퇴행성 슬관절염의 운동치료 효과에 대한 생체역학적 분석

Abstract

ABSTRACT

The Effect of Exercise Therapy on Degenerative Arthritis in the Knee Joints, using Biomechanical Analysis

Lee, Hee-Kyung Advisor: Prof. Lee, Kyoung-Il Department of Physical Education Graduate School of Chosun University

The study is to analyze the biomechanical variables on the effect of exercise therapy on degenerative arthritis in the knee joints. For the purpose, it targets 6 old female patients who were diagnosed as having degenerative arthritis in their knee joints. Before exercise therapy, it conducts a pre-test and 8 weeks of exercise therapy followed by a post-test to analyse the changes before and after the therapeutic exercise. The body compositions and radiography of the subjects for the pre-and post-tests are examined. To identify the kinematic and kinetic variables of gait, their gait in three-dimension using images, ground reaction force, and EMG are analyzed, to identify isokinetic strength, its function was measured by isokinetic instrument. For the therapy program, the aquatic exercise was applied to the subjects three times a week and strength exercise twice a week for 8 weeks. The total biomechanical variables for this study include ; ?@ body composition variables : weight, muscle mass, soft lean mass, fat free mass, and body mass index, ?A radiographic variables: tibio-femoral angle and knee joint angle, ?B isokinetic strength variables: peak torque and peak torque( % BW), ?C kinematic variables : step length, step length/ lower limb length, stride length, stride length/lower limb length, walking base, walking base/lower limb length, stride time, horizontal displacement of COG, vertical displacement of COG, foot angle, ankle joint angle, knee joint angle, and hip joint angle, ?D kinetic variables : right and left ground reaction force in both direction, back and forth ground reaction force, vertical ground reaction force (Fx, Fy and Fz), ?E EMG variables : changes in muscle activity of quadriceps femoris and hamstring.

The results of the study are summarized as follows:

1. Though it increases muscle mass and fat free mass at the lower limb, it has no effect on the tibio-femoral angle and joint space narrowing due to increased body mass index and weight. 2. It improves the two isokinetic strength variables at one lower limb with mild degenerative arthritis. In right and left strength ratio and flexor․extensor development, the subjects show diversified aspects according to the degrees of degenerative arthritis (the limbs with less arthritis show better results) or past exercise experiences (the subjects who have no exercise experiences show better results. For the transitional aspects according to joint angles, the subjects show complicated changes according to changes in angles before the therapy, but after the therapy, the peak torque appears within 20?? where the patients have the least pain. Therefore, the most significant results from the isokinetic strength variables are obtained after the therapy. 3. All the kinematic variables of stride, stride/lower limb length, stride length, stride length/lower limb length, walking base, walking base/lower limb length increase. General walking time increases. Stance phase increases while swing phase decreases during walking. Right and left axis displacement is same but central back and forth axis displacement decreases a little. Walking base increases, and right ankle joint angle decreases while left joint angle increases in case of toe off. The maximum flexion of the knee joint angle increases in the stance phase while it decreases in the swing phase. In the hip joint angle, the right hip joint angle increases at toe off while it decreases at heel contact. Therefore, in respect to kinematic variables, more efficient walking is achieved after the therapy. 4. In respect to the ground reaction force, maximum ground reaction force and event-based ground reaction force are same or decrease, but an unstable flat plateau pattern shown on the vertical ground reaction force before the therapy disappears and at loading response and terminal stance, a pattern close to "M" indicating peak appears. As means and maximum integral calculus EMG increase at each phase, which indicates respective increase of muscle activity, and as simultaneous shrinkage of the quadriceps femoris and the hamstring increase. efficient flexive shrinkage appears, which indicates the significant effect of the therapy.