Abstract
Design: Observational cross-sectional study. The current study aims to yield normative data: i.e., the physiological standard for 30 selected quantitative 3D parameters that accurately capture and describe a full-skeleton, upright-standing attitude. Specific and exclusive consideration was given to three distinct categories: postural, spine morphology and pelvic parameters. To capture such 3D parameters, the authors selected a non-ionising 3D opto-electronic stereo-photogrammetric approach. This required the identification and measurement of 27 body landmarks, each specifically tagged with a skin marker. As subjects for the measurement of these parameters, a cohort of 124 asymptomatic young adult volunteers was recruited. All parameters were identified and measured within this group. Postural and spine morphology data have been compared between genders. In this regard, only five statistically significant differences were found: pelvis width, pelvis torsion, the “lumbar” lordosis angle value, the lumbar curve length, and the T12-L5 anatomically-bound lumbar angle value. The “thoracic” kyphosis mean angle value was the same in both sexes and, even if, derived from skin markers placed on spinous processes it resulted in perfect agreement with the X-ray based literature. As regards lordosis, a direct comparison was more difficult because methods proposed in the literature differ as to the number and position of vertebrae under consideration, and their related angle values. However, when the L1 superior–L5 inferior end plate Cobb angle was considered, these results aligned strongly with the existing literature. Asymmetry was a standard postural-spinal feature for both sexes. Each subject presented some degree of leg length discrepancy (LLD) with μ = 9.37mm. This was associated with four factors: unbalanced posture and/or underfoot loads, spinal curvature in the frontal plane, and pelvis torsion. This led to the additional study of the effect of LLD equalisation influence on upright posture, relying on a sub-sample of 100 subjects (51 males, 49 females). As a result of the equalisation, about 82% of this sub-sample showed improvement in standing posture, mainly in the frontal plane; while in the sagittal plane less than 1/3 of the sub-sample showed evidence of change in spinal angles. A significant variation was found in relation to pelvis torsion: 46% of subjects showed improvement, 49% worsening. The method described in study presents several advantages: non-invasive aspect; relatively short time for a complete postural evaluation with many clinically useful 3D and 2D anatomical/biomechanical/clinical parameters; analysis of real neutral unconstrained upright standing posture.
Highlights
Spine and posture disorders are topics of great interest in biomechanical research and in a variety of clinical fields
In addition to statistical tests, we identified and described the distributions of “Thoracic” kyphosis and “Lumbar” lordosis angle values (Fig 5), curve lengths (Fig 6) and Upper and Lower limit vertebrae occurrence rate (Fig 7)
The results showed that about two thirds of Females present a “Lumbar” lordosis angle value higher than 40 ̊ (Fig 5) and more than 70% present a “Lumbar” lordosis length of between 6 and 8 vertebrae, with the peak frequency being 31.6% with lordosis length of 6 vertebrae (Fig 6)
Summary
Spine and posture disorders are topics of great interest in biomechanical research and in a variety of clinical fields. The major categories of ill-health/injury under consideration are those involving the spine [2] and back pain, degenerative neural disorders/stroke [3] and falls in the elderly [4] The latter in particular arises from the involvement of postural and trunk malfunction in the pathogenesis of a range of musculoskeletal disturbances [2,5]. It is important to establish the relationship between postural balance and anthropometric measurements for determining reference values in normal and pathological conditions [6] This framework has to be taken into account in designing and developing treatment programs in rehabilitation, planning of orthopaedic surgical procedures [5] and monitoring the progression of pathology and/or treatment outcomes [7,8]
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