Biomechanical assessment of human posture: A literature review

doi:10.1016/j.jbmt.2013.11.018

Journal of Bodywork and Movement Therapies

Volume 18, Issue 3, July 2014, Pages 368-373

https://doi.org/10.1016/j.jbmt.2013.11.018 Get rights and content

Summary

Introduction

Postural deviations have been linked to a series of different kinds of pain and dysfunction. However, posture is not an easy subject to study, mainly because postural assessments are still scientifically inaccurate, such as photography, or expensive, such as MRI, whereas others, such as X-ray, involve radiation problems. The aim of this literature review was to search for new scientific methods for assessing posture and to discuss which among both new and old methods are best for scientific and clinical objectives.

Materials and methods

The Medline and Lilacs databases were searched for the period 2003 to 2013 with the use of the following keywords: “posture” and “postural.”

Results

A total of 452 articles that assessed posture in some way were found. Twenty-two articles were selected, and 11 relevant types of technologies were described.

Discussion

The relevant technologies discussed were force plate; pictures; goniometers, inclinometers, tape, and other devices; 3D analysis; 3D X-ray; sensors; electromyography; Kinect; magnetic resonance imaging; 4D computed tomography; and infrared.

Conclusion

There is enough technology to make a very good quantitative evaluation possible. For example, the 3D MRI or the 4D CT can register static and dynamic posture. Other cheaper solutions may use combined and synchronized equipments. However, these synchronizations still require validation.

Introduction

Postural deviations have been linked to a series of different kinds of pain and dysfunction. However, posture is not an easy subject to study, mainly because postural assessments are still scientifically inaccurate, such as photography, or expensive, such as MRI, whereas others, such as X-ray, involve radiation problems (Rosário et al., 2012, Suzuki et al., 2010, Berthonnaud et al., 2009, Steffen et al., 2010).

There is some scientific evidence establishing connections of posture and equilibrium problems with orthopedic and rheumatologic diseases, such as knee osteoarthritis, ankle instability, neck tension, and back pain (Missaoui et al., 2008).

Among the most common methods to evaluate posture in literature reviews are force platform for balance (Missaoui et al., 2008) and the use of a goniometer, an inclinometer, flexible curves, tape measurements, and photography of the posture itself (Fortin et al., 2011).

Myers (2006) affirmed that posture, meaning standing or sitting still, does not exist because humans are never placed in stillness. In other words, people are always moving, shifting, balancing, and adapting. Consequently, in the present article, the word posture has a wide range of meanings in order to increase the possibilities of assessment. Stillness, balance, and repeated patterns of stabilization movement are all considered as posture.

Therefore, the aim of this literature review was to search for efficient scientific methods for assessing posture and to discuss which among both new and old methods are best for scientific and clinical objectives.

Section snippets

Search methods

The keywords “posture” and “postural” were used in searching the Medline and Lilacs databases for relevant articles from 2003 to 2013. The articles needed to be in English, Portuguese, French, Italian, or Spanish.

Criteria for inclusion and exclusion

All articles that assessed posture in some way were considered. This criterion was kept as broad as possible to identify all possible ways of postural evaluation. Reviews of postural assessment and articles that discussed posture in some manner that could help the discussion were also

Results

The twenty-two most relevant articles were selected (Table 1), and 11 relevant types of technologies were described, namely, force plate; pictures; goniometers, inclinometers and tape; 3D analysis; 3D X-ray; sensors; electromyography; Kinect; magnetic resonance imaging; 4D computed tomography; and infrared.

Discussion

The general idea of the article was to show the common and uncommon options used to evaluate posture. Thus, to facilitate understanding, the assessment procedures were divided into categories describing related technologies.

Conclusion

Posture evaluation is a difficult task. However, there is enough technology to make a very good quantitative evaluation possible. For example, 3D MRI or 4D CT can accurately register static and dynamic posture and are the gold standard despite being expensive. Cheaper solutions may apply combined and synchronized equipment, such as cameras and accelerometers, or infrared, force plate, and cameras. Nevertheless, validation of these synchronizations and scientific tests to verify the sensitivity

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Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis
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Postural assessment of the lower limbs is important not only in the diagnosis of misalignment and imbalance but also because these conditions could be linked to orthopedical or rheumatological issues.1-3
The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods.
A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane.
The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = –0.2° (–2.8° to 2.41°), male patient HKA angle = 0.77° (–2.91° to 7.94°), and female patient HKA angle = –0.67° (–5.32° to 3.98°).
This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from –3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.
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Another method is skin-surface 3-dimensional motion analyses. However, this method is also limited owing to clinical space, the relatively high cost of fixed infrared cameras, and complex reflective marker settings.14 Inertial measurement units are useful for collecting spinal surface profiles.
The purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device.
A total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles.
The agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement.
Our results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.
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Quantitative measures such as posturography [24], Gait variability analysis [25] and muscle activity [26–28] allow non-subjective assessment of balance performance. Several indices have been proposed based on the static posturography (COP measures) [29–34] to evaluate different aspects of the balance performance and possible underlying neurophysiological disorders. In a next step to further improve the sensitivity of such analysis, dynamic posturography was proposed [35,36].
Balance impairment is critical for many patient groups such as those with neural and musculoskeletal disorders and also the elderly. Accurate and objective assessment of balance performance has led to the development of several indices based on the measurement of the center of pressure. In this study, a robotic device was designed and fabricated to provide controlled and repeatable mechanical perturbations to the standing platform of the user. The device uses servo-controlled actuators and two parallel mechanisms to provide independent rotations in mediolateral and anterior-posterior directions. The device also provides visual feedback of the center of pressure position to the user. Functional tests were run and showed that the device is able to provide an appropriate dynamics (time constant of 0.19 s and bandwidth of 0.85 Hz) for the two motions. The efficacy of the device on the balance assessment was then evaluated experimentally. Ten healthy subjects performed a balance task with and without perturbations and seven center of pressure indices were measured. It was shown that the sensitivity of the indices to the user's performance was statistically increased in all indices particularly in anterior/posterior direction when the mechanical perturbations were present.
Ergonomic evaluation on the manufacturing shop floor: A review of hardware and software technologies
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A photogrammetric analysis method was used by Naddeo et al. [80] to measure joint angles of the Neck, shoulders, elbow and wrists for comfort evaluation of upper extremities of the human body. Microsoft Kinect has been recommended as an alternative method for risk assessment because of its low cost and 3D motion capture capabilities [63,76,81–85]. This review paper aims at studying previous review papers that have conducted systematic and comprehensive studies on ergonomic evaluation on shop floors between 2010 and 2015, to identify the hardware and software utilized for ergonomic evaluation on the shop floor.
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Initially, due to limited technical capacity, posture was commonly measured in one plane only, as arrangements of body segments, such as around a plumb-line, by tracing spinal positions from a flexible ruler, by photographs or visual observation (Singla and Vegar, 2014). Now, with technology advancements, it is common to use three-dimensional (3D) posture analysis, by photographically capturing and analyzing multiple sequences of multiple anatomical points per second (Brink et al., 2011; Capodaglio et al., 2012; Rosário, 2014). Since the 1900's, associations between good or poor posture and health status have been postulated.
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This paper reports on data captured at baseline and 12-month follow-up, in adolescents in school using computers. Four sitting postural angles, head flexion (HF), neck flexion (NF), craniocervical angle (CCA) and trunk flexion (TF), and self-reported seated UQMP in the previous month were captured at each time-point. Research questions were: 1) What is the magnitude and direction of change in each postural angle over 12 months? 2) What are best cut-points in the continuous posture change distribution to most sensitively test the association between posture change and UQMP? 3) Is gender-specific cut-points required? The 12-month posture angle change data was divided into quintiles (0–20th%; 21-40^th%, 41-60^th%, 61-80^th%, >80^th%), and the odds of UQMP occurring in each posture change quintile were calculated using logistic regression models.
Two hundred and eleven students participated at baseline, of which 153 were followed-up at one year. Both males and females with postural change into extension (which represents lesser flexion range) were more at risk for the development of UQMP, than any other group. The best cut-point for HF was 40^th% (≤−3.9°), NF was 20th% (≤−2.9°) and TF was 40^th% (≤−1.1°). For CCA however, change at or beyond 40^th % for extension or beyond 60% for flexion was associated with UQMP.
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Literature reviewBiomechanical assessment of human posture: A literature review

Summary

Introduction

Materials and methods

Results

Discussion

Conclusion

Introduction

Section snippets

Search methods

Criteria for inclusion and exclusion

Results

Discussion

Conclusion

Gait Posture

Appl. Ergon.

Med. Eng. Phys.

Neurophysiol. Clin.

Clin. Radiol.

Clin. Chiropractic.

A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass

Curr. Opin Neurol.

The new 4-dimensional computed tomographic scanner allows dynamic visualization and measurement of normal acromioclavicular joint motion in an unloaded and loaded condition

J Comput. Assist. Tomogr.

Classification of pelvic and spinal postural patterns in upright position. Specific cases of scoliotic patients

Comput. Med. Imaging Graph.

Three-dimensional lumbar spine postures measured by magnetic resonance imaging reconstruction

Spine

Revision of posturography based on force plate for balance evaluation

Rev. Bras. Fisioter.

Literature review
Biomechanical assessment of human posture: A literature review