목적 : 본 연구는 일상생활활동 훈련프로그램을 적용하여 엉덩관절치환술 환자의 일상생활 수행 능력과 작 업치료 인식도 및 만족도에 미치는 효과를 알아보고자 하였다. 연구방법 : 본 연구는 엉덩관절치환술을 받은 노인 40명(실험군 20명, 대조군 20명)이었고, 연구 설계는 비동등성 대조군 전후시차 설계를 적용하였다. 중재는 주 5회 30분씩, 4주간, 총 20회기를 실시하였다. 결과 : 일상생활활동 훈련프로그램 실험군은 일상생활활동 비디오 시청 대조군과 비교하여 일상생활 수행 능력과 작업치료 인식도 및 만족도에서 유의한 차이를 나타냈다. 결론 : 본 연구의 일상생활활동 훈련프로그램은 엉덩관절치환술을 받은 노인들의 일상생활 수행 능력과 작 업치료 인식도 및 만족도를 향상시키어 작업치료의 전문성과 가치를 높였다. 이에 엉덩관절치환술 환자 의 재활을 위한 작업치료 중재 프로그램으로 제안하는 바이다.

Background: Gluteus medius muscle is important for the stability of hip joint. The sufficient core stability can be contributed to the performance of gluteus medius muscle in standing position. In addition, the external support may affect core stability in standing position. Objects: The purpose of this study was to investigated the effectiveness of the external support on the strength and muscle activity of hip abductor muscle during hip abduction in standing position in subjects without core stability. Methods: Fifteen subjects participated in this study. The subjects were evaluated by using the double-leg lowering with bent knees to measure the core stability. The strength and muscle activity of hip abductors was measured in standing position with the condition with and without external support using the tensiometer sensor and the surface electromyography. The paired t-test was used to investigate the difference between hip abductor strength and activity according to external support. The level of statistical significance was set at α = 0.05. Results: The hip abductor strength and muscle activity of gluteus medius muscle with external support were significantly greater than those without external support during hip abduction in standing position (p < 0.05). Conclusion: During hip abduction in standing position, the external support may be contributed to the improvement of the hip abductor strength and muscle activity of gluteus medius especially in the subjects without core stability.

Background: Muscle activities of gluteus maximus (GM) and hamstring (HAM) have important roles in the stability and mobility of the hip joint during various functional activities including bridge and prone hip extension exercises. Objects: The purpose of this study is to investigate muscle activities of GM, multifidus (MF) and HAM during three different bridge exercises in healthy individuals. Methods: Twenty healthy subjects were participated. Electromyography device was used to measure muscle activities of GM, MF and HAM. Each subject was asked to perform three different bridge exercises with hip abduction (0°, 15°, 30°) in random order. One-way repeated measures analysis of the variance and a Bonferroni post hoc test were used. Statistical significance was set at α = 0.01. Results: The muscle activity of GM was significantly different among three conditions (hip abduction 0°, 15°, 30°) (adjusted p-value [Padj] < 0.01). The muscle activity of GM was significantly greater during bridge exercise with hip abduction 30° compared to 0° and 15° (Padj < 0.01). There was no significant difference in the muscle activity of MF and HAM muscle (Padj > 0.01). The ratio of muscle activity (ratio = GM/HAM) during bridge exercise with hip abduction 30° was significant greater compared to the hip abduction angles 0° and 15° (Padj < 0.01). Conclusion: Bridge exercise with hip abduction 30° can be recommended to selectively facilitate the muscle activity of GM and improve the ratio of muscle activity between GM and HAM.

이 연구의 목적은 6주간의 엉덩관절 강화 훈련이 근력, 동적 자세 조절 및 하체 손상 준거에 미치는 영향을 보고자 하였다. 운동선수 20명을 운동군과 통제군으로 분류하여, 운동군은 주 3회, 60분, 6주간 엉덩관절 강화훈련을 하였다. 이 연구의 측정 변인은 유연성, 근력, 동적 자세 조절 및 하체 부상 준거로 하였다. 연구 결과 유연성에서 운동의 효과가 유의하지 않았으나 배근력에서는 유의하였다. 동적 자세 조절 결과, 좌·우 후방 가쪽 및 안쪽에서 운동의 효과가 유의하였다. 또한 종합점수에서도 운동의 효과가 유의하였고, 좌·우 다리 간의 차이는 없었다. 결론적으로 엉덩관절 강화 운동은 근력과 동적 자세 조절 능력의 증가와 하체 손상의 우려는 감소시키는 것으로 나타났다.

Background: Improvement of the lumbo-pelvic stability can reduce the compensatory action of the erector spinae (ES) during prone hip extension (PHE). Furthermore, the application of abdominal drawing-in (ADI) maneuver increases the action of gluteus maximus (GM) and decreases the action of ES during PHE by improving the lumbo-pelvic stability. However, the post-ADI exercise effects on PHE, not the real-time application of ADI maneuver, has not been studied. Objects: This study is aimed at investigating the post-ADI exercise effects on the muscle activities of GM and ES during PHE. Methods: A total of 24 female adults participated in the study, and they were divided into two groups: Those with normal abdominal muscles (n1=12) and those with weak abdominal muscles (WA) (n2=12). Before the intervention, the subjects’ GM and ES muscle activities during PHE were measured. Subsequently, the two groups were asked to perform the ADI exercise for 10 minutes. After the ADI exercise, the GM and ES activities were equally measured during PHE. Results: The comparison result of the ES muscle activities before intervention shows a significant difference between the two groups (p<.05); the WA group showed higher muscle activities than the normal group. For the within-group comparison, the muscle activities of the ES in the WA group significantly decreased after the ADI exercise (p<.05). For the GM muscle activity, no significant difference was observed in all comparisons (p>.05). For the changes in muscle activities before and after the ADI exercise, a significant difference exists between the two groups only for the changes in ES activities (p<.05); WA group exhibits higher changes than the normal group. By contrast, no significant difference exists between the two groups for the changes in GM activities (p>.05). Conclusion: After the ADI exercise, the compensatory action of ES in the female adults with WC is implied to decrease during PHE.

Background: A limited hip rotational range of motion (ROM) has been considered to be one of characteristics of low back pain (LBP) in athletes. Although LBP frequently occurs in jiu-jitsu athletes, no previous has compared hip rotational ROM between jiu-jitsu athletes with and without LBP. Objects: The aim of the study was to compare ROM for hip internal rotation (IR) and external rotation (ER), and total hip rotation between jiu-jitsu athletes with and without LBP. Methods: Jiu-jitsu athletes were recruited for the LBP group (n1=15) and control group without LBP (n2=15). IR, ER, and total rotational range of hip joint were measured using a goniometer. Analysis of variance was used to compare the ROM between groups and sides. Results: The LBP group showed a significantly lower range of passive hip IR, passive total rotation, active IR, active ER, and active total rotation than the control group (p<.05). Dominant side of passive hip IR and active IR had a significantly lower ROM than non-dominant side (p<.05). In passive ER ROM, non-dominant side was significantly greater than dominant side (p<.05). Conclusion: Compared to jiu-jitsu athletes without LBP, athletes with LBP exhibit a loss of hip rotational ROM. Based on these results, clinicians and athletic trainers should measure hip rotational ROM when designing the management plan for jiu-jitsu athletes with LBP.

Background: Improvement of lumbo-pelvic stability can reduce the compensatory action of the quadratus lumborum (QL) and selectively strengthen the gluteus medius (GM) during side-lying hip abduction (SHA). There are abdominal draw-in maneuver (ADIM) and abdominal bracing (AB) as active ways, and pelvic compression belt (PCB) as a passive way to increase of lumbo-pelvic stability. It is necessary to compare how these stabilization methods affect the selective strengthening of the GM. Objects: To investigate the effects of ADIM, AB, and PCB during SHA on the electromyography (EMG) activity of the GM, QL, external oblique (EO) and internal oblique (IO), and the GM/QL EMG activity ratio. Methods: A total of 20 healthy male adults participated in the study. The subjects performed three conditions in side-lying in random order: SHA with ADIM (SHA-ADIM), SHA with AB (SHA-AB), and SHA with PCB (SHA-PCB). To compare the differences among the three conditions, the EMG activities of the GM, QL, EO and IO, and GM/QL EMG activity ratio were analyzed using one-way repeated ANOVA. Results: The EMG activity of the QL was significantly higher in SHA-AB than in SHA-ADIM and SHA-PCB. The GM/QL activity ratio was significantly higher in SHA-PCB than in SHA-ADIM and SHA-AB. In addition, the figure for SHA-ADIM was significantly higher than that for SHA-AB. In the case of the EO, the figure for SHA-AB was significantly higher than corresponding values for the other two conditions. The figure for SHA-ADIM was significantly higher than that for SHA-PCB. The EMG activity of the IO was significantly higher in SHA-AH than in SHA-PCB. Conclusion: It can be suggested that wearing the PCB can more selectively strengthen the GM than to perform ADIM and AB during SHA. In addition, the ADIM can be recommended when there is a need to strengthen abdominal muscles during SHA.

Background:To improve lumbo-pelvic stability, passive support devices (i.e., a pelvic belt) are recommended clinically. Nevertheless, to understand the influence of passive support on lumbo-pelvic stability, it is necessary to examine the influence of a pelvic belt on the abdominal and hip abductor muscles.Objects:To examine the effects of a pelvic belt on the forces of the hip adductor and abductor muscles and activity of the abdominal muscles during isometric hip adduction and abduction.Methods:This study recruited 14 healthy men. All subjects performed isometric hip adduction and abduction with and without a pelvic belt in a neutral hip position. Load cells, wrapped with a non-elastic belt, were placed above the medial and lateral malleoli of the dominant leg to measure the muscle forces of the hip adductors and abductors, respectively. The forces of the hip adductors and abductors were measured using a load cell during isometric hip adduction and abduction, while the electromyographic activities of the bilateral rectus abdominis, internal oblique, and external oblique muscles were measured.Results:The forces generated by the hip adductors and abductors were significantly greater with the pelvic belt than without (p<.05). No significant differences in abdominal muscle activities between the two conditions were found (p>.05).Conclusion:These findings suggest that use of a pelvic belt could lead to effective strengthening exercise of hip muscles in individuals with sacroiliac joint pain.

This study investigated the effect of a load of 15% body weight on trunk, pelvis and hip joint coordination and angle variability in subjects with and without chronic low back pain (CLBP) during an anterior load carriage task. Thirty volunteers participated in the study (15 without CLBP, 15 with CLBP). All participants were asked to perform an anterior carriage task with a load of 15% body weight. The outcome measures included the means and standard deviations for measurements of three-dimensional coordination and angle variability of the trunk, pelvis and hip joint. As CLBP patient group .06, control group .70, the correlation coefficient between the groups showed a significant difference only in trunk-pelvic in the sagittal plane (p<.05). Angle variability of CLBP patient group increased significantly in the trunk in frontal plane, the pelvis in all sagittal plane, frontal plane, transverse plane, and the hip in sagittal plane, the hip in frontal plane than angle variability of control group (p<.05). This results mean that the CLBP patient group showed a disconnected coordination pattern in the trunk-pelvis in the sagittal plane, an increased pelvic angle variability in all three planes, and hip angle variability in the sagittal, and frontal planes. The CLBP patient group may have developed a compensatory movement of the pelvis and hip joint arising from the changed stability due to the abnormal coordination patterns of the trunk-pelvic in the sagittal plane. Therefore, CLBP symptoms can potentially worsen in the pelvis and adjacent hip joint in CLBP patients who perform weight-related behaviors in their daily lives. Further research is needed to determine the three-dimensional characteristics of the electromyography and neuromuscular aspects of subjects with CLBP.

Although there have been various studies related to the body's movement from a sitting to a standing position (sit-to-stand task), there is limited information on the kinematic changes on the frontal and transverse planes. The purpose of this study was to ascertain how pelvic tilt affects kinematic changes in the frontal and transverse planes in the hip and knee joints during a sit-to-stand task. For this study, 33 healthy participants (13 female) were recruited. Each participant rose from a sitting to a standing posture at his or her preferred speed for each of three different pelvic tilt trials (anterior, posterior, and neutral), and the measured angles were analyzed using a 3-D motion analysis system. A one-way repeated measure analysis of variance was performed with Bonferroni's post hoc test. In addition, an independent t-test was carried out to determine the sex differences in hip and knee joint kinematic changes during the sit-to-stand tasks. The results were as follows: 1) The hip and knee joint angle in the frontal and transverse planes showed a significant difference between the different pelvic tilt postures during sitting in the pre-buttock lift-off phase (pre-LO) (p<.05). Compared to the posterior pelvic tilt posture, the anterior pelvic tilt posture involved significantly greater hip joint adduction and internal rotation, knee joint adduction, and reduced internal rotation of the knee joint. 2) Sex differences were found with significant differences for males in the initial and maximal angles in the frontal plane of the hip and knee joint (p<.05). Females had a significantly smaller initial abduction angle of the hip joint and a significantly greater maximal angle of the hip adduction joint. These results suggest that selecting a sit-to-stand exercise for pelvic tilt posture should be considered to control abnormal movement in the lower extremities.

The effects of an abdominal drawing-in maneuver (ADIM) using a pressure bio-feedback unit (PBFU) were compared to the effects of a pelvic belt (PB) on the muscle activities of the hip and back extensor muscles during hip extension in the prone position. Fifteen healthy male participants all performed prone hip extensions under three conditions: 1) preferred hip extension (PHE), 2) performing an ADIM, and 3) using a PB. The muscle activities of the erector spinae, the gluteus maximus, and the medial hamstring on the right side were recorded by surface electromyography. The muscle activity of the erector spinae was significantly lower while performing an ADIM during prone hip extension than during PHE or with a PB (p<.05). Gluteus maximus muscle activity was significantly higher while performing an ADIM (p<.05). No significant difference was found for the medial hamstring muscle among the three conditions (p>.05). We concluded that the internal stabilization of the pelvis and lumbar spine afforded by the ADIM using a PBFU could be more effective than the external stabilization provided by a PB in terms of increasing selectively gluteus maximus activation during prone hip extension.

The purpose of this study was to examine the effect of the hip internal rotation on knee extensor and hip abductor electromyographic (EMG) activity during stair up and stair down mobility. Eighteen healthy subjects were recruited. All subjects performed stair up and down movements on a step of 30cm height while maintaining the hip in neutral (condition 1) and hip in internal rotation (condition 2). Surface EMG activity was recorded from five muscles (gluteus maximus, vastus lateralis (VL), vastus medialis oblique (VMO), posterior gluteus medius (Gmed), and tensor fascia latae (TFU)) and hip internal rotation angle was measured using a three dimensional motion analysis system The time period for stair up and down was normalized using the MatLab 6.5 program, and EMG activity was normalized to the value of maximal voluntary isometric contraction (%MVIC). The EMG activities according to the hip rotation (neutral or internal rotation) during the entire time period of stair up and down in each phase were compared using a paired t-test. During the entire period of stair up, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). During the entire period of stair down, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). However, the EMG activities of the other muscles were not significantly different between the conditions (p>.05). These results suggest that the stair up and down maintaining hip internal rotation was could be a contributing factor on patellar lateral tracking.

The purpose of this study was to examine inter- and intra-examiner reliability of the sacroiliac joint (SIJ) anatomical landmarks palpation. Two physical therapists and one doctor specializing in rehabilitation examined 22 asymptomatic subjects. They examined anterior superior iliac supine (ASIS), posterior superior iliac supine (PSIS) and iliac crest (IC). For the assessment of intra-examiner reliability, 3 examiners repeated the measurements 3 times over a 2-week interval. Kappa (Kg) yielded intra-examiner reliability that ranged between slight to fair for the ASIS (Kg=.06 to .26; mean Kg=.19), and slight for the PSIS(Kg=-.04 to .18; mean Kg=.07) and slight to fair for the IC (Kg=.06 to .32; mean Kg=.21). Inter-examiner reliability was slight (ASIS Kg=.13; PSIS Kg=.05; IC Kg=.14). These results suggest that the reliability of the assessing SIJ anatomical landmarks using palpation and observation as an indication of SIJ dysfunction still remains questionable. Before this test can be relied upon as an accurate indicator of SIJ dysfunction, it must undergo further research. This further research needs to examine not only reliability, but also validity, sensitivity and specificity.

This study examined the muscle recruitment order during extension of the hip joint in normal subjects, and evaluated whether the external support obtained from wearing a lumbosacral corset had an effect on muscle recruitment leading to increased lumbar stability. The subjects were 40 normal adults (32 male, 8 female) with no history of low back pain and no pathological findings in the nervous or musculoskeletal systems. All subjects extended their hip joints under 3 positions (prone, sidelying, standing). During extension, the onsets of contraction of the rectus abdominis, gluteus maximus, and semitendinosus muscles were measured. Electromyographic activity was measured using a surface electrode, and the muscle contraction onset time was designated as the point exceeding a threshold of 25 ms, using a mean plus twice of the standard deviation. To compare the average order of muscle contraction onset time, a Freedman two-way analysis of variance by ranks was used. The relative difference between muscle contraction onset time wearing and not wearing a lumbosacral corset was measured using a paired t-test. A difference in the average muscle contraction onset order for the rectus abdominis, gluteus maximus, and semitendinosus muscles was observed (p<.05) among three positions. However, wearing a lumbosacral corset did not. change the contraction order. In addition, wearing a lumbosacral corset produced a significant difference (p<.05) in the relative onset time between the rectus abdominis and gluteus maximus in the standing position, but no difference was observed for the other muscles or positions. In the future, patients suffering from low back pain should be compared with normal subjects to determine the effectiveness of a lumbosacral corset in changing muscle recruitment order.

본 연구는 엉치엉덩관절의 골절, 탈구, 엉치엉덩 퇴행성관절염 진단을 위한 가장 좋은 영상을 얻기 위해 골반 팬톰과 엑스선관을 각도 변화를 주어 엉치엉덩관절의 Joint space 가장 잘 나타내는 영상을 얻어 방사선사에게 주관적 평가를 받아 보았다. 평가 결과 결론으로 엉치엉덩관절염과 퇴행성 관절염 발견을 위한 단순촬영에서는 엎드린상태에서 촬영은 검사반대쪽 엉덩이를 25°~30° 들어올리고 엑스선관을 앞엉덩뼈가시에서 2.5 cm 안쪽을 지나는 시상면에 대해 수직촬영 하고 누운자세에서는 검사쪽 엉덩이를 25°~30° 들어올리고 위앞엉덩뼈가시가 중앙에서 위앞엉덩뼈가시가 중앙에 대해 엑스선관 각도를 발쪽으로 5° 촬영 하며 반드시 양쪽 엉치엉덩관절후전사방향(RAO,LAO) 및 전후사방향(RPO, LPO) 모두 촬영을 하게 되면 관절염 진단을 내리는데 있어 많은 도움이 되리라 본다.

본 연구는 엉덩관절 정면 검사 시 격자 제거와 관전압, Cu Filter의 조합을 이용하여 환자의 피폭을 감소 하고자 시행하였다. 엉덩관절 정면 검사법을 대상으로 격자의 사용과 제거 상태에 따라 각각 관전압을 60~ 90 kV로 변화시키고 Cu Filter를 0.1~0.3 mm로 추가시켜 입사선량, 유효선량을 측정하고 영상의 진단적 가치를 평가하였다. 격자를 사용하고 관전압 60 kV, none filter에서 입사선량은 4.77 mGy로 가장 높은 측정치를 나타냈고 격자를 사용하지 않고 90 kV, 0.3 mm Cu filter 조건에서의 입사선량은 0.14 mGy로 가장 낮았으며 약 34배의 차이를 나타냈다. ICRP Pub. 60을 기준으로 70 kV에서 고환, 난소의 유효선량은 격자를 사용 했을 경우 0.255 mSv, 격자를 제거하였을 경우에는 0.049 mSv로 약 5.2배의 차이를 나타냈다. ICRP Pu b. 103을 기준으로 70 kV에서 고환, 난소의 유효선량은 격자를 사용했을 경우 0.090 mSv 격자를 제거하였 을 경우에는 0.020 mSv로 약 4.5배의 차이를 나타냈다. 격자를 사용하였을 경우의 노광지수는 671~782, 격 자를 제거하였을 경우에는 513~606 사이로 적정 노출조건이었으며 영상평가결과 모두 진단적 가치가 있는 영상으로 나타났다. 따라서 엉덩관절 정면 검사 시 격자를 제거하고 관전압을 높이고 Cu Filter를 추가시켜 촬영하면 환자의 피폭을 줄일 수 있을 것이다.