Search Results (148)

Three-dimensional surface topography offers a noninvasive alternative to radiographic imaging for evaluating trunk morphology and posture. This study aimed to establish normative values of trunk cross-sectional geometry and to examine their associations with spinal alignment in healthy young adults. A cross-sectional sample of 108 participants (62 women, 46 men; 19–23 years, normal BMI) underwent assessment using two complementary techniques: TorsoScan, which reconstructed 360° trunk cross-sections at thoracic levels T1, T4, T8, and T12, and DIERS Formetric 4D, which quantified spinal posture parameters. For each cross-section, sagittal and coronal diameters and cross-sectional areas were calculated; sex differences were analyzed using Welch’s t tests and effect sizes, and associations with posture were examined by Pearson correlations with false discovery rate correction and regression modeling. Trunk geometry followed a regular thoracic profile, with the largest coronal diameter at T4 and the maximal area at T8. Men showed consistently larger diameters and areas than women, with large effect sizes at T4–T12. Four associations remained significant: reduced mid-thoracic breadth and area were linked to greater lumbar lordosis, while upper thoracic depth correlated positively with thoracic kyphosis. Predictive models based on posture explained limited variance (R² ≤ 0.19). These findings provide sex-specific reference values and demonstrate that TorsoScan and DIERS Formetric yield complementary, partly convergent measures that may support radiation-free evaluation of trunk morphology in clinical and rehabilitative settings. Full article

We present the findings of a case showing an improvement in severe, chronic mid-back pain (MBP) and disability following sagittal correction of the thoracic spine using Chiropractic BioPhysics^® (CBP^®) spinal rehabilitation with a nine-month long-term follow-up. A 40-year-old female had suffered for years and was referred for spinal rehabilitation by her physicians and physical therapist to treat her severe, chronic MBP. The symptoms had not improved despite several months of physical therapy, traditional chiropractic spinal manipulation, and pain management trigger point injections. The pain was reported as severe and rated as 8/10 at worst on the numerical rating scale. The pain was severe enough to interfere with her normal activities including martial arts training. Postural analysis revealed increased thoracic flexion and spine hyperkyphosis. Lateral thoracic radiography showed a previously undiagnosed wedged vertebral body at T6. Mensuration of the radiograph found an increase in overall posterior tangent angulation from T3–T10 measuring 66.2°. Negative sagittal balance measured from a vertical of T3 above T10 was −16.3 mm. Treatment included Chiropractic Biophysics^® (CBP^®) orthopedic rehabilitation protocols including postural and radiographic based Mirror Image^® (MI^®) exercises, spinal manipulation, and traction. The patient was treated in-office 37 times over the course of 3 months and all initial subjective and objective outcomes were re-assessed. It was reported that the initial average pain of 8/10 for the mid-back had nearly resolved and was rated as 2/10. All ADLs were reported as pain free, including intense exercise and martial arts. Post-treatment radiography was taken following a 24 h “rest-period” and found reduction in the overall hyperkyphosis from T3–T10 now measured 45.2°. Due to the presence of the wedge vertebra, it was recommended that the patient continue home traction and exercises, and long-term follow-up was assessed at 9 months including a repeat of all initial examinations, for subjective and objective outcomes. Thoracic kyphosis was maintained at 47.7° and VAS was 0/10 at 9-month follow-up and symptoms remained nearly resolved. Full article

Background/Objectives: This case represents the successful treatment of cervical spine injury from high-speed rear-impact motor vehicle collision and abnormal cervical kyphosis with left arm radiculopathy, utilizing conservative spine care rehabilitation methods. This patient was treated with a multimodal treatment approach integrating a cervical spine extension traction protocol. Subject and Methods: A 50-year-old male with a history of motor vehicle collision presented with left arm radiculopathy, as well as cervical and upper thoracic spine pain. Notably the cervical spine presented with kyphotic deformity. The patient presented, after a being struck during a rear-end motor vehicle collision, with neck, upper back, and left arm radiculopathy. Prescription medication and traditional chiropractic care proved ineffective for substantive symptom and quality-of-life improvement. Treatment frequency was three times per week for eight weeks using the Chiropractic Biophysics^® protocol of mirror image (MI^®) postural exercise, spinal adjustment, and cervical spinal traction. On completion of in-office care, the patient was treated monthly, performed home care at least three times per week, and was re-examined at one year. Results: Final examination after eight weeks of care showed significant improvement in cervical lordosis (21.8 degrees), resulting in reduced cervical kyphosis. The patient completed outcome indices before, during, and 12 months after cessation of active care, all indicating improvement. Conclusions: This case report demonstrates both subjective and objective improvement in cervical spine kyphosis and attendant symptoms. The successful treatment of chronic pain, peripheral weakness, and radiculopathy with long-term follow-up using CBP care is documented as well. The treatment was designed to improve sagittal balance and reduce radiographic abnormalities evincing spinal misalignment. Administration of subjective, objective, and health-related quality-of-life outcome indices during, following, and 12 months post-treatment are suggestive of long-term efficacy of Chiropractic BioPhysics^® (CBP) treatment methods. Larger studies are needed to substantiate this given the limitations of a case report. Full article

Background/Objectives: Duchenne muscular dystrophy (DMD) leads to postural abnormalities and increased lumbar lordosis, which may affect gait and spinal load. This study aimed to assess the reliability of sagittal spinal curvature measurements using the Rippstein plurimeter and to analyze spinal curvature in ambulant boys with DMD compared to healthy peers. Additionally, the study examined the effect of lower limb positioning in standing on sagittal spinal alignment in boys with DMD and investigated the relationship between hip adduction and extension range and spinal alignment. Methods: The study included 42 boys with DMD and 36 healthy peers aged 5–14 years. In boys with DMD, spinal curvature was measured using the Rippstein plurimeter in two positions: feet in alignment with hip joints axis and with feet together. In healthy participants, measurements were taken in the first position only. Hip adduction and extension ranges were also assessed in both groups. Results: Plurimeter measurements demonstrated high reliability. Boys with DMD showed significantly increased cervical retraction, greater sternal deviation from the vertical, and increased lumbar lordosis compared to healthy peers. Lower limb positioning (adduction) altered sagittal spinal alignment. Hip adduction and extension ranges were decreased in the DMD group and showed a correlation with spinal alignment. Conclusions: The Rippstein plurimeter provides reliable measurements and is useful for monitoring posture in boys with DMD. Reduced hip mobility and lower limb positioning influence lumbar lordosis and should be considered in physiotherapy planning for DMD. Full article

Children with cerebral palsy (CP) have impaired standing balance ability, caused by increased muscle tone, muscle weakness, and joint deformity. It is necessary to investigate standing balance for children with CP. Compared with postural stability assessment using force plates, OpenCap has the potential to be used utilized as a cost-effective standing balance assessment tool, providing details about the center of mass (CoM) and joint angles. This study aims to evaluate the feasibility of using OpenCap for standing balance assessment in children with CP by (i) examining the validity of OpenCap-based CoM parameters against force plate center of pressure (CoP) measures and (ii) exploring associations between joint angles and CoM displacement. Twenty-two children with CP completed standing balance trials on a force plate-based balance tester while two smartphones recorded synchronized videos for OpenCap processing. For the correlation between CoM parameters and CoP parameters, Pearson’s R values were from 0.39 to 0.94 between the two systems. After correcting the CoM parameters, the R² values ranged from 0.98 to 1.00. Regarding the relationship between the joint angles and CoM, maximum and minimum sagittal angles in the ankle were corrected with CoM displacement along the x-axis. These findings suggest that OpenCap may be a potential, cost-effective tool for standing balance assessment in children with CP. Full article

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of postural and functional deficits. Methods: This cross-sectional study included a total of 494 students (8–17 years; 50% girls) from 14 schools in Murcia (Spain). Exclusion criteria included diagnosed spinal pathology or major physical injury, lack of signed informed consent, absence on the testing day, and incomplete Postural Fitness assessment. The “Postural Fitness” protocol included assessments of sagittal spinal alignment (inclinometer), hip range of motion (ROM) (inclinometer with an extendable telescopic arm), pelvic tilt (goniometer with a spirit level system), and trunk muscle endurance (chronometer). Tests were conducted in physical education sessions by trained sports scientists. Results: Significant sex-based differences were observed. Boys exhibited greater thoracic kyphosis (40.3 ± 9.6° vs. 36.7 ± 9.2°), reduced hip ROM (passive hip extension (PHE): 16.8 ± 8.1°, passive hip flexion with knee extension (PHFKE): 68.9 ± 8.6°), and more posterior pelvic tilt (104.9 ± 8.4° vs. 99.7 ± 8.1°), whereas girls demonstrated increased lumbar lordosis (35.7 ± 8.6° vs. 31.5 ± 8.5°), greater hip ROM (PHE: 18.5 ± 9°, PHFKE: 77.9 ± 13°), and superior trunk extensor endurance (123.2 ± 74.7 s vs. 106.2 ± 69.8 s). Lateral trunk muscle endurance was higher in boys (48.7 ± 31 s vs. 41.4 ± 24.9 s). Conclusions: The “Postural Fitness” protocol proved feasible in school settings and revealed key sex-based disparities in spinal and neuromuscular profiles. These findings highlight the need for individualized, sex-specific screening and preventive programs to enhance back health during growth. Implementing this protocol may support early identification of modifiable risk factors linked to spinal dysfunction and pain in youth. Full article

Objective: This study aimed to assess the dentoskeletal and postural modifications induced by treatment with the Swallowing Occlusal Contact Intercept Appliance (SOCIA III) in patients with pseudo-Class III malocclusion. The main hypothesis was that treatment with the SOCIA appliance induces significant skeletal and dentoalveolar changes in growing patients with pseudo-Class III malocclusion. Methods: Fifty-two pseudo-Class III malocclusion patients with a mean age of 8.5 were analyzed and compared with fifty-two untreated patients. Cephalometric evaluations were carried out at baseline (T0) and at the end of treatment. The cephalometric analysis comprised sagittal measurements (SNA, ANB, WITS, CB, ACB), dental variables (UI-PP, LI-MP, OVERJET, OVERBITE), and postural parameters (SNBa and cranio-cervical angle of the maxilla). Within-group comparisons at baseline (T0) and post-treatment (T1) were performed using the paired t-test or the Wilcoxon signed-rank test. Inter-group comparisons were based on the differences in variables between the two time points (ΔT1–T0), using the independent samples t-test or the Mann–Whitney U test. Results: At the end of treatment with the SOCIA appliance, significant improvements were observed in the ANB angle (0.61° to 2.06°, p = 0.001), SNA (81.56° to 83.26°, p = 0.006), WITS appraisal (−0.75 mm to 1.24 mm, p = 0.001), ACB angle (9.35 mm to 11.45 mm, p = 0.05), CB (64.78 mm to 65.51 mm, p = 0.03), and SNBa angle (127.57° to 129.14°, p = 0.01), as well as in overjet (0.62 mm to 3.60 mm, p = 0.001) and overbite (0.29 mm to 1.82 mm, p = 0.001). Conclusions: The SOCIA III appliance is effective in correcting pseudo-Class III malocclusion in growing patients by improving skeletal and dentoalveolar relationships. Full article

Background/Objectives: Dental professionals engage in a variety of dental procedures within a confined workspace that is often challenging to access and navigate. This environment frequently results in static, asymmetrical, and inappropriate postures, which can lead to muscular imbalances and cause pain or damage to the musculoskeletal system. Such issues can adversely affect the dental workforce, resulting in increased absenteeism, reduced productivity, disability, and premature retirement from the profession. Therefore, the objective of this study was to develop and evaluate the performance of an Artificial Intelligence (AI)-based deep learning model designed to assess dental ergonomics. Methods: An AI-based Dental Ergonomic Posture Assessment Model [SBK-DentErgo] was developed through the strategic integration of YOLOv11 and MediaPipe. Model training and validation were conducted using 500 photographs of dental professionals performing procedures on patients, captured from both frontal and sagittal planes. In the initial phase of the study, two calibrated evaluators assessed 50 photographs, demonstrating excellent agreement. In the subsequent phase, five dental specialists, along with the AI model, evaluated the same set of photographs, and the results were recorded. Results: AI-based model demonstrated excellent agreement with that of calibrated evaluators (Kappa = 0.922, p = 0.000). The reliability of AI-based scores was also consistent (ICC = 1.000, p = 0.000). Human evaluation of ergonomic posture exhibited very low sensitivity (20.5%) compared to AI, which showed very high sensitivity (97%). The specificity of human evaluation was also extremely low (9.1%) in contrast to AI (85.7%). The AI model (AUC = 0.917, 95% CI 0.762–1.000) could serve as the ‘gold standard’ in evaluating dental operator ergonomics. Conclusions: This AI model demonstrated exceptional performance in evaluating the working postures of dental professionals, surpassing experienced specialists in both sensitivity and specificity. The model provides real-time feedback, enabling dentists to conduct self-assessments and correct their posture immediately, thereby preventing postural issues. Full article

Orthoses are a vital part of treating gait disorders, especially in children and adolescents with neurological and neuromuscular conditions. For proper walking, the supporting leg must be stable to allow the other leg to swing forward and take a step. Stability is also essential for motor development. This stability depends on the inclination of the tibia, which needs to be kept upright during mid-stance in both the sagittal and coronal planes. Controlling the load axis in all planes and the foot in the transverse plane helps maintain proper tibial control. More studies are now examining the effects different orthoses and designs. While much focus has been on the sagittal plane, there is much less information about how orthoses influence the coronal plane or foot control. As a result, there is limited guidance from the existing literature. Children who find it hard to express discomfort or negative effects may simply reject orthoses altogether. This paper explains how important proper tibia inclination and control on the load axis are in all planes and how they affect stability. The foot acts as a lever for the gastrosoleus muscle, which controls the tibia. In case of foot instability or deformity, the foot requires support that takes into account the changing load when walking. I also emphasize that these points are regularly considered when studies are reported. Full article

Accurate gait assessment is essential for managing pathological locomotion, especially in elderly patients recovering from hip joint surgeries. Inertial measurement units (IMUs) provide real-time, objective data in clinical settings. This study examined pelvic oscillations in sagittal, frontal, and transverse planes using a wearable IMU system in two groups: Group A (n = 15, osteosynthesis metallica) and Group B (n = 34, arthroplasty), all over age 65. Gait analysis was conducted during assisted and unassisted walking. In the frontal plane, both groups showed statistically significant improvements: Group A from 46.4% to 75.2% (p = 0.001) and Group B from 52.6% to 72.2% (p = 0.001), reflecting enhanced lateral stability. In the transverse plane, Group A improved significantly from 47.7% to 80.2% (p = 0.001), while Group B showed a non-significant increase from 73.0% to 80.5% (p = 0.068). Sagittal plane changes were not statistically significant (Group A: 68.8% to 71.1%, p = 0.313; Group B: 76.4% to 69.1%, p = 0.065). These improvements correspond to better pelvic symmetry and postural control, which are critical for a safe and stable gait. Improvements were more pronounced during unassisted walking, indicating better pelvic control. These results confirm the clinical utility of IMUs in capturing subtle gait asymmetries and monitoring recovery progress. The findings support their use in tailoring rehabilitation strategies, particularly for enhancing frontal and transverse pelvic stability in elderly orthopedic patients. Full article

Objectives: To comprehensively examine the association between spinopelvic alignment and muscle shortening in healthy young men, focusing on the individual and interactive effects of thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt using SHapley Additive exPlanation (SHAP) analysis. Methods: Forty-one healthy young adult men participated in this cross-sectional study. Thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt were measured using a flexible curve ruler and inclinometer. Muscle length indices for six muscles (iliopsoas, rectus femoris, gluteus maximus, hamstrings, back extensors, and abdominals) were assessed via standardized physical examinations and image analysis. A machine learning model was developed, and SHAP analysis applied to determine individual and interactive contributions of spinopelvic angles to each muscle length index. Results: SHAP analysis showed that hip-related muscle shortening (iliopsoas, rectus femoris, hamstrings, gluteus maximus) was influenced by both individual alignments and interactions, especially between thoracic kyphosis and lumbar lordosis. Lumbar lordosis was most associated with iliopsoas shortening (SHAP = −0.09), while anterior pelvic tilt was linked to hamstring shortening (SHAP = −0.30). Thoracic kyphosis was the key factor for rectus femoris shortening (SHAP = −0.05). Interactive effects exceeded individual contributions for the rectus femoris, gluteus maximus, and hamstrings. In contrast, spinal alignment had minimal influence on the back extensors and abdominals. Conclusions: Both individual and intersegmental spinal alignments are associated with muscle shortening, particularly in hip-related muscles. The interaction between thoracic kyphosis and lumbar lordosis plays a pivotal role. These findings underscore the importance of evaluating segmental spinal interactions when assessing muscle flexibility and posture. Full article

Background/Objectives: Prolonged sitting is linked to musculoskeletal discomfort, yet optimal sitting posture remains poorly defined, and the consistency with which individuals reproduce specific sitting strategies is unclear. This study examined postural variability across three sitting strategies—comfortable, habitual, and correct—using three common chair types: a stool, computer chair, and ergonomic chair. Methods: Thirty healthy young adults (fifteen men, fifteen women) participated. Global sagittal joint angles—head inclination (HI), trunk angle (TA), and knee angle (KA)—were measured using a motion analysis system across five repetitions per condition. Results: The chair type significantly influenced HI and TA (p < 0.001), with ergonomic chairs encouraging more upright trunk postures. The sitting strategy significantly affected TA and KA (p < 0.01), with comfortable sitting associated with more extended angles. Women exhibited greater TA (114.8° vs. 109.0°, p < 0.001) and lower within-subject variability. Substantial postural variability was observed across all conditions, with mean ranges exceeding minimum detectable change thresholds for HI (10.3°), TA (6.9°), and KA (11.3°). Notably, correct sitting reduced KA variability compared to other strategies (p < 0.01). Conclusions: These findings highlight the individualized and variable nature of sitting posture, even under controlled instructions. The results question the reliability of memory-based seat adjustments and emphasize the need for dynamic, user-centered ergonomic design and personalized clinical guidance to support musculoskeletal health. Full article

This study aims to develop and evaluate a cycling-specific marker protocol that minimises the number of markers while accounting for the unique biomechanics of cycling. Although movements in the frontal and transverse planes during cycling are limited, they are clinically relevant due to their association with overuse injuries. Existing gait-based marker protocols often fail to consider cycling-specific factors such as posture, range of motion, marker occlusion, and muscle-induced artifacts. The proposed protocol (PP) uses 15 physical and 8 virtual markers. In the absence of a gold standard for 3D pedalling kinematics, the PP was evaluated by comparing it with established gait analysis protocols. The protocol demonstrated high correlation in gait (CCC > 0.98 for hip and knee in the sagittal plane), low intra-subject variability (CV < 15% for hip, knee, and ankle), and high repeatability. During pedalling, position, velocity, and acceleration were measured in all three spatial directions. Notably, angular velocity and linear acceleration showed significant components outside the sagittal plane, particularly for angular velocity. These findings highlight the importance of considering 3D motion when estimating forces, joint moments, and joint-specific powers in cycling biomechanics. Full article

Background/Objectives: Accurate postural assessment is essential for managing musculoskeletal disorders; however, routine screening is often limited by radiation exposure, cost, and accessibility constraints of radiography. Recent advances in artificial intelligence (AI) have enabled automated, marker-free analysis using two-dimensional photographs. This study evaluated the validity and reliability of MORA Vu, an AI-based posture estimation software, against radiographic parameters. Methods: A prospective pilot study was conducted with 72 participants, divided equally into the cervical and lower-limb alignment groups. Forward head posture (FHP) and digital hip–knee–ankle (DHKA) angles were measured using MORA Vu and compared with corresponding radiographic parameters. Three healthcare professionals independently conducted the AI-based assessments. Correlations were analyzed, and interrater reliability was assessed using the intraclass correlation coefficient (ICC). Results: FHP showed the strongest correlation with the craniovertebral angle (r = −0.712) and C2–7 sagittal vertical axis (r = 0.704). The DHKA angle strongly correlated with the radiographic hip–knee–ankle angle (r = 0.754). Interrater reliability demonstrated high agreement (ICC: 0.84 FHP, 0.90 DHKA). Conclusions: MORA Vu demonstrated strong validity and high reliability, supporting its potential as a noninvasive screening tool for postural assessment. Given its accessibility and radiation-free nature, it may serve as a viable alternative for routine postural evaluation. Full article

Spinal deformities, particularly thoracolumbar kyphosis, affect approximately one-third of patients with Parkinson’s disease (PD) and significantly impair their quality of life and mobility. Conventional treatments, including levodopa and surgical interventions, have limited efficacy, necessitating alternative therapies. In this report, a 76-year-old woman with PD and severe thoracolumbar kyphosis (TK: 77.7°; sagittal vertical axis [SVA]: 95.55 mm) experienced postural instability and gait impairment. She underwent integrative postural rehabilitation (acupuncture, pharmacopuncture, Chuna spinal manual therapy, thermotherapy, and bodyweight exercises). A 4-week inpatient treatment improved spinal alignment (TK: 61.1°; SVA: 77.84 mm), gait, postural stability (MDS-UPDRS score improved by 3 points), and functional outcomes, with reductions in the Oswestry Disability Index (70 to 31) and pain severity (Numeric Rating Scale: 50 to 40). No adverse events were observed. Integrative postural rehabilitation can mitigate paraspinal muscle atrophy and fatty infiltration by promoting protein synthesis, neurotrophic factor expression, and proprioceptive neuromodulation. Our literature review suggests that proprioceptive stimulation and exercise enhances postural stability and gait, aligning with the outcomes of this case. This report suggests that integrative rehabilitation may improve kyphotic deformities and related motor dysfunctions in patients with PD. Further research is warranted to validate the treatment’s efficacy and long-term benefits. Full article