PREVALENCE OF LOWER CROSSED SYNDROME
AMONG GIZA SCHOOLCHILDREN.
Moemen H. Taiaa¹ ; Yasser M. Aneis² and Hanaa K. Atta3
1 Researcher of physical therapy for Basic Science Department, Cairo University.
2 Professor Doctor of Physical Therapy for Basic Science Department, Faculty of
physical therapy. Cairo University
3 Lecturer of Physical Therapy for Basic Science Department, Faculty of physical
therapy, Cairo University
1E-mail- Moementaiaa@gmail.com
Key Words: Lower crossed syndrome, Children ongoing School ,
muscular imbalance.
ABSTRACT :
Background : Lower crossed syndrome (LCS) is a musculoskeletal
imbalance characterized by specific patterns of muscle weakness
(Abdominals and Gluteus Maximus) and tightness (iliopsoas and spinal
extensors) that crosses between the dorsal and the ventral sides of the
body. This postural imbalance among schoolchildren can lead to Low
back pain in future. Purpose of this study is
to investigate the prevalence of lower crossed syndrome in Giza
schoolchildren in male and female subjects between the age group of 9 to
12 years. Methods : A total 232 student between age group 9 to 12 years
were taken with parents consents. Each student underwent for assessment
of strength of abdominal muscles and gluteal muscles with the use of
Manual Muscle Test and measurement of tightness of hip flexor muscles
with the use of Thomas test, and measurement of tightness of lower back
extensors muscles with the use of Schober test .
Results : 12.1 % of the total population have lower crossed syndrome i.e
28 subjects out of 232 total subjects have lower crossed syndrome.
Conclusion: Out of the total subjects 12.1% of subjects were found to be
prevalent for lower crossed syndrome.
INTRODUCTION
Lower Crossed Syndrome (LCS) is a “S” shaped lower back posture
characterized by tension in the hip flexors and lower back muscles, as well
as weakening in the abdominal and gluteus maximus muscles. It is also
known as distal or pelvic crossed syndrome. On the dorsal side of LCS, the
thoraco-lumbar extensors are tight and there are tightness also in the
iliopsoas and rectus on the other side. While there are weakness in the deep
abdominal muscles crosses ventrally with gluteus maximus weakness. Joint
dysfunction occurs as a result of this pattern of imbalance, particularly at the
Egypt. J. of Appl. Sci., 36 (7-8) 2021 133-150
L4-L5 and L5-S1 segments, the Sacroiliac joint, and the hip joint (Shriya et
al.,2017) .
In LCS there are specific postural changes which include increased
lumbar lordosis, anterior pelvic tilt, lateral lumbar shift, lateral leg rotation
and knee hyperextension. The imbalance is predominantly in the pelvic
muscles when the lordosis is deep and short, and the imbalance is
predominate in the trunk muscles when the lordosis is shallow and extends
into the thoracic area ( Parashar et al .,2014 ).
Joint dysfunction (ligamentous strain and increased pressure
particularly at the L4-L5 and L5-S1 segments, the hip joint and the SI joint),
specific postural changes (such as increased lumbar lordosis ,anterior pelvic
tilt, external rotation of hip, lateral lumbar shift, and knee hyperextension)
and joint pain (lower back, hip and knee) results from muscle imbalance .
Changes in posture may occur in other parts of the body, such as: increased
thoracic kyphosis and increased cervical lordosis (Chaitow et al.,2002 ).
Janda defines muscle imbalance as impairment in the interaction
between muscles that are prone to tightness or shortness and those that are
prone to inhibition. Our bodies have two types of muscles: phasic muscles
like the abdominals and hip extensors, and postural muscles like quadrates
lumborum , back rotators ,erector spinae, and the iliopsoas. He noted that
both static and postural muscles have a tendency to tighten. (Shriya et
al.,2017) .
In various movements, these muscles have a tendency to develop
weakness because they are more activated than the muscles which are
predominantly dynamic and phasic in function. ( Parashar et al .,2014 )
Janda found that static posture for long time, such as sitting on the
desk for many hours , which lead the hip flexors to be shortened or tight. As
a result, the brain will begin to shut down or inhibit the gluteus muscles on
the opposite side. Because of the forward pelvic tilt and hip flexion
contracture, as well as the overuse of the hip flexors to compensate for the
weak abdominals, the hip flexors are overworked, this imbalance pattern
leads to increasing lumbar lordosis (Dhanani et al.,2014).
Because of the presence of an inhibited antagonistic gluteus maximus,
tightness of the psoas would result in a poor quality of hip extension because
the contralateral lumbar erector spinae and ipsilateral hamstrings would have
to become overactive and eventually tight to perform the required hip
extension instead of the gluteus maximus. (Dhanani et al.,2014).
Low back pain is a universal problem and one of the threatening
combinations of biomechanical muscle imbalance is lower crossed
syndrome, due to over stress it places on the structures in the area of lower
back. People with postural imbalance complain from lower back pain and if
it is left unchecked, this postural imbalance can generate a chronic low back
134 Egypt. J. of Appl. Sci., 36 (7-8) 2021
pain that becomes more difficult to correct in later stages. (Shriya et
al.,2017) .
According to a study, over a period of 5 years the annual incidence of
low back pain in children of age between 11 to 15 gets increasing from
11.8% to 21.5%. The lifetime prevalence of low back pain increased from
11.6% to 50.4% between the age from 11 to 15 years. ( Shrikrushna et
al.,2019) .
According to Birger , 85 % of low back pain is caused by muscle
imbalance, which is most usually caused by long-term postural defects
known as lower crossed syndrome.
Schoolchildren with neck or back pain had more severe functional
disability, as measured by a subjective functional disability index. Because
of pain, the former group had more difficulties sleeping, sitting during
lessons, walking, physical activity, and hobbies.(Mikkelsson et al., 1997).
There are lack of literature evidence, which can show the prevalence
of lower crossed syndrome in Schoolchildren (males and females) .As a
result, the goal of this study was to identify the population at risk of
developing lower crossed syndrome, which can lead to low back pain (LBP)
in the long run, and to identify a cost-effective musculoskeletal corrective
measure that can be implemented at an early stage to reduce the risk of LBP.
Therefore, the present study intended to find out the prevalence of
lower crossed syndrome in Schoolchildren within the age group of 9 to 12
years.
MATERIALS AND METHODS
Design of study: Cross sectional study.
The current study was conducted at 4 schools in Giza government ,
in the period from March 2019 to November 2020, to evaluated the
prevalence of lower crossed syndrome in schoolchildren . After getting
ethical clearance from the institutional ethics committee, the consent forms
were given to all the parents of children of age between 9 to 12 years.
Consents of the parents and assents of 232 children were obtained.
The students participated in the current study after approval of Ethical
Committee of the faculty of physical therapy, Cairo University with number
(P.T.REC/012/002562), and all subjects provided written inform consent by
their parents .
Participants :
Inclusion criteria :
232 of Both boys and girls willing to participate in the study between
the age group of 9 to 12 years. Informed consent form (which also includes
permission to use their data and photograph for presentation and publication
purpose) written in their preferred language (English/ Arabic) was obtained
from parents of the children who agreed to participate.
Egypt. J. of Appl. Sci., 36 (7-8) 2021 135
Exclusion Criteria :
The schoolchildren with history of back or lower limb surgery, trauma
to back or lower extremity, low back pain since six months, rheumatoid
arthritis, spinal deformity, spasm of paraspinal muscle, any neurological
disease, and uncooperative schoolchildren were excluded.
All the schoolchildren performed warm up exercises (under
therapist’s supervision ) 5 repetition of back & hip flexor stretches before
the evaluation of muscle length and strength .
Outcome Measures :
- The strength of glutues maximus and abdominal muscles are evaluated by
Manual Muscle Test Grading.
-The flexibility of the lower back muscles are evaluated by Schober Test,
and the flexibility of hip flexors are evaluated by Modified Thomas Test.
Instruments and Scales of assessment :
1-Goniometer: A goniometer is a device that measures the range of motion
at a joint. There are several types of goniometers; the most common is
the universal standard goniometer, which is composed of plastic or metal.
It comprises of a fulcrum, a stationary arm, and a moveable arm.. Manual
goniometers yielded good test-retest reliability and validity
(Nussbaumer et al,2010)
2-Tape measurement: A tape measure is a measuring device made of
metal, plastic, or fabric with numbers printed on it..
3- The Modified Thomas Test (MTT) : is used to measure the tightness of
hip flexor, a specific observational clinical test for posture, postural
adaptation, and lower extremity kinematics that is often employed. It
indirectly provides information about hip and knee musculature
flexibility, particularly the m. iliopsoas, m. rectus femoris, tensor fasciae
latae, and sartorius. ( Dalibor et al., 2018 ) . Modified Thomas test were
reliable to evaluate hip flexor tightness with Intra-class correlation
coefficient = (0.98 ). ( Kim et al., 2015 ) .
4- Modified-Schober Test : used to measure length of spinal extensor
muscles by non elastic measuring tape , this test is classically used to
determine if there is a decrease in lumbar spine range of motion (flexion)
(Rezvani et al., 2012 ) . The validity against radiographs was. strong
(r=0.90),the reliability was found to be excellent (r=0.96). ( Tousignant
2005 ).
5- Manual muscle testing Grading : Manual Muscle Test was used to
assess the strength of the abdominal muscle and bilateral Gluteus
maximus muscle. The use of MMT for patients with musculoskeletal
dysfunction has been shown to be reliable and valid. (Cuthbert SC et
al.,2007)
136 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Assessment :
Measurement of iliopsoas muscle length ( Norkin et al ,2004 ) :-
The students were advised to lie supine on the bench with half of their
thigh protruding, and the therapist standing near the exam table. The lumbar
spine was examined for signs of severe lordosis. To flatten down the lumbar
spine and stabilize the pelvis, the volunteers were instructed and
demonstrated to pull (flex) and hold the non-tested hip in a flexed posture,
bringing the knee close to the chest. With a universal goniometer, the
examiner measured the length of the opposite side iliopsoas by keeping the
fulcrum above the greater trochanter, the movable arm parallel to the lateral
border of the femoral shaft, and the stationary arm parallel to the tested
bench. Both sides were subjected to the test. If the hip flexion angle was
more than 15 degrees, the iliopsoas was considered tight.
Measurement of strength of abdominal muscle ( Magee D , 2002 ) :-
The children were placed in a supine position with both hip and knee
flexed and hands clasped behind their heads (for Grade-V), arms crossed
over the chest (for Grade-IV), and arms outstretched in full extension above
the plane of body (for Grade-V) (For Grade-III). During the test, the
therapist stood at the side of the table at the level of the child chest to ensure
scapular clearance from the table. After that, the children were told to flex
their trunks to their entire range of motion. The trunk was emphasised
curling up till the scapula cleared the table. “Tuck your chin and lift your
head, shoulders, and arms off the table, as if you were doing a sit up,” was
the instruction.
Measurement of length of spinal extensors muscle (Tousignant et al.,
2005):
This was assessed in standing position, the child is standing with his
back towards the examiner, the intersection between the venus of dimples on
the lower back was marked with a marker as a reference line, 10 cm above
and 5 cm below the therapist draw from the reference line. The child was
then asked to bend forward, and the examiner measured the increase in
distance with a measuring tape. The outcome measures are the differences
between these points.
Measurement of gluteus Maximus strength ( Kendall et al.,1993 ) : -
The child is asked to lie prone with one knee flexed to 90 degrees. On
the tested side, the therapist was standing at the level of the pelvis. The
therapist used one hand to apply downward pressure and the other hand at
the low back, stabilizing the pelvis. The child was asked to extend his hip
while keeping his knees flexed at 90 degree .The therapist apply resistance
Egypt. J. of Appl. Sci., 36 (7-8) 2021 137
(minimal resistance for Grade 4 and maximum for Grade 5 ) at the lower
part on the posterior thigh in the direction of hip flexion so that the child
could reach the full range of hip extension. According to MRC grading. The
strength of gluteus maximus was graded.
Data analysis and statistical design
Data were expressed as mean± SD. Descriptive statistics was used to
determine the frequency of lower crossed syndrome, frequency of hip flexor
tightness, abdominal and gluteus Maximus weakness in male and female
subjects. Chi-square test was used to find out the homogeneity of proportion
of males and females having tight hip flexor, weak abdominal and gluteus
Maximus. Statistical package for the social sciences computer program
(version 20 for Windows; SPSS Inc., Chicago, Illinois, USA) was used for
data analysis. P less than or equal to 0.05 was considered significant.
RESULTS
This study was conducted to identify schoolchildren at risk of
developing lower crossed syndrome at an early stage.
General characteristics:
The mean ±SD of age, of the studied group were 10.59± 1.06 years
(table 1). The studied group was consisted of 232 children 138 males
(59.5%) and 94 females (40.5) Figure(1).
Table (1): The children age of this study.
Items N Minimum Maximum Mean SD
Age (years) 232 9 12 10.59 1.06
N: number, SD: standard deviation
Figure (1): Sex distribution of the study group.
138 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Normality test:
Data were screened for normality assumption, homogeneity of
variance, and presence of extreme scores. Shapiro-Wilk test for normality
showed that all measured variables (hip flexors flexibility by Thomas
test, spinal flexibility, abdominal and gluteal muscle strength) were not
normally distributed, so Wilcoxon test was for within subjects’
comparison. Statistical analysis was conducted using SPSS for Windows,
version 20 (SPSS, Inc., Chicago, IL). Alpha level set at 0.05.
The Prevalence of hip flexion flexibility among children:
Right hip flexor flexibility:
● For right hip flexors there were 211 children (90.9%) with normal
hip flexors flexibility (less than 15 degrees hip flexion) and 21
children (9.1%) had tight hip flexor (more than 15 degrees hip
flexion) (table 2).
Comparison between both sex revealed that, there was no
significant difference between both sex (p=0.813), there were 86 females
(91.4%) and 125 males (90.5%) with normal hip flexors flexibility.
While 8 females (8.6%) and 13 males (9.5%) had tight hip flexor.
Left hip flexor flexibility:
● For left hip flexors there were 214 children (92.2%) with normal
hip flexors flexibility (less than 15 degrees hip flexion) and 18
(7.8%) children had tight hip flexor (more than 15 degrees hip
flexion) (table 2).
Comparison between both sex revealed that, there was no
significant difference between both sex (p=0.884), there were 87 females
(92.5%) and 127 males (92%) with normal hip flexors flexibility. While
7 females (7.5%) and 11 males (8%) had tight hip flexor.
Table (2): Percentage of right and left hip flexion flexibility
Total 232 Female
(n=94)
Male (138) p-value
Hip flexion
(right)
Normal
(less than 15)
211
(90.9%)
86 (91.4%) 125
(90.5%)
0.813
Tight
(more than 15)
21 (9.1%) 8 (8.6%) 13 (9.5%)
Hip flexion
(left)
Normal
(less than 15)
214
(92.2%)
87 (92.5%) 127 (92%) 0.884
Tight (more than 15) 18 (7.8%) 7 (7.5%) 11 (8%)
Egypt. J. of Appl. Sci., 36 (7-8) 2021 139
Figure (2 ): Prevalence of right hip flexor flexibility
Figure (3 ): Prevalence of left hip flexor flexibility
The Prevalence of Schöber test of lumbar flexor flexibility among
children:
● For Schöber test: there were 116 children (50%) with normal lumbar
flexors flexibility (more than 20 cm) and 116 children (50%) had
tight lumbar flexor (less than 20 cm) (table 3).
Prevalence of right hip flexor flexibility
13,
9.5%
125,
90.5%
Male
Tight Normal
8,
8.6%
86,
91.4%
Female
Tight Normal
Prevelance of left hip flexor flexibility
11;
8%
127;
92%
Male
Tight Normal
7,
7.5%
87,
92.5%
Female
Tight Normal
140 Egypt. J. of Appl. Sci., 36 (7-8) 2021
● Comparison between both sex revealed that, there was no significant
difference between both sex (p=0.422), there were 44 females
(46.8%) and 72 males (52.2%) with normal lumbar flexors flexibility.
While 50 females (53.2%) and 66 males (47.8%) had tight lumbar
flexor.
Table (3): Percentage of lumbar flexor flexibility
Schöber test Total 232 Female (n=94) Male (138) p-value
Normal
(more than 20 cm)
116 (50%) 44 (46.8%) 72 (52.2%) 0.422
Tight
(less than 20 cm)
116 (50%) 50 (53.2%) 66 (47.8%)
Figure (4 ): Prevalence of lumbar flexor flexibility
The Prevalence of muscle strength among children:
For Abdominal muscle there were 24 (10.3%) had weak abdominal
muscle, 208 (89.7%) had normal abdominal muscle (table 4). There were
24 (10.3%), 48 (20.7%), 100 (43.1%) and 60 (25.9%), had grades of
manual muscle test of abdominal muscle of 2, 3, 4 and 5 respectively
(table 5).
Comparison between both sex revealed that, there was no
significant difference between both sex (p=0.358), there were 10 females
(10.6%) and 14 males (10.2%) had grade 2 MMT. There were 19 females
(20.2%) and 29 males (21%) had grade 3 MMT, there were 46 females
(49%) and 54 males (39.1%) had grade 4 MMT, there were 19 females
(20.2%) and 41 males (29.7%) had grade 5 MMT
Prevelance of lumbar flexor flexibility
72,
52.2%
66,
47.8%
Male
Normal Tight
44,
46.8%
50,
53.2%
Female
Normal Tight
Egypt. J. of Appl. Sci., 36 (7-8) 2021 141
Table (4): frequency distribution of muscle strength
Abdominal muscle Female (94) Male (138) Total (232) p-value
Weak 10 (10.6%) 14 (10.1%) 24 (10.3%) 0.904
Normal 84 (89.4%) 124 (89.9%) 208 (89.7%)
Right gluteus muscle
Weak
6 (6.4%)
8 (5.8%)
14 (6.1%)
0.854
Normal 88 (93.6%) 130 (94.2%) 218 (93.9)
left gluteus muscle
Weak
7 (7.4%)
12 (8.7%)
19 (8.2%)
0.733
Normal 87 (92.6%) 126 (91.3%) 213 (91.8%)
Table (5): Comparison of frequency distribution of muscle strength
MMT grade p- value
2 3 4 5
Abdominal
muscle
Total (n=232) 24 (10.4%) 48 (20.7%) 100 (43.1 %) 60 (25.9%) 0.358
Female (n=94) 10 (10.6%) 19 (20.2%) 46 (49%) 19 (20.2%)
Male (n=138) 14 (10.2%) 29 (21%) 54 (39.1%) 41 (29.7%)
Right
gluteus
muscle
Total (n=232) 14 (6.2%) 64 (27.5%) 92 (39.6%) 62 (26.7%) 0.491
Female (n=94) 6 (6.3%) 30 (32%) 32 (34%) 26 (27.7%)
Male (n=138) 8 (5.8%) 34 (24.7%) 60 (43.5%) 36 (26%)
Left
gluteus
muscle
Total (n=232) 19 (8.2%) 68 (29.3%) 90 (38.8%) 55 (23.7%) 0.680
Female (n=94) 7 (7.4%) 28 (29.8%) 40 (42.6%) 19 (20.2%)
Male (n=138) 12 (9%) 40 (29%) 50 (36 %) 36 (26%)
Figure (5): Frequency of abdominal muscle strength among the study
group
142 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Figure (6): Prevalence of abdominal muscle strength
For right gluteus muscle there were 14 (6.1%) had weak right gluteus
muscle and 218 (93.9%) had normal right gluteus muscle (table 4).
There were 14 (6%), 64 (27.6%), 92 (39.7%) and 62 (26.7%), had grades
of manual muscle test of right gluteus muscle of 2, 3, 4 and 5
respectively (table 5).
Comparison between both sex revealed that, there was no significant
difference between both sex (p=0.491), there were 6 females (6.3%) and
8 males (5.8%) had grade 2 MMT. There were 30 females (32%) and 34
males (24.7%) had grade 3 MMT, there were 32 females (34%) and 60
males (43.5%) had grade 4 MMT, there were 26 females (27.7%) and 36
males (26.8%) had grade 5 MMT
Figure (7): Frequency of right gluteus muscle strength among the study
group
Prevelance of Abdominal muscle strength
14,
10.1%
124,
89.9%
Male
Weak Normal
10,
10.6%
84,
89.4%
Female
Weak Normal
Egypt. J. of Appl. Sci., 36 (7-8) 2021 143
Figure (8): Prevalence of right gluteus muscle strength
For left gluteus muscle there were 19 (8.2%) had weak left gluteus
muscle and 213 (91.8%) had normal left gluteus muscle (table 4). There
were 19 (8.2%), 68 (29.3%), 90 (38.8%) and 55 (23.7%), had grades of
manual muscle test of left gluteus muscle of 2, 3, 4 and 5 respectively
(table 5).
Comparison between both sex revealed that, there was no significant
difference between both sex (p=0.680), there were 7 females (7.4%) and
12 males (9%) had grade 2 MMT. There were 28 females (29.8%) and 40
males (29%) had grade 3 MMT, there were 40 females (42.6%) and 50
males (36%) had grade 4 MMT, there were 19 females (20.2%) and 36
males (26%) had grade 5 MMT
Figure (9): Frequency of left gluteus muscle strength among the study
group
Prevelance of right gluteus muscle strength
8, 5.8%
130,
94.2%
Male
Weak Normal
6, 6.4%
88,
93.6%
Female
Weak Normal
144 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Figure (10): Prevalence of left gluteus muscle strength
Prevalence of lower crossed syndrome
There were 28 (12.1%) from the children had lower crossed
syndrome and there were 204 (87.9%) hadn’t lower crossed syndrome
(table 6).
Comparison between both sex revealed that, there was no
significant difference between both sex (p=0.497), there were 13 females
(13.8%) and 15 males (10.7%) were affected. There were 81 females
(86.2%) and 123 males (89.1%) were not affected.
Table (6): Prevalence of lower crossed syndrome among males and
females
Female (n=94) Male (n=138) Total (n=232) p-value
Affected 13 (13.8%) 15 (10.9%) 28 (12.1%) 0.497
Normal 81 (86.2%) 123 (89.1%) 204 (87.9%)
Figure (11): Prevalence of lower cross syndrome
Prevelance of left gluteus muscle strength
12,
8.7%
126,
91.3%
Male
Weak Normal
7, 7.4%
87,
92.6%
Female
Weak Normal
Prevelance of lower cross syndrome
15,
10.9%
123,
89.1%
Male
Affected Normal
13,
13.8%
81,
86.2%
Female
Affected Normal
Egypt. J. of Appl. Sci., 36 (7-8) 2021 145
Power of the study:
The power of the study was measure by G*Power 3.1 software
was, with sample size 232 subjects,0.05 type I error (2 tailed) and effect
size of 0.15; the power is 0.99.
DISCUSSION
One of the most common reasons of low back pain in young
individuals is muscle imbalance .Lower crossed syndrome (LCS) is a
muscle imbalance characterized by weakness of the gluteus maximus
muscle and abdominal muscles, as well as tightness of hip flexors, lower
back muscles, ,all this changes alter the biomechanical force distribution in
the lower back region, leading to chronic low back pain.(Shriya et al.,2017)
The time children spend in a seated position is average 7-8 hours a
day, which consists of 6-7 hours in school, 1-2 hours in tuitions, 1 hour in
front of television. This time reaches its peak in between 11 to 13 years.
(Justyna et al., 2015 )
There are lack of literature which can state the prevalence of LCS
among children, so this study was focused on prevalence of lower crossed
syndrome in schoolchildren of age 9 to 12 years.
After getting ethical clearance from the institutional ethics committee,
the consent forms were given to all the parents of children of age between 9
to 12 years. Consents of the parents and assents of 232 children were
obtained. After getting the consent, manual muscle testing for checking the
weakness of abdominal and gluteal muscle, and Thomas test was performed
for checking the hip flexor tightness and Schober Test was performed to
measure lower back flexibility.
This study was applied in 5 schools in Giza Government Schools, In
this study 232 student were enrolled, According to the data analysis of the
current study we found that there were 211 children (90.9%) with normal
RT hip flexors flexibility and 21 children (9.1%) had tight RT hip flexor,
there were 214 children (92.2%) with normal LT hip flexors flexibility and
18 (7.8%) children had tight LT hip flexor , there were 87 females (92.5%)
and 127 males (92%) with normal hip flexors flexibility. While 7 females
(7.5%) and 11 males (8%) had tight hip flexor.
There were 116 children (50%) with normal lumbar flexors flexibility
and 116 children (50%) had tight lumbar flexor. 44 females (46.8%) and 72
males (52.2%) with normal lumbar flexors flexibility. While 50 females
(53.2%) and 66 males (47.8%) had tight lumbar flexor.
Regarding to the strength of gluteus and abdominal muscle , there
were 14 (6.1%) had weak right gluteus muscle and 218 (93.9%) had normal
right gluteus muscle , 6 females (6.3%) and 8 males (5.8%) had grade 2
MMT, there were 19 (8.2%) had weak left gluteus muscle and 213 (91.8%)
had normal left gluteus muscle , there were 7 females (7.4%) and 12 males
146 Egypt. J. of Appl. Sci., 36 (7-8) 2021
(9%) had grade 2 MMT, and also we found that there were 24 (10.3%) had
weak abdominal muscle, 208 (89.7%) had normal abdominal muscle , 10
females (10.6%) and 14 males (10.2%) had grade 2 MMT.
Prolonged sitting causes hip flexor tightness which causes anterior
pelvic tilt which promotes lumbar lordosis. This causes weakness of gluteal
muscles and abdominal muscles. This pattern of muscular weakness give
rise to low back pain. (Shrikrushna et al.,2019) .
In the general population, muscle tightness is caused by an increase in
tension caused by active or passive mechanisms. Due to spasm or
contraction, muscles can become shorter when they are active. A muscle on
the other hand, can be passively shortened as a result of postural adaptation
or scarring. Tightness, regardless of the cause, restricts range of motion and
can lead to muscular imbalance. Soft tissues such as muscles and ligaments
are unable to keep up with the rate of bone growth during periods of rapid
growth, resulting in muscular imbalances and a decrease in flexibility in the
young population. ( Janssen J.et al., 2014 )
Janda found that muscles have a tendency to be either tight or weak in
dysfunction. Because of the overload caused by poor posture and
ergonomics, they are prone to tightness. Muscles that are prone to tightness
are often found to be weak, whereas muscles that are prone to weakness are
often found to be tight. According to Janda's LCS model, hip flexors and
spinal extensors muscles are prone to tightness due to their tonic character,
whereas gluteus maximus and abdominal muscles are prone to muscle
weakening due to their phasic nature. (Shriya et al.,2017) .
According to a study, the incidence of low back pain in children of
age between 11 to 15 years gets increasing from 11.8% to 21.5% over a
period of 5 years. (Burton et al ., 1996 )
Furthermore, the present study are in agreement with a pervious study
found that prevalence of lower crossed syndrome are more in boys which is
22% as compared to girls which is 18% in school going children of age 11
to 15 years. (Shrikrushna et al.,2019) ,which used to measure the
flexibility of hip flexor using Thomas test ,and strength of gluteus maximus
and abdominal muscle using Manual muscle test. .
While this study was inconsistent with a study found that prevalence
of lower crossed syndrome in females were higher than males at age 21 to
31 year.( (Shriya et al.,2017) and another study stated that there is 85% of
young females have lower cross syndrome at age 16-22 year. (Dhanani et
al.,2014). Both of this studies measured 3 outcomes: strength of gluteus
maximus , abdominal muscle and flexibility of hip flexors.
According to Mills M et al (2015), restricted hip flexor muscle
length is thought to reduce neuronal drive to the hip extensor musculature.
Reciprocal inhibition of the gluteus maximus, which occurs as a result of
Egypt. J. of Appl. Sci., 36 (7-8) 2021 147
over activity of the hip flexor muscle group, has been linked to lower
extremity injury.
CONCLUSION :
The study concludes that there is 12.1% of school going students of
age 9 to 12 years have incidence of lower crossed syndrome ,13 females
(13.8%) and 15 males (10.7%) were affected.
Conflict of interest:-
There are no conflicts of interest reported by the authors for this
study. This article's content and writing are solely the responsibility of
the writers.
Funding:-
To complete this project, no funding were received from any
organisation or individual.
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أنتشار متلازمو التقاطع السفمي بين طلاب مدارس الجيزه
*مؤمن حسين طايع، ** ياسرمحمد أنيس، *** هناء قناوي عطا
* باحث علاج طبيعى بقسم العموم الاساسيو .جامعو القاىره
** استاذ دکتور العلاج الطبيعى بقسم العموم الاساسيو .جامعو القاىره
*** أستاذ )م( العلاج الطبيعى بقسم العموم الاساسيو.جامعو القاىره
متلازمو التقاطع السفمي ىي عباره إختلال عضمي ىيکمي ينتج بسبب ضعف في عضلات
البطن و العضمو الألويو , مع وجود شد في العضمو الحرقفيو والقطنيو الکبيره و العضلات
الناصبو لمفقار.
الهدف : تحديد مدي انتشار متلازمو التقاطع السفمي بين طلاب مدارس الجيزه الذکور والإناث
, عن طريق إج ا رءإختبار عضمي يدوي لعضلات البطن و العضمو الالويو , و إختبا ا رت أخري
لمعرفو مقدار الشد في عضلات الناصبو لمفقار و العضمو الحرقفيو , لعدد مائتان وأثنين و
ثلاثون طالب و طالبو من الم ا رحل الإبتدائيو في مدارس محافظو الجيزه ,النتائج : وجود
ثمانيو و عشرون من الطلاب مصابون بمتلازمو التقاطع السفمي .
الکممات الدالو : متلازمو التقاطع السفمي , الإختلال العضمي الييکمي ,
150 Egypt. J. of Appl. Sci., 36 (7-8) 2021
