Spinal posture and pelvic position in three hundred forty-five elementary school children: a rasterstereographic pilot study

Asymmetry of the pelvis in Polish young adults

Introduction

Symmetry is one of the criteria of correct body posture in upright position. The spatial positioning of the pelvic girdle is crucial to it. Functional and structural asymmetries within the lumbo-pelvic-hip complex can have a significant influence on the structure and functions of many human body organs and systems. The aim of the study was to present the results of inclinometer measurements of selected landmarks of the pelvic girdle in young adults aged 19-29.

Methods

The analysis of occurrence of spatial pelvic asymmetry was based on the authors' original, clinical classification and the significance of the body mass and height for the analyzed asymmetries. The inclinometer measurements of the selected landmarks of the pelvic girdle were performed in a sample consisting of 300 young individuals. Then, the occurrences of the spatial asymmetry of the pelvis were analyzed based on the authors' own clinical classification using alignment symmetry of the iliac crests, the anterior superior iliac spines and the trochanters major as a criterion. All study subjects with asymmetry <1 degree were treated as those with a symmetrical pelvis.

Results

The significance of gender, body mass and height for the analyzed asymmetries was assessed. Symmetric positioning of the iliac crests was observed in only 32% of the respondents. The iliac crest depression on the left side was more frequently observed - in 41% of the respondents. This occurred more often in women (44%) than in men (38%). In the group of women, the rotated pelvis was the most often observed (39.4%) asymmetry, while for men, it was the oblique pelvis (40%). More detailed analysis by pelvic asymmetry subtypes showed their statistical differentiation between women and men (p    <     0.0001). Analysis of moderate rotation of the pelvis for men, were reported slightly higher values but these differences were not statistically significant (p = 0.253). Women, in turn, showed slightly higher mean values but here too, the differences were not statistically significant (p = 0.245).

Discussion

Asymmetries in the pelvis area are common; they were observed in less than three-quarters of the examined population. Oblique pelvis was found in less than a quarter of women and in more than one-third men with the predominant structural asymmetries. Rotated pelvis was observed in more than one-third of women and men with dominating functional asymmetries. There were no linear correlations between the body mass and height, and the angle of asymmetries.

Reference Values for 3D Spinal Posture Based on Videorasterstereographic Analyses of Healthy Adults

Visual examinations are commonly used to analyze spinal posture. Even though they are simple and fast, their interrater reliability is poor. Suitable alternatives should be objective, non-invasive, valid and reliable. Videorasterstereography (VRS) is a corresponding method that is increasingly becoming established. However, there is a lack of reference data based on adequate numbers of participants and structured subgroup analyses according to sex and age. We used VRS to capture the spinal posture of 201 healthy participants (aged 18-70 years) divided into three age cohorts. Three-dimensional reference data are presented for the global spine parameters and for every vertebral body individually (C7-L4) (here called the specific spine parameters). The vertebral column was found to be systematically asymmetric in the transverse and the coronal planes. Graphical presentations of the vertebral body posture revealed systematic differences between the subgroups; however, large standard deviations meant that these differences were not significant. In contrast, several global parameters (e.g., thoracic kyphosis and lumbar lordosis) indicated differences between the analyzed subgroups. The findings confirm the importance of presenting reference data not only according to sex but also according to age in order to map physiological posture changes over the life span. The question also arises as to whether therapeutic approximations to an almost symmetrical spine are biomechanically desirable.

Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program

BACKGROUND

The child's spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP).

OBJECTIVE

The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children.

METHODS

This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children's parents or legal guardians filled in a questionnaire according to the children's responses about the BP suffered in the previous week and the preceding year.

RESULTS

The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009-1.160, p= 0.028).

CONCLUSIONS

To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

Relationship between frontal knee position and the degree of thoracic kyphosis and lumbar lordosis among 10-12-year-old children with normal body weight

INTRODUCTION

Incorrect positioning of the body in space increases the tension of the myofascial tissue and overloads the skeleton. It is important to look for factors that affect the deterioration of body posture that could be eliminated. Understanding the interrelationship between the positioning of individual body segments should be the key knowledge for those involved in the prevention and correction of faulty body posture. The study aimed to determine the relationship between the degree of physiological curvatures of the spine and the incidence of incorrect knee position.

MATERIALS AND METHODS

The study involved 685 children aged 10-12. Body height, weight and BMI were measured and calculated. The degree of thoracic kyphosis and lumbar lordosis was assessed using the Zebris Pointer ultrasound system. Valgus and varus knees were diagnosed in an upright position based on the intermalleolar distance with knees together, and intercondylar distance with the feet placed together. The statistical analysis uses descriptive statistics, the Mann-Whitney U test (comparison of girls and boys), the Kruskal-Wallis test, the Tukey's post hoc test (comparison of variables in participants with correct, varus and valgus knees) and Spearman's rank correlation coefficient (the relationship between the position of the spine and knees).

RESULTS

The examined girls were heavier than the boys and had higher BMI. Spine deformities and incorrect knee position are common among 10-12-year-old children. The girls and boys differed significantly in the spine shape in the sagittal plane and the intermalleolar distance. Round lumbar lordosis is more characteristic for girls, and for boys, round thoracic kyphosis. For both genders, valgus knees occur more often than varus knees and coexist with decreased thoracic kyphosis. The rounder the thoracic kyphosis, the greater distance between the knees and the smaller distance between ankles.

CONCLUSIONS

The frontal knee position significantly correlated with the depth of thoracic kyphosis.

Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women

The influence of high-heel footwear on the lumbar lordosis angle, anterior pelvic tilt, and sacral tilt are inconsistently described in the literature. This study aimed to investigate the impact of medium-height heeled footwear on the static posture parameters of homogeneous young adult standing women. Heel geometry, data acquisition process, as well as data analysis and parameter extraction stage, were controlled. Seventy-six healthy young adult women with experience in wearing high-heeled shoes were enrolled. Data of fifty-three subjects were used for analysis due to exclusion criteria (scoliotic posture or missing measurement data). A custom structured light surface topography measurement system was used for posture parameters assessment. Three barefoot measurements were taken as a reference and tested for the reliability of the posture parameters. Two 30-degree wedges were used to imitate high-heel shoes to achieve a repeatable foot position. Our study confirmed the significant (p < 0.001) reduced vertical balance angle and pelvis inclination angle with large and medium-to-large effects, respectively, due to high-heel shoes. No significant differences were found in the kyphosis or lordosis angles. High-heeled shoes of medium height in young asymptomatic women can lead to a straightening effect associated with a reduced vertical balance angle and decreased pelvic inclination.

Video rasterstereography of the spine and pelvis in eight erect positions: A reliability study

INTRODUCTION

To investigate the reliability and variability of Video Rasterstereography (VR) measurements of the spine and pelvis, for eight proposed standing postures, in order to help define an optimal standing position for erect pelvis radiography.

METHODS

Surface topography data were collected using the formetic 4D dynamic modelling (Diers) system. 61 healthy participants were recruited; each participant performed eight different standing positions. Four positions were performed with the feet shoulder width apart and parallel, and four positions were performed with the feet shoulder width apart and internally rotated. For the upper extremity, each of the (two sets of) four positions were performed with different arm positions (arms by the sides, arms crossed over the chest, arms 30° flexed and touching the medial end of the clavicle, arms 30° flexed with the hands holding a support). Three sets of surface topography were collected in the eight positions (n = 24). The variability was assessed by calculating standard error of the measurement (SEm) and the coefficient of variation (CV). Reliability was assessed using intra-class correlation coefficients (ICC ± 95% CI).

RESULTS

No significant differences in the SEm were found between the three paired measurements for all standing positions (P > 0.05). ICC values demonstrated excellent reliability for all measurements across the eight standing positions (range 0.879-1.00 [95% CI 0.813-1.00]).

CONCLUSION

Evaluating eight standing positions radiographically would be unethical as it would involve repeat radiation exposures. Using the formetic 4D dynamic modelling (Diers) system, provides an alternative and has shown that there was only a minimal, non-statistically significant, differences between the eight different standing positions.

IMPLICATION FOR PRACTICE

Different standing positions were proposed for erect pelvis radiography.

Spinal posture changes using dynamic rasterstereography during the modified Matthiass test discriminate between postural weak and strong healthy children (10-14 years): a pilot study

The aim of this pilot study was to investigate whether the clinical Matthiass test can be objectified by means of dynamic rasterstereography in children. We aimed at discriminating between postural weak and strong children. Dynamic rasterstereography was used to capture sagittal spinal posture changes during the modified Matthiass test (mMT). Primary outcomes were spinal posture changes (trunk inclination, kyphotic and lordotic angles) during the test. Two-step cluster analysis was run jointly on the three primary outcomes. Data of 101 healthy children (10-14 years, 46% girls) were assessed. Cluster analysis identified two groups of participants with significantly different postural performance levels during the mMT (low vs. high performers). Low performers showed a higher increase in backward lean, as well as kyphosis and lordosis (4°-5°, respectively) when compared to high performers. The two performance groups were age-, BMI-, and activity-matched.Conclusion: This pilot study established preliminary normative data on spinal posture changes during the Matthiass test (high performers) and provided corresponding cutoff values for postural weakness (low performers). These results could provide a basis for future longitudinal and interventional studies targeting long-term consequences of childhood postural weakness and the prevention of back pain. What is Known: • The prevalence of postural insufficiencies in children is high. • No consensus exists about the postural assessment in children. • A common clinical test to identify postural insufficiency is the Matthiass test yet criticized for its subjective assessment. What is New: • This pilot study objectified the modified Matthiass test by rasterstereography and statistically identified two groups of healthy children with different postural performance levels. • It established preliminary normative data on spinal posture changes and provided corresponding cutoff values for postural weakness.

Spinal postural changes during the modified Matthiass test in healthy children : Interday and interrater reliability of dynamic rasterstereographic measurements

OBJECTIVE

The Matthiass test serves to identify postural insufficiencies by evaluating the sagittal posture but this subjective assessment may be responsible for different reports on the prevalence of postural insufficiencies in children. Previously, rasterstereography was used to objectify this clinical test. Until now, the coupling of the Matthiass test with rasterstereography has not yet been applied to children and the reliability is unknown; therefore, the objective of our study was to provide interday and interrater reliability of rasterstereographic measurements during dynamic (modified Matthiass test) and static trials (only interday) in healthy children.

METHODS

Trunk inclination, kyphotic, and lordotic angles were measured using rasterstereography during static and dynamic trials (modified Matthiass test: 90° shoulder flexion, hand-held load, 5% of body weight). Intraclass correlation coefficients (ICC) were calculated using a two-way mixed model (absolute agreement, average measure).

RESULTS

In this study 21 healthy children were assessed (age range 10-12 years). Dynamic rasterstereographic measurements showed fair to good interday and interrater reliability (ICC 0.46-0.70) and static measurements good to excellent interday reliability (ICC 0.63-0.91).

CONCLUSION

Dynamic rasterstereography during the modified Matthiass test furnishes reliable data serving to objectify spinal changes of healthy children and detect postural insufficiencies. Additional efforts are needed to investigate how the early detection of postural insufficiencies can help to prevent back pain in children, adolescents and adults.

Effects of athletic training on the spinal curvature in child athletes

The purpose of this study was to examine the spinal posture in young athletes depending on training intensity. The spinal curvature of 245 children, age 8 to 12 years, was evaluated using rasterstereography. According to their weekly training time group 1 (mean age: 9.54 ± 1.18) did 2-6, group 2 (mean age: 9.49 ± 0.87) did 6-15 and group 3 (mean age: 9.68 ± 0.87) did over 15 hours of training. Group 1 had a significantly higher weight (p = 0.028) (33.86 ± 7. kg) than those of the more active groups (30.67 ± 6.49 kg and 29.46 ± 4.33 kg). The mean kyphotic angle decreased significantly (p < 0.001) with the amount of training per week from 46.86 ± 8.2° in group 1 to 40.08 ± 8° in group 3. We also found a significant decrease (p = 0.047) in lateral deviation with training from group 1 with 5.3 ± 3 mm to group 2 with 4.1 ± 1.6 mm. The results of our study suggest that higher training time can be associated with lower weight and decreases in thoracic kyphosis and lateral deviation of the spine.