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Aoki K1, Yamada J2, Sugimoto N2, Uehara T3, Yamada S3, Suzuki N4
1Nagoya Gakuin University, Faculty of Rehabilitation Sciences, Seto, Japan, 2NTT-West Tokai Hospital, Department of Rehabilitation, Nagoya, Japan, 3Nagoya City West Medical Center, Department of Rehabilitation, Nagoya, Japan, 4NTT-West Tokai Hospital, Department of Orthopaedic Surgery, Nagoya, Japan
Background: The degenerative processes associated with aging, aggravate thoracic kyphosis. An increase in the thoracic curvature results in an increased sagittal vertical axis (SVA), a slouched postural alignment and eventual gait disturbance. Such thoracic structural changes may influence lumbar lordosis and sacral slope, and upright posture can present with spinal imbalance, particularly in the sagittal plane.
Purpose: An increase in thoracic kyphosis may decrease spinal flexibility and increase SVA in the sagittal plane. The increase in thoracic kyphosis influences lumbar lordosis and sacral slope, and eventually causes gait disturbance and can lead to a bedridden state. When performing mobilization of the thoracic spine in healthy subjects, we examined the influences of lumbar lordosis, sacral slope and spinal range of motion (ROM) in the upright posture.
Methods: Study, participants comprised 20 healthy individuals with a mean age of 22.8 years and no history of low back pain in the preceding 3 months. During mobilization, the subject was in a prone position with a pillow under the abdomen to prevent lumbar hyperlordosis, with the therapist applying pressure to the top of the thoracic kyphosis with the palm of the hand. We measured spinal alignment with a Spinal Mouse ® (SM ), and compared the measured posture and the provided data for upright, maximum trunk flexion and maximum trunk extension postures, before and after thoracic mobilization. The following parameters were measured:
1) thoracic kyphosis angle (TKA);
2) lumbar lordosis angle (LLA); and
3) sacral slope (SS). Spinal ROMs were also measured, as spinal extension ROM (E-ROM), and flexion ROM (F-ROM).
We used R2.8.1 software on a personal computer for statistical analysis. The level of significance was set at 0.05.
Results:
1) Changes to upright alignment of the spine: After thoracic mobilization, TKA was significantly decreased (p 0.01) in the upright posture. With this change, LLA significantly decreased (p 0.01). SS was only slightly decreased. However, LLA changed by >5° in 8 subjects, and SS significantly decreased (p 0.05).
2) Changes to spinal ROM in flexion and extension: In terms of spinal flexion, thoracic ROM was significantly increased (p 0.01). However, lumbar flexion ROM decreased significantly (p 0.05). With spinal extension, thoracic ROM tended to increase, but this change was not significant. Lumbar extension ROM significantly increased (p 0.05), although flexion ROM decreased.
Conclusion(s): This study suggests thoracic curvature influenced lumbar alignment. Increased thoracic curvature reduced thoracic ROM, and lumbar curvature progressed to hyperlordosis and affected the sacral slope. We therefore suggested that adverse effects on lumbosacral alignment do not appear if the thoracic curvature does not progress to increased kyphosis.
Implications: The thoracic spine includes costovertebral joints constituting superior and inferior costal facets and transverse costal facets besides the thoracic facet joints. Degenerative processes of the spine therefore result in rigid segments of the thoracic spine. A physiological curvature is hard to repair when segments of the thoracic spine become rigid. The present results suggest that maintaining thoracic physiological mobility is effective in preventing spinal kyphosis.
Keywords: spinal alignment, horacic kyphosis, Spinal Mouse®
Funding acknowledgements: Research grants were received from Nagoya Gakuin University.
Purpose: An increase in thoracic kyphosis may decrease spinal flexibility and increase SVA in the sagittal plane. The increase in thoracic kyphosis influences lumbar lordosis and sacral slope, and eventually causes gait disturbance and can lead to a bedridden state. When performing mobilization of the thoracic spine in healthy subjects, we examined the influences of lumbar lordosis, sacral slope and spinal range of motion (ROM) in the upright posture.
Methods: Study, participants comprised 20 healthy individuals with a mean age of 22.8 years and no history of low back pain in the preceding 3 months. During mobilization, the subject was in a prone position with a pillow under the abdomen to prevent lumbar hyperlordosis, with the therapist applying pressure to the top of the thoracic kyphosis with the palm of the hand. We measured spinal alignment with a Spinal Mouse ® (SM ), and compared the measured posture and the provided data for upright, maximum trunk flexion and maximum trunk extension postures, before and after thoracic mobilization. The following parameters were measured:
1) thoracic kyphosis angle (TKA);
2) lumbar lordosis angle (LLA); and
3) sacral slope (SS). Spinal ROMs were also measured, as spinal extension ROM (E-ROM), and flexion ROM (F-ROM).
We used R2.8.1 software on a personal computer for statistical analysis. The level of significance was set at 0.05.
Results:
1) Changes to upright alignment of the spine: After thoracic mobilization, TKA was significantly decreased (p 0.01) in the upright posture. With this change, LLA significantly decreased (p 0.01). SS was only slightly decreased. However, LLA changed by >5° in 8 subjects, and SS significantly decreased (p 0.05).
2) Changes to spinal ROM in flexion and extension: In terms of spinal flexion, thoracic ROM was significantly increased (p 0.01). However, lumbar flexion ROM decreased significantly (p 0.05). With spinal extension, thoracic ROM tended to increase, but this change was not significant. Lumbar extension ROM significantly increased (p 0.05), although flexion ROM decreased.
Conclusion(s): This study suggests thoracic curvature influenced lumbar alignment. Increased thoracic curvature reduced thoracic ROM, and lumbar curvature progressed to hyperlordosis and affected the sacral slope. We therefore suggested that adverse effects on lumbosacral alignment do not appear if the thoracic curvature does not progress to increased kyphosis.
Implications: The thoracic spine includes costovertebral joints constituting superior and inferior costal facets and transverse costal facets besides the thoracic facet joints. Degenerative processes of the spine therefore result in rigid segments of the thoracic spine. A physiological curvature is hard to repair when segments of the thoracic spine become rigid. The present results suggest that maintaining thoracic physiological mobility is effective in preventing spinal kyphosis.
Keywords: spinal alignment, horacic kyphosis, Spinal Mouse®
Funding acknowledgements: Research grants were received from Nagoya Gakuin University.
Topic: Musculoskeletal: spine; Musculoskeletal; Orthopaedics
Ethics approval required: No
Institution: NTT -West Tokai Hospital
Ethics committee: The ethics committee at NTT -West Tokai Hospital
Reason not required: It was taken as an investigation without the risk.
All authors, affiliations and abstracts have been published as submitted.
