• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.276-281
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• 2016

Objective : Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods : A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results : Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion : For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.

• Physical Therapy Korea
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• v.22 no.1
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• pp.37-48
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• 2015

This study aimed to investigate the effect of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) on trunk stabilization, as well as trunk muscle activities and differences in quadruple visual analogue scale, Korean Oswestry Disability Index, and Fear Avoidance Beliefs Questionnaire scores, in patients with chronic low back pain and lumbar spine instability. To increase intra-abdominal pressure during the trunk stabilization exercise, the technique of pushing the abdomen out using diaphragmatic abdominal breathing suggested by Pavel Koral was used, which we termed the AEM. Fifty patients who tested positive on more than three of the five lumbar spine instability tests were separated from 138 patients with chronic low back pain of these patients, 16 were placed in the control group (trunk stabilization exercise), 17 were placed in the ADIM group (trunk stabilization exercise with ADIM), and 17 were placed in the AEM group (trunk stabilization exercise with AEM). Each group participated in the study for 30 minutes three times weekly for 4 weeks. Surface electromyography was used to measure the trunk muscle activities during the kneeling forward and supine bridging positions, and one-way repeated analysis of variance was used to determine the statistical significance of the trunk muscle activities in the rectus abdominis, internal oblique (IO), erector spinae, and multifidus (MF) muscles. The ADIM and AEM groups showed relatively larger improvements in psychosocial and functional disability level than control group. There were significant changes among the three groups, those from the measured values of the AEM group was significantly higher than the other two groups in changes in IO and MF trunk muscle activities (p<.05). This finding demonstrates that trunk stabilization exercises with AEM is more effective than ADIM for increasing trunk deep muscle activity of chronic low back pain patients with lumbar spine instability.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.35 no.3
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• pp.103-109
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• 2012

The purpose of this paper is to suggest the strategical lifting postures able to alleviate imbalanced EMG amplitude leading to an increase in low back muscle fatigue while lifting asymmetric load dynamically. Eleven male subjects are required to lift symmetrically an external load with 15.8kg and load center of gravity (LCG) deviated 10cm to the right from the floor to the waist height at the speed of about 25cm/sec. The EMG amplitudes on bilateral low back muscles (Longissimus, Iliocostalis, and Multifidus) are recorded during 2sec and analyzed. Independent variables are trunk postures (No bending vs. Bending to the LCG) and feet placements (Parallel vs. Right foot in front of the other vs. Right foot behind the other). Dependent variables are EMG amplitude average on six muscles and the EMG amplitude difference between right and left muscle group. Results indicate the phenomenon showing an amplitude increase in the left muscle group is equal to an decrease in the right one is observed in dynamic as well as static lifts, bending the trunk to the LCG increases amplitude discrepancy more than no trunk bending, and the amplitude discrepancy in one foot ipsilateral to LCG in front of the other foot is lowest among other foot postures. As bilateral EMG amplitude discrepancy increases total low back muscle fatigue, the strategical combination of no trunk bending and one foot close to LCG in front of the other is recommended for preventing elevated incidence of low back pain (LBP).

• 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.

• The Journal of the Korea Contents Association
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• v.11 no.4
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• pp.235-243
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• 2011

The purpose of the study was to examine the thickness of the trunk muscles ie. external obliques (EO), transversus abdominis (TrA), and multifidus and the trunk endurance strength in order to determine any relationship between the presence or absence of low back pain (LBP) and the size of trunk muscles. Data were obtained from 50 subjects, aged between 19-29 years. Participants had no experience of spinal problems that had resulted in a restriction of normal activity or time-off work and no current spinal symptoms. Measurements of muscle thickness of the trunk muscles were collected at rest, contraction and 15 seconds of post contraction during endurance strength tests. Background information was obtained followed all physical measures. Subjects were divided into two groups based on their experience of LBP. In draw-in maneuver, increasing the thickness of TrA was observed in all participants while EO was decreased at contraction in group 1 and increase in group 2. Only subjects in the group 2 had TrA increased during the flexion endurance test. In the side-bridge endurance test, the thickness of the right TrA was also observed differently between groups. Therefore, the results of the study may suggest that a function of specific muscle should be addressed for training persons with LBP.

• The Journal of Korean Physical Therapy
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• v.30 no.1
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• pp.23-28
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• 2018

Purpose: This study examined the effectiveness of iliopsoas self-stretching on the hip extension angle, gluteus maximus (GM) activity, and pelvic compensated angle during prone hip extension (PHE) in subjects with iliopsoas shortness. Methods: Twenty-healthy subjects with iliopsoas shortness were recruited. Electromyography (EMG) was used to examine erector spinae (ES), multifidus (MF), GM, and biceps femoris (BF) while performing PHE. An electromagnetic tracking motion analysis device was used to measure the pelvic compensations. The pelvic compensations while performing PHE were considered to be anterior tilting and rotation. A modified Thomas test was used to monitor the hip extension angle before and after iliopsoas self-stretching. A paired t-test was used to investigate the significant difference after iliopsoas self-stretching during PHE. The level of statistical significance was set to ${\alpha}=0.05$. Results: Muscle activity of GM and hip extension angle were significantly greater after iliopsoas self-stretching compared to that before iliopsoas self-stretching during PHE (p<0.05). BF and pelvic rotation angle were significantly lower after iliopsoas self-stretching compared to that before iliopsoas self-stretching during PHE (p<0.05). The muscle activity of ES was not significantly different between PHE before and after iliopsoas self-stretching (p>0.05). Conclusion: Iliopsoas self-stretching can be effective in selectively strengthening the GM muscles with minimized pelvic compensation in subjects with iliopsoas shortness.

• The Journal of Korean Physical Therapy
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• v.27 no.5
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• pp.281-286
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• 2015

Purpose: The study was to determine whether mechanical horseback-riding training according to velocity may improve trunk muscles thickness in healthy adults. Methods: Twenty healthy adults participated in this study. The subjects were divided into 2 groups as follows: 10 subjects in high velocity mechanical horseback-riding training (MHRT) and 10 subjects in low velocity MHRT. Subjects in all groups performed a total of 18 sessions 3 times a day for 20 minutes and this experiment lasted for 6 weeks. Mann-Whitney and Wilcoxon Signed Rank test were used in analysis the results of trunk muscle thickness. Ultrasonography was performed to evaluate for thickness of rectus abdominis (RA), external oblique (EO), internal oblique (IO), transverse abdominis (TrA), erector spine (ES), and multifidus (MF) in trunk muscles. Results: Results on the changes of EO, IO, and ES of high velocity MHRT showed a significant increase after 6 weeks (p<0.05). Regarding the changes of EO, IO, ES, TrA, and MF of low velocity MHRT, a significant increase was observed after 6 weeks (p<0.05). The differences in change of trunk muscle thickness before training, after 6-week training between groups, TrA and MF of low velocity MHRT were significantly higher (p<0.05). Conclusion: Based on the results of the current study, the velocity of MHRT was shown to affect change of trunk muscle thickness in healthy adults. In particular, low velocity MHRT may serve as a useful method to provide for TrA, MF thickness improvement related to trunk stabilizers.

• Physical Therapy Korea
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• v.23 no.1
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• pp.80-86
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• 2016

Background: Prone hip extension (PHE) can be performed to measure the lumbopelvic motor patterns and motions. Imbalances in lumbopelvic muscle activity and muscle weakness can result in instability including pain in lumbopelvic region. The posterior oblique sling (POS) muscles contribute to dynamic lumbopelvic stability. In addition, POS are anatomically aligned with the trapezius muscle group according to shoulder positions. Objects: This study compared the electromyography (EMG) activity of POS and pelvic compensations during PHE with and without pre-activation of lower trapezius muscle (lowT). Methods: Sixteen healthy males were recruited. PHE was performed in randomized order: PHE with and without lowT pre-activation. Surface EMG signals were recorded for biceps femoris (BF), gluteus maximus (GM) (ipsilateral), lumbar multifidus (MF) (bilateral), and the lowT (contralateral). An electromagnetic tracking motion analysis was used to measure the angle of pelvic rotation and anterior tilting. Results: The ipsilateral GM and bilateral MF EMG amplitudes were greater during PHE with lowT pre-activation compared to PHE without lowT pre-activation (p<.05). The BF amplitude during PHE without lowT pre-activation was significantly greater than that during PHE with lowT pre-activation (p<.05). The angles of pelvic rotation and anterior tilting during PHE with lowT pre-activation were significantly smaller compared to PHE without lowT pre-activation (p<.05). Conclusion: PHE with lowT pre-activation, which is aligned with the POS, showed more increased MF and GM muscular activity with smaller lumbopelvic compensations in rotation and anterior tilting compared to PHE without lowT pre-activation.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.20-27
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• 1998

Among many kinds of introduced free flaps, scapular freeflap is one of the most popularly using modalities in fasciocutaneous defect coverage with minimal donor defect and easier procedure and constant vascular patterns of the donor. Many surgeons who had experience of this flap pointed out deficit of the reliable sensation of the transplanted flap is the main shortcoming of the scapular free flap. If we can subjugate that point, scapular free flap is the most excellent procedure in such a cases as heel pad reconstruction and hand reconstruction which are relatively important to have skin with protective sensation. Author performed anatomical literature review, 10 cadaveric dissections and 12 clinical dissections. In surgical anatomical aspect, the upper six dorsal rami of the thoracic nerves have medial branches which pierce Longissimus thoracis and Multifidus muscle with small cutaneous twigs which pierce Latissimus dorsi and Trapezius muscle. Among that cutaneous twigs, several twigs distribute to the skin of the back from midline to lateral aspect which territory is identical to scapular free flap. We analysed clinical experiences of that sensory bearing scapular free flap surgical anatomy and one year follow-up studies with several results. 1) Two to three cutaneous twigs which pierced from the Trapezius muscle over the scapular free flap region. 2) Each twigs has two to four nerve fascicles with small artery. 3) The nerve distributed to the ordinary scapular free flap and large enough size and pedicle length to neurorrhapy with various recipient site nerves. 4) The inconvenience of this procedure is the vascular pedicle and nerve pedicle have opposite directions, vascular pedicle of that comes from lateral direction from subscapular vessels, but nerve pedicle comes from medial direction from trapezius muscle. Author can found constant cutaneous nerve branches which come from piercing the Trapezius. This nerves are helpful for protective sensation in transplanted scapular free flap. We can't had enough follow-up and evaluation of the nerve function of this procedure, we need continuous research works to application of this procedure. The in conveniences come from directional differences of pedicle can solve with longer harvest neural pedicle and change direction of the neural pedicle.

• 한국체육학회지인문사회과학편
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• v.54 no.1
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• pp.505-514
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• 2015

The purpose of this study was to examine the muscle activation in trunk and low-limbs muscle during squat exercise on various instability surface. 10 subject performed squat with 75% of 1 repetition maximum (1RM) on a stable floor, stability blue, stability black and BOSU. Electromyographic (EMG) activity was measured trunk muscle such as rectus abdomina (RA), external obliques (EO), internal obliques (IO), multifidus (MF), and low-limbs muscle such as gluteus maximus (GMA), gluteus medius (GME), biceps femoris (BF), rectus femoris (RF), vastus medialis oblique (VMO), vastus lateral oblique (VLO), medialis gastrocnemius (MG), lateral gastrocnemius (LG), soleus (SOL) and anterior tibia (AT) when ascending and descending squat phase. One-way ANOVA repeated measure with Sheffe used to compare the muscle activity on the stable and unstable surface. Squat with BOSU ball induces higher muscle activity of IO, MF, GMA and GME compared with stability and stability blue and blackduring descending motion. Squat with BOSU ball induces higher muscle activity of GMA compared with stability and stability blue and blackduring ascending motion. This results suggested that BOSU ball in the squat could be effective increasing of trunk stability and gluteal muscle activity. However, there was no difference of squat on low-limb muscle with or without instability.