Postural Deformities Research Articles

The Effect of Parity on Age-Related Degenerative Changes in Sagittal Balance.

Retrospective cohort study. Evaluate the effects of parity (number of births) on measures of sagittal posture in elderly women. The long-term objective of this study is to identify and mitigate factors contributing to age-related postural deformity in older adults. Adult spinal deformity is a prevalent condition that often requires costly surgical management. Females are disproportionately represented in spinal deformity surgical cases with up to 90% of patients being women. The potential contributions of pregnancy on postural degeneration have only begun to be acknowledged and require further study. Two hundred eight women with standing lateral radiographs were selected from the TwinsUK register. Parity information was extracted from questionnaires. Sagittal balance measurements (thoracic kyphosis, lumbar lordosis [LL], pelvic incidence [PI]) were collected and PI-LL mismatch was calculated. One-way analysis of variance tests were done between three separate age categories for measures of sagittal balance and parity and stepwise multivariate regression was done for PI-LL. Both age and PI-LL mismatch significantly differed between parity categories. PI-LL was on average 7.0° ± 2.5° greater in multiparous (3+ births) subjects than in nulliparous subjects (P < 0.01). Parity did not have an independent relationship with lumbar disc degeneration, lumbar bone mineral density, or any of the individual sagittal balance parameters (P > 0.05 for all), except for PI-LL. From a subanalysis of the effect of parity on sagittal alignment within twin pairs, we found that within pair differences in parity associate with within pair differences in thoracic kyphosis. This study established correlations between measures of spinal curvature in older women and parity for the first time. Longitudinal research is required to establish a causative relationship. 4.

Reliability of the DIERS Formetric 4D Spine Shape Parameters in Adults without Postural Deformities.

The DIERS formetric 4D provides a safe method to monitor and track the progression of postural deformities over time. However, further evaluation of reliability is necessary. Reference values are also needed to indicate postural change. The current study examined the reliability of spine shape parameters produced by the formetric 4D in adults without postural abnormalities and established reference values to determine when real change occurs. Thirty participants were scanned during 1 week. Intraclass correlation coefficients (ICCs) were calculated for 40 spine shape parameters for scans with participants stationary between scans, scans with repositioning between scans, and between days. Within-day and between-day standard error of measurement (SEM), absolute relative SEM, and smallest detectable change (SDC) were reported. ICC for stationary scans was excellent for 29 parameters, good for 10 parameters, and fair for 1 parameter. With repositioning, ICC was excellent for 27 parameters, good for 12 parameters, and fair for 1 parameter. Between days, ICC was excellent for 26 parameters, good for 10 parameters, and fair for 4 parameters. Within-day SEM% was greater than 10% for 6 parameters. Within-day SDC ranged from 1.80 to 25.03 units for a single scan and from 0.97 to 17.93 units for 6 scans. Between-day SEM% was greater than 10% for 9 parameters. Between-day SDC ranged from 1.44 to 28.24 units for a single scan and from 1.05 to 22.2 units for 6 scans. Thirty-six of the 40 spine shape parameters from the DIERS formetric 4D reliably distinguished between participants over time. Reference values were established that can be used to track patient postural change over time. Future research should investigate the clinical relevance of these 40 spine shape parameters and determine when a clinically important change in posture occurs.

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.

Postural deformities in patients with Parkinson disease (clinical and social aspects)

The analysis was presentedabout the dynamics of the functional and psychological state and quality of life of patients with trunk deformities in Parkinson’s diseaseusing Dysport. The optimal regimens was reflected about the administration of botulinum toxin for patients with camptocormia and Pisa syndrome.

Short-term effect of a hamstring stretching program in hamstring extensibility and sagittal spinal curvatures in high school students

Hamstring shortness and postural deformities are frequent in adolescents. For this reason, the purpose of this study was to analyse the influence of a shortterm stretching program in hamstring extensibility and sagittal spinal curvatures in high school students. Sixty-two male high school students aged 14-17 years old performed a 70 seconds hamstring stretching program (3 exercises) twice a week for five weeks during their physical education classes. Hamstring extensibility was measured by the straight leg raise test and sit-and-reach test. Thoracic and lumbar curves and pelvic inclination were measures in relaxed standing and in the sit-and-reach test. These measures were assessed before (pre-test) and after (post-test) the intervention program. Significant increases in the sit-and-reach score (d= 0.23) and in the straight leg raise angle (d= 0.85-0.90) were found. Sagittal spinal curvatures in standing showed no differences between pre- and post-test. In the maximal trunk flexion position during the sit-and-reach was detected a lower thoracic kyphosis and posterior pelvic tilt (p &lt; 0.05) in post-test although with a low size effect (d=0.02-0.22). A hamstring muscle stretching program with a volume of 2 sessions per week (70 seconds each session), for 5 weeks, improves hamstring extensibility in adolescents and slightly reduces the thoracic bending and posterior pelvic tilt in trunk flexion postures with extended knees.

Follow-up Comparison of the Effect of Eight-weeks Corrective Exercises With and Without Myofascial Release on Postural Kyphosis Deformity

Introduction: The present research aimed to compare and follow-up the effect of 8-week corrective exercises with and without the myofascial release on functional kyphosis deformity in young adults. Methods: It was a randomized controlled trial in the university laboratory. Forty-five male students suffering from abnormal hyperkyphosis deformity (kyphosis of more than 42°) were selected and randomly assigned to three groups: corrective exercises, combinational exercises (corrective and myofascial release), and control. The Mean±SD age, height, and weight of the study sample were 22.12±2.88 years, 175.44±6.80 cm, and 71.21±7.31 kg, respectively. The study groups did the exercises for 8 weeks, under the direct observation of the researchers. The kyphosis angle of the participants was measured using a flexible ruler, at the baseline, post-test, and follow-up (4 weeks after the end of the exercises) stages. The collected data were analyzed with repeated measures Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA) tests. Results: After 8 weeks of exercises, the degree of kyphosis in the post-test and follow-up stages was significantly lower than that in the pre-test, in both training groups. The results of the ANCOVA test demonstrated that the thoracic kyphosis degree in the combinational exercises group was significantly lower than that of the corrective exercises group (P≤0.05), in the post-test and follow-up stages. Conclusion: According to the results, the corrective exercises program in combination with the myofascial release is more effective than the corrective exercises alone, in correcting the thoracic kyphosis deformity.

CHANGES IN SOME PERFORMANCE INDICATORS FOLLOWING THE IMPLEMENTATION OF AN EXPERIMENTAL MODEL FOR BODY CORPUS MUSCLE STABILITY IN PHYSICAL EDUCATION AND SPORTS CLASSES

Muscles of the trunk are responsible for the movement and stability of the spine. Very often children worsen their body posture in school-age because of weak musculature and bad studying position. THE PURPOSE of the study is to apply an experimental model of body corpus muscle stability in physical education and sports classes and to compare the strength performance indicators of those muscles before and after the experiment. METHODS: The contingent of the study represents 21 students on average age 12.4 years. Data of anthropometric indicators, static and dynamic strength indicators of body corpus muscles and degree of mobility of the spine were collected during the experiment. All data were processed and statistically analyzed. RESULTS: The analysis of the results shows that the implementation of the experimental model of exercises significantly improves the static and dynamic muscular strength of body corpus muscles and does not increase the flexibility of the spine. CONCLUSIONS: We can conclude that the obtained results confirmed the effectiveness of the experimental model of exercises and it could be included in ordinary Physical education and sports classes like the opportunity to counteract of poor body posture and spinal deformities.

Bases fisiológicas de la corrección de los trastornos posturales mediante actividad muscular ordenada regularmente

Posture deformation occurs under the influence of factors that violate the vertical position of the spine. When the load on the spine is redistributed, the position of the body is adjusted by selective training of the muscles of the trunk and changing the position of the pelvis in the frontal plane. Exercises for impaired posture should be aimed primarily at preventing progression and correcting curvature and twisting of the vertebrae. It is important not only the correction of curvature, but also the stabilization of the spine in a corrected position. Saving the achieved results contributes to the formation of a new static-dynamic stereotype of the spine. This is possible by deliberately influencing the upper and lower in relation to the main curvature of the links of the musculoskeletal system and muscle tone-regulating groups involved in posture formation.

The Intelligent Diagnosis and Treatment of Postural Deformities by Analyzing Kinect™ Camera Data

The Intelligent Diagnosis and Treatment of Postural Deformities by Analyzing Kinect™ Camera Data

Correlation between isometric strength in five muscle groups and inclination angles of spine.

This study was aimed to identify correlation between maximum isometric strength in five muscle groups determined by dynamometry results of muscle tests and the inclination angles of the spine. This predictive correlational study included 63 young healthy athletes aged 10-15. (m/f 31/32; 12.73 ± 1.58years; 162.57 ± 12.94cm; 52.86 ± 12.17kg; 3.95 ± 1.70 training years; 4.05 ± 1.31 training h/week).The maximum isometric strength in five muscle groups was measured by a handheld dynamometer with external belt fixation using a portable stabilization device. The inclination angles were measured with a digital inclinometer. The data were analyzed using descriptive statistics, and correlations were estimated by Pearson's correlation coefficient (r). The isometric muscular strength of the muscle group of the hip extensors was in a significant correlation with the lumbar lordosis angle (LLA), r = 0.714 (p < 0.0001). The isometric muscular strength of the muscle group of the erector spinae was in a significant correlation with the LLA, r = 0.578 (p < 0.0001) and with thoracic kyphosis angle(TKA), r = 0.522 (p < 0.0001). There is a strong association between isometric strength of the muscle groups of the hip extensors and erector spinae and the inclination angles of the spine. Based on the isometric results, physical therapy can be proposed for increasing the muscular strength of those muscle groups, which can help in the prevention of more severe forms of postural deformities. These slides can be retrieved under Electronic Supplementary Material.

Prevalence of Lower Extremities’ Postural Deformities in Overweight and Normal Weight School Children

Background: The increasing trend of both obesity and postural disorders in pediatric population. Objectives: We aimed to determine the prevalence of lower extremities' postural disorders among school children in Qom province, Iran. Methods: In this cross-sectional study, a representative sample of schoolchildren aged 6 - 7 years was selected by multi-stage clustering method from all urban and rural regions of Qom province. Presence of postural deformities of lower limbs, including genu valgum, genu varum and flat foot were evaluated and recorded. Prevalences of deformities in different categories of weight status (underweight, normal and overweight) were compared. Results: Out of 20000 school children 1450 students were randomly selected. Genu valgum, genu varum and flat foot was present in 256 (17.7%), 351 (24.2%) and 194 (13.38%) of studied population. 1021 (70.41%), 161 (11.1%) and 268 (18.48%) students were normal weight, underweight and overweight/obese, respectively. Prevalence of flat foot and genu valgum was significantly higher in obese/overweight students (P < 0.01). Mean of skin fold thickness was significantly higher in students with genu valgum (P < 0.001). A significant relation existed only between occurrence of lower limb postural deformities and body mass index [OR = 1.89, CI (95%) = 1.18 - 3.03]. Conclusions: The findings of this study indicate that prevalence of genu valgum and flat foot are higher in overweight/obese children. In addition to early diagnosis and timely treatment of the deformities, developing and validation of a multidisciplinary care for obese and overweight children to reduce the occurrence of obesity related musculoskeletal complications is of importance.

Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review.

Deep brain stimulation (DBS) effects on postural deformities are still poorly explored. Systematic review in accord with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines (PRISMA). All 38 studies that met predefined eligibility criteria had high risk of bias attributed to retrospective analysis of heterogeneous populations with variable and incompletely reported demographic and clinical characteristics, definitions, outcomes, DBS indications, targets, and settings. Five patient groups were identified in the 35 studies with individual data available: (1) parkinsonian camptocormia (n = 96): 89 patients underwent subthalamic (STN) and 7 globus pallidus pars interna (GPi) DBS. Camptocormia was the indication in 3 patients. After DBS, camptocormia improved in 57 of 96 patients (4.3-100% improvement) and remained stable or worsened in 39 of 96 patients (2-100% worsening). (2) dystonic camptocormia (n = 16): All underwent GPi-DBS. They were younger and with shorter disease duration, but longer deformity duration, compared with parkinsonian camptocormia. After GPi-DBS, camptocormia improved in all patients (50-100% improvement). (3) Parkinsonian Pisa syndrome (n = 14): 11 patients underwent STN-DBS for motor fluctuations whereas Pisa syndrome was the indication for pedunculopontine and GPi-DBS in 2 patients. After DBS, Pisa improved in 10 of 14 patients (33.3-66.7% improvement). (4) Dystonic opisthotonus: 2 young patients remarkably responded to GPi-DBS. (5) Parkinsonian anterocollis: There were variable responses in 3 patients after STN-DBS for motor fluctuations. Low-quality level of evidence suggests that dystonic camptocormia and opisthotonus improve after GPi-DBS. Parkinsonian camptocormia, Pisa syndrome, and anterocollis have variable responses, and their dystonic features should be further explored.

Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety.

There is substantial evidence for normal relationships between spine and postural parameters, as measured from radiographs of standing patients. Sagittal balance, cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more complex understanding of the interrelations between these essential components of normal stance have evolved to where there are known, established thresholds for normalcy. These spinal parameters are reliably measured from X-ray images and serve as goals of care in the treatment of spine and postural disorders. Initial and follow-up spinal imaging by X-ray is thus crucial for the practice of contemporary and evidence-based structural rehabilitation. Recent studies have demonstrated that improvement in the spine and posture by nonsurgical methods offers superior long-term patient outcomes versus conventional methods that only temporarily treat pain/dysfunction. Low-dose radiation from repeated X-ray imaging in treating subluxated patients is substantially below the known threshold for harm and is within background radiation exposures. Since alternative imaging methods are not clinically practical at this time, plain radiography remains the standard for spinal imaging. It is safe when used in a repeated fashion for quantifying pre–post spine and postural subluxation and deformity patterns in the practice of structural correction methods by chiropractic and other manual medicine practices.

A new therapeutic strategy with istradefylline for postural deformities in Parkinson's disease.

Postural deformities are common in Parkinson's disease (PD) patients. Several treatment options have been reported, but responses to these treatments appear unpredictable. Istradefylline is a novel drug for PD. Cases of PD patients whose postural deformities were improved after withdrawal of dopamine agonists and initiation of istradefylline are presented. Four consecutive patients with postural deformities including antecollis, Pisa syndrome, and camptocormia were recruited and treated with istradefylline in combination with withdrawal of dopamine agonists, which are possible causes of postural deformities. The dopamine agonists were discontinued an average of 26 months after the development of the postural deformities, and istradefylline was initiated an average of 1.3 months after dopamine agonist withdrawal. Three patients with preserved paraspinal muscle volume showed good responses to the treatment regimen at least two months after dopamine agonist withdrawal. Postural deformities caused by dopamine agonists generally improve less than two weeks after dopamine agonist withdrawal. Given the response time in the present study, the response was unlikely to be caused solely by dopamine agonist withdrawal. Istradefylline can be a potential therapeutic option; however, appropriate selection of patients for treatment with istradefylline is warranted.

Treatment with istradefylline for postural abnormalities in Parkinson's disease.

In the current edition, Fujioka and colleagues report on four Japanese patients with Parkinson disease (PD) and severe postural abnormalities treated with istradefylline (adenosine A2A receptor antagonist); further, dopamine agonists were with- drawn. Three patients experienced significant improvements of postural abnormalities. Postural abnormalities in PD include camptocormia, antecollis, lateral trunk flexion, and scoliosis. They may be very pronounced and significantly reduce quality of life. The therapy of postural deformities in PD is currently disappointing. Effective therapeutic strategies for postural deformities in PD are an unmet need. Larger clinical trials investigating novel approaches including istradefylline are warranted.

Deterioration of postural deformity in Parkinson’s disease patients with punding and hobbyism

This study aimed to examine whether worsening of postural deformities is seen in Parkinson’s disease (PD) patients who exhibit the behavioral disorders punding or hobbyism (P-H), which involve maintaining the same poor posture. The subjects were 80 patients with PD (aged 73.1 ± 8.8 years; duration of disease, 6.4 ± 5.5 years). Using the Japanese-language version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (J-QUIP), a group with P-H alone (P-H only group) and a group without impulsive-compulsive behaviors (non-ICB group) were compared with respect to the angles of forward and lateral trunk flexion while standing at rest. The group with ICBs (ICB group) identified by the J-QUIP consisted of 36 patients (45.0%). Of these, 25 (31.3%) were in the P-H only group. The non-ICB group, who were negative on all items of the J-QUIP, consisted of 44 patients (55.0%). Significantly higher values were seen in the P-H only group compared with non-ICB group for the angle of forward flexion of the trunk (FFT angle, p = 0.04), Unified Parkinson’s Disease Rating Scale (UPDRS) part II score (p = 0.002), and UPDRS total score (p = 0.007). The FFT angle was increased and activities of daily living decreased in PD patients with P-H.

Congenital Muscular Torticollis: Bridging the Gap Between Research and Clinical Practice.

Congenital muscular torticollis (CMT) is a common postural deformity evident shortly after birth, typically characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation due to unilateral shortening of the sternocleidomastoid muscle. New evidence is emerging on the pathogenesis of CMT, the negative long-term consequences of delaying intervention, and the importance of early identification and early intervention to maximize outcomes. Our purpose in this article is to inform pediatricians and health care providers about new research evidence and share selected recommendations and implementation strategies specifically relevant to pediatric practice to optimize outcomes and health services for infants with CMT.

Statics analysis of an extensible continuum manipulator with large deflection

Statics modelling is critical to posture deformation analysis and shape control under external loads, especially large deflections. This paper presents a novel statics modelling method to discuss the shape deformation of an extensible continuum manipulator (ECM) under an external tip load. According to the equivalence of the elastic bending potential energy, the ECM is simplified as an equivalent-fixed-guided beam (EFGB) with the corresponding equivalent bending stiffness. Subsequently, a large deflection statics model of the EFGB is established based on the continuous beam theory, and a solution is calculated by employing the elliptical integral algorithm. Further, based on the large deflection statics model, several shape simulations under different external tip loads of the ECM are discussed, especially the shape deformation of the vertical posture. In addition, the statics experiments of the ECM are performed to validate the presented statics modelling method by comparing the shape deformation under different directions of the external tip load between the theoretical and experimental value. The experiments and the contrast demonstrate that the results match with the theoretical solution well, and that the proposed statics modelling method is efficient and precise for predicting the shape deformation of the ECM.

Movement Analysis in Orthopedics and Trauma Surgery - Measurement Systems and Clinical Applications.

Technical development lead to an enhancement of clinical movement analysis in the last few decades and expanded its research and clinical applications. Since the mid 20th century, human movement analysis has made its way into clinical practice, e.g. in treating poliomyelitis and infantile cerebral palsy. Today, it has a wide range of applications in various clinical areas. The aim of this narrative review is to illustrate the variety of camera-based systems for human movement analysis and their clinical applications, specifically in the field of orthopaedics and trauma surgery (O/U). Benefits and limitations of each system are shown. Future development and necessary improvements are discussed. A selective literature review was undertaken with the databases PubMed and Google Scholar using keywords related to clinical human movement analysis in the field of orthopaedics and trauma surgery. Furthermore standard book references were included. Common video camera systems (VS) are used for basic visual movement analysis. Instrumented movement analysis systems include marker-based systems (MBS), markerless optical systems (MLS) and rasterstereographic analysis systems (VRS). VS, MBS and MLS have clinical use for dynamic examination of patients with various disorders in movement and gait. Among such are e.g. neuro-orthopaedic disorders, muscular insufficiencies, degenerative and post-trauma deficiencies with e.g. resultant pathologic leg axis. Besides the measurement of kinematic data by MBS and MLS, the combination with kinetic measurements to detect abnormal loading patterns as well as the combination with electromyography (EMG) to detect abnormal muscle function is a great advantage. Validity and reliability of kinematic measurements depend on the camera systems (MBS, MLS), the applied marker models, the joints of interest and the observed movement plane. Movements in the sagittal plane of the hip and knee joint, pelvic rotation and tilt as well as hip abduction are generally measured with high reliability. In the frontal and transverse planes of the knee and ankle joint substantial angular variabilities were noted due to the small range of motion of the joints in these planes. Soft tissue artefacts and marker placement are the biggest sources of errors. So far MLS did not improve these limitations. MBS are most accurate and remain the gold-standard in clinical and scientific movement analysis. VRS is used clinically for static 3D-analysis of the trunk posture and spine deformities. Current systems allow the dynamic measurement and visualisation of trunk and spine movement in 3D during gait and running. Planar x-ray-imaging (Cobb's angle) and to some extent cross sectional imaging with CT-scan or MRI are commonly used for the evaluation of patients with spinal deformities. VRS offers functional 3D data of trunk and spine deformities without radiation exposure, thus allowing safer clinical monitoring of the mainly infantile and adolescent patients. The accuracy, validity and reliability of measurements of different VRS-systems for the clinical use has been proven by several studies. The instrumented movement analysis is an additional tool that aids clinical practitioners of O/U in the dynamic assessment of pathologic movement and loading patterns. In conjunction with common radiologic imaging it aids in the planning of type and extent of corrective surgical interventions. In the field of orthopaedics and trauma surgery movement analysis can help as an additional diagnostic tool to develop therapeutic strategies and evaluate clinical outcomes.

The effect of postural deformities on back function and pain in patients with Parkinson's disease.

Postural deformities, such as Pisa syndrome (PS), and camptocormia and antecollis (C&A) are common in patient with Parkinson's disease (PwPD). These deformities can lead to back disability and pain with different mechanisms, including abnormal loading or stress on soft tissues as muscles, lumbar discs and ligaments. To evaluate the effect of different postural deformities including PS and C&A on back function and pain in PwPD. The function, disability and pain were assessed by Oswestry disability index (ODI) and brief pain inventory (BPI). All participants completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). PS and C&A groups significantly showed worse disability ODI and pain BPI, and higher LEDD and mH&Y stage compared with PD groups. However, no differences were found in PD duration and UPDRS in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales. These results demonstrated that PS and C&A are associated with severe impairment of back functions and pain. Rehabilitation programs for PwPD and PS, and C&A should include spine alignment and postural training.