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Indian Pediatr. 2010 Jul;47(7):575-80. Ramprasad M, Alias J, Raghuveer AK.

Carrying heavy backpacks could cause a wide spectrum of pain related musculoskeletal
disorders and postural dysfunctions. To determine the changes in various postural angles with
different backpack weights in preadolescent children… digitizing software was used for
analyzing photographs to determine craniovertebral (CV), head on neck (HON), head and
neck on trunk (HNOT), trunk and lower limb angles. Postural angles were compared with no
backpack and with backpacks weighing 5% to 25% of the subject’s bodyweight. The CV angle
changed significantly after 15% of backpack load (P <0.05). The HON and HNOT angles changed
significantly after 10% of backpack load (P <0.05). The trunk and lower limb angle also changed
significantly after 5% of backpack load (P <0.05). Carrying a backpack weighing 15% of body
weight change all the postural angles in preadolescent children.

9) Spinal Posture in the Sagittal Plane Is Associated With Future Dependence in Activities of
Daily Living: A Community-Based Cohort Study of Older Adults in Japan.

J Gerontol A Biol Sci Med Sci. 2013 Jan 28. Kamitani K, Michikawa T, Iwasawa S, Eto N, Tanaka T,
Takebayashi T, Nishiwaki Y.

Accumulated evidence shows how important spinal posture is for aged populations in
maintaining independence in everyday life. However, the cross-sectional designs of most
previous studies prevent elucidation of the relationship between spinal posture and future
dependence in activities of daily living (ADL). We tried to clarify the association by measuring
spinal posture noninvasively in a community-based prospective cohort study of older adults,
paying particular attention to thoracic curvature, lumbar curvature, sacral hip angle, and
inclination to determine which parameter is most strongly associated with dependence in ADL…
This study indicates that spinal inclination is associated with future dependence in ADL
among older adults.

10) Association of spinal inclination with physical performance measures among community-
dwelling Japanese women aged 40 years and older.

Geriatr Gerontol Int. 2012 Dec 26. Abe Y, Aoyagi K, Tsurumoto T, Chen CY, Kanagae M,
Mizukami S, Ye Z, Kusano Y.

Spinal inclination assesses spinal posture as a whole. However, the association between spinal
inclination and physical performance has not yet been fully elucidated. Therefore, this study
aimed to explore the association of spinal inclination with physical performance measures. The
participants were 107 Japanese women aged 40-84 years. Spinal posture was assessed as
inclination to a perpendicular line by using a computer-assisted device. Increased inclination
value means forward inclination of the spine. Physical performance was measured by using the
following methods: 6-m walking time, chair stand time, functional reach, Timed Up & Go Test,
and grip strength. Information on participants’ comorbidities, osteoporosis, knee joint pain,
back pain, falls in the previous year, regular exercise and usage of non-steroidal anti-
inflammatory drugs (NSAIDs), was also collected. Pearson’s correlation analysis showed
significant associations between spinal inclination and all of the physical performance