Rounded Shoulder Research Articles

Marginal adaptation of zirconia-reinforced lithium silicate overlays with different preparation designs.

Following the advent of strong adhesive bonding, the conservative tooth preparation designs without a retentive form gained increasing popularity. This study aimed to evaluate the marginal adaptation of zirconia-reinforced lithium silicate (ZLS) overlays with different preparation designs. Forty sound human maxillary first molars were collected and divided into four groups (n = 10) according to their preparation design for the fabrication of ZLS overlays: (O) anatomical occlusal reduction, (OS) anatomical occlusal reduction with rounded shoulder, (OG) anatomical occlusal reduction with a central groove, and (OSG) anatomical occlusal reduction with rounded shoulder and central groove. A video measuring machine (VMM) was used to measure the marginal gap. Statistical analysis was carried out using one-way ANOVA followed by paired t test and Tukey's test (α = .05). The gap size was significantly different between the groups both before (P = .004) and after (P = .008) cementation, and it was significantly smaller in group O than group OSG (P = .002 before and P = .004 after cementation). Marginal gap increased in all groups following cementation (P < .001). Group O showed comparable marginal adaptation with groups OS and OG while group OSG with the most complex design showed the lowest marginal adaptation for ZLS overlays. According to the results of this in vitro study, it may be stated that for defect-free teeth requiring occlusal restoration, the occlusal surface preparation alone would suffice to achieve optimal marginal adaptation, and retentive and more invasive preparation designs are not required.

Effects of Kinesiology Taping on Shoulder Posture and Peak Torque in Junior Baseball Players with Rounded Shoulder Posture: A Pilot Study.

Rounded shoulder posture (RSP) causes an imbalance of the adjacent joints due to the malalignment of the shoulder joint, and thus affects the strength of the muscles surrounding the shoulder. This study aimed to investigate the effect of rounded shoulder taping (RST) on shoulder posture and muscle strength in junior baseball players. Nineteen junior baseball players participated in the study, which used a crossover design at an interval of 1 week. The participants were randomized to receive rounded shoulder taping (RST) and sham kinesiology taping (SKT) using kinesiology tape. RSP was measured using two 12-inch combination squares, and shoulder peak torques were measured by isokinetic equipment. The results showed that RST led to significant changes in RSP (p < 0.05), but no significant changes were observed with SKT (p < 0.05). RST led to significant changes in the peak torques of external rotation and internal rotation of the shoulder (p < 0.05), but no significant changes were observed with SKT (p < 0.05). These results suggest that RST could help to correct RSP and improve peak torque of external and internal rotation of the shoulders of junior baseball players with RSP.

Evaluation of scapular mobilization and comparison to pectoralis minor stretching in individuals with rounded shoulder posture: A randomized controlled trial

BackgroundRounded shoulder posture (RSP) is a common postural condition which can alter scapular position. Although, there is no consensus on the relationship between posture and musculoskeletal dysfunction, some evidence suggests a significant relationship between RSP and shoulder dysfunction. Therefore, treatment of this postural condition is important. Various treatment methods are used to correct RSP. However, the effectiveness of scapular mobilization, (SM) as a method which can alter scapular kinematics, has not been investigated. ObjectiveTo evaluate the effects of SM on scapular resting position in individuals with RSP, and to compare this technique to pectoralis minor self-stretching (PMS), and combined SM + PMS. Methods52 healthy students (18 men and 34 women; mean age 23.67 ± 6.73 years) with RSP were randomly assigned to four groups (SM, PMS, combined SM + PMS, control). The mobilization group received SM, the stretching group performed self-PMS, and the combined group received SM + PMS. The control group received no treatment. Kinematics data to measure scapular protraction (cm), anterior tilt (°), internal rotation (°), and downward rotation (°) were captured with a motion analysis system before and after 5 sessions of group intervention. ResultsAll variables decreased significantly post-intervention compared to baseline values (P < 0.05). Internal rotation and downward rotation decreased significantly in the intervention groups compared to the control group (P < 0.05). No significant differences were observed between the intervention groups. ConclusionSM appears to be an effective technique to change scapular resting position in individuals with RSP. However, this technique was not superior to PMS or a combination of SM + PMS.

Further Data on Fell Points from the Southern Cone of South America

ABSTRACT Early projectile points frequently referred to as “fishtails” or “Fell” are found from northern Mesoamerica to the southern tip of South America. Becoming a widespread PaleoAmerican marker spanning ∼11,000–10,000 radiocarbon years ago, these points are found in the highest concentration in the Southern Cone of South America. To continue documenting and adding data on this topic, in this brief report we present morpho-technological observations on six specimens recently documented in the Republics of Uruguay and Argentina. The points in this sample resemble other Fell points in their general shape, straight and rounded shoulders, resharpening, and overall dimensions.

The Effect Of Baduanjin Exercise On University Students With Neck/shoulder Muscle Strength Imbalance

Muscular strength imbalance (MSI) on shoulder and neck is often a detonate for shoulder and neck postural diseases, for this reason, improving the neck/shoulder muscle imbalance could be a good method to prevent neck and shoulder problems. PURPOSE: This study tested the efficacy of Baduanjin exercise (BDJ), a traditional Chinese mind-body exercise, on shoulder and neck muscle strength imbalance, and see if it is possible through this method provide a new idea of sports rehabilitation for shoulder and neck diseases problems. METHODS:40 sedentary university students, with either forward head posture and/or round shoulder posture were randomized to the BDJ intervention group (n=20) and control group (n=20), the same evaluation protocol was used before and after the intervention. During six weeks of training, The BDJ group was given Baduanjin training combined with a basic health education program, and the control group was treated only with a basic health education program. Baduanjin training was conducted three times a week, every time 50 minutes. The contents of health education program include healthy lifestyle tips, postural education and muscle stretching method. RESULTS: Significant changes were found within the BDJ group, specially on Forward Head Angle test, Maximal Internal/External Rotation test and upper quarter Y-balance test. CONCLUSIONS: this randomized control trial provides some evidence to support the positive effect of BDJ exercise as a new method of sport therapy for rehabilitation among people with shoulder/neck MSI.

Effect of Tooth Preparation Design on Fracture Resistance of Zirconia-Reinforced Lithium Silicate Overlays.

To assess the effect of tooth preparation design on fracture resistance of zirconia-reinforced lithium silicate overlays. This study evaluated 50 human maxillary first molars with no caries, restorations or anatomical defects. The teeth were randomly divided into five groups (n = 10/group) based on preparation design for the fabrication of overlay restorations: (O) anatomical occlusal reduction, (OS) anatomical occlusal reduction with round shoulder preparation, (OG) anatomical occlusal reduction with a central groove, (OSG) anatomical occlusal reduction with round shoulder preparation and central groove, and (C) no preparation of tooth (control group). All restorations were fabricated using zirconia-reinforced lithium silicate (Vita Suprinity). The specimens underwent thermomechanical fatigue loading in a masticatory simulator (1.2 million cycles at 98 N). Fracture resistance was measured using a universal testing machine. The mode of failure was determined as well. Data were analyzed using one-way ANOVA followed by Tukey's post-hoc test, paired t-test and Fisher's exact test (α = 0.05). Group O showed significantly higher fracture resistance than groups OG and OSG (p = 0.002 and p = 0.001, respectively). The fracture resistance of group OS was significantly higher than that of group OSG (p = 0.008). The fracture resistance of the control group was significantly higher than that of OG and OSG (p = 0.001) and had no significant difference with other groups. Group O (anatomical occlusal reduction alone), which had the most conservative preparation design, yielded the highest fracture resistance.

Evaluation of the effects of finish line type and width on the fracture strength of provisional crowns.

This study aimed to investigate the impacts of finish line type and width on the fracture resistance of provisional crowns, and to determine the suitable type of crown material to use for that purpose. Chamfer and rounded shoulder preparations were done with stainless steel master models with a width of 0.6mm and 1.0mm and a total convergence angle of 6°. The provisional crowns were obtained using computer-aided design/computer-aided manufacturing (CAD/CAM) polymethyl methacrylate (PMMA) material in the mandibular left first molar. From the obtained molar tooth, a silicon mold was used to obtain the provisional crowns from the CAD/CAM PMMA, bis-acrylic resin, and self-curing composite materials. The lowest fracture strength was found in the bis-acrylic resin group made using the rounded shoulder preparation with a width of 0.6mm (699N). The highest fracture strength was found in the CAD/CAM PMMA group made using the rounded shoulder preparation with a width of 1mm (1339N). The fracture strength is higher for CAD/CAM PMMA than the other provisional crown materials; thus, it is recommended that this material be used in provisional crown restorations due to its other advantages.

Effectiveness of Structured Exercise Programme Versus Elastic Band Exercie on Individuals with Rounded Shoulder

Background: Rounded shoulder is a common postural abnormality in young adults due to abnormal posture adaptation while working. It may lead to decrease in thoracic mobility and increase in intradiscal pressure. In severe cases breathing problem may occur due to changes in the anterio-posterior diameter. Few studies have shown the effect of elastic band exercise on rounded shoulder to improve the postural alignment. Shoulder stabilization exercises and pectoralis minor stretching is also effective in rounded shoulder. In these study structured exercise were use to correct the rounded shoulder posture and to prevent the further complication. Objective: To find out the effectiveness of structured exercise programme on subjects with rounded shoulder. Material and method: In this pre-post intervention study 32 individuals with rounded shoulders were included. They were randomly divided into 2 groups with 16 individuals in each group. Group A were treated with structured exercises and Group B were treated with elastic band exercises for 4 weeks. After pre-post assessment, data was analysed with the help of appropriate statistical methods. Results: According to the statistical analysis there is significant decrease in measurement of rounded shoulder in both Group A and Group B with p value &lt;0.0010 and &lt;0.0001 respectively. Conclusion: Structured exercise and elastic band exercises both are equally effective in improving the rounded shoulders.

Lateral aerodynamic interference between an interior train and a flat box bridge-deck

This paper studies the crosswind aerodynamics of an interior train and flat box bridge-deck system via a series of wind tunnel experiments in wind angle of attack α = [−12°, 12°]. Aerodynamics of the train- and bridge-only models is measured as benchmarks under similar conditions. Upon comparing with the train- and bridge-only cases, the lateral aerodynamic interference between the train and bridge-deck is qualitatively identified by smoke-wire visualization and quantitatively detected by surface pressure and flow profiles located 8 mm upstream from the train model and 490 mm downstream from the bridge-deck model. Generally, the lateral aerodynamic interference on the train model is primarily manifested by suppression of underbody vortex shedding, shielding effect of bridge-deck leading-edge, and quasi-Reynolds number effect. Compared to the train-only case, the suppression of underbody vortex shedding reduces fluctuating drag, lift, and moment coefficients, whereas the shielding effect decreases the mean drag coefficient. The quasi-Reynolds number effect, owing to the accelerated and turbulent approaching flow over the rounded shoulder of the train model as α varies, abruptly alters drag, lift, and moment coefficients mimicking the classical Reynolds number effect, while the inflow Reynolds number remains unchanged. On the other hand, the lateral aerodynamic interference on the bridge-deck model is chiefly presented as flow transition promoting effect and intensifying effect on bridge-deck trailing-edge flow separating. Compared to the bridge-only case, the flow transition promoting effect leads to the global centerline of the bridge-deck aerodynamics to be parallel shifted about 4° to the positive direction of α, while the intensifying effect increases fluctuating drag, lift, and moment coefficients. Finally, the aerodynamics of the whole train-bridge system is briefly discussed.

Marginal and internal fit of provisional crowns fabricated using 3D printing technology.

Clinicians routinely provide provisional crowns following teeth preparation. Three-dimensional (3D) printing technology could be used over conventional methods for better fit as lack of adequate fit would result in plaque accumulation, micro-leakage, teeth sensitivity, caries and periodontal diseases. The aim of the study was to evaluate the marginal and internal fit of provisional crowns fabricated using 3D printing technology and to compare it with that of compression molding and milling methods. Ninety study models were fabricated by duplicating metal master models of the maxillary first premolar molar with three different finish line chamfer, rounded shoulder and rounded shoulder with bevel. On each study model, provisional crowns were fabricated using compression molding (Mo. group, n= 30 - by over impression technique), milling (Mi. group, n= 30 - by 5-axis dental milling machine), and 3D printing method (3D-P. group, n= 30 - by 3D printer). Marginal and internal fit of the samples were evaluated by measuring gap using a scanning electron microscope with a magnification of 27 ×, at 7 zones A-G on different finish line models. The data were statistically analysed using one-way analysis of variance (ANOVA) at the 0.05 significance level. The p-values were calculated using Dunnett's test. The marginal gap was minimal for the 3D-P. group for each finish line with lowest for rounded shoulder with bevel at zone A 30.6 ± 5.3 and at zone G 32.8 ± 5.4. In axial area, i.e. zones B and F, the minimum gap was noticed for the Mo. group and in Occlusal area (cusp and fossa), for zones C-E maximum gap was determined in Mi. group followed by Mo. and 3D-P. groups. 3D printed provisional crowns have better marginal and internal fit compared to milled and molded provisional crowns.

INFLUENCE OF THE PREPARATION DESIGN AND AGING ON THE VERTICAL MARGINAL GAP OF OCCLUSAL VENEERS CONSTRUCTED OF DIFFERENT CERAMIC MATERIALS

Twenty freshly extracted mandibular second molars were used in this study. The teeth were randomly divided into 2 groups according to the occlusal veneer material (n =10 each). The first group in which the teeth were restored with occlusal veneers constructed of Celtra Duo while the second group, the occlusal veneer material was the Vita Enamic. Each group was further subdivided into 2 subgroups (n =5 each) according to the preparation design either conventional occlusal reduction or reduction of the cclusal surface plus 1 mm axial reduction with rounded shoulder finish line. The vertical marginal gap was measured using stereomicroscope. Results: the results showed that the marginal gap of the two preparation designs of the two materials were statistically non significant before ageing P≤ 0.05.while after ageing, the subgroups of Celtra recorded, 90.45±13.0 and88.7±11.60µm, for conventional and, rounded shoulder designs respectively, with no significant difference between the two designs, while the subgroups of Vita Enamic recorded 113±7.01µm and 105.2±8.01µm for conventional and, rounded shoulder designs respectively, with high significant difference p≤0.003. Conclusions: The choice of certain preparation design should be associated with meticulous knowledge of the material of the occlusal veneers properties .

Diagnostic values of abdominal muscles thickness and sterno-costal angle for young adults with rounded shoulders

Objective: The purposes of this study was to evaluate the diagnostic values of abdominal muscles thickness and sterno-costal angle as the quantitative...

The comparison of acromiohumeral distance and scapular dyskinesis prevalence in females with and without rounded shoulder posture.

Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups’ comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants’ AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

Effect of Body Mass Index on Craniovertebral Angle and Shoulder Angle in Egyptian Adolescents

Purpose: To explore the effect of body mass index (BMI) on Craniovertebral Angle (CVA) and Shoulder Angle (SA) in Egyptian Adolescents. Methods: Cross Sectional Study designe was used.Eighty-six physical therapy students were selected randomly, and their age were ranged from 18-27 years. They were divided into three groups according to BMI. The first group with normal BMI (18.5-24.9 Kg/m2), while the second group was overweight (BMI was ranged from 25-29.9 Kg/m2). The third group was obesity class I (BMI was ranged from 30-34.9 Kg/m2).Photogrammetry method used (the photographic sessions by mobile phone Samsung J-7 Camera and use of Corel Draw software to analyze the pictures). Results: A significant difference was detected between normal BMI and overweight (p 0.2), and for SA non-significant difference between normal BMI and obese (p>0.41) and non-significant difference between overweight and obese (p>0.2). Conclusion: overweight and obesity change CVA and forward head posture and overweight changed SA and so rounded shoulder appeared. However, obesity did not change SA and rounded shoulder.

Evaluation of Influence of Finish line Design on Marginal Discrepancy of All-ceramics Lithium disilicate Crown restorations using μ-CT

Purpose of this study was to evaluate influence of finish line design on marginal discrepancies of lithium disilicate crown restoration fabricated with CAD/CAM. 24 crown restorations (n=8 each group) were designed with three different finish lines: Shoulder finish line (SFLC), Round Shoulder finish line (RSFLC) and Deep Chamfer finish line. All dies were prepared with additive manufacturing whereas crowns were fabricated with CAD/CAM using these preparations. After fixation, restorations were scanned using SRμCT and obtained reconstructed 2D slices were used to measure marginal discrepancy (MD) and absolute marginal discrepancy (AMD) at four sites (buccal, lingual, mesial and distal) of each specimen with the help of Image J software. Finally, recorded data was analyzed by one way ANOVA and Tukey’s test. The mean marginal discrepancies (MD±SD) for three groups were as follow: SFLC (91.6 ±3.5), RSFLC (72.8 ±3.9) and DCFLC (65.9 ±5.2) whereas Mean absolute marginal discrepancies (AMD±SD) were as follow: SFLC (104.4 ±6.8), RSFLC (85.5 ±3.5) and DCFLC (78.7 ±5.3). According to results, marginal discrepancies as well as absolute marginal discrepancies of SFLC group were significantly higher than those of RSFLC and DCFLC groups. After all, MDs and AMDs of all three groups were below clinical acceptable value. For allceramics restorations, marginal discrepancies of lithium dislicate crown restorations were below clinical acceptable range and restorations designed with RSFLC and DCFLC demonstrated superior results compared to preparations designed with SFLC.

Fit of cobalt-chromium copings fabricated by the selective laser melting technology and casting method: A comparative evaluation using a profilometer

This study aimed to assess the marginal adaptation and internal fit of cobalt-chromium copings fabricated by the selective laser melting (SLM) and conventional techniques using a profilometer. In this in vitro study sample size was calculated to be a total of 10 in two groups (n = 5). A brass model was used that had a circular cross-section with a round shoulder margin with 0.5 mm thickness and axial walls with 10 mm length and 6° taper. The copings fabricated with both techniques (SLM and casting method) were placed on the model, and vertical marginal gap was measured using a profilometer. The internal fit of copings was assessed by weighing the light-body addition silicone applied inside them, which simulated the cement. Data were analyzed through parametric (Independent t-test) and nonparametric (Mann-Whitney U-test, Bootstrap, Spearman, and Pearson Correlation) analysis. All analyses were performed at a significant level (α = 0.05) using SPSS. The mean marginal gap in the casting group (132.93 ± ) was significantly higher than that in the SLM group (67.14 ± 15.67 μm) (P < 0.05). The mean weight of light-body silicone was 9.60 ± in the SLM and 8.70 ± 1.21 mg in the casting group. No significant difference was noted between the two groups regarding the internal fit (P > 0.05). The copings fabricated by the SLM technique showed a smaller vertical marginal gap compared to the casting group. However, the two groups were not significantly different in terms of internal fit.

Effect of Strengthening of Scapular Stabilizers in Treatment of Rounded Shoulder Posture in Dental Students

Objective: The objective of this study was to investigate the effects of scapular stabilizer strengthening in rounded shoulder posture in male dental students.Method: Ethical clearance was obtained from the institutional ethical committee. Total 30 Subjects were selected as per the inclusion criteria and rests were excluded. Participants were informed about the study & written consent was taken prior to participation. In pre test assessment, subjects were assessed by scapular index. They were given strengthening exercises of scapular stabilizers as a treatment of rounded shoulder posture before they start working for 30 minutes per day, 5 days a week and were continued for 4 weeks. Post test assessment was done by using same outcome measure. Interpretation of the study was done on the basis of comparing pre test and post test assessment. Thus, the study was concluded with the help of statistical analysis by using paired ‘t’ test.Results: The study showed effect of strengthening of scapular stabilizers on rounded shoulder posture in dental students is (p>0.0001), which is extremely significant.Conclusion: On the basis of the results of our study, it is concluded that strengthening of scapular stabilizersis extremely significant effective in correcting rounded shoulder posture among male dental students.

【論文摘要】Effects of Kinesiology Taping With Exercise on Clinical Performance and Posture in Round Shoulder Subjects With Subacromial Pain Syndrome: A Single-Blinded Randomized Controlled Trial

Background and Purpose: Subacromial pain syndrome (SAPS) is a common diagnosis in shoulder region and round shoulder posture (RSP) is believed to be one of risk factors resulting in SAPS. Treatment strategy for subjects with SAPS has been focused on posture correction exercises. Despite moderate to large improvements in functional ability and pain with exercises, RSP remains in SAPS. Application of taping with exercise may have an additional effect on posture correction. The aim of this study was to compare the effects of exercise intervention with and without kinesiology taping in RSP subjects with SAPS. Methods: Subjects diagnosed with SAPS and RSP (acromial distance ≥ 2.6 cm) were recruited and randomly allocated to kinesiology taping or placebo taping group. Shoulder angle (SA), pain score, Taipei, Taiwan and self-reported Flexilevel Scale of shoulder function (FLEX-SF) were assessed before allocation. Kinesiology taping group received taping with 35–40% stretch while placebo taping group received taping without tension applied. Both groups underwent the same exercise protocols consisting of side-lying external rotation, prone horizontal abduction with external rotation, prone extension, and pectoralis minor stretching. Subjects received the intervention two times per week lasting for four weeks. Outcomes including pain, FLEX-SF, and SA were assessed at baseline, week 2 and week 4. Results: Thirty-six RSP subjects with SAPS participated and 2 subjects in placebo group dropped out. Only significant main effect of time (p = 0.027) was found in FLEX-SF. Greater decrease in pain level was correlated with improved functional performance in both groups (kinesiology group: r = -0.76, p ＜ 0.0005; placebo group: r = -0.67, p = 0.008). There is no significant interaction effect and main effect in SA. Significant correlation between posture and pain was found in kinesiology taping group (r = -0.60, p = 0.018). Conclusion: Significant improvement on functional performance was found in both groups after 4-week exercise intervention with or without kinesiology taping. Improvements in clinical symptoms were related to better posture. Clinical Relevance: Pain and function can be improved with exercise program in subject with SAPS and RSP However, taping treatment may not add an additional effect.

Bite Out Your Tongue

Bite Out Your Tongue

The Effects of Various Bag-Carrying Styles on the Muscle Tone and Stiffness and the Spinal Alignment of Adults with Rounded Shoulder Posture during Treadmill Walking

Background : There is lack of studies on the effects of the bag-carrying style on the shoulder muscles and body alignment in adults with rounded shoulder posture (RSP). Objective: The purpose of this study was to investigate the effects of various bag-carrying styles on muscle tone, muscle stiffness and spinal alignment in 20 adults with RSP as they were walking on a treadmill. Design : Crossover Study Design. Methods: A subject performed treadmill walking for 15 minutes at a speed of 4 ㎞/ｈ while carrying three different types of bags: a backpack, a cross bag, and a shoulder bag. Results : The results showed that the main effect of timing was observed in the muscle tone for all the variables and in muscle stiffness only for the upper and lower trapezius muscles. As for the main effect of timing, the muscle tone of the upper trapezius and the pectoralis major significantly increased in all conditions, while the muscle tone of the lower trapezius significantly decreased in all conditions. The muscle stiffness of the upper trapezius significantly increased in all conditions, while the muscle stiffness of the lower trapezius significantly decreased in all conditions. As for the spinal alignment, the dimple distance data values significantly decreased for the cross-bag style. Conclusions : This study demonstrated that walking with a heavy bag, regardless of the bag-carrying style, increased muscle stiffness around the shoulders in adults with rounded shoulder posture, and walking with a crossbag also induced changes in spinal alignment.