Sagittal spinal morphotype assessment in 8 to 15 years old Inline Hockey players

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.

Lower-Limb Range of Motion Predicts Sagittal Spinal Misalignments in Children: A Case-Control Study

The main objective of this study was to determine lower-limb range of motion (ROM) as a risk factor associated with sagittal spinal misalignments in children. Two hundred and one children (10.9 ± 0.7 years old) from five different primary schools were recruited for this retrospective case-control study. Anthropometric variables, sagittal spinal alignment in habitual everyday postures, and lower-limb ROM, such as ankle dorsiflexion with the knee flexed (ADF-KF), hip extension with the knee relaxed (HE), and hip flexion with the knee extended (HF-KE) were measured. Multivariate and univariate analyses revealed differences between the means of HE and HF-KE ROM, and the thoracic and lumbar curves (p ≤ 0.034; η² ≥ 0.052). The HE (p ≤ 0.028; OR ≥ 1.066) predicted sagittal thoracic misalignment in the slump sitting (SSP) and relaxed standing (RSP) postures in males and the sagittal lumbar misalignment in the RSP in female children; while HF-KE (p ≤ 0.006; OR ≥ 1.089) predicted sagittal thoracic misalignment in the maximum trunk forward flexion posture (MTFP) and sagittal lumbar misalignment in SSP and MTFP in males. In this study, the reference values for restricted HE and HF-KE were significantly associated with sagittal spinal misalignment in male children but not for the ankle ROM. Physical education teachers should include stretching exercises in the ISQUIOS programme to increase the extensibility of the iliopsoas (HE) and hamstrings (HF-KE) and prevent sagittal spinal misalignments in habitual everyday postures.

The Sagittal Integral Morphotype in Male and Female Rowers

The goal of this study was to describe the integrated spinal assessment of the sagittal morphotype in rowers to determine whether the intense practice of rowing causes a modification of the sagittal curvatures of the spine, its relationship with the rowing technique, and training background. The second goal was to analyse how the dorsal and lumbar curves behave in the three phases of the rowing gesture, and to determine which phases can be detrimental to the correct development of the spine during growth. We analysed the spine curvatures in the sagittal plane of 29 females and 82 males, which were measured with an inclinometer in standing, slump sitting, maximal trunk flexion and during rowing performance. The average value of thoracic kyphosis in the rowers was 30° (mean, 30 + 8.27°). Thoracic hyperkyphosis was found in only two rowers (1.8%). Lumbar lordosis was within normal range in 84.1% of the males (mean, 27 + 9.57°) and 75.9% of female rowers (mean, 33°). Functional thoracic hyperkyphosis was observed in 57.4% of the males and 17.1% of the females. Functional lumbar hyperkyphosis was observed in 28 of the 69 males (40.5%) and five of 22 females (17.2%). Rowing seems to provide adequate spine alignment in the sagittal plane on standing. The integrated spinal assessment of the sagittal morphotype showed that half or our rowers presented with functional thoracic hyperkyphosis, and 43.2% presented with functional lumbar hyperkyphosis. Spine behaviour during the rowing technique shows that the thoracic kyphosis (98.2%) and lumbar spine (91%) perform within normative ranges and could explain the adequate positioning of the spine in the sagittal plane on standing. Years of rowing training tend to reduce thoracic kyphosis in males.

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.

The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis

It is assumed that mechanical restriction of hamstring tightness disrupts sagittal spine–pelvis–leg alignment and alters the lumbar–pelvic rhythm predisposing to low back pain (LBP) in athletes; however, this association is not clear. A prospective cross-sectional cohort study was conducted to determine the influence of hamstring extensibility (HE) on sagittal pelvic tilt, sagittal spinal curves, and LBP in 94 soccer and basketball players (61 man and 33 woman) with (n = 36) and without recurrent LBP (n = 58). Descriptive analysis displayed significant gender differences for HE, sagittal pelvic tilt, and lumbar curve. Differences were found between the low-HE and high-HE groups in lumbosacral angle in for the maximum trunk forward flexion (LH-MTFP). Low-HE was associated with LH-MTFP, lumbar curve and LBP in male players (p ≤ 0.023). In female players, LH-MTFP and lumbar curve were associated with low-HE (p ≤ 0.020). Low-HE predicted LH-MTFP (p = 0.000; OR = 65.6950) and LBP (p = 0.028; OR = 13.915) in male players. The decision tree analysis showed that 50.8% of the players were classified with restricted LH-MTFP, 77.4% with low-HE among male players. The 100% of male players with recurrent LBP had low-HE. The 65% of female players with low-HE had restricted LH-MTFP. Measurement of HE, lumbar curve, and LH-MTFP are important in making training decisions for to reduce the incidence of recurrent LBP in soccer and basketball players.

Sagittal Integral Morphotype of Competitive Amateur Athletes and Its Potential Relation with Recurrent Low Back Pain

Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.

Sagittal Integral Morphotype of Female Classical Ballet Dancers and Predictors of Sciatica and Low Back Pain

The aims of this study were to describe the sagittal integral morphotype (SIM) of classical ballet (CB) dancers, and to establish predictor factors and their cut off values for high risk of experiencing sciatica or low back pain (LBP). This retrospective cohort study was performed in 33 female professional CB dancers. Data related to anthropometric parameters, CB dance experience, sciatica or LBP history, and sagittal spine curvatures were collected. A binary logistic regression and receiver-operating characteristic analysis were performed. The main spine misalignments observed in the SIM of CB dancers were thoracic functional hyperkyphosis, hypomobile kyphosis, and hypokyphosis, and those for the lumbar curvature were hyperlordotic attitude and functional hyperkyphosis. The lumbar curvature in slump sitting and trunk forward bending positions, together with the stature, were significant predictor factors of sciatica history, while the years of dance experience was a significant predictor factor of LBP history. The cut off values analysis revealed that dancers with a stature of 161 cm or less, and those with 14 years of experience or more, have a greater probability of experiencing sciatica or LBP history, respectively.

Asymmetry and Tightness of Lower Limb Muscles in Equestrian Athletes: Are They Predictors for Back Pain?

Athletes may suffer from low back pain (LBP). Some studies have considered restricted range of motion (ROM) as a risk factor for LBP in athletes; however, ROM has not been evaluated in equestrian athletes (EAs) with LBP. The aims of this research in EAs were (I) to analyze the relationship between lower limb ROM (tightness and asymmetry) and LBP and (II) to determine the reference values for lower limb ROM indicating high risk of LBP. Forty-three young (9–18 years old) EAs were voluntarily recruited in technical training camps. The EAs were assessed for 11 passive lower limb ROMs using the ROM-SPORT I Battery. LBP data were taken at the end of a 1-year period through a questionnaire. Binary logistic regression and receiver operating characteristic curves were calculated. Sixty-seven percent of EA had suffered LBP. Hip adduction (OR = 1.347, medium; p = 0.015) and knee flexion (OR = 1.109, small; p = 0.023) were predictors of LBP in EAs. A hip adduction of 26° and knee flexion of 128° were found to be the optimal cutoff values for predictive screening of EAs at high risk of LBP.

Trunk Lateral Flexor Endurance and Body Fat: Predictive Risk Factors for Low Back Pain in Child Equestrian Athletes

Low back pain (LBP) is the most common overuse musculoskeletal injury suffered by child equestrian athletes (CEA). Despite this, little is known about the risk factors related to LBP in these athletes, and very limited research has been conducted on this topic. This study was designed to investigate predictive risk factors for LBP in CEA. The purposes of this research were to determine whether anthropometric, range of motion (ROM), core endurance and sagittal spinal morphotype measures are risk factors for LBP and to establish a diagnostic cutoff value for those factors associated with LBP. Nineteen CEA between the ages of 12 and 17 years were voluntarily recruited. Potential risk factors evaluated included corporal composition, lower limb ROM, core endurance and sagittal spinal measures. Associations and predictions were calculated between these risk factors and the LBP during the last 12 months. Almost half of the CEA have suffered at least one episode of LBP. Two risk factors and cutoff values were identified as predictors of LBP in CEA: having a high body fat higher than 23% (p = 0.01) and trunk lateral flexor endurance lower to 65 s (p = 0.021), body fat being the strongest predictor.

Back Pain Related with Age, Anthropometric Variables, Sagittal Spinal Curvatures, Hamstring Extensibility, Physical Activity and Health Related Quality of Life in Male and Female High School Students

Spinal pain (SP) is widely extended among adolescents. The origin of SP can be multifactorial; thus, the present study aimed to estimate the prevalence and risk of SP in high school students and to determine the differences in sagittal spinal curvatures and pelvic tilt, hamstring extensibility, age, anthropometric variables and healthy lifestyle habits dependent on SP between sexes. Two hundred seventy-three teenagers took part in this cross-sectional study. Age, sagittal spinal curvatures, hamstring extensibility, physical activity, sedentary lifestyle, anthropometric variables and health related quality of life (HRQL) were recorded. SP was reported by 16.12% of adolescents. Differences were observed in the HRQL according to SP (p < 0.05). Participants without SP were less sedentary (22.12%) and younger (13.10 years old) than participants with SP (40.91% and 13.66, respectively) (p < 0.05). A logistic regression model showed that both variables were significantly collinear (VIF = 1.01; Durbin-Watson = 2.10). Subjects with low back pain (LBP) had a higher weight, body max index, and hip girth than subjects without pain (p < 0.05). A misalignment in the lumbar spine was associated with LBP for males (Cramer’s V = 0.204, p = 0.022). In conclusion, adolescents with SP were older and had a lower HRQL in all dimensions. SP could be predicted according to age and sedentary habits.

Straight Leg Raise Test: Influence of Lumbosant© and Assistant Examiner in Hip, Pelvis Tilt and Lumbar Lordosis

The passive straight leg raise (PSLR) test is widely used to assess hamstring extensibility. However, to accurately measure hamstring extensibility throughout PSLR, appropriate stabilization of the pelvis must be provided in order to minimize the possible influence of any compensatory movement in the scores reached. The main purpose of this study was to demonstrate the degree of influence of the Lumbosant© and an assistant examiner in hamstring extensibility in healthy young adults. A secondary objective was to verify the variability of the posterior pelvic tilt movement. Hamstring muscle extensibility was measured using the traditional (only an examiner) and new (using a low-back protection support Lumbosant© and two trained [principal and assistant] examiners) PSLR procedures. Correlation coefficients were expressed using r values, accompanying descriptors and 90% confidence intervals. Variance explained was expressed via the R2 statistic. To examine possible differences, the Mann-Whitney U-test was conducted. Additionally, Cohen’s d was calculated for all results, and the magnitudes of the effect were interpreted and statistical significance set at p < 0.05. A stepwise multiple regression analysis was performed to examine the relationship between scores and values. The final score that was determined with the new PSLR is significantly lower (13° approximately) than the one obtained through the traditional procedure (75.3 ± 14.4° vs. 89.2 ± 20.8°; d = −0.777 [moderate]). The data presented in this study suggest that the PSLR may overestimate hamstring extensibility unless lumbopelvic movement is controlled. Therefore, we recommend the use of Lumbosant© and an auxiliary examiner to obtain more accurate hamstring extensibility scores.

Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8-12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

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

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