Decreasing thoracic hyperkyphosis - Which treatments are most effective? A systematic literature review and meta-analysis

Effects of 60 versus 30 Minutes of Pilates Exercise on Cervicothoracic Alignment, Muscle Strength, and Endurance in University Students with Upper Crossed Syndrome

Background/Objectives: This study determined the effects of 60 min or 30 min Pilates program on cervicothoracic alignment, muscular strength, and endurance in university students with upper-crossed syndrome (UCS). Methods: Twenty-six university students with UCS were randomly allocated into 60 min Pilates (60 PG, n = 9), 30 min Pilates (30 PG, n = 9), and control (CG, n = 8) groups. The 60 and 30 PG students participated in the Pilates program, focusing on relaxation, stability, mobility, and strengthening of the cervical, thoracic, and scapular muscles for 60 or 30 min per session, twice a week, for 12 weeks. Cervicothoracic alignment was measured using BodyStyle to determine craniovertebral angle (CVA), forward shoulder angle (FSA), head position angle (HPA), head tilt angle (HTA), and kyphosis angle (KA). We measured the muscular strength and endurance of the shoulder on the dominant side. Results: After the intervention, CVA, HPA, HTA, and KA significantly improved in the 60 and 30 PG (all p < 0.01) but not in the CG (p > 0.05). There were no significant differences between the 60 and 30 PG at 4, 8, and 12 weeks. Shoulder strength differed between shoulder flexion and horizontal abduction (p < 0.01). Shoulder endurance differed between extension, flexion, and horizontal abduction (p < 0.05, p < 0.01, and p < 0.001, respectively). Conclusions: This study confirmed the effectiveness of the Pilates program in improving cervicothoracic sagittal alignment and shoulder muscular function in university students with UCS. Additionally, the effects of participating in 60 and 30 min Pilates programs were found to be equivalent. Therefore, encouraging busy university students to participate in at least 30 min of the Pilates program is important.

The effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in elderly subjects: systematic review and meta-analysis

PURPOSE

Age-related postural hyper-kyphosis is an exaggerated anterior curvature of the thoracic spine, that impairs balance and increases the risk of falls and fractures in elderly subjects. Our objectives are to review the effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in this subjects.

MATERIALS AND METHODS

We searched PubMed, Scopus, ISI web of Knowledge, ProQuest and Cochrane library to identify relevant studies that assessed efficacy of spinal orthoses on muscle function and kyphosis angle of elderly subjects with elderly with hyper-kyphosis. Quality assessment was implemented using the Downs and Black scale.

RESULTS

Results for 709 individuals were described in 18 articles which 12 studies involved RCT. There was significant difference for kyphosis angle after use of orthosis of 148 participants (SMD: -3.79, 95% CI -7.02 to -0.56, p < 0.01). Except one study, all of studies showed significantly increased on the back muscle strength when the participants wore the spinal orthosis and this effect was significantly better in long-term follow up (MD: 84.73; 95% CIs, 23.24 to 146.23; p < 0.01). In the outcome of pain, the efficacy brought by orthosis was large and significant (SMD: -1.66; 95% CIs, -2.39 to 0.94; p < 0.01).

CONCLUSIONS

Spinal orthosis may be an effective treatment for elderly hyper-kyphosis. However, the small number, and heterogeneity of the included studies, indicate that higher-quality studies should be conducted to verify the effectiveness and orthosis in hyper-kyphosis.

Self-management in patients with adult spinal deformity: a best practice implementation project

INTRODUCTION

The prevalence of adult spinal deformity (ASD) has increased in recent years. Patients often have to live for a prolonged period from the onset of the condition, up until the need for surgical treatment. Self-management plays a crucial role in disease progression and prognosis.

OBJECTIVES

This project aimed to promote evidence-based practices for the self-management of patients with ASD.

METHODS

This project was guided by the JBI Evidence Implementation Framework project and was conducted in the orthopedic department of a tertiary care hospital in China. A baseline audit was conducted to evaluate current practice against best practice recommendations. Barriers were identified and, after the implementation of improvement strategies, a follow-up audit was conducted to assess project effectiveness.

RESULTS

A comparison between the baseline and follow-up audits revealed a significant increase in nurses' compliance with best practices (rising from 0%-64% to 97.7%-100%) in the following areas: improved health promotion behaviors by nurses in self-management of ASD patients; acquisition and application of communication skills with patients; increased availability of educational materials in the ward; and establishment of conservative treatment follow-up instructions for patients. For patients, the Visual Analog Scale of pain decreased from (2.72 ± 1.67) to (1.90 ± 1.14), the Oswestry Disability Index decreased from (49.96 ± 16.49) to (39.83 ± 18.97), self-management behaviors improved from (10.84 ± 4.31) to (19.52 ± 6.31), and maximum isometric muscle strength in the standing position increased from (179.48 ± 91.18)N to (250.03 ± 91.50)N, all with statistically significant improvements ( p <0.05). For nurses, the knowledge questionnaire score improved from (34.83 ± 24.16) to (82.00 ± 11.11) ( p <0.05).

CONCLUSIONS

This project helped ASD patients improve self-management, alleviated their clinical symptoms, and improved nurses' knowledge of best practices. Future audits will be conducted to review long-term project outcomes.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A193.

Don't Throw the 'Bio' out of the Bio-Psycho-Social Model: Editorial for Spine Rehabilitation in 2022 and Beyond

Spinal injuries, disorders and disabilities are among the leading causes for work loss, suffering, and health care expenditures throughout the industrialized world [...].

A feasibility study on home-based kyphosis-specific exercises on reducing thoracic hyperkyphosis in older adults

Objectives

This study aimed to assess the feasibility of the home-based kyphosis-specific exercises among Chinese older adults with different exercise habits and explore its potential effects on reducing the kyphosis angle and improving physical performance.

Methods

A single-group, pre-and post-test design was conducted according to CONSORT 2010 statement: extension for pilot and feasibility trials. A total of 20 participants aged ≥60 with thoracic hyperkyphosis and rehabilitation potential were recruited from four local communities in Wuhan, China. Participants underwent a six-week home-based kyphosis-specific exercises intervention that included warm-up, muscle strengthens, spinal alignment, spinal mobility and flexibility, and cool down five sections (22 exercises). The intervention involved seven 1-h group classes and 35 times daily home practice with identical content. At pre- and post-intervention, the participants' kyphosis angle in two standing postures, static balance, dynamic balance, cardiopulmonary function, dynamic gait assessment, pain, and self-image were assessed and compared. Feasibility was assessed by group class attendance, home practice adherence, and participant evaluations.

Results

All participants completed group classes and >75% home practice. Post-intervention, the participant's kyphosis angle in relaxed and best-standing postures was changed by -12.0° (-15.5°, -4.0°) (Z = - 3.98, P < 0.001）and -10.0° (-14.0°, -5.3°) (Z = -3.79, P < 0.001), respectively. In addition, participants had significantly less pain (P < 0.001), better self-image (P < 0.001), and improved performance in five physical assessments (P < 0.01). Different pre-intervention hyperkyphosis angle and daily physical activity did not affect intervention effects. Most participants considered the interventional exercise as moderate intensity and satisfactory.

Conclusions

Home-based kyphosis-specific exercises showed the possibility of being a feasible intervention. And it was advantageous to reducing the kyphosis angle and improving physical performance.

The Effects of Exercise in Older Adults with Hyperkyphotic Posture

The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.