Effects of Contralateral Hip Adduction on Muscle Thickness ...rotation, hip elevationor pelvic ,...
Transcript of Effects of Contralateral Hip Adduction on Muscle Thickness ...rotation, hip elevationor pelvic ,...
Effects of Contralateral Hip Adduction on
Muscle Thickness, Activity of Lumbar
Stabilizers and Pelvic Lateral Tilting
During Hip Abduction in Sidelying
Hyo uen Kim
The Graduate School
Yonsei University
Department of Rehabilitation Therapy
Effects of Contralateral Hip Adduction on
Muscle Thickness, Activity of Lumbar
Stabilizers and Pelvic Lateral Tilting
During Hip Abduction in Sidelying
Hyo uen Kim
The Graduate School
Yonsei University
Department of Rehabilitation Therapy
Effects of Contralateral Hip Adduction on
Muscle Thickness, Activity of Lumbar
Stabilizers and Pelvic Lateral Tilting
During Hip Abduction in Sidelying
A Masters Thesis
Submitted to the Department of Rehabilitation Therapy
and the Graduate School of Yonsei University
in partial fulfillment of the
requirements for the degree of
Master of Science
Hyo uen Kim
December 2011
This certifies that the masters thesis of Hyo uen Kim is approved.
Thesis Supervisor: Ohyun Kwon
Chunghwi Yi
Heonseock Cynn
The Graduate School
Yonsei University
December 2011
Acknowledgements
After the years of efforts, I am now able to complete graduate school. I would like
to take this opportunity to express my gratitude to everyone who has helped me to
graduate.
First, I sincerely appreciate Profs. Ohyun Kwon. He provided me with direction. I
could not have finished the course without his guidance. I deeply thank Profs.
Chunghwi Yi and Heonseock Cynn. I have written a better graduate thesis as a result
of your guide and advice. I also thank Profs. Sanghyun Cho, Hyeseon Jeon and
Seunghyun Yoo. I have expanded my knowledge and perspective from interactions
with you. I also give thanks to Mr. Byungkyu Lee, who always took care of
administrative issues.
I appreciate all my fellow students, especially Wonhwee Lee, Sujung Kim and
Boram Choi. You gave me lots of help with my thesis and with school life generally.
I also appreciate my coworkers. You always tried to cheer me up and were a great
comfort to me. Finally, I want to express my love for my parents, sister and Jinsu Lim.
You always prayed for me from your hearts. I was able to finish the course with your
support and encouragement.
Thanks to all of you. I hope to be able to repay your favors someday.
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Table of Contents
List of Figures ···································································· ⅲ
List of Tables ····································································· ⅳ
Abstract ··········································································· ⅴ
Introduction ······································································· 1
Method ············································································· 4
1. Subjects ······································································ 4
2. Experimental Equipment ·················································· 5
2.1 Sonography System ···················································· 5
2.2 Electromyography System ············································ 7
2.3 3D Motion Analysis System ········································· 8
3. Experimental Procedure ··················································· 9
4. Statistical Analysis ························································· 12
Results ············································································ 13
1. Muscle Thickness ·························································· 13
2. Muscle Activity ···························································· 16
3. Pelvic Lateral Tilting ······················································ 17
Discussion ········································································ 18
Conclusion ········································································ 23
References ········································································ 24
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Abstract in Korean ······························································ 29
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List of Figures
Figure 1. Measurement of the muscle thickness ······························· 6
Figure 2. Test postures ···························································· 11
Figure 3. Comparison of muscle thickness ···································· 15
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List of Tables
Table 1. Characteristics of the subjects ········································ 4
Table 2. Means and standard deviations of muscle thickness ············· 14
Table 3. Comparison of muscle thicknesses ································· 14
Table 4. Comparison of the muscle activity ··································· 16
Table 5. Comparison of the angle pelvic lateral tilting ····················· 17
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ABSTRACT
Effects of Contralateral Hip Adduction on
Muscle Thickness, Activity of Lumbar
Stabilizers and Pelvic Lateral Tilting
During Hip Abduction in Sidelying
Hyo uen Kim Dept. of Rehabilitation Therapy
The Graduate School
Yonsei University
The purpose of this study was to determine the effects of contralateral hip
adduction on muscle thickness, muscle activity of lumbar stabilizers, and the angle of
pelvic lateral tilting during hip abduction in side lying. Twenty healthy male subjects
with no medical history of lower extremity or lumbar spine disorders were recruited
for this study. Subjects performed 35° preferred hip abduction (PHA) and 35° hip
abduction with 10° contralateral hip adduction (CHA) during side lying. Thicknesses
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of the transverses abdominis (TrA), internal oblique (IO), and quadratus lumborum
(QL) were measured in the rest position (RP) and during PHA and CHA using a
sonography system. Muscle activities of the dominantside rectus abdominis (RA),
external oblique (EO), IO, QL, gluteus medius (GM), and nondominant-side hip
adductor longus (Add) were measured during PHA and CHA using a surface
electromyography system (EMG). Kinematic data for pelvic lateral tilting were
collected during PHA and CHA using a threedimensional (3D) motionanalysis
system. Oneway repeated analysis of variance was used to compare the thickness of
the muscles, and a paired ttest was used to compare EMG activity and the angle of
pelvic lateral tilting between the two exercises. Thicknesses of the TrA and IO were
significantly increased in CHA versus PHA, but there was no significant difference
between RP and PHA. Thickness of QL (anterioposterior, AP) was increased in
CHA more than PHA, but QL (mediolateral, ML) was not significantly different
between PHA and CHA. EMG activities of all muscles were increased significantly
more in CHA versus PHA. Pelvic lateral tilting was decreased significantly more in
CHA versus PHA. These results suggest that CHA could be recommended as a hip
abduction exercise for activating lumbar stabilizers and decreasing compensatory
pelvic tilting motion.
Key Words: Electromyography, Hip abduction, Lumbar stabilizer, Sonography,
Pelvic tilting.
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Introduction
Lumbar stabilization has been actively studied over the past decade (Cynn et al.
2006). The concept of lumbar stabilization involves maintaining lumbar stability
through isometric contraction of lumbar and abdominal muscles during limb
movement. Increasing lumbar stability is considered an effective method of
preventing lumbar musculoskeletal disease and improving lumbar function (Kisner
and Colby 2002). Increasing lumbar stabilization is also effective for patients with
low back pain regardless of the cause or status (Luoto et al. 1998; O’Sullivan et al.
1997).
Previous studies have demonstrated that the activity of the lumbar stabilizers is
decreased and delayed during limb movement in patients with low back pain
compared with subjects without low back pain (Hodge and Richardson 1997;
Sahrmann 2002). Decreased lumbar stability during limb movement causes
compensatory movements. Excessive compensatory movement can causes
microtrauma, and repeated microtrauma can lead to lumbar dysfunction (Sahrmann
1993).
Hip abduction in side lying is commonly used clinically to evaluate movement
patterns (Libenson 1996; Sahrmann 1993) and to improve gait and balance ability
(Judge et al. 1993; Sashika et al. 1996). Many studies have investigated lumbar
stabilization in the standing and supine lying position, whereas few have examined
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the sidelying position (Hodges and Richardson 1999; Jull et al. 1993). Cynn et al.
(2006) reported that an abdominal drawingin maneuver and using a pressure
biofeedback unit increased lumbar stability and decreased pelvic lateral tilting during
hip abduction in side lying.
When a hip abduction exercise is performed in side lying, unwanted compensatory
pelvic lateral tilting can appear (Norris 1995). The normal pattern of hip abduction
has been described as about 40° abduction, with no hip flexion, external or internal
rotation, hip elevation, or pelvic rotation. When the hip abduction is initiated by
contraction of the quadratus lumborum before 20°, hip abduction induces pelvic
lateral tilt or hip hike. This altered movement pattern can cause excessive stress to
lumbosacral segments during a hip abduction exercise (Libenson 2007).
The function of TrA and IO in lumbar stability was investigated in previous studies
(Hodges and Richardson 1997; Hodges and Richardson 1999; O’Sullivan et al. 2002).
QL can stabilize the lumbar region during isometric contraction (Cholewicki and
Vanvliet 2002; McGill 1996). Page et al. (2010) stated that the role of the QL
changed from pelvic stabilizer to the prime mover in hip abduction, resulting in a
pelvic lateral tilt during hip abduction in side lying.
During hip abduction, contraction of contralateral hip in adduction can stabilize
the lumbar region (Lee 1999). Lee (1999) described four systems that contribute to
lumbo–pelvic stability: the anterior oblique, posterior oblique, longitudinal, and
lateral systems. Among them, the lateral system consists of the hip abductor and the
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contralateral hip adductor. These muscles are related closely in the kinetic chain to
make forces and cocontract or release to optimize the function of the pelvis (Lee
1999). Root and Spero (1981) also demonstrated that enough force from the
contralateral hip adductor can act against the force of hip abductor, maintaining
pelvic stability. However, there has been no reported study on whether contralateral
hip adduction can increase lumbar stability in hip abduction in side lying.
The extent of lumbar stability had been measured through the activity of the
lumbar stabilizers (Cholewicki and McGill 1996; Reeve and Dilley 2009). The
quantity of muscle activity can be measured using electromyography. The increased
thickness of lumbar stabilizers could reflect their increased activity (Hodges et al.
2003; McMeeken 2004) and the thickness of lumbar stabilizers can be measured
using sonography (AinscouphPotts et al. 2006).
The purpose of this study was to investigate the effects of contralateral hip
adduction on the thickness and activity of the lumbar stabilizers and pelvic lateral
tilting during hip abduction in side lying. The hypothesis of the study was that
thickness and activity of lumbar stabilizers would be increased and pelvic lateral
tilting would be decreased in hip abduction with contralateral hip adduction (CHA)
compared with preferred hip abduction (PHA).
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Method
1. Subjects
Twenty healthy male subjects were recruited from Yonsei University. Exclusion
criteria were past or present neurological, musculoskeletal, or cardiopulmonary
disease. Subjects with low back pain, knee pain, hip joint contracture, and gluteus
medius strength below a grade of good on manual muscle testing were also excluded.
All subjects were rightleg dominant.
Prior to the study, ethics approval was obtained from Yonsei University. All
subjects were informed about the purpose and procedures of the study, and written
informed consent was obtained. Characteristics of the subjects are presented in Table
1.
Table 1. Characteristics of the subjects (N=20)
Parameter Mean ± SD
Age (yr) 21.8 ± 2.8
Body mass (㎏) 71.9 ± 10.8
Height (㎝) 173.3 ± 4.1
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2. Experimental Equipment
2.1 Sonography System
The SONOACE X8 (Medison, Inc., Seoul, South Korea) was used to measure
muscle thickness of the dominantside TrA, IO, and QL. A linear transducer
(L512EC) 4.5㎝ in size and with a frequency of 10 MHz was used (Richardson,
Hodge and Hides 2004). TrA and IO were measured at a point 2.5㎝ anteromedial
to the midpoint between the ribs and ilium on the midaxillary line (Critchley 2002;
Mcmeeken et al. 2004). The thickness of TrA and IO were measured (vertical
diameter) between the fascias at a point 1.5 cm from the aponeurotic attachment
(Reeve and Dilley 2009) (Fig. 1). To measure the QL, the transducer was moved
laterally from the transverses plane at the L3 level until an image was obtained
(Desmoulin and Millner 2007). The thickness of the QL was measured (mediolateral
(ML) diameter and anterioposterior (AP) diameter) at the widest point (Desmoulin
and Milner 2007) (Fig. 1). Measurements were conducted by one expert and
measured while the subject maintained end posture while holding his breath after
expiration. The transducer was maintained vertical to the skin and in the same
position during the measurements to reduce errors.
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Figure 1. Measurement of muscle thickness
A: internal oblique, B: transverses abdominis, C: quadratus
lumborum anterioposterior, D: quadratus lumborum
mediolateral.
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2.2 Electromyography System
The Noraxon Telemyo 2400T (Noraxon, Inc., Scottsdale, AZ, USA) was used to
measure muscle activity The skin was shaved with a razor, rubbed with sand paper,
and cleaned with alcohol. Pairs of surface electrodes and adhesive skin interfaces
were separated by 2㎝. The reference electrode was placed on the anterior superior
iliac spine (ASIS). EMG data were collected from the following muscles:
dominantside rectus abdominis (RA; parallel and approximately 3㎝ lateral and
superior to the umbilicus, arranged along the longitudinal axis over the muscle belly);
dominantside EO (half way between the ASIS of the pelvis and the inferior border
of the rib cage at a slightly oblique angle, running parallel to the underlying muscle
fibers); dominantside IO (half way between the ASIS of the pelvis and the midline,
just superior to the inguinal ligament); dominantside gluteus medius (GM; over the
proximal third of the distance between the iliac crest and the greater trochanter);
dominant-side QL (approximately 4 ㎝ lateral from the vertebra ridge and at a
slightly oblique angle at half the distance between the 12th rib and the iliac crest); and
non-dominantside hip adductor longus (Add; medial aspect of the thigh in an
oblique direction, 4㎝ from the pubis).
Raw data were rectified and filtered using a Lancosh FIR digital filter. The
sampling rate was 1000 Hz. A bandpass filter (20500 Hz) and a band stop (60 Hz)
were used. EMG data were converted to root mean square (RMS) values. To
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normalize the EMG data, the mean RMS of three trials of 5s maximal voluntary
isometric contractions (MVICs) was calculated for each muscle at a manual
muscletesting position, according to Kendall et al. (2005). The data were expressed
as a percentage of the MVIC (%MVIC), and the mean value of three trials was used
for data analysis.
2.3 3D Motion Analysis System
A threedimensional ultrasonic motion analysis system (CMSHS, Zebris,
Medizintechnik, Isny, Germany) was used to measure pelvic lateral tilting during hip
abduction in side lying. Three active markers were placed at the level of the dominant
ASIS by fastening a belt. The markers faced the measuring sensor, which consisted
of three microphones. The measuring sensor was placed in front of the subject and
recorded the ultrasonic signals from the markers. The angle of the pelvic lateral tilt
was calibrated to 0° at the rest position as a reference before the movement, and then
the relative angle of the pelvic lateral tilt during hip abduction was calculated from
this reference. The sampling rate was set at 20 Hz. A lowpass filter with a cutoff
frequency was set at 8Hz. Kinematic data were analyzed using the Windata software
(ver. 2.19). The mean angle of three trials was used in data analysis.
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3. Experimental Procedure
The rest position (RP) was a sidelying position with the nondominant lower
extremity contacting a firm mattress. The upper trunk, pelvis, and dominant lower
extremity were aligned in a straight line. PHA is a 35° abduction of the dominant hip
during side lying (Cynn 2006). CHA is 10°adduction of the contralateral hip and then
a 35° dominanthip abduction during side lying. The degree of contralateral hip
adduction was set at the proper angle according to a pilot study. During PHA and
CHA, subjects were required to maintain steady trunk alignment without hand
support. Bars were placed at 35° hip abduction and 10° hip adduction positions (Fig.
2).
Before testing, subjects were trained for approximately 15 min to familiarize them
with PHA and CHA. Subjects performed RP, PHA, and CHA randomly. The subject
was asked to maintain each posture for 5 s to allow image capture of TrA, IO, and
QL using the sonography system. The principal investigator placed the transducer at
a point 2.5㎝ anteromedial to the midpoint between the ribs and ilium on the
midaxillary line for the TrA and IO muscles. After capturing TrA and IO images, the
transducer was moved laterally at the L3 level to capture the QL image. Between the
two conditions, a 5min rest period was provided at the RP.
After a 30min rest, electrodes and the three markers were attached for collecting
EMG and kinematic data. Subjects were asked to perform PHA and CHA in the same
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way. During the each test, muscle activity and the angle of pelvic lateral tilting were
recorded using EMG and a 3D motion analysis system. All examinations were
conducted by the same researcher.
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Figure 2. Test postures
A: rest Position, B: preferred hip abduction,
C: hip abduction with contralateral hip adduction.
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4. Statistical Analysis
Repeatedmeasures oneway analysis of variance (ANOVA) was used to
determine significant differences in muscle thicknesses of the TrA, IO, and QL
among RP, PHA, and CHA, and the least significant difference (LSD) was calculated
post hoc. The paired ttest was used to determine significant differences in muscle
activity of the RA, IO, EO, QL, GM, and Add muscles and pelvic lateral tilting
between PHA and CHA. The level of statistical significance was set at α = 0.05.
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Results
1. Muscle thickness
The mean thickness of TrA and IO in each posture is presented in Table 2. The
thickness of TrA and IO increased significantly in CHA compared with PHA and RP
(F = 92.61, p = 0.000; F = 10.09, p = 0.000, respectively; Table 3; Fig. 3). The AP
thickness of QL was increased significantly in CHA versus PHA (F = 86.63, p =
0.000; Table 3; Fig. 3). The ML thickness of QL decreased significantly (F = 16.54,
p = 0.000; Table 3). The result from the post hoc analysis showed no significant
difference between PHA and CHA (Fig. 3).
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Table 2. Means and standard deviations of muscle thickness
RPa: rest position; PHAb: preferred hip abduction; CHAc: hip abduction with contralateral hip adduction; TrAd: transverses abdominis; IOe: internal oblique; QL (M-L)f: quadratus lumborum (mediolateral); QL (A-P)g: quadratus lumborum (anterioposterior). hmean±SD.
Table 3. Comparison of muscle thicknesses
TrAa: transverses abdominis; IOb: internal oblique; QL (M-L)c: quadratus lumborum (mediolateral); QL (A-P)d: quadratus lumborum (anterioposterior).
Muscle (㎝) RPa PHAb CHAc
TrAd 0.61 ± 0.14h 0.73 ± 0.15 0.86 ± 0.18
IOe 0.65 ± 0.23 0.82 ± 0.26 0.99 ± 0.20
QL (M-L)f 1.74 ± 0.28 1.53 ± 0.30 1.52 ± 0.21
QL (A-P)g 0.40 ± 0.10 0.44 ± 0.11 0.48 ± 0.14
Muscle Type Ⅲ Sum of Squares df Mean Square F p
TrAa 0.59 2 0.29 92.61 0.000
IOb 0.99 2 0.48 10.09 0.000
QL (M-L)c 0.65 2 0.32 16.54 0.000
QL (A-P)d 0.07 2 0.03 86.63 0.000
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Figure 3. Comparison of the muscle thicknesses
RP: rest position; PHA: preferred hip abduction; CHA: hip abduction
with contralateral hip adduction; TrA: transverses abdominis; IO:
internal oblique; QL (ML): quadratus lumborum (mediolateral); QL
(AP): quadratus lumborum (anterioposterior); *p < 0.05.
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2. Muscle activity
Mean values and standard deviations of EMG amplitude for each muscle are
presented in Table 5. The activity of all muscles was statistically significantly
increased in CHA versus PHA (Table 4).
Table 4. Comparison of the muscle activity
PHAa: preferred hip abduction; CHAb: hip abduction with contralateral hip adduction; RAc: rectus abdominis; IOd: internal oblique; EOe: external oblique; QLf: quadratus lumborum; GMg: gluteus medius; Addh: hip adductor longus. imean±SD.
Muscle (%MVC) PHAa CHAb t p
RAc 1.63±0.86i 7.07±3.89 6.29 0.000
IOd 10.46±4.77 24.86±10.77 7.77 0.000
EOe 6.17±3.89 26.94±17.64 5.92 0.000
QLf 17.07±9.38 54.22±24.33 8.79 0.000
GMg 26.11±18.38 46.21±38.35 4.19 0.000
Addh 1.24±2.09 10.20±7.60 5.48 0.000
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3. Pelvic lateral tilting
The angle of pelvic lateral tilting was significantly decreased in CHA versus PHA
(p = 0.000) (Table 5).
Table 5. Comparison of the angle of pelvic lateral tilting
PHAa: Preferred hip abduction; CHAb: Hip abduction with contralateral hip adduction
cmean±SD.
PHAa CHAb t p
Pelvic lateral tilting (°) 11.41±4.71c 7.78±3.19 6.33 0.000
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Discussion
This study was performed to determine whether contralateral hip adduction could
improve lumbar stability, activate lumbar stabilizers and the gluteus medius muscle,
and decrease unwanted compensatory pelvic lateral tilting during hip abduction in
side lying. To compare changes in muscle thickness, realtime ultrasound was used.
The result of this study demonstrated that the thicknesses of TrA, IO, QL (AP)
increased significantly in CHA versus PHA. Furthermore, activity in the
dominantside RA, EO, IO, and QL increased significantly in CHA versus PHA.
The observed increased muscle thickness in TrA, IO, and QL (AP) and increased
muscle activity in RA, EO, IO, and QL under the CHA condition may have several
explanations.
First, the base of support (BOS) in CHA was less than that in PHA. In this study,
subjects were asked to maintain the alignment without hand support during the tests.
Under the CHA condition, the subject was asked to adduct his bottom leg. Thus, the
contact area of the body on the floor, BOS, was markedly decreased in the CHA
condition versus PHA. A previous study demonstrated that decreased BOS was more
challenging and led to coactive muscle contraction (Santos and Aruin 2009).
AinscouphPotts et al. (2006) showed that TrA and IO thickness increased
significantly in decreasing the stability and area of BOS in a sitting position and
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lifting the foot off the floor on a gym ball compared with crooked lying and relaxed
sitting on a gym ball with both feet on the ground. Kim et al. (2011) reported that
singleleg raising in hooklaying position on a round foam roll, which provided a
small BOS, induced more abdominal muscle activity than lying on the floor. Thus,
TrA, IO, and QL (A-P) and the activity of RA, EO, IO, and QL are likely to contract
synergistically, especially under the CHA condition when there is less BOS than
under the PHA condition.
Second, the load to the lumbar vertebrae was increased significantly in CHA
versus PHA. Cholewicki et al. (2002) reported that 10 major trunk muscles (RA, EO,
IO, latissimus dorsi, iliocostalis lumborum, longissimus thoracis, lumbar erector
spinae, multifidus, psoas, QL) contributed to maintaining stability of the lumbar
spine rather than single muscles of the trunk, according to the increased load to the
lumbar vertebrae in a biomechanical model study. Cholewicki and McGill (1996)
demonstrated that the relative stability index and muscle effort increased with
increased moment demand or the joint compression force during the tasks in their
study. Cholewicki, Simons, and Radebold (2000) reported that vertical and horizontal
trunk load magnitude increased the activity of trunk muscles. In the present study, the
load on the trunk may have been increased in CHA due to lifting both legs. This
increased trunk load during CHA increased the demand for muscle contraction in the
trunk. Thus, RA, EO, IO, and QL activity was significantly increased in CHA.
In this study, activity in RA, EO, IO, and QL increased significantly in CHA
versus PHA. Some authors have suggested that the activity of local muscles,
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including TrA and the multifidus for lumbar segmental stability, is needed for lumbar
stability (Hodge and Richardson 1997; Hodge and Richardson 1999). However,
others have insisted that the activities of all muscles of the trunk are important for
lumbar stability (Cholewicki and McGill 1996; Cholewicki and Vanvliet 2002). The
results of this study support the latter conclusion: not only local muscles but all
muscles of the trunk play an important role in lumbar stability. Although activity of
the TrA was not included in this study, it seems possible that TrA activity is
increased in CHA. EMG activities of TrA and IO have been shown to act together for
all directions of rapid shoulder movement (Marshall and Murphy 2003). Thus, CHA
would help to increase activity of the TrA.
The hip abduction test can be used to evaluate the quality of the lateral muscular
pelvic brace and lumbopelvic stabilization. The poorest pattern of hip abduction is
when the QL acts in pelvic tilting rather than pelvic stabilization (Libenson 1996).
Alteration in hip abduction patterns may cause excessive stress to lumbopelvic
segments. Cynn et al. (2006) demonstrated that lumbar stabilization during hip
abduction was useful to prevent excessive activation of the QL and excessive pelvic
lateral tilting. In the present study, the activity of GM increased significantly in CHA
compared with PHA. Kinematic data showed a significantly decreased angle of
pelvic lateral tilting in CHA compared with PHA. Contraction of the contralateral hip
adductor muscle during contraction of the hip abductor muscle may stabilize the
pelvis in CHA (Lee 1999). A stabilized pelvis may result in increased GM activity
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and a decreased angle of pelvic lateral tilting in CHA. Thus, the CHA exercise can be
recommended to prevent unwanted compensatory pelvic lateral tilting during hip
abduction in side lying.
In this study, the thickness of QL (AP) increased significantly in CHA versus
PHA. The thickness of the QL has not yet been thoroughly investigated. However,
Desmoulin and Milner (2007) demonstrated that the thickness of the QL (AP) was
significantly correlated with the isometric lateral flexion force of the trunk. McGill
(1996) demonstrated that the quadratus lumborum appeared to be an important
stabilizer of the lumbar column and acted primarily during isometric sidesupport
tasks. Consequently, QL functions as a stabilizer during the isometric sideflexion
force of the trunk. Although these studies did not use the same method as the present
study, maintaining hip abduction in side lying produced isometric lateralflexion
force on the trunk. Thus, the increased thickness of QL (AP) and activity of the QL
demonstrated that the QL contracts isometrically and acts as a stabilizer of the pelvis
during the CHA condition.
This study has some limitations. First, the results were obtained only in young
healthy male subjects. Older persons or those with injured spines may show different
results. Second, the standard references for the thickness of the QL by sonography
were insufficient. Although Desmoulin and Milner (2007) demonstrated that the AP
thickness of the QL increased significantly during isometric lateral flexion of the
trunk, it is necessary that the thickness of the QL using a sonography system also be
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investigated. Third, this study was a crosssectional study that investigated the effects
of CHA on muscle thickness, activity of lumbar stabilizers, and pelvic lateral tilting
during CHA. The effects of longterm training using CHA should be examined in
further studies.
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Conclusion
In this study, the effect of CHA on lumbar stabilizers and compensatory movement
was determined. The results demonstrate that the thickness and activity of lumbar
stabilizers were significantly increased in CHA compared with PHA. Furthermore,
the angle of pelvic lateral tilting was decreased significantly in CHA versus PHA.
Thus, a CHA exercise can be recommended to prevent unwanted compensatory
pelvic lateral tilting during hip abduction exercises in side lying.
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References
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국문 요약
옆으로 누운 자세에서 고관절 외전 시 반대측 고관절
내전이 요추 안정화 근육의 두께, 근활성도와 골반
외측경사에 미치는 영향
연세대학교 대학원
재활학과
김 효 언
본 연구는 옆으로 누운 자세에서 고관절 외전 시 반대측 고관절
내전이 요추 안정화 근육의 두께와 근활성도, 골반 외측경사에 미치는
영향을 알아보기 위해 시행되었다. 본 연구는 요추나 하지의 과거 병력이
없는 20명의 건강한 성인 남성을 대상으로 하였다. 대상자는 옆으로 누운
자세에서 임의로 고관절 35°외전 (preferred hip abduction; PHA)과
반대측 고관절 10°내전 후 고관절 35°외전 (hip abduction with
contralateral hip adduction; CHA)을 실시하였다. 대상자가 동작을 하는
동안 오른쪽 복횡근, 내복사근과 요방형근의 두께, 오른쪽 복직근,
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외복사근, 내복사근, 요방형근, 중둔근과 왼쪽 고관절 내전근의 근활성도,
골반의 외측경사를 측정하였다. 휴식자세 (rest position), PHA와 CHA
시 근육의 두께를 비교하기 위해 반복 측정된 일요인 분산분석 (repeated
one-way analysis of variance)을, PHA와 CHA 시 근활성도와 골반
외측경사를 비교하기 위해 짝비교 t-검정 (paired t-test)을 사용하였다.
내복사근과 복횡근의 두께는 PHA시 보다 CHA 시 유의하게 두꺼워졌다.
요방형근의 안-밖 두께는 CHA와 PHA사이 유의한 차이가 없었으며 앞-
뒤 두께는 CHA 시 PHA보다 유의하게 두꺼워졌다. 근활성도는 모든
근육에서 CHA시 PHA보다 유의하게 증가하였다. 골반의 외측경사는
CHA시 PHA보다 유의하게 감소하였다. 이러한 결과들은 옆으로 누운
자세에서 고관절 외전 시 반대측 고관절을 동시에 내전하는 것이 요추의
안정성을 증가시키고 골반의 보상작용을 줄일 수 있다고 제안할 수 있을
것이다.
핵심 되는 말: 고관절 외전, 골반경사, 근전도, 요부 안정화, 초음파.