Mrozkowiak Mirosław, Szark-Eckardt Mirosława, Żukowska Hanna, Zukow Walery.

Review of methods for assessing

body posture. Part 2 = Przegląd metod oceny postawy ciała. Część 2. Journal of Health Sciences. 2014;4(11):95-102.
ISSN 1429-9623 / 2300-665X. http://journal.rsw.edu.pl/index.php/JHS/article/view/2014%3B4%2811%29%3A95-102
The former journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1107. (17.12.2013).

© The Author (s) 2014;

This article is published with open access at Licensee Open Journal Systems of Radom University in Radom, Poland
Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,
provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License
(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.
This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial
use, distribution and reproduction in any medium, provided the work is properly cited.
Conflict of interest: None declared. Received: 10.09.2014. Revised 15.09.2014. Accepted: 04.11.2014.

Review of methods for assessing body posture

Przegląd metod oceny postawy ciała

Part 2

Mirosław Mrozkowiak, Mirosława Szark-Eckardt, Hanna Żukowska, Walery Zukow

Faculty of Physical Education, Health and Tourism, Kazimierz Wielki University in

Bydgoszcz, Poland

Keywords: habitual posture, posture assessment, evaluation criteria.

Słowa kluczowe: postawa habitualna, ocena postawy, kryteria oceny.

Plan
1. The first attempts to measurements of body posture.
2. Methods of measuring the body posture in the seventeenth and nineteenth centuries.
3. Methods of assessing body posture used in the world in the twentieth and twenty-first
century.
4. Methods of assessing body composition in Poland after 1945.
5. Methods of assessing body posture used in Poland in the twenty-first century.
6. Reliability evaluation methods of posture.
7. The first attempts to establish population norms, determine the type of body posture by
Brown and Wolanski.
8. Recent methods of assessment of body posture in 3D system.

Abstract
In view of the limited size of the publication, the work is divided into two parts. The first part contains the characteristics of points from
1 to 4 with the work plan stated above, the second describes the points from 5 to 8.
How should we judge the question of assessing posture had its source in the current canon attitude. In subsequent epochs of interest
anatomists mechanical design meant that the focus was on the issue of static human body. The culmination of investigations was published in
1679 Borellius work of the center of gravity of the human body. For the Polish issue of posture has arrived in the late twenties and thirties of
the twentieth century. Everyone agrees with the assertion that the basic assumption in assessing the attitude is always subject to the
assessment of habitual attitude, as a relatively stable characteristic of human-subject. Classification of methods of diagnosing posture is
much the author has adopted its own division methods for assessing attitudes: watching methods, silhouetted, diagnosis of manual -
functional, scoring, during physical activities, using complex mechanical measuring instruments, using simple measuring instruments,
technically advanced methods to assess posture, including technical equipment mapping surface. Next made a brief characterization of over
100 methods to assess the attitude of the body, starting with the method watching Klapp 1927 and ending with the latest laser mapping
method in 3D space.

Streszczenie
W związku z ograniczoną wielkością publikacji, pracę podzielono na dwie części. W pierwszej części zawarto charakterystykę
punktów od 1 do 4 z planu pracy zamieszczonego powyżej, w drugiej opisano punkty od 5 do 8.
Jak należy sądzić problematyka oceny postawy ciała miała swoje źródło w obowiązującym kanonie postawy. W kolejnych epokach
zainteresowania mechaniczno-konstrukcyjne anatomów sprawiły, że skupiono się nad zagadnieniem statyki ciała ludzkiego. Zwieńczeniem
dociekań była opublikowana w 1679 roku praca Borelliusa o środku ciężkości ciała człowieka. Do Polski problematyka postawy ciała
zawitała na przełomie dwudziestych i trzydziestych lat XX wieku. Wszyscy są zgodni z twierdzeniem, że podstawowym założeniem w

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ocenie postawy jest to, aby ocenie podlegała zawsze postawa habitualna, jako względnie trwała właściwość osobnicza człowieka.
Klasyfikacji metod diagnozowania postawy ciała jest wiele autor przyjął własny podział metod oceny postawy na: metody oglądowe,
sylwetkowe, diagnostyki manualno – czynnościowej, punktowania, podczas czynności ruchowych, wykorzystujące złożone mechaniczne
przyrządy pomiarowe, wykorzystujące proste przyrządy pomiarowe, zaawansowane technicznie metody oceny postawy ciała, w tym
urządzenia techniczne odwzorowujące powierzchnię. Dalej dokonano krótkiej charakterystyki ponad 100 metod oceny postawy ciała,
poczynając od metody oglądowej Klappa z 1927 roku a kończąc na metodzie najnowszej laserowego odwzorowywania powierzchni w 3D.

5. Methods of assessing body posture used in Poland in the twenty-first century

One of the first devices of this type was electromyographic method in 1957. Method highly
useful in the diagnosis of lateral curvature of the spine only, and few reliable in assessing
posture. Because recorder also take into account the short-term muscle spasms, which are
always disproportionately greater than the force required to opposition the forces acting on the
body gravity. In addition, body test subject phenomenon sway, having the character of losing
and recovering balance. ISIS Method 1991 allowed for spatially recording surface of the back,
especially scoliosis. TV camera and projector lights are placed at specific positions. The
projector emits light that falls planes successively from top to bottom of the irradiated area of
the back. This allows rotating the mirror. The camera has a preview of the test surface and the
light falling on it from the bottom (below the line input of light). This early two-dimensional
line through the control and processing of three-dimensional geometric shape gives the
surface. The accuracy of the reconstruction of the surface is 1.5 mm. Posturometer S Plum
construction in 1995, working with a computer and printer. It allows you to easily manipulate
the data and visualize them on the printouts. Advantages Manufacturer: large measuring
range, the ability to study mobility of the hip joints, non-invasive way to measure,
measurement and calculation of arbitrary curves of selected measurements, the repeatability
of the measurement, the use of modern methods of data archiving, short duration of the study
the patient's own verified software for measurement and analysis program Measuring SCAN
diagnostic program SPINE, SCAN STAT statistical program, a program to calculate the
length - CIRCUITS. Construction slightly later is a method Metrecom System. The device
consists of: the main part - the column with the appropriate sensor, computer equipment - is
equipped with a specially designed computer program for the study of posture, sensor (three-
dimensional analog-to-digital converter) is connected to the column device using an
articulated boom with a length of 1.5 m, which allows for complete freedom of movement.
The system allows you to: assess the functional spine of the side slopes, the assessment of
functional spine slope backwards and forwards, the measurement of the size of the rib hump,
expert assessment of the pelvis and lower limbs of the body distribution of the test, an
analysis of the (projection of the center of gravity of the eyes open and closed) diagnostics
posture in frontal and sagittal plane. Important factors that affect the end result studies are:
adequate training, professionalism and accountability of individuals using computer
diagnostics, the ability of locating specific points on the body of the test, the patient's ability
to maintain a constant position during the test. Points anthropometric taken into account in the
study: L / P anterior superior iliac spine [ASIS], top of the head, the L / P point above the ear
lobe, navel, L / R greater trochanter, L / P shore side slits of the knee, L / R edge of the medial
the cracks of the knee, medial and lateral edges of the patella [measured from the base of the
patella], L / P tuberosity of the tibia, L / P cube side, L / P medial ankle, L / R distal portion of
the second metatarsal, front - scanning from point the neck below the Adam's apple to a point
5 cm below the navel, scanning the back - a scan of the skull base to the point at the height of
S 4, L / R shoulder blades appendix, L / R rear upper iliac spine [PSIS], L / R on the back - the
center of the knee to knee height cracks, L / P talus bone - posterior lateral part, L / P talus
bone - posterior medial part, substrate - point between the feet of the subject. The study is to
determine the appropriate points on the human body by the sensor. Patient set back in relation
to the column. On the basis of the marked points of the computer creates an image of posture

96
and spine, comparing it with the correct values. The measuring device Metrecom memory
system is an ideal model of the spine, which is subject to comparison with the length and
shape of the spine of the test. The shape of the spine is entered into the computer by moving
the tip of the spinous squamous vertebrae C1 - S4. Method called Quantec scanner consists
of: projector, camera, computer, lamp and table allows the calculation of the size of the
studied traits. The measurement results obtained this way are comparable to the X-ray
photographs. The study involves the analysis of points:
 Anterior -posterior (AP): the line runs through the center of the front of the bridge,
falls between the navel and feet
 Posterior-anterior PA): the line runs through C7 and Th12, L5 and between interest
 Lateral (L): exp. Shoulder, measure limits the rough iliac crest, greater trochanter of
the femur and falls around the lateral malleolus feet
 Photogrammetric method existed in Poland 1997 eye. In subsequent years Swierc from
originally developed by the Zawieska and Nowotny has made significant technical
improvements, using the projection moiré invariably as an essential element of the
measurement. Mora is the result of interference of two linear structures, geometrical layouts
(grids - raster). Interference effect is reflected in the form of a new line (bands) - moiré
images. These bands are similar to contour lines on maps describe the actual shape of the
object. Depending on how you generate the raster image on the surface of the test
distinguishes between two groups of techniques: Shadowless, projection and reflective.
Obtaining spatial image is made possible by a message on the child's back line with specific
parameters. Lines falling on the back are distorted depending on the configuration of the
surface. Thanks to the lens, the image of the test can be taken by a special optical system of
the camera, and then transferred to a computer monitor. Image distortion lines recorded in the
computer memory, the algorithm converts the number to a contour map of the surface.
Advantages: o bioactivity, uncontact, complexity, and diversity one time measurement objects
and dynamic phenomena occurring on them, the ability to quickly measure any number of
points in the images, the ability to archive data and use them any number of times, the
possibility of complete automation of measurement, high accuracy, of the order 1/10000
distance. Defects. Research Kotwicki (2004) have shown that the angle of scoliosis
demonstrated in all groups of patients was lower than in the radiographs, and this discrepancy
increased with the angle of scoliosis, the authors sources of error divided into three groups:
errors at the stage of the test run, the errors at the stage developing the recorded image, the
errors at the stage of calculating the program parameters, the reference translation of the
curvature line linking C 7 and S 1 instead of the vertical line issued from S1 and dividing by
the program automatic distance C 7 - S 1 in 17 equal parts which is not corresponds to the
actual distance between the spinous processes. In 2012 Mrozkowiak and thatch made
modifications, adding a scoring system and a two-disc posturometer mat strain gauge.
Another somewhat simpler system is System Analysis of body posture of a computer program
"Attitude-Screening" to 2009.The method differs from the method of scoring only archiving
of test images. It requires a lot of experience and knowledge posturogenesis. Along with
duometer (linear and angular measurements) and inclinometer (type goniometer) is a valuable
addition to the diagnostic approach.

6. The reliability of publicly available methods for assessing postural

Stolbiecka et al. (1936) found that using a subjective method of assessing the rate of
orthopedic achieved a 30% higher rate of feet considered flat than in the method
plantoconturographic widely recognized as one of the more perfect. We have several methods
of assessing flat feet, but these methods are not comparable with each other. Comparative
analysis of research results in feet / in the methods shows that the only method of Clarke gives

97
the most reliable results. Nowotny et al. (2002) believes that the photogrammetric survey does
not indicate, in fact, the attitude of the body as a whole, and can currently only be treated as
an additional test. The authors point out that there is still the basis for recognition of
locomotor dysfunction should be insightful, the classic physical examination.
Research Lewandowski (2003) on how to measure the curvature of the spine and
evaluation of their reliability showed that among the not invasive methods of measuring high
rates of integration found in the study of curves arcometer and inclinometer. On the other
hand inclinometer Myrina, kyphometer Debrunner, spinal pantograph and stereographic grid
showed a much lower degree of reproducibility and comparability of test results than the
described system load cell. Zak and Dziak (2005) for objective methods of recording
deviations or existing posture received: a photograph, X-ray, tonometer and chronaxiometer
and dynamometer. These methods are available for parents and teachers, but also very
complicated to use, and therefore require the participation of professionals in their execution
and evaluation. Kluszczyński (2009) showed that the photogrammetric method as a screening
method to detect the curvature of the spine seems to be subject to significant error, due to the
technical capabilities of equipment and specificity of the test object. The low level of
accuracy in the assessment of photogrammetric plane back explains a large discrepancy
between the results of photogrammetry and clinical trial results obtained using plurimeter
Rippstein. Plurimetr Rippstein should become a tool for rapid, inexpensive and accurate
assessment of the child's posture in the sagittal and transverse complementing clinical trial in
outpatient orthopedic, pediatric and rehabilitation. Research Mrozkowiak (2010) Mora
projection physiological curvatures of children and adolescents aged 4 to 18 years of Warmia
and Mazury shown that these values are close to the measurement results of Wolanski from
the 1960s and other researchers.
Tokarczyk and Mazur (2006) asked a very important question: What conditions should be
fulfilled in order to photogrammetric measurement system was widely used? Analysis of the
literature related to this issue, which to a large degree consists of publications published in the
International Archives of Photogrammetry Managing Company and Remote Sensing (ISPRS)
of the Congress in Hamburg (1980) after the Congress in Istanbul (2004) and a list of online
publications allow these conditions to formulate as follows:
1. The measuring system must operate where the result of the measurement is used, so the
GP surgery, or should be portable to carry out preventive examinations (eg. The detection of
scoliosis among children in schools and daycare).
2. Acquiring images and performance measurement process must be fast enough to be able
to get the results already during the visit to the doctor.
3. The measurement results should be presented in an intelligible form, primarily for the
physician, but also for the patient. Should be comparable to the standard engaging a model or
models specified medical knowledge. Preferred is a form of graphical results (images and
graphs).
4. The measurement should be simple enough for the system to be operated by medical
personnel, particularly desirable is its automation.
5. The system must be reliable, ie. Does not require the intervention of a specialist -
fotogrametry and resistant to operator errors.

7. The first attempts to establish population norms, defining the attitude of the body

Biotonix System – a system to evaluate the global body posture based on biomechanics of
spine. This tool is applied as a starting point for correction of musculo-skeletal disorders
including pain syndromes of the spine. This system provides a diagnosis of muscular
asymmetries using a mathematical analysis of the following variables: individual vertical

98
loading, vertical deviations of the trunk and centre of gravity. The obtained data is analysed
and compared against the assessment base of 350 thousand biomechanical assessments of
body posture. Then, the system automatically generates the corrective program for identified
postural mistakes and defects. The posture assessment includes 3 steps:
Step 1 – 32 reflective markers are placed at specific locations on the patient’s body and then
four digital pictures are taken of the patient from the lateral, anterior, and posterior views.
Step 2 – web-based software is used to scan the images and conduct a comparative analysis
with Biotonix base.
Step 3 – identification and assessment of postural mistakes and defects. On this basis, the
system generates a 10-week corrective exercise program.

8. Recent methods of assessment of body posture in 3D system

Advanced methods of assessment of body posture are:
1. Thermal - consisting of passive registration of emission of infrared radiation emitted from
the skin surface and the execution of spatial image reconstruction including operations
morphometric enable comparative assessment of the basic elements of geometry usable body.
Play an important modern methods of image processing.
2. Ultrasonic - attractive from the point of view of low invasiveness, but less accurate than
the test radiophotographic, the ultrasonic tomography.
The use of scanning heads that emit sounds at a frequency of 3,6-5 MHz, allows the spatial
image reconstruction of bone and soft tissue. This method is useful in the diagnosis of
children - particularly sensitive to X-ray radiation.
3. Conturography gradient - allows you to take pictures before and after treatment in visible
light, then subjected to image transformations that display voltage changes paraspinal
muscles, is a simple method of obtaining data figures reflect the degree of asymmetry of
curvature of the back and the effectiveness of the treatment process.
4. Photostereoscopic - is an extension of previous ideas is stereoscopic photometric analysis
of patient motion, the essence of which is simultaneous, multidirectional recording of multiple
cameras, giving the opportunity to determine the points of marker specific parts of the body
while also assessing their displacement vectors.
5. Measurement marker - is the arrangement of passive optical or luminescent markers in
nodal points of the geometry of the patient's body (suit measurement) and performing a static
measurement or sequence of images in different positions diagnostics. Differences in the
positions of individual markers in the pictures it possible to assess the morphology and
symmetry of movement.
6. Computed tomography - is a spatial image reconstruction made on the basis of layered
images obtained using X-ray radiation or the spatial distribution of the magnetic field (MR),
the essence of which is the transformation matrix 2D in 3D. The advantage of this form of
presentation is a three-dimensional image representation of the shape and the relationship
planimetric hidden structures inside the body anatomy.
7. System Biotonix.
8. Posturecheck.
9. System Diers - based on the projection of structured light, and short scan time of approx. 40
ms. Allows you to record the dynamic characteristics of the spine. Example: Formetric 3D /
4D - prod. Germany
10. Posture Analysis Systems (Chinesport). Analyzes the feet, knees and trunk mounting
bracket enables the analysis, bone, allows the simulation of the visual system when you use
the markers in selected anthropometric points. It allows you to generate a line in the hurdles.
Front for easier analysis of asymmetry attitude. Raw data scanned by each process can not be
used in its original form. Most scanners are equipped with a program for visualizing and

99
editing and exporting data. Measurements of body posture in the sagittal, frontal and
transverse, well in advance (mirror).
11. Capacitive technology - the geometric relationship used in the construction of an electric
capacitor, wherein one electrode is the surface of the test body, and the second metal plate
sliding parallel to the plane of measurement which stimulates in this way a variable
capacitance capacitor. Capacitance of the capacitor is not only a function of the distance but
also the properties of "lining" and dielectric - sweat or other skin changes can distort the
measurement result. Scanning takes a long time because of the limited speed of the
mechanical system. The patient passes the test current. It is necessary to ensure adequate
security of the system.
12. The method of X-ray - considered the most reliable method of diagnosing posture.
Advantages: enables analysis of the relationship of bone in different parts attitude. Cons:
require expensive equipment and trained personnel, frequent exposure has negative
consequences of short-term and long-Image X-ray whole attitude is divided in half (not so
large plates). Different methods of diagnosis: Comba, Gruca, Fergusson
For the latest technical equipment mapping the test surface, and used in the assessment
of attitudes include:
1. Profilers - have a small size (10 x 30 cm.).Types of distinction: the base, the number of
laser lines, cameras and sensors. They consist of a camera and a laser light source, sliding
along the surface of the back of the test to obtain a digital image of the surface. The test is
highly accurate and precise. Examples: Kreon KLS171, French production, Metris LC15 -
mounted on the CMM, the Belgian production, Allaince PHT1 - mounted on the robot, made
in Germany.
2. Portable projection systems - are submit to the one or more digital cameras and white light.
They are small in size and therefore easy to transport. By changing or shifting the lens of the
projector and the camera can be used to analyze the different fields of view. Examples:
Steinbichler Comet IV, has a different base and LED light source, a German production,
GOM ATOS-III, has two cameras, a German production, Polygon Technologu QTSculptor,
has a rotating basis, a German production. Used to generate a complete three-dimensional
model image of the observed object. The main advantage of the system is the creation of high-
speed digital image-lit large areas. If the attitude is examined from different positions, you
must manually combine the recorded images using the appropriate program for computer
ditches. The system on a rotating basis enables automatic synchronization of various images.
The system allows for the simultaneous capture of high quality images with different
configurations are not included in profilers laser.
3. Systems "desktop" - used different technologies of sensors, but the most used is coded light
or laser profiling. Image of the surface obtained fully automatically is possible during the
movement of the object or motion sensor. The fully automated process allows you to: coded
light - images are obtained by covering the entire building individual scans and rotate or pivot
object profiler laser - laser line moves around the facility and are derived profiles. The sensor
and the object must be moved in order to obtain total surface scan. It are produced different
settings platforms - biaxial X-Y, up to 7 axis, turning, "jaw", rotating, swinging. Examples:
3D Shape S-200 - used the platform 3 axes and laser profile, the production of Danish, IVB-
Jena HSdig Volume - light encoded with a system of mirrors and 5-axis platform, a German
production.
4. Laser measurements, in which the object and the sensor is on the move - the simplest
method of obtaining an image in 3D space. Obtain a picture of the entire surface followed by
movement of the object and the sensor. The measurement process is automatic. Disadvantage
- a long time data acquisition. Asset - low cost compared to other Systems. Different types of
systems due to numerous concept of movement of the object and the sensor. Examples:

100
Skantech ST600 - a two-axis sensor, the object rotates in one line and turn, prod. Danish,
Callidus CT900 - the sensor has a single line or double swivel Single-axis and the object, the
German production.
5. Manual laser profilers or hand held - the object or the sensor is manually adjustable to
obtain a digital image of the surface. The system allows total freedom of movement. There are
three types: (1) Laser Profiler on a mechanical arm - the scan process is controlled manually
by the movement of the profiler over the object. Articulated arm will allow a very fair setting
and orientation sensor which allows for instant images scanned surface.(2) Laser Profiler is
stable and the object in motion. (3) Profiler laser or dot is hand held and the property is stable.
Advantages (1 and 2): manual control over the scanning process, insight into real time 3D
measurements made. The user can in a shorter time than the automated devices depict
complex objects.
Detailed technical devices, the surface mapping are used in:
1. Systems for measurement specialist in 3D - are composed of different systems specialized
in the measurement of specific objects. Laser scanning is used or coded light emitted
simultaneously by multiple sources, and recorded by several sensors or specific movements of
a single sensor. At the same time the object is stationary. Examples: Mensi S25 - laser scanner
with 4 light sources encoded and 2 cameras, production. Danish foot scanner with laser
measurement system, two cameras, single-axis linear motion platform and single axle motor,
made in Italy.
2. Scanning systems attitude - consist of a laser light source safe for the eyes and designing
one or more lanes on the human body. Uses special optical systems, light sensors and mirrors
to generate strips from a single light source. The entire scanner is moved so as to obtain a
digital image of the surface. Type ii traffic LOSC scanners can vary depending on the subject.
Examples: Bodyline - full body scanner consists of 4 scanners, 4 simultaneously and
vertically moving pillars, made in Japan. Disadvantage: high cost of production and parts,
require a lot of time in getting the image large areas, involuntary movements (cl. Rib eye
muscle) can cause errors in the results of measurements, Head & Face Color 3D 3030
Skanner of Cyberware - scan of the head and face, US production Pedus of Vitronics -
scanner feet, made in Germany.
3. Systems design patterns light. The system creates 3D models based on 2D images recorded.
Whole body scan takes three images of human (two in front, one on the side).Using the
symmetry of the human body, the system generates the most important dimensions with
sufficient accuracy. Two types: (1) with a fixed scanner, and the light is projected on the body
as a sensor digital camera captures the image. The scanner is the projector patterns and light
sensor. More complex systems use two or interior light sensors. Process The measuring
method is similar to laser scanning. Belts are measured individually. In one measurement of
the total scanned surface can be converted into a digital image. Greater resolution is achieved
by registering more pictures when you move the straps. The measurement time for 1 sec.
Body image can be converted to digital. The system allows you to scan ½ body. Uncontrolled
movements (cl. chest, eyes, heart ...) does not affect the results. (2) Capturor - ½ body scans.
For the measurement of the whole body it is required to use 6 scanners. Cons - scanners can
not be used simultaneously because of their mutual light to interfere with each other. That is
why it is used serial, and this increases the measurement time. Examples: 2D Contour -
German production, FaceGen 3D - made in the USA.

Conclusion
We judge the question of assessing posture had its source in the current canon attitude. In
subsequent epochs of interest anatomists mechanical design meant that the focus was on the
issue of static human body. The culmination of investigations was published in 1679 Borellius

101
work of the center of gravity of the human body. For the Polish issue of posture has arrived in
the late twenties and thirties of the twentieth century. Everyone agrees with the assertion that
the basic assumption in assessing the attitude is always subject to the assessment of habitual
attitude, as a relatively stable characteristic of human-subject.
Classification of methods of diagnosing posture is much the author has adopted its own
division methods for assessing attitudes: watching methods, silhouetted, diagnosis of manual -
functional, scoring, during physical activities, using complex mechanical measuring
instruments, using simple measuring instruments, technically advanced methods to assess
posture, including technical equipment mapping surface and brief characterization of over 100
methods to assess the attitude of the body, starting with the method watching Klapp 1927 and
ending with the latest laser mapping method in 3D space.

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