Spinal curvature in female and male university students with prolonged bouts of sedentary behaviour

doi:10.21203/rs.3.rs-1989231/v1

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Spinal curvature in female and male university students with prolonged bouts of sedentary behaviour

https://doi.org/10.21203/rs.3.rs-1989231/v1

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Background: seated behaviour and a lack of physical activity among university students may cause changes to posture leading to health problems. We were interested whether between-gender differences in spinal curvature exist among university students with a predominantly sedentary lifestyle.

Methods: a group of 20 female (age 20 ± 0.73 years) and 39 male (age 20 ± 1.08 years) university students with a predominantly sedentary lifestyle participated in the study. The thoracic and lumbar curvature was evaluated while standing and sitting using the Spinal Mouse.

Results: showed that 10% of the female students and 30.77% of the male students had thoracic hyperkyphosis, while 10% of the female students and 2.56% of the male students suffered from lumbar hyperlordosis in the standing posture. In the sitting posture, 0% of the females and up to 30.77% of the males had mild thoracic hyperkyphosis, and 25.00% of the females and 23.90% of the males had mild lumbar hyperkyphosis.

Conclusions: these findings indicate that differences between the sexes as regards to curvature of the spine exist. Prolonged sitting during university courses could contribute to their poor posture. It is therefore necessary to focus purposefully on compensation exercises that eliminate postural deviations in female and male young adults.

posture

spinal morphology

thoracic spine

lumbar spine.

After entering the university studies, students acquire sedentary habits with a very low contribution of leisure activities [1–2]. This causes the physical performance of youth to be reduced [3]. This trend has been confirmed by a number of authors following the monitoring of the physical fitness of university students [4–5]. Adults sit eight hours daily and are on average in motion for 4 hours. This is a great disparity, which is reflected in their worsening physical fitness. The lack of motion activities and the predominance of a seated posture among students leads to an overloading of the same joint structures and the same muscle groups [6]. Motion passivity causes an insufficiency of the information coming into the Central Nervous System, which shares in the emergence of faulty motion stereotypes and muscle imbalance [7].

The main causes of muscle imbalance include hypokynesis, chronic loading above the limit set by muscle quality, asymmetric loading without sufficient compensation, and changes to the mobility stereotype, for example as a result of an injury or an illness [8]. Also Hansraj [9] in their studies point to the influence of external factors that affect posture. Among these appear unilateral loading, static overburdening, lack of movement and inappropriate physical activities.

The influence of life quality on posture has been dealt with in their studies by many authors [10–12]. Many researchers have used the Spinal Mouse (SM) equipment for the evaluation of curvature of the spine in the frontal and sagittal planes, while others in their evaluations of spinal curvature in the frontal and sagittal planes made use of Spinal Mouse equipment, confirming the safety of this equipment without side effects and with dependability [13–16]. Spinal Mouse is a practical and reliable device which physiotherapists can use in field screening and in the clinical evaluation of spinal problems. SM used [17–18] in their research, in which they evaluated the support, locomotor system of different groups of people.

Using this equipment, we have investigated whether there are gender differences in thoracic kyphosis and lumbar lordosis among young adults with a predominantly sedentary lifestyle.

Basic somatic characteristics of the participants are shown in Table 1. The BMI of both groups is normal and does not affect their posture.

Table 1

Basic somatic characteristics
	Age (years)	Height (cm)	Body mass (kg)	BMI
Males (n = 39)	20 ± 1.08	181.20 ± 6.94	77.74 ± 12.32	23.8 ± 1.6
Females (n = 20)	20 ± 0.73	169.08 ± 4.23	61.08 ± 5.76	21.4 ± 1.4

The set was made up of two heterogeneous groups. The first group was made up of 39 bachelor-level male students, and the second of 20 bachelor-level female students, all from the Faculty of Mechanical Engineering, Slovak University of Technology in Bratislava. There is a higher proportion of men (80%) than women (20%) of all students at the University, which results in a disparity between groups.

Demographic information questionnaire, inclusion and exclusion criteria

The questionnaire assessed demographic questions such as age, height, weight, BMI, as well as questions related to the inclusion criteria including no pregnancy, lack of regular exercise, lack of history of spine surgery, lack of history of orthopedic disease in the past 5 years, no specific drug use for musculoskeletal or neurovascular disorders, lack of history of irreversible kyphosis or lordosis, and no history of scoliosis. The questionnaire was filled out by the students after self-report at the beginning of the study. Exclusion criteria were dissatisfaction for cooperation.

Once a week the students took part in compulsory elective physical education. The females in their lessons had various types of aerobics, while the males took part in indoor football and floorball. We evaluated the participants at the beginning of their second semester of physical education. The testing was carried out by a member of our research team with long-term experience with Spinal Mouse measurement. All participants were acquainted in advance with the course of testing and agreed with its conditions. The measuring was done under standard practice, with observance of hygienic, safety and discretion conditions. The man were undressed in upper body and the women had a swimsuit top and sports pants. Participants were evaluated by the same methodology in two different positions using the Spinal Mouse. The first measurements were directed to evaluating the spine in a standing posture, the second while sitting.

In our work we used Spinal Mouse equipment, which gave us a more detailed evaluation of posture. The diagnostic tool that we used for our research purposes consisted of a Spinal Mouse, a computer, and electro-mechanical equipment (Idiag, Fehraltdorf, Switzerland). The measurement of posture was performed on a sagittal level, in relaxed standing, sitting and sitting-stretching positions. The measurements were made in random order. All the measuring was done on one day, in the same environment, and with similar conditions; there was a 5-minute rest between each measurement. Prior to the testing, the participants did not perform any strenuous exercises nor sports training. Before the measuring, the examiner determined the starting point C7 and the upper part of the anal fold (end point) by palpation and marked them on the ski. The examiner ran the Spinal Mouse along the central axis of the spine (or mildly paravertebrally in particularly thin individuals) from C7 to the upper part of the anal fold (about S3). In each position, the values of the chest (T1-2 to T11-12) and the lumbar spines (T12-L1 to the sacrum bone) were recorded. In the lumbar curve, negative values corresponded to lumbar lordosis (posterior concavity).

Evaluation positions:

Standing: the participant stood in a relaxed position, with an upright head, arms next to the body, knees stretched out, feet shoulder-width apart;

Seated: the participant sat on the edge of a chair, knees bent to a 90° angle with legs spread, not touching the ground, head slightly bent, hands on knees.

Spinal Mouse is a valid and reliable device for measuring the global thoracic and lumbar curvatures when compared to radiographic techniques [19, 20, 21], documented by the ICC greater than 0.8 and a standard error of measurement (SEM) lower than 4º for all spinal parameters evaluated [20].

Statistical analysis

Data analyses were performed using the statistical program SPSS for Windows, version 18.0 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics, including mean and standard deviations, were calculated for all variables. The hypotheses of normality and homogeneity of variance were analyzed using the Shapiro-Wilk test. Unpaired Student t-test was conducted to examine differences between females and males for all variables. The significance level was set at p < 0.05.

To evaluate the standing posture with the Spinal Mouse we used a classification of thoracic kyphosis of the spine by Mejia et al. [22] (Fig. 1). Values between 20° and 45° were accepted as neutral thoracic kyphosis, values less than 20° were considered as thoracic hypokyhosis and values greater than 45° were considered as thoracic hyperkyphosis. For an evaluation of the lumbar spine, we used a classification according to Tüzün et al. [23] (Fig. 1). In the lumbar curve, in a standing position, values between 20° and 40° were taken as neutral while values less than 20° were considered as hypolordotic and values greater than 40° were considered as hyperlordotic.

Table 2

Values of thoracic kyphosis and lumbar lordosis in a standing position for male and female students.
	Thoracic part of the spine while standing			Lumbar part of the spine while standing
	20° − 45° Neutral thoracic kyphosis	< 20° Thoracic hypokyhosis	> 45° Thoracic hyperkyphosis	20° − 40° Neutral lumbar lordosis	< 20° Lumbar hypolordosis	> 40° Lumbar hypolordosis
Females	80.00%	10.00%	10.00%	90.00%	0.00%	10.00%
Mean	33.25°	18.50°	47.00°	-33.11°	0.00°	-41.00°
Min	25,00°	18.00°	46.00°	-25.00°	0.00°	-41.00°
May	45.00°	19.00°	48.00°	-40.00°	0.00°	-41,00
Males	69.23%	0%	30.77%	97.44%	0%	2.56%
Mean	35.33°	0.00°	54.27°	-29.76°	0.00	-50.00°
Min	21.00°	0.00°	46.00°	-39.00°	0.00	-50.00°
Max	45.00°	0.00°	65.00°	-16.00°	0.00	-50.00°

In the first measurement in a standing position, 80% of the female students had neutral thoracic kyphosis, with an average value of 33.25°. Fewer male students (69.23%) had neutral thoracic kyphosis, with a mean value of 35.33°. We found thoracic hypokyhosis in 10% of the female students, with a mean value of 18.50°. Thoracic hyperkyphosis greater than 47° was found in 10% of the female students, with a mean value of 47°. On the other hand, we found thoracic hyperkyphosis (54.27°) in 31% of the male students (Table 2).

We also found gender differences in the total evaluation of the differences in the thoracic part of the spine, a significant difference to the detriment of the male students (Tables 3 and 4).

In evaluating the lumbar part of the spine in a standing position, we found in 90% of the female students a neutral position of the lumbar lordosis, with a mean value − 33.11°. We found even better results with 97.44% of the male students having a neutral position of the lumbar lordosis, with a mean value of -29.76°. We did not detect lumbar hypolordosis in any of the female students. We found increased hyperlordosis in 10% of female students, with a mean value of -41°. In 2.56% of the male students we found more pronounced hyperlordosis with a mean value of -50° (Table 2).

We found gender differences with the total evaluation of the differences in the lumbar part of the spine to the detriment of the female students (Tables 3 and 4).

Table 3

Statistical analysis of the measured data of the thoracic and lumbar spines of standing male and female st dents.
	Thoracic part of spine, standing		Lumbar part of spine, standing
	Females (n = 20) (Col_1)	Males (n = 39) (Col_5)	Females (n = 20) (Col_2)	Males (n = 39) (Col_6)
Median	32	45	-35	-28.5
Minimum	19	25	-41	-37
Maximum	48	60	-25	-22
Range	29	35	16	15
Lower quartile	28	36.5	-37.5	-34.5
Upper quartile	37.5	50	-32	-23.5
Interquartile range	9.5	13.5	5.5	11

Table 4

Statistical significance of the gathered thoracic and lumbar data of standing male and female students.
Contrast	Sig.	Difference	+/- Limits	Contrast	Sig.	Difference	+/- Limits
Col_1 - Col_5	*	-9.46538	5.49245	Col_2 - Col_6	*	-3.61795	3.31012
* denotes a statistically significant difference * denotes a statistically significant difference

In evaluating seating posture with the Spinal Mouse, we used the classification of the thoracic part of the spine according to Martinez [24] (Fig. 2). Values less than 41° were accepted as a neutral thoracic spine, values from 41° to 53° were considered as light thoracic hyperkyphosis, and values over 53° were considered as increased light hyperkyphosis. For evaluating the lumbar part of the spine we also used a classification according to Martinez [24] (Fig. 2). In the lumbar curve in the seating position, values less than 14° were considered neutral, while values from 14° to 21° were considered as light lumbar hyperkyphosis and values over 21° were considered as increased light lumbar hyperkyphosis.

Table 5

Values of the thoracic and lumbar parts of the spine in a seated position for male and female students.
	Thoracic part of the spine while seated			Lumbar part of the spine while seated
	< 41° Neutral thoracic spine	41° − 51° Light thoracic hyperkyphosis	> 53° Mild thoracic hyperkyphosis	< 14° Neutral lumbar spine	14° − 21° Light lumbar hyperkyphosis	> 21° Mild lumbar hyperkyphosis
Females	70.00%	30.00%	0.00%	70.00%	5.00%	25.00%
Mean	30.2°	47.5°	0	7.0°	16.0°	22.5°
Min	8.0°	42.0°	0	-22.0°	16.0°	22.0°
Max	40.0°	51.0°	0	12.0°	16.0°	24.0°
Males	33.33%	23.08%	46.15%	38.46%	35.90%	25.64%
Mean	30.62°	46.67°	59.76°	6.6°	16.14°	23.9°
Min	22.0°	42.0°	50.0°	1.0°	14.0°	22.0°
Max	40.0°	51.0°	79.0°	12.0°	21.0°	27.0°

In measuring the spine when sitting, we found that 70.00% of the female students had the thoracic part of the spine in a neutral position (mean angular values: 30.20°). Only 33.33% of the male students had a neutral position in the thoracic part of the spine when sitting (30.62°). Here we found a significant difference in comparison with standing, where 69.23% of the students had an approximately equal value of 35.33°. The 30% of the female students had light thoracic hyperkyphosis (mean angular values: 47.50°) in a sitting position. We found about equal values in 23.08% of the male students (mean angular values: 46.67°). In the sitting position, we found not one case of mildly increased hyperkyphosis among the female students, but 46.15% of the male students had indications of mild thoracic hyperkyphosis, with a mean value of 59.76°.

We found intergender differences in the overall evaluation of the thoracic part of the spine when sitting. There was a significant difference to the detriment of the male students (Tables 6 and 7).

In the evaluations of the lumbar part of the spine when sitting, 70% of the female students and only 38.46% of the male students had a neutral lumbar part of the spine, with a mean value of 7°. Slightly increased lumbar hyperkyphosis in the sitting position was found in 25% of the female students, with a mean value of 22.5°. The 36% of the male students had light lumbar hyperkyphosis (mean angular values: 16.14°) and in 28% of the male students was found slightly increased lumbar hyperkyphosis (mean angular values: 25.64°) (Table 5).

When evaluating the lumbar part of the spine in a sitting position, we found no significant differences (Tables 6 and 7).

Table 6

Statistical analysis of measured values of the spine when sitting.
	Thoracic part of spine, seated		Lumbar part of spine, seated
	Females (n = 20) (Col_1)	Males (n = 39) (Col_5)	Females (n = 20) (Col_2)	Males (n = 39) (Col_6)
Median	38.5	55	8	13
Minimum	18	38	-22	-27
Maximum	49	68	24	23
Range	31	30	46	50
Lower quartile	27	44.5	-1.5	3
Upper quartile	44	60	17	19.5

Table 7

Statistical significance of the gathered thoracic and lumbar data of standing male and female students.
Contrast	Sig.	Difference	+/- Limits	Contrast	Sig.	Difference	+/- Limits
Col_1 - Col_5	*	-11.5256	7.12553	Col_2 - Col_6		-4.11538	6,.
* denotes a statistically significant difference * denotes a statistically significant difference

Young adults and university students spend most of their time in a sedentary way at school, as well as in the leisure time, typical for office workers [25, 26, 27], which puts them at permanent risk of future musculoskeletal problem. The consequence of their sedentary lifestyle results in significantly reduced strength expenditure and fatigue resistance. Higher fatigue in sedentary people than physically active people is associated with longer sitting [28] and this can be a major cause of back pain. Based on the above facts, we can suggest that our tested group of students would achieve better posture if they engaged in sports regularly. We believe that a lower percentage would have chest hyperkyphosis in men and lumbar hyperlordosis in women. However, this finding requires further testing of the effects of physical activities on posture. Lack of exercise causes joint contracture, narrowing or stiffness of the joints [29]. Physical inactivity also causes changes in muscle fibers, which can contribute to muscle stiffness [30]. Fatigue-induced reduction in active muscle stiffness increases antagonistic co-contraction to maintain stability, leading to increased spinal compression with fatigue [31]. Fatigue of back muscles of young healthy individuals aggravates the ability to adapt their posture management strategy to prevailing conditions and may lead to a similar posture strategy to that seen in patients with recurrent LBP as postural demands increase [32]. The predominance of the sedentary lifestyle leads to a reduction in muscle strength. Young healthy adults lose 2% of their muscle mass after 28 days of bed rest [33]. This muscle weakness is associated with many unhealthy effects, including changes in motoric control of deep trunk muscles and, consequently, changes in postural control strategies [34] and emerges as a potential risk factor for back pain, which underlining the importance of identifying posture defects from the neutral spine position. Normal posture is defined as the gravitational line passing through the external auditory meatus, the body of the cervical spine and the acromium, and fore of the thoracic spine [35]. These facts point that unilateral, insufficient or excessive load or exercise without adequate compensatory procedures can lead to increased muscle imbalance. In this regards it is also important to add tests of reactive balance and strength of related muscle groups in functional testing of young adults in order to more effectively identify their back problems [36, 37].

At present, a trend of increasing functional breakdowns of the locomotor system is apparent. Among students, this arises from adaption to a daily mobility regime in which the same muscle groups are overused, leading to faulty mobility stereotypes [38]. Our research monitoring confirms for us the occurrence of sexual dimorphism of shortened and weakened muscles with a trend towards a greater occurrence of shortened muscles among the male population and weakened ones among the females. The shortening of the pectoral muscles promotes the development of chest kyphosis. Weakening of the abdominal muscles promotes the development of lumbar lordosis. A number of authors [39–41] inter alia have reached similar conclusions in their research work. Differences in posture between men and women have been confirmed by several researchers. Yi-Lang Chen et al. [42] found differences in posture in sitting between men and women. Gender differences in posture confirm higher prevalence and incidence of musculoskeletal disorders females than males [43]. The age of women affects the position of the torso more in the sagittal plane than in the frontal one [44].

It is clear from the study that it is very important to perform compensatory exercises, stretching, targeted strengthening exercises and exercises aimed at training the correct movement stereotypes. The effects of targeted exercises are reflected in the overall posture. Interventions to increase either active breaks or postural shifts reduced new onset of neck and low-back pain among high-risk office workers [45]. The effects of mobilization and stabilization exercises focused on muscle strength and flexibility increase resistance to LBP [46–48]. They concluded that the muscular activation was effective and that the exercises that decreased the Oswestry Disability Index also increased muscular strength. This is because thoracic joint mobilization or self-stretching exercises for the spine improve limited movements of the spine, recover facet joint sliding, and normalize the articular capsule, thereby decreasing kyphosis and enhancing the flexibility of thoracic extension [49–51]. Unilateral, insufficient or excessive burdening without adequate compensatory measures may lead to an increase of muscle imbalance. Accordingly, the performance of compensatory exercises, stretching, targeted strengthening exercises and exercises focused on the practicing of correct movement stereotypes is extremely important. The results of purposed exercising are reflected in overall posture.

Study by Jankowicz-Szymańska et al. [52] found that hyperlordosis is characteristic for young female students, while hypolordosis for older women. In our research, we found a higher incidence of hyperlordosis (10%) than students (2.56%). Interestingly, hyperlordosis as a negative state of posture is a positive signal of sexual sensitivity for some women. In general, an increase in thoracic kyphosis causes lumbar hyperlordosis to maintain sagittal balance [53]. It can be said that the higher incidence of hyperkyphosis in men may be a clinical sign of the presence of osteoporosis and a potentially modifiable risk factor for adverse health consequences [54]. Our study also confirmed a higher incidence of hyperkyphosis in students (30.77%) than in female students (10.00%). According Almujel et al. [55] correct curvature of the spine correlates significantly positively with the strength of the back muscles, and these factors are important for maintaining quality of life.

The main limitation of this study is the low number of female students tested, due to the overall low number of female students at the technical university. This study is limited by the fact that there are currently no other studies that we could relevantly compare with our results.

Gender differences in the curvature of the thoracic spine in the standing position are to the detriment of men (37% thoracic hyperkyphosis, 54.27°), while in the lumbar part they are to the detriment of women (10% lumbar hyperlordosis, -41.00°). Gender differences in the curvature of the spine in the sitting position showed that mild thoracic hyperkyphosis predominated in men (46.15%, 59.76°). Mild lumbar hyperkyphosis in the sitting position is almost the same for both female students (25%, 22.5°) and male students (25.64%, 23.9°). These findings suggest that there are gender-specific differences in spinal curvature. Long-term sitting increases muscle fatigue, worsens posture and may be a possible cause of back pain. It is practical to take short regular breaks to focus on compensatory sitting and standing exercises. By focusing attention on the selection of special exercises for problematic parts of the spine, the work capacity and vitality of students will thereby be enhanced.

Author Contributions

Conceptualization, A.C., E.Z, J.M.M. and M.U.; methodology, A.C., E.Z, J.M.M., L.Š and M.U.; formal analysis, A.C.; investigation, A.C., E.Z, J.M.M., L.Š and M.U.; data curation, A.C., E.Z, J.M.M..; writing—original draft preparation, A.C.; writing—review and editing, A.C., E.Z, J.M.M.; supervision, A.C. All authors have read and agreed to the published version of the manuscript.

Funding:

This research received no external funding.

Informed Consent Statement:

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement: Data are available upon request.

Acknowledgments:

This work was supported by the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Research and Development Agency under the contract (No.APVV-15-0704).

Institutional Review Board Statement:

The project was approved by the ethics committee of the Faculty of Physical Education and Sport, Comenius University in Bratislava (No. 4/2017).

The procedures described are in accordance with the ethical standards on human experimentation stated in compliance with the 1964 Declaration of Helsinki and its later amendments

Conflicts of Interest:

The authors declare no conflict of interest.

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Spinal curvature in female and male university students with prolonged bouts of sedentary behaviour

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