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3/22/2016 Methods of Postural Assessment Used for Sports Persons

measurement of postural variables [8,13].

In a study which was done by Neikerk et al., two postural tools were used. LODOX (low dose radiograph) was
used to obtain radiographs and PPAM (photographic posture analysis method) was used to take photographs of the
subjects in the sitting position at a computer workstation. A total of 39 subjects were there. Both of the
measurement tools captured images of the subjects from head to T8 level, with the camera being placed two metres
away from the chair, on a tripod. Retroreflective markers were placed at 6 anatomical landmarks. Intellect 1.1.4
software and an additional software (DVT Reader) were used to digitize the markers. Trigonometric formulae were
used to calculate the various angles of the upper body. The values of five postural angles, which were obtained by
using the two methods were compared and a strong correlation was found between them, except for one angle
(protraction/retraction angle). Authors concluded that apart from the existing ‘gold standard’ method i.e. the
radiographic method, photographs could be thought to be as an alternative ‘gold standard’ for evaluation of sitting
posture [13].

Photogrammetric method

Off­late, photogrammetric method has come into existence and its use as a method for postural evaluation is
indisputable. This method seems to have evolved from the photographic and digitization method. In this method,
photographs of the subjects are taken in frontal or sagittal plane with a camera which is mounted on a leveled tripod
stand, which is placed at some distance from the subjects. This distance varies amongst various researches. The
photographs which are thus obtained are transferred to a computer system. They are used to calculate postural
angles with the help of some software which has been installed in the computer system. The type of software too
varies from research to research. Angles are then drawn between the markers by drawing horizontal and/or vertical
lines. With the use of this method, quantifiable and reliable data can be obtained. Its use in measuring head posture,
shoulder posture, cervical lordosis, thoracic kyphosis, lumbar lordosis, lower limb posture and pelvic tilt has been
reported in the literature [1,6,14]. This method was compared with the visual method, goniometry and radiography
[1,6]. Reliability of this method too was tested. Various postural evaluation studies which had been conducted by
using this method are.

Photogrammetry versus radiography

Upon comparison of postural angles which were obtained from photographic images with the angles which were
obtained from radiographic images, craniovertebral and cervical inclination angles were found out to be valid
measurements for the assessment of craniocervical posture [15].

Reliability of photogrammetric method

Photogrammetry has been reported to have a good to excellent interrater reliability. The ICC values which were
obtained for 33 postural variables were between 0.84 and 0.99 [16]. The digital camera that was used in this study
was placed at a distance of 3 metres from the subject and at a height of 90 cms from the ground, on a tripod, so that
all the anatomical landmarks, starting from glabella till the point between head of second and third metatarsals, were
visible in the photographs. SAPO software was then used to analyze the various postural variables.

In a recent study [17] done by Souza et al., digital camera mounted on a tripod was placed 3 metres from the
subject at a height which corresponded with approximately half the subject’s height. Whole body images of the
subject were obtained, with the camera being placed anterior, posterior and lateral with respect to the subject. The
researchers had used SAPO posture assessment software (v.0.68) in their study. Interexaminer and intraexaminer
reliabilities were examined after measuring 20 angles (A1 to A20) by three examiners. The ICC measures for trunk
angle (A13) and hip angle (A14) were found out to be 0.623 and 0.568, respectively. The level of reliability of
these two angles was thus classified as not acceptable. The ICC values for leg/right hindfoot angle and leg/left
hindfoot angle were 0.743 and 0.860, respectively. The former’s level of reliability was classified as acceptable and
the latter’s as very good. The interrater reliability for rest of the angles was classified as excellent, since the ICC
values for these were greater than 0.90. Four out of twenty angles yielded non­repeatable intrarater values. The

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064851/ 4/7