European Spine Journal

, Volume 28, Issue 5, pp 1072–1081 | Cite as

Lumbar spine posture and spinopelvic parameters change in various standing and sitting postures

  • Abdulhamit MisirEmail author
  • Turan Bilge Kizkapan
  • Suleyman Kasim Tas
  • Kadir Ilker Yildiz
  • Mustafa Ozcamdalli
  • Mehmet Yetis
Original Article



This study aimed to compare differences in lumbosacral and spinopelvic parameters between pain developers and non-pain developers as well as the effects of various posture changes.


A total of 38 consecutive participants, 20 standing-induced low back pain developers (mean age: 27.7 ± 5.3; mean BMI: 22.64 ± 2.95) and 18 non-pain developers (mean age: 29.0 ± 7.5; mean BMI: 24.2 ± 1.87) (p > 0.05), were prospectively evaluated. Six sagittal plane radiographs were taken. Upright standing posture was used as the reference posture. Lumbar lordosis, lumbosacral lordosis, L1/L2 and L5/S1 intervertebral (IV) joint angles, pelvic incidence, pelvic tilt and sacral slope were measured on each radiograph.


There were no significant differences in terms of age, BMI, SF-36 score, or Oswestry Disability Index scores between pain developer and non-pain developer groups (p > 0.05). Pain developers had significantly larger lumbar lordosis, larger L1/L2 intervertebral angles, larger pelvic incidences and sacral slopes in all postures (p < 0.05). The contribution of L5/S1 intervertebral angle to lumbar flexion was higher than that of the L1/L2 intervertebral angle during stair descent, the sitting and the leaning forward while sitting postures (p < 0.05).


The current study supports the assertion that increased lumbar lordosis is associated with increased pain. Lumbar spine angles change in various postures. The changes were more prominent in pain developers than in non-pain developers. Larger lumbar lordosis due to larger pelvic incidence may be a risk factor for the development of standing-induced low back pain.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Low back pain Pain developer Lumbar Posture Spinopelvic Standing-induced 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2018_5846_MOESM1_ESM.pptx (1.7 mb)
Supplementary material 1 (PPTX 1758 kb)


  1. 1.
    Gallagher KM, Callaghan JP (2015) Early static standing is associated with prolonged standing induced low back pain. Hum Mov Sci 44:111–121. CrossRefPubMedGoogle Scholar
  2. 2.
    Picavet HS, Schouten JS (2000) Physical load in daily life and low back problems in the general population-The MORGEN study. Prev Med 31(5):506–512CrossRefPubMedGoogle Scholar
  3. 3.
    Gallagher KM, Wong A, Callaghan JP (2013) Possible mechanisms for the reduction of low back pain associated with standing on a sloped surface. Gait Posture 37(3):313–318. CrossRefPubMedGoogle Scholar
  4. 4.
    Nelson-Wong E, Callaghan JP (2014) Transient low back pain development during standing predicts future clinical low back pain in previously asymptomatic individuals. Spine (Phila Pa 1976) 39(6):E379–383. CrossRefGoogle Scholar
  5. 5.
    Sorensen CJ, Norton BJ, Callaghan JP, Hwang CT, Van Dillen LR (2015) Is lumbar lordosis related to low back pain development during prolonged standing? Man Ther 20(4):553–557. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gallagher KM, Campbell T, Callaghan JP (2014) The influence of a seated break on prolonged standing induced low back pain development. Ergonomics 57(4):555–562. CrossRefPubMedGoogle Scholar
  7. 7.
    Gallagher KM, Sehl M, Callaghan JP (2016) A radiographic assessment of lumbar spine posture in four different upright positions. Clin Biomech 37:131–136. CrossRefGoogle Scholar
  8. 8.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11(1):80–87CrossRefPubMedGoogle Scholar
  9. 9.
    Day JW, Smidt GL, Lehmann T (1984) Effect of pelvic tilt on standing posture. Phys Ther 64(4):510–516CrossRefPubMedGoogle Scholar
  10. 10.
    Keegan JJ (1953) Alterations of the lumbar curve related to posture and seating. J Bone Joint Surg Am 35(A(3)):589–603CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen AL, Gjessing CC, Fine LJ, Bernard BP, McGlothin JD (1997) Elements of ergonomic programs: a primer based on workplace evaluations of musculoskeletal disorders. National Institute of Occupational Health and Safety, CincinnatiGoogle Scholar
  12. 12.
    Gallagher KM, Callaghan JP (2016) Standing on a declining surface reduces transient prolonged standing induced low back pain development. Appl Ergon 56:76–83. CrossRefPubMedGoogle Scholar
  13. 13.
    Whistance RS, Adams LP, van Geems BA, Bridger RS (1995) Postural adaptations to workbench modifications in standing workers. Ergonomics 38(12):2485–2503. CrossRefPubMedGoogle Scholar
  14. 14.
    Fewster KM, Gallagher KM, Callaghan JP (2017) The effect of standing interventions on acute low-back postures and muscle activation patterns. Appl Ergon 58:281–286. CrossRefPubMedGoogle Scholar
  15. 15.
    Hagg O, Fritzell P, Nordwall A, Swedish Lumbar Spine Study Group (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12(1):12–20. CrossRefPubMedGoogle Scholar
  16. 16.
    Nelson-Wong E, Callaghan JP (2010) Repeatability of clinical, biomechanical, and motor control profiles in people with and without standing-induced low back pain. Rehabilit Res Pract 2010:289278. CrossRefGoogle Scholar
  17. 17.
    Bontrager KL, Lampignano JP (2014) Bontrager’s handbook of radiographic positioning and techniques, 8th edn. Elsevier Mosby, St. LouisGoogle Scholar
  18. 18.
    Wall BF (2004) Radiation protection dosimetry for diagnostic radiology patients. Radiat Prot Dosim 109(4):409–419. CrossRefGoogle Scholar
  19. 19.
    National Council on Radiation Protection and Measurements (2009) Ionizing radiation, exposure of population in United States. National Council on Radiation Protection and Measurements, BethesdaGoogle Scholar
  20. 20.
    U.S. Food and Drug Administration (2009) What are the radiation risks from CT? Accessed 18 May 2018
  21. 21.
    Yochum TR, Rowe LJ (2004) Essentials of skeletal radiology, vol 1, 3rd edn. Lippincott Williams & Wilkins, BaltimoreGoogle Scholar
  22. 22.
    Chung NS, Jeon CH, Lee HD, Won SH (2017) Measurement of spinopelvic parameters on standing lateral lumbar radiographs. Clin Spine Surg 30(2):E119–E123. CrossRefPubMedGoogle Scholar
  23. 23.
    Ellis PD (2010) The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  24. 24.
    Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 8(6):429–438CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Aoki Y, Sugiura S, Nakagawa K, Nakajima A, Takahashi H, Ohtori S, Takahashi K, Nishikawa S (2012) Evaluation of nonspecific low back pain using a new detailed visual analogue scale for patients in motion, standing, and sitting: characterizing nonspecific low back pain in elderly patients. Pain Res Treat 2012:680496. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Astfalck RG, O’Sullivan PB, Straker LM, Smith AJ, Burnett A, Caneiro JP, Dankaerts W (2010) Sitting postures and trunk muscle activity in adolescents with and without nonspecific chronic low back pain: an analysis based on subclassification. Spine (Phila Pa 1976) 35(14):1387–1395. CrossRefGoogle Scholar
  27. 27.
    Callaghan JP, McGill SM (2001) Low back joint loading and kinematics during standing and unsupported sitting. Ergonomics 44(3):280–294. CrossRefPubMedGoogle Scholar
  28. 28.
    Epstein JA (1998) Lumbar lordosis: effects of sitting and standing. Spine (Phila Pa 1976) 23(17):1923CrossRefGoogle Scholar
  29. 29.
    Lord MJ, Small JM, Dinsay JM, Watkins RG (1997) Lumbar lordosis. Effects of sitting and standing. Spine (Phila Pa 1976) 22(21):2571–2574CrossRefGoogle Scholar
  30. 30.
    Nachemson A (1981) Disc pressure measurements. Spine (Phila Pa 1976) 6(1):93–97CrossRefGoogle Scholar
  31. 31.
    Duval-Beaupere G, Marty C, Barthel F, Boiseaubert B, Boulay C, Commard MC, Coudert V, Cosson P, Descamps H, Hecquet J, Khoury N, Legaye J, Marpeau M, Montigny JP, Mouilleseaux B, Robin G, Schmitt C, Tardieu C, Tassin JL, Touzeau C (2002) Sagittal profile of the spine prominent part of the pelvis. Stud Health Technol Inform 88:47–64PubMedGoogle Scholar
  32. 32.
    De Carvalho DE, Soave D, Ross K, Callaghan JP (2010) Lumbar spine and pelvic posture between standing and sitting: a radiologic investigation including reliability and repeatability of the lumbar lordosis measure. J Manip Physiol Ther 33(1):48–55. CrossRefGoogle Scholar
  33. 33.
    Endo K, Suzuki H, Nishimura H, Tanaka H, Shishido T, Yamamoto K (2012) Sagittal lumbar and pelvic alignment in the standing and sitting positions. J Orthop Sci 17(6):682–686. CrossRefPubMedGoogle Scholar
  34. 34.
    Huec JCL, Aunoble S, Philippe L, Nicolas P (2011) Pelvic parameters: origin and significance. Eur Spine J Suppl 5:564–571. CrossRefGoogle Scholar
  35. 35.
    Mitchell T, O’Sullivan PB, Burnett AF, Straker L, Smith A (2008) Regional differences in lumbar spinal posture and the influence of low back pain. BMC Musculoskelet Disord 9:152. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30(3):346–353CrossRefGoogle Scholar
  37. 37.
    Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jentzsch T, Geiger J, Bouaicha S, Slankamenac K, Nguyen-Kim TD, Werner CM (2013) Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine. BMC Med Imaging 13:34. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Dankaerts W, O’Sullivan P, Burnett A, Straker L (2006) Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976) 31(6):698–704. CrossRefGoogle Scholar
  40. 40.
    Gill KP, Bennett SJ, Savelsbergh GJ, van Dieen JH (2007) Changes in spine posture at lift onset with changes in lift distance and lift style. Spine (Phila Pa 1976) 32(15):1599–1604. CrossRefGoogle Scholar
  41. 41.
    Burton AK (1987) The ratio of upper lumbar to lower lumbar sagittal mobility related to age, sex, and low back trouble. Eng Med 16(4):233–236CrossRefPubMedGoogle Scholar
  42. 42.
    Claus AP, Hides JA, Moseley GL, Hodges PW (2018) Different ways to balance the spine in sitting: muscle activity in specific postures differs between individuals with and without a history of back pain in sitting. Clin Biomech 52:25–32. CrossRefGoogle Scholar
  43. 43.
    Suzuki H, Endo K, Mizuochi J, Murata K, Nishimura H, Matsuoka Y, Tanaka H, Yamamoto K, Tateiwa T (2016) Sagittal lumbo-pelvic alignment in the sitting position of elderly persons. J Orthop Sci 21(6):713–717. CrossRefPubMedGoogle Scholar
  44. 44.
    Obeid I, Boissiere L, Yilgor C, Larrieu D, Pellise F, Alanay A, Acvaroglu E, Perez-Grueso FJ, Kleinstuck F, Vital JM, Bourghli A, European Spine Study Group (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25(11):3644–3649. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologySanliurfa Training and Research HospitalSanliurfaTurkey
  2. 2.Department of Orthopaedics and TraumatologyBursa Cekirge State HospitalBursaTurkey
  3. 3.Department of Orthopaedics and TraumatologyBaltalimani Bone and Joint Diseases Training and Research HospitalIstanbulTurkey
  4. 4.Department of Orthopaedics and Traumatology, Faculty of MedicineAhi Evran UniversityKirsehirTurkey

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