 고교선수 85%, 프로선수 88% 로b 연령이증가할수록주관절의방사선학적변화가증가한다고보고하고있다 [14]. 주관절변형은선수생명을단축시킬수도있으며, 주관절이상을가진야구선수의 43% 는무증상을보이기때문에주관절을치료보다예방이무엇보다중요하다.[15-16]. 근육과관련된체력요인을평가하는데있어서일반적으로정적인상태에서절대근력을평가하지만모든운 동은움직이면서근력이발생되고움직이는상태에서의동적근력평가가더효과적이며, 장력측정과절대근력평가가함께이루어져야한다 [17]. 일정한속도로근수축운동을하는등속성운동은전운동가동범위에서동일한최대부하를받으면서수행하고근수축시에발생하는장력은운동부위의움직임에가속도를발생시켜속도증가를시키므로근력향상시키는데효과적인운동으로보고하고있다. 또한근육의기계적운동결과는절대근력 (peak torque), 상대근력 (peak torque per body weight) 등은짧은시간에측정하여근기능평가를위한자료로제시해줄수있으며, 근기능의기계적운동평가에대한측정신뢰도가높은것으로보고하고있다 [18-22]. 고교야구선수들의체력수준을평가하는기준에있어근력은지도자와트레이너에게있어훈련계획수립및손상후재활을위한진단과평가도구로매우중요한정보를제공할수있다 [23]. 고교야구선수들은과거에비해기술과체력적인측면에서많은발전을하고있으나이를뒷받침할수있는객관적인기초체력평가및기준은부족한실정이다. 주관절은야구선수들에게가장많이발생되는손상임에도불구하고지난 10년간국내야구선수를대상으로한연구는주관절골의변화 [14, 24-25] 및손상후재활에관한연구 [2, 26] 위주로진행되어져왔으며, 이또한미비한실정이다. 야구선수들의주관절손상을예방하고경기력향상을위해상대적근력수준과훈련효과를보다객관적으로평가할수있는근력척도가필요하며, 이를바탕으로한주관절손상예방및트레이닝을위한연구가필요할것으로사료된다. 따라서이연구는고교야구선수들의주관절근력을정량적, 객관적으로제시함으로써훈련을계획하는야구지도자들의참고자료로제공할수있을것으로생각되며, 주관절손상후안전한복귀를위한기준을제시할수있을것으로사료된다. 2. 연구방법 2.1 연구대상이연구의대상자는대한야구소프트볼협회 (Korea Baseball Softball Association) 에등록되어있는서울, 443
한국산학기술학회논문지제 18 권제 10 호, 2017 Table 1. The characteristics of subjects N Height(cm) Weight(kg) Age(yrs.) Career(yrs.) Body Fat(%) 201 175.20±5.61 76.58±10.98 17.66±0.70 6.68±1.57 15.92±5.6 Means ± SE. 경기지역고등학교야구팀남자야구선수중무작위로 201명을표집하였다. 실험당시연구의목적과실험에대해충분한설명하고사전동의를얻었으며, 병력조사와신체검사를통하여의학적인문제가있는선수는연구대상에서제외하였다. 대상자의신체적특성을다음 Table 1과같다. 2.2 측정방법및변인 2.2.1 주관절의굴곡과신전검사주관절운동을평가할수있는주관절의굴곡과신전장치인등속성근력장비 HUMAC NORM(CSMI, Stoughton, MA, USA) 를이용하였다. 연구대상자은상체운동검사테이블 (Upper Body exercise and testing table; UBXT) 에시선이천정을바라보도록눕게한 (supine position) 후연구대상자주관절의외측상과 (lateral epicondyle) 의회전축을동력계의회전축과일치시키고검사중팔꿈치가아닌다른부위가움직여골반및하지근에외력이가해지지않도록고정띠로가슴과복부를고정시켰다. 또한주관절의발휘가제대로이루어질수있도록주관절보조기구 (elbow adapter) 를이용하여전완부길이를조정하여고정시키고주관절보조기구손잡이 (elbow adapter handle) 를잡고신전및굴곡운동을실시하였다 <Figure 1>. 검사자는연구대상자의해부학적조준 (set anatomical zero) 을설정하고관절가동범위는 0~150로설정하였다. 이때주관절의부하속도는 60 /sec에서 4회를실시하였으며, 정확한측정을위해시험전최대근력에서 3회연습하고휴식을취한후실험을수행하였다. 2.2.2 측정변인피크토크 (peak torque) 는체중을고려하지않고측정된근력으로최고치토크로절대근력을나타내며, 단위는 Nm로표시하였고, 단위체중당피크토크 (peak torque per body weight) 는체중을고려하여측정된근력으로최고치토크를체중으로나눈값으로상대근력을나타내며, 단위는 % 로나타냈다. Fig. 1. Measurement of the computer assisted isokinetic muscle strength in the elbow joint 2.3 자료처리수집된모든자료는 SPSS 18.0(SPSS Inc., Chicage, IL, USA) 통계프로그램을이용하여평균 (mean; M) 과표준오차 (standard error; SE) 를산출하였으며, 고교야구선수의주관절의등속성근력평가기준치설정을위해정규분포를검증하고, 변인에따른측정결과는전체사례수를고려한백분위 (percentile) 점수를적용하여 Cajori 의 5 단계로구분한구간추정 (interval estimation) 방식에의해설정하였다. 급간에따른해당비율과평가기준은다음 Table 2과같다. Table 2. Norm- referenced criterion value using 5-point scale of cajori Scale Percentage(%) Stage 5 6.06 Very low 4 24.17 Low 3 38.30 Moderate 2 24.17 High 1 6.06 Very high 3. 연구결과 등속성근력장비 Humac Norm(CSMI, Stoughton, MA, USA) 이용하여고교야구선수들의주관절의근력검사에서측정된각변인들의분석한결과는다음과같다. 444
등속성장비를이용하여한국고교야구선수주관절근력평가기준치설정 : ( 서울및경기도중심으로 ) 3.1 주관절의등속성근력측정값각속도 60 /sec 에서주관절의절대근력 (peak torque) 는굴근의평균은 37.88±8.14Nm 신근은 44.59±11.79Nm 으로나타났으며, 상대근력 (peak torque per body weight) 의굴근의평균은 50.06±8.66Nm 신근은 58.28±12.84Nm로나타났다 [Table 3]. 3.2 주관절의등속성굴근과신근의평가기준치각속도 60 /sec에서주관절굴근 (flexer) 과신근 (extensor) 의절대근력 (peak torque) 과상대근력 (peak torque per body weight) 의평가기준치는다음에제시한 Table 4와같다. Table 3. The values of peak torque & peak per boby weight elbow joint flexor and extensor at 60 /sec speed Speed Muscle Group Side peak torque(nm) peak torque body weight(%) Fle Dominate 37.88±8.14 50.06±8.66 60 /sec Ext Dominate 44.59±11.79 58.28±12.84 Values are means ± SE. Fle : flexor, Ext : extensor Table 4. Norm- referenced criterion value of peak torque & peak torque per body weight elbow joint flexor and extensor at 60 /sec speed Speed Muscle Group Side Very Low Low Moderate High Very High 60 /sec Fle Dominate 25.7 less 25.8-33.7 33.8-41.9 42.0-50.0 50.1 more (PT) Ext Dominate 26.9 less 27.0-38.7 38.8-50.5 50.6-62.2 62.3 more 60 /sec Fle Dominate 37.1 less 37.2-45.7 45.8-54.3 54.4-63.0 63.1 more (PT%BW) Ext Dominate 39.0 less 39.1-51.8 51.9-64.6 64.7-77.5 77.6 more PT : peak torque(nm), PT%BW : peak torque per body weight(%) Fle : flexor, Ext : extensor 4. 논의야구선수들에게주관절과견관절통증은과도한투구수와상관관계를보이고있으며, 미국야구위원회의의무분과에서는어린선수를보호하기위해투구의수를제안할것을권고하고있다 [27]. 특히주관절통증은연령의증가와체중증가, 과한중량운동시, 잘못된자세, 투구수증가원인으로보고하고있다. 손상을예방하고경기력향상을위해상대적인근력수준과훈련의효과를보다정확히평가할수있는일종의근력측정기준치가필요하다. 주관절의부하속도 60 /sec 에서절대근력 (peak torque) 의선행연구를살펴보면대학야구선수 15명과일반대학생 15명의근력을비교한 Park[28] 의연구에서는주관절의굴근과신근의평균은각각 53.5±7.5Nm, 70.9±15.6Nm 으로일반대학생의 39.0±6.7Nm 50.0±8.5Nm 보다높은것으로보고하고있으며, Kim 등 [29] 은 18명의대학야구투수들을대상으로주관절의굴근과신근의평균은각각 55.17±14.71Nm, 53.50±10.30Nm이였으며, 주관절신근력과굴근력은직구스피드와유의한상관관계가있 다고보고하였다. 고교야구선수들을대상으로한 Jang[30] 은연구에서는주관절굴근과신근의평균은각각 40.94±1.45Nm, 50.13±1.24Nm로보고하였다. 이연구에서는고교야구선수들의주관절의굴근과신근의평균은 37.88±8.14Nm, 44.59±11.79Nm으로대학야구선수들보다낮은수준을보였으며, 대상자가유사한 Jang[30] 연구보다낮은경향으로나타났다. 그이유로는 Jang[30] 연구의대상자의특성을보면투수들을대상으로실시하여서보다낮은결과가나타났다고사료된다. 주관절의부하속도 60 /sec에서의상대근력 (peak torque per body weight) 은대학야구선수 15명과일반대학생 15명의근력을비교한 Park[28] 의연구에서는주관절상대근력의굴근과신근의평균은각각 69.3±10.7Nm, 91.9±20.5Nm으로일반대학생의 58.7.0±8.1Nm, 76.1± 15.5Nm 보다높은것으로보고하고있으며, 대학야구투수 18명을대상으로한 Kim 등 [29] 의연구에서는주관절의상대근력굴근과신근의평균은각각 55.83± 9.32Nm, 59.67±12.68Nm로나타났으며, 신근력 (BW%) 은직구와슬라이드스피드에유의한상관관계가있다고보고하고있다. 이연구에서는고교야구선수들의주관절 445
한국산학기술학회논문지제 18 권제 10 호, 2017 상대근력의굴근과신근의평균은 50.06±8.66Nm, 58.28±12.84Nm로대학야구선수들보다낮은수준을보였다. 이상의결과에서고교야구선수들은대학야구선수들보다낮은절대근력 (peak torque) 과상대근력 (peak torque per body weight) 수준을보이고것으로나타났다. 선행연구보다많은인원을대상으로로실시한이연구로주관절의절대근력과상대근력의평가기준치를제시함으로써야구지도자, 선수트레이너재활전문가등에선수들의부상회복및재활복귀시기초자료로유용하게쓰일것으로사료된다. 5. 결론 이연구의목적은훈련을계획하고평가하는야구지도자및트레이너, 재활전문가들에게객관적인평가기준치를제시하고자하였다. 고교야구선수들의주관절근력의정량적, 객관적근력기준치를제시함으로써훈련계획및평가하는야구지도자와트레이너들에게참고자료로제공할수있을것으로사료되며, 손상시고교야구선수들의주관절근력평가함으로써선수들의부상회복및재활복귀시기초자료에많은도움을줄것으로생각된다. 이후주관절부상방지와보호를위해보다다양한측면에서연구되어야할것으로생각되며초 중학교야구선수들을대상으로한연구도진행되어야할것이다. 고교야구선수 201명을대상으로한이연구는현장에있는지도자와선수트레이너들에게매우유용한자료로제공될수있으며, 고교야구선수들의정확한주관절근력기준을제안한다. Reference [1] KOREA BASEBALL SOFTBALL ASSOCIATION, http://www.korea-baseball.com/info/player/player_list?kin d_cd=31", 2017. [2] S. K. Lim, "Review of ulnar collateral ligament injuries and prevention in baseball players", Journal of Coaching Development, vol. 9, no. 3, pp. 65-80, 2007. [3] J. O. Yoon, K. W. Lee, J. M. Shin, J. H. Woo, "Analysis of Elbows in Middle School Baseball Pitchers". The Korean Journal of Sports Medicine, vol. 22, no. 2, pp. 194-202, 2004. [4] G. S. Fleisig, J. R. Andrews, C. J. Dillman, R. F. Escamilla, "Kinetics of baseball pitching with implications about injury mechanisms", The American journal of sports medicine, vol. 23, no. 2, pp. 233-239, 1995. DOI: https://doi.org/10.1177/036354659502300218 [5] S. Lyman, G. S. Fleisig, J. W. Waterbor, E. M. Funkhouser, L. Pulley, J. R. Andrews, E. D. Osinski, J. M. Roseman, "Longitudinal study of elbow and shoulder pain in youth baseball pitchers", Medicine and science in sports and exercise, vol. 33, no. 11, pp. 1803-1810, 2001. DOI: https://doi.org/10.1097/00005768-200111000-00002 [6] S. Lyman, G. S. Fleisig, J. R. Andrews, E. D. Osinski, "Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers", The American journal of sports medicine, vol. 30, no. 4, pp. 463-468, 2002. DOI: https://doi.org/10.1177/03635465020300040201 [7] S. J. Olsen, G. S. Fleisig,, S. Dun,, J. Loftice, J. R. Andrews,"Risk factors for shoulder and elbow injuries in adolescent baseball pitchers", The American journal of sports medicine, vol. 34, no. 6, pp. 905-912, 2006. DOI: https://doi.org/10.1177/0363546505284188 [8] K. M. Reagan, K. Meister, M. B. Horodyski, D. W. Werner, C. Carruthers, K. Wilk, "Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players", The American Journal of Sports Medicine, vol. 30, no. 3, pp. 354-360, 2002. DOI: https://doi.org/10.1177/03635465020300030901 [9] M. B. Sabick, M. R. Torry, Y. K Kim, R. J. Hawkins, "Humeral torque in professional baseball pitchers", The American journal of sports medicine, vol. 32, no. 4, pp. 892-898, 2004. DOI: https://doi.org/10.1177/0363546503259354 [10] M. Magra, D. Caine, N. Maffulli, "A review of epidemiology of paediatric elbow injuries in sports", Sports medicine, vol. 37, no. 8, pp. 717-735, 2007. DOI: https://doi.org/10.2165/00007256-200737080-00005 [11] D. H. Kim, K. Y. Lee, H. Y. Lee, S. H. Jang, K. Y. Baek, H. W. Kim, S. W. Jang, J. W. Park, " A Study on the Elbow Joint Injuries of Baseball Players" Korean Journal of Sports Science, vol. 17, no. 2, pp. 751-763, 2008. [12] Y. K. Kim, D. M. Kim, "Analysis of the Injuries by Position in Baseball Players" The official journal of the Korean academy of kinesiology, vol. 14, no. 1, pp. 67-76, 2012. [13] J. W. Na, "The Analysis of physical injuries of the baseball players in Middle and High School", Graduate school, ChungAng University, pp. 31, 2006. [14] C. J. Lim, S. T. Kim, C. Y. Kim, K. Y. An, J. B. Park, T. H. Youn, "A Study for Prevalence od Pain and Bony Changes of the Elbow in Baseball Players" Journal of Korean orthopaedic society for sports medicine, vol. 6, no. 1, pp. 50-56, 2007. [15] K. Miyashita, Y. Urabe, H. Kobayashi, K. Yokoe, S. Koshida, M. Kawamura, K. Ida, "The role of shoulder maximum external rotation during throwing for elbow injury prevention in baseball players", Journal of sports 446
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