Sagittal Spinal Mobility and Back Extensor Muscle Function in Older Females with Age-Related Hyperkyphosis
-
Tayebeh Roghani
,
Amy Gladin
,
Saeed Talebian
,
Minoo Khalkhali Zavieh
,
Hoda Niknam
,
Wendy B. Katzman
Abstract
Introduction: Spinal range of motion (ROM) is a potential and modifiable variable that may contribute to the maintenance of upright sagittal alignment. The present study aimed to compare spinal ROM in older females with and without hyperkyphosis and investigate associations between thoracic kyphosis and spinal ROM, back extensor strength (BES), and back extensor endurance (BEE).
Materials and Methods: Sagittal spinal curvature and ROM were measured with the Spinal Mouse. Also, BES and BEE were assessed with a load cell. Variables were compared between older females with and without hyperkyphosis with the independent sample t test. We used the Pearson correlation coefficient to calculate associations between variables. Multiple linear regression was used to find which variable is best associated with kyphosis.
Results: Lumbar and total spinal ROM were lower in the hyperkyphosis compared to the normal group (P<0.05). Thoracic kyphosis was associated with total lumbar ROM (r=-0.30, P=0.03), total spinal ROM (r=-0.35, P=0.01), BES (r=-0.73, P< 0.001), and BEE (r=-0.60, P< 0.001). Multiple linear regression analysis after adjusting for age, weight, and BMI showed that BES (P<0.001) and BEE (P=0.01) but not spinal ROM (P=0.16) were significantly associated with thoracic kyphosis.
Conclusion: Females with hyperkyphosis had lower spinal ROM than those with normal kyphosis. While thoracic kyphosis was significantly associated with total lumbar ROM, total spinal ROM, BES, and BEE, multivariate regression showed that ROM was not a significant contributor to thoracic kyphosis. BES and BEE were significant contributors to thoracic kyphosis and should be targeted in the rehabilitation of hyperkyphosis.
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3. Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: Update of its potential causes and clinical impacts-narrative review. Aging Clinical and Experimental Research. 2017; 29(4):567-77. [DOI:10.1007/s40520-016-0617-3] [PMID] [PMCID]
4. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: Its causes, consequences, and management. The Journal of Orthopaedic and Sports Physical Therapy. 2010; 40(6):352-60. [DOI:10.2519/jospt.2010.3099] [PMID] [PMCID]
5. Schenkman M, Shipp KM, Chandler J, Studenski SA, Kuchibhatla M. Relationships between mobility of axial structures and physical performance. Physical Therapy. 1996; 76(3):276-85. [DOI:10.1093/ptj/76.3.276] [PMID]
6. Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Okada K, et al. Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporosis International. 2005; 16(12):1871-4. [DOI:10.1007/s00198-005-1953-x] [PMID]
7. Saimon Y, Goh AC, Momose K, Ryuzaki D, Akahane H, Oba A, et al. Correlation between radiographic sagittal alignment, range of motion, muscle strength, and quality of life in adults with spinal deformities. Journal of Physical Therapy Science. 2020; 32(2):140-7. [DOI:10.1589/jpts.32.140] [PMID] [PMCID]
8. Hirano K, Imagama S, Hasegawa Y, Wakao N, Muramoto A, Ishiguro N. Impact of back muscle strength and aging on locomotive syndrome in community living Japanese women. Nagoya Journal of Medical Science. 2013; 75(1-2):47-55. [PMID]
9. Miyakoshi N, Itoi E, Kobayashi M, Kodama H. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporosis International. 2003; 14(12):1007-12. [DOI:10.1007/s00198-003-1510-4] [PMID]
10. Imagama S, Hasegawa Y, Matsuyama Y, Sakai Y, Ito Z, Hamajima N, et al. Influence of sagittal balance and physical ability associated with exercise on quality of life in middle-aged and elderly people. Archives of Osteoporosis. 2011; 6(1-2):13-20. [DOI:10.1007/s11657-011-0052-1] [PMID] [PMCID]
11. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: A systematic review. Archives of Physical Medicine and Rehabilitation. 2014; 95(1):129-40. [DOI:10.1016/j.apmr.2013.06.022] [PMID] [PMCID]
12. Roghani T, Khalkhali Zavieh M, Talebian S, Akbarzadeh Baghban A, Katzman W. Back muscle function in older women with age-related hyperkyphosis: A comparative study. Journal of Manipulative and Physiological Therapeutics. 2019; 42(4):284-94. [DOI:10.1016/j.jmpt.2018.11.012] [PMID]
13. Granito RN, Aveiro MC, Renno AC, Oishi J, Driusso P. Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: A cross-sectional preliminary study. Archives of Gerontology and Geriatrics. 2012; 54(2):E199-202. [DOI:10.1016/j.archger.2011.05.012] [PMID]
14. Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E. Non-radiographic methods of measuring global sagittal balance: A systematic review. Scoliosis and Spinal Disorders. 2017; 12:30. [DOI:10.1186/s13013-017-0135-x] [PMID] [PMCID]
15. Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Dehghan Manshadi F, Akbarzadeh Baghban A, et al. The reliability of standing sagittal measurements of spinal curvature and range of motion in older women with and without hyperkyphosis using a skin-surface device. Journal of Manipulative and Physiological Therapeutics. 2017; 40(9):685-91. [DOI:10.1016/j.jmpt.2017.07.008] [PMID]
16. Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Manshadi FD, Akbarzadeh Baghban A, et al. The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis. Physiotherapy Theory and Practice. 2018; 34(11):882-93. [PMID] [PMCID]
17. Portney LG, Watkins MP. Foundations of clinical research: Applications to practice. New Jersey: Prentice Hall Health; 2000. https://www.google.com/books/edition/Foundations_of_Clinical_Research/zzhrAAAAMAAJ?hl=en
18. Cunha-Henriques S, Costa-Paiva L, Pinto-Neto AM, Fonsechi-Carvesan G, Nanni L, Morais SS. Postmenopausal women with osteoporosis and musculoskeletal status: A comparative cross-sectional study. Journal of Clinical Medicine Research. 2011; 3(4):168-76. [DOI:10.4021/jocmr537w] [PMID] [PMCID]
19. Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Noguchi H, Kamo K, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. Journal of Bone and Mineral Metabolism. 2010; 28(1):82-7. [DOI:10.1007/s00774-009-0107-1] [PMID]
20. Mika A, Unnithan VB, Mika P. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976). 2005; 30(2):241-6. [DOI:10.1097/01.brs.0000150521.10071.df] [PMID]
21. Kado DM, Prenovost K, Crandall C. Narrative review: Hyperkyphosis in older persons. Annals of Internal Medicine. 2007; 147(5):330-8. [DOI:10.7326/0003-4819-147-5-200709040-00008] [PMID]
22. Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. Journal of the American Geriatrics Society. 2009; 57(9):1569-79. [DOI:10.1111/j.1532-5415.2009.02391.x] [PMID] [PMCID]
23. Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: Results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporosis International. 2017; 28(10):2831-41. [DOI:10.1007/s00198-017-4109-x] [PMID] [PMCID]
24. Katzman WB, Parimi N, Gladin A, Poltavskiy EA, Schafer AL, Long RK, et al. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: A randomized controlled trial. BMC Musculoskelet Disord. 2017; 18(1):509. [DOI:10.1186/s12891-017-1862-0] [PMID] [PMCID]
25. González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PloS One. 2019; 14(4):e0216180. [DOI:10.1371/journal.pone.0216180] [PMID] [PMCID]
26. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. The Spine Journal. 2004; 4(4):413-7. [DOI:10.1016/j.spinee.2004.01.002] [PMID]
27. Goh S, Price RI, Leedman PJ, Singer KP. The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis. Clinical Biomechanical. 1999; 14(7):439-48. [DOI:10.1016/S0268-0033(98)00105-3]
28. Nardo L, Lane NE, Parimi N, Cawthon PM, Fan B, Shepherd J, et al. Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: A cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976). 2014; 39(24):E1418-24. [DOI:10.1097/BRS.0000000000000615] [PMID]
29. Drzal-Grabiec J, Snela S, Rykala J, Podgorska J, Banas A. Changes in the body posture of women occurring with age. BMC Geriatrics. 2013; 13:108. [DOI:10.1186/1471-2318-13-108] [PMID] [PMCID]
30. Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device. Archives of Physical Medicine and Rehabilitation. 2010; 91(1):137-42. [DOI:10.1016/j.apmr.2009.08.145] [PMID]
2. Fon GT, Pitt MJ, Thies AC Jr. Thoracic kyphosis: Range in normal subjects. AJR. American Journal of Roentgenology. 1980; 134(5):979-83. [DOI:10.2214/ajr.134.5.979] [PMID]
3. Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: Update of its potential causes and clinical impacts-narrative review. Aging Clinical and Experimental Research. 2017; 29(4):567-77. [DOI:10.1007/s40520-016-0617-3] [PMID] [PMCID]
4. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: Its causes, consequences, and management. The Journal of Orthopaedic and Sports Physical Therapy. 2010; 40(6):352-60. [DOI:10.2519/jospt.2010.3099] [PMID] [PMCID]
5. Schenkman M, Shipp KM, Chandler J, Studenski SA, Kuchibhatla M. Relationships between mobility of axial structures and physical performance. Physical Therapy. 1996; 76(3):276-85. [DOI:10.1093/ptj/76.3.276] [PMID]
6. Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Okada K, et al. Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporosis International. 2005; 16(12):1871-4. [DOI:10.1007/s00198-005-1953-x] [PMID]
7. Saimon Y, Goh AC, Momose K, Ryuzaki D, Akahane H, Oba A, et al. Correlation between radiographic sagittal alignment, range of motion, muscle strength, and quality of life in adults with spinal deformities. Journal of Physical Therapy Science. 2020; 32(2):140-7. [DOI:10.1589/jpts.32.140] [PMID] [PMCID]
8. Hirano K, Imagama S, Hasegawa Y, Wakao N, Muramoto A, Ishiguro N. Impact of back muscle strength and aging on locomotive syndrome in community living Japanese women. Nagoya Journal of Medical Science. 2013; 75(1-2):47-55. [PMID]
9. Miyakoshi N, Itoi E, Kobayashi M, Kodama H. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporosis International. 2003; 14(12):1007-12. [DOI:10.1007/s00198-003-1510-4] [PMID]
10. Imagama S, Hasegawa Y, Matsuyama Y, Sakai Y, Ito Z, Hamajima N, et al. Influence of sagittal balance and physical ability associated with exercise on quality of life in middle-aged and elderly people. Archives of Osteoporosis. 2011; 6(1-2):13-20. [DOI:10.1007/s11657-011-0052-1] [PMID] [PMCID]
11. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: A systematic review. Archives of Physical Medicine and Rehabilitation. 2014; 95(1):129-40. [DOI:10.1016/j.apmr.2013.06.022] [PMID] [PMCID]
12. Roghani T, Khalkhali Zavieh M, Talebian S, Akbarzadeh Baghban A, Katzman W. Back muscle function in older women with age-related hyperkyphosis: A comparative study. Journal of Manipulative and Physiological Therapeutics. 2019; 42(4):284-94. [DOI:10.1016/j.jmpt.2018.11.012] [PMID]
13. Granito RN, Aveiro MC, Renno AC, Oishi J, Driusso P. Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: A cross-sectional preliminary study. Archives of Gerontology and Geriatrics. 2012; 54(2):E199-202. [DOI:10.1016/j.archger.2011.05.012] [PMID]
14. Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E. Non-radiographic methods of measuring global sagittal balance: A systematic review. Scoliosis and Spinal Disorders. 2017; 12:30. [DOI:10.1186/s13013-017-0135-x] [PMID] [PMCID]
15. Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Dehghan Manshadi F, Akbarzadeh Baghban A, et al. The reliability of standing sagittal measurements of spinal curvature and range of motion in older women with and without hyperkyphosis using a skin-surface device. Journal of Manipulative and Physiological Therapeutics. 2017; 40(9):685-91. [DOI:10.1016/j.jmpt.2017.07.008] [PMID]
16. Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Manshadi FD, Akbarzadeh Baghban A, et al. The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis. Physiotherapy Theory and Practice. 2018; 34(11):882-93. [PMID] [PMCID]
17. Portney LG, Watkins MP. Foundations of clinical research: Applications to practice. New Jersey: Prentice Hall Health; 2000. https://www.google.com/books/edition/Foundations_of_Clinical_Research/zzhrAAAAMAAJ?hl=en
18. Cunha-Henriques S, Costa-Paiva L, Pinto-Neto AM, Fonsechi-Carvesan G, Nanni L, Morais SS. Postmenopausal women with osteoporosis and musculoskeletal status: A comparative cross-sectional study. Journal of Clinical Medicine Research. 2011; 3(4):168-76. [DOI:10.4021/jocmr537w] [PMID] [PMCID]
19. Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Noguchi H, Kamo K, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. Journal of Bone and Mineral Metabolism. 2010; 28(1):82-7. [DOI:10.1007/s00774-009-0107-1] [PMID]
20. Mika A, Unnithan VB, Mika P. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976). 2005; 30(2):241-6. [DOI:10.1097/01.brs.0000150521.10071.df] [PMID]
21. Kado DM, Prenovost K, Crandall C. Narrative review: Hyperkyphosis in older persons. Annals of Internal Medicine. 2007; 147(5):330-8. [DOI:10.7326/0003-4819-147-5-200709040-00008] [PMID]
22. Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. Journal of the American Geriatrics Society. 2009; 57(9):1569-79. [DOI:10.1111/j.1532-5415.2009.02391.x] [PMID] [PMCID]
23. Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: Results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporosis International. 2017; 28(10):2831-41. [DOI:10.1007/s00198-017-4109-x] [PMID] [PMCID]
24. Katzman WB, Parimi N, Gladin A, Poltavskiy EA, Schafer AL, Long RK, et al. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: A randomized controlled trial. BMC Musculoskelet Disord. 2017; 18(1):509. [DOI:10.1186/s12891-017-1862-0] [PMID] [PMCID]
25. González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PloS One. 2019; 14(4):e0216180. [DOI:10.1371/journal.pone.0216180] [PMID] [PMCID]
26. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. The Spine Journal. 2004; 4(4):413-7. [DOI:10.1016/j.spinee.2004.01.002] [PMID]
27. Goh S, Price RI, Leedman PJ, Singer KP. The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis. Clinical Biomechanical. 1999; 14(7):439-48. [DOI:10.1016/S0268-0033(98)00105-3]
28. Nardo L, Lane NE, Parimi N, Cawthon PM, Fan B, Shepherd J, et al. Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: A cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976). 2014; 39(24):E1418-24. [DOI:10.1097/BRS.0000000000000615] [PMID]
29. Drzal-Grabiec J, Snela S, Rykala J, Podgorska J, Banas A. Changes in the body posture of women occurring with age. BMC Geriatrics. 2013; 13:108. [DOI:10.1186/1471-2318-13-108] [PMID] [PMCID]
30. Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device. Archives of Physical Medicine and Rehabilitation. 2010; 91(1):137-42. [DOI:10.1016/j.apmr.2009.08.145] [PMID]
| Files | ||
| Issue | Vol 16 No 2 (2022) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v16i2.9306 | |
| Keywords | ||
| Spinal range of motion Hyperkyphosis Muscle function Aging | ||
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How to Cite
1.
Roghani T, Gladin A, Talebian S, Khalkhali Zavieh M, Niknam H, Katzman WB. Sagittal Spinal Mobility and Back Extensor Muscle Function in Older Females with Age-Related Hyperkyphosis. jmr. 2022;16(2):189-198.
