Journal of The Korean Society of Integrative Medicine, 2021, 9(1), 133~140 https://doi.org/10.15268/ksim.2021.9.1.133 ISSN 2288-1174(Print) ISSN 2383-9651(Online) 슬링을이용한교각운동시장력센서와경사계를이용한시각적피드백이근활성도에미치는영향 권유정 ǂ 송민영 동의과학대학교물리치료과교수 Effects of the Symmetry of Muscle Activity by Application of Visual Feedback using Tension Sensor and Inclinometer during Bridge Exercise with Sling Yu-Jeong Kwon, PT, Ph.D ǂ Min-Young Song, PT, MS Dept. of Physical Therapy, Dong-Eui Institute of Technology, Professor Abstract Purpose: This study aimed to compare the relative muscle activity on the erector spinae, gluteus maximus, and hamstring, using a non-visual feedback bridge exercise and a visual feedback bridge exercise with a tension sensor and clinometer. Methods: Twenty-two healthy subjects participated in this study. The study subjects performed bridge exercises without visual feedback, bridge exercises using a tension sensor, and bridge exercises using an inclinometer in the supine position, and the muscle activity of the left and right erector spinae, gluteus maximus, and hamstring muscles was measured while maintaining isometric contraction during the bridge movement. Muscle activity was measured by using surface an electromyography equipment. To standardize the measured action potential of each muscle, the maximum voluntary isometric contraction was measured. The bridge exercise was repeated 3 times for 5s each. Using repeated analysis of variance, we compared the significant difference in EMG activity for each muscle between the three experiments, and all statistical processing was performed using SPSS version 26. The statistical significance level was set at α = 0.05. Results: During bridging exercises, the asymmetry of the muscle activity of the erector spinae and gluteus maximus during visual feedback guiding was lower than that during no visual feedback. However, there was no significant difference. Moreover, the asymmetry of the muscle activity of the hamstring muscles was significantly lower during tension sensor visual feedback than that during no visual feedback (p<0.05). Conclusion: These findings suggest that bridge exercise with visual feedback using a tension sensor and an inclinometer is effective in inducing symmetrical movement. When it is necessary to symmetrically adjust the weight load of both feet during the bridge exercise, it is effective to apply visual feedback using a tension sensor. 1) Key Words : bridge exercise, muscle activity, visual feedback ǂ 교신저자 : 권유정, yjkwon@dit.ac.kr 논문접수일 : 2021 년 1 월 15 일 수정일 : 2021 년 2 월 2 일 게재승인일 : 2021 년 2 월 5 일 슬링을이용한교각운동시장력센서와경사계를이용한시각적피드백이근활성도에미치는영향 133
대한통합의학회지제 9 권제 1 호 Ⅰ. 서론 최근근육뼈대계질환에대한재활에서운동치료는근육의불균형을해소하고선택적훈련을통한기능향상에필수적인접근법중하나이다. 단순히약화된근육의근력강화에만초점을두지않고약화된근육을선택적으로강화하고운동조절능력향상을위한다양한방법이제시되고있다 (Arlotta 등, 2011; Selkowitz 등, 2013). 장시간앉아서작업하는시간이증가하고신체활동량이부족하여바른자세유지및신체균형자각능력등이부족한현대인에게이러한근육의불균형을해결하기위한접근은무엇보다필요하다 (Lee 등, 2011). 특히척추의안정화를위한운동치료는바른자세를유지할뿐만아니라만성적인요통을방지하기위한보존적요법으로활용되고있다 (Park, 2012). 척추안정화를위한운동방법으로는허리굽힘및폄운동으로엎드린자세, 똑바로누운자세, 교각자세등에서매트, 볼, 아령, 균형판을이용한운동형태까지다양하게제시되고있다 (Park & Kim, 2012). 그중교각자세는바로누운자세에서엉덩관절과무릎관절을굽힘하여허리만곡이감소하여허리가바닥에닿아허리통증이있는환자에게편안함과통증감소를가져오는자세라고할수있다 (Kavcic 등, 2004). 이러한교각자세에서수행되는교각운동은몸통의안정성증가와엉덩관절폄근강화를위하여적용되는대표적인몸통안정화운동으로 (Park & Kim, 2012), 척추주변조직에가해지는외력을흡수하고반복적인손상을예방하기위해수행되며 (Kisner & Colby, 2002), 척추및골반바닥근육과다리주변근육들의협응작용과상호보완작용및협응할수있도록재훈련시킬수있는대표적인저강도닫힌사슬운동으로알려져있으며, 허리통증환자의재활초기에주로적용할수있다 (Park & Lee, 2020). 교각운동의효과를비교하기위한선행연구들을살펴보면, 골반과엉덩관절의움직임에따른근활성도 (Kim & Hwang, 2013; Lee, 2012; Lee & Jeon, 2014), 무릎관절각도에따른근활성도 (Kim 등, 2010), 지지면에따른근활성도 (Jung & Kang, 2017) 등에관한연구들과슬링을이용한교각운동시에스트랩의위치변화와교각운동 자세변화에따른근활성도 (Kim & Park, 2016) 를알아보거나, 슬링과전신진동의결합된형태에대한연구 (Oh 등, 2018) 등이보고되었다. 교각운동은팔다리에체중을지지한상태에서닫힌사슬운동으로진행되기때문에몸통과다리의근육불균형이있을경우왼쪽과오른쪽의대칭적인움직임을유도하는데어려움이있다. 그러므로시각적피드백을적용하여정확한운동을수행할수있도록훈련하는것이무엇보다중요하다. 시각적피드백훈련은운동을수행하는동안실시간으로시각적정보를제공하여독립적으로정확한운동을수행하도록도와주는훈련으로대칭적인자세조절능력향상과동기부여증진에효율적인방법으로알려져있다 (Christiansen 등, 2015). 최근교각운동시시각적피드백을적용한연구에는양다리에부하되는정량적인인장력값을통한시각적피드백훈련에대한연구 (Kim, 2018), 초음파나레이저포인트를이용한시각적피드백을적용한연구 (Park & Kim, 2019) 등을들수있다. 정교하고대칭적인교각운동을수행하기위한시각적피드백의종류에따른몸통과다리의근활성도를비교한연구들은부족한실정이다. 그러므로본연구에서는장력센서를이용하여양쪽다리체중부하에대한시각적피드백과경사계를이용한골반기울기에대한시각적피드백을적용하였을때각각의시각적피드백에따라몸통폄근과엉덩관절폄근의활성도에어떠한차이가있는지비교하여보다효과적인시각적피드백을제안하고자하였다. Ⅱ. 연구방법 1. 연구대상본연구의대상자는부산광역시에소재한 D 대학재학생중연구의취지를알고자발적으로참가하고자하는건강한성인 22 명대상으로하였다. 실험에영향을미칠수있는팔다리질환이없는자, 슬링교각운동이가능하며의사소통이가능한자로선정하였다. 실험전에대상자들에게연구의취지를설명하고참여동의를 134 Journal of The Korean Society of Integrative Medicine Vol.9 No.1
권유정 송민영 얻었으며, 대상자의일반적인특성은다음과같다 (Table 1). Table 1. General characters of subjects (n=22) Variables Mean±SD Age (years) 24.27±3.65 Height ( cm ) 166.95±6.95 Weight ( kg ) 66.68±14.24 Male/ Female 9/13 덩이주름사이의중간지점에, 큰볼기근은근육과평행하게넙다리뼈큰돌기와제 2 엉치뼈추체사이의중간지점으로하였다 (Fig 2). 각근육의활동전위를표준화하기위하여 Kendal 등 (2005) 이제안한방법으로최대수의적등척성수축 (maximal voluntary isometric contraction; MVIC) 를측정하였으며, 각운동동안등척성수축을 5 초간실시하여처음 1 초와마지막 1 초씩을제외한 3 초의평균신호량을 % 최대수의적등척성수축 (% MVIC) 으로활용하였다. 2. 측정장비 양쪽척추세움근, 큰볼기근과뒤넙다리근의근활성도를측정하기위해표면근전도장비 (Ultioum EMG system, Noraxon, USA) 를사용하였다 (Fig 1). 전극을부착하기전근전도신호에대한피부의저항을최소화시키기위해체모를제거하고, 전극의피부부착부위를알코올솜을이용해깨끗하게닦아주었다. 양쪽척추세움근은허리뼈 1 번의가시돌기에서 2 cm수평하게떨어진지점에부착하였고. 뒤넙다리근은무릎의주름과엉 Fig 1. Surface EMG Fig 2. Electrode attachment position A: erector spinae, B: hamstring muscles 3. 실험방법 1) 장력센서시각적피드백을이용한교각운동 장력센서시각적피드백을이용한교각운동은장력 센서가부착된슬링에양쪽다리를걸고실시간수집된정보를시각적으로제공하는태블릿 PC 를대상자의시야앞에고정하여교각운동시시각적피드백이제공되도록시행하였다 (Fig 3). 장력센서는교각운동동안양쪽다리체중부하에따라늘어나는장력값을객관적이 슬링을이용한교각운동시장력센서와경사계를이용한시각적피드백이근활성도에미치는영향 135
대한통합의학회지 제9권 제1호 고 정량적으로 실시간 시각적으로 제공하여, 대상자가 왼쪽과 오른쪽 불균형을 맞추어 대칭적인 교각운동을 수행할 수 있도록 하였다. 장력센서 시각적 피드백을 이 용한 교각운동은 5 초씩 총 3 번 반복하여 시행하였다 (Park & Kim, 2019)(Fig 4). Fig 5. Clinometer program Fig 3. Tension sensor program Fig 6. Bridge exercise with clinometer 4. 연구절차 연구대상자는 바로 누운 자세에서 시각적 피드백 없 이 슬링을 이용한 교각운동, 장력센서를 이용한 교각운 동, 경사계를 이용한 교각운동을 시행하였으며, 교각운 Fig 4. Bridge exercise with tension sensor 동의 순서는 제비뽑기를 통해 무작위로 진행되었다. 교 각운동 시 등척성 수축을 유지하는 동안 오른쪽과 왼쪽 2) 경사계 시각적 피드백을 이용한 교각운동 몸통과 엉덩관절 폄근의 활성도를 측정하였다. 실험에 교각운동 시 양쪽 골반을 수평으로 유지하기 위한 시 들어가기에 앞서 교각운동과 시각적 피드백 장치를 숙 각적 피드백는 디지털 경사계를 이용하였으며, 양쪽 앞 지할 수 있도록 5 회의 연습 동작을 수행하였다. 이후 연 위엉덩뼈가시(ASIS)를 가로질러 경사계를 부착하여 골 구대상자가 충분히 준비가 되었을 때 실시하였다. 슬링 반 기울기를 블루투스로 실시간 태블릿 PC 로 전달하여 로프 높이는 대상자가 바로 누운 자세에서 무릎을 90 시각적 피드백을 제공하여 교각운동을 수행하도록 하였 굽혔을 때의 높이로 정하였다(Kim, 2018). 동작 순서는 다(Fig 5). 경사계 시각적 피드백을 이용한 교각운동 또 좌우 발목을 슬링 스트랩 위에 올려놓고 무릎을 아래로 한 5 초씩 총 3 번 반복하여 시행하였다(Fig 6). 누르면서 펴고, 골반을 바닥에서 들어 올려 어깨관절, 엉 덩관절, 무릎관절 및 발목관절이 직선이 되도록 들어 올 리게 하였다. 시각적 피드백을 통한 교각운동은 수행하 136 Journal of The Korean Society of Integrative Medicine Vol.9 No.1
권유정 송민영 기전양쪽균형을나타내주는태블릿 PC 화면에대해이해할수있도록충분히설명하고교각운동을수행하였다. 모든대상자는등척성교각자세를 5 초간유지하였으며, 총 3 회반복하여수행하여이들의평균값을최종분석하였다. 실험동안피로를최소화하기위해각회당 1 분간의휴식시간을주면서측정하였다 (Kim, 2018). 4. 자료처리및분석방법시각적피드백에따른근활성도를분석하기위하여 SPSS version 26 을사용하였다. 연구대상자들에대한일반적인특성을분석하기위해기술통계를사용하여평균과표준편차를산출하였으며시각적피드백에따른교각운동시양쪽근활성도차이를비교하기위하여 Repeated ANOVA( 반복측정분산분석 ) 를사용하였다. 사후분석을위해 Bonferroni 검증을실시하였고통계적유 의수준은 0.05 로설정하였다. Ⅲ. 결과 척추세움근의왼쪽과오른쪽근활성도차이값이통계학적으로유의한변화를보이지않았지만, 시각적피드백을주지않았을때양쪽근활성도차이가가장크게나타났고경사계를이용한시각적피드백을적용하였을때가장작게나타났다. 큰볼기근의왼쪽과오른쪽근활성도차이또한통계학적으로유의한차이를보이지않았으나시각적피드백을적용하지않았을때차이가크게나타났다. 뒤넙다리근의왼쪽과오른쪽근활성도차이는통계학적으로유의한차이를보였으며, 사후검증결과시각적피드백을적용하지않았을때보다장력센서를이용한시각적피드백을적용하였을때양쪽근활성도차이는통계학적으로유의하게감소하였다 (Table 2). Table 2. Differences in muscle activity of muscles according to visual feedback (unit : %MVIC, n=22) Muscles Bridge exercise with sling Bridge exercise with tension sensor Bridge exercise with clinometer p Erector spinae 7.51±7.89 6.10±5.09 5.68±4.51 0.30 Gluteus maximus 3.60±3.18 3.20±3.13 3.49±2.70 0.61 Hamstring 9.09±8.80 a 4.25±3.28 b 6.66±7.13 ab 0.00 a,b Different superscripts indicate significant differences (p<0.05) Ⅳ. 고찰 본연구는장력센서를이용하여양쪽다리체중부하에대한시각적피드백과경사계를이용한골반기울기에대한시각적피드백을적용하여각각의시각적피드백에따라몸통폄근과엉덩관절폄근의활성도차이를알아보고자하였다. 교각운동은척추세움근과뒤넙다리근과같은표재성근육과뭇갈래근, 큰볼기근과같은심부근육의협응성을 증진하여몸통의안정성과근력증진을위한목적으로널리사용되는중재방법중하나이다 (O Sullivan & Schmiz, 2007). 교각운동을적용할때는척추심부근육의동시수축을통해척추와골반의올바른정렬과중립자세의유지하는것이중요한데, 정확한동작이이루어지지않을때과도한허리앞굽음이유발되거나, 몸통근육과다리근육의비대칭을초래할수있다 (Stevens 등, 2006). 그러므로대상자의수준에따라운동난이도를조절하여정교하게적용되는것이무엇보다중요하기 슬링을이용한교각운동시장력센서와경사계를이용한시각적피드백이근활성도에미치는영향 137
대한통합의학회지제 9 권제 1 호 때문에다양한도구들을접목한교각운동과피드백을적용한운동효과를비교한연구들이보고되었다. 그중슬링을이용한교각운동은볼이나바닥에서실시하는교각운동보다척추세움근과뭇갈래근의근활성도를유의하게증가시켰다고보고하였으며 (Kang 등, 2012), 허리통증환자의근력과고유수용성감각증진에도효과적이라고보고하였다 (Dannelly 등, 2011). 이에본연구에서도슬링을이용한교각운동을적용하여시각적피드백의유무와종류에따른몸통과엉덩관절폄근의왼쪽과오른쪽근활성도의차이를비교하였다. 본연구결과시각적피드백을이용한교각운동을실시하였을때시각적피드백을적용하지않은교각운동보다몸통과엉덩관절폄근의양쪽근활성도차이가감소하는경향을보였으며특히뒤넙다리근은장력센서를이용한시각적피드백을적용하였을때적용하지않았을때보다양쪽근활성도의차이가유의하게감소하였다. 이러한연구결과는 Kim(2018) 의연구에서와같은결과로장력센서와경사계를이용한시각적피드백을적용한교각운동이왼쪽과오른쪽대칭적인움직임을유도하는데효과적임을시사한다. 시각적피드백을적용한교각운동중경사계를이용한골반기울기에대한시각적피드백은척추세움근의양쪽근활성도차이가감소하는경향을보이고, 장력센서를이용한하지체중부하에대한시각적피드백은엉덩관절폄근의양쪽근활성도차이가감소하는경향을보였다. 이러한결과는시각적피드백장치의위치와종류에따라조절하고자하는움직임이달라질수있기때문이다. 장력센서를이용한시각적피드백을적용할때는양쪽다리에누르는장력을동일하게주기위해노력하기때문에척추세움근, 큰볼기근보다뒤넙다리근에대칭적인근활성도를유발하는데효과적이라생각되며, 경사계를이용한시각적피드백은골반기울기에대한시각적피드백으로뒤넙다리근과큰볼기근보다척추세움근에대칭적인근활성도를유발할수있다고생각된다. 따라서슬링을이용한교각운동적용시양쪽다리의체중부하에대한대칭적인조절이필요할경우장력센서를이용한시각적피드백을적용하는것이효과적이라고사료된다. 본연구의제한점으로는연구대상자수가다소적고, 건강한대학생을대상으로하였으므로실제요통이있는환자에게일반화시켜적용하는데제한적이다. 향후연구에서는이러한제한점들을고려하여실제요통이있는환자를대상으로다양한시각적피드백을이용하여증상의변화를분석한추가적인연구가필요할것으로사료된다. Ⅴ. 결론 본연구는건강한대학생 22 명을대상으로슬링을이용한교각운동시장력센서와경사계를이용한시각적피드백을적용하였을때척추세움근, 큰볼기근, 뒤넙다리근의근활성도차이를비교하였다. 그결과, 시각적피드백을제공하였을때양쪽근육활성도차이가감소하는경향을보였으며, 경사계시각적피드백은양쪽척추세움근의활성도차이가가장감소하였고, 장력센서시각적피드백은양쪽뒤넙다리근에서유의하게감소하였다. 그러므로허리근육의불균형은경사계시각적피드백을, 다리근육의불균형은장력센서시각적피드백을적용하는것이효과적이라사료된다. 참고문헌 Arlotta M, Lovasco G, McLean L(2011). Selective recruitment of the lower fibers of the trapezius muscle. J Electromyogr Kinesiol, 21(3), 403-410. https://doi.org/ 10.1016/j.jelekin.2010.11.006. Christiansen CL, Bade MJ, Davidson BS, et al(2015). Effects of weight-bearing biofeedback training on functional movement patterns following total knee arthroplasty: A randomized controlled trial. J Orthop Sports Phys Ther, 45(9), 647-655. https://doi.org/ 10.2519/jospt.2015.5593. Dannelly BD, Otey SC, Croy T, et al(2011). The effectiveness of traditional and sling exercise strength training in women. J Strength Cond Res, 25(2), 138 Journal of The Korean Society of Integrative Medicine Vol.9 No.1
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