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Hong KB, Lee WS, Kang K, Kang KT, Cho BW. Evaluation of lateral and anterior center-edge angles according to sex and anterior pelvic plane tilt angle: a three-dimensional quantitative analysis. J Orthop Surg Res 2023; 18:280. [PMID: 37020213 PMCID: PMC10077611 DOI: 10.1186/s13018-023-03763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This study aimed to quantitatively evaluate lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) according to sex and the anterior pelvic plane (APP) tilt angle and analyze the correlation between these measurements and acetabular coverage. METHODS Computed tomography scans of 71 adults (38 men and 33 women) with normal hip joints were obtained. LCEA, anterior ACEA, and acetabular coverage were measured with APP tilt every 5° from - 30° to + 30° and were compared between the sexes. The correlation between acetabular coverage and LCEA/ACEA was also analyzed. RESULTS (1) LCEA, ACEA, and acetabular coverage were statistically larger in men than in women at all APP tilt angles (with the exception of acetabular coverage ≥ 25°). (2) LCEA, ACEA, and acetabular coverage differed according to APP tilt angle. LCEA and acetabular coverage showed maximum values at 10°. ACEA showed a tendency to increase by an average of 3.6° for every 5° increase in the APP tilt angle. LCEA demonstrated strong and very strong associations across all APP tilting angles, whereas ACEA showed a moderate association at angles ≥ 15° in men and ≥ 30° in women. CONCLUSIONS The LCEA and ACEA are adequate measurement methods that reflect actual acetabular coverage unless the pelvis is tilted excessively anteriorly. While pelvic tilting does not need to be considered for LCEA within the physiologic range, it should always be taken into account for ACEA, as it increases by an average of 3.6° for every 5° increase in APP tilt angle. LEVEL OF EVIDENCE Level III: retrospective cohort study.
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Affiliation(s)
- Kee-Bum Hong
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyutae Kang
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Byung Woo Cho
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Calcaterra V, Marin L, Vandoni M, Rossi V, Pirazzi A, Grazi R, Patané P, Silvestro GS, Carnevale Pellino V, Albanese I, Fabiano V, Febbi M, Silvestri D, Zuccotti G. Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16728. [PMID: 36554608 PMCID: PMC9779104 DOI: 10.3390/ijerph192416728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Luca Marin
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Agnese Pirazzi
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Roberta Grazi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Pamela Patané
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | | | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Ilaria Albanese
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Massimiliano Febbi
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Dario Silvestri
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations. Spine (Phila Pa 1976) 2022; 47:1303-1313. [PMID: 35797644 DOI: 10.1097/brs.0000000000004411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations. SUMMARY OF BACKGROUND DATA The Roussouly classification was validated for adults. Alignment types may vary during growth. MATERIALS AND METHODS Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression. RESULTS The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age. CONCLUSION Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4. LEVEL OF EVIDENCE Level III.
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Molina-Garcia P, Miranda-Aparicio D, Ubago-Guisado E, Alvarez-Bueno C, Vanrenterghem J, Ortega FB. The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6134724. [PMID: 33580953 DOI: 10.1093/ptj/pzab066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight. METHODS PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed. RESULTS Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results. CONCLUSION Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents. IMPACT This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.
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Affiliation(s)
- Pablo Molina-Garcia
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Damian Miranda-Aparicio
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Biosciences and Nutrition, Karolinska Institute, Sweden
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Baker JF. Computed tomography study of the relationship between pelvic incidence and bony contribution to lumbar lordosis in children. Clin Anat 2021; 34:934-940. [PMID: 34003513 DOI: 10.1002/ca.23756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/31/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022]
Abstract
There is little data regarding the relationship in children and how it may change with aging. The aim of this radiographic study was to define the relationship between pelvic incidence (PI) and segmental vertebral body lordosis through childhood. In 150 children, CT scans of the lumbar spine and pelvis were analyzed measuring PI, sacral table angle (STA), sacral kyphosis (SK), and segmental lordosis (SL) individually L1-L5. Children were grouped by age: (1) 0-60 months; (2) 61-120 months; (3) 121-185 months. Mean PI for the entire cohort was 40.4, mean SL for L1-0.6, L2 0.0, L3 1.8, L4, 4.7, and L5 11.4. There were 40 children in Group 1, 63 in Group 2 and 37 in Group 3. SL differed between age groups at all levels except at L2. L1 and L2 became more kyphotic with increasing age; L3, L4, and L5 became more lordotic with increasing age. The correlation between PI and SL at each level became stronger with increasing age. Similarly, the correlation between PI and STA and between PI and SK also became stronger with increasing age. As children mature, the relationship between PI and segmental lordosis at each level of the lumbar spine becomes stronger-the relationship between PI and lordosis trends toward that seen in the adult. Future work should aim to define when the adult PI-LL relationship is realized.
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Affiliation(s)
- Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Koumantakis GA, Malkotsis A, Pappas S, Manetta M, Anastopoulos T, Kakouris A, Kiourtsidakis E. Lumbopelvic sagittal standing posture associations with anthropometry, physical activity levels and trunk muscle endurance in healthy adults. Hong Kong Physiother J 2021; 41:127-137. [PMID: 34177201 PMCID: PMC8221983 DOI: 10.1142/s1013702521500128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Various factors, inherited and acquired, are associated with habitual spinal postures. Objective The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants. Methods In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2-22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected. Results LC and SS angles correlated significantly ( r = 0 . 80 , p < 0 . 001 ). Statistically significant differences for both LC ( p = 0 . 023 ) and SS ( p = 0 . 013 ) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ( r =- 0 . 27 , p = 0 . 004 ); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ( r =- 0 . 17 , p = 0 . 08 ). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC-SS) in standing and the participants' body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day. Conclusion The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.
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Affiliation(s)
- George A Koumantakis
- Department of Physiotherapy, 401 General Army Hospital of Athens, Panagioti Kanellopoulou 1, Athens, Greece.,School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Antonios Malkotsis
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Stefanos Pappas
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Maria Manetta
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Timotheos Anastopoulos
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Apollon Kakouris
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Eleutherios Kiourtsidakis
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
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Karuc J, Marković G, Mišigoj-Duraković M, Duncan MJ, Sorić M. Is Adiposity Associated with the Quality of Movement Patterns in the Mid-Adolescent Period? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249230. [PMID: 33321850 PMCID: PMC7763001 DOI: 10.3390/ijerph17249230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
This study examined the association between functional movement (FM) and adiposity in adolescent population (16–17 years). This study was conducted in a representative sample of urban adolescents as the part of the CRO-PALS longitudinal study (n = 652). Body mass index (BMI), a sum of four skinfolds (S4S), waist and hip circumference were measured, and FM was assessed via Functional Movement ScreenTM (FMSTM). Furthermore, total FMSTM screen was indicator of FM with the composite score ranged from 7 to 21, with higher score indicating better FM. Multilevel analysis was employed to determine the relationship between different predictors and total FMS score. In boys, after controlling for age, moderate-to-vigorous physical activity, and socioeconomic status, total FMS score was inversely associated only with BMI (β = −0.18, p < 0.0001), S4S (β = −0.04, p < 0.0001), waist circumference (β = −0.08, p < 0.0001), and hip circumference (β = −0.09, p < 0.0001). However, among girls, in adjusted models, total FMS score was inversely associated with S4S (β = −0.03, p < 0.0001), while BMI (β = −0.05, p = 0.23), waist circumference (β = −0.04, p = 0.06), and hip circumference: (β = −0.01, p = 0.70) failed to reach statistical significance. Results showed that the association between adiposity and FM in adolescence is sex-specific, suggesting that boys with overweight and obesity could be more prone to develop dysfunctional movement patterns. Therefore, exercise interventions directed toward correcting dysfunctional movement patterns should be sex-specific, targeting more boys with overweight and obesity rather than adolescent girls with excess weight.
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Affiliation(s)
- Josip Karuc
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
- Correspondence:
| | - Goran Marković
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
| | | | - Michael J. Duncan
- Faculty Research Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK;
| | - Maroje Sorić
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
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Santonja-Medina F, Collazo-Diéguez M, Martínez-Romero MT, Rodríguez-Ferrán O, Aparicio-Sarmiento A, Cejudo A, Andújar P, Sainz de Baranda P. Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072467. [PMID: 32260344 PMCID: PMC7177434 DOI: 10.3390/ijerph17072467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Fernando Santonja-Medina
- Department of Medicine and Orthopaedic Surgery, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30100 Murcia, Spain;
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
| | - Mónica Collazo-Diéguez
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Rehabilitation Sciences and Physiotherapy, Albacete University Hospital Complex, C.P. 02006 Albacete, Spain;
| | - María Teresa Martínez-Romero
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30720 Murcia, Spain
- Correspondence: ; Tel.: +34-868-888-824
| | - Olga Rodríguez-Ferrán
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30720 Murcia, Spain
| | - Alba Aparicio-Sarmiento
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30720 Murcia, Spain
| | - Antonio Cejudo
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30720 Murcia, Spain
| | - Pilar Andújar
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Rehabilitation Sciences and Physiotherapy, Albacete University Hospital Complex, C.P. 02006 Albacete, Spain;
| | - Pilar Sainz de Baranda
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, C.P. 30100 Murcia, Spain; (M.C.-D.); (O.R.-F.); (A.A.-S.); (A.C.); (P.S.d.B.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, C.P. 30720 Murcia, Spain
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Sagittal standing posture and relationships with anthropometrics and body composition during childhood. Gait Posture 2019; 73:45-51. [PMID: 31299503 DOI: 10.1016/j.gaitpost.2019.07.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 06/06/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anthropometry and body composition are plausible influences on pediatric sagittal standing posture. Despite that, the relationship of anthropometrics since birth and body composition with individual postural parameters in children has never been assessed. RESEARCH QUESTION To assess the associations between anthropometrics since birth and body composition parameters, and angles of sagittal standing posture in children. METHODS The sample included 1021 girls and 1096 boys, evaluated in the population-based birth cohort Generation XXI, Portugal. Weight and height were obtained at birth, 4 and 7 years of age. At age 7, total body less head fat/fat-free mass and bone properties were estimated from whole body dual energy X-ray absorptiometry scans and posture was assessed through right-side photographs during habitual standing with retro-reflective markers placed on body landmarks. RESULTS Girls showed increased values of lumbar angle, head and neck flexion, and craniocervical angle with the largest mean (standard deviation) difference in lumbar angle [281.7° (7.4) vs. 276.8° (7.1) in boys, p < 0.001]. In both genders, weight and body mass index were weakly associated with lumbar angle: 0.24 ≥ r ≤ 0.31 in girls and 0.16 ≥ r ≤ 0.26 in boys, all p < 0.001. Fat and fat-free mass and bone mineral density were weakly associated with lumbar angle in both genders. SIGNIFICANCE Our study showed clear postural heterogeneity between girls and boys in early ages. Lumbar angle is likely to be the single most relevant proxy of overall posture based on the associations with the exposures reported in this study.
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Abstract
STUDY DESIGN A cross-sectional, retrospective cohort study. OBJECTIVE To examine the prevalence of the pedicle stress injury, spondylolysis in children and adolescents with low back pain. And secondly, to test the hypothesis that these pathologies are associated with lumbar lordosis angle. SUMMARY OF BACKGROUND DATA The prevalence of the pedicle stress injury has not been investigated in children with low back pain. In recent studies, lumbar lordosis angle was associated with spondylolysis, on the other hand the pedicle stress injury was not investigated yet. METHODS In this retrospective study, 789 consecutive lumbar magnetic resonance imaging under 18 years of age were reviewed between January 2015 and July 2018. Seven hundred magnetic resonances imaging among them were included in the study (mean age: 14.87 ± 2.41 yrs; range: 4-17). Prevalence of spondylolysis, spondylolisthesis, pedicle stress injury, pedicle deformation, disc degeneration, and increased lordosis was investigated and compared in terms of sex. The relationship between increased lordosis and other pathologies was evaluated with risk ratio. Nominal variables were evaluated between the two groups using chi-square, Mann-Whitney U test. RESULTS Prevalence of pedicle stress injury (12.7%), spondylolysis (8.7%), spondylolisthesis (4.1%), pedicle deformation (3.1%), disc degeneration (24%), increase in lordosis (17.4%) was found. Spondylolysis and pedicle injury were more frequent in males (P = 0.025, P < 0.001, respectively). Increased lordosis was more frequent in females (P < 0.001). Pedicle stress injury was frequently observed between 13 to 17 years and often an isolated lesion (69.6%). Spondylolysis, spondylolisthesis, pedicle deformity were more frequent in increased lordosis (P < 0.001), whereas pedicle injury frequency was not found to be different (P = 0.997). CONCLUSION Pedicle stress injury is a common cause of back pain under 18 years of age, more common in males, and often an isolated lesion. No relationship was found between pedicle stress injury and increased lordosis, unlike other pathologies. LEVEL OF EVIDENCE 3.
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Gilsanz V, Wren TAL, Ponrartana S, Mora S, Rosen CJ. Sexual Dimorphism and the Origins of Human Spinal Health. Endocr Rev 2018; 39:221-239. [PMID: 29385433 PMCID: PMC5888211 DOI: 10.1210/er.2017-00147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 12/26/2022]
Abstract
Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan.
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Affiliation(s)
- Vicente Gilsanz
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Tishya A L Wren
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine 04074
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Poorghasamians E, Aggabao PC, Wren TAL, Ponrartana S, Gilsanz V. Vertebral cross-sectional growth: A predictor of vertebral wedging in the immature skeleton. PLoS One 2017; 12:e0190225. [PMID: 29281728 PMCID: PMC5745000 DOI: 10.1371/journal.pone.0190225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022] Open
Abstract
The degree of vertebral wedging, a key structural characteristic of spinal curvatures, has recently been found to be negatively related to vertebral cross-sectional area (CSA). The purpose of this longitudinal study was to examine the relation between vertebral cross-sectional growth and vertebral wedging progression within the immature lumbar spine. Using magnetic resonance imaging (MRI), we analyzed the potential association between increases in lumbar vertebral CSA and changes in L5 vertebral wedging in 27 healthy adolescent girls (ages 9–13 years) twice within a two-year period. Vertebral CSA growth was negatively associated with changes in posteroanterior vertebral wedging (r = -0.61; p = 0.001). Multiple regression analysis showed that this relation was independent of gains in age, height, and weight. When compared to the 14 girls whose vertebral wedging progressed, the 13 subjects whose vertebral wedging decreased had significantly greater vertebral cross-sectional growth (0.39 ± 0.25 vs. 0.75 ± 0.23 cm2; p = 0.001); in contrast, there were no significant differences in increases in age, height, or weight between the two groups. Changes in posteroanterior vertebral wedging and the degree of lumbar lordosis (LL) positively correlated (r = 0.56, p = 0.002)—an association that persisted even after adjusting for gains in age, height, and weight. We concluded that in the immature skeleton, vertebral cross-sectional growth is an important determinant of the plasticity of the vertebral body; regression of L5 vertebral wedging is associated with greater lumbar vertebral cross-sectional growth, while progression is the consequence of lesser cross-sectional growth.
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Affiliation(s)
- Ervin Poorghasamians
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Patricia C. Aggabao
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Tishya A. L. Wren
- Division of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Skorn Ponrartana
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Vicente Gilsanz
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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13
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Wren TA, Ponrartana S, Aggabao PC, Poorghasamians E, Gilsanz V. Association Between Vertebral Cross-sectional Area and Vertebral Wedging in Children and Adolescents: A Cross-sectional Analysis. J Bone Miner Res 2017; 32:2257-2262. [PMID: 28667786 DOI: 10.1002/jbmr.3210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/16/2017] [Accepted: 06/24/2017] [Indexed: 11/11/2022]
Abstract
A small vertebral cross-sectional area (CSA) imparts a mechanical disadvantage that escalates the risk for vertebral fractures in elderly populations. We examined whether a small vertebral CSA is also associated with a greater degree of vertebral wedging in children. Measurements of vertebral CSA, lumbar lordosis (LL) or thoracic scoliosis angle, and vertebral wedging were obtained in 100 healthy adolescents (50 boys and 50 girls) and 25 girls with adolescent idiopathic scoliosis (AIS) using magnetic resonance imaging. Vertebral CSA of the lumbar vertebrae negatively correlated to the degree of posteroanterior vertebral wedging at L5 (r = -0.49; p < 0.0001); this was true whether all subjects were analyzed together or boys and girls independently. In contrast, we found a positive correlation between the degree of LL and vertebral wedging (r = 0.57; p < 0.0001). Multiple regression analysis showed that the association between vertebral CSA and wedging was independent of age and body mass index. In girls with AIS, vertebral CSA negatively correlated to the degree of lateral thoracic vertebral wedging (r = -0.66; p = 0.0004), an association that persisted even after accounting for age and body mass index. Additionally, Cobb angle positively correlated to lateral thoracic vertebral wedging (r = 0.46; p = 0.021). Our cross-sectional results support the hypothesis that smaller vertebral CSA is associated with greater vertebral deformity during growth, as in adulthood. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tishya Al Wren
- Division of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patricia C Aggabao
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ervin Poorghasamians
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vicente Gilsanz
- Division of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Schlösser TPC, Janssen MMA, Hogervorst T, Vrtovec T, de Vos J, Öner FC, Castelein RM. The odyssey of sagittal pelvic morphology during human evolution: a perspective on different Hominoidae. Spine J 2017; 17:1202-1206. [PMID: 28343047 DOI: 10.1016/j.spinee.2017.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/20/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Michiel M A Janssen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tom Hogervorst
- Department of Orthopaedic Surgery, Haga Hospital, Els Borst-Eilersplein 275, 2545AA, The Hague, The Netherlands
| | - Tomaž Vrtovec
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška c. 25, 1000, Ljubljana, Slovenia
| | - John de Vos
- Naturalis Biodiversity Center, Vondellaan 55, 2332 AA, Leiden, The Netherlands
| | - F Cumhur Öner
- Department of Orthopaedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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Dolphens M, Vleeming A, Castelein R, Vanderstraeten G, Schlösser T, Plasschaert F, Danneels L. Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:448-457. [PMID: 28578458 DOI: 10.1007/s00586-017-5156-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth. METHODS In this cross-sectional baseline study, 1190 healthy pre-peak growth velocity subjects were included. Coronal plane TA was evaluated using back surface topography. Whole-body sagittal alignment (previously validated and objectively classified as neutral, sway-back or leaning-forward) and sagittal spinopelvic profile (trunk lean, lumbar lordosis, thoracic kyphosis, sacral inclination and length of the posteriorly inclined thoracolumbar segment) were determined, as were height, proportion of trunk to body length, body mass index, generalized joint laxity, and handedness. RESULTS Logistic regression analysis yielded overall sagittal posture class to be independently associated with coronal plane TA: having a leaning-forward posture associated with a nearly three times higher odds of coronal TA (p < 0.001) compared to neutrals. A sway-back was 2.2 times more likely to show TA (p = 0.016) than a neutral, yet only in boys. Significant associations with coronal TA were also found for trunk lean, thoracic kyphosis and body mass index. These correlations, however, were gender and posture class specific. The spinal region where asymmetry is seen, varies according to the whole-body sagittal alignment type: primary thoracic curves were the most frequent in leaning-forwards, whereas primary curves in the lumbar or declive thoracolumbar segment were the most common in sway-backs. CONCLUSIONS In immature spines without known scoliosis, coronal plane TA is associated with whole-body sagittal alignment. It is more often seen in non-neutral than neutral sagittal posture types. Whether adolescent idiopathic scoliosis is related with postural characteristics before pubertal growth peak, should be addressed in future prospective studies.
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Affiliation(s)
- Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium.
| | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Anatomy, Medical Faculty, Center of Excellence in Neuroscience, University of New England, Biddeford, ME, USA
| | - René Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Plasschaert
- Department of Orthopedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
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16
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Wren TAL, Ponrartana S, Gilsanz V. Vertebral cross-sectional area: an orphan phenotype with potential implications for female spinal health. Osteoporos Int 2017; 28:1179-1189. [PMID: 27975301 DOI: 10.1007/s00198-016-3832-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/02/2016] [Indexed: 12/23/2022]
Abstract
A high priority in imaging-based research is the identification of the structural basis that confers greater risk for spinal disorders. New evidence indicates that factors related to sex influence the fetal development of the axial skeleton. Girls are born with smaller vertebral cross-sectional area compared to boys-a sexual dimorphism that is present throughout life and independent of body size. The smaller female vertebra is associated with greater flexibility of the spine that could represent the human adaptation to fetal load. It also likely contributes to the higher prevalence of spinal deformities, such as exaggerated lordosis and progressive scoliosis in adolescent girls when compared to boys, and to the greater susceptibility for spinal osteoporosis and vertebral fractures in elderly women than men.
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Affiliation(s)
- T A L Wren
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - V Gilsanz
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Department of Radiology, Children's Hospital Los Angeles, MS no. 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
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Wren TAL, Aggabao PC, Poorghasamians E, Chavez TA, Ponrartana S, Gilsanz V. Association between vertebral cross-sectional area and lumbar lordosis angle in adolescents. PLoS One 2017; 12:e0172844. [PMID: 28245271 PMCID: PMC5330489 DOI: 10.1371/journal.pone.0172844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/11/2017] [Indexed: 11/18/2022] Open
Abstract
Lumbar lordosis (LL) is more prominent in women than in men, but the mechanisms responsible for this discrepancy are poorly defined. A recent study indicates that newborn girls have smaller vertebral cross-sectional area (CSA) when compared to boys-a difference that persists throughout life and is independent of body size. We determined the relations between vertebral cross-sectional area (CSA) and LL angle and whether sex differences in lumbar lordosis are related to sex differences in vertebral CSA. Using multi-planar magnetic resonance imaging (MRI), we measured vertebral cross-sectional area (CSA) and vertebral height of the spine of 40 healthy boys and 40 girls, ages 9-13 years. Measures of the CSA of the lumbar vertebrae significantly differed between sexes (9.38 ± 1.46 vs. 7.93 ± 0.69 in boys and girls, respectively; P < 0.0001), while the degree of LL was significantly greater in girls than in boys (23.7 ± 6.1 vs. 27.6 ± 8.0 in boys and girls, respectively; P = 0.02). When all subjects were analyzed together, values for LL angle were negatively correlated to vertebral CSA (r = -0.47; P < 0.0001); this was also true when boys and girls were analyzed separately. Multivariate regression analysis indicated that vertebral CSA was independently associated with LL, even after accounting for sex, age, height or vertebral height, and weight. Similar negative relations were present when thoracic vertebrae were analyzed (Model P < 0.0001, R2 = 0.37, thoracic vertebral CSA slope P < 0.0001), suggesting that deficient vertebral cross-sectional dimensions are not merely the consequence of the anterior lumbar curvature. We conclude that vertebral CSA is negatively associated with LL, and that the greater degree of LL in females could, at least in part, be due to smaller vertebral cross-sectional dimensions. Studies are needed to examine the potential relations between vertebral CSA and spinal conditions known to be associated with increased LL, such as spondylolysis and spondylolisthesis.
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Affiliation(s)
- Tishya A. L. Wren
- Department of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Patricia C. Aggabao
- Departments of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Ervin Poorghasamians
- Departments of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Thomas A. Chavez
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Skorn Ponrartana
- Departments of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Vicente Gilsanz
- Department of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Departments of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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Defining Patterns of Sagittal Standing Posture in Girls and Boys of School Age. Phys Ther 2017; 97:258-267. [PMID: 28204737 DOI: 10.2522/ptj.20150712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022]
Abstract
Abstract
Background
Sagittal postural patterns are associated with back pain in adolescents and adults. However, whether postural patterns are already observable during childhood is unknown. Such a finding would confirm childhood as a key period for posture differentiation and thus for chronic pain etiology.
Objective
The aims of this study were to identify and describe postural patterns in girls and boys of school age.
Design
This was a cross-sectional study.
Methods
Eligible children were evaluated at age 7 in the population-based birth cohort Generation XXI in Portugal. Posture was assessed through right-side photographs during habitual standing with retroreflective markers placed on body landmarks. Postural patterns were defined from trunk, lumbar, and sway angles with model-based clusters, and associations with anthropometric measures were assessed by multinomial logistic regression.
Results
Posture was evaluated in 1,147 girls and 1,266 boys. Three postural patterns were identified: sway (26.9%), flat (20.9%), and neutral to hyperlordotic (52.1%) in girls and sway to neutral (58.8%), flat (36.3%), and hyperlordotic (4.9%) in boys. In girls, a higher body mass index was associated with a sway pattern (versus a flat pattern: odds ratio = 1.21; 95% CI = 1.12, 1.29), whereas in boys, a higher body mass index was associated with a hyperlordotic pattern (versus a flat pattern: odds ratio = 1.30; 95% CI = 1.17, 1.44).
Limitations
Photogrammetry as a noninvasive method for posture assessment may have introduced some postural misclassifications.
Conclusions
Postural patterns in 7-year-old children were consistent with those previously found in adults, suggesting that childhood is a sensitive period for posture differentiation. Sagittal morphology differed between girls and boys, emphasizing sex-specific biomechanical loads during a habitual upright position even in prepubertal ages.
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Reliability and Validity Measurement of Sagittal Lumbosacral Quiet Standing Posture with a Smartphone Application in a Mixed Population of 183 College Students and Personnel. Adv Orthop 2016; 2016:3817270. [PMID: 27843650 PMCID: PMC5097790 DOI: 10.1155/2016/3817270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022] Open
Abstract
Accurate recording of spinal posture with simple and accessible measurement devices in clinical practice may lead to spinal loading optimization in occupations related to prolonged sitting and standing postures. Therefore, the purpose of this study was to establish the level of reliability of sagittal lumbosacral posture in quiet standing and the validity of the method in differentiating between male and female subjects, establishing in parallel a normative database. 183 participants (83 males and 100 females), with no current low back or pelvic pain, were assessed using the “iHandy Level” smartphone application. Intrarater reliability (3 same-day sequential measurements) was high for both the lumbar curve (ICC2,1: 0.96, SEM: 2.13°, and MDC95%: 5.9°) and the sacral slope (ICC2,1: 0.97, SEM: 1.61°, and MDC95%: 4.46°) sagittal alignment. Data analysis for each gender separately confirmed equally high reliability for both male and female participants. Correlation between lumbar curve and sacral slope was high (Pearson's r = 0.86, p < 0.001). Between-gender comparisons confirmed the validity of the method to differentiate between male and female lumbar curve and sacral slope angles, with females generally demonstrating greater lumbosacral values (p < 0.001). The “iHandy Level” application is a reliable and valid tool in the measurement of lumbosacral quiet standing spinal posture in the sagittal plane.
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Ludwig O, Hammes A, Kelm J, Schmitt E. Assessment of the posture of adolescents in everyday clinical practice: Intra-rater and inter-rater reliability and validity of a posture index. J Bodyw Mov Ther 2016; 20:761-766. [DOI: 10.1016/j.jbmt.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/08/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022]
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Dolphens M, Vansteelandt S, Cagnie B, Vleeming A, Nijs J, Vanderstraeten G, Danneels L. Multivariable modeling of factors associated with spinal pain in young adolescence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2809-21. [PMID: 27278392 DOI: 10.1007/s00586-016-4629-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains. METHODS In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains. RESULTS A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6-11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5-23.9), TSP in the last month (4.9; 2.2-10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3-5.7) or NP (5.5; 2.6-11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm. CONCLUSIONS Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.
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Affiliation(s)
- Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium.
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
| | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Anatomy, Center for Excellence in the Neurosciences, Medical Faculty, University of New England, Biddeford, ME, USA
| | - Jo Nijs
- Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
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Liu Z, Bao H, Qiu Y, Qiao J, Xu L, Zhu F, Qian B, Zhu Z. Evaluation of demographic factors affecting predictability of the sacro-femoral-pubic angle in healthy adolescents. J Anat 2014; 226:163-8. [PMID: 25469639 DOI: 10.1111/joa.12268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 11/28/2022] Open
Abstract
The objectives of the present study are to evaluate the correlation between pelvic tilt (PT) and the sacro-femoral-pubic (SFP) angle in Asian healthy adolescents, to provide the normal value of SFP angle as reference data in Asian adolescents, and to clarify whether the predictability of PT could be affected by gender and ontogenesis. In all, 100 girls with a mean age of 12.66 years (range 8-18 years) and 70 boys with a mean age of 13.35 years (range 8-18 years) were recruited in this retrospective study. SFP angles and PT were obtained on long-cassette standing upright radiographs. The subjects were grouped based on age. Independent-sample t-tests were performed to compare age, SFP angle, and PT between genders. In all age groups, the relationship between SFP angle and PT was analyzed by Pearson's correlation analysis and linear regression analysis, respectively. Reliability analysis showed high intra- and inter-observer agreements in PT and SFP, with an intra-class correlation coefficient (ICC) > 0.8. SFP angle averaged 71.64° ± 4.91 in all the normal subjects, of which the mean PT was 72.03°± 4.94 in the female group and 71.09°± 4.83 in the male group. SFP and PT were strongly correlated in all the age groups according to Pearson's correlation analysis. The overall coefficient was 0.679 in girls and 0.584 in boys. The present study is the first to describe the normal value of SFP angle in healthy Asian adolescents to serve as a reference data. In all age groups, SFP angles can be used to predict PT when lateral radiographs do not permit assessment of PT. The predictability of SFP angle for PT was not affected by gender or maturation status.
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Affiliation(s)
- Zhen Liu
- Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Schlösser TPC, Vincken KL, Rogers K, Castelein RM, Shah SA. Natural sagittal spino-pelvic alignment in boys and girls before, at and after the adolescent growth spurt. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1158-67. [DOI: 10.1007/s00586-014-3536-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Dolphens M, Nijs J, Cagnie B, Meeus M, Roussel N, Kregel J, Malfliet A, Vanderstraeten G, Danneels L. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial. BMC Musculoskelet Disord 2014; 15:149. [PMID: 24885889 PMCID: PMC4028010 DOI: 10.1186/1471-2474-15-149] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/29/2014] [Indexed: 12/19/2022] Open
Abstract
Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web-based questionnaires will be completed at baseline, after the first 3 treatment sessions, post-treatment, and at 6 and 12-months follow-up. Discussion Findings may provide empirical evidence on: (1) the effectiveness of a modern neuroscience approach to CSP for reducing pain and improving functioning, (2) the effectiveness of a modern neuroscience approach for normalizing brain gray matter in CSP patients, and (3) factors associated with therapy success. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities’ recommendations. Trial registration ClinicalTrials.gov Identifier: NCT02098005.
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Affiliation(s)
- Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000 Ghent, Belgium.
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Posture class prediction of pre-peak height velocity subjects according to gross body segment orientations using linear discriminant analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:530-5. [PMID: 24097292 DOI: 10.1007/s00586-013-3058-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/09/2013] [Accepted: 09/27/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Measurement and classification of standing posture in the sagittal plane has important clinical implications for adolescent spinal disorders. Previous work using cluster analysis on three gross body segment orientation parameters (lower limbs, trunk, and entire body inclination) has identified three distinct postural groups of healthy subjects before pubertal peak growth: "neutral", "sway-back", and "leaning-forward". Although accurate postural subgrouping may be proposed to be crucial in understanding biomechanical challenges posed by usual standing, there is currently no objective method available for class assignment. Hence, this paper introduces a novel approach to subclassify new cases objectively according to their overall sagittal balance. METHODS Postural data previously acquired from 1,196 pre-peak height velocity (pre-PHV) subjects were used in this study. To derive a classification rule for assigning a class label ("neutral", "sway-back", or "leaning-forward") to any new pre-PHV subjects, linear discriminant analysis was applied. Predictor variables were pelvic displacement, trunk lean and body lean angle. The performance of the newly developed classification algorithm was verified by adopting a cross-validation procedure. RESULTS The statistical model correctly classified over 96.2% of original grouped subjects. In the cross-validation procedure used, over 95.9% of subjects were correctly assigned. CONCLUSIONS Based on three angular measures describing gross body segment orientation, our triage method is capable of reliably classifying pre-PHV subjects as either "neutral", "sway-back", or "leaning-forward". The discriminant prediction equations presented here enable a highly accurate posture class allocation of new cases with a prediction capability higher than 95.9%, thereby removing subjectivity from sagittal plane posture classification.
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