Flexicurve Ruler Research Articles

A comparison of spinal curvatures and posture between active kayakers and physically active non-kayakers

Background. Kayaking is a sport that places repetitive demands on the spinal column and upper body musculature to propel the body and kayak forward. There is significant potential for curvature changes attributed to sustained periods of the kayaking posture as well as the effect of ageing on spinal curvatures. Therefore, the study purposed to investigate the association between kayaking and spinal curvature anomalies (cervical lordosis, thoracic kyphosis, and lumbar lordosis) in males aged 40 to 60 years. Materials and methods. Fifty-two male participants were included in this study, with two groups — those participating in kayaking (K) and those that do not participate in kayaking (Non-kayaking, NK) — comprising 26 participants in each group, respectively. Full-body photographs were taken and analysed using PosturePro™. Spinal curvatures were measured using a Flexicurve ruler, and angles were calculated using BiomechFlex software. Results. There was no significant difference in mean spinal angles between the groups. T-Flex and T-Cobb angles showed trends toward differences between the groups, with the K group having larger values than the NK group. There were statistically significant positive correlations between activity years and T-angles (T-Flex: p = 0.015 and T-Cobb: p = 0.014) in the K group. Also, a moderate negative correlation between activity years and L-angles (L-Flex: p = 0.03 and L-Cobb: p = 0.02) was noted in the K group. Conclusion. Spinal alignment changes can be affected through exposure to specific postural states. Kayaking has a specific postural pattern, and although not all results were of significant value, an altered spinal curvature associated with kayaking was found.

The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review.

The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review.

Prevalence of Thoracic Hyperkyphosis Posture among Female Students of Allied Health Institutes and Its Association With Rounded Shoulders

Background: Thoracic hyper kyphosis and rounded shoulders are common postural abnormalities among young females, which can lead to musculoskeletal impairments and reduced quality of life. Prolonged sitting and poor posture are key contributing factors to these conditions.Objective: To determine the prevalence of thoracic hyper kyphosis among female students at allied health institutes and its association with rounded shoulders.Methods: A cross-sectional study was conducted on 334 female students aged 18 to 25 years from three allied health institutes in Faisalabad. Thoracic hyper kyphosis was measured using a flexi curve ruler from C7 to T12, and rounded shoulders were assessed with a Vernier caliper measuring the acromion-to-bed distance. Data were analyzed using SPSS version 27, including descriptive statistics and logistic regression to assess associations.Results: The prevalence of thoracic hyper kyphosis was 19.5%, and rounded shoulders were observed in 21.6% of participants. A significant association was found between thoracic hyper kyphosis and rounded shoulders (p = 0.005). Each additional hour of sitting increased the odds of hyper kyphosis by 43% (OR = 1.43, 95% CI: 1.12 - 1.82) and rounded shoulders by 51% (OR = 1.51, 95% CI: 1.18 - 1.93).Conclusion: The study identified a significant prevalence of thoracic hyper kyphosis and rounded shoulders among female students, linked to prolonged sitting. Preventive measures focusing on postural correction and reducing sitting time are recommended.

Effectiveness of Blackburn Exercise with Thoracic Extension Exercises Versus Thoracic Extension Exercise on Postural Hyper Kyphosis and Scapula Position in Young Asymptomatic Individuals - A Comparative Study

BACKGROUND: The spine is composed of two types of curvature: kyphosis and lordosis. Postural hyper kyphosis is the most common posture abnormality and can happen at any age. Causes are idiopathic, sedentary lifestyle, impairments, and aging. Abnormal posture has a detrimental effect on articular and muscular structures as it leads to muscular weakness and degenerative changes. It affects the muscular tension around the neck and shoulder; as it shifts the neck forward (muscle tightness) and the shoulder moves more internally, leading the upper back scapular muscle lengthening. This study uses a flexi-curve ruler to measure postural hyper kyphosis and lateral scapula slide test(LSST) to measure scapula distance. The Blackburn protocol is often used for shoulder and scapular impairments; in this study, the protocol is used to manage postural hyper kyphosis as it targets the same muscle groups that are in an altered state. OBJECTIVE: To compare the effect of Blackburn exercise along with thoracic extension exercise versus thoracic extension exercise on postural hyper kyphosis and scapula position in young asymptomatic individuals. METHODS: A comparative study included 70 samples, age between 18 and 28, divided into 2 groups. The degree of kyphosis was measured using a flexi curve ruler (fcr), and scapula distance was measured using a lateral scapula slide test (lsst) at three positions. Intervention was given for six weeks. RESULTS: After 6 weeks of data analysis, Group A's p-value for kyphosis angle is 0.5 and lateral scapula slide test at 0 degree is 0.735, at 45 degree is 0.1992, and at 90 degree is 0.536, showing significant improvement over another group. Conclusion: Blackburn exercises, along with thoracic extension exercises, were found to be effective in reducing the angle of kyphosis in the young population. Keywords: Hyper kyphosis, Flexi curve Ruler, LSST, Blackburn protocol.

A comparative study to assess thoracic kyphotic index in adults with and without mechanical neck pain.

To assess thoracic kyphotic index in adults, and to find out the correlation between Neck Disability Index and Thoracic Kyphotic Index. The analytical cross-sectional study was conducted from October 2020 to January 2021 at the Shifa Tameer-e-Millat University, Islamabad, Pakistan, and comprised adults aged 18-35 years. Those with neck pain formed group A, while those without neck pain formed group B. The Numeric Pain Rating Scale and the Neck Disability Index were used to measure mechanical neck pain, while the Thoracic Kyphotic Index value was measured using a flexicurve ruler. Data was analyzed using SPSS 24. Of the 74 subjects, 37(50%) were in each of the two groups. There were 19 (51.40%) females and 18(48.60%) males in group A, while in group B there were 18(48.60%) females and 19(51.40%) males. The overall mean age of the sample was 23.35±3.31 years. Group A showed higher Thoracic Kyphotic Index value than group B (p=0.0001). The Neck Disability Index showed negative weak (r=-0.18, p=0.28) correlation with Thoracic Kyphotic Index in group B and moderate positive correlation (r=0.33, p=0.04) in group A. Higher Thoracic Kyphotic Index value was found among adults with mechanical neck pain compared to healthy adults.

Methods of Postural Assessment used in Hyperkyphotic Elders: A Narrative Review

Background and objective: Aging is a natural process and associated changes in posture, mainly at the spine lead to complications in functional independence and quality of life. The aim of this review is to identify existing measuring tools used to measure hyperkyphotic posture in the elderly population. Methods: Electronic databases were searched from January 2001 to December 2021, with different combinations of keywords, “thoracic kyphosis” or “hyperkyphosis” or “kyphotic posture” or hyperkyphotic posture” or “flexed posture” or “spinal curve” and “assessment”, “measurement” or “instrument” or “equipment” and “elderly” or “older adults” or “elders”. Studies were selected based on inclusion and exclusion criteria. Results: Four thousand one hundred sixty-six studies were obtained from electronic databases. After the removal of 3227 duplicate studies, twenty-six relevant studies were selected from 939 unique studies. Radiographic measurement, Flexicurve ruler, Debrunner kyphometer, Gravity-dependent inclinometer, occiput to wall distance (OTW), tragus to wall distance (TWD), and spinal mouse were used for hyperkyphotic measurement. The radiographic method and Flexicurve showed very high reliability. The block method and flexicurve are widely used methods for assessing hyperkyphotic posture in older adults. Conclusion: Postural assessment methods showed variability in defining criteria for hyperkyphosis in the elderly population. Flexicurve and block methods can be used as non-invasive methods for the early detection of hyperkyphosis. In the future, more measurement tools should be developed for the measurement of kyphosis, that are cost-effective, with excellent reliability and validity.

EFFECTS OF ELDOA TECHNIQUE VERSUS MCKENZIE EXTENSION EXERCISES ON NON-SPECIFIC LOW BACK PAIN PATIENTS.: A RANDOMIZED CLINICAL TRIAL

Background: Low back pain may lead cause disability in the patients. There are several physical therapy protocols used to manage the low back pain including McKenzie exercises. The Elongation Longitudinaux Avec Decoaption Osteo Articulaire (ELDOVA) is novel techniques could help to reduce the pain and disability related to lower back problems. Objective: to determine the effects and compare the McKenzie extension exercise and ELDOA stretch in non-specific low back pain patients. Methodology: A randomized clinical trial was conducted at Railway General Hospital, Rawalpindi and Irada Rehabilitation Center, Buchal Kalan from October 2021 - December 2021. The female participants with the age range of 40-69 years and had chronic non-specific low back pain for more than 3 months were included in the study. The participants were randomly divided into group A which received McKenzie extension exercises while group B received ELDOA stretch. The patient’s outcome measures were assessed through Numeric Pain Rating Scale (NPRS), inclinometer for, flexi curve ruler for lordships angle, and Oswestry Disability Index (ODI) for disability. MANCOVA test was used for controlling the covariates at baseline. Friedman with post hoc Wilcoxon test (non-parametric-within group analysis) for ODI variables RMANOVA was applied to observe pairwise changes with-in the groups for ODI total score, lordosis angle at baseline, and end of second, and fourth week of the treatment. NPRS and range of motion (extension, flexion) at pre and post treatment session. Results: The mean age of study participant was 44.29±3.08. Within group analysis showed that significant improvement (p<0.05) was observed in both groups regarding ODI total score, NPRS, Lordosis angle and range of motion (flexion, extension) from baseline to the end of 4th week and at each level of assessment. The group A (McKenzie extension exercises) was a significantly improved on the combined dependent variables as compared to group B (ELDOA stretch) after controlling for baseline values of BMI, NPRS, lordosis angle and ROMs, F (7, 34) = 55.12, p<0.001, Wilks' Λ=0.018, ηp2=0.49.Conclusion: McKenzie extension exercise showed better result in improving pain, range of motion, angle of lordosis and disability than ELDOA technique. Keywords: disability, low back pain, physical therapy, stretching exercises. ROM

Assessment of Thoracic Kyphosis Using Flexicurve Ruler after Open Heart Surgery: A Cross-Sectional Study

In literature, the development of spinal deformities was reported after surgical intervention for congenital heart disease using thoracotomy and sternotomy incisions in children; however, there are not enough data regarding the incidence of spinal kyphosis after open-heart surgery in adults. This study aimed to determine the impact of open-heart surgery using median sternotomy incision on the sagittal plane thoracic spine curve and pulmonary functions after open-heart surgery. A cross- sectional study was conducted on 100 participants (53 ± 9.43 years), who underwent open heart surgery using median sternotomy. The spinal kyphotic curve was evaluated using a Flexicurve ruler and spirometry parameters [forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC)] were evaluated before and one week after open-heart surgery. The comparison between the preoperative and postoperative measurements of the variables under study was performed using the paired t-test. Statistical significance was set at (P ˂ 0.05). The results revealed a significant increase in the dorsal kyphotic curve (9.75 ± 2.32) and a significant decrease in all spirometry parameters under study [(FVC: 2.12 ± .77); (FEV1:1.55 ± .64) and (FEV1/FVC: 0.72 ± .13)] with an alpha level of (P < 0.05). There is a high incidence of exaggerating the sagittal plane thoracic spine curvature (thoracic kyphosis), and reduction in the pulmonary functions after open-heart surgery using median sternotomy incision.

Prevalence of Lumbar Hyperlordosis in Dance Department Students, Faculty of Performing Arts, Indonesian Art Institutes Denpasar Bali Batch of 2018-2020.

Background: The spinal curvature of an adult varies in normal range. Abnormal curvature of the spine is known as scoliosis, kyphosis, and lordosis. There areseveral factors that can cause spinal abnormalities, one of which is the continuous application of abnormal posture. Body posture during traditional Balinese dance is considered abnormal because it applies positions such as excessive curving of the spine and puffing out the chest towards the front so that the dancer's body curve is seen more clearly. Poor posture that is used continuously can affect the curvature of the spine.
 Objective: The study was to identify the prevalence of lumbar hyperlordosis in Dance Department Students, Faculty of Performing Arts, Indonesian Arts Institute Denpasar Bali Batch of 2018-2020.
 Method: This study is a descriptive quantitative study with a cross-sectional design. The research sample was 44 students of the Department of Dance. Allsamples were given a self-data questionnaire then the spinal curvature was measured with a flexicurve. Analysis of the data collected in univariate andbivariate analysis, processed using SPSS Version 26 using cross tabulation.
 Result: The prevalence of students experiencing lumbar hyperlordosis was found more than normal lumbar lordosis, namely 35 people (79.5%) with hyperlordosis and 9 people (20.5%) with normal lumbar lordosis.
 Conclusion: The prevalence of lumbar hyperlordosis was higher than normal lumbar lordosis in female students with Balinese dance activities.
 Keywords : Balinese dancer, lumbar lordosis, flexicurve ruler

Association of Foot Posture with Lumbar Lordosis Angle in Teachers

Context: Anatomical alteration in the alignment of the foot leads to changes in proximal joints that in turn cause mechanical variations in the spine. Changes in the lower kinematic chain can have functional consequences in the form of low back pain and may be seen in professions requiring long-standing. This is often an unexplored, under-evaluated component of low back pain and hence proves its need. Aim: To study the relationship between ankle-foot complex and lumbar spine, and also to determine the association between Foot Posture and Lumbar Lordosis angle in teachers. Settings and Design: Data for the observational study were collected from school and college teachers of Belagavi city. Materials and Methods: Foot posture of 200 teachers in the age group of 20–50 years was assessed using Chippaux Index and Foot Posture Index-6 (FPI-6). Lumbar curvature was measured using Flexi curve ruler and angle was calculated. Functional limitation was assessed using Low Back Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire. Statistical Analysis Used: Spearman's rank correlation and t-test were used for analysis. Results: Statistically significant association was noted between FPI-6, lumbar angle, Low back pain scores, and Modified Oswestry score with P = 0.0001. Gender comparison of the outcome measures did not reveal any significant relationship. Conclusion: Alteration in foot posture leads to changes in lumbar lordosis angle, which in turn may cause low back pain.

Effect of different Pilates workout endings on the kyphotic and lumbar lordotic angles

Abstract Introduction: There are no studies that investigate whether different workout endings of the Pilates method (PM), either prioritizing the activation of powerhouse muscles or the relaxation of muscles trained during the session, affects spinal curvature. Objective: Identify the immediate effect of a PM session that ends with soft tissue mobilization or wall exercises on the kyphotic and lumbar lordotic angles. Methods: A crossover clinical trial with 19 female Pilates practitioners that used a Flexicurve ruler to evaluate thoracic and lumbar spine curvature before and after a PM exercise protocol, and after endings that involved soft tissue mobilization using massage balls or wall exercises. The order of the different endings was chosen by random draw and the study volunteers participated in two interventions, with intervals of seven to ten days between them. Two two-way ANOVAs were performed (one for each postural variable), using the factors “assessment time” (pre-session; post-PE; post-ending) and “type of ending” (soft tissue or wall exercises). Results: There was no significant difference between the assessment times or endings for the kyphotic (p = 0.972; p = 0.747) and lumbar lordotic angles (p = 0.574; p = 0.627), respectively. Conclusion: Pilates instructors can opt for more relaxing or more active endings without affecting the kyphotic and lumbar lordotic angles.

The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses

Simple SummaryAltered spinal posture in a horse often relates to an underlying musculoskeletal condition that results in a negative effect on performance and welfare. Equine physiotherapy aims to adapt a horse’s posture by prescribing strengthening exercises to improve spinal range of movement and facilitate contraction of specific muscles. The aim of this study was to test the reliability of an outcome measure to objectively measure thoracolumbar posture before and after physiotherapy exercises over a specific time-period. The adapted flexicurve ruler (aFCR) had excellent intra-rater reliability compared to a standard flexicurve ruler. There were significant increases in thoracolumbar flexion after physiotherapy intervention at the specific time periods, of thirty minutes and one hour, however no significant changes at twenty-four hours. The physiotherapy intervention tested was shown to produce a short-term postural change, and over time may allow a long-term postural change with frequent practice. Outcome measures are valuable within veterinary physiotherapy to support clinical reasoning and the aFCR is shown to measure thoracolumbar posture pre and post-physiotherapy. Creating a postural change in horses can aid in a rehabilitation programme with veterinary physiotherapy, aiming to relieve pain and stiffness. Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.

Effects of a Virtual Reality Dance Training Program on Kyphosis Angle and Respiratory Parameters in Young Women With Postural Hyperkyphosis: A Randomized Controlled Clinical Trial.

Thoracic hyperkyphosis, one of the most common spinal deformities, may lead to undesirable pulmonary outcomes. To study, the efficacy of virtual reality exercise training on thoracic hyperkyphosis and respiratory parameters in young women. Randomized clinical trial. Laboratory setting. Participants were randomly assigned to one of two 4-week exercise training groups: regular training (RT), which involved stretch and strength training, or virtual reality with RT (VRRT), which involved dance training with the Xbox 360 Kinect® game in addition to the exercises, which the RT group received. The authors measured kyphosis angle with a Flexicurve ruler and recorded respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in 1s [FEV1]) with a spirometer in each participant at baseline and postintervention. Separate 2 × 2 repeated-measure analysis of variances were used to analyze differences between means for kyphosis angle, FEV1, and FVC. Based on the significant interactions between time and group, the paired t test was used to compare the results at baseline and postintervention, and the independent sample t test was used to compare the differences in changes between groups. Level of significance was considered at P < .05 except for paired t test that was adjusted to P < .025 for each variable in 2 groups. The results showed statistically significant interactions between time and group for kyphosis angle, FEV1, and FVC. Postintervention thoracic kyphosis angle decreased and FVC increased significantly in both groups and FEV1 improved significantly in virtual reality with RT group. The improvements in thoracic kyphosis, FVC, and FEV1 in the virtual reality with RT group were significantly greater (P < .001) than in the RT group. Dance training with the Xbox 360 Kinect game was an effective therapy in improving thoracic kyphosis angle, FVC, and FEV1 in young women with thoracic hyperkyphosis.

Effect of Upper Body Strength Training in Spatiotemporal Parameters of Gait In Individual with Thoracic Kyphosis

Background: The human spine is an integral part of the human body. Its function includes mobilizing the torso, controlling postural stability, transferring, loads from upper body to lower body, all of which is essential for the activity of daily living. Spine deformity affects spinal mobility and trunk balance, thus altering locomotion pattern during each step. Spinal deformity also alters the center of body mass (com) during gait which leads to gait abnormality. Exaggerated thoracic kyphosis is common in the elderly as there is age related increase in thoracic spine curvature. Generally, patients with thoracic kyphosis mostly have gait impairment with reduced movement in upper limb strength and muscle mass gets altered in upper limb. Objective: The objective of the study is to study the effect of upper body strength training on spatiotemporal parameters of gait in individuals with thoracic kyphosis and to find out the effect of upper body strength program on gait parameters after thoracic kyphosis. Material and Method: In this interventional study a total of 25 individuals with in the age group of 20 to 50 years, were selected. Pre-test and post-test assessment was done using the outcome measures of flexi curve ruler to assess kyphosis index and spatiotemporal measurement. Exercises were administered for 6 weeks. Later, post-test assessment and statistical analysis was done to determine its significance. Results: According to the result, there was a considerable change in the stride length(p-value&lt;0.0001) step length(p-value&lt;0.0001) and cadence (p-value&lt;0.0001). There was also a marked change in the kyphosis index. (p-value&lt;0.0001). Conclusion: As per the result of this study, we conclude that the effect of upper body strength training on spatiotemporal parameters of gait in individuals with thoracic kyphosis was extremely significant.

Non-invasive Measurement of Thoracic Kyphosis and Lumber lordosis among Agricultural workers and Corporate Professionals( IT) using Flexicurve Ruler

Background: This study was undertaken to introduce a non- invasive technique for clinical diagnosis of spinal cord deformities. The purpose of the present study is to evaluate the postural deformities and onset of thoracic Kyphosis and lumber Lordosis among agricultural workers and Information Technology workers.&#x0D; Methodology: This cross-sectional study was carried out on thirty Agricultural workers (41-45 years) and twenty-five Information Technology workers (21-25 years) and their age matched control groups. The subjects were taken from their respective population by simple random sampling method. Measurements were made by Flexicurve Ruler in special standing posture. Kyphosis and Lordosis angles and Indices were calculated.&#x0D; Results: It indicates that maximum percentage of subjects had kyphotic angle between 400 -600. Twenty-three out of 30 agricultural workers (76.66%) and 22 out of 25(88%) information technology workers had kyphosis angle between 400- 600 but the same in case of control groups were 60% and 64% respectively. Maximum subjects had lordotic angle between 300 - 500. Thirteen out of 30 agricultural workers (43.33%) and 17 out of 25 information technology workers (68%) had lordotic angle in between 300 -500.The same in case of control groups were 43.33% and 56% respectively. Kyphosis index, Kyphosis angle and lordosis index, lordosis angle are significantly lower (p&lt;0.05) in agriculture workers in comparison to its control group but the differences are not significant in case of information technology workers as well as between agriculture group and information technology group. But information technology workers show higher values of Kyphosis and lordotic index than agriculture workers, probably due to prolong sitting posture at work. Again 47% agricultural workers and 11% IT workers reported lumbar pain when compared to control groups (10% and none respectively).&#x0D; Conclusion: Although no significant deviation of kyphotic and lordotic angle has been observed in agricultural and information technology workers but significantly higher percentage of these 2 groups reported shoulder and lumbar pain indicating risk of dysfunction in shoulder, pelvic girdle and spine. Thus measurement of thoracic kyphosis and lumbar lordosis may be useful in examining the degree of spinal cord deformities. By utilizing these information therapeutic and ergonomic intervention can be applied and application of modern sophisticated machine for improvement in postural condition can reduce their work stress and disabilities.

Thoracic Kyphosis Angle in Relation to Low Back Pain among Dentists in Iran.

BACKGROUND:Non-specific low back pain (LBP) has a direct impact on the quality of life, active days at work and health care costs.AIM:This study was conducted to determine the relationship between LBP and thoracic kyphosis angle among dentists.MATERIAL AND METHODS:This cross-sectional and descriptive-analytical study carried out in the form of census among 84 dentists employed in a specialised clinic in Iran. Dentists LBP prevalence and intensity and thoracic kyphosis angle were evaluated respectively with the self-administered body map questionnaire, visual analogue scale and flexicurve ruler. Statistical data analysis was done using SPSS software, version 22.RESULTS:The data showed that the prevalence of LBP in dentists was 44.9% and intensity of LBP was reported about 71.9 ± 19.34. Pearson correlation coefficient between thoracic kyphosis angle and dentist’s characteristics was not significant except for work experience. The single linear regression model showed that 1.3% of thoracic kyphosis angle changes was positively dependent on LBP. Also, the present study proved that thoracic kyphosis angle changes were positively dependent to 2.6%, 10.8% and 5.7 percent of age, work experience and Body Mass Index (BMI), respectively.CONCLUSION:Despite the lack of significant statistical relation between LBP and thoracic kyphosis angle, there is a high prevalence and intensity of LBP among Dentists. To reduce the risk of work-related LBP among dentists, managing factors such as BMI, work postures and exercises during work should be taken into consideration.

Relationship between trunk extensor muscle's endurance and static postural stability in hyperkyphotic and normal kyphotic women with osteoporosis

Background: Considering the Importance of Back Extensor Muscles on the Postural Control and Risk of Falling in Osteoporotic Postmenopausal Women, We Investigated the Effects of Back Extensor Endurance on the Thoracic Kyphosis and Static Balance Control in Hyper and Normal Kyphotic Women with osteoporosis. Methods: a total of 22 Osteoporotic Women, based on the Kyphosis Degree, were evaluated in two groups: Hyperkyphotics (No=10) and Normal Kyphotics (No=12). The Kyphosis Degree Measured by Flexi curve ruler. The Isometric Strength of the Back Extensors measured by a Digital Hand-held Dynamometer. Modified Sorensen Test was used for Back Extensor Endurance Evaluation. Static Balance Parameters Evaluated in Double Stand Position by Force plate. Results: In the Hyperkyphotic Group, the time duration of Modified Sorensen Test was Significantly Lower than that in the Normal Kyphotic Group (P=0.029), there was also a significant negative correlation to the Medio-Lateral Displacement of the center of pressure (Correlation Coefficient: - 0/521, P = 0.047). The Multiple Regression test showed a significant effect of the modified Sorensen's time Duration on the increase of thoracic kyphosis (P = 0.044). In Hyperkyphotic Group, Standard deviation of the Anterior-Posterior of the Center of Pressure displacement was significantly higher than that in the normal kyphotic Group (P = 0.05). Conclusion: Regarding to the negative correlation between the Trunk Extensor Endurance and Thoracic Hyperkyphosis and also medio-lateral of COP displacement, it suggests the Trunk Extensor Endurance exercise be considered in therapeutic programs of osteoporotic women.

Kyphosis and incident falls among community-dwelling older adults.

To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Community-dwelling adults aged 65 and older (n=72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1year, with falls outcomes confirmed through telephone interview. Mean age was 77.8 (±7.1) among the 52 women and 20 men. Over 12months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons.

BackgroundThe causes of age-related hyperkyphosis (HK) include osteoporosis, but only 1/3 of those most severely affected have vertebral fractures, suggesting that there are other important, and potentially modifiable causes. We hypothesized that muscle mass and quality may be important determinants of kyphosis in older persons.MethodsWe recruited 72 persons >65 years to participate in a prospective study designed to evaluate kyphosis and fall risk. At the baseline visit, participants had their body composition measures completed using Dual Energy X-ray Absorptiometry (DXA). They had kyphosis measured in either the standing [S] or lying [L] position: 1) Cobb angle from DXA [L]; 2) Debrunner kyphometer [S]; 3) architect’s flexicurve ruler [S]; and 4) blocks method [L]. Multivariable linear/logistic regression analyses were done to assess the association between each body composition and 4 kyphosis measures.ResultsWomen (n = 52) were an average age of 76.8 (SD 6.7) and men 80.5 (SD 7.8) years. They reported overall good/excellent health (93%), the average body mass index was 25.3 (SD 4.6) and 35% reported a fall in the past year. Using published cut-offs, about 20–30% were determined to have HK. For the standing assessments of kyphosis only, after adjusting for age, sex, weight and hip BMD, persons with lower TLM were more likely to be hyperkyphotic.ConclusionsLower TLM is associated with HK in older persons. The results were stronger when standing measures of kyphosis were used, suggesting that the effects of muscle on thoracic kyphosis are best appreciated under spinal loading conditions.

The association between spinal curvature and balance in elderly women at high risk of osteoporotic fractures in primary health care

The main aim was to study the relationship between spinal curvature and balance in elderly women at high risk of osteoporotic fractures. Ninety-four women were included in this cross-sectional study. Static timed standing and dynamic balance tests were performed; spinal curvature was measured by using the Flexicurve ruler; and radiological data on vertebral fractures were gathered. The women in the hyperkyphosis subgroup had a 5.6 s longer tandem standing time eyes open (p < 0.05), tandem gait forwards (p < 0.05) and tandem gait backwards (p < 0.01) than those without hyperkyphosis. Logistic regression with the ability to tandem walk as a dichotomous outcome (cut-off ≥4 steps) showed that women with a hyperkyphosis had an age-adjusted Odds ratio of 4.5 (95% CI 1.7–12.1) to perform ≥4 tandem steps backwards and their Odds ratio to perform ≥4 tandem steps forwards was also significantly higher with an age-adjusted Odds ratio of 2.8 (95% CI 1.1–7.4). Lordotic Index was positively correlated to one-leg standing with eyes open (p < 0.05). The present study suggests an association between hyperkyphosis and a better tandem standing and tandem gait forwards and backwards.