Non-structural misalignments of body posture in the sagittal plane

Trunk Posture Adaptations during Sitting on Dynamic Stool: A Validation Study

Back pain is a complex condition that results from multiple factors including sitting issues such as the chair type and spinal sitting posture. The physiological spinal curvature on the sagittal plane represents a typical feature of good body posture. Sitting postures matching the physiological shape of the spine on the sagittal plane during standing are deemed advantageous from a postural point of view. The aim of this study was to validate a novel dynamic stool by comparing trunk posture adaptations on the sagittal plane during dynamic sitting vs. conventional sitting (standard stool) in healthy people. In total, 100 healthy adults were included. Age, sex and body mass index were recorded. Thoracic kyphosis and lumbar lordosis were measured with the IncliMed® goniometer during standing posture, conventional sitting posture (standard stool) and dynamic sitting posture (novel dynamic stool). Sitting posture was maintained for 2 min before evaluation. Thoracic kyphosis and lumbar lordosis were significantly different between standing vs. sitting (dynamic and conventional) posture (p < 0.001) and between dynamic vs. conventional sitting posture (p < 0.001). Sitting on the novel dynamic stool tested in this study was shown to provide a greater match of thoracic kyphosis and lumbar lordosis with the physiological spinal curvature on the sagittal plane during standing than conventional sitting.

Effect of 9-month Pilates program on sagittal spinal curvatures and hamstring extensibility in adolescents: randomised controlled trial

The percentage of spine misalignment increases during the childhood and adolescence stages. The Pilates method has been associated with an improvement in the sagittal spine disposition, but no studies have been conducted on adolescents. Therefore, the present study aimed to evaluate the effectiveness of a 9-month Pilates exercise program (PEP) on hamstring extensibility and sagittal spinal curvatures on adolescents. This randomised controlled trial included 236 adolescents. The experimental group (EG) received a PEP (9 months, 2 sessions/week, 15 minutes/session). The control group (CG) did not receive any intervention. Hamstring extensibility was measured with the passive and active straight leg raise and toe-touch tests. Sagittal spinal curvatures and pelvic tilt was assessed in relaxed standing, active alignment and toe-touch test positions. The EG had significant changes in hamstring extensibility, lumbar curvature and pelvic tilt in standing sagittal curvature. The CG became significantly worse in thoracic kyphosis in standing. This study provides evidence of nine-months of a PEP increased the hamstring extensibility; averted the increase of the thoracic curvature, and decreased the curvature of the lumbar lordosis and pelvic tilt in standing position; avoided a greater increase of thoracic curvature in active alignment in standing position; and avoided the increase of thoracic curvature in trunk flexion.

Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain)

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a “normal” morphotype for both dorsal and lumbar curves, respectively. After the application of the “Sagittal Integral Morphotype” protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a “normal sagittal integral morphotype” for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the “integral” sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: protocol for a parallel-group randomized controlled trial

Background

Upper crossed syndrome (UCS) refers to specific altered muscle activation and changed movement patterns along with some postural deviations in the upper quarter of the body. This syndrome might contribute to the dysfunction of the cervicothoracic and glenohumeral joints.

Objectives

The present study will aim to investigate the effectiveness of a comprehensive corrective exercises program (CCEP) and subsequent detraining on alignment, muscle activation and movement pattern in men with UCS.

Methods/design

This is a parallel-group randomized controlled trial. Participants will be 22 men aged 18 to 28 years who are suffering from UCS. Participants in the intervention group will conduct CCEP (three times a week for 8 weeks), followed by 4 weeks of detraining. The control group will do their daily activities. Participants will be randomized (1:1) into the intervention or the control group. The primary outcome will be upper trapezius activations. Secondary outcomes consist of electromyography of middle and lower trapezius and serratus anterior muscles, scapular dyskinesis test, forward head and shoulder angles, thoracic kyphosis angle, and neck flexion pattern test.

Discussion

We propose to evaluate the effectiveness of a randomized controlled trial of a CCEP in men with UCS on their alignment, selected muscle activations, and relevant movement patterns. Results from our trial may provide new insights into the effects of exercise not only on the alignment but also on muscle activation and movement patterns that are important outcomes for people with postural malalignments and, if successful, could assist therapists in evidence-based clinical decision-making.

Trial registration

Iranian Registry of Clinical Trials, IRCT20181004041232N1. Registered on 26 October 2018.

Obesity does not impact clinical outcome but affects cervical sagittal alignment and adjacent segment degeneration in short term follow-up after an anterior cervical decompression and fusion

BACKGROUND CONTEXT

Obesity increases complications and cost following spine surgery. However, the impact on sagittal alignment and adjacent segment degeneration (ASD) after anterior cervical decompression and fusion is less understood.

PURPOSE

To compare clinical and radiographic outcomes after anterior cervical decompression and fusion between obese and nonobese patients.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

In all, 467 patients that underwent an anterior cervical decompression and fusion procedure from January 2008 through December 2015 were assessed. Surgery indications were radiculopathy, myelopathy, or myeloradiculopathy that had failed nonoperative treatments. Exclusion criteria included patients who had postoperative follow-up less than 6 months. Of 467 patients originally identified, 399 fulfilled the inclusion and exclusion criteria.

OUTCOME MEASURES

The following patient-reported outcomes were obtained: Neck Disability Index and Visual Analog Scale scores for the neck and arm pain. Radiographic assessments included: C2-C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis, ASD, and presence of fusion.

METHODS

Plain radiographs were performed preoperatively, immediately postoperatively, and final follow-up. Demographic information was collected on all patients. Baseline patient characteristics were compared using chi-squared analysis and independent sample t tests for categorical and continuous data, respectively. For analysis, patients were divided into 4 groups based on obesity stratification as defined by Center for Disease Control: body mass index (BMI) <25 kg/m² (normal weight), BMI≥25 kg/m² to <30 kg/m² (overweight), ≥30 kg/m² to <35 kg/m² (Class I obesity), BMI≥35 kg/m² to <40 kg/m² (Class II obesity), and BMI≥40 kg/m² (Class III obesity). Additionally, obese (≥30 kg/m²) and nonobese (<30 kg/m²) patients were compared in a separate analysis. Multivariate analysis was used to compare clinical and radiographic outcomes among all BMI classes, as well as between BMI≥30 kg/m² versus BMI<30 kg/m² study groups. Multivariate analyses controlled for differences in baseline patient characteristics and included age, sex, smoking, American Society of Anesthesiologists Physical Status Score, diabetes mellitus, and number of levels.

RESULTS

Of the 399 patients assessed, 97 were identified as normal weight, 157 as overweight, 81 with Class I obesity, 45 with Class II obesity, and 19 with Class III obesity. On multivariate analysis, despite having similar SVA measurements on preoperative radiographs, increase in BMI was associated with increase in postoperative SVA (p=0.041) along with significantly larger SVA in immediate postoperative (p=0.004) and final follow-up radiographs (p=0.003) for patients with BMI≥30 kg/m² versus BMI<30 kg/m². Furthermore, patients with BMI≥30 kg/m² had smaller preoperative (p=0.012), immediate postoperative (p=0.017), and final lordosis (p<0.001) in addition to smaller immediate postoperative (p=0.025) and final fusion segment lordosis (p=0.015) and smaller preoperative (p=0.024) and final distal lordosis (p=0.021) compared with patients with BMI<30 kg/m². Additionally, greater BMI was associated with lower final Visual Analog Scale neck scores (p=0.008). Radiographic early ASD rates were higher in patients BMI≥30 kg/m² versus BMI<30 kg/m² (p=0.028).

CONCLUSIONS

Overall, obese patients who underwent anterior cervical decompression and fusion had similar patient-reported outcomes compared with nonobese patients but had worse radiographic parameters and higher rates of ASD development compared with nonobese patients. This underscores the importance of patient selection and surgical approach for both patient populations.

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the effects of different exercise programs on thoracic kyphosis and lumbar lordotic angle. This meta-analysis adhered to the PRISMA guideline and it was registered at PROSPERO. Five electronic databases (Pub Med, Cochrane, WOS, PEDro and EBSCO) were searched up to 31 July 2018. Eligible studies were randomized controlled trials that applied an exercise intervention and measured a kyphosis and/or lordotic angle. Study quality was performance by PEDro score. Risk of bias was assessed using the SIGN 50 checklist for randomized controlled trials. External validity was assessed using the EVAT. Ten randomized controlled trials were included for systematic review and meta-analysis. Meta-analysis with a random effect model was performed to infer the pooled estimated standardized mean difference. All studies were RCTs and they involved a total of 284 cases and 255 controls. Seven studies measured kyphosis angle. A large significant effect of the exercise on kyphosis was identified (SMD = -1.400 (95% CI-2.150 a -0.660), p = 0.000). Four studies assessed lordotic angle and moderate but not significant improvement was shown (SMD = -0.530 (95% CI-1.760 a -0.700), p = 0.401). The results suggest that exercise programs may have a positive effect on thoracic kyphosis angle, but no clear effect on lordotic angle. This systematic review suggests that strengthening rather than stretching could be more relevant for kyphosis and both qualities are important for lordosis. It is necessary to conduct more randomized controlled trials to assess the effects of strengthening and/or stretching program on kyphosis and lordotic angle and to establish the type of the exercise that is better for maintaining the sagittal disposition within normal ranges.

Effects of Physical Therapy on Pain, Functional Status, Sagittal Spinal Alignment, and Spinal Mobility in Chronic Non-specific Low Back Pain

Objective

To investigate the effects of physical therapy (PT) on pain, functional status, sagittal spinal alignment, and spinal mobility in chronic non-specific low back pain (NSLBP).

Materials and Methods

The study population consisted of 100 patients with chronic NSLBP. The study group comprised 60 patients to whom a PT program including superficial heat, transcutaneous electrical nerve stimulation, and ultrasound for 10 sessions was assigned. The control group was composed of 40 patients who received no PT. Home exercise programs were applied to both groups. Pain severity was determined using a Visual Analog Scale (VAS), and functional status was evaluated using the Oswestry Disability Index (ODI). Spinal sagittal alignment in regard to lumbosacral, lumbar lordosis, and thoracic kyphosis angles and spinal mobility regarding lumbar and thoracic flexion and extension degrees were assessed using a digital inclinometer. Lumbar flexion was also assessed using the modified lumbar Schober test (mLST). Evaluations were performed at baseline and after completing the therapy sessions.

Results

There were significant decreases in VAS scores in each group upon therapy completion. However, significant improvements in ODI, mLST, and all inclinometric evaluations in terms of sagittal spinal alignment and spinal mobility were noted only in the study group compared with baseline values (p<0.05).

Conclusion

Despite the short course of treatment, PT was found to have significant positive effects on pain severity, functional status, sagittal spinal alignment, and spinal mobility. PT was determined to be an effective treatment option for chronic NSLBP.

A Short Overview of the Effects of Kinesio Taping for Postural Spine Curvature Disorders

Spine curvature disorders are very common in the population. Several therapeutic methods have been implemented over time. Kinesio Taping (KT) is a solution that is utilized for several purposes. This narrative review aims to discuss KT methodology as a valid solution for spinal curvature disorders, especially for structured and non-structured spine deviations. The matter is poorly discussed in the current literature. Nevertheless, KT seems to indirectly influence posture and spine curvature disorders through peripheral and central nervous system stimulation, but further investigations are needed to demonstrate these unknown effects clearly. The present review provides a valuable contribution to the existing literature and may represent a starting point and a useful guide for further studies in this field of research.