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., E-mail: shk8275@hanmail.net 2009 11 10 / 2009 11 15 / 2009 11 18
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. 1. 2009 3 9 4 3, 4
D 10, 10 20. 21.9±1.77. 10, 10. 2.,., (, 1999). 10 15 1) (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. 1 100% 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) 0.05. Ⅲ. 1. 20 Table1. 20,
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 21.80 ± 2.20 22.00 ± 1.33 Height 170.60 ± 7.93 166.40 ± 9.86 Weight 62.90 ± 12.26 62.60 ± 13.69 21.8±1.77, 10. 21.80 ±2.20, 62.90±12.26kg, 170.60± 7.93cm. 22.20± 1.33, 62.60±13.69kg, 166.40 ±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 78.10 ± 5.82 81.70 ± 4.32 86.10 ± 3.38 86.60 ± 3.16 70.50 ± 10.91 73.50 ± 14.55 75.10 ± 12.41 75.60± 12.89 Table 3. Results of effect within subjects for CROM extension 591.600 197.200 10.523.000* *Group 48.950 16.317.871.462 Error() 1011.950 18.740 Table 4. Comparison of CROM extension within treatment period * Group 462.40 462.40 22.70.000* 396.90 396.90 21.40.000* 108.90 108.90 4.59.046* 28.90 28.90 1.42.249 28.90 28.90 1.56.227.90.90.038.848
Table 5. Results of effect between subjects for CROM extension Group 1786.050 1786.050 5.832.027* Error 5512.650 306.258 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, 1 6 1 6 (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 49.40 ± 11.35 55.50 ± 10.62 60.60 ± 7.50 63.8± 8.12 58.20 ± 11.92 56.30 ± 11.88 62.30 ± 10.00 63.7± 10.84 Unit : Table 7. Results of effect within subjects for CROM flexion 1298.250 661.314 15.546.000* *Group 248.100 126.379 2.971.065 Error() 1503.150 42.538
Table 8. Comparison of CROM flexion within treatment period * Group 990.03 990.03 24.57.000* 585.23 585.23 17.35.001* 44.10 44.10 4.73.043* 198.03 198.03 4.91.040* 126.03 126.03 3.74.069 160.00 160.00 17.15.001* Table 9. Results of effect between subjects for CROM flexion Group 156.800 156.800.450.511 Error 6277.650 348.758 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 43.10 ± 8.23 49.70 ± 6.67 48.50 ± 7.01 47.40 ± 5.27 37.70 ± 7.27 41.10 ± 7.13 42.20 ± 5.43 42.20 ± 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 417.138 209.873 12.146.000* *Group 49.938 25.125 1.454.247 Error() 618.175 17.279
Table 12. Comparison of mouth opening within treatment period * Group Type SS MS F p 193.600 193.600 9.699.006* 345.025 345.025 89.188.000* 250.00 250.00 21.802.000*.100.100.005.944 21.025 21.025 5.297.034* 25.600 25.600 2.233.152 Table 13. Results of effect between subjects for mouth opening Group 945.313 945.313 6.601.019* Error 2577.925 143.218 1 1, 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) 56 78.6%., Dahlstrom(1992)
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