Papel do fisioterapeuta e outros profissionais da saúde nas ações de promoção da saúde no ambiente escolar / Role of physiotherapist and other health professionals in health promotion actions in the school environment / Papel del fisioterapeuta y otros profesionales de la salud en las acciones de promoción de la salud en el entorno escolar

Embora a escola seja um importante local para a promoção da saúde, no Brasil não é comum a presença de um profissional responsável pela área da saúde nos locais de ensino. O objetivo do presente estudo foi revisar sistematicamente a inserção do profissional da saúde no ambiente escolar quanto à realização de ações que visem a promoção da saúde para escolares. A metodologia adotada neste estudo foi a revisão sistemática. Realizou-se uma busca sistemática nas bases de dados Scopus, PubMed, Embase e Bireme, com termos em português e em inglês. Os artigos desta revisão foram incluídos e avaliados quanto à qualidade metodológica. Inicialmente, foram encontrados 2.202 artigos, sendo incluídos 16 conforme os critérios preestabelecidos. Os resultados indicaram a ausência de estudos que abordassem a educação em saúde no Brasil; a ação da saúde mais presente nos estudos é a educação postural; a fisioterapia é a área da saúde que mais tem se envolvido com promoção da saúde nas escolas; os estudantes do ensino fundamental são os escolares mais beneficiados com a promoção da saúde. Concluiu- -se que o fisioterapeuta e outros profissionais da saúde, tais como educadores físicos, médicos, farmacêuticos e enfermeiros estão inseridos no ambiente escolar com o intuito de promoção da saúde, principalmente envolvidos em ações que visem à educação postural dos escolares.

Although school is an important place for the promotion of health in Brazil, it is not common to have a professional responsible for health in local schools. The objective of this study is to systematically review the inclusion of the health professional in school environment; for the conduction of actions for the promotion of health at the schools. We performed a systematic research on Scopus, PubMed, Embase and Bireme databases with terms both in Portuguese and English. The articles for this review were included and assessed considering methodological quality. Initially, 2202 articles were found and 16 articles were included according to the predetermined criteria. From this systematic review, no studies involving health education in Brazil were found; postural education is the health action more present in the studies; Physical therapy is the health area that is most involved with health promotion in schools; and middle school students are the most benefited with school health promotion. However, these results should be approached cautiously and should not be understood as the reality of health promotion in the school environment.

Aunque la escuela es un lugar importante para la promoción de salud en Brasil, no es común tener un profesional responsable por la salud en el sistema de enseñanza. El objetivo de este estudio fue revisar sistemáticamente la inclusión del profesional de salud en el ambiente escolar, con el objetivo de promover acciones dirigidas a la promoción de la salud para la escuela. Se realizó una búsqueda sistemática en las bases de datos Scopus, PubMed, EMBASE y Bireme con términos en portugués e inglés. Los artículos de esta revisión fueron incluidos y evaluados de acuerdo con la calidad metodológica. 16 artículos fueron incluidos de acuerdo con los criterios predeterminados. A partir de esta revisión sistemática no se encontraron estudios que abordan la educación para la salud en Brasil; la acción presente en la mayoría de los estudios de salud es la educación postural; la fisioterapia es el área de la salud que más ha participado en la promoción de la salud en las escuelas; y los estudiantes de la enseñanza primaria son los más beneficiados con la promoción de la salud escolar. No obstante, estos resultados deben tomarse con cautela y no deben ser entendidos como la realidad de la promoción de la salud para la escuela.

Monitoring the prevalence of postural changes in schoolchildren.

[Purpose] The aim of this study was to identify whether postural changes are prevalent with advancing age using a photogrammetric method performing one-year follow-up study. [Subjects and Methods] Thirty-eight schoolchildren were evaluated in 2011 and 2012 in this cohort study. The subjects underwent a postural evaluation, which involved palpation of reference anatomic points, placement of reflexive markers over the anatomic points, image acquisition, and point digitalization using the Digital Image-based Postural Assessment evaluation software. For data analysis, descriptive statistics and inferential statistics were analyzed by McNemar's test. [Results] The results showed a significant increase in postural change prevalence for the lumbar spine in the sagittal plane (from 42.2% to 81.6%) and the knees in the frontal plane (from 39.5% to 63.2%) and a significant decrease in the prevalence of scoliosis (from 68.5% to 42.2%). [Conclusion] The findings indicate an increase in the prevalence of postural changes in schoolchildren from Teutônia, RS, Brazil, in 2012 compared with 2011. The development of longitudinal investigations for long-term monitoring of the evolution of posture and of schoolchildren habits's representing a viable alternative to subsidize health actions.

Propriocepção, equilíbrio corporal e funcionalidade em indivíduos com reconstrução do LCA / Proprioception, body balance and functionality in individuals with ACL reconstruction

Objetivo: Avaliar e comparar a propriocepção, o equilíbrio corporal ea funcionalidade do joelho em indivíduos com e sem reconstrução unilateral do ligamento cruzado anterior (LCA). Métodos: Quarenta indivíduos foram divididos em dois grupos: grupo experimental, 20indivíduos com reconstrução unilateral do LCA há seis meses; e grupo controle, 20 indivíduos sem histórico de lesão. No grupo experimental foram avaliados os membros inferiores com LCA reconstruído e contra lateral; no grupo controle foram avaliados o membro inferior dominante e não dominante. Todos os indivíduos realizaram teste de sensação da posição da articulação para avaliar a propriocepção,avaliação do equilíbrio corporal unipodal, e teste de subir e descer de grau (SDD), para avaliar a funcionalidade. Resultados: Não foram encontrados déficits de propriocepção do joelho e equilíbrio corporal.No teste SDD, a força aplicada na subida do degrau mostrou valores5% inferiores em pacientes com LCA reconstruído, porém sem diferença estatisticamente significativa. Enquanto isso, o impacto e a força aplicada na descida do degrau foi 30% maior em indivíduos com LCA contra lateral e no grupo controle. Conclusão: Os indivíduos que realizaram a reconstrução do LCA há seis meses não apresentaram alterações de propriocepção e equilíbrio corporal, porém apresentaram alterações no controle motor, influenciando a funcionalidade do joelho. Nível de Evidência IV, Estudos Prognósticos.

Objective: To evaluate and compare proprioception, body balanceand knee functionality of individuals with or without unilateralanterior cruciate ligament (ACL) reconstruction. Methods: Fortyindividuals were divided in two groups: Experimental group, 20individuals with ACL reconstruction at six months postoperative,and control group, 20 individuals with no history of lower limbpathologies. In the experimental group, we assessed lower limbswith reconstructed ACL and contralateral limb; in the controlgroup the dominant and the non-dominant lower limbs were assessed.All subjects were submitted to joint position sense test toevaluate proprioception, postural control measure in single-limb,and step up and down (SUD) test for functional assessment.Results: There were no deficits in proprioception and posturalcontrol. In the SUD test, a 5% decrease in lift up force was foundin reconstructed ACL lower limbs, however, a statistically notsignificant difference. The impact and step down force duringthe course of test were 30% greater in anatomic ACL than incontrol lower limbs. Conclusion: The individuals with ACL reconstructionat six months postoperative did not show changesin proprioception and postural control, but showed motor controlchanges, influencing knee functionality. Level of Evidence IV,Prognostic Studies.

Photogrammetry as a tool for the postural evaluation of the spine: A systematic review.

AIM: To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture. METHODS: A systematic search using keywords was conducted in the PubMed, EMBASE, Scopus, Science and Medicine(®) databases. The following inclusion criteria adopted were: (1) the use of photogrammetry as a method to evaluate spinal posture; (2) evaluations of spinal curvature in the sagittal and/or frontal plane; (3) studies published within the last three decades; and (4) written entirely in English. The exclusion criteria were: (1) studies which objective involved the verification of some aspect of validation of instruments; (2) studies published as abstracts and those published in scientific events; and (3) studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine. The articles in this review were included and evaluated for their methodological quality, based on the Downs and Black scale, by two independent reviewers. RESULTS: Initially, 1758 articles were found, 76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria. In addition, after analyzing the references in those articles, a further six articles were selected, so that 35 articles were included in this review. This systematic review revealed that the photogrammetry has been using in observational studies. Furthermore, it was also found that, although the data collection methodologies are similar across the studies, in relation to aspects of data analysis, the methodologies are very different, especially regarding the mathematical routines employed to support different postural evaluation software. CONCLUSION: With photogrammetry, the aim of the assessment, whether it is for clinical, research or collective health purposes, must be considered when choosing which protocol to use to evaluate spinal posture.

PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION.

OBJECTIVE: : To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. METHODS: : Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. RESULTS: : There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. CONCLUSION: : The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies.

Prevalência de dor nas costas em estudantes do ensino fundamental e médio de uma escola estadual de Gravataí-RS / Prevalece of back pain in students of elementary and high school in a public school in Gravataí-RS / Prevalencia de dolor en las espaldas en estudiantes de la educación primaria y secundaria de una escuela estadual de Gravataí-RS

O presente artigo tem como objetivo verificar a prevalência de dor nas costas em estudantes do Ensino Fundamental e Médio da cidade de Gravataí, no Rio Grande do Sul (RS), bem como se a dor está associada a fatores demográficos (idade e gênero), comportamentais (hábitos de vida diários) e hereditários (ocorrência de dor nas costas nos pais). Quanto à metodologia, aplicamos o questionário BackPEI a 321 estudantes de 10 a 17 anos. A partir de análise multivariável, apurou-se que a dor nas costas está associada (p<0,05) com: idade (maior prevalência aos 16, 17 e 18 anos); postura inadequada ao sentar; e dor nas costas nos pais. Concluimos que a prevalência de dor nas costas neles foi de 54,6%, o que sugere a necessidade de ações destinadas à prevenção e promoção de saúde, por meio de programas educacionais para eles.

This article aims to determine the prevalence of back pain on students of elementary and high school at Gravataí in the state of Rio Grande do Sul - Brazil, and to verify if the pain is associated with demographic (age and gender), behavior (daily lifestyle habits) and hereditary (parents back pain) factors. The sample was composed by 321 students ranging from 10 to 17 years old answering the BackPEI questionnaire. As a result, from multivariate analysis, back pain is associated (p<0.05) with: age (the highest prevalence at 16, 17, and 18 years old); inappropriate sitting posture; and parents back pain. We have concluded that the prevalence of back pain in students was 54.6%, which suggests the need for prevention and efforts promotions through schoolchildren health education programs.

El presente artículo tiene como objetivo verificar la prevalencia de dolor en las espaldas en estudiantes de educación primaria y secundaria de la ciudad de Gravataí, en el Río Grande Del Sur (RS), y ver si el dolor de asocia con factores demográficos (edad y sexo), comportamiento (hábitos de vida diaria) y/o hereditario (aparición de dolor en las espalda en los padres). Con relación a la metodologia, 321 estudiantes de 10 a 17 años respondieron el cuestionario BackPEI. A partir del análisis multivariado, el dolor de espalda se asocia (p<0,05) con la edad (prevalencia más alta a los 16, 17 y 18 años); postura incorrecta al estar sentado; y el dolor en las espalda de los padres. Concluimos que la prevalencia de dolor en las espalda en los niños fue de 54,6%, lo que sugiere la necesidad de medidas para prevenir y promover acciones de programas de educación para la salud de los escolares.

Relação entre alterações posturais e fatores associados em escolares do ensino fundamental / Relación entre cambios posturales y factores asociados en estudiantes de la escuela primaria / Relationship betwween postural changes and associated factors in elementary school students

Este estudo teve como objetivos: (1) verificar a prevalência de alterações posturais da coluna vertebral; (2) identificar os hábitos de vida adotados pelos escolares; e (3) verificar a relação entre as alterações posturais e os fatores associados. Os 65 escolares participantes foram submetidos a uma avaliação postural, que consistiu na palpação de pontos anatômicos, registros fotográficos e digitalização no software Digital Image-based Postural Assessment (DIPA). Além disso, os escolares responderam a um questionário para identificar a presença de dor nas costas e fatores de risco. Para análise estatística foi utilizado cálculo das razões de prevalência, por meio de uma análise multivariável, e seus respectivos intervalos de confiança de 95% (α=0,05). Os resultados deste estudo demonstraram uma elevada prevalência de alterações posturais nos planos sagital e frontal. Verificou-se também elevados níveis de hábitos de vida inadequados durante a realização das atividades de vida diária. Foram encontradas associações entre alteração da cifose torácica e a postura inadequada ao pegar objeto do chão; alteração entre lordose lombar e a presença de dor nas costas e a prática de exercício físico; além de associações entre escoliose e o hábito de dormir em decúbito ventral e a postura adequada ao pegar objeto do chão.

The objectives of this study were: (1) to determine the prevalence of postural changes of the spine; (2) to identify the lifestyle adopted by the students; and (3) to assess the relationship between postural changes and associated factors. The 65 students who participated were submitted to a postural assessment, which consisted in palpation of anatomical landmarks, digital photographs and postural analysis using Digital Image-based Postural Assessment (DIPA). Moreover, the students answered a questionnaire to identify the presence of back pain and assess risk factors. To statistical analysis, the prevalence ratios were calculated by multivariate analysis, and their respective 95% confidence intervals (α=0.05). Results demonstrated a high prevalence of postural changes in sagital and frontal planes. Despite this, high levels of inadequate postures were found in students daily activities. Associations were found between altered thoracic kyphosis and incorrect posture to get the object from the floor; altered lumbar lordosis and back pain and physical exercise. In addition, there was association between scoliosis and sleeping on prone position and adequate posture to get the object from the floor.

Este estudio tuvo como objetivos: (1) determinar la prevalencia de alteraciones posturales de la columna vertebral; (2) identificar los hábitos de vida adoptados por los estudiantes; y (3) evaluar si existe una relación entre los cambios posturales y factores asociados. Los 65 estudiantes se sometieron a una evaluación postural, que consistía en la palpación de los puntos de referencia anatómicos, registros fotográficos y digitalización en el software DIPA (Digital Image-based Postural Assessment). Además, los estudiantes respondieron a un cuestionario para identificar la presencia de dolor de espalda y factores de riesgo. Para el análisis estadístico fue utilizado el cálculo de razones de prevalencia, por medio de un análisis multivariable y de sus respectivos intervalos de confianza del 95% (α=0,05). Los resultados de este estudio demostraron una alta prevalencia de los cambios posturales en el plano sagital y frontal. También se encontró un alto nivel de hábitos de vida inadecuados durante la realización de las actividades de la vida diaria. Fueron encontradas asociaciones entre alteración de la cifosis torácica con la postura inadecuada al recoger objeto del suelo, alteración de la lordosis lumbar con la presencia de dolor de espalda y con la práctica de ejercicio físico. Además de asociaciones entre escoliosis y el hábito de dormir en decúbito ventral y con la postura adecuada al recoger objeto del suelo.

Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane.

Objective. to verify the validity and reproducibility of using the flexicurve to measure the angles of the thoracic and lumbar curvatures. Method. 47 subjects were evaluated by: (1) palpation and marking of the spinous processes using lead markers, (2) using X-rays in the sagittal plane to measure the Cobb angles, (3) molding the flexicurve to the spine, and (4) drawing the contour of the flexicurve onto graph paper. The angle of curvature was determined with the flexicurve based on a 3rd order polynomial. Results. No differences were found between the Cobb angles and the angles obtained using the flexicurve in thoracic and lumbar curvatures (P > 0.05). Correlations were strong and significant for the thoracic (r = 0.72, P < 0.01) and lumbar (r = 0.60, P < 0.01) curvatures. Excellent and significant correlations were found for both the intraevaluator and interevaluator measurements. Conclusion. The results show that there is no significant difference between the values obtained using the flexicurve and those obtained using the X-ray procedure and that there is a strong correlation between the two methods. This, together with the excellent level of inter- and intraevaluator reproducibility justifies its recommendation for use in clinical practice.

Validating a postural evaluation method developed using a Digital Image-based Postural Assessment (DIPA) software.

OBJECTIVE: To investigate (1) the accuracy of the palpatory method to identify anatomical points by comparison with the X-ray exams, (2) the validity of classifying spinal posture in the frontal plane using Digital Image-Based Postural Assessment (DIPA) software by comparison with the X-ray exams and (3) the intra and inter-evaluator reproducibility of the DIPA software. MATERIALS AND METHODS: The postural assessment and X-ray examination of the spine, both in the frontal plane and standing position, were performed consecutively in 24 subjects. The postural assessment protocol consisted of: (1) palpation and the use of reflective markers containing lead to mark the spinous processes (SP) of the C7, T2, T4, T6, T8, T10, T12, L2, L4 and S2 vertebrae and; (2) acquisition of photographic records. First, the X-ray examinations were used to check the correlation between the palpated and marked SP and the true location of the SP of the vertebra in question, by assessing the distance between them. The spinal posture was classified based on the calculation of the scoliosis arrows in the DIPA (DIPA-SA). The X-ray examinations provided the scoliosis arrows (X-SA), the Cobb angles and the classification of spinal posture based on the Cobb angle. The results from the DIPA protocol were compared to those from the X-ray examination-based protocol. The statistical tests used were: (1) Kruskal-Wallis--differences in terms of the numerical distance between the markers and the anatomical landmarks, (2) Pearson's Correlation--DIPA-SA and Cobb angles, (3) Pearson's Correlation--X-SA and DIPA-SA; (4) Bland and Altman's graphic representation--X-SA and DIPA-SA, (5) Spearman's Correlation--classification of spinal posture obtained using the X-ray and DIPA protocols, (6) the intraclass correlation test (ICC) for the relationship between the DIPA-SA made by each evaluator (inter-evaluator), and (7) independent t-test to compare the data from the two evaluation days (intra-evaluator), α=0.05. RESULTS: There were no significant differences between the location of the anatomical points located using palpation and identified with reflective markers and the respective location of the SP as identified using X-ray exams (χ²=9.366, p=0.404). Significant correlations were found between the DIPA-SA and the Cobb angles in the dorsal (r=0.75, p<0.001) and lumbar (r=0.76, p=0.007) regions; between the DIPA-SA and the X-SA in the dorsal (r=0.79, p<0.001) and lumbar (r=0.92, p<0.001) regions and; between the classifications of posture obtained with the DIPA and X-ray protocols (r=0.804, p<0.001). Bland and Altman's representation showed agreement between DIPA-SA and X-SA for both curvatures. Significant correlations were found for the intra-evaluator test in the thoracic (r=0.99, p<0.001) and lumbar (r=0.98, p<0.001) regions; for the inter-evaluator test in the thoracic (r=0.99, p<0.001) and lumbar (r=0.88, p<0.001) regions. CONCLUSION: The results suggest that the DIPA protocol constitutes a valid simple, practical and low-cost non-invasive tool for the evaluation of the spine in the frontal plane which can be used to obtain reproducible measurements (inter and intra-evaluators).

Alterações posturais em escolares do ensino fundamental de uma escola de Teutônia/RS / Postural changes of basic school school children of school from Teutônia/RS

Este estudo teve como objetivo verificar, por meio da fotogrametria, se existe diferença na prevalência de alterações posturais entre os sexos, masculino e feminino, e verificar se existe um aumento desta prevalência com o avanço da idade em escolares do Ensino Fundamental de uma escola da cidade de Teutônia, Rio Grande do Sul. A amostra, composta por 65 escolares, foi submetida a uma avaliação postural, a qual consistiu na palpação e marcação de pontos anatômicos, com marcadores reflexivos, no plano sagital (PS) e plano frontal (PF). Em seguida, ocorreram registros fotográficos dos indivíduos em ortostase, no PS (na posição de perfil direito) e no PF (na posição de costas). As imagens foram digitalizadas e analisadas pelo software DIPA, sendo obtidas informações quantitativas da postura. Os resultados analisados por meio de estatística descritiva demonstraram que as principais alterações encontradas foram: (1) no PS, desequilíbrio anterior (53,8%), hiperlordose lombar (46,2%), hipercifose dorsal (40%), coluna cervical anteriorizada (36,9%); e no (2) PF, escoliose (63,1%), desalinhamento dos ombros (36,9%), desequilíbrio corporal direito (32,3%) e joelho valgo (24,6%). Os resultados demonstraram também que (1) existe diferença significativa entre os sexos apenas no PS no equilíbrio corporal e na postura da coluna dorsal, e que (2) não existe diferença significativa entre os grupos etários para todas as variáveis nos planos PS e PF. Concluiu-se que a prevalência de alterações posturais nesse grupo de escolares foi alta, estando em acordo com a literatura, o que sugere a necessidade da implantação de programas educativos e preventivos no contexto escolar.

The objective of this study was verify, using photogrammetry, if there is difference in postural changes prevalence between male and female, and verify if there is an increase in this prevalence with increasing age of basic education schoolchildren in a school in Teutônia, Rio Grande do Sul. The sample, composed by 65 schoolchildren, was submitted to a postural assessment, which consisted of palpation and marking of anatomical points, using reflective markers, on sagittal plane (SP) and frontal plane (FP). Then, occurred photographic records of subjects standing on SP (position of right profile) and FP (position on the back). The images were scanned and analyzed by DIPA software, being obtained quantitative information of posture. The results analyzed by descriptive statistic showed that the main postural changes were: (1) on SP, previous imbalance (53,8%),lumbar hyperlordosis (46,2%), dorsal hyperkiphosis (40%), cervical spine anterior (36,9%); and on (2) FP, scoliosis (63,1%), shoulders misalignment (36,9%), right body imbalance (32,3%) and valgus knee (26,4%). The results also showed that (1) there is significant difference between sex only on SP on body balance and on dorsal spine posture, and (2) there is no significant difference between age groups to all variables on SP and FP. It was concluded that the prevalence of postural changes in this group is high, agreeing with literature, what suggests the need of implantation of educative and preventive programs in school context.

Pontos marcados na superfície da pele representam os processos espinhosos quando a postura é modificada? / Can skin markers represent spinous process when the posture is changed?

O objetivo do estudo foi verificar radiograficamente se a posição dos marcadores de superfície, identificados por palpação em ortostase, é alterada com a modificação da postura para o decúbito lateral. Dez indivíduos foram: palpados e marcados com adesivos de superfície, os processos espinhosos das vértebras C7, T2, T4, T6, T8, T10, T12, L2, L4 e S2; submetidos a um exame radiológico da coluna vertebral na posição ortostática e em decúbito lateral direito para verificar se o marcador de superfície colocado sobre o processo espinhoso estava condizente com o processo espinhoso da imagem radiográfica. Uma ANOVA two-way mostrou diferenças significativas para o deslocamento do marcador de superfície entre as posições para as vértebras C7, T2, T4, T6, T8, T10, L2 e S2 (p<0,001). Nas vértebras T12 e L4 não foram encontradas diferenças significativas. Os resultados indicam que a localização do marcador de superfície não foi condizente com o processo espinhoso identificado no exame radiológico, entre as posições. O movimento da pele pode ter deslocado o marcador de superfície, quando o indivíduo modificou sua posição da posição ortostática para decúbito lateral direito.

The objective was to radiographically verify if the position of skin markers, identified by palpation in orthostasis posture, changes when the subject position shifts to lying posture. Ten subjects underwent two X-ray tests, first, in orthostasis and right lying posture. Ten subjects were palpated and marked with skin markers in the orthostasis posture, in the spinous process of the vertebrae C7, T2, T4, T6, T8, T10, T12, L2, L4 and S2 . After palpation, subjects underwent X-ray exams in orthostasis and lying postures to verify if the surface marker matched the spinous process shown on X-ray. A two-way ANOVA indicated significant differences for the displacement of the skin markers, for the C7, T2, T4, T6, T8, T10, L2 and S2 spinous processes (p<0.001). The T12 and L4 spinous processes did not indicate significant differences. The skin markers locations were not consistent with the spinous processes identified in X-rays for both positions. The skin movement may have displaced the skin markers when the subject changed from orthostasis to lying posture.