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J Exerc Rehabil > Volume 14(4);2018 > Article
Lee: Incidence analysis of axial and lower extremity deviations based on the physical characteristics between domestic and foreign college students

Abstract

This research was performed to identify the incidence and to determine the effects of risk factors of axial and lower extremity deformities. One hundred forty-seven domestic college students (102 males and 45 females) and 72 foreign students (33 males and 39 females) were subjects in this study. Data collecting was performed by questionnaire and visual postural evaluation. For backpack shoulder dominance, higher incidences of genu varus (P=0.043) and lower incidence of leg length discrepancy (LLD) (P=0.001) were found in both shoulder carrier, while the incidence of lordosis was higher in left (P=0.001) and both (P=0.012) carrier in domestic students. The incidence of genu varus (P=0.022) and scoliosis (P=0.002) were significantly lower in both shoulder carrier in foreign students. For dominant arm, the incidence of forward head (P=0.001) and of lordosis (P=0.029) were significantly higher in left handedness both in domestic students and in foreign students. As the body mass index increases, the incidence of protruding abdomen (P=0.001) and lordosis (P=0.009) showed significant increase, but, the incidence of kyphosis (P=0.022) and scoliosis (P=0.001) decreased in domestic students, and same tendency for lordosis (P=0.001) and for scoliosis (P=0.001) in foreign students. As a whole, in domestic students, female students revealed significantly high (P=0.004) incidence of genu recurvatum compared to significantly low (P=0.022) incidence of LLD. However, no significant incidence difference found in foreign students. Male students showed significantly low incidence (P=0.001) of LLD and high incidence (P=0.014) of lordosis. In foreign students, female students also showed significantly low incidence (P=0.032) of LLD in foreign students compared to their counterparts.

INTRODUCTION

Incidence of musculoskeletal diseases has increased in recent years. Musculoskeletal diseases are one of the main health problems around world and have great consequences for public health because of the large amount of their health and social resources. Nevertheless, epidemiological studies on the incidence and impact of musculoskeletal diseases compared with systemic diseases are infrequent (Carmona et al., 2001).
Axial and lower extremity deviations must be diagnosed in their beginning stages to prevent severe deformity because early diagnosis and detection of the abnormality increases the chance of correction (Eden-Kilgour and Gibson, 1990; Gunnoe, 1990). Left untreated, a mild condition can become so severe that it could cause back pain and damage to internal organs, and even require corrective surgery (Eden-Kilgour and Gibson, 1990; Francis and Bryce, 1987).
The most controversial issues relating to postural deviations continue to be those of risk factors. Etiologies of some axial and lower extremity deviations are generally classified as idiopathic. However, most researchers agree that gender (Mattila et al., 2007) and age (Palmer and Goodson, 2015) are the most common risk factors. Some researchers suggested that handedness (Walker and Perreault, 2015; Williams et al., 2002), backpack shoulder dominance (Grimmer et al., 2002), and height and weight (Viester et al., 2013) might be possible risk factors of axial and lower extremity deviations.
Spinal deformities might be considered to relate to the lower extremities, such as knee or hip flexion and extension positions (Itoi, 1991). However, no study has reported on the relationship between spinal and lower extremities based on the nationality.
Therefore, the purpose of this study was to determine the incidence of axial and lower extremity deviations and identify the effects of risk factors (backpack shoulder dominance, handedness, body mass index [BMI], nationality, and gender) on the development of axial deformities (forward head, protruding abdomen, kyphosis, lordosis, scoliosis) and lower extremity deformities (genu valgus, genu varus, genu recurvatum, leg length discrepancy).

MATERIALS AND METHODS

Participants

One hundred forty-seven (102 males and 45 females) domestic college students and 72 (33 males and 39 females) foreign students were subjects in this study. Physical characteristics of the subjects are listed in Table 1.

Data collecting

Subjects with a history of related disorders or injury to vertebrae or lower extremity were barred from participation. All subjects were asked wear tight-fitting stretch swimming suits only. No socks were permitted for the data collecting. The subjects were asked to answer each question on the questionnaire including nationality, backpack shoulder dominance, handedness, gender, age, height, and weight.

Experimental procedures

The visual postural examination of the spine and lower extremity was conducted from anterior, posterior, lateral, and prone positions. From the anterior view, height of the shoulder on both side was observed. From the posterior view, any sign of scoliosis, genu valgus, genu varus, or genu recurvatum was observed. From the lateral view, any sign of forward head, protruding abdomen, kyphosis, lordosis was observed. From the prone position, observation was performed if there is leg length discrepancy. This procedure was established and validated by Wen et al. (1998).

Statistical analysis

A logistic regression was used to identify the association of genu valgus, genu varus, genu recurvatum, leg length discrepancy, forward head, protruding abdomen, kyphosis, lordosis, and scoliosis. Independent variables were nationality, gender, backpack shoulder dominance, handedness, and BMI converted from the height and the weight. Each spinal and lower extremity deformities were considered as dependent variable in the study. Data were analyzed with IBM SPSS Statistics ver. 20.0 (IBM Co., Armonk, NY, USA) and statistical significance was set at P<0.05 for all tests.

RESULTS

Table 2 shows the result of the effects of backpack shoulder dominance on the incidence of each spinal and lower extremity deviations. As shown in the Table 2, subjects carrying the backpack on both shoulder showed significantly higher incidence of genu varus (P=0.043) and lower incidence of LLD (P=0.001) than right shoulder carrying in domestic students. Subjects carrying the backpack on the left shoulder (P=0.001) and on both shoulder (P=0.012) showed significantly higher incidence of lordosis, respectively than right shoulder carrying in domestic students. In contrast, subjects carrying the backpack on both shoulder showed significantly lower incidence of genu varus (P=0.022) and scoliosis (P=0.002) than right shoulder carrying in foreign students.
The result of the effects of dominant arm on the incidence of each spinal and lower extremity deviations is presented in Table 3. According to the Table 3, in domestic students, subjects with left hand dominance showed the significantly higher incidence of forward head (P=0.001) while incidence of lordosis was significantly higher (P=0.029) in left hand dominance subjects than their counterparts in foreign students.
Table 4 represents the result of the effects of BMI on the incidence of each spinal and lower extremity deviations. In domestic students, as the BMI increases, the incidences of protruding abdomen (P=0.001) and lordosis (P=0.009) showed significantly high increases while significantly low decrease in kyphosis (P=0.022) and in scoliosis (P=0.001). However, incidence of lordosis (P=0.001) significantly increased and the incidence of scoliosis (P=0.001) significantly decreased in foreign students.
The incidence difference between nationality and gender are shown in Tables 5 and 6. As a whole, in domestic students, female students revealed significantly higher (P=0.004) incidence of genu recurvatum and significantly low incidence of LLD (P= 0.022) compared to male students. However, no significant incidence difference found in foreign students.
Male students showed significantly low incidence of LLD (P=0.001) and high incidence of lordosis (P=0.014) in foreign students, Female students also showed significantly low incidence of LLD (P=0.032) in foreign students compared to domestic students.

DISCUSSION

The results of this study revealed that subjects carrying their backpack on both shoulder showed higher incidence of genu varus and lordosis in domestic students. High incidence of genu varus might be explained that the reason of high incidence is not due to backpack but traditional sitting-on life style of Korean people even though Western life style is stabilized in their current daily life. High incidence of lordosis also might be caused by the influence of heavy backpack load during junior to high school days. This result is consistent with the report by Grimmer et al. (2002) suggesting that backpacks should be positioned high on the trunk to minimize antigravity stresses on body tissues and loads should be limited to 10% of their body weight. Subjects with left hand dominance showed significantly high incidence of forward head in domestic students and lordosis in foreign students. Even the small percentile of left-handed subject, this result coincides with the results of the research by Williams et al. (2002) explaining that physiological and mechanical modifications to muscle structure and composition from long term preferential use of one hand.
In this study, it was found that students with high BMI showed no significant difference on lower extremity but on axial spine. Especially, students with high BMI showed high incidence of lordosis and low incidence of scoliosis. Even the relationship between BMI and musculoskeletal deformities has been focused in studies on low back pain (Shiri et al., 2010) it could be argued that high BMI is associated with deformities in other body regions such as neck, shoulder, and lower limbs (Viester et al., 2013). Even it is difficult to compare the incidence of musculoskeletal deviations due to the absent of research between nations the reason of high incidence of genu recurvatum in female students seems to the weakness of muscle force on the lower extremity because of insufficient of physical activities. Low incidence of LLD in foreign students compared to domestic students might be attributed to their standing-up life style.

Notes

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

Carmona L, Ballina J, Gabriel R, Laffon A; EPISER Study Group. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis. 2001;60:1040–1045.
crossref pmid pmc

Eden-Kilgour S, Gibson DE. Nursing management of children with scoliosis. J Pract Nurs. 1990;40:34–38.


Francis RS, Bryce GR. Screening for musculoskeletal deviations--a challenge for the physical therapist. The Utah Study. Phys Ther. 1987;67:1221–1225.
crossref pmid pdf

Grimmer K, Dansie B, Milanese S, Pirunsan U, Trott P. Adolescent standing postural response to backpack loads: a randomised controlled experimental study. BMC Musculoskelet Disord. 2002;3:10
crossref pmid pmc pdf

Gunnoe BA. Adolescent idiopathic scoliosis. Orthop Rev. 1990;19:35–43.
pmid

Itoi E. Roentgenographic analysis of posture in spinal osteoporotics. Spine (Phila Pa 1976). 1991;16:750–756.
crossref pmid

Mattila VM, Niva M, Kiuru M, Pihlajamäki H. Risk factors for bone stress injuries: a follow-up study of 102,515 person-years. Med Sci Sports Exerc. 2007;39:1061–1066.
crossref pmid

Palmer KT, Goodson N. Ageing, musculoskeletal health and work. Best Pract Res Clin Rheumatol. 2015;29:391–404.
crossref pmid pmc

Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171:135–154.
crossref pmid pdf

Viester L, Verhagen EA, Oude Hengel KM, Koppes LL, van der Beek AJ, Bongers PM. The relation between body mass index and musculoskeletal symptoms in the working population. BMC Musculoskelet Disord. 2013;14:238
crossref pmid pmc pdf

Walker EH, Perreault EJ. Arm dominance affects feedforward strategy more than feedback sensitivity during a postural task. Exp Brain Res. 2015;233:2001–2011.
crossref pmid pmc

Wen DY, Puffer JC, Schmalzried TP. Injuries in runners: a prospective study of alignment. Clin J Sport Med. 1998;8:187–194.
crossref pmid

Williams DM, Sharma S, Bilodeau M. Neuromuscular fatigue of elbow flexor muscles of dominant and non-dominant arms in healthy humans. J Electromyogr Kinesiol. 2002;12:287–294.
crossref pmid

Table 1
Physical characteristics of subjects
Variable Domestic Foreign


Male (n=102) Female (n=45) Male (n=33) Female (n=39)
Age (mo) 273.71±13.72 255.13±14.09 266.93±16.12 263.67±23.55

Height (cm) 176.44±5.39 163.16±3.31 179.73±4.34 165.05±5.87

Weight (kg) 73.14±10.97 56.11±7.72 76.03±9.65 59.18±5.16

BMI (kg/m2) 23.42±2.74 21.05±2.62 23.49±2.36 21.75±1.91

Values are presented as mean±standard deviation.

BMI, body mass index.

Table 2
Backpack shoulder dominance
Variable Domestic Foreign


95% CI Odds ratio P for trend 95% CI Odds ratio P for trend
Genu valgus
 LF 0 1.000 0.997 0 0.001 0.999
 BOTH 0 1.000 1.000 0.040–1.166 0.216 0.075

Genu varus
 LF 0.776–22.378 4.167 0.096 0 0.001 0.999
 BOTH 1.047–17.396 4.268 0.043* 0.028–0.762 0.147 0.022*

Genu recuvatum
 LF 0.046–3.210 0.383 0.377 0 0.001 0.999
 BOTH 0.131–1.990 0.511 0.333 0.356–32.033 3.375 0.289

Leg length discrepancy
 LF 0.243–1.700 0.643 0.373 0.504–29.261 4.333 0.182
 BOTH 0.083–0.463 0.198 0.001* 0.032–4.319 0.371 0.429

Forward head
 LF 0.269–3.088 0.912 0.882 0.107–13.300 1.190 0.887
 BOTH 0.696–3.660 1.596 0.270 0.378–7.351 1.667 0.500

Protruding abdomen
 LF 0.579–6.254 1.903 0.289 0 0.001 0.999
 BOTH 0.373–2.896 1.040 0.940 0.101–5.796 0.765 0.795

Kyphosis
 LF 0 0.001 0.998 0 1.000 1.000
 BOTH 0.465–6.202 1.698 0.423 0 1.000 1.000

Lordosis
 LF 2.880–54.254 12.500 0.001* 0.053–5.129 0.524 0.579
 BOTH 1.477–22.539 5.769 0.012* 0.160–2.184 0.591 0.431

Scoliosis
 LF 0.026–1.691 0.210 0.143 0 0.001 0.999
 BOTH 0.326–2.161 0.840 0.718 0.016–0.393 0.078 0.002*

CI, confidence interval; LF, left shoulder carrying; BOTH, both shoulder carrying.

* P<0.05, significant difference.

Table 3
Dominant arm (left shoulder carrying)
Variable Domestic Foreign


95% CI Odds ratio P for trend 95% CI Odds ratio P for trend
Genu valgus 0 0.001 0.998 0 0.001 0.998

Genu varus 0.928–9.513 2.971 0.067 0.410–6.470 1.630 0.488

Genu recuvatum 0 0.001 0.998 0.058–5.202 0.548 0.600

Leg length discrepancy 0.488–2.247 1.048 0.905 0.243–10.106 1.567 0.637

Forward head 1.805–9.468 4.133 0.001* 0.410–6.470 1.630 0.488

Protruding abdomen 0.056–1.133 0.252 0.072 0.316–18.241 2.400 0.398

Kyphosis 0.153–3.741 0.757 0.733 0.058–5.202 0.548 0.600

Lordosis 0.718–5.522 1.991 0.186 1.159–15.225 4.200 0.029*

Scoliosis 0.109–1.393 0.390 0.147 0.862–9.530 2.867 0.086

CI, confidence interval.

* P<0.05, significant difference.

Table 4
Effects of body mass index on the incidence of each spinal and lower extremity deviations
Variable Domestic Foreign


95% CI Odds ratio P for trend 95% CI Odds ratio P for trend
Genu valgus 0 1.000 0.991 0.762–1.435 1.046 0.783

Genu varus 0.681–1.047 0.844 0.123 0.919–1.610 1.216 0.171

Genu recuvatum 0.761–1.147 0.934 0.515 0.471–1.210 0.755 0.243

Leg length discrepancy 0.906–1.136 1.014 0.803 0.515–1.276 0.810 0.364

Forward head 0.981–1.277 1.119 0.095 0.779–1.388 1.040 0.790

Protruding abdomen 1.471–2.564 1.942 0.001* 0.561–208.129 10.801 0.115

Kyphosis 0.579–0.958 0.745 0.022* 0.489–1.239 0.779 0.291

Lordosis 1.057–1.475 1.249 0.009* 1.325–3.263 2.079 0.001*

Scoliosis 0.474–0.746 0.595 0.001* 0.168–0.603 0.318 0.001*

CI, confidence interval.

* P<0.05, significant difference.

Table 5
Relationship between deformity incidence and nationality
Variable Domestic Foreign


95% CI Odds ratio P for trend 95% CI Odds ratio P for trend
Genu valgus 0 0.001 0.998 0.529–15.026 2.818 0.225

Genu varus 0.082–1.812 0.385 0.227 0.216–3.135 0.824 0.776

Genu recuvatum 1.776–21.127 6.125 0.004* 0 0.001 0.998

Leg length discrepancy 0.190–0.881 0.409 0.022* 0.203–8.236 1.292 0.787

Forward head 0.155–1.065 0.407 0.067 0.073–1.311 0.310 0.111

Protruding abdomen 0 0.001 0.997 0 0.001 0.998

Kyphosis 0.111–2.682 0.547 0.457 0 0.001 0.998

Lordosis 0.265–2.331 0.786 0.664 0.006–0.436 0.053 0.006

Scoliosis 1.115–6.668 2.727 0.028 0 0.001 0.998

CI, confidence interval.

* P<0.05, significant difference.

Table 6
Relationship between deformity incidence and gender
Variable Male Female


95% CI Odds ratio P for trend 95% CI Odds ratio P for trend
Genu valgus 0.571–74.309 6.516 0.131 0 0.001 0.997

Genu varus 0.473–4.614 1.477 0.502 0.577–17.314 3.162 0.185

Genu recuvatum 0 0.001 0.998 0.179–1.933 0.588 0.382

Leg length discrepancy 0.016–0.319 0.073 0.001* 0.059–0.884 0.229 0.032*

Forward head 0.278–1.823 0.712 0.478 0.126–2.328 0.542 0.410

Protruding abdomen 0.151–1.478 0.474 0.201 0.234–1.658 0.912 0.254

Kyphosis 0 0.001 0.998 0.577–17.314 3.162 0.185

Lordosis 1.256–7.867 3.143 0.014* 0.024–1.886 0.211 0.164

Scoliosis 0 0.001 0.998 0.608–3.902 1.540 0.363

CI, confidence interval.

* P<0.05, significant difference.

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