Postural assessment of lumbar lordosis and pelvic alignment angles in adolescent users and nonusers of high-heeled shoes

Immediate Effect of Simulated High Heels on Pelvic and Spinal Posture in Healthy Young Subjects: A Cross-Sectional Study

Background Investigations regarding the role of high-heeled shoes in the alteration of the spinopelvic profile attempted to identify a correlation with pain in the lower back. Conclusions from these studies, however, are controversial. In authors knowledge no studies were carried out to investigate the effect of heels on male population, which has been overlooked due to gender-related customs. Research question What is the immediate effect of the height of heels on the sagittal back profile (trunk inclination (TI), pelvic inclination, lordotic lumbar angle (ITL-ILS), kyphotic dorsal angle, lumbar arrow, and cervical arrow) in females and males, not used to wearing high-heeled shoes? Methods One hundred healthy young adult subjects were enrolled. Three were excluded. The remaining 97 subjects (48 female and 49 male) underwent a three-dimensional analysis of the posterior surface of the trunk, using rasterstereography. The spinopelvic profile in the barefoot condition, and with the heel raised by 3 and 7 cm, was recorded. To evaluate the reproducibility of the measure, the neutral evaluation was repeated twice in 23 subjects (13 males, 10 females). Results The change of heel height did not show statistically significant differences for any of the variables used; instead, significant differences were found stratifying the results according to the sex of the subjects tested. Test-retest evaluation in the neutral condition showed no significant differences using the Student's t-test (p > 0.05). Repeatability was excellent and significant for all data used (minimum TI r = 0.85, maximum ITL-ILS r = 0.97). Significance Studying the effect of heels on the spino-pelvic profile also in the male population is crucial for promoting gender-inclusive healthcare, enhancing occupational health practices and developing possible preventive measures. Nevertheless, in the sample of females and males evaluated in this study, the different heights of heel lift did not immediately induce significant changes in pelvis and spine posture. If there is therefore a correlation between low-back pain and the use of heels, it should not reasonably be sought in the immediate change of the spino-pelvic profile caused by raising the heels. However, the variables analyzed differed according to sex.

An investigation of the reproducibility of a self-selected natural feet position when standing: Implications for the assessment of upright standing posture

BACKGROUND

Photogrammetry is often used to evaluate standing static postural alignment. Patients are often instructed to self-select a natural feet position but it's unclear whether this position can be consistently replicated across repeated assessments.

OBJECTIVE

To determine whether people can replicate a self-selected natural feet position in upright standing across three sessions on different days.

DESIGN

Between days test-retest reliability.

SETTING

University laboratory.

METHODS

Three variables - Base of Support (BoS), Foot Width (FW), Feet Opening Angle (FOA) - were measured from foot tracings of 150 participants (18-30 years) using established procedures. BoS data were assessed for systematic bias (Analysis of Variance), and absolute (Coefficient of Variation - CV%) and relative (Intraclass Correlation Coefficient - ICC) reliability.

RESULTS

There was systematic bias in the BoS data across the three testing sessions. The CV% for the BoS data was 15.2%. The ICC (95% CI) for the BoS data was 0.84 (0.79-0.87). There were moderate-large correlations between the BoS and both FOA and FW respectively within each session.

CONCLUSION

If clinicians want to allow patients to use their self-selected natural feet position for repeated photogrammetric assessment of their static postural alignment it would be better to standardise the position of the feet, for example, by creating a tracing of a patient's self-selected natural feet position.

Harmful female footwear: A public health perspective

Footwear fashion is an instance of a socially formed attitude affecting somatic population health. High-heeled, particularly pointy-toed shoes are posed to structurally distort and overload feet leading to musculoskeletal sequelae. Here we compiled multilanguage website images presenting female footwear produced by the top manufacturers to assess the advertising effects on the prevailing height of heels worn by women. The method was based on the analysis of websites using the command "woman shoes" in scores of languages of the Internet Google browser. We then compared the results of the internet search with those of a live street surveillance of the footwear worn by 100 adult women in the downtown Warsaw metropolis in Poland. We found that stiletto heels with pointed shoe tips significantly predominated in images representing the countries belonging to the Western cultural sphere compared to less affluent world areas where low or flat heels prevailed. However, we noted a gradual departure from the fashion of high heels over the last decade, confirmed by live street surveillance, liable to reflect changes in the website presentations of top shoe manufacturers consistent with increasing awareness of potential harm by high heels. Yet the female aptitude for wearing more physiologic shoe models appears to exceed that resulting from marketing campaigns. Doing away with high-heeled pointy-toed shoes requires intensification of pro-health preventive measures in the field of public health.

Can We Quantify Aging-Associated Postural Changes Using Photogrammetry? A Systematic Review

BACKGROUND

Aging is widely known to be associated with changes in standing posture. Recent advancements in the field of computerized image processing have allowed for improved analyses of several health conditions using photographs. However, photogrammetry's potential for assessing aging-associated postural changes is yet unclear. Thus, the aim of this review is to evaluate the potential of photogrammetry in quantifying age-related postural changes.

MATERIALS AND METHODS

We searched the databases PubMed Central, Scopus, Embase, and SciELO from the beginning of records to March 2021. Inclusion criteria were: (a) participants were older adults aged ≥60; (b) standing posture was assessed by photogrammetric means. PRISMA guidelines were followed. We used the Newcastle-Ottawa Scale to assess methodological quality.

RESULTS

Of 946 articles reviewed, after screening and the removal of duplicates, 11 reports were found eligible for full-text assessment, of which 5 full studies met the inclusion criteria. Significant changes occurring with aging included deepening of thoracic kyphosis, flattening of lumbar lordosis, and increased sagittal inclination.

CONCLUSIONS

These changes agree with commonly described aging-related postural changes. However, detailed quantification of these changes was not found; the photogrammetrical methods used were often unvalidated and did not adhere to known protocols. These methodological difficulties call for further studies using validated photogrammetrical methods and improved research methodologies.

Effect of Eutonia, Holistic Gymnastics, and Pilates on body posture for pre-adolescent girls: Randomized clinical trial

INTRODUCTION

Postural changes frequently occur in pre-adolescent girls, with sedentary lifestyle with reduced physical activity level as one of the risk factors.

OBJECTIVE

To investigate the effects of Eutonia, Holistic Gymnastics, and Pilates on body posture in pre-adolescent girls.

METHODS

A randomized prospective quantitative clinical trial was conducted. The study included girls aged 10-13 years and compared the effects of Eutonia, Holistic Gymnastics, and Pilates on body posture. The sample comprised 80 girls divided into three intervention groups as follows: Eutonia group, 26 girls; Holistic Gymnastics group, 27 girls; and Pilates group, 27 girls. Ten sessions of 1 h each were conducted on a weekly basis. Static posture was analyzed using the Postural Analysis Software SAPO; dynamic posture, using the modified Layout for Assessing Dynamic Posture LADy; and lifestyle, using the Body Posture Evaluation Instrument Back PEI questionnaire. The data were statistically analyzed using the analysis of variance (ANOVA) by Kruskal-Wallis' averages test at 5% significance level (p < 0,05).

RESULTS

The results showed that the three body movement practices improved the head inclination in the frontal plane (1,49°) and pelvic anteversion in the right (1,9°) and left profiles (2,09°). In addition, 25% of pre-teens started to carry their school bag correctly, improving their posture.

CONCLUSION

The body movement practices of Eutonia, Holistic Gymnastics, and Pilates improved head inclination, pelvic anteversion, and the correctness rate of carrying the schoolbag.

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.

Foot Deformities in Women Are Associated with Wearing High-Heeled Shoes

Background

The aim of this study was to assess the association between foot deformities and type of shoe regularly worn at work.

Material/Methods

We studied 150 employed women ages 30–40 years and divided them into 3 groups according to type of footwear worn: women in Group I wore flat-soled shoes, women in Group II wore mid-heeled shoes (heels 4.0±0.5 cm), and women in Group III wore high-heeled shoes (heels 10.0±0.5 cm). We used the CQ-ST podoscope for measurements.

Results

We found significant differences in right foot γ angle between Groups I and III (p=0.033) and between Groups II and III (p=0.040). For the left foot, differences were noted between Groups I and III (p=0.012). Group III subjects had higher values of α angle compared to Group I (p=0.000) and Group II (p=0.000). Significant correlations were also found between specific type of footwear worn and the incidence of hallux valgus of the right foot (p=0.010) and left foot (p=0.000), and the varus deformity of the fifth toe (β) of the left foot (p=0.015).

Conclusions

The feet of women wearing high-heeled shoes were significantly flatter transversely, with a more laterally flexed hallux, as compared to those wearing low-heeled or flat-soled shoes. Wearing high-heeled shoes was associated with higher incidence of hallux valgus. The incidence of varus deformity of the fifth toe was associated with wearing high-heeled shoes.

Key concepts in children's footwear research: a scoping review focusing on therapeutic footwear

BACKGROUND

Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children's gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children's footwear and to establish the range of studies that considered therapeutic footwear.

METHODS

A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children's footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies.

RESULTS

The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional).

CONCLUSION

Children's footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children's therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children's therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.

Can wearing high heels influence anal canal pressure and the severity of fecal incontinence?

INTRODUCTION AND HYPOTHESIS

Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence.

METHODS

In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: "high heels" vs "no high heels."

RESULTS

The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with "high heels." No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure.

CONCLUSIONS

In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.

Thoracic Kyphosis and Lumbar Lordosis Assessment by Radiography and Photogrammetry: A Review of Normative Values and Reliability

OBJECTIVE

The purpose of this study was to review referential values for thoracic kyphosis and lumbar lordosis for radiography and photogrammetry analysis and search for information about the interrater and intrarater reliability.

METHODS

The databases PubMed/Medline and LILACS were searched using the following keywords: radiograph and posture, postural alignment, and photogrammetry or photometry or biophotogrammetry. Studies containing values of thoracic kyphosis and lumbar lordosis or a reliability test assessed by radiography and photogrammetry were selected. Random numbers were generated in MATLAB from each study individually to establish normative values for the thoracic kyphosis and lumbar lordosis for both methods. After that, frequencies (median, first quartile, and third quartile) were obtained in SPSS 20.0 (IBM Corp, Armonk, New York).

RESULTS

Twenty-six articles were selected, of which 23 studies contained values for thoracic kyphosis and lumbar lordosis and 10 tested the intra- and interrater reliability of both methods. For the studies with radiography that calculated the angle by the same method of assessment, the mean was 44.07° (4.75) for L1 to L5 and 58.01° (5.75) for L1 to S1, and for T1 to T12 the mean was 48.33° (6.24). Most studies used the intraclass correlation coefficient test, showing strong reliability.

CONCLUSION

No concordance among the results for both methods was shown. Also, it was not possible to perform the same procedure with the photogrammetry studies because of the great discrepancy in procedures and angle calculations. To assess the reliability, it is necessary to use the proper statistical test.

Recognition of a Person Wearing Sport Shoes or High Heels through Gait Using Two Types of Sensors

Biometrics is currently an area that is both very interesting as well as rapidly growing. Among various types of biometrics the human gait recognition seems to be one of the most intriguing. However, one of the greatest problems within this field of biometrics is the change in gait caused by footwear. A change of shoes results in a significant lowering of accuracy in recognition of people. The following work presents a method which uses data gathered by two sensors: force plates and Microsoft Kinect v2 to reduce this problem. Microsoft Kinect is utilized to measure the body height of a person which allows the reduction of the set of recognized people only to those whose height is similar to that which has been measured. The entire process is preceded by identifying the type of footwear which the person is wearing. The research was conducted on data obtained from 99 people (more than 3400 strides) and the proposed method allowed us to reach a Correct Classification Rate (CCR) greater than 88% which, in comparison to earlier methods reaching CCR’s of <80%, is a significant improvement. The work presents advantages as well as limitations of the proposed method.

Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis

Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women. Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the "threats to validity tool". Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (-1.36 (95% CI -2.30, -0.42) p =  0.004) and induced 15° dorsiflexion (-1.65 (95% CI -2.49, -0.81) p =  0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (-2.28 (95% CI -3.96, -0.60) p =  0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI -0.75, 1.35) p =  0.57) or maximal voluntary contraction (0.97 (95% CI -0.77, 2.72) p =  0.27). Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position. Implications for rehabilitation Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion. As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion. Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position. Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women

There is still conflicting evidence about the effect of high-heeled footwear on posture, especially if methodological confounders are taken into account. The purpose of this study was to investigate the effect of high-heeled footwear on lumbopelvic parameters in experienced younger and middle-aged women while standing and walking. Thirty-seven experienced younger (n=19:18-25 years) and middle-aged (n=18:26-56 years) women were included in this randomized crossover study. Using a non-invasive back shape reconstruction device (rasterstereography), static (pelvic tilt and lumbar lordosis angle) and dynamic (pelvic rotation, median lumbar lordosis angle and range of motion) parameters representing pelvis position and lumbar curvature were measured. In order to analyse standing and walking on a treadmill (0.83m/s), the effects of high-heels (7-11cm) were compared to standard control shoes. There were no effects on the lumbar lordosis angle or range of motion under static or dynamic conditions (p>0.05, d≤0.06). But there was a small effect for a reduced pelvic tilt (p=0.003, d=0.24) and a moderate effect for an increased transversal pelvic rotation (p=0.001, d=0.63) due to high heel shoed standing or walking, respectively. There were no significant age-group or interaction effects (p>0.05). Altered pelvic parameters may be interpreted as compensatory adaptations to high-heeled footwear rather than lumbar lordosis adaptations in experienced wearers. The impact of these findings on back complaints should be revisited carefully, because muscular overuse as well as postural load relieving may contribute to chronic consequences. Further research is necessary to examine clinically relevant outcomes corresponding to postural alterations.

The Effects of Heel Height on Head Position, Long-Term Average Spectra, and Perceptions of Female Singers

Female singers often wear high heels for auditions and performances. Heel height research in non-singing contexts indicates that wearing heels can affect body alignment and head position. Studies in orthodontics, sleep apnea, and voice science suggest that head and neck positioning can alter the vocal tract. The purpose of this study was to assess the effects, if any, of heel height (barefoot, 10.16-cm stilettos) on three angles of singer head position (calculated from C7-tragus-nasion), long-term average spectra data, and perceptual data (questionnaire) acquired from female (N = 30) soloists during alternating periods of silence and singing. Results indicated that all participants (100%) significantly decreased head position angle measurements (inferior and posterior head and neck movement) when singing in high heels compared with singing barefoot. Participants, on average, significantly increased head position angle measurements (superior and anterior head and neck movement) when singing compared with standing silently, and did so to a greater degree when transitioning from silent heels to singing heels compared with transitioning from silent barefoot to singing barefoot. Long-term average spectra data indicated significant spectral energy differences between barefoot and high heel singing conditions across participants. Most participants (n= 21, 70.00%) indicated they felt comfortable and sang their best while barefoot. Results of this study, the second in a series of experiments addressing the effects of shoe heel height on female singers' vocal production, were discussed in terms of application to vocal pedagogy and directions for future research.

Procedures of assessment on the quantification of thoracic kyphosis and lumbar lordosis by radiography and photogrammetry: A literature review

The quantification of thoracic kyphosis and lumbar lordosis can be assessed in different ways; among them radiography and photogrammetry. However, the assessment procedures are not consistent in the literature for either method. The objective of this study was to conduct a literature review about postural assessment through radiography and photogrammetry, for delineating the procedures for both methods. In total 38 studies were selected by an online search in the MEDLINE and LILACS databases with the keywords: radiograph and posture, postural alignment, photogrammetry or photometry or biophotogrammetry. For the radiographic method, the results showed divergences in arm positioning and in the calculation of thoracic and lumbar angles. The photogrammetry demonstrated differences in relation to the camera, tripod, plumb line and feet positioning, angle calculation, software utilization, and the use of footwear. Standardization is proposed for both methods to help establish normative values and comparisons between diagnoses.

Influence of high-heeled shoes on the sagittal balance of the spine and the whole body

PURPOSE

Wearing high heels is associated with chronic pain of the neck, lower back and knees. The mechanisms behind this have not been fully understood. The purpose of this study was to investigate the influence of high-heeled shoes on the sagittal balance of the spine and the whole body in non-habitual wearers of high heels.

METHODS

Lateral standing whole body low-dose radiographs were obtained from 23 female participants (age 29 ± 6 years) with and without high heels and radiological parameters describing the sagittal balance were quantified. These were analyzed for differences between both conditions in the total sample and in subgroups.

RESULTS

Standing in high heels was associated with an increased femoral obliquity angle [difference (Δ) 3.0° ± 1.7°, p < 0.0001], and increased knee (Δ 2.4° ± 2.9°, p = 0.0009) and ankle flexion (Δ 38.7° ± 3.4°, p < 0.0001). The differences in C7 and meatus vertical axis, cervical and lumbar lordosis, thoracic kyphosis, spino-sacral angle, pelvic tilt, sacral slope, and spinal tilt were not significant. Individuals adapting with less-than-average knee flexion responded to high heels by an additional increase in cervical lordosis (Δ 5.8° ± 10.7° vs. 1.8° ± 5.3°).

CONCLUSIONS

In all participants, wearing high heels led to increased flexion of the knees and to more ankle flexion. While some participants responded to high heels primarily through the lower extremities, others used increased cervical lordosis to adapt to the shift of the body's center of gravity. This could explain the different patterns of pain in the neck, lower back and knees seen in individuals wearing high heels frequently.

Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus Strength More Than Gastrocnemius in Healthy Young Females

BACKGROUND

Habitual use of high-heeled shoes (HHS) has been reported to negatively impact different body structures. However, few studies have investigated its effect on plantarflexor performance. The aim of this study was to investigate the effect of habitual wear of HHS and knee joint position (to isolate the function of the gastrocnemius) on the isokinetic performance of the plantarflexors and ankle joint range of motion (ROM).

METHODS

A high-heel (HH) group included 12 women (25.4 ± 4.8 y) who have been wearing HHS for ≥40 hours/wk and for at least a year. A control group (CTRL) had 12 women (21.3 ± 0.5 y) who have occasionally been wearing HHS for <10 hours/wk. Participants performed isokinetic (60 degrees/s) plantarflexion movements through a range set between 15 degrees dorsiflexion and 30 degrees plantarflexion. Ankle joint ROM and average peak plantarflexion torque and power were recorded in 2 knee joint positions, extension and 90 degrees flexion.

RESULTS

Overall, torque was significantly affected by knee position (P = .04) and habitual use of HHS (P < .001), whereas power was impacted by knee position only (P < .001). Within each group, flexing the knee reduced isokinetic measurements. However, the reduction was greater for the HH group (torque: 54 Nm, power: 35.6 W) compared with the CTRL group (torque: 42 Nm, power: 32.5 W). Ankle joint ROM was significantly different between groups in knee flexion only.

CONCLUSION

Flexing the knee limited the plantarflexor muscular performance and the limitation was more significant in habitual users of HHS compared to nonusers. Thus, it is concluded that habitual use of HHS impacts the contractile properties of soleus more than gastrocnemius.

CLINICAL RELEVANCE

The soleus is important for walking and anterior cruciate ligament protection. Thus, HHS users could be susceptible to injury and may need longer and more intensive posttraumatic rehabilitation. Therefore, clinicians should consider knee position when examining the plantarflexors of habitual HHS users.

Photogrammetry as a tool for the postural evaluation of the spine: A systematic review

AIM: To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture.

METHODS: A systematic search using keywords was conducted in the PubMed, EMBASE, Scopus, Science and Medicine^® databases. The following inclusion criteria adopted were: (1) the use of photogrammetry as a method to evaluate spinal posture; (2) evaluations of spinal curvature in the sagittal and/or frontal plane; (3) studies published within the last three decades; and (4) written entirely in English. The exclusion criteria were: (1) studies which objective involved the verification of some aspect of validation of instruments; (2) studies published as abstracts and those published in scientific events; and (3) studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine. The articles in this review were included and evaluated for their methodological quality, based on the Downs and Black scale, by two independent reviewers.

RESULTS: Initially, 1758 articles were found, 76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria. In addition, after analyzing the references in those articles, a further six articles were selected, so that 35 articles were included in this review. This systematic review revealed that the photogrammetry has been using in observational studies. Furthermore, it was also found that, although the data collection methodologies are similar across the studies, in relation to aspects of data analysis, the methodologies are very different, especially regarding the mathematical routines employed to support different postural evaluation software.

CONCLUSION: With photogrammetry, the aim of the assessment, whether it is for clinical, research or collective health purposes, must be considered when choosing which protocol to use to evaluate spinal posture.

Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis

[Purpose] The purpose of this study was to compare the effects of an abdominal drawing-in maneuver (ADIM), measured using a pressure bio-feedback unit, on the activities of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension. [Subjects and Methods] Thirty healthy adult subjects (14 male, 16 female), were recruited. Subjects’ lumbar lordosis and pelvic tilt angles were measured, and based on the results, the subjects were divided into two groups: a hyperlordotic lumbar angle (HLLA) group (n=15) and a normal lordotic lumbar angle (NLLA) group (n=15). The muscle activities of the hamstring and gluteus maximus, and of the erector spinae on the right side of the body, were recorded using surface electromyography. [Results] When performing ADIM with prone hip extension, the muscle activity of the gluteus maximus of the HLLA group significantly improved compared with that the NLLA group. [Conclusion] This study demonstrated that ADIM with prone hip extension was more effective at eliciting gluteus maximus activity in the HLLA group than in the NLLA group. Therefore, ADIM with prone hip extension may be useful for increasing the gluteus maximus activity of individuals with lumbar hyperlordosis.

Effect of abdominal drawing-in maneuver during hip extension on the muscle onset time of gluteus maximus, hamstring, and lumbar erector spinae in subjects with hyperlordotic lumbar angle

Background

The abdominal drawing-in maneuver (ADIM) is used to prevent abnormal movements of the lumbar spine and pelvis during therapeutic exercises. This study compared the effects of ADIM on the muscle onset time of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension exercise in subjects with or without hyperlordotic lumbar angle. Forty healthy adults (18 male, 22 female) were recruited for this study.

Methods

The lumbar lordotic angles and pelvic tilt angles of the subjects were measured using the Avaliação postural analysis software. The subjects were divided into two groups: the lumbar hyperlordotic angle (LHLA) and lumbar normal lordotic angle (LNLA) groups. The muscle contraction onset time of the hamstring, gluteus maximus, and erector spinae were assessed using surface electromyography.

Results

During ADIM application, the muscle contraction onset time of the gluteus maximus was significantly increased in the LHLA group compared with the LNLA group.

Conclusions

ADIM application during prone hip extension was more effective for gluteus maximus onset time in the LHLA group. Therefore, ADIM during prone hip extension may be useful for gluteus maximus training in individuals with lumbar hyperlordosis.

Effect of posterior pelvic tilt taping in women with sacroiliac joint pain during active straight leg raising who habitually wore high-heeled shoes: a preliminary study

OBJECTIVE

The purpose of this study was to assess whether a 1-day application of posterior pelvic tilt taping (PPTT) using a kinesiology tape would decrease anterior pelvic tilt and active straight leg raising test scores in women with sacroiliac joint who habitually wore high-heeled shoes.

METHODS

Sixteen women (mean age, 23.63 ± 3.18 years) were enrolled in this study. Anterior pelvic tilt was measured using a palpation meter before PPTT application, immediately after PPTT application, 1 day after PPTT application, and immediately after PPTT removal after 1 day of application. Active straight leg raising scores were measured at the same periods. Posterior pelvic tilt taping was applied in the target position (posterior pelvic tilt position).

RESULTS

The anterior pelvic tilt was decreased during and after 1 day of PPTT application (before and after kinesiology tape removal) compared with the initial angle (all P < .05). Active straight leg raising scores were decreased during and 1 day after PPTT application (before and after kinesiology tape removal) compared with the initial score (all P < .05).

CONCLUSION

The results of this preliminary study suggests that PPTT may temporarily decrease anterior pelvic tilt and active straight leg raising score in women with sacroiliac joint pain who habitually wear high-heeled shoes.

The effects of high heeled shoes on female gait: a review

Walking is the most common form of human locomotion. From a motor control perspective, human bipedalism makes the task of walking extremely complex. For parts of the step cycle, there is only one foot on the ground, so both balance and propulsion are required in order for the movement to proceed smoothly. One condition known to compound the difficulty of walking is the use of high heeled shoes, which alter the natural position of the foot-ankle complex, and thereby produce a chain reaction of (mostly negative) effects that travels up the lower limb at least as far as the spine. This review summarises recent studies that have examined acute and chronic effects of high heels on balance and locomotion in young, otherwise healthy women. Controversial issues, common study limitations and directions for future research are also addressed in detail.

Implications of high-heeled shoes on body posture of adolescents

OBJECTIVE

To review studies regarding effects of high-heeled shoes on body posture of adolescents.

DATA SOURCES

The research was conducted in the Scopus, SciELO and PubMed databases between 1980 and 2011, searching for articles written in English and Portuguese with the following key-words: "posture", "center of gravity", and "high-heeled shoes". Among 55 retrieved articles, 20 were analyzed regarding posture of the spine and lower limbs, the center of gravity, and the effects of high-heeled shoes in the musculoskeletal system in adolescents.

DATA SYNTHESIS

Frequent use of high-heeled shoes leads to modification of the gravity center and body balance, which can lead to changes in the alignment of body segments. This has a negative impact on motor development of adolescents. In this phase, it is necessary to keep the posture in order to maintain the physiological growth and development of the musculoskeletal system.

CONCLUSIONS

High-heeled shoes in adolescents can lead to the development of postural disorders, among which stands out the forward head posture, lumbar hyperlordosis, pelvic anteversion, and knee valgus. The height and width of the heels are characteristics that exert most influence in the emergence of postural changes and body imbalance.

Measurement of lumbar lordosis in static standing posture with and without high-heeled shoes

OBJECTIVE

Some doctors and therapists believe that wearing high-heeled shoes causes increased lumbar lordosis and that this may be a cause of low back pain. The purpose of this study was to evaluate whether high-heeled shoes increase lumbar lordosis and to do so with more reliable methods and a larger sample size than used in previous studies.

METHODS

Fifty participants from a chiropractic university were included in a test group (32 female and 18 male) and 9 in a control group (3 female and 6 male). A Spinal Mouse was used to measure lumbar lordosis in test participants barefoot and then again with 3- or 4-in high-heeled shoes after a 10-minute adaptation period of walking and sitting and standing while wearing the shoes. Reliability of the testing conditions was evaluated with 9 barefoot control participants before and after an identical adaptation period, and intra- and interexaminer reliability of Spinal Mouse measurements was tested by use of a wooden model built to mimic the proportions of a human spine.

RESULTS

Both groups showed non-significant decreases in lordosis between the first and second scans (high heels: 23.4° to 22.8°, P = .17; control: 18.8° to 17.6°, P = .16). Scans of the wooden spine model were highly reliable (intra- and interexaminer intraclass correlation coefficients > .999).

CONCLUSIONS

Consistent with most previous studies, high-heeled shoes did not affect lumbar lordosis in most people while standing. Future research could investigate the effect of shoes during dynamic conditions or identify affected subgroups.

Avaliação da coluna lombar e torácica nas situações com salto alto e com os pés descalços com o instrumento arcômetro

O salto alto há muitos anos tem sido um grande aliado das mulheres, tornando-se uma ferramenta fundamental em seu dia a dia. Contudo, a utilização indiscriminada, seja do ponto de vista da frequência de utilização ou da altura do salto, pode trazer prejuízos para a saúde do corpo, que, a busca do melhor equilíbrio, pode desencadear alterações da postura, trazendo problemas para os pés e para a coluna vertebral. Os objetivos deste estudo foram: identificar a postura das curvaturas das colunas vertebral, torácica e lombar de estudantes universitárias, a partir do conhecimento dos ângulos destas curvaturas, e comparar esta postura nas situações com salto alto e com os pés descalços. Foram avaliadas 34 estudantes do sexo feminino, com idades médias de 20±1,9 anos, utilizando o instrumento arcômetro, nas situações com salto alto de 9 cm de altura e com pés descalços. O arcômetro foi colocado sobre os processos espinhosos das vértebras T1, T12, L1 e L5, identificados por palpação, e forneceu os ângulos das curvaturas. Para verificar as diferenças dos ângulos e da postura entre as duas situações de teste, foram utilizados o teste t pareado e o do χ², respectivamente (a=0,05). Os resultados demonstraram que a utilização de salto alto não modificou significativamente os ângulos das curvaturas torácica e lombar da coluna vertebral, bem como não interferiu na classificação da postura das estudantes universitárias, as quais, em sua maioria, apresentaram postura normal da coluna vertebral.