The comparison of the psoas muscle thickness and strength, and sagittal lumbopelvic alignment in female gymnasts with sway-back posture and normal posture

Introduction: Sway-Back Posture (SBP) is one of the most common poor postures especially among the female gymnastics athletes. It can result in multifidus muscles insufficiency and inability to support the spinal column. The aim of this study was to evaluate the intra-rater reliability of ultrasound imaging to measure the thickness of lumbar multifidus (LMM) muscle at different lumbar levels during both states of muscle at rest and contraction. Materials and Methods: The subjects of this study were 10 females’ gymnastics athletes among whom five had sway back posture. To have the posture assessed the plumb line and grid paper were used. The LMM thicknesses of all lumbar segments were measured thrice (with 1houre minutes interval) by the same examiner in both rest and contraction position simultaneous with arm lifts done by a real time Ultrasonography device. Results: The results of the relative and the absolute reliability of LMM thickness measurements at the state of rests were 0.97 < ICC < 0.99, 0.34 < SEM < 0.48 and 0.94 < MDC< 1.34 and at the state of contractions they were as: 0.95 < ICC < 0.98, 0.47< SEM < 0.71 and 1.31 < MDC< 1.98. The results of the Bland-Altman plotting indicated a good level of agreement between two measurements at all lumbar levels in both states of rest and contraction. Conclusion: The results of this study indicated that the method of ultrasonography had a high level of reliability and accuracy to measure the thickness of LMM in both states of muscle at rest and contraction. The method is highly recommended in physiotherapy and rehabilitation assessments. Key words: Gymnastic, Lumbar Multifidus Muscle, Reliability, Sway-Back Posture, Thickness, Ultrasound Imaging

Abdominal Muscle Endurance and its Association with Posture and Low Back Pain: An initial investigation in male and female élite gymnasts

BACKGROUND AND AIM: Sway-Back Posture (SBP) is the most common deviation or faulty posture of sagittal alignment, characterized by anterior translation of the pelvis and hip joints, beyond the center of gravity line, a flatted curve in the lumbar region and overextended hip and knee joints. It can cause a variety of symptoms and may be caused by several factors including poor posture, muscle imbalance, congenital conditions, and obesity and so on. The goal of the study is to ascertain the efficacy of spinal mobility exercises and bal asana in subjects with sway back posture. METHODS: Sixty subjects aged from 18 to 25 of both genders with deviation of at least the pelvis tipped forward for 10 degree or took part in the study that was conducted. The subjects were randomly segregated into two groups; Spinal mobility exercise group were given spinal mobility exercise whereas the control group were given Bal asana, the intervention period was of 8 weeks. The postural analysis of the subjects was evaluated pre and post-training using APECS (AI Posture Evaluation and Correction System). RESULT: Spinal mobilization along with lumbar spine mobility exercise was found to be effective compared to Bal asana in improving posture and performance of individuals with sway back posture. CONCLUSION: Spinal mobility group had better functional movement and muscular balance and seen to have reduced degree of anterior pelvic tilt compared to Bal Asana group. It is concluded that Spinal mobility group provides more functional movement and is seen as the effective treatment in sway back posture. Keyword: technology, spine, posture, lumbosacral region, good health and well-being.

Background: Sway back posture (SBP) is a common postural deviation of sagittal alignment and is the most common postural deviation in 18 to 28-year-old individuals, but there is no standard exercise protocol for treating SBP. Our objective was to assess the effectiveness of the global corrective exercise intervention (GCEI) on spinal posture of healthy individuals 18-25 years of age with SBP. Methods: This study was a randomized controlled design with a parallel group, two-arm trial with 1:1 allocation ratio. Seventy participants (mean age 20.9±2.1 years) with SBP (⩾ 10°) were enrolled in the study for 12 weeks. The participants were randomly assigned to an exercise (n=35) or control group (n=35). The targeted global spine strengthening and stretching exercise intervention included core and postural training, delivered by a corrective exercise specialist in 2 groups of 20 and 15 participants 3 times a week for 12 weeks. Forward head angle and sway angle were measured using a digitized side-view photograph. Kyphosis index and llordosis index were measured using a flex curve ruler. Results: The 12-week intervention program resulted in significant within group differences in forward head, kyphosis, lordosis and postural sway angle (p<0.001). There was also a significant between group difference in the changes of all postural variables (p<0.001). Conclusions: The GCEI resulted in improved sway back posture in our sample of 18-25-year-old participants. This study supports the theoretical basis for clinical rehabilitation of postural deviations. Further studies are required to generalize these findings to other age and population groups. Key words : posture, sway back, corrective exercise, spinal alignment

Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture. To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs). This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for 5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position. Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle. It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture.

Purpose: This paper proposes proper and effective neck exercises by comparing the deep and superficial cervical flexor muscle activities and thickness according to the pressure level during cranio-cervical flexion exercises between a normal posture group and forward head posture group. Methods: A total of 20 subjects (8 males and 12 females) without neck pain and disabilities were selected. The subjects’ craniovertebral angles were measured; they were divided into a normal posture and a forward head posture group. During cranio-cervical flexion exercises, the thickness of the deep cervical flexor neck muscle and the activity of the surface neck muscles were measured using ultrasound and EMG. Results: The results showed that the thickening of the deep cervical flexor was increased significantly to 28 and 30 mmHg in the forward head posture group. The sternocleidomastoid muscle activity increased significantly to 24, 26, 28, and 30 mmHg in the forward head posture group. The anterior scalene muscle activity increased significantly to 26, 28, and 30mmHg in the forward head posture group. A significant difference of 26, 28, and 30 mmHg in the sternocleidomastoid and anterior scalene muscles was observed between two groups. Conclusion: To prevent a forward head posture and maintain proper cervical curve alignment, the use of the superficial cervical flexor muscles must be minimized. In addition, to perform a cranio-cervical flexion exercises to effectively activate the deep cervical flexor muscles, 28 and 30 mmHg for normal posture adults and 28 mmHg for adults with forward head postures are recommended.

Maximal voluntary strength of the trunk muscles was measured in 57 male elite athletes (soccer players, wrestlers, tennis players, and gymnasts), 14 female elite gymnasts, and in a normal group of 87 conscripts. Mean ages in the different groups ranged from 18-22 yr. An isokinetic (constant velocity) technique was used to record maximal torque produced by trunk and hip muscles during flexion, extension, and lateral flexion over the range of motion. The constant angular velocities used were 15 deg.s-1 and 30 deg.s-1, respectively. Isometric strength was measured in a straight body position (0 deg. of flexion). The measurements were made with the subjects in a horizontal position with the pivot point at the hip and at the lumbar (L2-L3) level. All male athlete groups showed higher peak torque values than the normals. The differences were largest in hip extension and trunk flexion. The male gymnasts also showed significantly higher peak values in hip flexion as compared to all other categories. There was no difference in strength per kg body weight between female gymnasts and untrained males, except in trunk extension. The position for peak torque occurred earlier in the movements for the athletes, especially for the gymnasts in extension movements and for the tennis players in flexion movements. In isometric contractions essentially the same strength differences were present as in the slow isokinetic contractions. In lateral flexion wrestlers and tennis players showed significantly higher strength in movements toward the nondominant side. Thus, differences were present between the athletes and the normals, some of which appeared to be sport specific and related to long-term systematic training.(ABSTRACT TRUNCATED AT 250 WORDS)

BackgroundBesides low back pain (LBP), also neck pain (NP) and mid back pain (MBP) are common health issues in adolescence. Psychological factors are regarded as main risk factors for spinal pain in adolescence, but recent studies suggest that the importance of physical factors might be underestimated. The purpose of this study was to summarize the results of studies on physical risk factors for adolescent NP and MBP.MethodsCross-sectional and prospective English studies on NP and MBP in adolescents aged 10 to 18 were searched by a professional librarian in Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro and PsycINFO up to October 2016. Studies that were restricted to self-report via questionnaires were excluded.ResultsEight cross-sectional studies could be included in this review. Some aspects of sagittal alignment in sitting (increased lumbar lordosis) and standing (anteroposition of the head, sway-back posture) were associated with NP. Study comparability was impeded by inconsistent definitions of NP and MBP and a wide variety of outcome measures.ConclusionsThis systematic review indicates that prospective studies using a consistent definition of NP and MBP are needed. Such studies might further investigate sagittal alignment in sitting and standing as possible risk factors for NP and MBP in adolescence using a consistent terminology for the outcomes and longitudinal research designs.

The identification of factors related to performance that can be improved during training is of primary interest for athletes. However, little is known about this issue among artistic gymnasts. The current pilot study aims to assess the association between training factors and anthropometric, body composition, and muscle strength (MS) variables in adolescent female artistic gymnastics. A total of 22 young female artistic gymnasts taking part in a professional team, who had a median age of 12.21 years and a median body mass index (BMI) of 18.72 kg/m2, were categorized into a competitive-level (8.00–17.00 h [h]/week) group (n = 16) and a pre-team-level (&lt;4 h/week) one (n = 6). The training factors considered were (i) training hours per session, (ii) training hours per week, and (iii) training years. All the participants underwent complete anthropometric measurements, including body composition assessments by means of bioelectrical impedance vector analysis (BIVA), and an objective physical activity evaluation with a portable accelerometer SenseWear Armband (SWA). MS was assessed using a handgrip dynamometer. The correlation and partial correlation were evaluated to test the associations between variables. The competitive-level group had higher fat-free mass (FFM), body cell mass (BCM), and MS compared to the pre-team group. However, after adjusting for confounders, only the number of training hours per session was associated with MS (ρ = 0.445, p &lt; 0.05) and BCM (ρ = 0.475, p &lt; 0.05). In conclusion MS and BCM but not FFM are correlated with the number of training hours per session. Future studies are needed to test the effects of specific programs based on this training parameter on these variables, to determine whether they can impact athletic performance in young female artistic gymnasts.

The aim of this study was to investigate BMD in Danish female elite gymnasts and the relationships to maximal muscle strength, sex hormone concentrations, and menstrual status. Six artistic gymnasts, five rhythmic gymnasts, and six controls aged 15-20 yr served as subjects. BMD (g x cm(-2)) of lumbar spine, proximal femur, distal radius, and whole body were measured by dual-energy x-ray absorptiometry (DXA) scanning. Maximal muscle strength (Nm) was measured in isokinetic trunk extension, trunk flexion, and knee extension. Serum concentrations of estrogen and progesterone in follicular and luteal phases were evaluated. Three out of six artistic gymnasts had amenorrhea, and two artistic and one rhythmic gymnast experienced oligomenorrhea. BMD in artistic gymnasts was greater than controls (24-45%, P < 0.05) in all sites except whole body. BMD in rhythmic gymnasts was greater than controls (4-26%, P < 0.05) in all sites except distal radius. In gymnasts, BMD correlated to both maximal muscle strength (0.60 < r < 0.85, P < 0.05) and serum progesterone (0.65 < r < 0.75, P < 0.05). In spite of oligomenorrhea or amenorrhea, it is possible for female gymnasts to maintain a high BMD in both the axial (L2-L4) and appendicular skeleton. The correlations between BMD and maximal muscle strength and progesterone concentration in gymnasts may indicate that within the same athletic group, progesterone concentration has a permissive role in bone formation, thus affecting the positive impact of muscle strength.

Comparative study of sagittal spino-pelvic alignment in children and adolescents with developmental lumbosacral spondylolisthesis compared with asymptomatic subjects. To develop a global postural model of sagittal spino-pelvic alignment. The relationships between parameters of sagittal spino-pelvic alignment in developmental spondylolisthesis are still unclear. Radiographs of 120 control subjects and 131 subjects with developmental spondylolisthesis (91 low-grade, 40 high-grade) were reviewed. Subjects with high-grade spondylolisthesis were divided according to their sacro-pelvic alignment: balanced versus retroverted sacro-pelvis. Parameters of the sacro-pelvis (pelvic incidence, pelvic tilt, sacral slope), lumbosacral region (lumbosacral angle, slip percentage), lumbar spine (lumbar lordosis, lumbar tilt), thoracic spine (thoracic kyphosis, thoracic tilt), and global balance (spinal tilt, sagittal offset between C7 and femoral heads) were assessed. Parameters were compared between all groups and a correlation study was performed between all parameters. A postural model that includes the measured parameters was used to analyze the obtained correlations. Significant differences in all parameters are found between all groups, except for sagittal offset. The pattern and strength of correlations is similar between normal and low-grade subjects, showing interdependence between sacro-pelvic, lumbosacral, lumbar, and thoracic regions. The pattern of relationships was altered in high-grade spondylolisthesis, especially for subjects with a retroverted sacro-pelvis for which correlations between pelvic incidence and pelvic tilt, and between the sacro-pelvic unit and lumbar spine geometry are lost. Children and adolescents stand with a relatively constant global sagittal spino-pelvic alignment, regardless of the local lumbosacral deformity. A normal posture is maintained in low-grade spondylolisthesis and in high-grade spondylolisthesis with a balanced sacro-pelvis. Posture is abnormal in high-grade spondylolisthesis associated with a retroverted sacro-pelvis, suggesting that surgical reduction of the local lumbosacral deformity in these patients could be attempted to restore a normal posture.

Cohort study. To construct a sagittal standing alignment classification system in which the clinical significance of identified subgroups was considered with spinal pain measures. Numerous grading systems for the categorization of sagittal standing alignment have been devised. However, no common consensus exists about which typology should be adopted. Furthermore, the clinical significance of proposed classification schemes has rarely been assessed in terms of their relationship with spinal pain. Given the importance of the adolescent period for musculoskeletal development, research within a young adolescent population is required. The study population consisted of 639 prepeak height velocity boys (mean age, 12.6 yr [standard deviation, 0.54 yr]). Sagittal posture was quantified during habitual standing; data were used to develop a classification system according to 3 gross postural and 5 lumbopelvic characteristics. Prevalence rates of spinal pain measures (pain and seeking care) were compared between postural subgroups. Cluster analysis indicated 3 types of characteristic overall sagittal profiles: neutral global alignment (n = 266 [41.6%]), sway-back (n = 199 [31.1%]), and leaning-forward (n = 174 [27.2%]). Within each of these categories, postural subgroups could be established according to specific lumbopelvic features. Logistic regression revealed that prevalence (lifetime and month) of low back pain and neck pain was significantly higher in boys classified as having sway-back posture than in those classified as having neutral global alignment. Spinal pain measures did not differ between groups of the lumbopelvic subclassification. Meaningful classifications exist for sagittal plane posture in young adolescent boys, both on gross body segment and lumbopelvic level. In terms of clinical importance, that is, low back pain and neck pain prevalence, postural subgrouping strategies based on the orientation of gross body segments are suggested to be superior when compared with lumbopelvic grading.

Kyphosis, initially modest, progresses to the well recognized dowager's hump of the postmenopausal osteoporotic woman. Kyphosis is not only associated with relatively altered vertebral body shape (anterior wedging), but also with reduced bone density and fitness, as well as decreased muscle strength, and is associated with reduced survival. We found an unexpectedly high (35%) incidence of kyphosis in a healthy sample of well women 20 to 64 years of age. The correlation between normal postural index of kyphosis (I/K) and upright postural I/K was substantial (r = 0.799). Among the postmenopausal women, normal postural I/K was inversely correlated with age. Upright postural kyphosis was not related to age, nor was normal postural I/K in the premenopausal woman. There was no direct relationship demonstrated between current calcium consumption and I/K. Similarly, neither estrogen levels nor follicle-stimulating hormone levels were related to current posture. Women with satisfactory exercise habits had significantly lower I/K. Because the capacity to stand up straight was consistently higher than the normal postural score, yet closely correlated to it, there may be a role for postural kyphosis in changing the architecture of the vertebral column. As normal posture becomes kyphotic, an individual can no longer straighten the vertebral column. The surveyor's flexicurve, which we employed for this study, provided a simple and inexpensive method for assessing postural index. This measurement can be routinely included in the comprehensive health examination. Assessment of bone health in women should be made within the context of a fixed postural kyphosis.

Background/Objectives: Atrophy of the paraspinal and psoas major muscles is closely linked to sagittal malalignment in adult spinal deformity (ASD). However, most studies overlook the balance between these muscle groups. This study investigates the relationship between trunk muscle balance and sagittal alignment in ASD patients. Methods: A single-institution database was reviewed for patients with sagittal malalignment (PT > 20° and PI-LL > 10°). Standard sagittal parameters were measured based on standing X-rays. The cross-section area (CSA) of trunk posterior muscles (CSAP: erector spinae and multifidus) and anterior muscles (CSAA: psoas) at L4 were measured based on a T2-weighted MRI. Patients with prior lateral fusions were excluded. Muscle balance was evaluated by the CSA ratio of trunk posterior to anterior muscles (CSAP/A). The relationship between sagittal alignment parameters and CSAP, CSAA, as well as CSAP/A were analyzed using linear and quadratic regressions. Akaike information criteria (AIC) compared model fit. Subgroup analyses examined the relationship between sagittal alignment changes and different CSAP/A levels. Results: A total of 112 patients met inclusion and exclusion criteria. CSAP correlated linearly with SS (r2 = 0.057, p = 0.011), PT (r2 = 0.043, p = 0.028), and T4-L1PA mismatch (r2 = 0.044, p = 0.027). CSAA showed no significant linear or quadratic relationships with sagittal spinal alignment parameters. In contrast, CSAP/A was quadratically associated with LL (r2 = 0.056, p = 0.044), SS (r2 = 0.134, p < 0.001), PI (r2 = 0.096, p = 0.004), L1PA (r2 = 0.114, p = 0.001), and T4-L1PA mismatch (r2 = 0.094, p = 0.005). Quadratic models of CSAP/A consistently had higher r2 and lower AIC values compared to the linear models of CSAP for most sagittal alignment parameters, especially in SS, PI, L1PA, and T4-L1PA mismatch (AIC difference ≥4). Higher CSAP/A is correlated to larger PI (and consequently, larger LL, SS, and L1PA). Conclusions: Trunk posterior-anterior muscle balance (CSAP/A) demonstrates a stronger relationship with sagittal alignment than individual muscle metrics. Quantitative MRI-based definitions of sarcopenia may need to be adjusted for PI.

We aimed to examine the relationship between clinical diagnosis of tendinopathy, tendon structure, and muscle strength in 207 rhythmic, acrobatic and artistic elite female gymnasts over a period of 12 months (age 11.9 ± 1.8 years at baseline). Participants were assessed for patellar-tendon and Achilles-tendon structure, anthropometric parameters, and muscle strength, and were physically examined for clinical tendinopathy of the patella and the Achilles. At baseline, 26.6% and 31.4% of the gymnasts had clinical tendinopathy in the patellar or Achilles tendon, respectively. At follow-up, 37.2% and 38.6% remained healthy; 9.7% and 15.5% recovered; 36.2% and 30.0% developed clinical tendinopathy; and 16.9% and 15.9% remained with clinical tendinopathy, respectively. The healthy and recovered groups exhibited decreased prevalence of disorganised patellar tendon and Achilles tendon fibres from baseline to follow-up, while those who sustained or had developed tendinopathy showed increased prevalence (p < 0.05). A high prevalence of clinical tendinopathy was observed among adolescent female gymnasts, with a limited chance of recovery. At baseline, gymnasts without tendinopathy exhibited higher muscle strength and lower prevalence of disorganised tendon fibres than gymnasts with tendinopathy. At follow-up, recovered gymnasts exhibited higher muscle strength and lower prevalence of disorganised tendon fibres than those who had sustained or developed tendinopathy.