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Thoracic Kyphosis Affects Spinal Loads and Trunk Muscle Force

AM Briggs, BSc(PT)Hon, PhD, was a doctoral candidate at the Centre for Health, Exercise and Sports Medicine, School of Physiotherapy and the Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia. Dr Briggs is currently a project manager in the Department of Epidemiology and Preventive Medicine, Monash University, Australia
JH van Dieën, PhD, is Professor of Biomechanics, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
TV Wrigley, BSc(Hon), MSc, is Director of Laboratories, Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne
AM Greig, BHK, BSc(PT)Hon, PhD, was a doctoral candidate at the Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, and the Department of Medicine, Royal Melbourne Hospital, University of Melbourne. Dr Greig is MPT Program Co-ordinator, School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
B Phillips, DipPhysio, PGDipHlthSci, PhD, is Associate Professor of Allied Health, La Trobe University, Ballarat Health Services, Melbourne, Victoria, Australia
SK Lo, PhD, is Associate Dean (Research), Deakin University, Burwood, Victoria, Australia
KL Bennell, BAppSci(PT), PhD, is Professor of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne

Address all correspondence to Dr Briggs at: abriggs{at}cabrini.com.au

Background and Purpose: Patients with increased thoracic curvature often come to physical therapists for management of spinal pain and disorders. Although treatment approaches are aimed at normalizing or minimizing progression of kyphosis, the biomechanical rationales remain unsubstantiated.

Subjects: Forty-four subjects (mean age [±SD]=62.3±7.1 years) were dichotomized into high kyphosis and low kyphosis groups.

Methods: Lateral standing radiographs and photographs were captured and then digitized. These data were input into biomechanical models to estimate net segmental loading from T2–L5 as well as trunk muscle forces.

Results: The high kyphosis group demonstrated significantly greater normalized flexion moments and net compression and shear forces. Trunk muscle forces also were significantly greater in the high kyphosis group. A strong relationship existed between thoracic curvature and net segmental loads (r =.85–.93) and between thoracic curvature and muscle forces (r =.70–.82).

Discussion and Conclusion: This study provides biomechanical evidence that increases in thoracic kyphosis are associated with significantly higher multisegmental spinal loads and trunk muscle forces in upright stance. These factors are likely to accelerate degenerative processes in spinal motion segments and contribute to the development of dysfunction and pain.

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