Background: Floor sit-to-stand (FSTS) places a higher load on the knees than chair sit-to-stand (CSTS). It is difficult to experimentally measure the maximum knee joint force during sit-to-stand motion. Objectives: This study's objectives were twofold: firstly, to quantify the differences in knee joint force between FSTS and CSTS, and secondly, to identify the angles at which the maximum knee joint force occurs during these motions. Design: Computer simulation study. Method: This study was conducted on 4 adult male subjects in their 20s. The FSTS and CSTS motion trajectories of the subjects were acquired using 3- dimensional motion analysis equipment. Using these, the human body mass model of the program was modified according to the subject, and the knee joint force was calculated. Also, the knee angle at which the maximum knee joint force occurs was found. Results: When the subjects performed the FSTS motion, a knee joint force that was up to about 160% higher than that of the CSTS motion occurred, and the angle at which the maximum knee joint force occurred was different between the sitting sequence(FSTS motion: 56~58 degree, CSTS motion: 78~82 degree) and the standing sequence(FSTS motion: 98~100 degree, CSTS motion: 70~74 degree). Conclusion: By comparing FSTS motion with CSTS motion, it is expected that it can be used as a quantitative guide for the effect of motion similar to FSTS motion on the knee when prescribing exercise for the elderly or patients with knee-related lesions.

본 연구의 목적은 허벅다리걸기 시 유도 선수들의 무릎 관절 부상 경험이 운동학적 요인과 압력 중심 요인들에 미치는 영향을 분석하는데 있었다. 본 연구에는 허벅다리걸기를 특기로 하는 오른손잡이 남 자 대학 유도 선수 중 최근 2년 이내 무릎 관절 부상 경험이 있었던 13명(연령, 20.69.1±0.75 세; 신장, 172.85±4.81 cm; 체중, 74.92±5.51 kg; 경력, 8.92±0.95 세)과 상해 경험이 없었던 13명(연령, 21.08.1±0.76 세; 신장, 172.54±6.32 cm; 체중, 76.62±9.09 kg; 경력, 9.46±0.94 세)이 두 그룹으로 나 뉘어 피험자로 참여하였다. 두 그룹의 발목, 무릎, 힙 관절각도 변인과 압력 중심 가동범위와 속도 요인들 의 차이를 분석하였다. 그 결과, 부상 경험 그룹은 부상 경험이 없었던 그룹에 비해 허벅다리걸기 기술 발 휘 시 한발 지지 구간 중 E3에서의 무릎 관절 굴곡 각도와 E4에서의 힙 관절 신전 각도에서 작은 수치를 나타내었다. 더불어 부상 경험 그룹은 부상 경험이 없었던 그룹에 비해 한발 지지 구간에서 압력 중심 가동 범위와 전방 이동 속도 요인에서도 낮은 수치를 나타내었다.

Background: If the weakness of the knee muscles persists and there is pain at the same time, lumbar mobilization can be used. Objectives: This study investigated the immediate effect of lumbar joint mobilization on postural sway and knee pain in elite volleyball players. Design: Randomized controlled trial. Methods: Twelve male elite volleyball players were recruited for this study. Lumbar joint mobilization was performed in all study subjects. Evaluation items were static and dynamic balance and knee pain change. All evaluations were made immediately after the intervention. Results: C90 area, trace length, and STD Y deviation in the open static balance were significantly decreased after intervention (P<.05). C90 area, trace length, Velocity, STD X deviation, and STD Y deviation in static balance with closed eyes decreased significantly after intervention (P<.05). In dynamic balance, the left and right side. COPs were significantly increased. Pain significantly decreased after intervention (P<.05). Conclusion: This study found that lumbar joint mobilization is an effective method for improving postural sway and knee pain in elite volleyball players.

병렬영상기법인 SENSE 기법은 슬관절 자기공명영상의 검사 시간을 획기적으로 단축할 수 있다. 그러나 기법 적용 시 SENSE factor를 증가시키면 영상에 인공물의 발생이 증가하는 문제점이 있어 개선을 위해 본 연구에서는 최소의 시간이 소요되면서 인공물이 발생하지 않는 최적의 SENSE factor를 제시하고자 하였다. 연구 방법은 SENSE factor 1.0을 기준 으로 0.5 간격씩 5.0까지 변화시켜 팬텀 실험과 임상실험을 시행하였다. 3.0T 초전도 자기공명영상장치와 dS Knee 코일 을 사용하여 T1, T2 강조영상을 획득하였으며, 영상의 비교평가는 임상 경력 10년 이상의 방사선사 10명이 5점 척도로 평가한 후, 일원배치 분산분석과 사후분석을 통해 유의한 차이가 있는지 판단하였다. 연구 결과 팬텀 실험은 T1, T2 강조 영상 모두 SENSE factor를 1.5 이하로 하였을 때 기준 영상과 차이가 없었으며, 임상실험은 SENSE factor를 2.0 이하로 하였을 때 기준 영상과 차이가 없었다. 결론적으로 슬관절 자기공명영상 시 검사 시간을 단축하면서 인공물이 발생하지 않는 최적의 SENSE factor는 팬텀 실험의 경우 1.5, 임상실험의 경우 2.0이 적정하리라 사료된다.

Background: Bird dog exercise (BDE) is one of the lumbar stabilization exercises that rehabilitate low back pain by co-contraction of the local and global muscles. Previous studies have reported the effect of various type of BDEs (for example, practicing the exercises on various surfaces and changing the limb movement) for muscle co-contraction. Objects: This study aimed to investigate the effect of knee joint flexion position of the raised lower limb on abdominal and back muscle activity during BDE in patients with chronic low back pain (CLBP). Methods: Thirteen males participated in this study (age: 32.54 ± 4.48 years, height: 177.38 ± 7.17 cm). Surface electromyographic (SEMG) data of the internal abdominal oblique (IO), external abdominal oblique (EO), lumbar multifidus (MF), and thoracic part of the iliocostalis lumborum (ICLT) were collected in two knee joint flexion positions (90° flexion versus 0° flexion) during BDE. The SEMG data were expressed as a percentage of root mean square mean values obtained in the maximal voluntary isometric contraction. Results: Greater muscle activity of the IO (p = 0.001), MF (p = 0.009), and ICLT (p = 0.021) of the raised lower limb side and the EO (p = 0.001) and MF (p = 0.009) of the contralateral side were demonstrated in the knee joint flexion position compared to the knee joint extension position. Greater local/global activity ratios of the abdominal muscle (i.e., IO and EO) of the raised lower limb (p = 0.002) and the back muscle (i.e., MF and ICLT) of the contralateral side (p = 0.028) were also noted in the knee joint flexion position. Conclusion: BDE with a knee joint flexion position might be recommended as an alternative lumbar stabilization exercise to enhance muscle activity in both the raised lower limb and the contralateral sides of the trunk for individuals with CLBP

Background: Individuals with scapular winging may have proprioceptive dysfunction which is important for motor control and causes shoulder instability. Reduced serratus anterior (SA) and lower trapezius (LT) muscle activity accompanied by over-active upper trapezius (UT), and pectoralis major (PM) may be contributing factors. Flexi-bar (FB) exercise may be used to increase joint position sense (JPS) and alter the target muscle activities. Objects: This study aimed to investigate the immediate effects of flexi-bar exercise prior to knee push-up plus (FPK) versus knee push-up plus (KPP) on JPS and muscle activity of SA, LT, UT, and PM in subjects with scapular winging. Methods: Eighteen subjects with scapular winging were recruited. JPS was investigated at baseline, after KPP and after FPK. Passive and active JPS errors were calculated by isokinetic equipment. Surface electromyography was used to record muscle activities during KPP and FPK. One-way repeated-measures analysis of variance and post hoc analyses were used to analyze the JPS error measured at baseline, after KPP and after FPK. Paired t-tests were used to compare muscle activities between KPP and FPK. Results: Passive JPS error was significantly decreased after KPP (p = 0.005) and after FPK (p = 0.003) compared to the baseline. Active JPS error was also significantly decreased after KPP (p = 0.016) and after FPK (p = 0.012) compared to the baseline. There was no significant difference in the passive and active JPS errors between KPP and FPK. SA activity during FPK was significantly increased (p = 0.024), and LT activity during FPK was significantly increased (p = 0.006). There were no significant differences in the UT and PM activity. Conclusion: FB might be recommended to immediately improve passive and active JPS and to selectively increase SA and LT muscle activities during KPP in individuals with scapular winging.

Background: Whole-body vibration (WBV) has been used to alleviate proprioceptive damage by musculoskeletal and neurological conditions. However, no study has determined whether wearing shoes while applying WBV can affect proprioception precision of the knee joint. Objects: This study aimed to determine the differences in the proprioceptive precision of the knee joint before and after WBV and to compare the proprioceptive precision of the knee joint between barefoot and shoe-wearing conditions. Methods: This study recruited 33 healthy participants. A passive-to-active angle reproduction test was used to measure the proprioception precision of the knee joint using an electrogoniometer, and the target angle was set to a knee flexion of 30°. Proprioception precision was calculated using the error angle (angular difference from 30°). Proprioceptive precision was measured in weight-bearing and non-weight-bearing positions before and after applying WBV for 20 minutes at 12 Hz in barefoot and shoe-wearing conditions. Mixed repeated analysis of variance was used to determine the differences in changes in the proprioceptive precision of the knee joint according to foot conditions. Results: There were significant improvements in the weight-bearing (p = 0.002) and nonweight- bearing (p < 0.001) proprioceptive precision of the knee joint after applying WBV. However, there was no significant difference in the change in proprioceptive precision of the knee joint after applying WBV between the barefoot and shoe-wearing conditions. Conclusion: WBV stimulation had an immediate effect on improving the proprioceptive precision of the knee joint. However, foot conditions (barefoot or shoe-wearing) during WBV application did not influence the proprioceptive precision of the knee joint.

Background: With the increasing elderly population, the need for gait analysis of these elderly individuals is also increasing. Most devices are costly and not portable; however, smartphones using built-in sensors capable of measuring motion and are easily available. Objectives: To examine the reliability and validity of knee joint angles of the elderly using smartphone measurements during walking. Design: Quasi-experimental research. Methods: Sixteen elderly people, aged 65+ and living in Daejeon and Chungbuk, South Korea, participated in the study. Electrogoniometers and smartphones were attached to the thigh and the side and front of the shank of each subject, respectively, using double-sided tape, an arm band, and an elastic band. Each subject completed two sets of at least seven gait cycles (14 steps). Results: Both the smartphones and electrogoniometers exhibited high agreement in terms of their primary and secondary measurements (ICC>.75). The agreement between the smartphones and electrogoniometers was also high in terms of both the primary and secondary measurements (ICC<.60). Conclusion: These results indicate that smartphones can be costly equipment cannot, even though they cannot completely replace existing clinical-grade devices. Their utility is emphasized herein for measuring knee joint angles of the elderly during walking.

본 연구의 목적은 딥 스쿼트 동작 시 발목 관절 유연성이 무릎 관절의 운동역학적 요인들간의 관련성을 분석하는데 있었다. 본 연구는 최근 1년간 하지 근골격계 병력이 없는 성인 남성 19명과 여성 8명이 연구대상자로 참여하였다. 딥 스쿼드 시 발목 관절 유연성과 하지 관절의 운동역학적 요인들과 상관관계를 검증하기 위해 pearson의 적률상관계수(pearson’s correlation coefficient)를 이용하였고(SPSS 24.0, Armonk, NY, USA), 통계적으로 유의미한 상관성을 나타낸 변인들은 단순회기분석(simple regression analysis)을 실시하였으며, 유의 수준은 .05로 설정하였다. 본 연구를 통해 발목 관절 유연성과 무릎 관절의 압력을 결정하는 최대 관절모멘트와 관절반발력 요인들 간의 관련성을 확인할 수 있었다. 그러므로 근력 트레이닝 시 딥 스쿼트와 같은 무릎 관절에 많은 부하를 발생시킬 수 있는 운동을 적용할 때 개인에 신체적 특성 중 발목 관절의 유연성의 정도를 확인하는 것은 신체의 안정성과 무릎 관절의 상해 위험성을 감소시킬 수 있는 운동 강도를 설정하는데 도움이 될 수 있을 것으로 기대한다.

The purpose of this study was to assess knee joint loading in the target knee during a golf swing compared to loading rates of high impact activities such as cutting and drop landings. Nine healthy competitive golfers completed golf swings with the target foot both straight and externally rotated 30 degrees, as well as drop landings and cutting maneuvers. Motion capture data was collected at 240 Hz and ground reaction force data was collected at 2400 Hz. The frontal and transverse knee moments were examined using repeated measures ANOVA through SPSS. The abduction moments were higher in golf swings as compared to the other high impact activities (p=.010), while the external rotation moments were lower (p=.003). There were no significant differences between externally rotated and neutral golf swings. These results suggest moments applied to the knee during a golf swing are similar to those applied during a high impact activity.

Background: Measurement of passive ankle dorsiflexion range of motion (ADROM) is often part of a physical therapy assessment. Objects: The objective of this study was to identify the effects of subtalar joint neutral position (SJNP) on passive ADROM according to knee position in young adults. Methods: We recruited 14 young adult participants for this study. Two examiners used a universal goniometer to measure passive ADROM with and without SJNP. Dorsiflexion force was applied to the forefoot until maximum resistance was reached in two knee positions (extension and 90˚ flexion) in the prone position. Subtalar joint position was also recorded at maximum ADROM. Passive ADROM was measured three times at different knee and subtalar joint positions, in random order. Two-way repeated-measures analysis of variance was used to compare the effects of subtalar joint and knee position on passive ADROM. Results: Passive ADROM was significantly lower with than without SJNP during both knee extension (mean difference: 7.4˚) and 90˚ flexion (mean difference: 16.9˚) (p<.01). Passive ADROM was significantly higher during 90˚ knee flexion than during knee extension both with (mean difference: 5.8˚) and without SJNP (mean difference: 15.2˚) (p<.01). The valgus position of the subtalar joint was significantly lower with than without SJNP during both knee extension (mean difference: 3.3˚) and 90˚ flexion (mean difference: 4.3˚) (p<.01). Conclusion: Our results indicate that the gastrocnemius may limit ankle dorsiflexion more than the soleus does. Greater dorsiflexion at the subtalar and midtarsal joints was observed during passive ADROM measurement without than that with SJNP; therefore, SJNP should be maintained for accurate measurement of ADROM.

Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.

목 적：Knee 자기공명영상에서 TSE 시퀀스에 SMS(Simultaneous MultiSlice)를 적용하여 유용성을 평가하고자 한다. 대상 및 방법：2019년 1월 10일부터 2019년 1월 31일까지 무릎 관절의 이상으로 본원에 내원 하여 진료중인 환자 30명(남 17명, 여 13명, 평균 50.25세)을 대상으로 conventional turbo spin echo(이하 cTSE)와 SMS turbo spin echo(이하 sTSE) 기법으로 T2WI와 PDWI sagittal 영상을 획득하였다. 전신용 3.0T MRI에 15 channel knee coil을 사용하였고, interpolation은 cTSE에만 적용하였다. 또한, 유용성 평가를 위하여 서울시 소재 임의의 5개 병원에서 cTSE의 검사시간을 조사하여 sTSE와 비교 평가하였다. 정량적 평가를 위해 획득한 영상을 viewing system으로 전송하여, ACL과 PCL이 가장 크게 보이는 부분에 ROI를 그려서 SNR을 측정하였고, infrapatellar fat pad(이하 IPFP)와의 CNR을 구하였다. 정성적 평가는 PACS로 전송된 영상을 영상의학과 전문의 2명이 각 시퀀스 간의 진단능과 영상품질에 대해 5점 척도로 평가하였다. 통계적 검증은 t-test를 이용하여 유의성을 검증하였다(p<0.05). 결 과：cTSE와 sTSE 두 시퀀스에서 T2WI로 촬영한 ACL의 SNR은 각각 10.68±2.6, 9.49±2.38, PCL의 SNR은 7.80±3.02, 6.93±1.73이었고, PDWI로 촬영한 ACL의 SNR은 21.39±6.09, 16.54±6.49, PCL의 SNR은 12.27±5.63, 8.51±2.86이었 다. cTSE와 sTSE 두 시퀀스의 T2WI에서 IPFP의 SNR은 각각 101.96±22.99, 97.59±15.96, PDWI에서는 135.51±32.97, 116.66±25.97이었다. cTSE와 sTSE 두 시퀀스에서 T2WI로 촬영한 ACL과 IPFP와의 CNR(이하 CNRACL-IPFP)은 각각 91.19±23.01, 79.10±14.91, PCL과 IPFP와의 CNR(이하 CNRPCL-IPFP)은 94.07±21.56, 90.66±14.7이었고, PDWI 에서 CNRACL-IPFP은 114.12±30.73, 100.12±24.18, CNRPCL-IPFP은 123.24±30.29, 109.1±24.56이었다. cTSE와 sTSE 의 T2WI로 촬영한 영상의 진단능을 정성적으로 평가한 결과 각각 4.49±0.49, 4.62±0.35이었고, PDWI에 서는 4.45±0.49, 4.55±0.35였다. 영상 획득 시간은 cTSE T2WI에서 3분 32초 이었고, sTSE T2WI에서는 1분 49초였으 며, cTSE PDWI에서는 3분 20초, sTSE PDWI에서는 1분 48초로, SMS를 사용하는 시퀀스에서 각각 50.9%, 54% 감소하 였다. cTSE와 sTSE 두 시퀀스의 SNR과 CNR에 대한 통계적 유의성 검정(t-test) 결과 T2WI와 PDWI 모두에서 p-value 가 0.05 이상으로 나타나 두 영상 간의 화질의 차이는 없는 것으로 나타났다. 결 론：sTSE 기법은 cTSE에 비해 화질의 변화 없이 검사시간을 약 50% 감소시킬 수 있어 소아나 넓은 검사 부위에 임상적으로 유용할 것으로 사료된다.

Background: Knee osteoarthritis (OA) is a single most arthritic disease. Knee joint space width (JSW) is commonly used for grading severity of knee OA. However, previous studies did not established criterion validity and test-retest reliability of ultrasound (US) image for measuring JSW. Objects: The aim of this study was to establish criterion validity and test-retest reliability of US measurement of medial and lateral knee JSW. Methods: Twenty-nine subjects with knee OA were participated. The US and X-ray were used to measure knee JSW. One sample Kolmogorov-Smirnov test was used to confirm the data normal distribution. Pearson correlation coefficient and ICC were used to calculated and establish criterion validity and test-retest reliability, respectively. Results: US measurement of medial and lateral knee JSW was highly correlated with radiographic imaging measure (r=.714 and .704, respectively). Test-retest reliabilities of medial and lateral knee JSW were excellent correlated (ICC=.959 for medial side and .988 for lateral side, respectively). Conclusion: US may be valid tool to measure knee JSW.

Background: Genu varum is also known as bow leg. It is a deformity wherein there is lateral bowing of the legs at the knee. it does give rise to pain, and persistent bowing can often give rise to discomfort in knees, hips and ankles. Objects: This study investigated the effect of narrow squats on the knee joint during a gait and distance between the knees of person with genu varum. Methods: This study analyzed 23 patient with genu varum that grade Ⅲ, 12 narrow squat group and 11 genenal squat group in motion analysis laboratory. The subjects of experiment took gait before and after intervention, the range of joint motion, moment of knee joint adduction, power, distance of the knees were measured. And in order to make an analysis between groups, an paiered t-test and independent t-test was carried out. For statistical significance testing, it was decided that significance level α be .05. Results: It was shown that the group of narrow squat exercise significantly decreased in distance of knees (p<.05),In moment of adduction of knee joint, it was shown to significantly decrease in two groups (p<.05), was significantly decreased in adduction, abduction, and rotation (p<.05). In relation of peak-knee adduction moment and valgus angle, there was significant decrease in narrow squat group (p<.05). Conclusion: When the above result of study were examined, a narrow squat exercise given to the genu varum patients significantly decreased the distance between the knees, range of knee adduction and abduction, knee adduction moment, knee power. And stability gains through the decrease of excursion of knee medial part be effective for the correction of genu varum deformation.

목 적 : 후방십자인대는 무릎 관절의 안정화를 위한 중요한 인대로 인체의 균형을 유지하는데 매우 중요한 역할을 한다. 본 연구에서는 후방십자인대의 해부학적 구조에 따라 사방향 관상면 영상과 이중 사방향 시상면 영상을 획득하여 그 유용성을 평가하고자 한다. 대상 및 방법 : 2016년 12월부터 2017년 1월까지 환자 20명을 대상으로 검사하였고 SIEMENS사의 Skyra 3.0T에서 knee coil을 사용하였다. 검사 방법은 T2 COR, PD SAG을 획득하고 원위부 후방십자인대의 해부학적 구조를 고려한 PD OBL COR과 전체적인 구조를 고려한 PD Dual OBL SAG을 획득하였다. PCL의 관상면 비교를 위하여 밑단점의 길이와 폭을 측정하여 비교하였고, 시상면 평가를 위하여 기시점, 중간지점, 밑단점을 측정하여 비교하였다. 측정결과를 Mann-Whitney 방법을 사용하여 통계적 유의성을 검정하였다. 정성적 방법은 기존의 관상면, 시상면 영상과 사방향 관상면, 이중 사방향 시상면 영상에서 후방십자인대를 비교하여 미흡, 대등, 우월 세 단계로 평가하였다. 결 과 : 검사를 진행한 결과 기존 관상면 영상보다 사방향 관상면 영상에서 원위부 후방십자인대의 길이는4 7.9%, 폭 14.9% 증가하였고, 기존 시상면 영상보다 이중 사방향 시상면 영상에서 기시점 19.8%, 중간지점 18.3%, 끝단점 33%의 증가된 것 으로 측정되었다. 결 론 : 사방향 관상면 영상과 이중 사방향 시상면 영상 모두 기존 영상보다 우월한 영상 검사방법으로 평가되었다. 이에 슬 관절 후방십자인대의 해부학적 관찰에는 기존 검사 방법에 사방향 관상면 영상 검사와 이중 사방향 시상면 영상 검사를 병 행하는 것이 유용할 것으로 사료된다.

Background: Many studies have reported positive results of the various mirror training and virtual reality games in improving dynamic standing balance and posture adjustment in chronic stroke patients. However, no systematic study has been conducted to compare the effects of virtual reality games and the mirror balance training. Objects: The purpose of this study was to compare the effectiveness of Wii balance games and Mirror Self- Balancing Exercises in improving proprioception of knee joint and standing balance of people with chronic stroke. Methods: Twenty patients with chronic stroke volunteered for this study. The subjects were randomly divided into a Wii balance games group and a Mirror Self-Balancing Exercises group with 10 patients in each group. Each training was performed for 30 mins a day for 4 days. In addition to the balance training, 30 mins neuro-developmental-treatment based routine physical therapy was given to both groups. Proprioception was measured using two continuous passive motion devices, and static balance was measured using a Wii balance board. Dynamic balance assessment tools included the Berg Balance Scale, Dynamic Gait Index, and Timed Up-and-Go test. Results: All measured variables before and after the experimental results showed a significant improvement in both groups (p<.05). Only the improvement of the affected knee proprioception appeared to be significantly greater in the Wii balance game group (p<.05). However, other variables did not differ between the groups (p>.05). Conclusion: The findings suggest that both Wii balance games and Mirror Self-Balancing Exercises may be helpful for improving the proprioception of knee joint and the balance of patients with chronic stroke.

Background: Squatting is one of the best functional exercises to strengthen the quadriceps muscle in independent gait and activities of daily living. Although the use of a gym ball during squat exercise is the most common way of strengthening the vastus medialis oblique (VMO) muscle, published data on this subject are limited. Objects: The purpose of this study was to compare the sequential muscle activation of the VMO and vastus lateralis (VL) muscles during squat exercise using a gym ball at different knee flexion angles. Methods: Forty healthy adults were randomly divided into experimental (squat exercise using a gym ball) and control (squat exercise alone) groups, in which squats were performed at 45° and 90° knee flexion. Electromyographic (EMG) activity data were collected over 10 seconds under the 2 angles of knee flexion (45° and 90°). Results: There was significant group and time interaction effect for VMO and VL muscle activation at 45° knee flexion. This was similarly demonstrated at 90° knee flexion. No significant group main effect and time main effect for VMO and VL muscle activation were noted at 45° knee flexion, respectively. In contrast, there was significant group main effect and time main effect for VMO and VL muscle activation at 90° knee flexion. These significant differences were demonstrated through two-way analysis of variance over repeated measurements, suggesting that the EMG activity of the VMO muscle during squatting with a gym ball showed remarkable improvement compared to that of the VL muscle. Conclusion: This research suggests that squat exercise using a gym ball may be more beneficial in improving the activity of VMO than of the VL muscle at both 45° and 90° of knee flexion, respectively. We highly recommend squat exercises with a gym ball for selective strengthening of the VMO muscle in knee rehabilitation.

The purpose of this study was to investigate the effects of combined wedge on the range of motion in ankle and knee joint, ankle eversion moment and knee adduction moment, and center of pressure excursion of foot for genu varus among adult men during gait. This study was carried out with 10 adult men for genu varus in a motion analysis laboratory in J university. The subjects of the experiment were measured above 5cm width between the knees on contact of both medial malleolus of ankle while standing. The width of their knees in neutral position was measured without the inversion or eversion of the subtalar joint by the investigator. The subjects of the experiment were ten who were conducted randomly for standard insole, insole with 10° lateral on rear foot wedge, insole at 10°lateral on rear foot and 5° medial on fore foot wedge. Before and after intervention, changes on the range of motion in ankle and knee joint, ankle eversion moment and knee adduction moment, and center of pressure excursion were measured. In order to compare analyses among groups; repeated one-way ANOVA and Scheffé post hoc test were used. As a result, combined wedge group was significantly decreased compared to control wedge group in terms of knee varus angle in mid-stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge group in terms of ankle eversion moment in whole stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge group in terms of knee adduction moment in whole stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge in terms of center of pressure excursion in whole stance(p<.05). The results of this study suggest that combined wedge for genu varus decreased ankle eversion moment and knee adduction moment upon center of pressure excursion. We hypothesize that combined wedge may also be effective in the protection excessive ankle pronation.