Background Low back pain (LBP) is a significant public health problem among adolescent population. Postural alterations and decreased flexibility have been considered as possible risk factors for adolescent LBP. Thus, examination of posture and muscle flexibility is essential for determining any potential contributing factors (1–3). However, studies addressing the relationship between posture and flexibility in the adolescents with a history of LBP are limited.

Objectives To examine whether the alteration in three-dimensional (3D) body posture is related to flexibility in adolescents with a history of LBP.

Methods Fourteen adolescent students (9 female, 5 male, median age 14 years) participated in this study. For 3D evaluation of posture, internet-based postural assessment system was used. Thirteen reflective markers were placed on anatomical landmarks of subjects. Three digital photographs were obtained in upright stance (antero-posterior, left-right lateral) and were analyzed through the system. Postural displacements of head, rib cage, and pelvis were calculated as rotations in degrees and translations in millimeters. Alteration in body posture (head, rib cage, and pelvis) was evaluated using posture index which is total postural displacements score. In this system, total score is 96 points. The higher posture index score indicates more severely displaced posture. Flexibility was measured by a sit-and-reach test. Spearman's rank correlation coefficient (rho) was used to evaluate the association between the measured parameters. The significance level was set at p<0.05.

Results As a result, 14.3% (n=2) of the adolescents had slight, 71.4% (n=10) had significant and 14.3% (n=2) had a moderate displacement in their posture according to posture index score. Participants had a median sit-and-reach score of 21 cm and a median posture index score of 17 points. Strong negative correlation was observed between posture index score and sit-and-reach test (rho=-0.610, p=0.020).

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Conclusions In conclusion, this pilot study suggests that alteration in body posture may be related to decreased flexibility in adolescents with a history of low back pain. Future studies should attempt to determine postural changes, flexibility evaluations and associations between these parameters more extensively.

1. Houghton KM. Review for the generalist: evaluation of low back pain in children and adolescents. Pediatr Rheumatol Online J 2010;8:28. doi: 10.1186/1546-0096-8-28.

2. Smith A, O'Sullivan P, Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine (Phila Pa 1976) 2008;33(19):2101–7.

3. Feldman DE, Shrier I, Rossignol M, Abenhaim L. Risk factors for the development of low back pain in adolescence. Am J Epidemiol 2001;154(1):30–6.

Acknowledgement The authors would like to thank to Dokuz Eylül University, Scientific Research Fund for providing financial support for this project.

Disclosure of Interest None declared