Using smartphones in the evaluation of spinal curvatures in a sagittal plane

Abstract Introduction: In physiotherapeutic diagnostic processes, various tools and methods may be used. However, price and availability may limit their daily use in clinical practice. Therefore, the suggestion that smartphones with specific applications may be useful as diagnostic tools can be found in the literature. However, before using them in clinical practice, it is important to verify their reliability. The aim of the study was to evaluate the consistency of measurements of the curvatures in the sagittal plane performed with the Saunders digital inclinometer and a smartphone application. Materials and methods: The study included 40 subjects aged 22-39 years (23.0 ± 3.7). All subjects had sagittal spinal curvatures (sacral slope - SS, lumbar lordosis - L, thoracic kyphosis - K, upper thoracic kyphosis - K1, lower thoracic kyphosis - K2) measured in both standing and sitting positions with the Saunders digital inclinometer and a smartphone application. Results: In measurements performed with the use of the Saunders inclinometer and the smartphone, no significant differences were found between the size of the curvatures of the spine in a standing position (SS 19° ±8.2 vs. 17° ±8.4 p=0.3; L 32° ±11.1 vs. 29° ±10.3 p=0.2; K 43° ±8.4 vs. 41° ±8.1 p=0.2; K1 31° ±7.2 vs. 29.0° ±7.3; K2 11o ±7.4 vs. 11.0° ±6.7) and a sitting position (SS 3.75° ±8.9° p=0.8; L 5.8° ±9.06 vs. 5.2° ±8.5 p=0.75; K 40.0° ±8.1 vs. 36.7° ±7.9 p=0.6; K1 25.8° ±7.1 vs. 24.9° ±7.1; K2 14.5° ±9.9 vs. 11.5° ±9.4). Conclusions: The examination of spinal curvatures in the sagittal plane using Saunders digital inclinometer and a smartphone application allows researchers to obtain reliable results. Therefore, smartphones can be used for an objective evaluation of the musculoskeletal system in daily clinical practice.

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Sagittal spinal morphotype assessment in 8 to 15 years old Inline Hockey players

PeerJ ◽

10.7717/peerj.8229 ◽

2020 ◽

Vol 8 ◽

pp. e8229 ◽

Cited By ~ 6

Author(s):

Pilar Sainz de Baranda ◽

Antonio Cejudo ◽

Victor Jesus Moreno-Alcaraz ◽

Maria Teresa Martinez-Romero ◽

Alba Aparicio-Sarmiento ◽

...

Keyword(s):

Thoracic Kyphosis ◽

Pelvic Tilt ◽

Joint Angle ◽

Standing Position ◽

Lumbar Curve ◽

Young Athletes ◽

Spinal Curvatures ◽

Hockey Players ◽

Thoracic Hyperkyphosis ◽

And Performance

Background Physiological sagittal spinal curvatures play an important role in health and performance in sports. For that reason, several scientific studies have assessed spinal morphology in young athletes. However, to our knowledge, no study has assessed the implications of Inline Hockey (IH) practice on sagittal integrative spinal morphotype in adolescent players. Objectives The aims of the present study were to describe habitual sagittal spinal posture in young federated IH players and its relationship with training load and to determine the sagittal integrative spinal morphotype in these players. Methods An observational analysis was developed to describe the sagittal spinal morphotype in young federated IH players. A total of 74 IH players from the Technification Plan organized by the Skating Federation of the Valencian Community (aged from 8 to 15 years) participated in the study. Thoracic and lumbar curvatures of the spine were measured in a relaxed standing position (SP), in a slump sitting position (SSP) and in maximum flexion of the trunk (MFT) to determine the “Sagittal Integrative Morphotype” of all players. An unilevel inclinometer was used to quantify the sagittal spinal curvatures. The Hip Joint Angle test was used to quantify the Lumbo-Horizontal angle in flexion (L-H fx) of all participants with a goniometer. Results When thoracic curvature was analyzed according to normality references, it was found that 64.9% of IH players had thoracic hyperkyphosis in a SSP, while 60.8% and 74.3% of players were classified as normal in a SP and in MFT, respectively. As for the lumbar curve, 89.2% in a SP and 55.4% in MFT were normal, whereas 68.9% of IH players presented lumbar hyperkyphosis in a SSP. Regarding the “Sagittal Integrative Morphotype,” only 17.6% of players were classified as “Normal” in the three measured positions for the thoracic curve, while 37.8% had “Thoracic Hyperkyphosis” and 41.8% presented “Functional Thoracic Hyperkyphosis.” As for the “Sagittal Integrative Lumbar Morphotype,” only 23% of athletes had a normal curve in the three positions, whereas 66.2% presented “Functional Lumbar Hyperkyphosis.” When the L-H fx was evaluated, the results showed that only 16.2% of the athletes were classified as normal. Conclusions Federative IH practice seems to cause specific adaptations in spinal sagittal morphotype. Taking into account the “Sagittal Integrative Morphotype” only 17.6% IH players presented “Normal Morphotype” with a normal thoracic kyphosis in the three measured positions, while only 23% IH players presented “Normal Morphotype” with a normal lumbar curvature in the three assessed positions. Furthermore, only 16.2% of IH players showed normal pelvic tilt. Exercise programs to prevent or rehabilitate these imbalances in young IH players are needed.

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Reliability and Validity Measurement of Sagittal Lumbosacral Quiet Standing Posture with a Smartphone Application in a Mixed Population of 183 College Students and Personnel

Advances in Orthopedics ◽

10.1155/2016/3817270 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

George A. Koumantakis ◽

Maria Nikoloudaki ◽

Sara Thacheth ◽

Kalliroi Zagli ◽

Konstantina Bitrou ◽

...

Keyword(s):

Sagittal Plane ◽

High Reliability ◽

Reliability And Validity ◽

Smartphone Application ◽

Quiet Standing ◽

Sacral Slope ◽

Lumbar Curve ◽

Intrarater Reliability ◽

Male And Female ◽

Spinal Posture

Accurate recording of spinal posture with simple and accessible measurement devices in clinical practice may lead to spinal loading optimization in occupations related to prolonged sitting and standing postures. Therefore, the purpose of this study was to establish the level of reliability of sagittal lumbosacral posture in quiet standing and the validity of the method in differentiating between male and female subjects, establishing in parallel a normative database. 183 participants (83 males and 100 females), with no current low back or pelvic pain, were assessed using the “iHandy Level” smartphone application. Intrarater reliability (3 same-day sequential measurements) was high for both the lumbar curve (ICC2,1: 0.96, SEM: 2.13°, andMDC95%: 5.9°) and the sacral slope (ICC2,1: 0.97, SEM: 1.61°, andMDC95%: 4.46°) sagittal alignment. Data analysis for each gender separately confirmed equally high reliability for both male and female participants. Correlation between lumbar curve and sacral slope was high (Pearson’sr=0.86,p<0.001). Between-gender comparisons confirmed the validity of the method to differentiate between male and female lumbar curve and sacral slope angles, with females generally demonstrating greater lumbosacral values (p<0.001). The “iHandy Level” application is a reliable and valid tool in the measurement of lumbosacral quiet standing spinal posture in the sagittal plane.

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Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

Journal of Neurosurgery Spine ◽

10.3171/2010.9.spine10129 ◽

2011 ◽

Vol 14 (2) ◽

pp. 184-191 ◽

Cited By ~ 64

Author(s):

Virginie Lafage ◽

Frank Schwab ◽

Shaleen Vira ◽

Robert Hart ◽

Douglas Burton ◽

...

Keyword(s):

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Sagittal Plane ◽

Pedicle Subtraction Osteotomy ◽

Sacral Slope ◽

Spinopelvic Parameters ◽

Sagittal Vertical Axis ◽

Significant Difference ◽

Spinopelvic Parameter ◽

Spinal Imbalance

Object Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to −4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = −0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = −0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = −0.358, p < 0.005). Conclusions The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

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Spinal curvatures of yoga practitioners compared to control participants—a cross-sectional study

PeerJ ◽

10.7717/peerj.12185 ◽

2021 ◽

Vol 9 ◽

pp. e12185

Author(s):

Małgorzata Grabara

Keyword(s):

Body Mass ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Sagittal Plane ◽

Body Height ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Spinal Curvatures ◽

Yoga Practitioners

Purpose The angles of thoracic kyphosis and lumbar lordosis determine the spinal alignment in the sagittal plane. The aim of this study was to compare the thoracic kyphosis and lumbar lordosis of male and female yoga practitioners with non-practicing participants and to determine the possible dependencies between sagittal spinal curvatures and somatic parameters, time spent on yoga exercise, and undertaking other physical activities in yoga practitioners. Methods The study involved 576 women and 91 men ages 18–68 years (mean = 38.5 ± 9) who were practicing yoga, and 402 women and 176 men ages 18–30 years (mean = 20.2 ± 1.3) as a control group. The angles of thoracic kyphosis and lumbar lordosis were measured using a Plurimeter-V gravity inclinometer. Results The two-way ANOVA demonstrated the influence of group (p < .0001) and sex (p = .03) on the angle of thoracic kyphosis, as well as the influence of group (p < .0001) and sex (p < .0001) on the angle of lumbar lordosis. It was noted that yoga practitioners had less pronounced thoracic kyphosis and lumbar lordosis and were more often characterized by normal or smaller thoracic kyphosis and lumbar lordosis than students from the control group. In yoga practitioners, the angle of thoracic kyphosis was positively correlated with age, body mass, BMI, and undertaking other forms of physical activity. The angle of lumbar lordosis was negatively correlated with body height and body mass. Conclusions The results suggest that yoga exercises can affect the shape of the anterior-posterior curves of the spine and may be an efficient training method for shaping proper posture in adults.

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Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-191727 ◽

2020 ◽

Vol 33 (6) ◽

pp. 1003-1014 ◽

Cited By ~ 1

Author(s):

Pilar Sainz de Baranda ◽

Pilar Andújar ◽

Mónica Collazo-Diéguez ◽

Antonio Pastor ◽

Fernando Santonja-Renedo ◽

...

Keyword(s):

Back Pain ◽

Thoracic Kyphosis ◽

Standing Position ◽

Cross Sectional Study ◽

Mean Value ◽

Spinal Alignment ◽

Cross Sectional ◽

Spinal Curvatures ◽

Sagittal Spinal Alignment ◽

The Mean

BACKGROUND: The child’s spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP). OBJECTIVE: The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children. METHODS: This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children’s parents or legal guardians filled in a questionnaire according to the children’s responses about the BP suffered in the previous week and the preceding year. RESULTS: The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009–1.160, p= 0.028). CONCLUSIONS: To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

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The Influence of the “Straighten Your Back” Command on the Sagittal Spinal Curvatures in Children with Generalized Joint Hypermobility

BioMed Research International ◽

10.1155/2017/9724021 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Dariusz Czaprowski ◽

Paulina Pawłowska ◽

Aleksandra Kolwicz-Gańko ◽

Dominik Sitarski ◽

Agnieszka Kędra

Keyword(s):

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Joint Hypermobility ◽

Control Group ◽

Sacral Slope ◽

Spinal Curvatures ◽

Generalized Joint Hypermobility ◽

Upper Thoracic

Objectives. The aim of the study was to assess the change of sagittal spinal curvatures in children with generalized joint hypermobility (GJH) instructed with “straighten your back” command (SYB).Methods. The study included 56 children with GJH. The control group consisted of 193 children. Sacral slope (SS), lumbar lordosis (LL), global thoracic kyphosis (TK), lower thoracic kyphosis (LK), and upper thoracic kyphosis (UK) were assessed with Saunders inclinometer both in spontaneous positions (standing and sitting) and after the SYB.Results. Children with GJH after SYB presented the following: in standing, increase in SS and decrease in TK, LK, and UK (P<0.01), with LL not significantly changed; in sitting: decrease in global thoracic kyphosis (35.5° (SD 20.5) versus 21.0° (SD 15.5),P<0.001) below the standards proposed in the literature (30–40°) and flattening of its lower part (P<0.001). The same changes were observed in the control group.Conclusions. In children with generalized joint hypermobility, the “straighten your back” command leads to excessive reduction of the global thoracic kyphosis and flattening of its lower part. Therefore, the “straighten your back” command should not be used to achieve the optimal standing and sitting positions.

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Body balance in a free-standing position in road and off-road cyclists

Baltic Journal of Health and Physical Activity ◽

10.2478/bjha-2014-0022 ◽

2014 ◽

Vol 6 (4) ◽

Cited By ~ 1

Author(s):

Paulina Hebisz ◽

Rafal Hebisz ◽

Marek Zaton

Keyword(s):

Sagittal Plane ◽

Standing Position ◽

The Body ◽

Free Standing ◽

Body Balance ◽

Eyes Closed ◽

Road Cycling ◽

Progressive Exercise ◽

Before And After ◽

Road Cyclists

AbstractBackground: The purpose of this study was to compare body balance in road and off-road cyclists, immediately before and after the racing season.Material/Methods: Twenty individuals participated in the study and they were divided into two groups: specialists in road-cycling (n = 10) and in off-road cycling (n = 10). Immediately before and after the five-month racing season stabilographic trials were carried out (at rest and after progressive exercise). In assessing body balance the distance and velocity of the centre shifts (in the anterior-posterior and left-right direction) were analysed. The tests were performed with the cyclists’ eyes open, eyes closed, and in feedback.Results: After the racing season, in the off-road cyclists’ group, distance and velocity of the centre of pressure shifts increased after a progressive exercise.Conclusions: In the off-road cyclists’ group the balance of the body in the sagittal plane deteriorated after the racing season. Moreover, after the racing season off-road cyclists were characterized by a worse balance of the body, compared to road cyclists

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Spinal Balance/Alignment—Clinical Relevance and Biomechanics

Journal of Biomechanical Engineering ◽

10.1115/1.4043650 ◽

2019 ◽

Vol 141 (7) ◽

Cited By ~ 4

Author(s):

Anoli Shah ◽

Justin V. C. Lemans ◽

Joseph Zavatsky ◽

Aakash Agarwal ◽

Moyo C. Kruyt ◽

...

Keyword(s):

Social Interaction ◽

Sagittal Balance ◽

Sagittal Plane ◽

The Body ◽

Optimal Configuration ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Compensatory Mechanisms ◽

Spinal Balance ◽

Spinal Imbalance

In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities—ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections—pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.

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Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

Scientific Reports ◽

10.1038/s41598-020-79523-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Scaramuzzo ◽

Antonino Zagra ◽

Giuseppe Barone ◽

Stefano Muzzi ◽

Leone Minoia ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Profile ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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