Active self correction of back posture

Manual Therapy 19 (2014) 392e398
Contents lists available at ScienceDirect
Original article
Active self-correction of back posture in children instructed
with ‘straighten your back’ command
Dariusz Czaprowski a,b,*, Paulina Paw1owska a, qukasz Stolinski b, Tomasz Kotwicki c
a Department of Physiotherapy, Józef Rusiecki University College, Bydgoska 33, 10-243 Olsztyn, Poland
b Rehasport Clinic, Poznan, Poland
c Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences in Poznan, Poland
a r t i c l e i n f o
Article history:
Received 5 December 2012
Received in revised form
12 October 2013
Accepted 21 October 2013
Keywords:
Self-correction
Body posture
Spine curvatures
a b s t r a c t
The ability to adopt the properly corrected body posture is one of the factors determining the effec-tiveness
of therapeutic programmes. This study determined the active self-correction expressed by the
change of sagittal spinal curvatures (in standing and sitting positions) in 249 children (136 females, 113
males, aged 10e14 years) instructed with ‘straighten your back’ command (SYB). Spinal curvatures
(sacral slope-SS, lumbar lordosis-LL, global, lower and upper thoracic kyphosis-TK, LK, UK, respectively)
were assessed using Saunders inclinometer. The assessment was done in spontaneous standing and
sitting positions and in the positions adopted after the SYB.
In a standing position SYB led to the significant (P 0.001) increase in SS, and the significant (P 0.01)
decrease in LL, TK, LK, UK. In a sitting position SYB led to significant changes (P 0.001) from kyphotic to
lordotic position of SS and LL and to the significant (P 0.001) reduction of TK (36.5 10.8 vs.
23.5 11) and the flattening of LK (15.2 8.7 vs. 1.0 8.4). There were gender-based discrepancy
regarding active self-correction only for LL in a standing and UK in a sitting position. Females demon-strated
a significant decrease in LL (P 0.001). UK significantly increased only in males (P 0.001).
The ‘straighten your back’ command leads to moving the spine away from mid-range towards end
range of motion. Therefore, the command should not be used to elicit the most optimal back posture.
Further studies are needed to determine if the active self-correction is different in females and males.
2013 Elsevier Ltd. All rights reserved.
1. Introduction
‘Good’ posture is the complex interplay between biomechanical
and neuromuscular functions which safely loads spinal segments
and conserves energy (Claus et al., 2009a). Although it is widely
accepted that a ‘good’ posture is vital for proper functioning of the
body, it proves to be difficult to define by means of quantitative
factors (Claus et al., 2009a).
One of the basic features determining the quality of body
posture is spinal curvatures in sagittal plane (Kendall et al., 2005). It
is suggested that a correct standing position should involve slight
lumbar lordosis and slight thoracic kyphosis (Kendall et al., 2005).
Kyphotic shape of lower thoracic kyphosis is of importance as well
since it serves an important role in maintaining rotational stabili-sation
of the spine (Kotwicki, 2002). However, it seems to be more
difficult to define the optimal sitting position. Some authors claim
that spinal curves in sitting should be similar to “ideal” standing
position (Lee, 2003; O`Sullivan, 2004; Claus et al., 2009a).
Currently, a number of children and youth are being diagnosed
with postural faults as well as back and neck pain (Jones and
Macfarlane, 2005; Kendall et al., 2005; Geldhof et al., 2007). One
reason, among other factors, may be prolonged poor sitting
(Murphy et al., 2004; Geldhof et al., 2007). Prolonged sitting has
also been reported to be a common aggravating factor for subjects
with low back pain (LBP) (Williams et al.,1991). Commonly adopted
relaxed postures (sway standing, slump sitting) has been also re-ported
to frequently exacerbate LBP (O`Sullivan, 2000; O`Sullivan
et al., 2002). Therefore, youths can be referred to various thera-peutic
programmes aimed at improving the quality of body posture
along with fostering the awareness of the importance of correct
posture when sitting and standing (Geldhof et al., 2007). Teaching
the appropriate active self-correction might be one of the elements
of such programmes (Weiss et al., 2006; Romano et al., 2008). Ac-cording
toWeiss et al. (2006) the ability to adopt and maintain the
properly corrected body posture whilst completing activities of
daily living is one of the factors determining the effectiveness of
corrective programmes concerning the improvement of body
* Corresponding author. Department of Physiotherapy, Józef Rusiecki University
College, Bydgoska 33, 10-243 Olsztyn, Poland. Tel./fax: þ48 89 5260400.
E-mail address: dariusz.czaprowski@interia.pl (D. Czaprowski).
Manual Therapy
journal homepage: www.elsevier.com/math
1356-689X/$ e see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.math.2013.10.005

D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398 393
posture. Active self-correction is also an essential part of the pro-gramme
of conservative treatment for idiopathic scoliosis (Romano
et al., 2008; Zaina et al., 2009) which may prove that the quality of
performing active self-correction is important.
Giving different commands such as ‘straighten your back’ might
be one of the ways of improving one’s body posture. The command
is used during therapeutic sessions as well as included in guidance
provided by a physiotherapist (Bulinska, 2005). Our experience and
observations show that it is also commonly given by parents and
teachers. However, it has not been yet determined whether sub-jects
following the aforementioned command adopt an optimal
position of the spine and hence whether the instructions prove
useful in improving the quality of body posture in youths.
The aim of this study was to determine the active self-correction
expressed by the change in the magnitude of spinal curvatures in
the sagittal plane both in standing and sitting positions in children
aged between 10 and 14 years instructed with ‘straighten your
back’ command. As yet there have been no studies examining
whether females and males perform active self-correction differ-ently,
we have additionally conducted the assessment of changes in
sagittal curvatures of the spine in individuals instructed with
‘straighten your back’ command for females and males separately.
2. Material and methods
2.1. Subjects
The recruitment of the subjects to the study took place during the
presentations for parents and their children. The presentations were
given in 5 randomly selected primary schools. The information
about the study was placed on notice boards and school websites
with the school master’s consent. 450 parents and their children
participated in the meetings. Finally, the study included 249 chil-dren
(136 females and 113 males) aged 10e14 years (11.80.8),who
met the following criteria: written informed consent of parents who
allowed their children to participate in the study, no participation in
corrective gymnastics classes, no previous guidance on how to ac-quire
the correct posture, no neurological disorders, injuries or
musculoskeletal pain in the preceding 12 months. The basic de-mographics
of the study group are given in Table 1.
2.2. Measurement protocol
2.2.1. Evaluation of sagittal curvatures of the spine
All of the children underwent the evaluation of spinal curvatures
in sagittal plane. The assessment was carried out with Saunders
inclinometer (Baseline Digital Inclinometer, The Saunders Group
Inc, Chaska, MN, USA). The measurements were conducted ac-cording
to the producer’s instructions following the American
Medical Association guidelines (Saunders, 1998; Andersson and
Cocchiarella, 2004). Prior to measurements, a non-toxic skin
marker was used to mark the following measurement points found
by palpation (Muscolino, 2008; O`Sullivan et al., 2010): lumbosacral
junction e L5/S1 (LS point), thoracolumbar junction e T12/L5 (TL
point), cervicothoracic junction e C7/T1 (CT point) and T6/T7
junction (T6 point) (Fig. 1). In order to assess the angle of sacral
slope, the inclinometer was reset in the horizontal position and
placed on the LS point. The angle of lumbar lordosiswas determined
after the inclinometer was reset at the LS point and the readingwas
taken at the TL point. The measurement of global thoracic kyphosis
angle started with resetting the inclinometer at the TL point and
then itwas applied to CT point. Additionally, the magnitude of lower
(T6/T7eT12/L1) and upper thoracic kyphosis (C7/T1eT6/T7) was
determined. The inclinometer was placed on the TL point, after
which it was reset and applied to T6 point to determine the
magnitude of lower thoracic kyphosis. In order to assess the upper
kyphosis, the inclinometer was reset at the T6 point and placed at
the CT point. Each measurement was carried out three times. The
average values of the three measurements were used for the analysis
(Saunders, 1998; Andersson and Cocchiarella, 2004).
The assessment of sagittal curvatures of the spine was carried
out with subjects in spontaneous standing and sitting positions and
the position adopted after the ‘straighten your back’ command. The
first measurement was carried out in a standing position. The
subjects were neither provided with any guidance nor received any
feedback on their posture. Kyphotic curves were represented as
positive angles, whereas lordotic curves were recorded as negative
(Claus et al., 2009a).
All the measurements were performed by one investigator.
2.2.2. Measurement of sagittal curvatures of the spine in a standing
position
The assessment was conducted with subjects in a spontaneous
standing position, shoeless (O`Sullivan et al., 2002). Their lower
limbs were extended at the knee joint, with feet hip-width apart.
The upper limbs were relaxed at the side of the body. Subjects were
requested to view a designated point ahead at eye level.
First, the magnitude of sagittal curvatures of the spine was
measured with subjects standing in a habitual, spontaneous posi-tion,
in line with the above mentioned methodology. Immediately
afterwards, every subject was given the ‘straighten your back’
command and after 5 s the measurement was taken (Fig. 2).
2.2.3. Measurement of sagittal curvatures of the spine in a sitting
position
The examination was conducted on a therapeutic table with a
subject in a sitting position, with no back support. The height of the
tablewas adjusted to every subject individually to achieve the most
natural and comfortable position. The height of the seat was
adjusted to the posterior knee crease level to achieve the flexion of
hip and knee joints at 90 (Claus et al., 2009a). The positions of hip
and knee joints were verified with a goniometer. The subject’s
hands rested on laps and their feet rested on 20-cm high box.
Every subject was requested to adopt a relaxed, spontaneous
position after being instructed with ‘sit as you usually do’ command
(O`Sullivan et al., 2010). Subjects were also requested to view a
designated point ahead at eye level (Caneiro et al., 2010; O`Sullivan
et al., 2010). After 5 s, spinal curvatures were measured following
the aforementioned measurement guidelines. Afterwards, the
subjects were instructed with ‘straighten your back’ command and,
after 5 s, the measurement was repeated (Fig. 3).
2.2.4. Active self-correction evaluation
In order to determine the effect of active self-correction, the
angular values of each spinal curvature were compared in different
positions: spontaneous standing and sitting positions as well as
positions adopted after ‘straighten your back’ command. The re-sults
obtained during the examinations were compared for the
whole group as well as for females and males separately.
The local Ethical Commission granted permission for this
research (permission number: 2/2012).
Table 1
Demographics of the study group (n ¼ 249).
Mean Minimum Maximum SD
Age (years) 11.8 10.0 14.0 0.8
Height (m) 1.51 1.3 1.74 0.1
Weight (kg) 44.4 21.0 72.0 10.2
BMI (kg m2) 19.2 11.0 35.1 4.0

394 D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398
2.2.5. Pilot reliability study
The reliability of the measurements performed in a spontaneous
standing position expressed by Cronbach’s alpha coefficient was as
follows (Czaprowski et al., 2012): (1) 0.85 for sacral slope; (2) 0.87
for lumbar lordosis; (3) 0.83 for thoracic kyphosis; (4) 0.82 for
lower thoracic kyphosis; and (5) 0.86 for upper thoracic kyphosis.
That indicates good reliability of the measurement (Bland and
Altman, 1997; Czaprowski et al., 2012). The measurement error
was calculated at (1) 3.3; (2) 3.2; (3) 3.8; (4) 3.3; and (5) 2.8,
respectively (Czaprowski et al., 2012). Additionally, prior to the
study, reliability of measurements and measurement error for
spontaneous sitting position were assessed. The reliability level and
measurement error were as follows: (1) 0.89 and 2.3; (2) 0.99 and
2.5; (3) 0.91 and 1.9; (4) 0.97 and 2.5; (5) 0.97 and 1.7 for sacral
slope, lumbar lordosis, thoracic kyphosis, lower thoracic kyphosis,
and upper thoracic kyphosis, respectively. That indicates excellent
and good reliability of these measurements (Bland and Altman,
1997).
2.3. Statistical analysis
Statistical analysis was performed with Statistica 7.1 (StatSoft,
Poland). The ShapiroeWilk test determined the normal distribu-tion
of the data. The Wilcoxon test was used to determine differ-ences
(in the whole group of children) for five spinal angles (sacral
slope, lumbar lordosis, thoracic kyphosis, and its lower and upper
part) evaluated before and after `straighten your back’ command.
The analysis was performed for standing and sitting position
separately. Apart from the analysis carried out for the whole group
of children, additionally, the same analysis procedure was repeated
for females and males separately. The value P ¼ 0.05was adopted as
the level of significance.
3. Results
3.1. Standing position e the whole group
The average magnitude of thoracic kyphosis in a spontaneous
standing position was 42.7 9.3 in the whole group and it
decreased significantly (P 0.001) after the ‘straighten your back’
command. A significant decrease was also observed in lower and
upper kyphosis (P 0.001) as well as in lumbar lordosis (P 0.01).
The sacral slope significantly increased after the `straighten your
back’ command (P 0.001) (Table 2).
3.2. Sitting position e the whole group
A significant (P 0.001) change from kyphotic to lordotic po-sition
in sacral slope and lumbar lordosis was observed after
`straighten your back’ command. Thoracic kyphosis and its lower
part significantly (P 0.001) decreased (from 36.5 10.8 to
23.5 11.7 and from 15.2 8.7 to 1.0 8.4, respectively). Upper
thoracic kyphosis significantly increased (P 0.001) after the
command (Table 2).
3.3. Standing and sitting positions e females
In females, in a standing position, after `straighten your back’
command, a significant (P 0.001) increase of sacral slope was
observed. The other parameters significantly (P 0.001) decreased.
In sitting, a significant (P 0.001) change from kyphotic to lordotic
position of sacral slope and lumbar lordosis was observed. Thoracic
kyphosis and its lower part significantly (P 0.001) decreased.
Upper thoracic kyphosis did not change significantly after the
command (Table 3).
Fig. 1. Location of the measurements points. LS e lumbosacral junction, TL e thor-acolumbar
junction, T6 e T6/T7 junction, CT e cervicothoracic junction.

Fig. 2. A e spontaneous, habitual standing posture, B e standing posture adopted after ‘straighten your back’ command.
3.4. Standing and sitting positions e males
In males, in a standing position, a significant (P 0.001) increase
of sacral slope was observed after ‘straighten your back’ command.
Thoracic kyphosis and its lower and upper parts significantly
(P 0.001) decreased after the command. Lumbar lorodosis did not
change significantly. In sitting, a significant (P 0.001) change of
sacral slope and lumbar lordosis from kyphotic to lordotic position
Fig. 3. A e spontaneous, habitual sitting position, B e sitting position adopted after ‘straighten your back’ command.

Table 2
Change in spinal curvatures in sagittal plane in standing and sitting - the whole group (n ¼ 249).
Parameter Spontaneous standing position Corrected standing position Spontaneous sitting position Corrected sitting position
Mean Median Mean Median Mean Median Mean Median
Sacral slope (L5/S1-horizontal line) 19.3 6.3 20 21.5 7.1 21** 11.4 9.0 12 7.1 8.2 8**
Lumbar lordosis (T12/L1eL5/S1) 33.0 13.0 33 31.3 10.3 31* 17.4 12.1 18 6.6 10.5 6**
Thoracic kyphosis (C7/T1eT12/L1) 42.7 9.3 42 33.2 11.6 33** 36.5 10.8 36 23.5 11.7 23**
Lower thoracic kyphosis (T6/T7eT12/L1) 9.5 7.7 10 2.6 9.4 3** 15.2 8.7 16 1.0 8.4 1**
Upper thoracic kyphosis (C7/T1eT6/T7) 33.2 7.4 33 30.2 10.0 31** 21.1 8.5 21 22.0 11.6 22**
was observed. Thoracic kyphosis and its lower part significantly
(P 0.001) decreased after ‘straighten your back’ command. Upper
thoracic kyphosis significantly (P 0.001) increased (Table 4).
4. Discussion
The aim of the study was to determine the change in body
posture expressed by the magnitude of sagittal curvatures of the
spine in children instructed with ‘straighten your back’ command.
Active self-correction was evaluated both in standing and sitting
positions. Due to the fact that so far there has been no analysis
determining whether this movement is determined by the gender,
the study additionally examined it for females and males
separately.
Apart from the standard assessment of the magnitude of sacral
slope, lumbar lordosis and thoracic kyphosis (Saunders, 1998;
Andersson and Cocchiarella, 2004), the study also evaluated up-per
and lower thoracic kyphosis separately. It stems from the fact
that lower thoracic kyphosis is crucial to the rotational stabilisation
of the spine and hypokyphosis of this part of thoracic spine is
typical for progressive idiopathic scoliosis (Kotwicki, 2002). Studies
conducted by O`Sullivan et al. (2006) also assessed the magnitude
of lower thoracic kyphosis (T6eT12).
4.1. Standing position
In the whole study group, a significant change was observed in
the magnitude of all measured parts of the spine in subjects
instructed with ‘straighten your back’ command. Thoracic kyphosis
as well as its upper and lower parts along with lumbar lordosis
decreased whereas sacral slope significantly increased.
The obtained results indicate that the ‘straighten your back’
command leads to the extension of the back expressed by the
decrease in the magnitude of kyphotic curves and the increase in
sacral slope.
4.2. Sitting position
It was typical for the whole study group, including both females
and males to acquire kyphotic posture (referred to as slump sitting)
in a relaxed sitting position (O`Sullivan et al., 2006; Caneiro et al.,
2010). The ‘straighten your back’ command brought about a
considerable change in position of the spine towards extension
what led to the decrease in thoracic kyphosis and its lower part as
well as the lordotic alignment of the lumbar spine and sacral slope.
However, it seems worth noting that the lumbar spine adopted only
a slightly lordotic position (median 6) and lower thoracic
kyphosis was flattened (median 1).
4.3. Females and males
In our study we have observed a slight discrepancy in active self-correction
performed by females and males. Females when
instructed with ‘straighten your back’ command demonstrated a
significant decrease in lumbar lordosis whereas in males this
parameter did not undergo any changes. In turn, upper thoracic
kyphosis increased in both females and males. However, this
change was statistically significant (P 0.001) in males only.
Similar changes were observed in other parts of the spine in both
groups. However, it is worth noting that in the present study there
was no direct comparison between genders. Therefore, further
studies are needed to determine whether the active self-correction
is the same or different in females and males.
4.4. Clinical relevance
Sitting is one of the risk factors contributing to low back pain.
Therefore, re-education of sitting posture may be one of the stra-tegies
of preventing and treating it (O`Sullivan et al., 2012). Yet, the
optimal sitting position is still the subject of ongoing discussions
(Claus et al., 2009a; O`Sullivan et al., 2010). Unquestionably, various
sitting and standing postures affect the activity of trunk muscles
and spinal load differently (O`Sullivan et al., 2002; O`Sullivan et al.,
2006; Claus et al., 2009b). A number of authors recommend
acquiring neutral spine position involving slight lumbar lordosis
and a relaxed thorax for those LBP subjects who are sensitive to
lumbar spine flexion and extension. This position enables subjects
to avoid pain resulting from adopting end-range positions and it
facilitates the adoption of the most desirable pattern of key trunk
muscles activation (Scannell and McGill, 2003; O`Sullivan et al.,
*p 0.01; **p 0.001; ‘e’ lordotic curve.
Table 3
Change in spinal curvatures in sagittal plane in standing and sitting e females (n ¼ 136).
Sacral slope (L5/S1-horizontal line) 21.3 6.0 21.5 22.7 6.7 22.5** 9.4 8.4 10 8.3 8.2 9**
Lumbar lordosis (T12/L1eL5/S1) 34.5 8.7 34 31.9 10.1 31** 15.2 12.1 16 7.6 10.6 7.5**
Lower thoracic kyphosis (T6/T7eT12/L1) 9.3 7.8 10 2.0 10.6 2.5** 15.5 9.2 16 0.5 8.7 1**
Upper thoracic kyphosis (C7/T1eT6/T7) 33.4 7.9 33 30.0 11.2 31.5** 20.7 8.7 21 20.7 12.4 21.5
**p 0.001; ‘e’ lorodotic curve.

Table 4
Change in spinal curvatures in sagittal plane in standing and sitting e males (n ¼ 113).
Sacral slope (L5/S1-horizontal line) 17.1 6.1 17 20.2 7.3 19** 13.8 9.2 15 5.5 8.0 5**
Lumbar lordosis (T12/L1eL5/S1) 31.2 8.5 31 30.7 10.6 31 20.1 11.5 20 5.4 10.2 5**
Lower thoracic kyphosis (T6/T7eT12/L1) 9.8 7.6 10 3.4 7.7 3** 14.9 8.2 16 1.4 8.1 1**
Upper thoracic kyphosis (C7/T1eT6/T7) 33.1 7.0 32 30.4 8.4 31** 21.6 8.2 21 23.5 10.4 24**
**p 0.001; ‘e’ lorodotic curve.
2006; Claus et al., 2009b). However, according to Claus et al.
(2009a) the adoption of such a position might prove difficult and
therefore it calls into question whether it might be used in clinical
practice.
According to Claus et al. (2009a), four types of sitting postures
can be distinguished by the direction of curve at thoraco-lumbar
and lumbar angles: (1) slump (thoraco-lumbar and lumbar spine
in a kyphotic position), (2) flat (thoraco-lumbar and lumbar spine
in a vertical position), (3) long lordosis (thoraco-lumbar and lumbar
spine in a lordotic position) and (4) short lordosis (thoracic
kyphosis and lumbar lordosis). Short lordosis is suggested as ‘ideal’
since it helps achieve proper spinal curves in standing (Claus et al.,
2009a). This position divides the direction of spinal curvatures
between thoracic and lumbar spine. Caneiro et al. (2010) and
O`Sullivan et al. (2006), in turn, proposed three thoraco-lumbar
sitting postures: (1) slump sitting (posterior rotation of the pelvis,
thoraco-lumbar spine relaxed while looking straight ahead), (2)
lumbo-pelvic upright sitting (anterior rotation of the pelvis in order
to achieve a neutral lordosis of the lumbar spine and relaxation of
the thorax) and (3) thoracic upright sitting (anterior rotation of the
pelvis, thoraco-lumbar spine extended with shoulder blades
slightly retracted).
Taking into consideration the above mentioned descriptions it
can be assumed that two types of postures appeared in our study,
namely slump sitting adopted before and long lordosis adopted
after the ‘straighten your back’ command (Claus et al., 2009a) or
thoracic upright sitting (O`Sullivan et al., 2006; Caneiro et al., 2010).
The thoracic upright position is connected with an increased ac-tivity
of thoracic erector spinae at T4 level and iliocostalis long-issimus
pars thoracis. Therefore, it might lead to the higher risk of
greater stress to articular and ligamentous structures, greater
compression load on cervico-thoracic spine as well as potential
discomfort (Lander et al., 1987; O`Sullivan et al., 2006; Claus et al.,
2009a, 2009b; Caneiro et al., 2010).
Neutral position of the spine, in turn, increases trunk muscles
activity without activating large, torque-producing muscles
(O`Sullivan et al., 2006; Claus et al., 2009b; Reeve and Dilley, 2009;
O`Sullivan et al., 2010). Such a position also modifies the activity of
key cervico-thoracic muscles which might be of importance in
maintaining the correct sitting posture without the excessive
muscle activity (O`Sullivan et al., 2006; Falla et al., 2007; Claus et al.,
2009b; Caneiro et al., 2010).
What is also interesting is that physiotherapists most frequently
(54.9%) indicate that lordosed lumbar spine posture together with
relaxed thoracic spine is the best sitting position (O`Sullivan et al.,
2012). Our study found that the ‘straighten your back’ command
brings about the adoption of a different position. Subjects assumed
the posture in which lumbar and thoracic spine was extended.
Taking into consideration the results of this study, it seems that
the ‘straighten your back’ command should not be used to elicit the
most optimal posture. Children who are not provided with any
guidance on the appropriate active self-correction are not able to
adopt a neutral spine position when instructed with the command.
Moreover, the assumed posture is characterised by the reduction of
lower thoracic kyphosis which might mean moving further from
mid-range and towards end range of motion. It is also confirmed by
observations made by Claus et al. (2009a) and O`Sullivan et al.
(2010) who claim that the majority of people are not able to ac-quire
short lordosis curves without facilitation and feedback and if
the correction is made independently (without a therapist’s assis-tance)
it is performed by extending the thoracic spine. This is all the
more important that even slight changes of spinal curvatures in
sagittal plane and the subsequent deviations from the neutral po-sition
may lead to the change in muscles activity and consequently
to changes in spinal load (O`Sullivan et al., 2006; Claus et al., 2009b;
Reeve and Dilley, 2009).
4.5. Limitations
The current study evaluated habitual standing and sitting po-sitions
and an actively corrected posture adopted after ‘straighten
your back’ command. These positions might have been interpreted
differently by individual subjects. However, the aim of our study
was not to determine the standard magnitude of spinal curvatures
in the adopted postures but to evaluate the change in sagittal spinal
curves in subjects instructed with the command. Therefore, we
believe that it did not influence the obtained results.
It is also worth noting that the extent of the differences between
some values, despite being statistically significant, were small and
in some cases only slightly over the standard error of measurement
(SEM 2.8e3.8 standing posture; 1.7e2.5 sitting posture). Spe-cifically
those for sacral slope, lumbar lordosis and upper thoracic
kyphosis performed in standing and upper thoracic kyphosis
measured in a sitting position (whole group) (Table 2). Therefore,
these differences may not be clinically meaningful. Hence further
research is needed to investigate whether the reported significant
differences in those instances are merely the effect of the phe-nomenon
of statistics or a true picture of ongoing changes.
In the instance of other measurements, namely thoracic
kyphosis and its lower part in standing as well as sacral slope,
lumbar lordosis, global thoracic kyphosis and lower thoracic
kyphosis in sitting, the differences between individual measure-ments
were large and they considerably exceeded the magnitude of
measurement errors. In our opinion it gives reason to believe that
these differences may be clinically significant. Therefore, the
fundamental observation we made concerning the reduction of
thoracic kyphosis and flattening of its lower part which occur in
individuals instructed with ‘straighten your back’ command both in
standing and sitting positions is significant and may be applied in
clinical practice.
The present study was conducted in a group of asymptomatic
children aged 10e14 years. Therefore, caution is advised when
transferring the obtained results (especially the potential clinical
meaningfulness) to other populations, e.g. children with

musculoskeletal pain or fatigue. Thus it is essential to undertake
further studies to confirm the current study findings in pathological
populations as well as those of younger or older children/youth.
Our study did not concentrate on evaluating the change in the
position of the head or trunk and neck muscles activity in the
posture assumed after ‘straighten your back’ command. However,
taking into consideration the relationship between head/neck po-sition
and thoraco-lumbar posture it seems that a further study
should be undertaken to determine the influence of the change in
position of one area of musculoskeletal system on the position and
functioning of body parts further away. Especially as Caneiro et al.
(2010) claim that management isolated in one segment might
prove less effective. Further studies might also be supplemented
with observations of changes in other than sagittal planes.
The majority of studies concerning various sitting and standing
postures concentrate on adults (O`Sullivan et al., 2002; O`Sullivan
et al., 2006; Womersley and May, 2006; Claus et al., 2009a;
Caneiro et al., 2010; O`Sullivan et al., 2010). Therefore, we should
be cautions when comparing the results of this study with results
presented by other authors without previously comparing the
active self-correction between children and adults.
In spite of the limitations, we believe that the results of the
study may have relevance to the clinical approach. Especially as the
current study included a large, homogeneous group of children and
it is them who are frequently referred to various preventive and
therapeutic programmes (Geldhof et al., 2007).
5. Conclusions
The ‘straighten your back’ command brings about the extension
of the entire spine. This active self-correction appears in both
standing and sitting positions. The reduction of global kyphosis
together with the flattening of its lower part, which was the result
of the command, calls into question whether the command should
be used to improve the body posture in children who were not
provided with any guidance on the correct shape of sagittal spinal
curves.
After ‘straighten your back’ command in a standing position, a
lumbar lordosis significantly changed (decreased) only in females,
while upper thoracic kyphosis significantly changed (increased) in
sitting only in males. Therefore, further studies are needed to
determine whether the active self-correction is different in females
and males.
References
Andersson GBJ, Cocchiarella L, American Medical Association. Guides to the eval-uation
of permanent impairments. 5th ed. Chicago: American Medical Associ-ation;
2004. p. 373e432.
Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. BMJ 1997;314:572.
Bulinska K. Program profilaktyczny “Wyprostuj sie˛ ” [The prevention program
“Straighten your back”]. Phys Health Educ 2005;8/9:5e9 [article in Polish].
Caneiro JP, O’Sullivan P, Burnett A, Barach A, O’Neil D, Tveit O, et al. The influence of
different sitting postures on head/neck posture and muscle activity. Man Ther
2010;15(1):54e60.
Claus AP, Hides JA, Moseley GL, Hodges PW. Is “ideal” sitting real?: measurement of
spinal curves in four sitting postures. Man Ther 2009a;14(4):404e8.
Claus AP, Hides JA, Moseley GL, Hodges PW. Different ways to balance the spine:
subtle changes in sagittal spinal curves affect regional muscle activity. Spine
2009b;34(6):E208e14.
Czaprowski D, Paw1owska P, Ge˛bicka A, Sitarski D, Kotwicki T. Intra- and interob-server
repeatability of the assessment of anteroposterior curvatures of the
spine using Saunders digital inclinometer. Ortop Traumatol Rehabil 2012;14(2):
145e53.
Falla D, O’Leary S, Fagan A, Jull G. Recruitment of the deep cervical flexor muscles
during a postural-correction exercise performed in sitting. Man Ther
2007;12(2):139e43.
Geldhof E, Cardon G, De Bourdeaudhuij I, De Clercq D. Back posture education in
elementary schoolchildren: a 2-year follow-up study. Eur Spine J 2007;16(6):
841e50.
Jones GT, Macfarlane GJ. Epidemiology of low back pain in children and adolescents.
Arch Dis Child 2005;90(3):312e6.
Kendall FP, Kendall McCreary E, Provance PG, McIntyre Rodgers M, Romani WA.
Muscles: testing and function with posture and pain. 5th ed. Baltimore: Lip-pincott
Williams Wilkins; 2005. p. 49e117.
Kotwicki T. Sagittal and transversal plane deformity in thoracic scoliosis. Stud
Health Technol Inform 2002;91:251e6.
Lander C, Korbon GA, DeGood DE, Rowlingson JC. The Balans chair and its semi-kneeling
position: an ergonomic comparison with the conventional sitting
position. Spine 1987;12(3):269e72.
Lee L. Ch 7: restoring force closure/motor control of the thorax. In: Lee D, editor. The
thorax: an integrated approach. 2nd ed. Minneapolis: OPTP; 2003. p. 103e35.
Murphy S, Buckle P, Stubbs D. Classroom posture and self-reported back and neck
pain in schoolchildren. Appl Ergon 2004;35(2):113e20.
Muscolino JE. The muscle and bone palpation manual with trigger points, referral
patterns and stretching. St. Louis: Mosby Elsevier; 2008. p. 106e7.
O’Sullivan K, O’Dea P, Dankaerts W, O’Sullivan P, Clifford A, O’Sullivan L. Neutral
lumbar spine sitting position in pain-free subjects. Man Ther 2010;15(6):557e
61.
O’Sullivan K, O’Sullivan P, O’Sullivan L, Dankaerts W. What do physiotherapists
consider to be the best sitting spinal posture? Man Ther 2012;17(5):432e7.
O’Sullivan PB. “Clinical instability” of the lumbar spine: its pathological basis,
diagnosis and conservative management. In: Boyling JD, Jull GA, editors.
Grieve’s modern manual therapy: the vertebral column. 3rd ed. Edinburgh:
Churchill Livingstone; 2004. p. 311e31.
O’Sullivan PB. Lumbar segmental “instability”: clinical presentation and specific
stabilizing exercise management. Man Ther 2000;5(1):2e12.
O’Sullivan PB, DankaertsW, Burnett AF, Farrell GT, Jefford E, Naylor CS, et al. Effect of
different upright sitting postures on spinal-pelvic curvature and trunk muscle
activation in a pain-free population. Spine 2006;31(19):E707e12.
O’Sullivan PB, Grahamslaw KM, Kendell M, Lapenskie SC, Moller NE, Richards KV.
The effect of different standing and sitting postures on trunk muscle activity in
a pain-free population. Spine 2002;27(11):1238e44.
Reeve A, Dilley A. Effects of posture on the thickness of transversus abdominis in
pain-free subjects. Man Ther 2009;14(6):679e84.
Romano M, Negrini A, Parzini S, Negrini S. Scientific exercises approach to scoliosis
(SEAS): efficacy, efficiency and innovation. In: Grivas TB, editor. The conserva-tive
scoliosis treatment. Amsterdam: IOS Press; 2008. p. 191e207.
Saunders HD. Saunders digital inclinometer. User’s guide. Chaska, MN, USA: The
Saunders Group Inc.; 1998. p. 5e19.
Scannell JP, McGill SM. Lumbar posture: should it and can it be modified? A study of
passive tissue stiffness and lumbar position during activities of daily living. Phys
Ther 2003;83(10):907e17.
Weiss HR, Hollaender M, Klein R. ADL based scoliosis rehabilitation e the key to an
improvement of time efficiency? Stud Health Technol Inform 2006;123:594e8.
Williams MM, Hawley JA, McKenzie RA, Van Wijmen PM. A comparison of the ef-fects
of two sitting postures on back and referred pain. Spine 1991;16(10):
1185e91.
Womersley L, May S. Sitting posture of subjects with postural backache.
J Manipulative Physiol Ther 2006;29(3):213e8.
Zaina F, Negrini S, Atanasio S, Fusco C, Romano M, Negrini A. Specific exercises
performed in the period of brace weaning can avoid loss of correction in
adolescent idiopathic scoliosis (AIS) patients: winner of SOSORT’s 2008 award
for best clinical paper. Scoliosis 2009;4:8.

Active self correction of back posture

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Active self correction of back posture

Similar to Active self correction of back posture (20)

More from Meziat

More from Meziat (8)

Recently uploaded

Recently uploaded (20)

Active self correction of back posture