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

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

BACKGROUND

Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.

METHODS

A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.

RESULTS

A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).

CONCLUSION

Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.

Sagittal spinal curvatures of young adults in the context of their self-reported physical activity and somatic parameters

The objective of this study was to assess the thoracic kyphosis (ThKA) and lumbar lordosis (LLA) in healthy young adults and to investigate potential relationships between spinal curvatures, self-reported physical activity (PA), and somatic parameters. The study included 380 female students and 211 male students aged 20.7 ± 1.5 years. The ThKA and LLA were measured using a Plurimeter-V gravity inclinometer. The level of PA was estimated using the International Physical Activity Questionnaire. ThKA was lower in women compared to men, while LLA was higher in women than in men (p < 0.0001). Female students reported lower PA than male students (p < 0.001). Female students with ThKA within normal values reported a significantly higher amount of low-intensity PA compared to those with ThKA below or above the norm. A correlation was found between ThKA and body mass index (BMI), body adiposity index (BAI), WC, and fat percentage (rho < 0.2), whereas LLA showed correlations with BMI, BAI, waist circumference, and fat percentage (rho < 0.2). Among male students, a correlation was found between LLA and BMI as well as WC (rho < 0.2). Maintaining a healthy body composition may be instrumental in mitigating the risk of developing spinal curvature abnormalities.

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.

Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis

INTRODUCTION

Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery.

METHOD

EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies.

RESULTS

In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%).

CONCLUSION

This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.

Comparison of the effects of core stability and whole-body electromyostimulation exercises on lumbar lordosis angle and dynamic balance of sedentary people with hyperlordosis: a randomized controlled trial

BACKGROUND

Hyperlordosis is an excessive inward curvature of the lumbar spine that affects spinal function. The aim of this study was to compare the effects of core stability exercises (CSE), Whole-Body Electromyostimulation (WB-EMS), and CSE Plus on the Lumbar lordosis angle and dynamic balance in sedentary people with hyperlordosis.

METHODS

In a parallel randomized controlled trial study, seventy five untrained male adults with hyperlordosis, recruited from clinics of sports medicine and corrective exercise centers in Tehran, were randomly assigned to four groups: CSE (n = 19), WB-EMS (n = 18), CSE Plus (n = 18), and control Group (CG) (n = 20). The CSE group performed Core stability exercises, the WB-EMS group followed a Whole-body electromyostimulation combined training protocol, and the CSE Plus group engaged in a combined program protocol (CSE with the WB-EMS vest), and the control group only participated in activities of daily living. Anthropometric parameters and outcomes, including the lordosis angle and dynamic balance, were assessed before and after a six-week training program. A flexible ruler was used to measure the angle of lordosis, and the Y balance test was employed to evaluate the dynamic balance.

RESULTS

The results indicated that the lordosis angle improved in both the CSE and CSE Plus groups compared to the CG in the post-test (P = 0.017, P = 0.024). However, there were no significant differences observed between the other group pairs. Additionally, a significant difference in dynamic balance was found between the CSE Plus group and the CG in the post-test (P = 0.001), while no significant differences were observed between the other group pairs. Furthermore, within-group test results demonstrated that lumbar lordosis angle and dynamic balance variables significantly improved in the post-test compared to the pre-test stage (P < 0.05).

CONCLUSIONS

The two CSE and CSE Plus training protocols are effective as training methods for correcting certain parameters and physical deformities, including lumbar lordosis. Furthermore, the CSE Plus group demonstrated a positive impact on improving dynamic balance. Consequently, it is highly recommended that individuals with hyperlordosis can benefit from the exercises of the present study, especially CSE Plus exercises along with other rehabilitation exercises.

TRIAL REGISTRATION

The trial was registered at Thai Clinical Trials Registry (TCTR20221004011, registration date: 04/10/2022).

Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial

BACKGROUND

Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis.

OBJECTIVE

This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis.

METHODS

In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant.

RESULTS

Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04).

CONCLUSION

It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.

Kyphoscoliosis complicating asthma with fixed airway obstruction

Introduction

Kyphoscoliosis is present in up to 2% of the juvenile population and can have deleterious effects on respiratory mechanics, leading to chronic respiratory failure later on in adult life.

Case presentation

Hereby we describe a 53-year-old patient with severe uncontrolled asthma who presented with chronic hypercapnic respiratory failure. During her medical workup, she was noted to have several comorbidities leading to her respiratory failure. The patient had radiological evidence of bronchiectasis with recurrent episodes of infection, and a severe deformity of the spine due to Kyphoscoliosis. Probably the kyphotic component of this deformity had worsened due to a long history of oral steroid use leading to severe osteoporosis and consequent vertebral compression fractures reaching a Cobb angle of 73 degrees. This was probably caused by the patient's non-compliance with inhaler therapy and an excessive reliance on oral steroid use. Her respiratory failure was treated with domiciliary noninvasive positive pressure ventilation and 24-hour oxygen therapy and her symptoms improved.

Conclusion

A multidisciplinary approach across different specialities is necessary when managing such a patient with kyphoscoliosis, bronchiectasis, asthma with airflow limitation with respiratory failure.

[Surgical treatment of kyphosis in children and adolescents]

OBJECTIVE

Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine.

INDICATIONS

Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar.

CONTRAINDICATIONS

No specific, but general contraindications for surgical treatment.

SURGICAL TECHNIQUE

Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques.

POSTOPERATIVE MANAGEMENT

The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance.

RESULTS

The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.

The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis

OBJECTIVES

This review study aimed to evaluate the impact of therapeutic exercises on Upper-Crossed Syndrome (UCS). The study utilized a systematic review and meta-analysis approach to investigate the effects of various therapeutic exercises on forward head posture, rounded shoulders, and hyperkyphosis associated with upper crossed syndrome.

METHODS

The study identified relevant keywords for each independent and dependent variable and conducted a search in scientific databases, including PubMed, Web of Science, Scopus, and Google Scholar, without any time limitations until 12 August 2023. Overall, 4625 articles were found in the selected databases, which were reduced to 1085 after being entered into the EndNote software and removing duplicate data. The full texts of 30 remaining studies were reviewed; ten articles meeting the criteria were included. Additionally, 12 studies from the Google Scholar database were included, resulting in 22 studies. Using Comprehensive meta-analysis software (CMA ver 3), data heterogeneity was measured with I2 and the Q tests. The Funnel Plot and Egger test methods were utilized to determine the possibility of publication bias. The JBI checklist was used to assess the quality of the studies.

RESULTS

The results of the meta-analysis showed that therapeutic exercises were effective in improving forward head, rounded shoulders, and thoracic kyphosis angles (CI 95% = -1.85-1.161, P = 0.001, P = 0.001, CI95%=-1.822-1.15, and P = 0.001, CI 95%= -1.83-1.09, respectively).

CONCLUSION

Based on the results, it appears that performing therapeutic exercises in the form of strength exercises, stretching, shoulder-based exercises, and incredibly comprehensive exercises that target all muscles may be effective in reducing forward head, rounded shoulders, thoracic kyphosis, and overall UCS.

LEVEL OF EVIDENCE: 1

The knowledge of movement experts about stretching effects: Does the science reach practice?

OBJECTIVE

Stretching is performed with numerous purposes in multiple settings such as prevention, rehabilitation, fitness training and sports. Its patterns of use substantially depend on the education and beliefs of health care and exercise professionals as they represent the multiplicators recommending and prescribing interventions to clients, patients and athletes. This study investigated movement experts' knowledge about the scientific evidence on stretching effects.

DESIGN

Survey study.

PARTICIPANTS

A total of 117 exercise and health professionals (physiotherapists, sports scientists, coaches) attending a training convention in Austria (male: n = 44, female: n = 73, 36±11 years) completed a digital survey. With its 22 items, the questionnaire addressed the movement experts' awareness of the evidence on stretching effects regarding a variety of related topics selected based on the findings of topical systematic reviews.

RESULTS

The majority of the individuals (57-88%) assumed positive effects of stretching on recovery, prevention of muscle injury, range of motion, muscular imbalance and artery elasticity. No or adverse effects were mostly claimed on bone injury prevention, maximal/explosive strength, and delayed-onset muscle soreness. In only 10 of 22 items, participants' classifications were in accord with the scientific evidence.

CONCLUSIONS

The awareness of research findings on stretching effects among exercise and health professionals is alarmingly low. Future studies may hence be geared to improve implementation and science communication.

Associations between Physical Activity and Kyphosis and Lumbar Lordosis Abnormalities, Pain, and Quality of Life in Healthy Older Adults: A Cross-Sectional Study

Significant evidence suggests that regular physical activity (PA) leads to numerous physical and psychological outcomes in the elderly. This cross-sectional study was designed to further explore this issue by investigating the associations between PA (measured by accelerometer) and kyphosis and lumbar lordosis abnormalities, pain, and quality of life (QoL) in the elderly. In this cross-sectional study, 163 older adults (73 women) over 65 years of age (mean age: 68.70 ± 3.09) from Russia acted as participants. The following instruments were used to measure research variables: ActiGraph wGT3X-BT for measuring PA, spinal-mouse for measuring kyphosis and lumbar lordosis abnormalities, and the World Health Organization Quality of Life Scale (WHOQOL-BREF) questionnaire for measuring QoL. Pain was measured using two questions. The Independent t-test and a regression analysis were used to analyze data. The results showed that our sample participated on average in 15.8 min of moderate PA (MPA) per day, which is lower than the recommended guidelines. Men were significantly more physically active than women. In addition, MPA was significantly associated with lower kyphosis and lumbar lordosis abnormalities and pain in older adults. Finally, MPA was significantly associated with higher QoL. These findings indicate that PA is a critical concern for the elderly. Accordingly, physical educators and fitness instructors should adopt appropriate strategies to promote an active lifestyle among older adults.

Does stretching of anterior structures alone, or in combination with strengthening of posterior structures, decrease hyperkyphosis and improve posture in adults? A Systematic Review and Meta-analysis

Kyphosis can lead to back pain, poor posture, and increased falls risk. This systematic review aimed to synthesize research on stretching alone, or in combination with strengthening, as a management for hyperkyphosis in the adult population (≥18 years old). An electronic database search was conducted from February to March 2022. The author and an independent reviewer screened titles and abstracts for inclusion criteria - those whose intervention involved stretching alone or with strengthening exercises. The author appraised and extracted data from included articles and performed a meta-analysis where appropriate. The database and citation search yielded 327 articles, 18 of which met inclusion criteria. One study included performed stretching as a standalone intervention; the remainder used a combination of stretching and strengthening. The meta-analysis (n=3, with 5 exercise groups) found a statistically significant difference (MD = -6.97 (95% CI -9.84, -4.10), p<0.00001) in post-intervention measures of hyperkyphosis favouring the exercise group. The narrative review of studies agrees with this finding, demonstrating statistically significant improvement in hyperkyphosis following various exercise programs. This review suggests that stretching and strengthening exercises improve hyperkyphosis in the short and long term. Low-quality evidence supports stretching as a standalone intervention. Further, more robust research is required to recommend procedures and determine if stretching alone is effective for treating hyperkyphosis in adults.

Adding corrective exercises along with bracing for postural hyperkyphosis among adolescents: A randomized controlled trial

BACKGROUND

Although most attention has been paid to the effectiveness of corrective exercises and bracing to improve thoracic hyperkyphosis, no study, to the best of our knowledge, has compared the effects of exercises plus bracing to bracing alone.

OBJECTIVE

To compare the effect of corrective exercises and bracing and bracing alone on the Cobb angle of thoracic kyphosis.

DESIGN

A parallel-group, blinded, randomized, controlled trial.

PARTICIPANTS

The participants included 180 adolescents with thoracic hyperkyphosis who were randomized into corrective exercises plus bracing (N = 60), only bracing (N = 60), and a waitlist control group (N = 60).

INTERVENTION

Intervention groups received their programs for 24 weeks, whereas the control group was placed on a waitlist for 6 months before receiving a delayed intervention.

MAIN OUTCOME MEASUREMENTS

The primary outcome was change from baseline to 6 months in Cobb angle measured from standing lateral spine radiographs.

RESULTS

Significant differences were observed in the Cobb angle of thoracic kyphosis between all groups at the posttest (p <.001). In post hoc analyses, we found significant differences between the corrective exercise plus bracing group (15.5° decline) and the bracing only group (8.8° decline), p <.001; both groups had bigger improvements than the control group, which increased by 1.2° (p <.001).

CONCLUSION

The combination of corrective exercises and bracing demonstrated better overall outcomes in Cobb angle compared to only bracing, as well as waitlist control in adolescents with thoracic hyperkyphosis.

Creation and Evaluation of a Severity Classification of Hyperkyphosis and Hypolordosis for Exercise Therapy

The rise in the occurrence of musculoskeletal disorders, such as thoracic hyperkyphosis (THK) or lumbar hypolordosis (LHL), is a result of demographic changes. Exercise therapy is an effective approach that can reduce related disabilities and costs. To ensure successful therapy, an individualized exercise program adapted to the severity of the disorder is expedient. Nevertheless, appropriate classification systems are scarce. This project aimed to develop and evaluate a severity classification focused on exercise therapy for patients with THK or LHL. A multilevel severity classification was developed and evaluated by means of an online survey. Reference limits of spinal shape angles were established by data from video rasterstereography of 201 healthy participants. A mean kyphosis angle of 50.03° and an average lordosis angle of 40.72° were calculated as healthy references. The strength of the multilevel classification consisting of the combination of subjective pain and objective spinal shape factors was confirmed by the survey (70% agreement). In particular, the included pain parameters were considered relevant by 78% of the experts. Even though the results of the survey provide important evidence for further analyses and optimization options of the classification system, the current version is still acceptable as therapeutic support.

Effects of a Pilates programme in spinal curvatures and hamstring extensibility in adolescents with thoracic hyperkyphosis: a randomised controlled trial

AIM

To evaluate the effects of a 9-month Pilates exercise programme on the sagittal spinal posture and hamstring extensibility of adolescents with thoracic hyperkyphosis.

DESIGN

Randomised controlled trial with blinded examiner.

PATIENTS

One-hundred and three adolescents with thoracic hyperkyphosis.

INTERVENTIONS

Participants were randomly placed into an experimental group which participated in a Pilates exercise programme implemented for a total of 38 weeks (two sessions/week, 15 min/session) (Pilates group (PG), sample = 49, or control group (CG), sample = 48).

MAIN OUTCOME MEASURES

The outcome measures were the thoracic curve in sagittal spinal curvature in relaxed standing, sagittal spinal curvatures and pelvic tilt in relaxed standing and sit-and-reach positions, and hamstring extensibility.

RESULTS

There was a significant adjusted mean difference between groups in favour of the PG in the thoracic curve in relaxed standing position (-5.6°, p = 0.003), pelvic tilt (-2.9°, p = 0.03) and all straight leg tests (p<0.001). The PG showed a significant change in thoracic curve (-5.9, p<0.001) and in lumbar angle (4.0, p = 0.001) in relaxed standing position and in all straight leg raise tests (+6.4 to +15°, p<0.0001).

CONCLUSIONS

The adolescents with thoracic hyperkyphosis from the PG had a decreased thoracic kyphosis in relaxed standing position, and improved hamstring extensibility as compared with the CG. More than 50% of the participants obtained kyphosis values inside normality, showing an adjusted mean difference between groups in the thoracic curve of about 73% of the baseline mean, resulting in a large improvement and high clinical importance.

TRIAL REGISTRATION NUMBER

NCT03831867.

Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?

There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann's kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student's t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann's kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant's thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.

Immediate Effects of Isolated Lumbar Extension Resistance Exercise (ILEX) on Spine Posture and Mobility Measured with the IDIAG Spinal Mouse System

Posture and mobility are important aspects for spinal health. In the context of low back pain, strategies to alter postural anomalies (e.g., hyper/hypolordosis, hyper/hypokyphosis) and mobility deficits (e.g., bending restrictions) have been of interest to researchers and clinicians. Machine-based isolated lumbar extension resistance exercise (ILEX) has been used successfully for rehabilitation of patients suffering from low back pain. The aim of this study was to analyse the immediate effects of ILEX on spinal posture and mobility. In this interventional cohort study, the posture and mobility measures of 33 healthy individuals (m = 17, f = 16; mean age 30.0 years) were taken using the surface-based Spinal Mouse system (IDIAG M360©, Fehraltdorf, Switzerland). Individuals performed one exercise set to full exhaustion with an ILEX-device (Powerspine, Wuerzburg, Germany) in a standardized setup, including uniform range of motion and time under tension. Scans were made immediately before and after the exercise. There was an immediate significant decrease in standing lumbar lordosis and thoracic kyphosis. No change could be observed in standing pelvic tilt. Mobility measures showed a significant decrease in the lumbar spine and an increase in the sacrum. The results show that ILEX alters spine posture and mobility in the short-term, which may benefit certain patient groups.

Evaluation of the effects of a novel exercise program in the treatment of low back pain in women working in a seated position: A randomized trial

BACKGROUND

Low back pain (LBP) in sedentary workers is an increasing problem. Hyperlordosis or hypolordosis of the lumbar spine may be one of the causes of LBP. Various exercise programs are used in the prevention of LBP, but they do not consider individualization for diagnosed hyperlordosis or hypolordosis of the lumbar spine.

OBJECTIVE

The purpose of this study was to evaluate the effect of the authors' original exercise program aimed at reducing hyperlordosis or increasing hypolordosis.

METHODS

Sixty women aged 26 to 40 working in a sedentary position participated in the study. The sagittal curvature and the range of motion of the lumbar spine flexion were measured with the Saunders inclinometer, and the level of LBP was evaluated using the VAS scale. Subjects were randomly divided into two groups that participated in a 3-month exercise program developed by the authors. The first group performed exercises adjusted to the diagnosed hyperlordosis or hypolordosis, and the second group performed the same exercises regardless of the lumbar lordosis angle. The study was conducted again after completing the exercises.

RESULTS

There was a statistically significant difference between the groups (p< 0.0001) in the level of pain, with better results in the group where individualized exercise was used - 60% of the participants reported complete absence of LBP. The lumbar lordosis angle was within normal limits in 97% of the subjects in the first group, and in 47% of the subjects in the second group.

CONCLUSION

The results of this study confirm the validity of using individualized exercises with regard to diagnosed hyperlordosis or hypolordosis of the lumbar spine in order to achieve better analgesic and postural correction effects.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).

DATA SOURCES

MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.

STUDY SELECTION

Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach.

DATA SYNTHESIS

Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected.

CONCLUSION

Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion and serve performance in competitive young tennis players

Introduction

Intensive tennis practice is known to generate sport-specific adaptations at the shoulder region and influence the sagittal spinal curvature. However, increased thoracic kyphosis decreases the shoulder functional capacity, which could limit tennis performance. Therefore, the aim of this study was to investigate the effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion, and serve performance in competitive young tennis players.

Methods

Eighteen male and four female players (age: 16.0 ± 2.4 years, height: 170.7 ± 11.0 cm; mass: 62.1 ± 11.5 kg; International Tennis Number: 3-4) performed their regular training during 8 weeks, which was used as a reference period, and implemented a multimodal program including stretching, strengthening, and myofascial release exercises, four times per week during 8 additional weeks, which corresponded to the intervention period. The thoracic curvature angle and mobility, the biacromial and interscapular distances, the glenohumeral range of motion and the tennis serve performance were assessed three times, i.e., before and after the regular training and after the 8-week multimodal program.

Results

The results showed that the 8-week regular training had no significant effects on thoracic curvature angle [effect size (ES) = 0.02-0.36, p = 0.06-0.46] and mobility (ES = 0.05-0.26, p = 0.13-0.42), biacromial (ES = 0.05, p = 0.18) and interscapular distances (ES = 0.03, p = 0.45), ranges of motion in glenohumeral internal (ES = 0.04, p = 0.43) and external rotation (ES = 0.43, p = 0.06), and tennis serve accuracy (ES = 0.33, p = 0.07) and velocity (ES = 0.09, p = 0.35). The 8-week multimodal program increased moderately the thoracic mobility (ES = 0.55, p = 0.01), moderately to strongly the serve accuracy and velocity (ES = 0.65, p = 0.003, for both), strongly decreased the interscapular distance (ES = 1.02, p < 0.001), and strongly increased the range of motion in glenohumeral internal (ES = 0.90, p < 0.001) and external rotation (ES = 1.49, p < 0.001).

Discussion

These findings indicated that an 8-week multimodal program, including spine and glenohumeral mobility and shoulder girdle strength exercises, performed four times per week during 8 weeks, is moderately relevant to rectify the sagittal thoracic curvature in competitive tennis players, while such a program may help regain the range of motion in glenohumeral rotation without tennis serve performance impairment.

The effect of a childbirth preparation program including posture correction and stretching movements on lordosis and lumbar pain

AIM

The study aimed at evaluating the effect of posture correction and stretching movements on lordosis and lumbar pain in pregnant women.

BACKGROUND

An increased lumbar lordosis during pregnancy is considered one of the most common causes of lumbar pain.

METHODS

This quasi-experimental study was performed on 66 pregnant women referred to health centers in Tabriz, Iran, from November 2020 to June 2021. The participants were randomly assigned to the intervention and control groups. The intervention group received training of posture correction movements and stretching exercises during pregnancy from 16 to 18 to 35-37 weeks of pregnancy in six sessions for 45-60 min. The data were collected using a flexible ruler and a visual analog scale. Independent t-tests, repeated measures ANOVA, and ANCOVA tests were used.

RESULTS

The mean (standard deviation: SD) of lumbar lordosis increased from 45.12 (2.07) to 54.97 (2.20) in the intervention group at 35-37 weeks and changed from 44.28 (2.03) to 55.54 (3.39) in the control group at 35-37 weeks (adjusted mean difference: -1.24, 95% confidence interval: -2.48 to -0.005, P = 0.04). The mean (SD) of lumbar pain at 28-30 weeks was 2.80 (1.72) in the intervention group and 3.74 (2.23) in the control group (P = 0.09). However, the mean (SD) of lumbar pain at 35-37 weeks in the intervention group 4.38 (2.45) was significantly lower than that in the control group 5.83 (2.96) (P = 0.04).

CONCLUSION

This study provides evidence for the potential health benefits of training posture correction and stretching movements on controlling lumbar lordosis and reducing lumbar pain during pregnancy.

Physical activity, sitting time, neck disability and posture in workers using visual display terminals (VDT)

BACKGROUND

Musculoskeletal pain represents a major public health problem. Workers who use visual display terminals (VDT) have suffered an increase in neck pain in recent decades.

OBJECTIVE

The aim of this study was to analyze the relationship between physical activity (PA), sitting time, posture, and neck disability in a population of employed adults who use a computer at work.

METHODS

In this descriptive-correlational study, 88 workers with a mean age of 48.31 years participated. All of the participants filled out the Self-Report Habit Index (SRHI), International Physical Activity Questionnaire (IPAQ), and Neck Disability Index (NDI). The postural situation was also assessed with Posture Assessment Software (PAS/SAPO).

RESULTS

A significant and inverse relationship was observed between the habit of PA practice and the Body Mass Index (BMI). A total of 59.1% of the participants have a moderate PA index. There was a statistically significant relationship between the NDI and the time that workers spend sitting in a workday. A significance level of p≤0.05 was established for all the statistical analyses.

CONCLUSION

The increase in sitting time produces an increase in neck disability among workers and there are no significant differences between the level of PA and the cervical angles analyzed. The promotion of leisure-time PA and the reduction of prolonged uninterrupted sitting time at work could be one of the means to reduce musculoskeletal morbidity in the working population.

Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT—ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.

Feasibility of a 4-Week Manual Therapy and Exercise Intervention on Posture and Function in Community-Dwelling Older Adults: A Pilot Study

BACKGROUND AND PURPOSE

Thoracic hyperkyphosis is a common condition that progresses with aging and has been associated with impaired functional performance, increased risk of falls, and even mortality. Previous studies to improve posture primarily used exercise for durations of 3 months or longer. The purpose of this pilot study was to examine the feasibility of a manual therapy intervention in community-dwelling older adults over a 4-week time frame that is comparable to the typical clinical setting, to test the appropriateness and procedures for the measurement of posture and function in the older population with hyperkyphosis, and to collect preliminary data to describe change in posture and function measures.

METHODS

Twenty-four participants with hyperkyphosis or forward head posture were recruited, and 22 participants completed this pilot study. Feasibility was measured based on attendance, tolerance, safety, and retention. Issues with measurement procedures were recorded. The intervention included manual therapy and exercise 3 times a week for 4 weeks to target spinal and peripheral joint stiffness, muscle lengthening, and muscle activation. Outcomes included height, kyphotic index (KI), Block Test, Acromion to Table (ATT), Timed Up and Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient-Specific Functional Scale (PSFS). Data collected at visits 1, 6, and 12 were analyzed using 1-way repeated-measures multivariate analysis of variance.

RESULTS AND DISCUSSION

Measurement and intervention protocols were found to be feasible. A significant effect for the aggregate dependent variables change over time was found. Univariate analysis of each dependent variable showed significance except for FR. All postural measures (height, KI, Block Test, and ATT) significantly improved statistically. The KI and ATT exceed the minimal detectable change for clinical significance. Function showed statistical improvements in the TUG, 5XSTS, 2MWT, and PSFS. Clinical significance was reached with the PSFS. Seven of 9 measures showed a statistically significant change in just 2 weeks.

CONCLUSIONS

This pilot study suggests that manual therapy and exercise applied to older adults shows promise for improvement in measures of posture and functional performance in a clinically feasible 4-week time frame.

A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises

PURPOSE

To compare the effects of postural corrective and Schroth-based three-dimensional exercises on thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), balance and quality of life (QoL) in individuals with postural kyphosis.

METHODS

This was a single-blind randomized controlled clinical trial with a total of 63 subjects (57 women, 6 men) with TKA of ≥40°. Subjects were separated into three groups: postural corrective exercise group (PCEG), Schroth-based three-dimensional exercise group (SBEG) and control group (CG). Participants in the exercise groups participated in the exercise program twice a week for eight weeks under the supervision of a physiotherapist: CG performed no exercise but was generally informed. The primary outcome variable was TKA. Secondary outcome variables were LLA, balance and QoL.

RESULTS

After the functional exercise programs, TKA (mean change for PCEG, SBEG: -9.71, -14.76, p < 0.001), static postural stability index overall (-0.22, -0.40, p < 0.05), and QoL (-0.41, -0.37, p < 0.001) significantly improved in both training groups compared with CG. The LLA (-3.95, p = 0.003) was significantly lower in the SBEG group than in CG.

CONCLUSION

This study demonstrated that Schroth-based three-dimensional exercises are an effective treatment for individuals with postural kyphosis and have a large effect size that improves TKA, LLA, balance and QoL. Clinical trial registration number: NCT03706495 Implications for rehabilitationEight weeks of postural corrective or Schroth-based three-dimensional functional exercise programs are effective in addressing thoracic kyphosis angle (TKA), balance, and quality of life in individuals with postural kyphosis.An eight-week Schroth-based three-dimensional exercise program was more effective than postural corrective exercises in improving TKA, lumbar lordosis angle, and balance for patients with postural kyphosis.Schroth-based three-dimensional exercise programs could promote balance and spinal health in young adults with thoracic kyphosis.

The importance of extrinsic and intrinsic compensatory mechanisms to body posture of competitive athletes a systematic review and meta-analysis

The aim of this systematic review (qualitative analysis) was to identify the variables of changes induced by extrinsic (sport specific training) and intrinsic (individual anatomical predispositions) compensatory mechanisms that impact on the physiological magnitude of spinal curvatures in the sagittal plane and their deviations in the frontal plane. Furthermore, the aim of the quantitative analysis was to verify and objectivize the impact of these variables on athlete’s body posture. A search of electronic database (PubMed, EBSCO, MEDLINE) was conducted to identify all studies on sports training and athlete’s spine and body posture from 2011 to 2021. In the sagittal plane, the pooled proportion accounted for 44.97% (95% CI 31.22–58.72%) for thoracic hyperkyphosis (TH), 4.98% (95% CI 1.60–8.36%) for lumbar hyperlordosis (hyperLL), and 12.35% (95% CI 1.60–8.36%) for lumbar hypolordosis (hypoLL). Furthermore, in the sagittal plane, the pooled mean of thoracic kyphosis angle was 37.59° (95% CI 34.45–40.73%), whereas lumbar lordosis angle was 29.79° (95% CI 26.46–33.12%). Professional athletes tend to have postural disturbances and/or spinal curvature disorders in the sagittal and frontal planes. The meta-analysis indicated which intrinsic and extrinsic components might induce spinal abnormalities.

Effects of Corrective Exercises on Lumbar Lordotic Angle Correction: A Systematic Review and Meta-Analysis

Lumbar lordosis is one of the most important parts of the spine, which is of special importance due to its unique position and direct contact with the pelvis. The aim of this study was to combine the results of several studies and to evaluate the magnitude of the effect of different Lumbar lordotic angle correction programs through meta-analysis. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Four databases were searched for articles collection: PubMed, Cochrane Library, Web of Science, and Google Scholar. The key search terms were: “Lumbar Lordotic angle”, “Lordosis”, “Hyperlordosis”, “Corrective exercise”, and “Low back pain. “The articles included in our study were limited to original articles written only in English that met the following inclusion criteria: (1) participants with lumbar lordosis or hyperlordosis or low back pain; (2) different programs of corrective exercises were applied; (3) Lumbar lordotic angle used as outcome measures. Ten studies are included in our systematic review and meta-analysis. The effect size for the Lumbar lordotic angle outcome was (SMD = 0.550, p ˂ 0.001, moderate effect size). Subgroup analysis for Lumbar lordotic angle: Subgroup Younger group (SMD = 0.640, p ˂ 0.001), Subgroup Older group, (SMD = 0.520, p ˂ 0.001). Subgroup Treatment (SMD = 0.527, p ˂ 0.001), Subgroup No treatment (SMD = 0.577, p = 0.002). This was the only outcome assessed in our analysis. The current meta-analysis indicates that different correction methods have a positive effect on subjects with lumbar lordosis or hyperlordosis. In the following research, we should try to determine which corrective methods have the best effects.

Associations between potentially modifiable clinical factors and sagittal balance of the spine in older adults from the general population

PURPOSE

Spinal sagittal balance is associated with back pain and quality of life. Enhancing understanding of the clinical factors associated with sagittal balance is essential for guiding the development of effective non-operative treatment. We aimed to evaluate the associations between spinal sagittal balance and potentially modifiable clinical factors and interactions between current back pain and the evaluated clinical factors.

METHODS

We conducted a cross-sectional study where sagittal alignment, measured radiographically by EOS, was defined by sagittal vertical axis (SVA). The clinical factors included non-radiographic (NR) lumbar lordosis angle, balance (Berg balance scale), hip and back extension range of motion (ROM) and extensor strength, and back pain. Pearson's correlation coefficients and multivariable regression analyses were conducted in 63 adult participants (70% female, mean age 73 (SD 8.6) years) from the general population.

RESULTS

We identified correlations between SVA and age (r = 0.4, p < 0.001), body mass index (BMI) (r = 0.3, p = 0.008), balance (r = - 0.5, p < 0.001) and NR lumbar lordosis angle (r = - 0.5, p < 0.001). The final model (R² = 58%) identified that, after controlling for age and BMI, larger SVA was associated with lower NR lumbar lordosis (R² = 15%, p < 0.001), poorer balance (R² = 7%, p = 0.02), greater hip extensor strength (R² = 4%, p = 0.053), and among people with back pain, NR lumbar extension ROM (R² = 3%, p = 0.034). Hip ROM and lumbar strength were not significant.

CONCLUSION

Reduced NR lumbar lordosis magnitude and ROM, balance and hip strength are associated with SVA; however, it is unclear if these factors are compensatory, contributing, or modifiable. Hence, future longitudinal studies are needed.

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

Objective

The objective of this study was to explore the impact of sarcopenia and sagittal parameters on the residual back pain (RBP) after percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fracture (OVCF).

Methods

This retrospective study included elderly patients (age range 60–90 years) with OVCF treated with PVP from January 2015 and December 2020 in our hospital. The skeletal muscle mass index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height from chest CT to diagnose sarcopenia. The radiological parameters for measuring the sagittal alignment were included: C7-sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI).

Result

According to whether the VAS score > 4, patients were divided into RBP group (56 patients) and Control group (100 patients). There was no difference in age, gender, body mass index, BMD, surgical segment, bone cement usage between the groups (P > 0.05). The SMI in RBP group (27.3 ± 5.1) was significantly lower compared to that in Control group (36.8 ± 3.2) (P < 0.05). Sarcopenia was present in 19 patients (20.3%) in RBP group, which was significantly more than that in Control group (P < 0.05). C7-SVA and TPA was significantly larger in the RBP group than in the Control group (P < 0.05). PI and LL was significantly smaller in the RBP group compared to the Control group (P < 0.05). However, no significant differences between the two groups with respect to TK, SS and PT (P > 0.05).

Conclusion

Poor sagittal parameters and sarcopenia in OVCF patients after PVP were more prone to residual back pain. Larger C7-SVA, TPA and PI-LL mismatch could increase the incidence of RBP in elderly patients with single-segment osteoporotic compression fractures.

Characteristics of Body Posture in the Sagittal Plane in 8–13-Year-Old Male Athletes Practicing Soccer

Background: An important part of a healthy lifestyle for children and adolescents is exercising to satisfy the natural need for physical activity. However, young athletes should take special care when they participate in intense physical training, to ensure their proper physical development. The aim of this study was to evaluate the body posture in the sagittal plane of soccer players in comparison with healthy untrained peers. Methods: A total of 245 young males aged 8–13 who participated in the study were divided into two groups: “Group F—Footballer”, elite youth soccer players comprising 132 male athletes, and “Group C—Control group”, consisting of 113 boys from primary schools. The elite, youth soccer players played and trained in the Gold Standard Certificate Academy for their age group and belonged to the top 1% of all players from their category, respectively (Polish Soccer Association (PZPN)). The control group consisted of healthy boys from primary schools in Wroclaw not practicing any sport. A photogrammetric method based on the projection moiré phenomenon was used to assess the body posture in all subjects. Results: The analysis showed statistically significant differences in body posture parameters in the sagittal plane between the trained (F) and non-trained (C) groups. In all age groups, a significantly higher value of the upper thoracic angle and a lower value of the trunk inclination angle were observed in the football players’ group. Significant differences were also observed for the thoracic spine in each age group. In the groups of 8–9 and 12–13 years, they concerned the angle of thoracic kyphosis, and in the group of 10–11-year-old, the depth of thoracic kyphosis. In the group of children with ages 8–9 and 10–11, significantly higher values of lumbosacral angle and upper thoracic angle were observed in the group of soccer players. Conclusions: The soccer training load can influence the anterior–posterior curvature of the spine. In the group of footballers in all age groups, higher angular values of thoracic kyphosis and greater tilt of the torso forward were found, compared with their untrained peers. There were also significant differences in body posture between children of different ages, both in the group of footballers and in the group of untrained children. In the group of footballers, the differences concerned mainly the size of the lumbosacral angle and the depth of both curves, which decreased with the age of the players. A similar phenomenon was observed in the group of untrained boys but only in children in the older age groups.

Sagittal spine disposition and pelvic tilt during outdoor fitness equipment use and their associations with kinanthropometry proportions in middle-aged and older adults

BACKGROUND

Outdoor fitness training has become popular as a tool for improving the health, especially middle-aged and older adults. For this purpose, outdoor fitness equipment (OFE) have been installed in public areas. However, their safety and effectiveness are still unknown. The aim of the present research was to analyze the sagittal disposition of the spine and pelvic tilt during the use of OFE, and to determine the influence of anthropometric variables on these factors in middle-aged and older adults.

METHODS

Seventy healthy volunteers, 56 women and 14 men (age: 63.14 ± 8.19 years) participated in the study. Sagittal spine disposition and pelvic tilt were measured using a Spinal Mouse®, in the relaxed standing position, and during the use of the OFE. In addition, kinanthropometry variables were also measured according to the guidelines of the International Society for the Advancement of Kinanthropometry.

RESULTS

Regarding thoracic kyphosis, a significant decrease was found in thoracic kyphosis in the initial position (IP) in single bonny rider (SBR) (p = 0.006) and row (p = 0.046), and a significant increase in the final position (FP) in the row (p = 0.011), surfboard (p < 0.001) and air walker (p = 0.027) machines. In relation to the lumbar curvature and pelvic tilt, a significant decrease in lumbar lordosis and a decrease in pelvic anteversion were observed in the IP and FP in SBR and row; and in the bike (p < 0.001) machine. In the surfboard machine, a significant decrease in lumbar lordosis was found (p = 0.002), with no changes in pelvic tilt. According to the multiple linear regression analysis, the subjects with a higher cormic index and height were more at risk of increasing their thoracic kyphosis, decreasing lumbar lordosis and/or decreasing pelvic anteversion towards pelvic retroversion.

CONCLUSIONS

Middle-aged and older adults show spinal misalignments when using the OFE with respect to the standing position, showing a decrease in the thoracic kyphosis in IP of SBR and ROW, and a significant increase in the surfboard and air walker, and in the FP of Row, in the lumbar lordosis in all the OFE in sitting and some in standing, and in the pelvic anteversion in all the OFE in sitting. The variables height and the cormic index explained most of the changes in sagittal spine disposition.

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

BACKGROUND

A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications.

OBJECTIVE

To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE.

RESULTS

Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to -1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to -0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis.

CONCLUSION

Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.

Spinal curvatures of yoga practitioners compared to control participants-a cross-sectional study

Purpose

The angles of thoracic kyphosis and lumbar lordosis determine the spinal alignment in the sagittal plane. The aim of this study was to compare the thoracic kyphosis and lumbar lordosis of male and female yoga practitioners with non-practicing participants and to determine the possible dependencies between sagittal spinal curvatures and somatic parameters, time spent on yoga exercise, and undertaking other physical activities in yoga practitioners.

Methods

The study involved 576 women and 91 men ages 18–68 years (mean = 38.5 ± 9) who were practicing yoga, and 402 women and 176 men ages 18–30 years (mean = 20.2 ± 1.3) as a control group. The angles of thoracic kyphosis and lumbar lordosis were measured using a Plurimeter-V gravity inclinometer.

Results

The two-way ANOVA demonstrated the influence of group (p < .0001) and sex (p = .03) on the angle of thoracic kyphosis, as well as the influence of group (p < .0001) and sex (p < .0001) on the angle of lumbar lordosis. It was noted that yoga practitioners had less pronounced thoracic kyphosis and lumbar lordosis and were more often characterized by normal or smaller thoracic kyphosis and lumbar lordosis than students from the control group. In yoga practitioners, the angle of thoracic kyphosis was positively correlated with age, body mass, BMI, and undertaking other forms of physical activity. The angle of lumbar lordosis was negatively correlated with body height and body mass.

Conclusions

The results suggest that yoga exercises can affect the shape of the anterior-posterior curves of the spine and may be an efficient training method for shaping proper posture in adults.

Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment

We reviewed exercise trials in men and women ≥ 45 years with hyperkyphosis at the baseline and performed meta-analyses for kyphosis and health-related outcomes.

PURPOSE

To determine the effects of exercise interventions on kyphosis angle, back extensor muscle strength or endurance, physical functioning, quality of life, pain, falls, and adverse events in adults 45 years or older with hyperkyphosis.

METHODS

Multiple databases were searched to May 2020. Randomized controlled trials (RCTs), non-RCT, and pre-post intervention studies that had at least one group with a mean kyphosis angle of at least 40° at the baseline were included.

RESULTS

Twenty-four studies were included. Exercise or physical therapy improved kyphosis outcomes (SMD - 0.31; 95% confidence intervals [CI] - 0.46, - 0.16; moderate certainty evidence), back extensor muscle strength (MD 10.51 N; 95% CI 6.65, 14.38; very low certainty evidence), and endurance (MD 9.76 s; 95% CI 6.40, 13.13; low certainty evidence). Meta-analyses showed improvements in health-related quality of life (HRQoL) (SMD 0.21; 95% CI 0.06, 0.37; moderate certainty of evidence), general pain (MD - 0.26; 95% CI - 0.39, - 0.13; low certainty of evidence), and performance on the timed up and go (TUG) test (MD - 0.28 s; 95% CI - 0.48, - 0.08; very low certainty of evidence). The effects on the rate of falls (incidence rate ratio [IRR] 1.15; 95% CI 0.64, 2.05; low certainty evidence) or minor adverse events (IRR 1.29; 95% CI 0.95, 1.74; low certainty evidence) are uncertain. No serious adverse events were reported in the included studies.

CONCLUSIONS

Interventions targeting hyperkyphosis may improve kyphosis outcomes in adults with hyperkyphosis.

The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study

BACKGROUND

Hyperkyphosis (HKP) and forward head posture (FHP) occur due to prolonged poor postures and repetitive activities.

OBJECTIVE

The present study aimed to compare the effects of the National Academy of Sports Medicine (NASM) and Sahrmann corrective exercises on HKP and FHP correction.

METHODS

This quasi-experimental study was conducted on 30 subjects with HKP and FHP, who were randomly assigned to the NASM (n= 15) and Sahrmann groups (n= 15). The ImageJ software and a spinal mouse device were used to measure FHP and HKP deformities, and neck and shoulder muscle strength, range of motion (ROM), and pulmonary function were assessed as the secondary outcomes before and after the eight-week intervention.

RESULTS

FHP improved more significantly in the Sahrmann group compared to the NASM group (P< 0.05), while no significant difference was observed between the groups in HKP (P> 0.05). The improvement in the neck and shoulder muscle strength was more significant in the Sahrmann group compared to the NASM (P< 0.05), except for the neck flexors. In addition, the neck extension ROM enhanced more significantly in the Sahrmann group compared to the NASM group (P< 0.05).

CONCLUSION

According to the results, the Sahrmann corrective exercises that focused on the correction of imbalanced muscle stiffness had more significant effects on the correction of FHP, neck and shoulder muscle strength and neck extension ROM.

Use of a Spinal Traction Device during Work Shift in Assembly Line Workers

Increasing back discomfort and spinal shrinkage during the workday is a problem that affects assembly line workers. The aim of this research was to analyze the effect of a spinal traction system on discomfort, spinal shrinkage, and spinal sagittal alignment in assembly line workers, who are in prolonged standing conditions during a workday. A total of 16 asymptomatic males were recruited to assess spinal shrinkage, spinal sagittal alignment, and back discomfort during the workday. The measurement was carried out in two days of work, a normal day, and the other using a spinal traction device utilized in two breaks during the workday. Assembly line workers lost height significantly on both control and intervention days. No differences were found between days. No changes were found in spinal sagittal alignment on the control day. Lumbar lordosis angle increased significantly at the end of the intervention day. The use of a spinal traction device during the workday in two breaks time did not significantly reduce the spinal shrinkage of healthy workers. Lumbar lordosis angle increased significantly at the end of the spinal traction intervention day. Prospective studies would be necessary to clarify the possible benefits of the traction device.

Postural Evaluation in Sports and Sedentary Subjects by Rasterstereographic Back Shape Analysis

Posture is defined as the position of the body in space, the aim of which is to maintain balance, both in static and dynamic conditions. Our purpose was to study various postural variables involved in postural adaptations of athletes practicing symmetric and asymmetric sports at professional level. Methods: Patients include sedentary subjects, competitive athletes practicing symmetrical and asymmetrical sports. Postural evaluation of the three different groups was performed using the rasterstereographic-system Formetric-4D. Results: 157 subjects were recruited. From the comparison between subjects playing symmetrical and asymmetrical sports, arises a statistically significant difference on cervical (p = 0.041) and lumbar (p = 0.047) flèche of Stagnara, with higher values for symmetrical athletes’ group. Hemipelvis torsion (p = 0.031) and lumbar flèche (p ≤ 0.001) of Stagnara are higher in symmetrical athletes’ group (sedentary). Hemipelvis torsion, cervical and lumbar flèche resulted to be higher among athletes (sedentary) (p = 0.016, p = 0.003, p = 0.027). Conclusions: In addition to the competitive sports’ medical examination, a screening with rasterstereographic-system Formetric-4D is suggested to all sedentary subjects, without serious skeletal pathologies which want to start athletic activity. Rasterstereographic-system Formetric-4D is also suggested to all athletes practicing sports, with the aim to identify eventual unknown postures, consequent to reiterated repetition of specific movements.

PROTOCOL: Exercise interventions to improve back shape/posture, balance, falls and fear of falling in older adults with hyperkyphosis: A systematic review

Aim

The aim of this systematic review is to evaluate and synthesize published and unpublished literature on the effectiveness of a diverse range of exercise programs on back shape/posture, balance, falling and fear of falling in older people with hyperkyphosis.

Objectives

The objective of this systematic review is to determine the effects of difference exercise programs on back shape/posture, balance, falling and fear of falling in older adults with hyperkyphosis.

Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials

Despite the widespread use of postural correction in exercise interventions, limited experimental evidence exists for its effectiveness. The present study aimed to systematically review the literature on the efficacy of exercise interventions in improving postural malalignment in head, neck, and trunk. A systematic review was performed by screening four scientific databases (MEDLINE, Web of Science, EBSCO, and Cochrane database) for published randomized controlled trials (RCTs) in English from 1996–2019. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Two researchers independently performed study screening, extracting data and assessing the risk of bias for each included study using the Cochrane Collaboration tool for evaluating the risk of bias. A total of 22 RCTs comprising 1,209 participants were identified for inclusion in the review. There was a high risk of bias across most of the included studies (12 studies). Only two studies were classified as low risk of bias, and eight studies were classified as moderate risk of bias. The intervention duration ranged from 2 to 13 weeks, frequency from 2 to 4 days per week, and duration of each session between 15 to 60 min. The insufficiency and quality of included studies did not allow an integrated assessment of the efficacy of exercise interventions on postural malalignments; however, the positive effects noticed in most of the studies indicate some advantages but underscores the necessity of adequately designed RCTs in this field.

Spinal sagittal alignment, spinal shrinkage and back pain changes in office workers during a workday

Purpose. Prolonged sitting is a risk factor for the appearance of lower back pain during work. The aim of this study was to observe changes in spinal sagittal alignment, height and the perception of back pain in office workers during a workday. Materials and methods. Forty-one office workers (20 women) were enrolled into a cross-sectional study. Height, sitting height and degrees of thoracic kyphosis and lumbar lordosis as well as perceived neck pain, lower back pain and upper back pain were determined, before and after an 8-h workday. Results. At the end of the day, workers had a significant decrease (p = 0.000) in height and sitting height, and upper back pain increased significantly (p = 0.023). In men, spinal shrinkage correlated with neck pain (r = 0.410, p = 0.027), and lumbar lordosis degrees in women correlated negatively with upper back pain at the end of the day (r = -0.440, p = 0.012). Conclusions. Spinal shrinkage equally affects men and women who perform the same work. There are no changes in spinal sagittal alignment throughout the workday in office workers. Office workers show significantly increased pain in the upper back at the end of the day.