본 연구는 근육의 경도와 탄성도를 측정하여 교근 피로에 대한 물리치료의 효과를 정량적으로 평가하고자 하였으며, 측두하악장애 치료에 가장 흔히 사용되는 물리치료이면서 작용기전은 서로 다른 세 가지 치료법인 전기침자극치료(EAST), 극초단파(Microwave diathermy), 저수준레이저치료(LLLT)의 효과를 비교하였다. 실험을 위하여 건강한 20대 지원자 10명을 선정하여, 교근의 전부와 하부의 근육 경도와 탄성도를 촉각센서로 측정하였다. 실험적으로 교근 피로를 유발하기 위해 피검자가 VAS (0 to 10) 5 이상의 통증을 느낄 때까지 껌을 씹게 하여 근육 변화를 조사하였으며 치료 없이 15분간의 휴식을 준 다음 다시 검사하여 물리치료 후의 효과 비교를 위한 대조군으로 사용하였다. 하루 간격으로 사흘에 걸쳐 동일한 시간 동안 껌을 씹게 한 다음, 물리치료 한 가지씩을 매일 시행하였으며 3가지 물리치료법의 적용 순서는 무작위로 하였다. 껌 저작 전, 직후, 15분 후, 각각의 물리치료 시행 후에 근육 경도와 탄성도 측정과 함께 피검자들이 느끼는 근육의 피로도를 VAS로 평가 하도록 조사하였다. 실험 결과, 저작측에서만 껌 저작 직후와 15분 후에 근육경도의 증가와 탄성도의 감소가 관찰되었으며 (p<0.05) 비저작측에서는 유의한 차이가 없었으나 VAS는 저작측과 비저작측 모두에서 증가하였다(p<0.05). 껌 저작으로 인해 변화되었던 근육경도와 탄성도는 전기침자극치료나 극초단파 치료 후에 효과적으로 회복되고 VAS가 감소했으나(p<0.05) 저수준레이저 치료 후에는 유의한 변화를 보여주지 않았다. 이상의 결과로 보아, 편측 저작은 저작측 근육의 경도를 증가시키고 탄성도는 감소시키는 반면, 비저작측에서는 변화가 없는 것을 알 수 있다. 또한 전기침자극치료와 극초단파치료는 모두 근육의 경도를 감소시키고 탄성도를 증가시켜 근육의 피로를 감소시키는데 효과적인 치료법인데 반해 저수준레이저치료의 효과는 미약한 것으로 판단된다.
본 연구는 근육의 경도와 탄성도를 측정하여 교근 피로에 대한 물리치료의 효과를 정량적으로 평가하고자 하였으며, 측두하악장애 치료에 가장 흔히 사용되는 물리치료이면서 작용기전은 서로 다른 세 가지 치료법인 전기침자극치료(EAST), 극초단파(Microwave diathermy), 저수준레이저치료(LLLT)의 효과를 비교하였다. 실험을 위하여 건강한 20대 지원자 10명을 선정하여, 교근의 전부와 하부의 근육 경도와 탄성도를 촉각센서로 측정하였다. 실험적으로 교근 피로를 유발하기 위해 피검자가 VAS (0 to 10) 5 이상의 통증을 느낄 때까지 껌을 씹게 하여 근육 변화를 조사하였으며 치료 없이 15분간의 휴식을 준 다음 다시 검사하여 물리치료 후의 효과 비교를 위한 대조군으로 사용하였다. 하루 간격으로 사흘에 걸쳐 동일한 시간 동안 껌을 씹게 한 다음, 물리치료 한 가지씩을 매일 시행하였으며 3가지 물리치료법의 적용 순서는 무작위로 하였다. 껌 저작 전, 직후, 15분 후, 각각의 물리치료 시행 후에 근육 경도와 탄성도 측정과 함께 피검자들이 느끼는 근육의 피로도를 VAS로 평가 하도록 조사하였다. 실험 결과, 저작측에서만 껌 저작 직후와 15분 후에 근육경도의 증가와 탄성도의 감소가 관찰되었으며 (p<0.05) 비저작측에서는 유의한 차이가 없었으나 VAS는 저작측과 비저작측 모두에서 증가하였다(p<0.05). 껌 저작으로 인해 변화되었던 근육경도와 탄성도는 전기침자극치료나 극초단파 치료 후에 효과적으로 회복되고 VAS가 감소했으나(p<0.05) 저수준레이저 치료 후에는 유의한 변화를 보여주지 않았다. 이상의 결과로 보아, 편측 저작은 저작측 근육의 경도를 증가시키고 탄성도는 감소시키는 반면, 비저작측에서는 변화가 없는 것을 알 수 있다. 또한 전기침자극치료와 극초단파치료는 모두 근육의 경도를 감소시키고 탄성도를 증가시켜 근육의 피로를 감소시키는데 효과적인 치료법인데 반해 저수준레이저치료의 효과는 미약한 것으로 판단된다.
The purpose of this study was to quantitatively assess treatment effect of physical therapy on experimentally-induced masseter muscle fatigue by two parameters of muscle stiffness and elasticity. Three physical therapeutic modalities inducing electroacupunture stimulation therapy(EAST), Microwave di...
The purpose of this study was to quantitatively assess treatment effect of physical therapy on experimentally-induced masseter muscle fatigue by two parameters of muscle stiffness and elasticity. Three physical therapeutic modalities inducing electroacupunture stimulation therapy(EAST), Microwave diathermy and low-level laser therapy(LLLT) were compared. 10 healthy volunteers with normal occlusion (mean age of $26.3{\pm}1.16$ years, M:F=1:1) were participated in this study. All subjects were asked to chew gum on the right side until they felt pain(more and VAS 5 (0 to 10)) and their masseter muscles were examined with a tactile sensor in order to evaluate changes of stiffness and elasticity according to gum chewing and three physical therapeutic modalities. Subjective discomfort or pain was self-estimated by VAS as well. Unilateral gum chewing increased stiffness and decreased elasticity only on the chewing side but VAS increased on the both sides(p<0.05). EAST or Microwave diathermy greatly decreased stiffness and VAS and increased elasticity(p<0.05) but LLLT did not exhibit significant difference. From the results of this study, it is concluded that both EAST and Microwave diathermy have favorable effect on stiffness and elasticity of muscles and pain relief while effect of LLLT is not reliable. In addition, experimental unilateral gum chewing compromises stiffness and elasticity of masseter muscles only the chewing side while subjective discomfort or pain can be felt on the both sides.
The purpose of this study was to quantitatively assess treatment effect of physical therapy on experimentally-induced masseter muscle fatigue by two parameters of muscle stiffness and elasticity. Three physical therapeutic modalities inducing electroacupunture stimulation therapy(EAST), Microwave diathermy and low-level laser therapy(LLLT) were compared. 10 healthy volunteers with normal occlusion (mean age of $26.3{\pm}1.16$ years, M:F=1:1) were participated in this study. All subjects were asked to chew gum on the right side until they felt pain(more and VAS 5 (0 to 10)) and their masseter muscles were examined with a tactile sensor in order to evaluate changes of stiffness and elasticity according to gum chewing and three physical therapeutic modalities. Subjective discomfort or pain was self-estimated by VAS as well. Unilateral gum chewing increased stiffness and decreased elasticity only on the chewing side but VAS increased on the both sides(p<0.05). EAST or Microwave diathermy greatly decreased stiffness and VAS and increased elasticity(p<0.05) but LLLT did not exhibit significant difference. From the results of this study, it is concluded that both EAST and Microwave diathermy have favorable effect on stiffness and elasticity of muscles and pain relief while effect of LLLT is not reliable. In addition, experimental unilateral gum chewing compromises stiffness and elasticity of masseter muscles only the chewing side while subjective discomfort or pain can be felt on the both sides.
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제안 방법
The the purposes of this study were to quantitatively assess therapeutic effectiveness of physical therapy on experimentally-induced masseter muscle fatigue by two parameters of muscle stiffness and elasticity and, thus, to compare commonly-used physical therapeutic modalities including electroacupuncture stimulation therapy (EAST), Microwave diathermy and LLLT. It was also evaluated difference in muscle stiffness and elasticity between chewing and non-chewing sides due to unilateral gum chewing.
Prior to gum chewing, the two spots selected for evaluation of masseter muscle were examined bilaterally with a tactile sensor while the subjects were asked to be relaxed (baseline data, Fig 2-C). To induce muscle fatigue experimentally, the subjects were instructed to chew gum(Excellent breath, Taiyo Co. Japan) at right side with a velocity of 2 times per second until he or she felt pain (more than 5 of VAS ranging from 0 (no pain) to 10 (the worst pain)) and the chewing time was recorded.
Muscle stiffness and elasticity was measured right after gum chewing(0 min after chewing) and the examination was repeated after having rest period of 15 minutes (15 min after chewing), which were used as control for comparison of therapeutic effect with three physical treatments to be followed. Rest period of 15 minutes resulted from that the longest time of physical therapy to be compared(i.
During the following three days, the subjects were asked to chew gum for the time previously recorded and given three physical treatments (EAST, Microwave diathermy and LLLT) respectively in random manner. Muscle examination was done before and after physical treatment and the subjective discomfort or pain was also recorded by VAS.
Muscle examination was done before and after physical treatment and the subjective discomfort or pain was also recorded by VAS. In order to reduce muscle fatigue due to repeated chewing, each experiment was performed with an interval of a day and the subjects were instructed to avoid other chewing during an hour prior to the experiment.
A number of physical therapeutic modalities are used to manage pain and dysfunction in patients with TMD and this study was designed to compare their therapeutic effect on the masseter muscles. Out of variable physical therapeutic modalities, electro-acupuncture stimulation therapy(EAST), Microwave diathermy and LLLT were selected to be compared because they are commonly used for TMDs in clinical setting but each has different mechanism of action.
Muscle condition related to gum chewing was evaluated by two parameters of muscle stiffness and elasticity in this study. The muscle stiffness significantly increased on the chewing side just after gum chewing, which was still found at 15 min after gum chewing.
대상 데이터
A tactile sensor system14) used for this study was Venustron®(Axiom Co. Ltd., Japan) as seen in Fig 1. When there is an electric input, the PZT element vibrates at its own inherent resonance frequency.
10 volunteers(M:F=1:1) were participated in this study. Their mean age was 26.
데이터처리
Muscle stiffness and elasticity between chewing and non-chewing sides was compared with paired t-test. A comparison among three physical therapies were assessed with ANOVA and Multiple Comparison t-tests. P-values of less than 0.
성능/효과
Table 5 shows the change of VAS related with gum chewing and physical therapy. VAS values reported by the subjects increased after gum chewing not only on the chewing side but also on the non-chewing sides, though VAS values on the chewing side was even higher than the non-chewing side. Significant decrease of VAS values for the chewing side was observed after EAST or Microwave diathermy on the chewing side (p<0.
VAS values reported by the subjects increased after gum chewing not only on the chewing side but also on the non-chewing sides, though VAS values on the chewing side was even higher than the non-chewing side. Significant decrease of VAS values for the chewing side was observed after EAST or Microwave diathermy on the chewing side (p<0.05), while LLLT did not exhibit noticeable decrease. EAST showed the best effect on pain relief(Fig.
In this study, there were little change of stiffness and elasticity of the masseter muscle on the non-chewing side, which resulted in significant side-to-side difference(p<0.05)(Table 3). Although several studies indicated compromised masticatory efficiency and occlusal force in most patients with unilateral TMD, it is likely that experimental gum chewing affected only the chewing side.
From the results of this study, it is concluded that both of EAST and Microwave diathermy have favorable effect on muscle stiffness and elasticity and pain relief but effect of LLLT is not reliable. In addition, experimental unilateral gum chewing compromises stiffness and elasticity of the masseter muscles only the chewing side while subjective discomfort or pain can be felt on the both sides.
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