ABSTRACT
Objective: The aim of this study was to assess existing differences in the isokinetic trunk muscle strength in males
and females aged between 10 and 11 years depending on body posture.
Methods: The study included 145 children (67 males and 78 females) divided into 2 age groups: 10-year-old males
(x = 9.98 2.34 years) and females (x = 9.85 2.94 years) and 11-year-old males (x = 11.14 2.22 years) and
females (x = 11.15 2.32 years). Posture in the sagittal plane was assessed by photogrammetry using the moir projection
technique. Based on a classification system, the participants were divided into subgroups of males and females with normal
and abnormal postures. Trunk muscle strength was measured using isokinetic dynamometry.
Results: A high prevalence of abnormal posture in children aged between 10 and 11 years was observed, primarily
represented by an excessive curvature of the spine in the sagittal plane. The males and females with poor posture
recorded lower values in isokinetic trunk muscle strength.
Conclusion: The results of the study point to the need for the application of suitable physiotherapy treatment
(corrective measures/exercises) to treat musculoskeletal disorders to compensate for the loss of trunk flexor muscle
strength in children with improper posture. (J Manipulative Physiol Ther 2015;38:484-492)
Key Indexing Terms: Posture; Moire Topography; Muscle Strength
T
a
Academic Teacher, Faculty of Physiotherapy and Occupational Therapy, Academy of Physical Education in Wroclaw,
Wroclaw, Poland.
b
Academic Teacher, Department of Physiotherapy and Occupational Therapy in Locomotor Dysfunction, Academy of
Physical Education in Wroclaw, Wroclaw, Poland.
c
Academic Teacher, Department of Physiotherapy and Occupational Therapy in Conservative and Interventional Medicine,
Academy of Physical Education in Wroclaw, Wroclaw, Poland.
d
Professor, Department of Physiotherapy and Occupational
Therapy in Conservative and Interventional Medicine, Academy
of Physical Education in Wroclaw, Wroclaw, Poland.
Submit requests for reprints to: K. Barczyk-Pawelec, PhD, PT,
Academic Teacher, Faculty of Physiotherapy and Occupational
Therapy, Academy of Physical Education in Wroclaw, al. I.J.
Paderewskiego 35, 51-612 Wroclaw, Poland.
(e-mail: kasiabar@autograf.pl).
Paper submitted October 14, 2013; in revised form August 29,
2014; accepted September 4, 2014.
0161-4754
Copyright 2015 by National University of Health Sciences.
http://dx.doi.org/10.1016/j.jmpt.2015.06.010
Barczyk-Pawelec et al
Posture and Muscle Strength in Adolescents
METHODS
Participants
The study was composed of 145 children (67 males and
78 females) aged between 10 and 11 years from randomly
selected primary schools located in the city of Wrocaw,
Poland. The schools were located in close proximity to the
city center and had similar educational and athletic
facilities. All the children attending these schools and
meeting the age requirement were selected for inclusion.
All lived in the city boroughs belonging to each school's
district.
A preliminary orthopedic examination was used to
eliminate children with any discrepancies in leg length,
scoliosis, exaggerated kyphosis or lordosis, or any
musculoskeletal disorder.
Written parental consent was obtained for every
participating child. The children who met the right criteria
for participation were then divided into 2 groups: younger
group, 31 males and 48 females aged 10 years (x = 9.98
2.43 and x = 9.85 2.94 years, respectively), and older
group, 34 males and 32 females aged 11 years (x = 11.14
2.22 and x = 11.15 2.32 years, respectively).
The research was performed by the same group of
researchers, at the same time of day (morning hours), and in
similar conditions at each school. Due consent was obtained
from the school districts, the participating children, and
their parents. The study procedure was approved by the
Ethics Committee for Scientific Research of the University
of Physical Education in Wroclaw, Poland.
It was assumed that trunk muscle strength will depend on
age and the anterior-posterior curvatures of the spinal
column, where children with abnormal posture would
record lower values of isokinetic trunk muscle strength due
to increased thoracic kyphosis and lumbar lordosis when
compared to children with right posture.
Postural Assessment
The participants' body height, weight, and body mass
index (BMI) were measured. 23 Posture was assessed by
photogrammetry using a projector/camera system 24 from
CQ Electronic (www.cq.electronicsystem.com). This system is based on the moir projection technique and
topographically measures the curvature of the spinal
column by having anatomical markers placed on the back.
The moir phenomenon is a type of optical distortion
created by the interference of light waves, as if an image
was refracted. A light is used to project a series of visible
lines on the surface of the back, which, at different angles,
are distorted depending on the distance of each anatomical
marker from the projector, mirroring the shape of the back.
A camera records the image, and the software is used to
create a contour map of the entire observed surface, in effect
providing a 3-dimensional coordinate image of the back.
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Posture and Muscle Strength in Adolescents
STATISTICAL ANALYSIS
Statistical analysis was performed using Microsoft Excel
and Statsoft Statistica PL 8.0 software. All raw data were
analyzed. Normality of the raw data was checked using the
Shapiro-Wilk test, 30 with findings that the hypothesis of
Barczyk-Pawelec et al
Posture and Muscle Strength in Adolescents
Age Group
10
11
10
11
y (n
y (n
y (n
y (n
= 31)
= 34)
= 48)
= 32)
Mean (SD)
Statistical Difference
Mean (SD)
Statistical Difference
139.71 (6.86)
147.35 (5.45)
139.61 (6.70)
145.09 (7.12)
0.0000 a
33.68 (6.48)
41.14 (8.41)
35.46 (7.71)
37.87 (6.87)
0.0002 a
0.0004 a
0.8042
Table 2. Mean and SD of the Anteroposterior Spinal Curves and Force-Velocity Parameters of Trunk Muscles in Males With Correct
and Incorrect Postures
Correct Posture, n = 19
Incorrect Posture, n = 46
10 y, n = 10
11 y, n = 9
10 y, n = 21
11 y, n = 25
Parameter
Mean (SD)
Mean (SD)
Mean (SD)
Mean (SD)
Angle
Angle
Angle
PT E60
PT F60
TW E60
TW F60
PT E120
PT F120
TW E120
TW F120
A/A E60
A/A F60
A/A E120
A/A F120
12.8 (2.1)
10.8 (2.8)
13.1 (1.9)
112.8 (36.2)
72.5 (19.8)
424.7 (45.3)
284.2 (77.9)
129.0 (37.0)
93.5 (18.9)
1014.5 (490.2)
705.9 (241.7)
63.5 (16.3)
66.3 (1.2)
60.6 (15.9)
71.2 (23.5)
10.8 (2.65)
9.5 (2.4)
15.4 (3.4)
147.7 (12.4)
90.1 (12.3)
616.8 (86.8)
353.0 (74.6)
163.3 (21.7)
92.6 (13.2)
1527.8 (321.4)
853.5 (203.6)
62.9 (9.7)
49.0 (9.6)
58.7 (12.2)
51.0 (11.0)
13.9 (4.98)
15.6 (2.7)
16.6 (3.3)
106.3 (26.4)
69.7 (14.9)
382.6 (132.8)
242.2 (63.9)
127.5 (23.4)
76.5 (15.6)
910.6 (297.3)
550.1 (175.6)
64.6 (17.4)
67.2 (10.7)
61.6 (16.9)
72.7 (22.1)
15.2 (4.18)
13.8 (2.3)
16.5 (3.04)
133.4 (28.9)
86.8 (20.5)
543.6 (139.8)
323.2 (52.3)
151.6 (32.9)
86.9 (10.9)
1394.6 (430.0)
786.9 (173.6)
63.5 (10.2)
50.7 (10.2)
59.1 (12.7)
57.7 (3.6)
RESULTS
Analysis of the somatic features showed significant
differences in body height between the separate age groups
of the males and females. In addition, statistically
significant differences were found in body weight between
the older and younger group of males (Table 1).
Table 2 presents the spinal curvatures and force-velocity
characteristics of the trunk muscles for the 2 age groups of
males with normal and abnormal postures. Irrespective of
age, higher angular values of the analyzed spine segments
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Posture and Muscle Strength in Adolescents
CP1-CP2
0.2750
0.2978
0.1133
0.0032 a
0.0229 a
0.0016 a
0.0292 a
0.0043 a
0.9119
0.0037 a
0.1298
0.4112
0.0213 a
0.2114
0.0145 a
CP1-ICP1
0.4713
0.0000 a
0.0032 a
0.5042
0.6665
0.3981
0.1106
0.9615
0.0138 a
0.4759
0.0301 a
0.6952
0.5662
0.5116
0.4998
CP2-ICP2
a
0.0047
0.0001 a
0.3412
0.1483
0.6161
0.1481
0.2615
0.2444
0.4071
0.3669
0.5007
0.5241
0.4332
0.5291
0.1669
ICP1-ICP2
0.2568
0.0240 a
0.8642
0.0004 a
0.0007 a
0.0000 a
0.0001 a
0.0029 a
0.0500 a
0.0000 a
0.0000 a
0.3695
0.0311 a
0.2585
0.0201 a
A/A E60 (%), A/A F60 (%) and A/A E120 (%), and A/A F120 (%),
muscle ratios: agonists-to-antagonists ratio; Angle , lumbosacral spinal
curvature; angle , thoracolumbar spinal curvature; angle , thoracic
spinal curvature; CP1, correct posture in 10-year-old males; CP2, correct
posture in 11-year-old males; ICP1, incorrect posture in 10-year-old males;
ICP2, incorrect posture in 11-year-old males; PT E60 and PT E120,
maximum force moment of extensor muscles; PT F60 and PT F120,
maximum force moment of extensor muscles and flexor; TW E60 and TW
E120, the work of all repositions for the extensor muscles; TW F60 and
TW E120, the work of all repositions for the flexor muscles.
a
P .05.
DISCUSSION
In this study, analysis of the participants' somatic
features showed significant differences in body height
between the 2 age groups of the males and females. The
observed differences between the groups of males demonstrate that the children are at the prepubertal dip, when
growth slows down at around 10 years of age only to be
followed by the pubertal growth spurt. 21 This tendency has
been observed by other authors evaluating the variability of
somatic characteristics during puberty in children from
Lithuania, Germany, and Japan. 31 -33
The children in this study were classified according to their
body posture based on a longitudinal study of sagittal spinal
curvature in a sample population of more than 3000 urban
children and adolescents from Poland. 26 In the study, the state
of health of the participants and the curvature ranges of the
thoracic kyphosis and lumbar lordosis were used to develop
and present, using mathematical and statistical models, a list of
characteristic types of postures at a given age.
Barczyk-Pawelec et al
Posture and Muscle Strength in Adolescents
Table 4. Mean and SD of the Anteroposterior Spinal Curves and Force-Velocity Parameters of Trunk Muscles in Females With Correct
and Incorrect Postures
Correct Posture, n = 18
Incorrect Posture, n = 62
10 years, n = 13
11 years, n = 5
10 years, n = 35
11 years, n = 27
Parameter
Mean (SD)
Mean (SD)
Mean (SD)
Mean (SD)
Angle
Angle
Angle
PT E60
PT F60
TW E60
TW F60
PT E120
PT F120
TW E120
TW F120
A/A E60
A/A F60
A/A E120
A/A F120
11.2 (2.6)
10.7 (1.8)
13.3 (1.7)
92.1 (19.8)
64.9 (10.1)
312.3 (56.9)
227.9 (6.8)
118.5 (13.8)
87.4 (21.9)
787.2 (177.9)
503.5 (34.0)
65.7 (4.2)
56.6 (16.6)
70.6 (16.6)
53.8 (13.6)
13.4 (1.7)
7.6 (1.3)
14.5 (2.5)
124.9 (29.9)
77.0 (25.1)
470.2 (108.9)
275.1 (84.5)
128.2 (18.2)
92.8 (24.4)
1021.1 (379.2)
591.7 (224.1)
60.4 (11.2)
56.9 (15.1)
65.6 (13.8)
57.6 (19.4)
16.9 (4.0)
15.0 (3.1)
15.4 (2.9)
90.5 (20.1)
60.4 (16.3)
322.2 (114.8)
225.7 (64.7)
115.5 (20.2)
79.9 (18.5)
698.4 (333.1)
483.0 (163.5)
66.7 (14.5)
57.9 (17.4)
71.2 (16.2)
53.9 (14.1)
14.9 (4.3)
13.2 (2.9)
15.2 (3.7)
118.4 (25.8)
76.5 (15.4)
500.8 (163.5)
310.7 (82.9)
146.3 (27.6)
94.8 (20.4)
1245.2 (468.5)
718.5 (212.1)
61.1 (12.3)
57.2 (16.8)
66.1 (14.1)
58.6 (19.9)
CP1-CP2
0.1954
0.0289 a
0.4543
0.0375 a
0.1748
0.0220 a
0.1883
0.4637
0.5608
0.2424
0.3667
0.1258
0.6321
0.4132
0.3997
CP1-ICP1
CP2-ICP2
ICP1-ICP2
0.0000 a
0.0000 a
0.0359 a
0.8470
0.4094
0.8139
0.9240
0.7251
0.1990
0.4734
0.7337
0.6352
0.5112
0.5996
0.6721
0.5691
0.0000 a
0.6245
0.7191
0.9641
0.6283
0.2848
0.1543
0.8152
0.2261
0.1617
0.5698
0.6112
0.6114
0.5993
0.0587
0.0133 a
0.8319
0.0000 a
0.0002 a
0.0000 a
0.0000 a
0.0000 a
0.0013 a
0.0000 a
0.0000 a
0.2366
0.6523
0.4023
0.2113
A/A E60 (%), A/A F60 (%) and A/A E120 (%), A/A F120 (%), muscle ratios:
agonists-to-antagonists ratio. Angle , lumbosacral spinal curvature; angle ,
thoracolumbar spinal curvature; angle , thoracic spinal curvature; CP1, correct
posture in 10-year-old females; CP2, correct posture 11-year-old females; ICP1,
incorrect posture 10-year-old females; ICP2, incorrect posture 11-year-old
females; PT E60 and PT E120, maximum force moment of extensor muscles;
PT F60 and PT F120, maximum force moment of extensor muscles and flexor;
TW E60 and TW E120, the work of all repositions for the extensor muscles;
TW F60 and TW E120, the work of all repositions for the flexor muscles.
a
P .05.
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Barczyk-Pawelec et al
Posture and Muscle Strength in Adolescents
STUDY LIMITATIONS
There are several limitations that need to be acknowledged and addressed regarding the present study. The first
limitation was the lack of factors in the children's physical
activity levels using available questionnaires. The second
limitation was concerns in the incongruous body positions
that were analyzed, where posture was assessed in the
standing position and measurement of trunk muscle
strength in the half-sitting position. This was as a result of
the adopted test methodology. Posture is most commonly
assessed in the upright standing position, as this best
reflects the anterior-posterior curvature of the spine,
whereas isokinetic dynamometry of the trunk muscles
(using in this case the Biodex Multi-Joint System) requires
a half-sitting position as the only possible way to measure
isokinetic trunk muscle strength.
An additional limitation was the placement of the
anatomical reference markers during postural assessment, as
their spatial accuracy depends largely on the skills of
the researcher. This was counteracted by having only 1
experienced researcher perform this task in the present study,
but this aspect nonetheless warrants some consideration.
However, the parameters adopted in the study are
determined automatically based on the external contour
of the body and, therefore, minimizes the possibility of
human error.
CONCLUSIONS
Based on the adopted typology, the present study
showed a high incidence of abnormal posture in children
as determined by the increased angular parameters of
the anterior-posterior curvature of the spine. This deepened spinal curvature was observed mainly in the thoracic
segment. Among the males and females with poor
posture, abnormal anterior-posterior curvature of the spine
CONTRIBUTORSHIP INFORMATION
Concept development (provided idea for the research):
B.P.K.
Design (planned the methods to generate the results):
B.P.K., R.K.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): B.P.K.
Data collection/processing (responsible for experiments,
patient management, organization, or reporting data):
B.P.K., P.R., D.W.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): B.P.K.,
R.K.
Literature search (performed the literature search):
B.P.K., P.J.R., D.W., R.K.
Writing (responsible for writing a substantive part of the
manuscript): B.P.K., R.K.
Critical review (revised manuscript for intellectual
content, this does not relate to spelling and grammar
checking): B.P.K., R.K.
Practical Applications
The results of the present study indicate a high
incidence of abnormal posture in children with
exaggerated spinal curvature in the sagittal plane.
This may be as a result of cultivated improper
habits associated with the sitting or standing
position.
Exaggerated anterior-posterior curvature of the
spine may also be one of the factors reducing
trunk muscle strength.
REFERENCES
1. Kendall FP, McCreary EK, Provance PG, Rodgers MM,
Romani WA. Muscles testing and function with posture and
pain. Lippincott Willims&Wilkins; 2005.
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Posture and Muscle Strength in Adolescents
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