Does stretching of anterior structures alone, or in combination with strengthening of posterior structures, decrease hyperkyphosis and improve posture in adults? A Systematic Review and Meta-analysis

Abstract

Kyphosis can lead to back pain, poor posture, and increased falls risk. This systematic review aimed to synthesize research on stretching alone, or in combination with strengthening, as a management for hyperkyphosis in the adult population (≥18 years old). An electronic database search was conducted from February to March 2022. The author and an independent reviewer screened titles and abstracts for inclusion criteria -those whose intervention involved stretching alone or with strengthening exercises. The author appraised and extracted data from included articles and performed a meta-analysis where appropriate. The database and citation search yielded 327 articles, 18 of which met inclusion criteria. One study included performed stretching as a standalone intervention; the remainder used a combination of stretching and strengthening. The meta-analysis (n=3, with 5 exercise groups) found a statistically significant difference (MD = -6.97 (95% CI -9.84, -4.10), p<0.00001) in post-intervention measures of hyperkyphosis favouring the exercise group. The narrative review of studies agrees with this finding, demonstrating statistically significant improvement in hyperkyphosis following various exercise programs. This review suggests that stretching and strengthening exercises improve hyperkyphosis in the short and long term. Low-quality evidence supports stretching as a standalone intervention. Further, more robust research is required to recommend procedures and determine if stretching alone is effective for treating hyperkyphosis in adults.

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

“…As early as 1997, Spring et al [ 64 ] recommended it as the gold standard of posture treatment and twenty years later, the application of stretch was still described a viable method preventing hypertonia-induced muscular imbalance [ 65 ]. While recent reviews did not consider stretching as a stand-alone intervention [ 18 , 66 ], Withers et al [ 28 ] were only able to include one stretching study in their meta-analysis. Summarizing the effects of 12 chronic stretching studies, our systematic review is the first to extensively examine the foundation of this approach.…”

“…Scoring was performed by two independent investigators (KW & LHL). If both did not reach consensus, a third examiner provided the decisive vote (JW) [ 28 ]. To estimate the risk of publication bias, funnel plots, created using the modification of Fernandez-Castilla et al [ 36 ] for multiple study outcomes, were visually inspected.…”

“…Yet, this assumption was based on the analysis of only 10 studies and, more importantly, no investigation of the isolated effects of stretching and stretching was performed. Withers et al [ 28 ] included different training approaches. Among these, they examined stretching as a stand-alone treatment for hyperkyphosis.…”