• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.2
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• pp.27-36
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• 2021

Background : Prone hip extension (PHE) is commonly used for exercises and tests in patients with low back pain. Previous studies have shown that pelvic compression belts (PCB) and non-elastic taping (NET) contribute greatly to improvements in lumbopelvic stability. This study aimed to compare the effect of two lumbopelvic stability methods such as PCB and NET on the trunk and hip extensor muscle activities during PHE tests. Methods: Subjects who experienced low back pain (low back pain group, LBPG; n=20) and those who did not experience low back pain (non-LBPG; n=20) participated in this study. The subjects were instructed to perform PHE with and without a PCB and NET. PHE tests were performed in the condition wherein the two stabilization methods were applied, and the actions of the muscles at that time were measured using surface electromyography (EMG). EMG data were collected from the hamstring, gluteus maximus, erector spine (ES), and multifidus (MF) muscles. The data were collected three times for 5 s with a 1-min rest between each of the three sets. Results: In the LBPG, EMG of the ES muscle was significantly reduced when NET or a PCB was applied (p<.05). There was no difference in the change in the ES muscle activity when NET and a PCB were applied. The ratio of MF/ES muscleactivity showed a significant increase in the LBPG with NET (p<.05). Conclusion: Both NET and PCB applied to subjects who experienced low back pain significantly reduced the ES muscle activity during PHE exercises and helped control the balance of the superficial and deep trunk extensor muscles.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.2
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• pp.1750-1755
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• 2019

Background: Most of the previous researches on the abnormality of breathing pattern have focused on the silence of functional movements owing to such abnormality, however, have not been clearly identified the relationship between the abnormal breathing pattern on one hand and kinesiophobia and flexion relaxation phenomenon (FRP) on the other hand. Objective: To compare patients with chronic low back pain (CLBP) and healthy person in the abnormality of breathing pattern, kinesiophobia, and FRP during flexion and extension of the trunk. Design: Case-control study. Methods: The research subjects consisted of a group of 15 healthy adults and another group of 15 patients with CLBP. Capnography was used to measure the endtidal $CO_2$ ($EtCO_2$) and respiratory quotient (RQ). The muscle activity of multifidus and erector spinae of the subjects was measured during flexion and extension of the trunk to identify their FRP. The Nijmegen Questionnaire (NQ) and Tampa Scale of Kinesiophobia (TSK) were utilized to measure their breathing patterns and kinesiophobia, respectively. The Kolmogorov-Smirnov (K-S) test was conducted in order to analyze the normal distribution of the measured data. Their general characteristics were identified by the descriptive statistics and the independent t-test was performed to identify the differences between the two groups in terms of abnormality of breathing pattern, kinesiophobia, and FRP. The level of significance was set at ${\alpha}=.05$. Results: The patients with CLBP had significantly less $EtCO_2$ and shorter breathing hold time (BHT) than normal healthy person (p<.05). The patient with CLBP also had significantly greater kinesiophobia than healthy person (p<.05), and had less FRP than the healthy person (p<.01). Conclusions: These results suggest that the CLBP had greater abnormality of breathing pattern and kinesiophobia with less FRP than healthy person.

• Physical Therapy Korea
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• v.29 no.1
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• pp.79-86
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• 2022

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.

• Physical Therapy Korea
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• v.30 no.2
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• pp.144-151
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• 2023

Background: The gluteus maximus (GM) muscle comprise the lumbo-pelvic complex and is an important stabilizing muscle during leg extension. In patients with low back pain (LBP) with weakness of the GM, spine leads to compensatory muscle activities such as instantaneous increase of the erector spinae (ES) muscle activity. Four-point kneeling arm and leg lift (FKALL) is most common types of lumbopelvic and GM muscles strengthening exercise. We assumed that altered hip position during FKALL may increase thoraco-lumbar stabilizer like GM activity more effectively method. Objects: The purpose of this study was investigated that effects of the three exercise postures on the right-sided GM, internal oblique (IO), external oblique (EO), and multifidus (MF) muscle activities and pelvic kinematic during FKALL. Methods: Twenty eight healthy individuals participated in this study. The exercises were performed three conditions of FKALL (pure FKALL, FKALL with 120° hip flexion of the supporting leg, FKALL with 30° hip abduction of the lifted leg). Participants performed FKALL exercises three times each condition, and motion sensor used to measure pelvic tilt and rotation angle. Results: This study demonstrated that no significant change in pelvic angle during hip movement in the FKALL (p > 0.05). However, the MF and GM muscle activities in FKALL with hip flexion and hip abduction is greater than pure FKALL position (p < 0.001). Conclusion: Our finding suggests that change the posture of the hip joint to facilitate GM muscle activation during trunk stabilization exercises such as the FKALL.

• Physical Therapy Korea
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• v.20 no.1
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• pp.1-9
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• 2013

The purpose of this study was to determine the effect of the pelvic compression belt (PCB) on the electromyography (EMG) activities of trunk muscles during sit-to-stand (SitTS), and stand-to-sit (StandTS) tasks. Twenty healthy subjects (7 men and 13 women) were recruited for this study. The subjects performed SitTS, and StandTS tasks, with and without a PCB. Surface EMG was used to record activity of the internal oblique (IO), external oblique (EO), rectus abdominis (RA), erector spinae (ES), and multifidus (MF) of the dominant limb. EMG activity significantly decreased in the RA (without the PCB, $8.34{\pm}6.04$ %maximal voluntary isometric contraction [%MVIC]; with the PCB, $7.64{\pm}5.11$ %MVIC), EO (without the PCB, $14.83{\pm}11.82$ %MVIC; with the PCB, $11.98{\pm}7.60$ %MVIC), MF (without the PCB, $21.74{\pm}7.76$ %MVIC; with the PCB, $18.50{\pm}8.04$ %MVIC), and ES (without the PCB, $18.39{\pm}7.16$ %MVIC; with the PCB, $16.63{\pm}6.31$ %MVIC) during the SitTS task and in the IO (without the PCB, $20.58{\pm}15.60$ %MVIC; with the PCB, $17.27{\pm}12.32$ %MVIlC), RA (without the PCB, $8.04{\pm}5.68$ %MVIC; with the PCB, $7.40{\pm}4.71$ %MVIC), EO (without the PCB, $13.29{\pm}8.80$ %MVIC; with the PCB, $11.24{\pm}6.14$ %MVIC), MF (without the PCB, $18.59{\pm}7.64$ %MVIC; with the PCB, $15.86{\pm}6.48$ %MVIC), and ES (without the PCB, $17.14{\pm}6.44$ %MVIC; with the PCB, $15.46{\pm}5.62$ %MVIC) during the StandTS task when a PCB was used (p<.05). In men the EMG activity of the MF significantly decreased during the SitTS task when a PCB was used (p<.05): in women, the EMG activity of the RA, EO, MF, and ES during the SitTS task and that of the EO, MF, and ES during the SitTS task significantly decreased when a PCB was used (p<.05). In addition, the rates of change in the EMG activity of each muscle differed significantly during the SitTS and StandTS tasks before and after the use of the PCB. However, the EMG activity did not significantly differ between the male and female subjects. These findings suggest that the PCB may contribute to the modification of activation patterns of the trunk muscles during SitTS, and StandTS tasks.

• Physical Therapy Korea
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• v.6 no.2
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• pp.16-31
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• 1999

The purpose of this study was to assess the fatigue in lumbar and abdominal muscles in patients with chronic low back pain compared with normal subjects using spectral analysis with mean power frequency and median power frequency. The experimental group consisted of twenty subjects who had experienced chronic low back pain for over one year after the onset day. A control group consisted of twenty normal subjects with no history of low back pain. All subjects stood in an apparatus to perform sustained contraction in the lumbar and abdominal muscles for 30 seconds with 60% maximal voluntary isometric contraction (MVIC). The resulting electromyographic (EMG) recorded time serial data were transformed into frequency serial data by Fast Fourier Transformation (FFT). The results were as follows: 1) lumbar muscles measured, the frequency change ratio of both median power frequency and mean power frequency was significantly greater for experimental group compared with control group group (p<0.05). In measured two abdominal muscles (inferior rectus abdominis, obliquus externus abdominis) except superior rectus abdominis, the frequency change ratio of both median power frequency and mean power frequency was significantly greater for experimental group compared with control group (p<0.05). 2) In all three (longissimus thoracis, iliocostalis lumborum, multifidus) lumbar muscles measured, the initial frequency value of both median power frequency and mean power frequency was significantly lower for the experimental group compared with the control group (p<0.05). In the two (inferior rectus abdominis, obliquus externus abdominis) abdominal muscles measured (superior rectus abdominis not included), the initial frequency value of both median power frequency and mean power frequency was significantly lower for the experimental group compared with the control group (p<0.05). These results suggest that in patients with chronic low back pain there is a trend for more fatigue to occur in both lumbar and abdominal muscles than in the normal control group. This would seem to suggest that in treatment programs for patients with chronic low back pain, improvement of endurance in all trunk muscles should be considered.

• The Journal of the Korea Contents Association
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• v.11 no.6
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• pp.270-278
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• 2011

The purpose of this study was to compare acute and chronic LBP patient in twenties and forties, respectively by size measure paraspinal muscle (cross-sectional area; CSA). CSA of paraspinal muscle (psoas, multifidus, erector muscle) size was measured by free-handling technique of the picture archiving and communication system(PACS) using MRI at the level(lower end-plate of L4) in twenties(9 males, 10 females) and forties(9 males, 8 females) in acute and chronic LBP patient. The results of this study showed no significantly difference between acute and chronic LBP (p>0.05) in twenties patients. However, there was significant difference between acute and chronic LBP (p<0.05) in forties patients. Also, there was significant difference in paraspinal muscle CSA between chronic LBP patients in twenties and chronic LBP patients in forties (p<0.05). This study showed that paraspinal muscle atrophy was observed in forties with various cause, but Not chronic LBP patients in twenties. Accordingly it is required for chronic LBP patients in forties to minimize trunk muscle atrophy through immediate back muscle dynamic exercise and early functional activity.

• The Journal of the Korea Contents Association
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• v.11 no.12
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• pp.326-334
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• 2011

The aim of the study was to investigate the thickness of deep neck muscles during neck endurance tests using ultrasonography images to assess muscle sizes in persons with or without neck pain experience. Sixty-five university students volunteered for the study. The thicknesses of longus colli, longus capitis, semispinalis and cervical multifidus were assessed bilaterally using diagnostic ultrasound equipment during each endurance test. Participants were divided into two groups based on their Neck Pain(NP) experience; 45 subjects of those had no experience of NP (Group1) whereas 20 subjects of those reported NP experience sometime in their lives (Group2). Endurance time of both neck flexion and extension tests in Group1 showed significantly longer than Group's (p<0.01). The thicknesses of deep neck flexors and extensors were observed smallest at the terminal of endurance tests in general. Only left longus colli was found to be significantly smaller at rest in subjects of Group2 than Group 1's (P=0.02). The size difference between at contraction and the terminal of right longus capitis was observed bigger in subjects of group1 than subjects in group2. Future studies are needed to conduct with clinical subjects to assess contraction patterns of neck muscles.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.22 no.3
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• pp.257-264
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• 2012

Objectives: This study's aims were to evaluate the effects of load center of gravity within an object lifted and feet placements on peak EMG amplitude acting on bilateral low back muscle groups, and to suggest adequate foot strategies with an aim to reducing low back pain incidence while lifting asymmetric load. Methods: The hypotheses that asymmetric load imposes more peak EMG amplitude on low back muscles contralateral to load center of gravity than symmetric load and maximum peak EMG amplitude out of bilateral ones can be relieved by locating one foot close to load center of gravity in front of the other were established based on biomechanics including safety margin model and previous researches. 11 male subjects were required to lift symmetrically a 15.8kg object during 2sec according to each conditions; symmetric load-parallel feet (SP), asymmetric load-parallel feet (AP), asymmetric load-one foot contralateral to load center of gravity in front of the other (AL), and asymmetric load-one foot ipsilateral to load center of gravity in front of the other (AR). Bilateral longissimus, iliocostalis, and multifidus on right and left low back area were selected as target muscles, and asymmetric load had load center of gravity 10cm deviated to the right from the center in the frontal plane. Results: Greater peak EMG amplitude in left muscle group than in right one was observed due to the effect of load center of gravity, and mean peak EMG amplitudes on both sides was not affected by load center of gravity because of EMG balancing effect. However, the difference of peak EMG amplitudes between both sides was significantly affected by it. Maximum peak EMG amplitude out of both sides and the difference of peak EMG amplitude between both sides could be reduced with keeping one foot ipsilateral to load center of gravity in front of the other while lifting asymmetric load. Conclusions: It was likely that asymmetric load lead to the elevated incidence of low back pain in comparison with symmetric load based on maximum peak EMG amplitude occurrence and greater imbalanced peak EMG amplitude between both sides. Changing feet positions according to the location of load center of gravity was suggested as one intervention able to reduce the low back pain incidence.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.1
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• pp.51-62
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• 2022

Objectives Objective of this study is to investigate the role of paraspinal muscles by examining the correlation between slip percentage (SP) of spondylolisthesis and fatty infiltration of lumbar paraspinal muscle. Methods Retrospective analysis was performed on 45 patients diagnosed with spondylolisthesis based on medical records. Using T2-weighted axial magnetic resonance imaging, cross-sectional areas (CSAs) of psoas major (PM), multifidus (MU) and erector spinae (ES) were calculated and divided by CSA of lower level vertebral body (VB). SP was measured using sagittal T2-weighted images. Correlation of SP with muscle relative cross-sectional area (RCSA) and muscle fatty infiltration by Goutallier classification was respectively analyzed using Spearman correlation. Statistic assessment conducted by Wilcoxon signed rank test and paired t-test using program GraphPad prism 5 (GraphPad Software, Inc., San Diego, CA, USA). Results Spondylolisthesis forward slip percentage by Taillard's method was negatively associated with both side MU RCSAs. No significant correlation was found between PM RCSA, ES RCSA and SP. Forward slippage was significantly correlated with fatty infiltration of lumbar paraspinal muscle measured by Goutallier classification. Conclusions This study is to understand the role of paraspinal muscle affecting spinal instability by investigating correlation between statistical deviation of lumbar muscle characters (RCSA, fatty infiltration of lumbar muscle) and SP. We found that spondylolisthesis SP is positively related to fatty infiltration of lumbar paraspinal muscle. and is negatively associated with both side MU RCSAs.