앞십자인대 재건술 후 엉덩관절 벌림근 강화운동이 근력과 보행에 미치는 영향

The Effects of Strengthening Exercise of Hip Abductors on Muscle Strength and Ambulation in Patient with ACL Reconstruction

  • 박병준 (대구가톨릭대학교 대학원 물리치료학과) ;
  • 김중휘 (대구가톨릭대학교 의료과학대학 물리치료학과)
  • Park, Byung-Joon (Department of Physical Therapy, Graduate School, Catholic University of Daegu) ;
  • Kim, Joong-Hwi (Department of Physical Therapy, College of Medical Science, Catholic University of Daegu)
  • 투고 : 2014.09.11
  • 심사 : 2014.10.15
  • 발행 : 2014.10.25

초록

Purpose: The purpose of this study was to investigate the effect of strengthening exercises of hip abductors on muscle strength and ambulation for patients with ACL reconstruction. Methods: The subjects were randomly assigned to the intervention group (general exercise plus strengthening of hip abductors) or the control group (general exercise without the strengthening of hip abductors). Both groups participated in a six-week exercise protocol after the surgery for ACL reconstruction. The knee strength test (quadriceps, hamstring, hip abductor) and gait analysis were performed in pretest and post-test. Results: Muscle strength was measured using the Biodex system III model (Biodex Medical System, Inc, NY, US). The results showed no significant difference in knee strength (quadriceps, hamstring) between the two groups (p>0.05), however, there was a significant difference in hip abductors (p<0.05). The gait analysis was measured with Gaitrite system (CIR System Inc, US). Results of comparison between groups showed a significant increase in the step length of both groups. (p<0.05), and there was a significant difference in the affected leg of the intervention group(p<0.05). Conclusion: Exercise of hip abductors for patients with ACL reconstruction provides significant benefits with respect to improvement of muscle strength in hip abductors, increasing the stride. This result indicates that a training program designed for ACL reconstruction patients should include strengthening of the hip abductor. We think that further study is needed to determine the relationship of hip muscles and knee joint for patients with ACL reconstruction.

키워드

참고문헌

  1. Chung JS. The effects of accelerated rehabilitation exercise on knee function, thigh circumference and lysholm score after ACL reconstruction. KEAGW. 2006;20(5):172-86.
  2. Lee LH. The effects of muscle strength and muscle power after rehabilitation exercise program in ACL reconstruction patients. Yeungnam University. Dissertation of Master's Degree 2006.
  3. Feagin, J.A, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med. 1976;4(3):95-100. https://doi.org/10.1177/036354657600400301
  4. Kim YJ, Lee YM. The effects of closed kinetic chain exercises on thigh circumference and lysholm scale of the knee joints of patients with ACL reconstruction. J Korean Soc Phys Ther. 2007;19(6):31-6.
  5. Jacobs CA, Uhl TL, Mattacola CG et al. Hip Abductor Function and Lower Extremity Landing Kinematics: Sex Differences. J athletic training 2007;42(1);76.
  6. Griffin LY, Agel J, Albohm MJ et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8(3):141-150.
  7. Jaramillo J, Worrell T, Ingersoll C. Hip isometric strength following knee surgery. J Orthop Sports Phys Ther. 1994;20(3):160-5. https://doi.org/10.2519/jospt.1994.20.3.160
  8. Judd DL, Eckhoff DG, Stevens-Lapsley JE. Muscle strength loss in the lower limb after total knee arthroplasty. Am J Phys Med Rehab. 2012;91(3):221.
  9. Andriacchi TP. Functional analysis of pre and post-knee surgery: total knee arthroplasty and ACL reconstruction. J Biomech Eng, 1993;115(4B):575-81. https://doi.org/10.1115/1.2895543
  10. Berchuck M, Andriacchi TP, Bach B. R. & Reider B. Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg Am, 1990;72(6):871-77.
  11. Choi WH. Effetcs of eccentric exercise of affected hip abductors on balance in patients with hemiplegia. Yong-In University. Dissertation of Master's Degree. 2002.
  12. Fredericson M, Cookingham CL, Chaudhari AM et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000;10(3):169-75. https://doi.org/10.1097/00042752-200007000-00004
  13. Dwyer MK, Boudreau SN, Mattacola CG et al. Comparison of lower extremity kinematics and hip muscle activation during rehabilitation tasks between sexes. J Athl Training. 2010;45(2):181. https://doi.org/10.4085/1062-6050-45.2.181
  14. Yu CS, Chang SK. The isokinetic evaluation of knee extensors and flexors in the normal subjects for those twenties. J Korean Soc Phys Ther. 2013;25(4):167-73.
  15. Stergiou N, Moraiti C, Giakas G et al. The effect of the walking speed on the stability of the anterior cruciate ligament deficient knee. Clin Biomech. 2004;19(9):957-63. https://doi.org/10.1016/j.clinbiomech.2004.06.008
  16. Richardson RS, Saltin B. Human muscle blood flow and metabolism studied in the isolated quadriceps muscles. Med Sci Sports Exerc. 1998;30(1):28-33.
  17. Kim YK. The Effects of a 12-week exercise training program on ligament stability, knee function, and lysholm score after anterior cruciate ligament reconstruction. Seoul National University. Dissertation of Doctorate Degree. 2002.
  18. Ahn DY. Effect of Rehabilitative Exercise on Isokinetic Muscle Function and Functional Exercise Performance in Male and Female Soccer Players with ACLR. Seonam University. Dissertation of Doctorate Degree. 2013.
  19. Hollman JH, Ginos BE, Kozuchowski J et al. Relationships between knee valgus, hip-muscle strength, and hip-muscle recruitment during a single-limb step-down. J Sport Rehab 2009;18(1):104.
  20. Claiborne TL, Armstrong CW, Gandhi V et al. Relationship between hip and knee strength and knee valgus during a single leg squat. J Appl Biomech. 2006;22(1):41-50.
  21. ML Keast ML. Nordic Walking: Introducing a New Low-Impact Exercise System for Cardiac Rehabilitation Patients. Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute. 2009;13-4.
  22. Kang YH. Effects of Nordic walking on tibialis anterior muscle fatigue. J Korean Soc Phys Ther. 2014;26(2):62-7.
  23. Nam SH, Kang KW, Kwon JW et al. The effects of handrails during treadmill gait training in stroke patients. J Korean Soc Phys Ther. 2013;25(1):23-8.
  24. Kim MJ, Lee SA, Kim SK, Sung IY. The study for gait speed of stroke patients: comfortable versus maximum safe speed. J of Korean Acad. Of Rehab. Med. 1994;18(4):736-41.
  25. Kim JH. Relationship between gait symmetry and functional balance, walking performance in subjects with stroke. J Korean Soc Phys Ther. 2014;26(1):1-8.
  26. Kim MK, Kim KH, Son K. Gait analysis of the normal and ACL deficient patients after reconstruction surgery using footground reaction force. KSME.2006;2006(6):247-52.
  27. Choi WH, Kim MJ. Effects of Eccentric Exercise of Hip Abductors on Gait Balance. KAOMPT. 2003;9(2):59-67.
  28. Jin YW, Song JW, Kang SG et al. Analysis of gait pattern according to passage of rehabilitation training of ACL patients. JESK. 2010;2010(5);250-3.
  29. Winter DA, Patla AE, Frank JS et al. Biomechanical walking pattern changes in the fit and healthy elderly. Phys Ther. 1990;70(6):340-7.
  30. Kim HW. A study on kinematic gait analysis of the normal adult. Kyung bok college. 2001;(5):513-20.
  31. Kwon DY, Sung IY, You JY et al. 3-Dimensional gait analysis of Korean adults. J. of Korean Acad. of Rehab. Med. 1998;22(5);1107-13.