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Sagittal Standing Posture and Its Association With Spinal Pain: A School-Based Epidemiological Study of 1196 Flemish Adolescents Before Age at Peak Height Velocity

Dolphens, Mieke MSc, PT*; Cagnie, Barbara PhD*; Coorevits, Pascal PhD; Vanderstraeten, Guy PhD*,‡; Cardon, Greet PhD§; D'hooge, Roseline MSc, PT*; Danneels, Lieven PhD*

doi: 10.1097/BRS.0b013e3182408053
Clinical Case Series

Study Design. Cross-sectional baseline data set on the sagittal standing posture of 1196 adolescents.

Objective. To describe and quantify common variations in the sagittal standing alignment in boys and girls who are in the same phase of growth and to explore the association between habitual standing posture and measures for spinal pain.

Summary of Background Data. Data on postural characteristics and spinal pain measures in adolescence are sparse, especially when somatic and biological maturity status is to be considered. Our understanding of the relationship between standing posture in the sagittal plane and spinal pain is also deficient.

Methods. A total of 639 boys (age [mean ± SD], 12.6 ± 0.54 yr) and 557 girls (10.6 ± 0.47 yr), with predicted years from peak height velocity (PHV) being 1.2 ± 0.71 and 1.2 ± 0.59 pre-PHV, respectively, were studied. Postural examination included the assessment of global alignment and local spinopelvic characteristics, using post hoc analyses of digital images and direct body measurements (palpation, digital inclinometry, and wheeled accelerometry). Spinal pain experience was assessed by questionnaire.

Results. A wide interindividual variation in sagittal posture characteristics was observed. Logistic regression analyses yielded global alignment parameters to be associated with low back pain (lifetime prevalence), neck pain (lifetime prevalence, 1-mo prevalence, and doctor visit), and thoracic spine pain (doctor visit) outcome measures. None of the included local spinopelvic parameters could be identified as an associated factor with measures of spinal pain.

Conclusion. The orientation of gross body segments with respect to the gravity line seems superior to local spinopelvic features in terms of clinical importance, at least in the current pre-PHV cohort. Opportunities may exist for postural subgrouping strategies to begin with global alignment parameters in order to gain further insight into the relationship between sagittal alignment and the relative risk of developing spinal pain/seeking medical consultation for this pain.

The current pre-PHV data set yields physiological standards for indicators of both “global” postural alignment and “local” spinopelvic features in 1196 Flemish adolescents. Besides the wide interindividual variation in sagittal profile, results suggest the orientation of gross body segments to the gravity line to be superior in terms of clinical importance.

*Departments of Rehabilitation Sciences and Physiotherapy

Public Health

Physical and Rehabilitation Medicine

§Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Artevelde University College, Ghent, Belgium.

Address correspondence and reprint requests to Mieke Dolphens, MSc, PT, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Artevelde University College, Faculty of Medicine and Health Sciences, Campus Heymans (3B3), De Pintelaan 185, 9000 Ghent, Belgium; E-mail:

Acknowledgment date: August 26, 2011. Revision date: October 25, 2011. Acceptance date: October 31, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.