This study examined the active self-correction of spinal curvatures in 249 children (136 females, 113 males aged 10-14 years) in response to the command "straighten your back". Spinal angles were measured in standing and sitting positions both spontaneously and after the command. In standing, the command significantly increased sacral slope and decreased lumbar lordosis, thoracic kyphosis, and lower and upper thoracic kyphosis. In sitting, the command significantly changed sacral slope and lumbar lordosis from kyphotic to lordotic and significantly reduced thoracic kyphosis and flattened lower thoracic kyphosis. There were some gender differences in self-correction of lumbar lordosis and upper thoracic kyphosis
This document discusses cervical disc herniation, including epidemiology, symptoms, diagnostic imaging, conservative and surgical treatment options, and rehabilitation guidelines. It provides an overview of the structures involved in cervical disc herniation, risk factors, common symptoms of nerve root compression, and imaging tools used for diagnosis. Conservative treatments discussed include medications, modalities, cervical traction, posture correction, and muscle strengthening. Surgical options covered are anterior/posterior decompression and fusion or disc arthroplasty. Post-surgical rehabilitation guidelines are also outlined.
This document provides information on managing ataxia in multiple sclerosis (MS) through a multidisciplinary rehabilitation approach. It discusses the importance of managing ataxia to minimize social isolation and maximize quality of life. Assessment involves evaluating multiple body systems that can contribute to ataxia in MS. Interventions discussed include exercises to challenge balance, activities to improve coordination, strategies to compensate for impairments, and considerations for mobility aids, posture, eating, and cooling techniques. Evidence is presented supporting long-term rehabilitation to maximize potential and slow deterioration.
This document contains summaries of several research articles on various topics related to physiotherapy and physical therapy. The articles discuss the effects of home exercise programs for older adults, interval bicycling interventions for Parkinson's disease, exergaming and treadmill training for Parkinson's disease, predictors of walking speed after stroke, reliability of chest x-ray interpretation by physiotherapy students, effects of home rehabilitation on activities of daily living and gait for older adults with heart failure, a model for teaching ethical reflection in service learning, and several other topics related to physiotherapy treatments and interventions.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
Effects of Virtual Reality with Cerebral Palsy Childrenspastudent
This document summarizes a study that investigated the effects of virtual reality (VR) physiotherapy on balance in children with cerebral palsy. The study hypothesized that VR would have no additional effects beyond conventional physiotherapy in improving balance. The study involved 12 children who received either conventional therapy alone or conventional therapy plus VR games for 6 weeks. Results found no significant differences in balance improvements between the two groups, supporting the hypothesis that VR provided no additional benefits beyond conventional therapy alone for balance in children with cerebral palsy.
This document discusses cervical disc herniation, including epidemiology, symptoms, diagnostic imaging, conservative and surgical treatment options, and rehabilitation guidelines. It provides an overview of the structures involved in cervical disc herniation, risk factors, common symptoms of nerve root compression, and imaging tools used for diagnosis. Conservative treatments discussed include medications, modalities, cervical traction, posture correction, and muscle strengthening. Surgical options covered are anterior/posterior decompression and fusion or disc arthroplasty. Post-surgical rehabilitation guidelines are also outlined.
This document provides information on managing ataxia in multiple sclerosis (MS) through a multidisciplinary rehabilitation approach. It discusses the importance of managing ataxia to minimize social isolation and maximize quality of life. Assessment involves evaluating multiple body systems that can contribute to ataxia in MS. Interventions discussed include exercises to challenge balance, activities to improve coordination, strategies to compensate for impairments, and considerations for mobility aids, posture, eating, and cooling techniques. Evidence is presented supporting long-term rehabilitation to maximize potential and slow deterioration.
This document contains summaries of several research articles on various topics related to physiotherapy and physical therapy. The articles discuss the effects of home exercise programs for older adults, interval bicycling interventions for Parkinson's disease, exergaming and treadmill training for Parkinson's disease, predictors of walking speed after stroke, reliability of chest x-ray interpretation by physiotherapy students, effects of home rehabilitation on activities of daily living and gait for older adults with heart failure, a model for teaching ethical reflection in service learning, and several other topics related to physiotherapy treatments and interventions.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
Effects of Virtual Reality with Cerebral Palsy Childrenspastudent
This document summarizes a study that investigated the effects of virtual reality (VR) physiotherapy on balance in children with cerebral palsy. The study hypothesized that VR would have no additional effects beyond conventional physiotherapy in improving balance. The study involved 12 children who received either conventional therapy alone or conventional therapy plus VR games for 6 weeks. Results found no significant differences in balance improvements between the two groups, supporting the hypothesis that VR provided no additional benefits beyond conventional therapy alone for balance in children with cerebral palsy.
Effects of Wii versus traditional supervised exercise on the functional fitne...spastudent
Effects of Wii versus traditional supervised exercise on the functional fitness of moderately frail Chinese population- A Pilot Study
Nanyang Polytechnic
Physiotherapy
This study examined bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a 12-week exercise program. The participants were randomly assigned to an exercise group or control group. The exercise group performed 100 two-footed jumps with a rope and muscle strength exercises 3 times per week. BMD was measured at the start, after 3 months, and after 6 months using dual-energy x-ray absorptiometry. The results showed that BMD values in the total body increased significantly in the exercise group after the program, while BMD measurements remained stable in the control group and for all participants remained within the normal reference range compared to other children. Thus, a short-
Cerebellar ataxia is a common symptom in multiple sclerosis that can cause motor and cognitive signs. Cerebellar lesions and ataxia are associated with poorer prognosis. Symptoms vary depending on the location of lesions within the cerebellum and connections. While training programs have shown benefits for motor function in cerebellar degenerations, the effects of specific oculomotor training in MS are unclear. Recovery from cerebellar damage may occur through substitution within the cerebellum or recruitment of other brain areas through mechanisms like synaptic plasticity.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adol...CrimsonPublishersOPROJ
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study by Joanne Yip in Orthopedic Research Online Journal
This document describes a study that quantified the physical demands of 21 Hatha yoga postures commonly practiced by older adults. Twenty older adult participants completed a 32-week yoga intervention, where they learned introductory postures for the first 16 weeks and intermediate postures for the second 16 weeks. Biomechanical data including joint angles, joint moments of force, and muscle activation levels were collected while participants statically held each posture. The results provide physical demand profiles for each posture that illustrate the ranges of motion, efforts required to maintain the poses, and activated muscle groups. These profiles can help instructors design safe and effective yoga routines for seniors.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
A prospective comparative study of three treatmentHemant Pippal
This study compared the effectiveness of three treatment modalities for idiopathic adhesive capsulitis of the shoulder: 1) conservative treatment including physical therapy, 2) intra-articular steroid injections plus physical therapy, and 3) arthroscopic capsular release plus physical therapy. The study found that arthroscopic capsular release resulted in significantly better improvement in external shoulder rotation compared to conservative treatment alone. However, overall functional outcomes as measured by a shoulder rating questionnaire were similar across groups. The study concluded that conservative treatment remains an effective first-line option for adhesive capsulitis, though arthroscopic release may provide faster recovery of external rotation.
SEAS is an individualized exercise program adapted for conservative scoliosis treatment. It is based on a specific active self-correction technique performed without aids to primarily improve spinal stability in active self-correction. The SEAS exercises train neuromotor function to stimulate reflexive self-corrected posture during daily life activities.
The document provides an overview of common balance tests and measures used in physical therapy, including functional scales like the Four Square Step Test (FSST) and Timed Up & Go (TUG), as well as subjective scales like the Activities-specific Balance Confidence Scale (ABC) and Dizziness Handicap Inventory (DHI). It discusses what components of balance the different tests measure, such as control of dynamics, static stability, and sensory integration. Cut-off scores and psychometric properties like reliability and validity are provided for each measure. The summary emphasizes selecting the best test based on the patient and condition, and tailoring interventions to the specific balance impairments measured.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
The importance & facts about Physical Activity in Obesity Management on:
Weight loss &Weight loss maintenance
Physical activity & obesity prevention
Effects on general health risks
Mechanisms of Action
Recommendations for Physical Activity in Obesity
Physical Activity Recommendations in Patients
This document summarizes 10 research studies on gait and balance as assessed through plantar pressure and center of pressure measurements. Several key findings are: 1) Certain center of pressure measures can predict chronic ankle instability but with low accuracy; 2) Center of pressure velocity can classify elderly fallers versus non-fallers with high accuracy; 3) Gait velocity affects orthotic prescription, as rearfoot pronation differs between walking and running; 4) Rocker-bottom shoes increase postural sway in response to perturbations compared to normal shoes; 5) Specific plantar pressure patterns are associated with lower leg injuries in runners; 6) Center of pressure data can indicate rearfoot motion but not precisely; 7) Plantar pressure can be reliably
This document discusses lumbar degenerative spondylolisthesis. It begins by covering the phylogenetic evolution of the spine from quadruped to biped posture and how this impacted spinal loading and development. It then reviews recent literature on controversies regarding conservative versus surgical management. Specifically, it summarizes findings from the SPORT, SLIP, and SSSS trials comparing laminectomy alone to laminectomy with fusion. The document concludes by outlining the authors' surgical experience with posterolateral fusion for spondylolisthesis.
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
This study analyzed muscle activation in the abdomen and other areas of 7 commercial abdominal machines (Ab Slide, Ab Twister, Ab Rocker, Ab Roller, Ab Doer, Torso Track, SAM) and 2 common exercises (crunch, bent-knee sit-up) using electromyography. The results showed the Ab Slide and Torso Track activated abdominal muscles the most while minimizing back and hip muscle activation. Exercises like the Ab Doer, Ab Twister, and bent-knee sit-up activated back muscles more and may irritate existing back issues. Overall, different exercises activated various muscles to different degrees, providing information to help address individual rehabilitation or training needs.
The document discusses unlocking the 'black box' of posture and pain by examining the scientific evidence. It makes 5 key points:
1) There is no consensus on what constitutes "good" posture. Studies show physiotherapists disagree on the best spinal posture.
2) Keeping the lumbar spine neutral while lifting is impossible, as the spine will flex no matter the lifting technique.
3) Squat lifting does not prevent back pain, and stoop lifting is not necessarily dangerous. Flexed spinal postures may be more efficient for lifting.
4) Individual posture varies due to genetic, physical, lifestyle and other factors. One should not expect all postures to be the same.
Scapular positioning and motor control in children and adults a laboratory st...lichugojavier
1) The study compared clinical measures of scapular positioning and motor control between adults (n=46) and children (n=59).
2) It found that children had significantly greater scapular upward rotation but smaller forward shoulder posture than adults when controlling for height.
3) The study also found no significant differences between children and adults in visual observation of scapular tilting or winging, or on the Kinetic Medial Rotation Test, a measure of scapular motor control. The results provide reference values for interpreting clinical tests of the scapula in adults and children.
Effects of Wii versus traditional supervised exercise on the functional fitne...spastudent
Effects of Wii versus traditional supervised exercise on the functional fitness of moderately frail Chinese population- A Pilot Study
Nanyang Polytechnic
Physiotherapy
This study examined bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a 12-week exercise program. The participants were randomly assigned to an exercise group or control group. The exercise group performed 100 two-footed jumps with a rope and muscle strength exercises 3 times per week. BMD was measured at the start, after 3 months, and after 6 months using dual-energy x-ray absorptiometry. The results showed that BMD values in the total body increased significantly in the exercise group after the program, while BMD measurements remained stable in the control group and for all participants remained within the normal reference range compared to other children. Thus, a short-
Cerebellar ataxia is a common symptom in multiple sclerosis that can cause motor and cognitive signs. Cerebellar lesions and ataxia are associated with poorer prognosis. Symptoms vary depending on the location of lesions within the cerebellum and connections. While training programs have shown benefits for motor function in cerebellar degenerations, the effects of specific oculomotor training in MS are unclear. Recovery from cerebellar damage may occur through substitution within the cerebellum or recruitment of other brain areas through mechanisms like synaptic plasticity.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adol...CrimsonPublishersOPROJ
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study by Joanne Yip in Orthopedic Research Online Journal
This document describes a study that quantified the physical demands of 21 Hatha yoga postures commonly practiced by older adults. Twenty older adult participants completed a 32-week yoga intervention, where they learned introductory postures for the first 16 weeks and intermediate postures for the second 16 weeks. Biomechanical data including joint angles, joint moments of force, and muscle activation levels were collected while participants statically held each posture. The results provide physical demand profiles for each posture that illustrate the ranges of motion, efforts required to maintain the poses, and activated muscle groups. These profiles can help instructors design safe and effective yoga routines for seniors.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
A prospective comparative study of three treatmentHemant Pippal
This study compared the effectiveness of three treatment modalities for idiopathic adhesive capsulitis of the shoulder: 1) conservative treatment including physical therapy, 2) intra-articular steroid injections plus physical therapy, and 3) arthroscopic capsular release plus physical therapy. The study found that arthroscopic capsular release resulted in significantly better improvement in external shoulder rotation compared to conservative treatment alone. However, overall functional outcomes as measured by a shoulder rating questionnaire were similar across groups. The study concluded that conservative treatment remains an effective first-line option for adhesive capsulitis, though arthroscopic release may provide faster recovery of external rotation.
SEAS is an individualized exercise program adapted for conservative scoliosis treatment. It is based on a specific active self-correction technique performed without aids to primarily improve spinal stability in active self-correction. The SEAS exercises train neuromotor function to stimulate reflexive self-corrected posture during daily life activities.
The document provides an overview of common balance tests and measures used in physical therapy, including functional scales like the Four Square Step Test (FSST) and Timed Up & Go (TUG), as well as subjective scales like the Activities-specific Balance Confidence Scale (ABC) and Dizziness Handicap Inventory (DHI). It discusses what components of balance the different tests measure, such as control of dynamics, static stability, and sensory integration. Cut-off scores and psychometric properties like reliability and validity are provided for each measure. The summary emphasizes selecting the best test based on the patient and condition, and tailoring interventions to the specific balance impairments measured.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
The importance & facts about Physical Activity in Obesity Management on:
Weight loss &Weight loss maintenance
Physical activity & obesity prevention
Effects on general health risks
Mechanisms of Action
Recommendations for Physical Activity in Obesity
Physical Activity Recommendations in Patients
This document summarizes 10 research studies on gait and balance as assessed through plantar pressure and center of pressure measurements. Several key findings are: 1) Certain center of pressure measures can predict chronic ankle instability but with low accuracy; 2) Center of pressure velocity can classify elderly fallers versus non-fallers with high accuracy; 3) Gait velocity affects orthotic prescription, as rearfoot pronation differs between walking and running; 4) Rocker-bottom shoes increase postural sway in response to perturbations compared to normal shoes; 5) Specific plantar pressure patterns are associated with lower leg injuries in runners; 6) Center of pressure data can indicate rearfoot motion but not precisely; 7) Plantar pressure can be reliably
This document discusses lumbar degenerative spondylolisthesis. It begins by covering the phylogenetic evolution of the spine from quadruped to biped posture and how this impacted spinal loading and development. It then reviews recent literature on controversies regarding conservative versus surgical management. Specifically, it summarizes findings from the SPORT, SLIP, and SSSS trials comparing laminectomy alone to laminectomy with fusion. The document concludes by outlining the authors' surgical experience with posterolateral fusion for spondylolisthesis.
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
This study analyzed muscle activation in the abdomen and other areas of 7 commercial abdominal machines (Ab Slide, Ab Twister, Ab Rocker, Ab Roller, Ab Doer, Torso Track, SAM) and 2 common exercises (crunch, bent-knee sit-up) using electromyography. The results showed the Ab Slide and Torso Track activated abdominal muscles the most while minimizing back and hip muscle activation. Exercises like the Ab Doer, Ab Twister, and bent-knee sit-up activated back muscles more and may irritate existing back issues. Overall, different exercises activated various muscles to different degrees, providing information to help address individual rehabilitation or training needs.
The document discusses unlocking the 'black box' of posture and pain by examining the scientific evidence. It makes 5 key points:
1) There is no consensus on what constitutes "good" posture. Studies show physiotherapists disagree on the best spinal posture.
2) Keeping the lumbar spine neutral while lifting is impossible, as the spine will flex no matter the lifting technique.
3) Squat lifting does not prevent back pain, and stoop lifting is not necessarily dangerous. Flexed spinal postures may be more efficient for lifting.
4) Individual posture varies due to genetic, physical, lifestyle and other factors. One should not expect all postures to be the same.
Scapular positioning and motor control in children and adults a laboratory st...lichugojavier
1) The study compared clinical measures of scapular positioning and motor control between adults (n=46) and children (n=59).
2) It found that children had significantly greater scapular upward rotation but smaller forward shoulder posture than adults when controlling for height.
3) The study also found no significant differences between children and adults in visual observation of scapular tilting or winging, or on the Kinetic Medial Rotation Test, a measure of scapular motor control. The results provide reference values for interpreting clinical tests of the scapula in adults and children.
Evidence Based Medicine on the Physiotherapeutic Scoliosis Specific ExercisesSanja Schreiber
This presentation provides evidence on the effect of physiotherapeutic scoliosis specific exercises on scoliosis outcomes that is coming from methodologically stronger studies.
This study examined the effects of kinesio taping in addition to physical therapy on seated postural control in 30 children with spastic diplegic cerebral palsy between 10-16 months of age. The children were randomly assigned to a study group that received kinesio taping applied to paraspinal muscles in addition to physical therapy, or a control group that received only physical therapy. Both groups showed improvements in kyphotic angle, Cobb's angle, and GMFM seated scores after treatment, but the study group showed significantly greater improvements, suggesting kinesio taping is a beneficial addition to physical therapy for improving seated posture and trunk control in children with spastic diplegic cerebral palsy.
Respond to the 5 post below.100-200 wordsAPA FORMAT (NO TITLE PA.docxaudeleypearl
Respond to the 5 post below.100-200 words
APA FORMAT (NO TITLE PAGE NEEDED)
Due Sunday January 26, 2020
Adam J
1. After selecting and reading two of the provided articles, I was able to notice some differences and similarities between the two studies. As I read the article by Grenier and McGill (2007), the focus seemed to be on explaining the methods of improving lumbar stability and determining which of these two methods was more efficient at providing stability to this region. Through this study, Grenier and McGill found that when comparing abdominal hollowing and abdominal bracing, major differences could be found. In fact, through this study, we are able to see that the strategy of abdominal bracing provided a 32% improvement in the observed stability of the lumbar spine. Although Okubo, et al. (2010) were also concerned with lumbar stability, their study focused more on specific exercises that maximize specific abdominal muscle activation. The information presented by Okubo, et al. shows that different exercises are necessary if our goal is to improve the overall stability of our lumbar spine.
The information gleaned from the two articles described above are both important when working with a patient/client who has need of improving their spinal stability. After reading these two articles, I feel instructing a patient/client to incorporate an abdominal brace can help prevent injury from occurring during the prescribed exercise program. McGill (2016) also claims that his studies have shown an instant reduction in pain levels in many of his patients when abdominal bracing is used. When abdominal bracing is used in combination with the exercises described by Okubo, et al. (2010), I believe we can help patients/clients avoid injury during exercise, while also improving the overall stability of the spine by strengthening the muscles associated with lumbar stability.
Josh Y
2. I chose to review the articles by Ishida, Suehiro, Kurozumi, and Watanabe (2016) and Grenier and McGill (2007). Both studies made use of electromyography, which helped to quantify their data, rather than basing it on subjects’ perceptions of or description of what they felt during the study. The overarching purpose of both studies was to examine core stability and how different techniques contribute to core stability
Grenier and McGill (2007) examined abdominal hollowing and abdominal bracing. To test the two techniques, subjects were handed either a bilateral or asymmetrical weight in their hands. Electromyographic findings showed that the abdominal brace increased stability by 32%.
Ishida, Suehiro, Kurozumi, and Watanabe (2016) studied abdominal bracing and expiration in relation to sudden trunk loading. Subjects were loaded while at rest and while performing each of the stabilization techniques (expiration and bracing). The timing of when the loading would be applied was unknown to the subjects. There proved to be no difference between expiration and braci ...
Ergonomics in NAEYC Accredited Child Care CentersChristina Kirsch
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should be practiced more.
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Active self correction of back posture
1. 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
2. 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
3. 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.
4. D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398 395
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.
5. 396 D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398
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).
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) 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**
Thoracic kyphosis (C7/T1eT12/L1) 42.6 9.9 42 33.1 12.0 32** 36.6 11.4 37 22.8 11.6 21**
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.
6. D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398 397
Table 4
Change in spinal curvatures in sagittal plane in standing and sitting e males (n ¼ 113).
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) 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**
Thoracic kyphosis (C7/T1eT12/L1) 42.9 8.7 43 33.5 11.4 36** 36.5 10.1 36 24.3 11.8 24**
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
7. 398 D. Czaprowski et al. / Manual Therapy 19 (2014) 392e398
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.
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