Effects of shoulder retraction orthosis and posture exercises on kyphosis, cervical tilt, and scapular protraction in adolescent girls with kyphotic posture

Abstract

Purpose: This study was aimed to investigate the effectiveness of posture exercise training and shoulder retraction orthosis on kyphosis, cervical tilt and scapular protraction in adolescent girls with kyphotic posture. Methods: Thirty adolescent girls with postural kyphosis participated in the study. The participants were randomly divided into exercise (n=15, mean age: 13.73±0.46 years, BMI: 20.61±1.98 kg/m2) and orthosis (n=15, mean age: 13.73±0.46 years, BMI: 20.19±1.72 kg/m2) groups. The exercise group performed posture exercise training (30-40 min/day/week) for 8 weeks that included spinal extensor and scapular strengthening, scapular stabilization, and stretching of the pectoralis muscles. The orthosis group used shoulder retraction orthosis (8 hours/day/week) for 8 weeks. Kyphosis was assessed with the kyphosis index obtained by the flex ruler measurement method. Anterior cervical tilt was evaluated with tragus wall distance, and shoulders protraction was assessed with the distance between the inferior of the two scapulae. Results: The pre and post-test comparison in the groups showed improvements in kyphosis index, cervical tilt and scapula protraction (p<0.05). The comparison of pre and post-test values between group, no differences were found in all parameters (p>0.05). Conclusion: Exercise training and shoulder retraction orthosis are affective methods in reducing postural kyphosis in adolescent girls. There is a need for randomized controlled studies which both methods are used in combination and with long-term follow-up.

Keywords

• Adolescent
• Posture
• Kyphosis
• Exercise
• Orthosis.

Kifotik postürlü adölesan kızlarda omuz retraksiyon ortezi ile postür egzersizlerinin kifoza, servikal tilte ve skapular protraksiyona etkileri

Abstract

Amaç: Bu çalışma, kifotik postüre sahip adölesan kızlarda postür egzersiz eğitimi ve omuz retraksiyon ortezinin kifoza, servikal tilte ve skapular protraksiyona olan etkisini araştırmak amacı ile yapıldı. Yöntem: Çalışmaya postüral kifozu olan 30 adölesan kız dahil edildi. Bireyler basit rastgele yöntem ile egzersiz (n=15, yaş ortalaması:13,73±0,46 yıl, VKİ: 20,61±1,98 kg/m2) ve ortez (n=15, yaş ortalaması: 13,73±0,46 yıl, VKİ: 20,19±1,72 kg/m2) grubuna ayrıldı. 8 hafta boyunca egzersiz grubuna (30-40 dk/gün/hafta) spinal ekstansörleri ve skapula kaslarını kuvvetlendirme, skapula stabilizasyonu, pektoral germe içeren postür egzersiz eğitimi verildi. Ortez grubu 8 hafta boyunca omuz retraksiyon ortezini (8 saat/gün/hafta) kullandı. Kifoz, esnek cetvel ölçüm yöntemiyle elde edilen kifoz indeksi ile değerlendirildi. Anterior servikal tilti değerlendirmek için tragus-duvar mesafesi, skapula protraksiyonu değerlendirmek için iki skapulanın inferior ucu arasındaki mesafe ölçüldü. Bulgular: Gruplar kendi içerisinde eğitim öncesi ve sonrası verileri karşılaştırıldığında kifoz indeksi, servikal tilt ve skapula protraksiyonunda iyileşme (p<0,05) gösterdi. Gruplar eğitim öncesi ve sonrası birbiriyle karşılaştırıldığında değerlendirilen parametreler açısından fark bulunmadı (p>0,05). Sonuç: Postür egzersiz eğitimi ve omuz retraksiyon ortezi adölesan kızlarda postüral kifozun azaltılmasında etkilidir. Her iki yöntemin kombine kullanıldığı, uzun dönemli takiplerin yapıldığı randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

• Adölesan
• Postür
• Kifoz
• Egzersiz
• Ortez

References

1. Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: a review of the literature. J Chiropr Med. 2017;16:220-229.
2. Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis, management, and selecting fusion levels. J Am Acad Orthop Surg. 2019;27:462-472.
3. Kale P, Dhawas A, Kale S, et al. Congenital kyphosis in thoracic spine secondary to absence of two thoracic vertebral bodies. J Clin Diagnostic Res. 2015;9:TD03-04.
4. Miladi L. Round and angular kyphosis in paediatric patients. Orthop Traumatol Surg Res. 2013;99:140-149.
5. Parlaz E, Tekgül N, Karademirci E, et al. Ergenlik dönemi: fiziksel büyüme, psikolojik ve sosyal gelişim süreci. Turkish Family Physician. 2012;3:10-16.
6. Feng Q, Wang M, Zhang Y, et al. The effect of a corrective functional exercise program on postural thoracic kyphosis in teenagers: a randomized controlled trial. Clin Rehabil. 2018;32:48-56.
7. Blouin JS, Descarreaux M, Bélanger-Gravel A, et al. Self-initiating a seated perturbation modifies the neck postural responses in humans. Neurosci Lett. 2003;347:1-4.
8. Balzini L, Vannucchi L, Benvenuti F, et al. Clinical characteristics of flexed posture in elderly women. J Am Geriatr Soc. 2003;51:1419-1426.

9. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641-661.
10. Katzman WB, Wanek L, Shepherd JA, et al. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40:352-360.
11. Abd-Eltawab AE, Ameer MA. The efficacy of Theraband versus general active exercise in improving postural kyphosis. J Bodyw Mov Ther. 2021;25:108-112.
12. Şen M. Türkiye'de ergen profili. Aile ve Toplum. 2011;7:89-102.
13. Kim KS, Choi JH, Park YG. Immediate effects of a postural correction garment designed for postural kyphosis on adolescents with thoracic hyperkyphosis: A pilot study. J Kor Phys Ther. 2011;18:43-50.
14. Ratamess N, Alvar B, Evetoch T, et al. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687-708.
15. Curtis T, Roush JR. The lateral scapular slide test: A reliability study of males with and without shoulder pathology. N Am J Sports Phys Ther. 2006;1:140.
16. Thomas SJ, Swanik KA, Huxel KC, et al. Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil. 2010;19:125-135.
17. Devaney L, Bohannon R, Rizzo J, et al. Inclinometric measurement of kyphotic curvature: Description and clinimetric properties. Physiother Theory Pract. 2017;33:797-804.
18. Vaughn DW, Brown EW. The influence of an in-home based therapeutic exercise program on thoracic kyphosis angles. J Back Musculoskelet Rehabil. 2007;20:155-165.
19. Barrett E, Lenehan B, O’sullivan K, et al. Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis. Physiother Theory Pract. 2018;34:301-308.
20. Yanagawa TL, Maitland ME, Burgess K, et al. Assessment of thoracic kyphosis using the flexicurve for individuals with osteoporosis. Hong Kong Physiother J. 2000;18:53-57.
21. Liguori G, Medicine ACoS. ACSM's guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins; 2020.
22. Birbaumer N, Flor H, Cevey B, et al. Behavioral treatment of scoliosis and kyphosis. J Psychosom Res. 1994;38:623-628.
23. Amini M, Alizadeh M, Jamali BS. ‎A Review of corrective exercise protocols in people with hyperkyphosis disorders‏‏. J Paramed Sci. 2020;9:96-107.
24. Yoo WG. Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain. J Phys Ther Sci. 2013;25:1509-1510.
25. Senthil P, Sudhakar S, Radhakrishnan R, et al. Efficacy of corrective exercise strategy in subjects with hyperkyphosis. J Back Musculoskelet Rehabil. 2017;30:1285-1289.
26. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014;95:129-140.
27. 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:e0216180.
28. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. J Manipulative Physiol Ther. 2017;40:1-10.
29. Kamali F, Shirazi SA, Ebrahimi S, et al. Comparison of manual therapy and exercise therapy for postural hyperkyphosis: a randomized clinical trial. Physiother Theory Pract. 2016;32:92-97.
30. Grant JA, Mohtadi NG, Maitland ME, et al. Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction: a randomized clinical trial. Am J Sports Med. 2005;33:1288-1297.
31. Jakobsen TL, Jakobsen MD, Andersen LL, et al. Quadriceps muscle activity during commonly used strength training exercises shortly after total knee arthroplasty: implications for home-based exercise-selection. J Exp Orthop. 2019;6:1-12.
32. Pizzutillo PD. Nonsurgical treatment of kyphosis. Instr Course Lect. 2004;53:485-491.
33. Karimi M. Effect of brace on kyphosis curve management: A review of literature. Health Rehabil. 2016;1:1-4.
34. Jiang J, Qiu Y, Mao S, et al. The influence of elastic orthotic belt on sagittal profile in adolescent idiopathic thoracic scoliosis: a comparative radiographic study with Milwaukee brace. Musculoskelet Disord. 2010;11:1-5.
35. Lenssinck MLB, Frijlink AC, Berger MY, et al. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther. 2005;85:1329-1339.
36. Sapountzi‐Krepia DS, Valavanis J, Panteleakis GP, et al. Perceptions of body image, happiness and satisfaction in adolescents wearing a Boston brace for scoliosis treatment. J Adv Nurs. 2001;35:683-690.
37. Coillard C, Leroux MA, Zabjek KF, et. al. SpineCor–a non-rigid brace for the treatment of idiopathic scoliosis: post-treatment results. Eur Spine J. 2003;12:141-148.
38. Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil. 2004;83:177-186.