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Classification System of the Normal Variation in Sagittal Standing Plane Alignment: A Study Among Young Adolescent Boys

Dolphens, Mieke PT, MSc*; Cagnie, Barbara PT, PhD*; Coorevits, Pascal BICT, PT, PhD; Vleeming, Andry PhD*,‡; Danneels, Lieven PT, PhD*

doi: 10.1097/BRS.0b013e318280cc4e
Health Services Research

Study Design. Cohort study.

Objective. To construct a sagittal standing alignment classification system in which the clinical significance of identified subgroups was considered with spinal pain measures.

Summary of Background Data. Numerous grading systems for the categorization of sagittal standing alignment have been devised. However, no common consensus exists about which typology should be adopted. Furthermore, the clinical significance of proposed classification schemes has rarely been assessed in terms of their relationship with spinal pain. Given the importance of the adolescent period for musculoskeletal development, research within a young adolescent population is required.

Methods. The study population consisted of 639 prepeak height velocity boys (mean age, 12.6 yr [standard deviation, 0.54 yr]). Sagittal posture was quantified during habitual standing; data were used to develop a classification system according to 3 gross postural and 5 lumbopelvic characteristics. Prevalence rates of spinal pain measures (pain and seeking care) were compared between postural subgroups.

Results. Cluster analysis indicated 3 types of characteristic overall sagittal profiles: neutral global alignment (n = 266 [41.6%]), sway-back (n = 199 [31.1%]), and leaning-forward (n = 174 [27.2%]). Within each of these categories, postural subgroups could be established according to specific lumbopelvic features. Logistic regression revealed that prevalence (lifetime and month) of low back pain and neck pain was significantly higher in boys classified as having sway-back posture than in those classified as having neutral global alignment. Spinal pain measures did not differ between groups of the lumbopelvic subclassification.

Conclusion. Meaningful classifications exist for sagittal plane posture in young adolescent boys, both on gross body segment and lumbopelvic level. In terms of clinical importance, that is, low back pain and neck pain prevalence, postural subgrouping strategies based on the orientation of gross body segments are suggested to be superior when compared with lumbopelvic grading.

Clinically meaningful posture clusters of young adolescent boys exist based on their individual sagittal standing profile. In these prepeak height velocity boys, an association was found between global alignment categorization and pain prevalence in the more mobile areas of the spine (namely the lumbar and cervical areas).

*Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Artevelde University College, Campus Heymans (UZ, 3B3), Ghent, Belgium

Department of Public Health & Research in Advanced Medical Informatics and Telematics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

Department of Anatomy, Medical Faculty, University of New England, Biddeford Campus, Biddeford, ME.

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

Acknowledgment date: March 2, 2012. First revision date: June 2, 2012. Second revision date: October 30, 2012. Acceptance date: November 29, 2012.

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins