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Prevalence of postural deviations and associated factors in children and adolescents: a cross-sectional study


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Introduction: Postural deviations are frequent in childhood and may cause pain and functional impairment. Previously, only a few studies have examined the association between body posture and intrinsic and extrinsic factors. Objective: To assess the prevalence of postural changes in school children, and to determine, using multiple logistic regression analysis, whether factors such as age, gender, BMI, handedness and physical activity might explain these deviations. Methods: The posture of 288 students was assessed by observation. Subjects were aged between 6 and 15 years, 59.4% (n = 171) of which were female. The mean age was 10.6 (± 2.4) years. Mean body weight was 38.6 (± 12.7) kg and mean height was 1.5 (± 0.1) m. A digital scale, a tapeline, a plumb line and standardized forms were used to collect data. The data were analyzed descriptively using the chi-square test and logistic regression analysis (significance level of 5%). Results: We found the following deviations to be prevalent among schoolchildren: forward head posture, 53.5%, shoulder elevation, 74.3%, asymmetry of the iliac crests, 51.7%, valgus knees, 43.1%, thoracic hyperkyphosis, 30.2%, lumbar hyperlordosis, 37.2% and winged shoulder blades, 66.3%. The associated factors were age, gender, BMI and physical activity. Discussion: There was a high prevalence of postural deviations and the intrinsic and extrinsic factors partially explain the postural deviations. Conclusion: These findings contribute to the understanding of how and why these deviations develop, and to the implementation of preventive and rehabilitation programs, given that some of the associated factors are modifiable.
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Fisioter Mov. 2016 Oct/Dec;29(4):777-85
ISSN 1980-5918
Fisioter. Mov., Curitiba, v. 29, n. 4, p. 777-785, Oct./Dec. 2016
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Prevalence of postural deviations and associated factors
in children and adolescents: a cross-sectional study
Prevalência de variações posturais e fatores associados
em crianças e adolescentes: um estudo transversal
Mariana Vieira Batistão, Roberta de Fátima Carreira Moreira, Helenice Jane Cote Gil Coury,
Luis Ernesto Bueno Salasar, Tatiana de Oliveira Sato*
Universidade Federal de São Carlos, (UFSCar), São Carlos, SP, Brazil
Introduction: Postural deviations are frequent in childhood and may cause pain and functional impairment.
Previously, only a few studies have examined the association between body posture and intrinsic and extrinsic
factors. Objective: To assess the prevalence of postural changes in school children, and to determine, using
multiple logistic regression analysis, whether factors such as age, gender, BMI, handedness and physical ac-
tivity might explain these deviations. Methods: The posture of 288 students was assessed by observation.
Subjects were aged between 6 and 15 years, 59.4% (n = 171) of which were female. The mean age was 10.6 (±
2.4) years. Mean body weight was 38.6 (± 12.7) kg and mean height was 1.5 (± 0.1) m. A digital scale, a tapeli-
ne, a plumb line and standardized forms were used to collect data. The data were analyzed descriptively using
the chi-square test and logistic regression analysis (signiicance level of 5%). Results: We found the following
deviations to be prevalent among schoolchildren: forward head posture, 53.5%, shoulder elevation, 74.3%,
asymmetry of the iliac crests, 51.7%, valgus knees, 43.1%, thoracic hyperkyphosis, 30.2%, lumbar hyperlor-
dosis, 37.2% and winged shoulder blades, 66.3%. The associated factors were age, gender, BMI and physical
activity. Discussion: There was a high prevalence of postural deviations and the intrinsic and extrinsic factors
partially explain the postural deviations. Conclusion: These indings contribute to the understanding of how
*MVB: Doctoral student, e-mail:
RFCM: PhD, e-mail:
HJCGC: PhD, e-mail:
LEBS: PhD, e-mail:
TOS: PhD, e-mail:
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Batistão MV, Moreira RFC, Coury HJCG, Salasar LEB, Sato TO.
and why these deviations develop, and to the implementation of preventive and rehabilitation programs, given
that some of the associated factors are modiiable.
Keywords: Disease Prevention. Low Back Pain. Posture.
Introdução: Variações posturais são frequentes na infância e podem causar dor e prejuízo funcional. Embora
a prevalência de variações posturais em crianças já tenha sido avaliada, poucos autores investigaram a asso-
ciação entre a postura e fatores intrínsecos e extrínsecos. Objetivo: Avaliar a prevalência de variações posturais
em crianças e adolescentes e identiϔicar fatores explicativos para estas variações, dentre eles: idade, gênero,
dominância manual, índice de massa corporal (IMC) e atividade ϔísica, por meio da análise de regressão logísti-
ca múltipla. Métodos: A postura de 288 estudantes foi avaliada de forma observacional. Os sujeitos tinham
idades entre 6 a 15 anos, sendo 171 (59,4%) do sexo feminino. A idade média foi de 10,6 (2,4) anos, massa
corporal de 38,6 (12,7) kg e altura de 1,5 (0,1) m. Utilizou-se balança digital, ϔita métrica, ϔio de prumo e for-
mulários padronizados. Os dados foram analisados descritivamente, com o teste de Qui-quadrado e regressão
logística (nível de signiϔicância - 5%). Resultados: A prevalência de anteriorização da cabeça foi de 53,5%;
elevação do ombro 74,3%; assimetria entre as cristas ilíacas 51,7%; joelhos valgos 43,1%; hipercifose torácica
30,2%; hiperlordose lombar 37,2% e 66,3% de escápulas aladas. Os fatores associados foram idade, sexo, IMC
e não realização de atividade ϔísica. Discussão: A prevalência de variações posturais foi alta. Os fatores escolhi-
dos explicam parcialmente as variações posturais. Conclusão: Esses achados contribuem para a compreensão
do desenvolvimento destas variações e para a proposição de programas preventivos e de reabilitação, conside-
rando que entre os fatores analisados, alguns são modiϔicáveis.
Palavras-chave: Prevenção de Doenças. Dor Lombar. Postura.
Good posture is a state of equilibrium of body
segments, in a position of least effort and maximum
support (1, 2). In children, whole body posture is in-
luenced by physical development, which depends on
nutritional, congenital and environmental factors (1).
Many postural deviations originate in childhood
and adolescence (2). Some of them are common in
children of the same age group and are considered
to be a response of the body to the demands of grav-
ity (3, 4). They are usually corrected spontaneously
with the development of muscle strength (1, 5, 6).
However, if they persist, they will lead to joint over-
load, causing discomfort and functional impairment
According to several studies, common postural
deviations found in at least 50% of healthy children
include poor formation of the longitudinal arch of the
foot; knee hyperextension and valgus; medial rotation
of the hip; pelvic anteversion; pelvic tilt; abdominal
protrusion; lumbar hyperlordosis; winged shoulder
blades; protruding shoulders; thoracic hyperkypho-
sis; and shoulder elevation (1, 3, 5, 7, 8, 9, 10).
It is important to diagnose postural deviations in
children, because their skeletal system is still sus-
ceptible to changes and poor posture is more easily
corrected at this stage of development (11, 12). Thus,
postural assessment should become a common prac-
tice in schools, in order to early detect and treat pos-
tural deviations in students (4). Besides this, schools
have the potential to develop children´s knowledge
and skills and to help them learn how to live a healthy
life (13, 14).
Postural assessment is a complex procedure, be-
cause it takes into account many intrinsic and extrin-
sic factors that can inluence an individual´s posture,
such as the environment, his/her social, cultural and
emotional status, physical activity, obesity, physio-
logical developmental disorders, sexual maturation,
gender and heredity (15).
Although many authors have investigated the
prevalence of postural deviations in children, only
few studies have examined the association between
body posture and intrinsic and extrinsic factors.
Arruda (16) has studied the association between
postural deviations and obesity in children aged 8-10
years. Detsch e Candotti (4) have found an associa-
tion between age and postural deviations in girls.
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Prevalence of postural deviations and associated factors in children and adolescents
Detsch et al. (3) have studied the association between
the postural deviations and type of school (public or
private), parental education, age, body mass index
(BMI) and body postures adopted in everyday situ-
ations. Penha et al. (9) have studied the association
between age and postural deviations. However, the
aforementioned studies have only used association
tests. Multiple logistic regression analysis, which al-
lows the simultaneous assessment of multiple factors
and can help understand the inluence of these fac-
tors upon postural deviations, has not been reported.
Thus, the objectives of this study were to deter-
mine the prevalence of postural deviations in school-
children aged 6 - 15 years, and to identify, using mul-
tiple logistic regression analysis, whether factors such
as age, gender, BMI, hand dominance and physical
activity are associated with these deviations.
Subjects and study site
All 1st to 8th graders from a public school in São
Carlos, SP, Brazil, were invited to participate in the
study. The selection criteria were: 1. formal consent
from a parent or legal guardian; 2. being in good
health at the time of the investigation; and 3. no
detected or reported neuromuscular, rheumatic or
metabolic disorders.
Three hundred and four (41.3%) of a total of 739
students enrolled at the school returned a signed con-
sent form and were then assessed. Of these, 16 were
excluded because they did not complete the assessment
procedures. Thus, the inal sample consisted of 288 stu-
dents whose characteristics are depicted in Table 1.
Table 1 - Participants' Anthropometric Data (mean ±
standard deviation)
Gender Female
(n = 171)
(n = 117)
(N = 288)
Age (years) 10.6 ± 2.4 10.5 ± 2.6 10.6 ± 2.4
Body mass
(kg) 39.1 ± 12.3 38.0 ± 13.2 38.6 ± 12.7
Height (m) 1.5 ± 0.1 1.5 ± 0.2 1.5 ± 0.1
Body mass
index (kg/
18.2 ± 3.5 17.5 ± 3.0 17.9 ± 3.3
This study met the criteria established by Resolution
196/96 of the National Health Council and was ap-
proved by the Research Ethics Committee of the Federal
University of São Carlos (CAAE 0124.0.135.000-08,
opinion 039/2009).
The following equipments were used in this study:
plumb line, rotating platform, tapeline (with an ac-
curacy of 5 mm) and digital scale (G Life®, maximum
180kg with an accuracy of ± 100 gram).
The researchers completed a questionnaire with
personal information such as age, gender, handed-
ness and physical activity, based on the students'
self-reports. After the interview, the children were
asked to change into bathing suits, so that the weight
of their clothes was not added to their weight and
we could get a better visualization of their body seg-
ments. Students' weight and height measurements
were then collected. Body mass was measured us-
ing a digital anthropometric scale, while height was
measured to the nearest 5 mm with a tapeline.
For the postural assessment, the children were
asked to step onto a rotating platform in front of one
of the researchers. Their feet should be about hip-
width apart and pointing straight ahead. Students
were instructed to stand still in a relaxed posture,
looking forward. A researcher rotated the platform
in order to prevent changes in position due to move-
ment by the subjects. Figure 1 shows a subject stand-
ing on the platform.
Note: Source: authors.
Figure 1 - Student standing on the rotating platform and
beside a plumb line for postural assessment.
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Batistão MV, Moreira RFC, Coury HJCG, Salasar LEB, Sato TO.
hemi-parts must be exactly symmetrical and, hypo-
thetically offset one another. In the side view, the
plumb line projection represents the gravity line in
the frontal plane. The plumb line ends slightly in front
of the lateral malleolus and also passes through most
of the bodies of the cervical and lumbar vertebrae
and the shoulder joint and slightly posterior to the
frontal transverse axis of the hip joint. The presence
of postural deviations was determined according to
the positioning of the aforementioned structures in
relation to the plumb line.
Data Analysis
The data were analyzed descriptively by calculat-
ing the proportion of individuals who had postural
deviations according to age, gender, body mass index
(BMI), handedness and physical activity.
BMI data were categorized as underweight (U), eu-
trophic (E), overweight (O) and obese (Ob), according to
the BMI curves by age provided by the North American
Center for Disease Control and Prevention (20).
Students were divided into three age groups. The
choice of these age groups was based on the litera-
ture, so that the irst group (6 - 9 years) was the pre-
puberty age group; the second group (10 - 12) was
the female puberty age group and the third group
(13 - 15) was the male puberty age group (21, 22).
The statistical analysis was performed using
the Statistical Package for Social Sciences software
(SPSS). Multivariate analysis of variance was pre-
ceded by univariate analyses to identify signiicant
associations (P < 0.05) between the response variable
and the factors. Univariate analysis was performed
using the chi-square association test (χ2).
The response variables used in the logistic regres-
sion analysis were all the postural deviations listed
above and explanatory variables were age, gender,
BMI, handedness and physical activity. We used a
logistic regression model with logit link function for
each postural deviation (response variable). For the
selection of important variables, we used the step-
wise selection method. All tests were two-tailed with
the level of signiicance set at 5%.
The sample size calculation was based on data on
the prevalence of postural variations, considering a
signiicance level of 5% and power of 80%. The ob-
tained sample was big enough for all postural devia-
tions analyzed, except elevation of the shoulders, for
which the calculation indicated a sample size of 340
Postural Assessment
When assessing posture, direct (quantitative)
measurements are comparatively more accurate than
subjective (qualitative) measurements (17). Direct
measurement methods include radiography and
software-based measuments (such as the ones us-
ing the Postural Assessment Software [PAS/SAPO]).
However, these types of assessments are more com-
plex, more time consuming, and restricted to certain
body parts (PAS/SAPO) and expose the subject to
radiation (radiography) (18, 19).
Qualitative assessment is more widely used in
clinical settings and more feasible for assessments in
larger sample sizes because it is more affordable, less
complex and requires less preparation of the study
site (9). For these reasons, qualitative assessment
was the method of choice for this study.
Two physical therapists and two senior Physical
Therapy students conducted the postural assess-
ments. Thus, all evaluators had the required train-
ing to perform the tasks of the assessments. In addi-
tion, a speciic eight-hour training was held for the
evaluators, in order to ensure the standardization of
data collection. The training consisted of discussing
the assessment form, deining the postural devia-
tions that would be analyzed and carrying out joint
assessments. Divergences during the assessments
were solved by consensus. Intra-evaluator reliability
was previously tested in 10 subjects and the results
showed an 80% agreement among measures.
The assessment was conducted by observation,
and the data for each subject were recorded on stan-
dardized assessment forms. Posture assessment was
performed in the anterior, posterior and lateral (right
and left) views. We identiied the main postural de-
viations in each view. In anterior view, we assessed
elevation of the shoulders, elevation of the iliac crests
and valgus knees. In the side view, we assessed for-
ward head posture, thoracic hyperkyphosis and lum-
bar hyperlordosis. Finally, in the posterior view, we
assessed the presence of winged shoulder blades.
Postural assessments were conducted using theo-
retical guidelines from Kendall et al. (1). According to
these authors, in the posterior view, a plumb line can
represent the gravity line in the mid-sagittal plane.
Thus, it should ideally go between the legs from the
midpoint between the heels, in the midline of the
pelvis, over the spine and the center of the skull base.
Also according to these guidelines, the right and left
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Prevalence of postural deviations and associated factors in children and adolescents
subjects. As the literature states with reference to the
adequacy of the sample size that at least 25 individu-
als should be included for each predictor variable, the
required sample size for multiple logistic regression
analysis was met (23).
Tables 2 and 3, respectively, show the prevalence of
postural deviations according to the factors analyzed and
the logistic regression results for signiicant associations.
Table 2 - Prevalence of postural deviations [n (%)] according to age, gender, body mass index and physical activity. Values
in bold indicate a significant association (in the chi-square test [2]) between the response variable (postural devia-
tion) and the factor
Shoulder elevation Elevation of the iliac
crest Valgus
Factors (n) RLRL
Age (years)
6 - 9 104 37 (35.6) 32 (30.8) 34 (32.7) 25 (24.0) 15 (14.4) 47 (45.2) 83 (79.8)
10 - 12 119 69 (58.0) 49 (41.2) 44 (37.0) 48 (40.3) 16 (13.4) 54 (45.4) 78 (65.5)
13 - 15 65 48 (73.8) 17 (26.2) 38 (58.5) 25 (38.5) 20 (30.8) 23 (35.4) 30 (46.2)
Female 171 94 (55.0) 36 (30.8) 47 (40.2) 39 (33.3) 22 (18.8) 79 (46.2) 102 (59.6)
Male 117 60 (51.3) 62 (36.3) 69 (40.4) 59 (34.5) 29 (17.0) 45 (38.5) 89 (76.1)
UW 27 18 (66.7) 11 (40.7) 9 (33.3) 11 (40.7) 7 (25.9) 9 (33.3) 24 (88.9)
Normal weight 217 120 (55.3) 73 (33.6) 89 (41.0) 78 (35.9) 41 (18.9) 86 (39.6) 153 (70.5)
Overweight 22 10 (45.5) 8 (36.4) 10 (45.5) 6 (27.3) 1 (4.5) 12 (54.5) 8 (36.4)
Obese 22 6 (27.3) 6 (27.3) 8 (36.4) 3 (13.6) 2 (9.1) 17 (77.3) 6 (27.3)
Yes 103 61 (59.2) 27 (26.2) 46 (44.7) 42 (40.8) 16 (15.5) 31 (30.1) 75 (72.8)
No 185 93 (50.3) 71 (38.4) 70 (37.8) 56 (30.3) 35 (18.9) 93 (50.3) 116 (62.7)
Note: BMI: Body mass index; UW: underweight; PA: physical activity.
Table 3 - Multiple logistic regression results of postural deviations in relation to the factors associated with them in the
univariate analysis
Postural deviations
Factors Forward head
posture Shoulder elevation Elevation of the
iliac crest
OR 95% CI p OR 95% CI p OR 95% CI P
10-12 0.18 0.09-0.34 0.000 1.74 1.16-2.59 0.007 0.23 0.12-0.44 0.000
13-15 0.47 0.25-0.87 0.016 3.58 2.32-5.52 0.000 0.44 0.24-0.81 0.009
Male - - - - - - - - -
Normal 7.14 2.64-9.31 0.000 - - - 6.14 2.32-6.26 0.000
Overweight 3.03 1.78-5.16 0.000 - - - 2.80 1.66-4.71 0.000
Obese 2.18 0.81-5.85 0.124 ---
1.08 0.39-2.98 0.882
No-- -- - ----
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Batistão MV, Moreira RFC, Coury HJCG, Salasar LEB, Sato TO.
There was a high prevalence of postural deviations
in the sample studied. 53.5% of the 288 subjects had
forward head posture; 74.3% had shoulder elevation;
51.7% had iliac crest elevation; 43.1% had valgus knees;
30.2% had thoracic hyperkyphosis; 37.2% had lumbar
hyperlordosis; and 66.3% had winged shoulder blades.
The prevalence of thoracic hyperkyphosis and
lumbar hyperlordosis were not associated with any
of the analyzed factors. For this reason, they are not
shown in Table 2. The same is true for handedness,
which was not signiicantly associated with any of
the postural deviations recorded.
The prevalence of winged shoulder blades was
found to decrease with age
(OR = 1.6), while the prevalence of forward head
posture (OR = 0.5), shoulder elevation (OR = 3.6)
and iliac crests elevation (OR = 0.4) were found to
be higher in the age group 13 - 15 years.
With regard to gender, we found a signiicant as-
sociation only between gender and winged shoulder
blades (OR = 0.3). Male students had a higher preva-
lence of this postural deviation.
BMI was also associated with postural deviations. The
forward head posture, elevation of the iliac crests, valgus
knees and winged shoulder blades were associated with
lower BMI, while the prevalence of valgus knee was asso-
ciated with higher BMI. Physical activity was signiicantly
associated with lower prevalence of valgus knees.
Regression analysis showed that winged shoul-
der blades were associated with factors such as age,
gender and BMI, with R2= 0.34. The other postural
deviations were less prevalent in the sample, ranging
from 7-16%.
This study aimed to assess the prevalence of postural
deviations in children and adolescents, and to identify,
using multiple logistic regression analysis, whether
factors such as age, gender, BMI, hand dominance and
physical activity are associated with these deviations.
The results indicated a high prevalence of postural de-
viations among schoolchildren, especially forward head
posture (53.5%), shoulder elevation (74.3%), iliac crest
elevation (51.7%), valgus knees (43.1%), thoracic hy-
perkyphosis (30.2%), lumbar hyperlordosis (37.2%),
and winged shoulder blades (66.3%).
Table 3 - Multiple logistic regression results of postural deviations in relation to the factors associated with them in the
univariate analysis
Hosmer and Lemeshow
2=3.196; p=0.535; R2=0.162
Hosmer and Lemeshow
2=31.154; p=0.000; R2=0.068
Hosmer and Lemeshow
2=2.694; p=0.747; R2=0.136
Postural deviations
Factors Valgus knees Winged shoulder
Age OR 95% CI p OR p
10-12 - - - 3.51 0.000
13-15 - - - 1.56 0.152
Male - - - 0.33 0.000
Normal 0.27 0.11-0.66 0.004 7.10 0.004
Overweight 0.38 0.25-0.57 0.000 2.85 0.000
Obese 0.72 0.29-1.78 0.482 0.54 0.254
No 2.37 1.49-3.77 0.000 - -
Hosmer and Lemeshow
2=3.196; p=0.535; R2=0.162
Hosmer and Lemeshow
2=31.154; p=0.000; R2=0.068
Note: BMI: Body mass index; PA: physical activity
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Prevalence of postural deviations and associated factors in children and adolescents
Postural deviations usually occur in children of the
same age group and most often do not require treat-
ment (24, 25). Such deviations come in response to
different balance requirements and different growth
rates of body segments (1, 5). When the body reaches
maturity, the balance of forces and the proportional
growth of body structures generally lead to regres-
sion of postural deviations (1).
In this study, we found an association among age,
BMI and forward head posture. The literature has
reported that younger children have greater degrees
of forward head posture (9). From a musculoskel-
etal standpoint, more mature children compensate
in other regions of the spine and hip, minimizing ab-
normalities in the alignment of the head in relation
to the trunk. However, in this study, the prevalence of
forward head posture was higher in the age group of
13 to 15 years. It can be assumed that this change has
been inluenced by environmental factors. A previous
study (26) has assessed the posture of elementary
schoolchildren during classes and its relation to the
inadequacy of the school furniture. The results have
shown that 38% of the tables and 50% of the seats
were too low for older students (8th graders). Thus,
these children had to maintain a head and trunk lex-
ion posture most of the time. Furthermore, the same
study has shown that at least 10% of the time the
lexion postures adopted were close to 30 degrees,
posing risks to the children's health. Since children
generally spend 30% of their awake time at school,
the development of postural deviations may be as-
sociated with positions adopted in the classroom.
Shoulder elevation was associated with increased
age. This indicates that this postural change arises
during the growth phase, possibly due to the differ-
ent growth rates of body segments. This asymmetry
can also be associated with differences in overload
between body sides, which is caused by external fac-
tors such as improper carrying of school supplies and
asymmetrical sitting posture (9, 27). However, this
postural change was not associated with handedness,
although it was expected that the handedness might
be associated with an elevation of the contralateral
shoulder (1).
This study found that a high BMI and lack of physi-
cal activity were associated with higher prevalence
of valgus knee, which is in line with the literature
(11, 25). Also, according to these authors, these two
factors may be interrelated. Most of the study par-
ticipants who regularly performed physical activity
did not have valgus knees. Since the most frequent
physical activity is soccer, it can be assumed that the
practice of this sport, which predominantly involves
striking the ball with the medial aspect of the foot,
might contribute to reduce of knee valgus loading.
Resende et al. (28) have assessed 128 14-17-year-old
boys who played and who did not played soccer. The
authors have found that those boys who played soccer
regularly had a prevalence of varus knees as high as
67.7% and a prevalence of valgus knees as high as
21.5%. School boys who did not play soccer regularly
had a prevalence of varus knees and valgus knees as
high as 30.1% and 52.4%, respectively.
On the other hand, physical activity might also
be associated with lower body mass, which, in turn,
is also associated with a lower prevalence of valgus
knees. Silva et al. (10) have compared 24 obese and
nonobese 9-17-year-old children and found a preva-
lence of knee deviations of 81.2% among obese chil-
dren and of 22.2% among nonobese children.
According to the literature, valgus knees physi-
ologically occur at age two years and reach peak in-
cidence at age three years. The emergence of these
deviations is associated with the search for a greater
support base and for a greater balance when a child
practices new movement strategies to improve his
walking ability. From six to eight years of age this
postural change tends to regress as a result of internal
tibial torsion, longitudinal growth of the femur and
disappearance of the inner tigh fat pad (5).
Obesity causes overload because of the overweight
on the lower limbs, and leads to increased pelvic ante-
version causing internal rotation of the hips. Especially
in childhood, these factors, associated with the accu-
mulation of fat in the inner thighs and the search for a
greater support base, cause the malleoli to move apart.
This, in turn, results in the opening of the medial com-
partment and increased pressure in the lateral knee
compartment. With time and development, uneven
growth occurs between the two compartments, lead-
ing to the emergence of a permanent valgus deformity
of the knee (5, 29). In this study, we found an associa-
tion between obesity and valgus knees, which indicates
the need for preventive measures.
The prevalence of thoracic hyperkyphosis was not
signiicantly associated with any of the assessed fac-
tors. Penha et al. (11) have found an increased preva-
lence of hyperkyphosis with increasing age. Thoracic
hyperkyphosis was found in 21% of girls aged 7 years,
27% of girls aged 8 years, 45% of girls aged 9 years and
Fisioter Mov. 2016 Oct/Dec;29(4):777-85
Batistão MV, Moreira RFC, Coury HJCG, Salasar LEB, Sato TO.
rehabilitation programs should take these aspects into
account, in order to avoid adult structural problems that
can be prevented in childhood and adolescence.
Kendall FP, Mccreary EK, Provance PG. Músculos
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42% of girls aged 10 years. Cil et al. (30) have found an
increase in the prevalence of thoracic hyperkyphosis
among children up to 10 years of age, a decrease in its
prevalence at ages 10 - 12 years, and a new increase at
ages 13-15 years. However, in this latest study, the tho-
racic curvature has been quantitatively assessed and
parameter of normality used has not been described,
which makes data comparison dificult. Several au-
thors have associated increased thoracic hyperkypho-
sis with the period of rapid growth in childhood and
adolescence (11, 30), specially for females, who tend
to hide their developing breasts by increasing kyphosis
and forward protrusion of the shoulders (11).
The prevalence of winged shoulder blades de-
creased with increasing age, possibly due to muscle
development, which leads to better attachment of
the scapula to the thorax (1, 24). Penha et al. (9) have
qualitatively assessed the posture of 191 seven- to
ten-year-old children and found that 100% of the
boys at age 7 years, 95% at age 8 years and 93.8%
at age 9 years had winged shoulder blades. As in this
study, the girls in the aforementioned study had lower
prevalence rates, namely 71.8% at age 7 years, 71%
at age 8 years and 66.7% at age 9 years. According
to Asher (5), girls reach their maximum muscle force
earlier than boys because in girls the sexual matura-
tion process begins earlier than in boys.
Although this study has shown signiicant associa-
tions, it has some important limitations such as its cross-
sectional design. It would be relevant to conduct a longi-
tudinal follow-up of these children to assess the progress
of these deviations throughout the children's develop-
ment. However, despite the study design, the fact that the
number of children per age group was relatively homo-
geneous allows us to assume that the age groups used
provide a relatively consistent notion of development.
The indings of this study contribute to a better un-
derstanding of this topic, because they allowed us to
identify the relationship between postural deviations
and factors such as age, gender, BMI, handedness and
physical activity, using logistic regression analysis. These
indings also contribute to the understanding of how
and why these deviations develop, and to the imple-
mentation of preventive and rehabilitation programs,
given that some of the analyzed factors, such as BMI and
physical activity, are modiiable. Future prevention and
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Received in 01/19/2015
Recebido em 19/01/2015
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Aprovado em 03/12/2015
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... FHP and Rounded Shoulder Posture (RSP) as the components of UCS are prevalent in people of all ages and with different jobs [6,[12][13][14][15]. In an Iranian academic dental staff, the prevalence rates of the FHP and RSP have been reported as 85.5%, 68.8%, respectively [14]. ...
... With this way of angle calculation, the participants with rounded shoulder posture have a smaller angle. The results showed that after 8 weeks of the Iyengar yoga with an emphasis on spine and shoulder exercises, the angle of the shoulder in women increased by 15 degrees, suggesting that the movements trained the tissues that contribute to improved posture. This finding is consistent with previous studies [43,44]. ...
Introduction: Upper Crossed Syndrome (UCS) is a combination of forward head, rounded shoulder, and hyperkyphosis deformities. Yoga is a non-competitive physical exercise with the potential to correct postural imbalances in the human body. Iyengar yoga is a form of Hatha yoga. Materials and Methods: The purpose of present study was to evaluate the effect of Iyengar yoga with an emphasis on spine and shoulder exercises on the UCS in middle-aged women. In this quasi-experimental applied research, 15 subjects were purposefully recruited out of middle- aged women affected with UCS. The participants performed Iyengar yoga exercises with an emphasis on the spine and shoulder. The photogrammetry method was used to measure UCS. Results: At the end of 8 weeks exercises, there was a significant increase in the cervical (P<0.001) and shoulder angles (P<0.005), and a significant decrease in thoracic flexion angle (P<0.001). Conclusion: All relevant coaches and therapists are recommended considering Iyengar yoga as an alternative for training programs in middle-aged women affected by UCS.
... In the presence of a well-balanced posture, the body is aligned optimally in a position of least effort and maximum support. However, due to lack of physical activity and incorrect body posture, posturalimbalanceisrathercommonnowadays [2]. Forward head posture (FHP) is defined as cervical hyperlordosis and head extension. ...
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Changes in craniocervical posture are a critical issue in modern society. Alterations of the mandible position in the anterior-posterior direction in association with head and neck posture are reported. The objective of the present review was to evaluate the relationship between craniocervical posture and sagittal position of the mandible and to evaluate the risk of bias inthe included studies. Electronic databases used to perform the search were PubMed, Wiley Online Library, and Cochrane. Only clinical trials that assessed sagittal craniocervical posture and mandible position in lateral cephalograms were included. Selected inclusion criteria were used to assess the finally selected studies. The upper and lower cervical spine was evaluated by seven and six studies, respectively. The risk of bias in the included studies varied from low to moderate. Literature research identified 438 records from 3 databases. Eventually, seven eligible clinical trials were included in this review. Evaluating the relationship between craniocervical posture and mandible position in the sagittal plane, it can be concluded that increased cervical inclination and head upright position are associated with the posterior position of the mandible. Attention to patients’ craniocervical posture should be paid as a part of clinical evaluation since it might be the reason for the changed mandible position.
... Furthermore, other authors observed that, except for the scapular abduction, changes in the shoulder girdle were more significant in girls when compared to boys, whereas a greater number of abducted scapulae was found among boys. 16 Regarding the difference between both sexes, Batistão et al. 17 reported a higher prevalence of winged scapulae among boys and an association of winged scapulae with age, BMI, and head protraction. Also, shoulder elevation was associated with increasing age. ...
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A avaliação da postura corporal estática de crianças permite identificar e prevenir desordens musculoesqueléticas no estágio inicial. Objetivo: Avaliar a postura estática de alunos de uma escola pública, comparando a postura entre as faixas etárias e entre os sexos. Métodos: A amostra foi composta por 130 escolares (62 do sexo masculino e 68 do sexo feminino), os quais tinham entre 6 e 10 anos de idade. Cada escolar foi fotografado nas vistas anterior, posterior e lateral direita, e o registro fotográfico foi analisado por meio do Software de Avaliação Postural (SAPo). Resultados: Somente foi encontrada diferença entre os sexos no ângulo do tornozelo, além de interação entre sexo e faixa etária. Em relação à idade, o alinhamento horizontal dos acrômios e o alinhamento horizontal da cabeça foram diferentes entre 6-7 e 9 anos. O alinhamento horizontal da cabeça, o alinhamento horizontal das espinhas ilíacas ântero-superior (EIAS) e o alinhamento sagital do membro inferior também apresentaram interação significativa entre sexo e idade. Conclusão: Em média, a maioria dos resultados demonstra que há um alinhamento vertical e uma simetria horizontal nos ângulos analisados, com exceção do alinhamento sagital do membro inferior, do ângulo do tornozelo e do alinhamento sagital do corpo que não demostraram um alinhamento próximo do ideal. Logo, os escolares avaliados apresentam uma boa saúde musculoesquelética.
... Deviations from the optimal spinal curvatures, such as thoracic hyperkyphosis, are a common problem observed in more than one in five adolescents 1 2 that can change the load distribution and increase intradiscal pressure 3 and viscoelastic deformation. [3][4][5] These factors are associated with a higher probability of developing different injuries, such as back pain, 6 spondylolisthesis, disc hernias or acute and chronic injuries in muscles, tendons and ligaments in the lower and upper extremities. 7 Postures in which the curvatures of the spine exceed the limits of normality are considered as postures that could increase the intradiscal pressure and favour the possibility of spinal, muscle, tendon or ligament injuries. ...
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Aim To evaluate the effects of a 9-month Pilates exercise programme on the sagittal spinal posture and hamstring extensibility of adolescents with thoracic hyperkyphosis. Design Randomised controlled trial with blinded examiner. Patients One-hundred and three adolescents with thoracic hyperkyphosis. Interventions Participants were randomly placed into an experimental group which participated in a Pilates exercise programme implemented for a total of 38 weeks (two sessions/week, 15 min/session) (Pilates group (PG), sample=49, or control group (CG), sample=48). Main outcome measures The outcome measures were the thoracic curve in sagittal spinal curvature in relaxed standing, sagittal spinal curvatures and pelvic tilt in relaxed standing and sit-and-reach positions, and hamstring extensibility. Results There was a significant adjusted mean difference between groups in favour of the PG in the thoracic curve in relaxed standing position (−5.6°, p=0.003), pelvic tilt (−2.9°, p=0.03) and all straight leg tests (p<0.001). The PG showed a significant change in thoracic curve (−5.9, p<0.001) and in lumbar angle (4.0, p=0.001) in relaxed standing position and in all straight leg raise tests (+6.4 to +15°, p<0.0001). Conclusions The adolescents with thoracic hyperkyphosis from the PG had a decreased thoracic kyphosis in relaxed standing position, and improved hamstring extensibility as compared with the CG. More than 50% of the participants obtained kyphosis values inside normality, showing an adjusted mean difference between groups in the thoracic curve of about 73% of the baseline mean, resulting in a large improvement and high clinical importance. Trial registration number NCT03831867 .
... Between the ages of 13 y and 18 y, a rapid increase in body height and accumulated fat is observed. This has been confirmed by previous studies, where older children aged 13-15 years are reported to have asymmetry in the position of shoulders, which is associated with varied overloads and carrying schoolbags on one side, which is typically observed in adolescents [30]. ...
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The main purpose of the study was to examine longitudinal associations between sport participation and fat mass with body posture in children. We used data from children recruited in the Czech European Longitudinal Study of Pregnancy and Childhood (CELSPAC) at the ages of 11 y (n=1065), 13 y (n=811) and 15 y (n=974). Information on body posture, practicing sport in a club and at a competitive level, and skinfold thicknesses (biceps, triceps, subscapula, suprailiaca and thigh) from pediatrician’s medical records were collected. Body posture was inspected by a pediatrician. The sum of 5 skinfolds was used as a proxy of fat mass. The 85th and 95th percentiles defined ‘overfat’ and ‘obese’ children. Practicing sport in a club and at a competitive level were included as ‘yes/no’ answers. General linear mixed models with risk ratios (RR) and 95% confidence intervals (95% CI) were calculated. Overall, 35.6% of children and adolescents had impaired body posture; the prevalence of 'incorrect' body posture increased by age (from 41.0% to 28.0%, p<0.001). Practicing sport in a club and at a competitive level decreased by follow-up (p<0.001), while the level of ‘overfat’ and ‘obese’ children increased (p<0.01). In separate models, 'incorrect' body posture was associated with non-practicing sport in clubs (RR=1.68; 95% CI 1.43-1.97, p<0.001) or at competitive level (RR=1.61; 95% CI 1.37-1.88, p<0.001) and with being 'overfat' (RR=2.05; 95% CI 1.52-2.75, p<0.001) and 'obese' (RR=2.15; 95% CI 1.68-2.75, p<0.001). When all variables were put simultaneously into the model additionally adjusted for sex, self-rated health and baseline body posture, similar associations remained. This study shows, that not participating in sport and being overfat/obese are longitudinally associated with ‘incorrect’ body posture. Therefore, the detection of these risk factors in childhood, through the development of school- and community-based interventions, should be advocated.
... Prior research has shown that good body alignment leads to improved stability with adequate distribution between muscular, skeletal, and nerve loads and maximizes also energy efficiency (Kendall et al., 2010;Diebo et al., 2015). According to several studies on posture in children, common postural deviations found in at least 50% of healthy children include the forward head posture, knee hyperextension and valgus, pelvic anteversion, pelvic tilt, protruding shoulders, scapula abduction, and winged shoulder blades (Penha et al., 2005Batistão et al., 2016Czaprowski et al., 2018). Postural characteristics of the participants in this study included an anteriorly protruding head position (90.8%) and an anteriorly tilted trunk position (72.3%). ...
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Poor posture has been shown to decrease both visceral and respiratory/circulatory function as well as to increase neuro-musculoskeletal system stress. Improper postures of children at school and in daily life can affect their physical and psychological development. In particular, many children who refuse to go to school or who have experienced school refusal have physical and mental problems. Given that posture is closely related to one’s psychological state, modifying one’s posture can improve both physical and psychological health problems. This study examined the changes to school-refusing students’ physical and psychological condition after attending an intervention to improve their posture. The participants were 65 high school students who have experienced school refusal and were attending a program to modify their posture for 2 months. Their posture and psychological states were recorded both pre- and post-intervention with the following measurements: postural alignment and spinal curve according to a sagittal plane, the General Health Questionnaire 30 (GHQ), and the Subjective Adjustment Scale (SAS). Post-intervention, most of the participants saw improvement in their postural alignment (e.g., trunk inclination in standing position, P < 0.001, 95%CI [2.00, 4.00]). Participants with improved standing posture post-intervention had higher SAS scores (e.g., feeling of acceptance and trust, P < 0.05, 95%CI [−3.00, −0.00]). We found that easy-to-implement postural interventions have a positive effect on students’ mental health. Furthermore, it was suggested that their adjustment to school would also improve as their posture improved. The contribution of this study shows that it is possible to care for the physical and mental health of students without using special facilities and techniques. It is hoped that the findings of this study will lead to an improved adjustment to both school or novel environments, as well as prevent health-based school refusal.
... Dėl spartaus kaulų augimo paauglių raumenys nespėja taip greitai prisitaikyti prie pakitusių sąlygų, dėl to sutrinka liemens raumenų stabilizacinė funkcija. Tai gali sukelti laikysenos nukrypimus nuo normos, o kartais net ir paauglių nugaros skausmus [10]. Daugiausia suaugusiųjų laikysenos sutrikimų prasideda vaikystės ir paauglystės 23 laikotarpiais, kai žmogaus stuburas labiausiai pažeidžiamas. ...
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Sparčiai vystantis technologijoms, paaugliai vis mažiau laiko užsiima fiziškai aktyvia veikla, jų gyvensena ir laisvalaikis tampa pasyvūs. Ankstyvoji paauglystė yra vienas iš kritinių laikotarpių, kai žmogaus organizmas dėl jame vykstančių permainų yra itin pažeidžiamas. Šiuo amžiaus tarpsniu išryškėja sumažėjusio fizinio ak­tyvumo pasekmės jauno žmogaus laikysenai. Tyrimo metu buvo siekiama nustatyti fizinio aktyvumo įtaką laikysenai ankstyvojoje paauglystėje. Tyrimas atliktas 2020 metais Vilniaus miesto mokykloje. Tyrime da­lyvavo 34 (n=34) 13-14 metų paaugliai. Tyrimo metu atlikti tiriamųjų antropometriniai matavimai, vertinta paauglių laikysena pagal W.W.K. Hoeger skalę, atlikta apklausa raštu naudojant Tarptautinio fizinio aktyvumo klausimyno trumpąją versiją. Fizinio aktyvumo klausi­myno duomenys konvertuoti į metabolinio ekvivalento vienetus (MET), nustatytas fizinio aktyvumo lygis. At­likta statistinė duomenų analizė. Įvertinus paaauglių fizinį aktyvumą, bendroje grupėje nustatytas vidutinis (aukštas) fizinio aktyvumo lygis. W.W.K. Hoeger skale įvertinus paauglių laikyseną, vidutinis įvertinimas ati­tiko patenkinamą laikyseną. Statistiškai reikšmingų skirtumų tarp lyčių nenustatyta (p>0,05). Koreliacinės analizės metu nustatyti neigiami vidutinio stiprumo ir silpni koreliaciniai ryšiai tarp paauglių vaikščiojimo kiekio ir galvos padėties (rs=-0,473, p=0,009), ben­dro fizinio aktyvumo ir stuburo įvertinimo (rs=-0,341, p=0,047), vidutinio intensyvumo fizinės veiklos ir kelių bei čiurnų padėties (rs=-0,344, p=0,046). Tyrimo išva­dose gauti koreliaciniai ryšiai parodė, kad laikysena iš dalies priklauso nuo fizinio aktyvumo lygio.
Conference Paper
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Creativity, unconventionality, rebellion, innovation and imagination are some of the closest terms we can associate with guerilla marketing. The purpose of the paper Social Media Marketing: Implementation of Guerrilla Marketing among Instagram Influencers is to present influencer marketing as a necessary marketing strategy that makes company brands more visible to a large number of people and allows their products and services to be placed on the mass market. Numerous companies are increasingly resorting to this way of advertising where they enter into partnerships with influencers whose profiles are widely visited and who will best present and display their name and their products. Doing business with influencers on Instagram has proven to be a great way to sell and promote a brand, and the closeness that influencers achieve with their followers significantly affects the way potential customers perceive a brand.
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Aims: This study aimed to investigate the effectiveness of the mat Pilates method, an exercise program, on postural alignment in the sagittal plane among children aged between 8 and 12 years. Method: This study used a blind randomized controlled clinical trial, with a Pilates group (PG) and control group (CG) at the Early Childhood Education Institute. A total of 40 children were randomized, who have no prior knowledge of the Pilates method and no exercise training in the last six months. Mat Pilates exercises were administered twice a week for four months in 50-minute sessions. Postural alignment in the sagittal plane was assessed using photogrammetry. Results: There was no statistically significant difference between the groups post-intervention A significant difference was found in the following outcomes that represent an improvement in intragroup postural alignment: among the children in PG, in the right sagittal view in the vertical body alignment (p=0.019; effect size, ES = 0.70; standardize response mean, SRM = 0.57) and in the sagittal head angle (p=0.035; ES = 0.41; SRM = 0.51). Among the children in the CG, in the vertical alignment of the trunk in the left sagittal view (p= 0.016; ES = 0.50; SRM = 0.44). Conclusion: The effectiveness of Pilates on postural alignment in the sagittal plane among children aged between 8 and 12 years was not confirmed.
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By determining the prevalence of postural disorders among eighth grade school students it is possible to indicate the state of these disorders at the end of the elementary school level of education, and compare it to the results obtained by applying corrective treatments on high school students. Thus, the aim of the research was to determine the prevalence of postural disorders among eighth grade school children. The research was carried out on a sample of 101 eighth grade students of both genders, aged 14. The photometry method was used to determine the presence of any postural disorders. The research results indicated that a proportionally statistically significant large number of participants with postural disorders were identified. Of the total number of participants, 60.4% had postural disorders, the most prevalent of which was flat back (22.8%), kypho-lordosis, (20.8%), lordosis (9.9%) and kyphosis (6.9%). Analyzed in terms of gender, the percentage of the girls with postural disorders is statistically significantly greater than that of the boys. Due to the large number of children with postural disorders, the recommendation is that the evaluation of the postural status of students should take place not only at the elementary school age, but also at the high school age. In addition, evaluation alone is insufficient, and exercise programs to correct postural disorders are required as well.
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Este estudo tem como objetivo apresentar e discutir os programas de Escola Postural desenvolvidos para escolares no Brasil. Foi realizada uma busca sistemática de artigos científicos em várias bases de dados e no Banco de Teses e Dissertações da Capes. A partir das nove publicações incluídas neste estudo, as quais cumpriram com os todos os critérios de inclusão, concluiu-se que os programas de Escola Postural são eficazes na melhora dos conhecimentos teóricos e na melhora da execução das atividades de vida diárias. No entanto, estudos que visem identificar se estas mudanças são permanentes ainda são escassos.
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This book is a practical text about ergonomics and designing for children for use by educators, ergonomists, toy designers, psychologists, health care professionals, therapists, manufacturers, architects, planners, parents, and attorneys. In fact, the text would be helpful for anyone who works with or designs for children, including chapters on child development (physical, visual, auditory), child activity (physical education, play with toys, handwriting, assistive technologies, technology use, learning, wayfinding), products for children (product design, back packs, classroom furniture, electronic media), child safety (injuries, warnings, musculoskeletal disorders), places for children (preschool and daycare, museums, playgrounds) and use of products not specifically designed for children (stairs, vehicles, cities and neighborhoods).
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O objetivo deste estudo foi verificar a incidência de desvios posturais em escolares. Foram realizadas avaliações posturais estáticas, goniométricas e medições das distancias escapulares em meninas entre 6 e 17 anos de idade (n=154). Os resultados indicaram que é comum a ocorrência de desvios posturais, principalmente a partir dos 10 anos, quando passa a ocorrer também um percentual maior de assimetrias entre as medidas do lado direito e esquerdo da cintura escapular e pélvica. Analisando as faixas etárias como um todo, os desvios mais observados foram: anteriorizaçao da coluna cervical (66,23%), protusão de ombros (47,40%), abdução escapular (80,52%), nipercifose dorsal (10,39%), hiperlordose lombar (31,17%) e cifolordose (29,22%). The objective of this study was to identify the incidence of postural deformity in students. Assessments of static posture, goniometrics and scapular measurements were mada in girls from 6 to 17 years old (n=154). The results indícate that the occurrence of postural deviation is common, specially from 10years old, when also starts to occur i righer percentage of asymmetry between the left and right sides of both the scapular and pelvic girths. The deformities most frequently observed were: anteriorization of the cervical spine
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Childhood obesity increases susceptibility to musculoskeletal injuries. The purpose of this study was to describe the prevalence of overweight and obesity and to identify differences in posture and musculoskeletal pain among eutrophic, overweight, and obese students. Participants were 420 students, 252 (60%) were females and 168 males (40%), with a mean age of 11.1 (±2.3) years. The posture of all participants was qualitatively assessed; the quantitative postural evaluation was performed using the Postural Assessment Software (PAS/SAPo) for a population subsample of 99 participants. An adapted version of the Nordic Musculoskeletal Questionnaire was used for pain assessment. Data were analyzed descriptively and via statistical tests (significance level of p<0.05). The target population exhibited 22.1% of overweight individuals and 14.1% of obese. Compared to the eutrophic students, the postural evaluation showed a higher knee valgus angle, higher incidence of thoracic kyphosis, and greater prevalence of lumbar hyperlordosis in overweight and obese students (p≤0.05). No association between overweight and pain complaints was detected (p=0.994). © 2014, Universidade Estadual Paulista - UNESP. All rights reserved.
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OBJECTIVE: The influence of the weight and positioning of school supplies and books in backpacks, on plantar force distribution (PFD) and pressure center location, was investigated among students. METHODS: Thirty volunteers of both genders participated in the study. Their mean age was 10.76 (± 1.35) years and none of them had postural abnormalities. Baropodometric data were collected using a computerized baropodometric system (Matscan Research, Tekscanâ, 5.72): without load (control) and with loads of 5, 10 and 15% of body weight in a backpack, positioned on the back, on the chest and on the right and left shoulders. RESULTS: The PFD without load was greater on the left heel than on the right heel (p
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INTRODUÇÃO: A obesidade infanto-juvenil é um problema muito frequente e implica complicações que podem estar presentes precocemente, como as alterações ortopédicas. OBJETIVO: descrever as alterações que atingem o aparelho locomotor em crianças e adolescentes com sobrepeso e obesidade. METODOLOGIA: Foram consultadas as bases de dados MEDLINE, SciELO, LILACS, ISI e base de dados da Universidade de Standford, com a combinação dos seguintes descritores: "obesidade", "complicações", "criança", "dores músculo-esqueléticas", "postura", "alterações ortopédicas", "marcha" e seus respectivos sinônimos em inglês. RESULTADOS: Pôde-se observar que as crianças e adolescentes obesos são mais predispostos a apresentar essas complicações ortopédicas que os indivíduos eutróficos, e os principais problemas relatados foram as alterações posturais, como hiperlordose lombar e joelhos valgos, e dores músculo-esqueléticas, principalmente na coluna lombar e membros inferiores. Os principais fatores que causam esses problemas não são bem definidos, mas incluem aumento da sobrecarga articular associado à fragilidade óssea em fase de crescimento e à diminuição da estabilidade postural, o que conduz ao aumento das necessidades mecânicas regionais. CONCLUSÃO: A identificação precoce dessas disfunções é fundamental para que essas crianças recebam tratamento multidisciplinar adequado.
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BACKGROUND: Postural abnormalities are often found in children. At this stage of life, posture undergoes many adjustments and adaptations due to body changes. Objective: To qualitatively identify the postural abnormalities which occur most frequently among children aged OBJECTIVE: Reven and ten years, comparing boys and girls, and to evaluate these subjects' lumbar flexibility. METHODS: One hundred and ninety-one children were photographed in the sagittal and frontal planes. The variables analyzed were: ankle (valgus and varus), tibiotarsal angle (opened and closed), knee (hyperextension and semiflexion, valgus and varus), pelvis (anteversion and retroversion; lateral pelvic inclination), trunk (antepulsion and retropulsion), lumbar spine (hyperlordosis and rectification), thoracic spine (hyperkyphosis and rectification), cervical spine (hyperlordosis and rectification), scoliosis, shoulder (imbalance and protraction), scapula (winged, abducted and adducted) and head (tilt and protraction). The lumbar flexibility was assessed using Schöber's index. RESULTS: The boys had greater incidence of winged scapula, shoulder imbalance, protraction of shoulders and head and cervical hyperlordosis than the girls did. Conversely, the girls had greater incidence of head tilt and larger Schöber index values. CONCLUSIONS: There were abnormalities in children's postural development that are probably related to muscle, skeletal and flexibility differences between the genders. These differences may influence each child's postural pattern during growth.
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Juskeliene V (Department of Children's Hygiene, Institute of Hygiene, Dldzioji 22, Vilnius 2024, Lithuania), Magnus P, Bakketeig L S, Dailidiene N and Jurkuvenas V. Prevalence and risk factors for asymmetric posture in preschool children aged 6–7 years. International Journal of Epidemiology 1996; 25: 1053–1059. Background Adult scoliosls can be a severe disease. Not much is known about its determinants and the predictive value of early trunk asymmetries. In Vilnius, Lithuania, a cohort study has been started among 6–7 year old children In 1994. The purpose of the present report was to estimate the prevalence of trunk asymmetry in 6–7 year old children, and the association between previous rachitis, frequent illness during childhood and reduced physical activity and trunk asymmetry. Methods The degree of asymmetry was established in 791 children in kindergartens by measuring with a ruler the distance from the seventh cervical vertebra to the lower angles of the left and the right scapulas. Rachitis and the number of illnesses were extracted from each child's medical card, whereas data on physical activity were based on questionnairesfilled in by parents and kindergarten teachers. Results In all, 46.9% of children were found to have trunk asymmetry. The odds ratio of asymmetric posture was 2.76 (95% confidence interval [Cl]: 1.62–4.72) for children with rachitis degree II compared to non-rachltic children, 3.97 (95% Cl : 2.48–6.36) for those who were ill 16–28 times (over the years) compared to those who reported fewer than nine illnesses and 2.44 (95% Cl : 1.21–4.91) for children with low physical activity level (13–22 points) as compared to children with a high level (>33 points). Conclusion These findings indicate the need for prophylactic measures to decrease the incidence of infantile rachitis, acute morbidity and to increase physical activity. The significance of the high frequency of asymmetric posture can only be assessed by a follow-up of this cohort.
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Reliability and validity of thoracic kyphosis measurements using flexicurve method Background: Thoracic hyperkyphosis is one of the most common postural abnormalities. It is defined as increased thoracic curvature in the sagittal plan of the vertebral column. Normal kyphosis may range from 20º to 50º according to Cobb's radiographic method. The radiographic method is the most popular kyphosis measuring method, but because it is an expensive method and it exposes the individual to radiation, it is not the most appropriate method for periodic patient follow-up. Routine clinical examinations such as physiotherapeutic evaluation of thoracic kyphosis need to be valid, reliable, sensitive, practical and cheap. Objective: To investigate the comparative validity and the intra and inter-rater reliability of thoracic kyphosis measurements using the flexicurve method. Method: This was a cross-sectional study in which the thoracic kyphosis of 56 people was evaluated from sagittal radiography of the thoracic column using Cobb's method and by means of the flexicurve method, by two evaluators. Results: The intraclass correlation coefficient (ICC) between the measurements from the Cobb and flexicurve methods was 0.906. For diagnosing thoracic hyperkyphosis, the sensitivity was 85% and the specificity was 97%. Conclusion: The flexicurve method was shown to be a suitable quantitative clinical method for measuring the curvature of thoracic kyphosis.
The aim of this study was to evaluate how the fixed furniture dimensions match with students' anthropometry and to describe head, upper back and upper limbs postures and movements. Evaluation was performed in 48 students from a Brazilian state school. Furniture dimensions were measured with metric tape, movements and postures by inclinometers (Logger Tecknologi, Akarp, Sweden). Seat height was high for 21% and low for 36% of the students; seat length was short for 45% and long for 9% and table height was high for 53% and low for 28%. Regression analysis showed that seat/popliteal height quotient is explained by 90th percentile of upper back inclination (beta=0.410) and 90th percentile of right upper arm elevation (beta=-0.293). For seat/thigh length quotient the significant variables were 90th percentile of upper back velocity (beta=-0.282) and 90th percentile of right upper arm elevation (beta=0.410). This study showed a relationship between furniture mismatch and postural overload. When the seat height is low students increase upper back left inclination and right upper arm elevation; when the seat is short students decrease the upper back flexion velocity and increase right upper arm elevation.