• 대한물리치료과학회지
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• 제30권1호
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• pp.31-40
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• 2023

Hamstring flexibility is an important factor that affects muscle performance of the lower extremities and is closely associated with sports injuries. Therefore, evaluation of flexibility is important in clinical practice. Results of evaluation are determined by types of tests and cut-off values used; therefore, accurate and detailed understanding of these is necessary before examination. Although the straight leg raise and sit and reach tests are used to evaluate hamstring extensibility, structures including the nerves, fascia, and other muscles can significantly confound the results of these tests. The knee extension test is performed at 90° of hip flexion to minimize the posterior pelvic tilt that occurs during the straight leg test. The knee extension test is most recommended for selective evaluation of hamstring flexibility. The knee extension test is classified into active and passive tests. The cut-off value is usually set at 20° for the active and at 10° for the passive knee extension test. Although a strong association is observed between the two tests, the active knee extension test is preferred in clinical practice because it can be performed by a single examiner, which serves as an advantage. Age, sex, and warm-up exercise tend to affect flexibility; therefore, results should be interpreted with caution. Detailed understanding of each flexibility test is important for reliable evaluation.

• The Journal of Korean Physical Therapy
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• 제18권2호
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• pp.35-45
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• 2006

Purpose: This study was to investigate the effect of isometric exercise and active stretching on joint function in patient with osteoarthritis. Methods: 30(M=1, F=29) subjects with osteoarthritis were divided in three groups: control group, quadriceps isometric exercise group, and hamstring active stretching group. After 6 weeks treatment, ROM(range of motion) and LSS(lysholm scoring scale) were measured. Results: There was a significant increase in knee flexion, extension in post-treat of quadriceps isometric exercise group and hamstring active stretching group(p<0.05). There was a significant increase in LSS in post-treat of quadriceps isometric exercise group and hamstring active stretching group(p<0.05). Conclusion: This study shows that both the active stretching exercise and the quadriceps isometric exercise effectively promote the range of knee extensions for osteoarthritis patients. Also, as measuring the ROM of knee flexion and extension by exercise methods, there is significant increase from knee flexion and extension in both hamstring stretching exercise group and quadriceps isometric exercise group. The increase of the range of knee is more effective in the exercise of knee extension with hamstring stretching exercise groups. And it is found that there are some difference between the experimental group and controlled group in statistics. As it is concerned with the function of knee extension, supporting and squatting are more effective to promote the both knee extension and flexion in its range. Therefore, this shows that the hamstring stretching exercise is required in general with enforcing the quadriceps at a sickbed in the present.

• 대한물리치료과학회지
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• 제28권1호
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• pp.76-84
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• 2021

Background: In clinical practice, active knee extension (AKE) test has been widely used to measure hamstring flexibility. During the AKE test, the knee extension is repeated six times. The first five repetitions are considered as warm-up, and the sixth is used as baseline. In order to accurately measure the subject's inherent flexibility, warm-up trials have been proposed as mentioned above; but currently, the evidence is insufficient. Design: Cross-sectional study. Methods: Forty-three healthy adults participated in this study. The AKE was performed slowly after flexing the hip and knee joints by 90° in a supine position. The knee was extended as far as could be done without causing discomfort or pain. When reaching the end range, knee flexion was performed without stopping. As per standard protocol, the subjects performed the knee extension six times. Results: There was no significant difference between the AKE value in the first trial with those in the other five trials. During the repetitions, the average value in the group with higher flexibility tended to decrease and the Intraclass correlation coefficient gradually decreased. Conclusion: Successive repetitions of the AKE test can misrepresent an individual's inherent hamstring flexibility. In order to avoid a decrease in hamstring flexibility, it is strongly recommended that individuals with high initial hamstring flexibility avoid unnecessary repetitions of the AKE test.

• 한국전문물리치료학회지
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• 제28권1호
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• pp.65-71
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• 2021

Background: The hamstring is a muscle that crosses two joints, that is the hip and knee, and its flexibility is an important indicator of physical health in its role in many activities of daily living such as sitting, walking, and running. Limited range of motion (ROM) due to hamstring tightness is strongly related to back pain and malfunction of the hip joint. High-frequency diathermy (HFD) therapy is known to be effective in relaxing the muscle and increasing ROM. Objects: To investigate the effects of HFD on active knee extension ROM and hamstring tone and stiffness in participants with hamstring tightness. Methods: Twenty-four participants with hamstring tightness were recruited, and the operational definition of hamstring tightness in this study was active knee extension ROM of below 160° at 90° hip flexion in the supine position. HFD was applied to the hamstring for 15 minutes using the WINBACK device. All participants were examined before and after the intervention, and the results were analyzed using a paired t-test. The outcome measures included knee extension ROM, the viscoelastic property of the hamstring, and peak torque for passive knee extension. Results: The active knee extension ROM significantly increased from 138.8° ± 9.9° (mean ± standard deviation) to 143.9° ± 10.4° after the intervention (p < 0.05), while viscoelastic property of the hamstring significantly decreased (p < 0.05). Also, the peak torque for knee extension significantly decreased (p < 0.05). Conclusion: Application of HFD for 15 minutes to tight hamstrings immediately improves the active ROM and reduces the tone, stiffness, and elasticity of the muscle. However, further experiments are required to examine the long-term effects of HFD on hamstring tightness including pain reduction, postural improvement around the pelvis and lower extremities, and enhanced functional movement.

• 대한정형도수물리치료학회지
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• 제13권2호
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• pp.45-54
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• 2007

The purpose of this study was effect of hamstring length on one leg stance test(OLST) in 108 persons. (men 28, women 80). The active knee extension test(AKE) was applied 3 times on both leg and high score was selected. Then, one leg stance test(OLST) was applied 3 times on both leg and high score was selected. Also, persons divided two group that is normal hamstring length group and shortening group). The result were as follows : 1. The correlation analysis between Lt. hamstring length and one leg stance time was no significant relation($p_{Lt.}=0.271$, $p_{Rt.}=0.051$). 2. The correlation analysis between Rt. hamstring length and one leg stance time was no significant relation($p_{Lt.}=0.837$, $p_{Rt.}=0.334$). 3. The independent T -test between Lt. hamstring normal (knee extension > 150degrees) & shortening group (knee extension ${\leq}$ 150 degrees) in Lt. leg stance time was no significant difference(p=0.73), but in Rt. leg stance time was statistically significant difference(p=0.04). 4. The independent T-test between Rt. hamstring normal (knee extension > 150degrees) & shortening group (knee extension ${\leq}$ 150 degrees) in one leg stance time was no significant difference($p_{Lt.}=0.09$, $p_{Rt.}=0.16$).

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2003년도 춘계학술대회 논문집
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• pp.1310-1315
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• 2003

Severe osteoarthrosis of the knee joint often requires total knee arthroplasty (TKA) to yield adequate knee function. The knee joint with TKA is expected ideally to restore the characteristics, however, this is not necessarily true in the clinical cases. In this study the motions of the intact joint and the joint after TKA were investigated numerically using computer simulation. For active knee extension from 90 degrees of flexion to full extension, the intact knee joint exhibited anterior tibial translation near the full extension while it showed only rotation for other flexion angles. Physiologic external rotation of the tibia near full extension was also noted in the analytical model. The analysis of the tibial insert of three different shapes (flat, semicurved, and curved types) demonstrated characteristic rotational and sliding motions as well as different contact forces.

• 한국정밀공학회지
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• 제21권9호
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• pp.188-195
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• 2004

Severe osteoarthrosis of the knee joint often requires total knee arthroplasty(TKA) to yield adequate knee function. The knee joint with TKA is expected ideally to restore the characteristics, however, this is not necessarily 1.ue in the clinical cases. In this study the motion of the intact joint and the joint after. TKA were investigated numerically using computer simulation. For active knee extension from 90 degrees of flexion to full extension, the intact knee joint exhibited anterior tibial translation near the full extension and it showed only rotation at other flexion angles. Physiologic external rotation of the tibia near full extension known as screw home movement was also noted in the analytical model. The analysis of the tibial insert of three different shapes (flat, semicurved, and curved types) demonstrated characteristic rotational and sliding motion as well as different contact forces.

• 대한정형도수물리치료학회지
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• 제5권1호
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• pp.39-51
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• 1999

Background and Purpose. Objective measurements of hamstring muscle length are needed to quantify baseline limitations and to document the effectiveness of therapeutic interventions. Several indirect clinical tests for measuring hamstring muscle length are available, but influence of their test procedure is not well documented. The purpose of this study were 1) to describe hamstring muscle length as reflected by use of six tests(active straight leg raising(ASLR), passive straight leg raising(PSLR), passive straight leg raising with the lower back flat(PSLRB), active knee extension(AKE), passive knee extension(PKE), hip joint angle(HJA). 2) to examine the correlation among the tests. Subjects, Sixty subjects(30 men. 30 women) ranging in age from 18 to 25 years(mean 20.2 years) and with no limitation hamstring flexibility and no neurological and orthopedical problems. Methods. All subjects performed six tests. A inclinometer was used to determine the end point of range of motion. HJA was measured using an inclinometer placed over the sacrum. PSLRB were tested PSLR with the low back flat and the opposite thigh slightly flexed and support on pillows. Results, A mean ASLR value of 85.9 degrees, PSLR value of 99.9 degrees, PSLRB value of 109.8 degrees, AKE value of 77.2 degrees PKE value of 83.1 degrees and HJA value of 73.0 degrees were obtained for all subjects. A dependent t-test showed significant difference between the angles of ASLR and PSLR(p<0.001). There was a significant difference between the angles of PSLR and PSLRB(p<0.001). There was a significant difference between the angles of AKE and PKE(p<0.001). The highest correlation was between PSLR and PSLRB(r=0.915, p<0.001). All SLR tests were significants related(p<0.001), as well as AKE and PKE(p<0.001). The lowest correlation was between PKE and HJA(r=0.171. p>0.05). Conclusion and Discussion. The results indicated that the hip flexion angles for ASLR, PSLR and PSLRB were a difference, and the knee extension angles for AKE and PKE were a difference.

• The Journal of Korean Physical Therapy
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• 제17권3호
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• pp.429-440
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• 2005

The purpose of this study was to compare the effects of knee joint position sense following local and general load protocols in 25 healthy male subjects. Proprioception of the knee joint was evaluated by measuring absolute angular errors at matching angles before, after and between 2 different types of load protocols. Proprioception tests(on the dominant knee) were performed in which proprioception of the passivepassive reproduced and active-active reproduced knee position was measured. Local load was provided with maximum isokinetic knee extension-flexion on the isokinetic dynamometer(Cybex), and general load was 10 minutes running on a treadmill. Peak torque(knee extension and flexion) and heart rate(beats per minute) was evaluated as an indicator of local and general fatigue during load protocols. The results were as follows: 1. For pasive-pasive reproduced knee position test, significant difference in absolute angular errors after general load protocol was detected compared with that before general load protocol(P<.05), significant difference in absolute angular errors after local load protocol was detected compared with that before local load protocol(P<.05). However, no significant difference in absolute angular errors of general load protocol was detected compared with that of local load protocol (P>.05), no significant difference in absolute angular errors of local load protocol was detected compared with that of general load protocol(P>.05). 2. For active-active reproduced knee position test, significant difference in absolute angular errors after general load protocol was detected compared with that before general load protocol(P<.05), significant difference in absolute angular errors after local load protocol was detected compared with that before local load protocol (P<.05). Also, significant difference in absolute angular errors of general load protocol was detected compared with that of local load protocol(P<.05), significant difference in absolute angular errors of local load protocol was detected compared with that of general load protocol(P<.05). 3. A significant decrease of peak torque of knee extensors and flexors was seen after local load, although heart rate was significantly increased(P<.05). No significant change of peak torque of knee extensors and flexors was seen after general load(P>.05), although heart rate was also significantly increased(P<.05). The previous study revealed that knee proprioception is significantly altered when the muscle mechanoreceptors are dysfunctional due to muscle fatigue, although the joint mechanoreceptors have no significantly effect on knee proprioception when the presence of knee muscle fatigue. However, the results of this study are different from those of the previous study in that muscle weakness of the knee could not be seen after general load. This study shows that general load may diminish motor control by the central nervous system. Proprioceptional decline without muscle weakness of knee after general load suggests a change in the proprioceptional pathway without influence from muscle mechanoreceptors.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.769-772
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• 2022

Femoral nerve injuries are devastating injuries that lead to paralysis of the quadriceps muscles, weakening knee extension to prohibit ambulation. We report a devastating case of electrical injury-induced femoral neuropathy, where no apparent site of nerve disruption can be identified, thus inhibiting the traditional choices of nerve reconstruction such as nerve repair, grafting, or transfer. Concomitant spinal cord injury resulted in spastic myopathy of the antagonist muscles that further restricted knee extension. Our strategy was to perform (1) supercharge end-to-side technique (SETS) to augment the function of target muscles and (2) fractional tendon lengthening to release the spastic muscles. Dramatic postoperative improvement in passive and active range of motion highlights the effectiveness of this strategy to manage partial femoral nerve injuries.