Postural abnormalities in people with chronic obstructive pulmonary disease (COPD)

Abstract

Rationale: Pain is common in people with chronic obstructive pulmonary disease (COPD) and the cause of upper and lower back pain in COPD may be postural dysfunction, including increased thoracic (Tx) kyphosis and altered scapula position. However, the extent of postural deviation in COPD is unknown. This study aimed to compare the postural characteristics of people with COPD to those of control subjects and explore the relationship between posture deviations and reports of pain in COPD. Methods: Subjects with COPD and age, gender, BMI and comorbidity-matched controls underwent a postural assessment in an upright standing position. Photogrammetry using digital photographs and 3-D motion analysis were used to generate the coordinates of skeletal structures from anatomical landmarks identified with reflective markers. The postural measures were spinal orientation, Tx kyphosis and scapula orientation. Those with COPD completed questionnaires related to pain. Results: Twenty-one subjects with COPD (mean FEV1 45% pd) and 21 matched controls completed the study. In controls, the spinal alignment (linear position of C7 in relation to S1 (anterior-posterior)) was 23mm(95% CI 12 to 33mm), while in COPD, the alignment was 42mm(95% CI 29 to 54); 50% of those with COPD exceeded the 95% CI of the control group. Tx kyphosis (p=0.03) and scapula anterior tilt (p=0.001) were increased in COPD compared to controls (p=0.03), but were unrelated to back pain intensity. Conclusions: Postural deviations are evident in COPD compared to those without lung disease, but appear to have no relationship to pain. Further work is needed to identify the contributing factors to these postural deviations.