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Keshavarzi F, Azadinia F, Talebian S, Rasouli O. Impairments in trunk muscles performance and proprioception in older adults with hyperkyphosis. J Man Manip Ther 2022; 30:249-257. [PMID: 35133255 PMCID: PMC9344955 DOI: 10.1080/10669817.2022.2034403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Thoracic hyperkyphosis is one of the most common postural deformities in the geriatric population. This study investigated whether trunk proprioception, muscle strength, and endurance differ between older adults with hyperkyphosis and the age-matched control group. This study also aimed to explore the association of kyphotic posture with muscle performance, position sense, and force sense. METHODS Ninety-seven elderly volunteers (61 with hyperkyphosis and 36 normal controls) participated in this cross-sectional study. The kyphosis degree, trunk position sense, force sense, back muscle strength, and endurance were assessed in all participants. RESULTS The results showed lower back extensor strength and endurance, also higher force and position sense error in the hyperkyphotic group than the control group. In addition, the findings revealed that back extensor strength and endurance, as well as trunk position sense, were associated with kyphotic posture in older adults. DISCUSSION AND IMPLICATIONS This study suggests that back extensor strength and endurance and trunk position sense and force sense are potentially modifiable impairments associated with thoracic kyphosis in older adults with hyperkyphosis. It seems monitoring these potentially contributing factors would be helpful in the assessment and treatment of hyperkyphotic older individuals.
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Affiliation(s)
- Fatemeh Keshavarzi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azadinia
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran,CONTACT Fatemeh Azadinia Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Omid Rasouli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Li WY, Chau PH, Dai Y, Tiwari AF. The Prevalence and Negative Effects of Thoracic Hyperkyphosis on Chinese Community-Dwelling Older Adults in Wuhan, Hubei Province, China. J Nutr Health Aging 2021; 25:57-63. [PMID: 33367463 DOI: 10.1007/s12603-020-1441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Globally, 20% to 50% older adults have been found to have thoracic hyperkyphosis. Negative effects on physical performance have been reported. However, there has been a lack of research on the prevalence and negative effects of thoracic hyperkyphosis among Chinese community-dwelling elderly. DESIGN A cross-sectional study. SETTING The communities in Wuhan, China. PARTICIPANTS Three hundred and ninety-five Chinese community-dwelling older adults with thoracic hyperkyphosis. MEASURES Chinese community-dwelling older adults aged 60 or above lived in Wuhan, China from August to December 2018 were recruited for spine and physical performance assessments. The primary outcome was the prevalence of thoracic hyperkyphosis estimated according to the angle of kyphosis which was measured by manual inclinometers. The secondary outcomes were the effects of thoracic hyperkyphosis on physical performance measured by One-leg Standing Test (OLS), Timed Up AND Go Test (TUG), Chest Expansion Test (CE), Six Minutes Walking Test (6MWT), and Farsi Version of Functional Gait Assessment (FGA). The socio-demographic and health-related information were collected by a questionnaire. RESULTS Among 395 participants, the mean angle of kyphosis was 49.0° ± 10.5°, 75.2% of participants had the angle of kyphosis >40° (i.e., having thoracic kyperkyphosis). Compared with older adults having no thoracic hyperkyphosis, older adults with thoracic hyperkyphosis had increased risks performing impaired in OLS (OR=4.55, 95% CI 2.18-9.53, p<0.001), TUG (OR=6.08, 95% CI 2.57-14.40, p<0.001), CE (OR=3.23, 95% CI 1.63-6.38, p=0.001), 6MWT (OR=4.64, 95% CI 1.98-10.86, p<0.001), and FGA (OR=5.18, 95% CI 2.25-11.89, p<0.001) after controlling socio-demographic and health-related factors. CONCLUSION The thoracic hyperkyphosis had high prevalence and associated with impaired performance in balance, gait, and cardiopulmonary function tests among Chinese community-dwelling older adults, which calls for the future intervention.
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Affiliation(s)
- W-Y Li
- Pui Hing Chau, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Hong Kong,
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Ebrahim Mousavi M, Ahmadi Bani M, Aboutorabi A, Zare H, Head J, Movahedi Yeghaneh M, Ahmadi E. The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis. Disabil Rehabil Assist Technol 2019; 15:205-210. [PMID: 31204547 DOI: 10.1080/17483107.2018.1555289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis (excessive spinal forward curvature) amongst elderly people. This condition can in turn impair mobility, reduce balance, and increase the risk of falling and mortality in affected individuals. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. However, there is little evidence that evaluates the use of corrective braces on foot pressure changes in these subjects.Methods: In this study, we evaluated the use of a thoracolumbosacral orthosis (TLSO) on 19 subjects over 60 years old who presented with hyperkyphosis. We measured foot pressure using the Pedar-X system before (without brace) and after (with brace) immediate using a TLSO in both static (quite standing) and dynamic (walking on a 5 meters freeway) scenarios.Results: The results demonstrated that using a TLSO immediately decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions. Hindfoot pressures were increased, but not significantly.Conclusion: This study showed that using a TLSO can be beneficial for elderly people with hyperkyphosis.Implications for rehabilitationThe ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis.The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly.Using a TLSO decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions.
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Affiliation(s)
| | - Monireh Ahmadi Bani
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - Atefeh Aboutorabi
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - Hessam Zare
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - John Head
- Institute for Health & Social Care Research (IHSCR), University of Salford, Salford, United Kingdom
| | | | - Elaheh Ahmadi
- Physical therapist, Allied Health Faculty Hacettepe University, Ankara, Turkey
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Mohebi S, Torkaman G, Bahrami F, Darbani M. Postural instability and position of the center of pressure into the base of support in postmenopausal osteoporotic and nonosteoporotic women with and without hyperkyphosis. Arch Osteoporos 2019; 14:58. [PMID: 31161413 DOI: 10.1007/s11657-019-0581-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/18/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED In postmenopausal women, thoracic hyperkyphosis affects postural instability in the sagittal plane, whereas osteoporosis affects it in the frontal plane. Decrease of hip muscle strength can be changed the center of pressure distance to the center of base of support. These results may be important to design the therapeutic exercise for decreasing the postural instability. PURPOSE In this study, we investigated the effect of bone mineral density (BMD) and thoracic kyphosis on the center of pressure (CoP) sway and its location related to the base of support (BoS). METHODS Ten young and 39 postmenopausal women voluntarily participated in this study. Postmenopausal women were divided into four groups according to the thoracic kyphosis angle (normal kyphotic < 50° ≤ hyperkyphotic) and T-score values. The isometric strength of the trunk and lower limb muscles were measured. The CoP postural sway was measured in a comfortable double stance position, and the location of the CoP was then determined related to the BoS. RESULTS In both hyperkyphotic groups (osteoporotic and normal BMD), the strength of back extension and hip adduction showed a significant decrease compared to the normal kyphotic groups. In the osteoporotic groups (hyper- and normal kyphotic), hip abduction and ankle plantar flexion were significantly weaker than those in the nonosteoporotic groups. In both hyperkyphotic groups, velocity of the CoP displacement in the anterior-posterior (AP) direction was significantly higher than that in the young group, while, in both of the osteoporotic groups, velocity of the CoP displacement in the medio-lateral (ML) direction was significantly higher than that in the young group. In postmenopausal women, hip extensor strength negatively and significantly correlated with the CoP distance to the center of the BoS. CONCLUSION It appears that thoracic hyperkyphosis affects postural instability in the AP direction and that a decrease of BMD affects postural instability in the ML direction.
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Affiliation(s)
- Sanaz Mohebi
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Giti Torkaman
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, P. O. Box: 1411713116, Ale-Ahmad Ave., Tehran, Iran.
| | - Fariba Bahrami
- Human Motor Control and Computational Neuroscience Lab, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Malihe Darbani
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Gross RH, Wu Y, Bonthius DJ, Gross V, Smith A, McCrackin MA, Wolfe M, Helke K, Gallien T, Yao H. Creation of a Porcine Kyphotic Model. Spine Deform 2019; 7:213-9. [PMID: 30660214 DOI: 10.1016/j.jspd.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN Large animal study. OBJECTIVE Create a thoracic hyperkyphotic deformity in an immature porcine spine, so that future researchers may use this model to validate spinal instrumentation and other therapies used in the treatment of hyperkyphosis. SUMMARY OF BACKGROUND DATA Although several scoliotic animal models have been developed, there have been no reports of a thoracic hyperkyphotic animal model creation in an immature animal. The present study was designed to produce a porcine hyperkyphotic model by the time the pig weighed 25 kg, which corresponds to the approximate weight of a child undergoing surgery for early-onset scoliosis (EOS). METHODS Successful surgical procedures were performed in 6 consecutive 10-kg (male, 5-week-old) immature Yorkshire pigs. Procedure protocol consisted of 1) a left thoracotomy at T10-T11, 2) screw placement at T9 and T11, 3) partial vertebrectomy at T10, 4) posterior interspinous ligament transection, and 5) placement of wire loop around screws and tightening. Weekly x-ray imaging was performed preoperatively and postoperatively, documenting progressively increasing kyphosis as the pig grew. Necropsy was performed 5-6 weeks after surgery, with CT, slab section, and histologic analysis. RESULTS Average T9-T11 kyphosis (measured by sagittal Cobb angle) was 6.1° ± 1.4° (mean ± SD) preoperatively, 30.5° ± 1.0° immediately postoperation, and significantly increased to 50.3° ± 7.2° (p < .0001) over 5-6 weeks in 6 consecutive pigs at time of necropsy. CONCLUSIONS An animal model of relatively more rigid-appearing thoracic hyperkyphotic deformities in immature pigs has been created. Subsequent studies addressing management of early-onset kyphosis with spinal instrumentation are now possible. LEVEL OF EVIDENCE Level V.
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Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP ® mirror image ® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018; 30:1039-1045. [PMID: 30154597 PMCID: PMC6110211 DOI: 10.1589/jpts.30.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis
by the Chiropractic BioPhysics® multimodal rehabilitation program.
[Participants and Methods] Ten randomly selected files and corresponding radiographs were
chosen from recent clinic archives of patients who were treated for thoracic
hyperkyphosis. All patients were treated by CBP mirror image® thoracic
extension traction and exercises, as well as spinal manipulative therapy. [Results]
Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25
treatments, over an average of 9 weeks. Patients also experienced a reduction in pain
levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious
progressive deformity that is related to a plethora of symptoms, syndromes, and early
death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic
extension protocols including mirror image extension traction and exercises, as well as
spinal manipulation as part of the CBP multi-modal rehabilitation program.
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Affiliation(s)
- Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON, L3Y 8Y8, Canada
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Paternostre F, Charles YP, Sauleau EA, Steib JP. Cervical sagittal alignment in adult hyperkyphosis treated by posterior instrumentation and in situ bending. Orthop Traumatol Surg Res 2017; 103:53-59. [PMID: 27889355 DOI: 10.1016/j.otsr.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 07/14/2016] [Accepted: 10/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the normal adult spine, a link between thoracolumbar and cervical sagittal alignment exists, suggesting adaptive cervical positional changes allowing horizontal gaze. In patients with thoracic hyperkyphosis, cervical adaptation to sagittal global alignment might be different from healthy individuals. However, this relationship has not clearly been reported in hyperkyphotic deformity. PURPOSE The purpose of this study was to identify cervical sagittal alignment types observed on radiographs in young adults with thoracic hyperkyphosis. The relationship between cervical and thoracolumbar alignment as well as the effect of posterior instrumentation and adaptive positional changes of the mobile cervical segment were retrospectively analyzed. PATIENTS AND METHODS Twenty-three patients (32.7 years; 5-year follow-up) were included. Full spine radiographic measurements were: T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, SVA C7, SVA C2, lordosis between C0-C2, C2-C7, C2-C4 and C4-C7. A Bayesian model and Spearman correlation were used. RESULTS Two alignment types existed: cervical lordosis (group A) and cervical kyphosis (group B). Preoperatively, T4-T12 kyphosis and L1-S1 lordosis were significantly higher in group A: 76.6° versus 59.4° and -72.8° versus -65.8° (probability of>5° difference P (β>5)>0.95). Pelvic incidence was higher in group A (49.8° versus 44.2°) and C0-C2 lordosis in group B (-29.4° versus -21.6°). A significant correlation existed between: T4-T12 kyphosis and C2-C7 lordosis, L1-S1 lordosis and pelvic incidence, C2-C7 lordosis and T1 slope, C2-C7 lordosis and T1-T4 kyphosis. Postoperatively, T4-T12 kyphosis decreased by 33.1° P (β>5)=0.9995), L1-S1 lordosis decreased by 17.7° (P (β>5)=0.961), T1-T4 kyphosis increased by 14.1° (P (β>5)=0.973). SVA C2 (translation) increased by 13.8mm. C0-C2 lordosis (head rotation) remained unchanged. Six patients changed cervical alignment. PJK occurred in 15 patients, unrelated to cervical alignment or proximal instrumentation level. DISCUSSION Two cervical alignment types, lordotic or kyphotic, were observed thoracic hyperkyphosis patients. This alignment was mainly triggered by the amount of thoracic kyphosis and lumbar lordosis, linked to pelvic incidence. Moreover, the inclination of the C7-T1 junctional area plays a key role in the amount of cervical lordosis. The correction of T4-T12 kyphosis induced compensatory modifications at adjacent segments: T1-T4 kyphosis increase (PJK) and L1-S1 lordosis decrease. Global spino-pelvic alignment and head position did not change in the sagittal plane. The cervical spine tented to keep in its preoperative position in most patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- F Paternostre
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Y P Charles
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - E A Sauleau
- Service de santé publique, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - J-P Steib
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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