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Effects of specific movement control exercises on lumbopelvic motion and trunk muscle activity during walking in subjects with lumbar extension rotation pattern

Other Titles
 허리 폄 돌림 패턴을 가진 대상자에게 특정 움직임 조절 운동이 걷기 시 허리골반 운동과 몸통 근육의 근활성도에 미치는 영향 
Authors
 김시현 
Issue Date
2014
Description
Dept. of Physical Therapy/박사
Abstract
Walking is one of the most repetitive movements in daily activities and changes in lumbopelvic motion and trunk muscle activities during walking are critical indicators of spinal dysfunction. The purpose of Study 1 was to demonstrate the differences in- viii - lumbopelvic motion and trunk muscle activities during walking between subjects with and without a lumbar extension rotation (ExtRot) pattern. In total, 26 subjects with a lumbar ExtRot pattern and 18 subjects without lumbar ExtRot were recruited. Twenty reflective markers were placed on the lower extremity and lumbar spine and a 3–D motion analysis system was used to measure lumbopelvic kinematics. A surface electromyography (EMG) system was used to measure the trunk muscle activities and surface electrodes were attached on both rectus abdominis (RA), abdominal external oblique (EO), abdominal internal oblique (IO), and erector spinae (ES) muscles. All subjects walked 12 times at a self–selected (comfortable) walking speed on the walkway. Kinematic data, at initial heel strike (HS), left toe–off (TO), left HS, and right TO, and EMG data at first double support, left swing, second double support, and right swing phase were used for the statistical analyses. To compare kinematic and EMG data between subjects with and without the lumbar ExtRot pattern, independent t–tests for parametric variables and Mann–Whitney U–tests for non– parametric variables were used. Subjects with a lumbar ExtRot pattern showed significantly increased pelvic and lumbar angles in the sagittal plane (p < 0.05); however, there was no significant difference in the pelvic or lumbar angle in the transverse plane between subjects with and without a lumbar ExtRot pattern (p > 0.05). In EMG activity, significantly increased activities in both ES muscles at all events and decreased right IO muscle activity at the second double support phase were seen in subjects with a lumbar ExtRot pattern versus subjects without (p < 0.05). Both RA, EO, and IO muscle activities, except the right IO muscle activity at the - ix - second double support phase, were not significantly different between subjects with and without the lumbar ExtRot pattern (p > 0.05). The purpose of Study 2 was to demonstrate the effects of a 6–week specific movement control exercise on pain behavior, lumbopelvic motion, and trunk muscle activities during walking in subjects with a lumbar ExtRot pattern. In total, 39 subjects with lumbar a ExtRot pattern (experimental = 19; control = 20) participated in this study. Subjects in the experimental group performed 6 weeks of movement control exercises and the exercise level of difficulty was adjusted progressively. Clinical outcome measures included pain intensity (visual analog scale), level of disability (Oswestry disability index and Roland Morris disability questionnaire), and fear and avoidance level (Fear–avoidance beliefs questionnaire) caused by low back pain (LBP). To measure lumbopelvic kinematics and EMG activities in the trunk muscles (RA, EO, IO, and ES) during walking, all subjects walked on an 8–m–long straight walkway. Kinematic data at initial right HS, left TO, left HS, and right TO and the EMG data at first double support, left swing, second double support and right swing phase were used for the statistical analysis. The Wilcoxon signed–rank test for non–parametric variables and the paired t–test for parametric variables were used to compare baseline and follow–up treatment within a group. After the 6–week intervention, pain intensity, level of disability, and fear and avoidance level caused by LBP were decreased significantly in the experimental group. Additionally, there were significantly decreased angles in the lumbar spine and pelvic region in the sagittal plane at all events in the experimental group. However, there was no significant difference in the pelvic or lumbar angle in the transverse plane in either group. In the EMG data, right ES muscle activity was decreased significantly during the first and second double support phase and left ES muscle activity was also decreased significantly during the second double support phase in the experimental group. However, in the control group, there was no significant difference in lumbopelvic motion or ES muscle activity. After the 6–week intervention, there was no significant difference in abdominal muscle activity in either group. Based on these two studies, it was demonstrated that subjects with a lumbar ExtRot pattern had greater angle in the lumbar spine and pelvic region in the sagittal plane, increased ES muscle activities at all events, and decreased right IO at the second double support phase during walking, compared with subjects without a lumbar ExtRot pattern. These changed patterns of lumbopelvic motion in the sagittal plane and ES muscle activity and pain behavior in subjects with a lumbar ExtRot pattern can be improved by specific movement control exercises over a 6–week course. Thus, specific movement control exercises can be an effective treatment for subjects with a lumbar ExtRot pattern to modify their excessive lumbopelvic motion in the sagittal plane and excessive muscle activity of the ES in walking.
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Appears in Collections:
7. Others (기타) > Others (기타) > 5. Others
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/136699
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