1 Introduction

Kyphosis or round back is the exaggeration of the posterior spinal curve and is generally
localized to the dorsal spine . The back is rounded, the head is carried forward and the chest is
flattened.
Habitual bad posture at school is the common cause. It could develop as a result of undetected
defects of vision or hearing. Mental or physical fatigue could also precipitate such habitual
postural tendencies.
Radiography only finds a clinical diagnosis for one out of every three spinal deformities.
Thoracic hyperkyphosis is one of the most prevalent postural abnormalities. The thoracic
hyperkyphosis refers to an increase in the thoracic curvature in the sagittal plane. Treatment
recommendations are determined by measuring the kyphosis angular measurement. According
to Cobb's radiographic approach, kyphosis ranges normally from 20 to 50º. The most widely
used techniques for measuring kyphosis are radiographic techniques. Nevertheless, these
approaches are not the best for routine patient follow-up or screening because they are costly
and expose people to radiation3.
The thoracic kyphosis can be clinically measured with a few different tools. The spine curvatures
on the sagittal plane have been measured using a flexible ruler known as the flexicurve. With
this tool, curvatures can be quickly, cheaply, and non-invasively assessed in field investigations
involving large populations as well as in clinical settings4.

To begin with, the flexicurve was first described by Takahashi and Atsumi5. The first application
of the flexicurve in a clinical context for measuring kyphosis using the kyphosis index (KI)
was detailed by Milne and Lauder 6. The measurement unit employed in this technique was
centimetres (cm). Burton7 provided an alternative technique for measuring the lumbar spine's
angular curvature using the flexicurve. By sketching the tangent of the traces that the flexicurve
yielded, the lordosis angle could be determined. Lovell, Rothstein, and Personius8 developed a
kyphosis evaluation approach utilising the flexicurve. They did this by transforming linear values
for lumbar lordosis into angular measures using a 2º degree polynomial.

Standard clinical assessments, like the physical therapy assessment of thoracic kyphosis, ought
to be practicable, affordable, sensitive, valid, and trustworthy. This study was out to confirm
the Flexicurve method's concurrent validity as well as the intra- and inter-rater reliabilities of the
thoracic kyphosis measures.

Indicator of total body muscular strength is voluntary handgrip strength (HGS), which is
strongly correlated with other body muscles operating . As a result of its shown strength as an
indicator of both nutritional and functional health , as well as its potential as a screening tool for
undernutrition , handgrip strength is the most commonly utilised measure of muscle function for
clinical purposes in clinical settings. Moreover, there is a substantial correlation between HGS
impairment and greater rates of hospitalisation , longer hospital stays , decreased short- and
long-term survival , and increased postoperative complications. Low HGS is used for frailty and
sarcopenia diagnosis and is described as a predictor of disability and frailty for older persons.

Indicator of total body muscular strength is voluntary handgrip strength (HGS), which is
strongly correlated with other body muscles operating . As a result of its shown strength as an
indicator of both nutritional and functional health , as well as its potential as a screening tool for
undernutrition , handgrip strength is the most commonly utilised measure of muscle function for
clinical purposes in clinical settings. Moreover, there is a substantial correlation between HGS
impairment and greater rates of hospitalisation , longer hospital stays, decreased short- and
long-term survival , and increased postoperative complications . Low HGS is used for frailty and
sarcopenia diagnosis and is described as a predictor of disability and frailty for older persons.

Compared to other functional, nutritional, and health status markers, hand dynamometry has
several advantages because it is a low-cost, portable, and simple technique. In addition, HGS
measures don't require specialised training, are noninvasive, fast to complete, dependable, and
show little intraobserver and between-observer variability.

Dynamometers come in a variety of models. The American Society of Hand Therapists

recommends the use of the Jamar dynamometer for HGS measurements, and interinstrument
agreement studies commonly select it as the benchmark criterion. Variability in the results
was seen in the research that evaluated the agreement between Jamar and other types of
dynamometers for HGS measurement in undernourished institutionalised older individuals and
in subjects living in freedom .

Prevalence
In the adolescent age, this deformity may occur as a result of arthritis, rheumatism, lung
affections (e.g., emphysema) and vertebral diseases besides habitual bad sitting postures.
In old age, it may be the result of previous bad posture, muscular weakness, osteoporosis and
degenerative diseases of the spine.

Hand grip strength prevalence in the Indian adult population:

Normative Values:
- A study published in the Journal of Clinical and Diagnostic Research (2017) reported the
following average hand grip strength values for Indian adults:
- Men: 34.6 ± 6.3 kg (right hand) and 33.4 ± 6.1 kg (left hand)
- Women: 23.4 ± 4.5 kg (right hand) and 22.4 ± 4.3 kg (left hand)

Age-Related Trends:
- Grip strength peaks between 25-34 years for both men and women.
- A decline in grip strength is observed after 45 years, with a sharper decline after 65 years.
- A study in the Indian Journal of Physiology and Pharmacology (2015) reported the following
average grip strength values across age groups:
- 20-29 years: Men (36.3 ± 5.6), Women (25.3 ± 4.3)
- 30-39 years: Men (34.5 ± 5.9), Women (23.5 ± 4.5)
- 40-49 years: Men (32.4 ± 5.9), Women (21.5 ± 4.3)
- 50-59 years: Men (29.4 ± 5.5), Women (19.5 ± 4.1)
- 60+ years: Men (24.5 ± 5.1), Women (16.4 ± 3.9)

Regional Variations:
- A study published in the Journal of Medical Science and Clinical Research (2017) found
regional variations in hand grip strength:
- North Indian men: 36.2 ± 6.1 kg (right hand)
- South Indian men: 33.4 ± 5.9 kg (right hand)
- North Indian women: 25.3 ± 4.5 kg (right hand)
- South Indian women: 22.4 ± 4.3 kg (right hand)
Need for study - correlation of thoracic kyphosis on handgrip strength in student population

2 Research Question: correlation of thoracic kyphosis on handgrip strength

3 Hypothesis

Null hypothesis: Thoracic kyphosis doesn't affect handgrip strength

Alternative hypotheses:Thoracic kyphosis affects handgrip strength

4 Review of literature
ROL 1
Lundon, Li, and Bibershtein12 investigated three distinct approaches to clinical kyphosis
assessment. Three separate examiners used three distinct equipment to analyse twenty-six
subjects: the DeBrunner's kyphometer compared to the Cobb's angle obtained with radiographs,
and the Kyphosis Index (KI) obtained with a flexicurve. The kyphometer demonstrated superior
intra- and inter-rater reliability when contrasted with the flexicurve. The information gathered
using the three analyses did not differ statistically significantly, as the analysis of variance
showed. However, the flexible ruler is significantly less expensive than the kyphometer.
On the other hand, the flexible ruler is far less expensive than the kyphometer. Contrary to what
we found, the authors suggested that the flexicurve is a useful qualitative tool for measuring
thoracic kyphosis. The flexible ruler can be used as a quantitative tool to measure the angle of
thoracic kyphosis using the Flexicurve method.

ROL-2
Hart and Rose (2013) have examined the degree of agreement between the flexicurve linked
to the tangent drawing method and radiological measurement. Utilising the data from a lone
assessor, the ICC was 0.87. The sample utilised for lumbar lordosis measurements in this
validity research consisted of just six people. Against the findings of the current investigation,
which included 56 patients and showed an ICC value of 0.906, the small sample size makes the
results of Hart & Rose questionable.
ROL-3
For lumbar flexion, Salisbury & Porter14 found a connection of r= 0.79 between the flexicurve
linked to the drawing tangents method and ultra-sound, and r= 0.69 for lumbar extension. The
outcomes were not as good as ours (r= 0.866). Strong agreement should not be interpreted
as strong association. Correlations simply show whether the obtained values rise or fall in
proportions that are similar.
ROL-4
The Flexicurve approach yielded better results than previous clinical tools used to measure
dorsal kyphosis. With r= 0.98, D'Osualdo, Scherano, and Iannis15 showed high correlation
between evaluators when measuring thoracic kyphosis using the archometer. Findings (r=
0.888) were superior to ours. But contrary to what we discovered using the Flexicurve approach,
they discovered a significant difference in agreement between the radiological measure and the
archometer (ICC = 0.906 and r= 0.862).
ROL-5
Korovesis et al.16 discovered that the measurements of dorsal kyphosis produced by the
DeBrunner's kyphometer had an ICC of 0.84 in respect to intra-rater agreement for other
devices. The ICC between two evaluators was 0.83 in Mannion et al.'s study of dorsal kyphosis
using the Spinal Mouse®. The inter-rater ICC for this study was 0.94, which is better agreement
than what was found for other instruments, according to the results.
ROL-6
The resolution of the dynamometers now on the market varies, and increasing the resolution
may help distinguish and record muscle strength measurements more accurately. There have
previously been differences in HGS results between the Jamar and other 4 dynamometers,
Grippit, Smedley's, Eisenhut, and Sammons Preston Rolyan Bulb, ranging from 2.2 to 8.7 kgf
and with wide margins of agreement ,led to the concept that improved HGS measurement,
particularly for low HGS values, would come from a dynamometer with smaller dimensions,
lower weight, and various ergonomics, including two handles of different forms. Larger and
heavier dynamometers might be suitable for certain people, but some demographic groups—
children, the elderly, sarcopenic, or undernourished subjects—may find it challenging to handle
them. The likelihood of causing differential mistakes will increase in paediatric and fragile
patients since they will need to exert more force and strength to support the device than other
subjects. Additionally, in everyday practice—such as in clinical settings—lighter and smaller
dynamometers are easier for measurers to carry and for examined people to manage.

ROL-7
When measured against the following: the Jamar; the MicroFET4 (Hoggan Scientific, LLC, Salt
Lake City, UT, USA); Eisenhut (Eisenhut Instruments GmbH, Frittlingen, Germany); Sammons
Preston Rolyan Bulb (Patterson Medical Holdings, Inc., Warrenville, IL, USA); Grippit (AB
Detektor, Goteborg, Sweden); Rolyan (Smith & Nephew, Inc., Germantown, WI, USA); and DynEx
(Fabrication Enterprises, Inc., White Plains, NY, USA)
Dynamometers have demonstrated good measurement accuracy in the lab (r2 > 0.999);
nevertheless, in human subjects, their error has varied according to the properties of the
subjects and the tested devices . In light of these findings and the fact that observable elements
account for these discrepancies, it is possible to enhance the attributes that could lower HGS
measurement errors. As a result, improving accuracy has advantages in clinical and other
contexts.

ROL-8

Additionally, a significant percentage of subjects in a research involving 314 inpatients with

mean ages of 57.3 (SD: 18.7) years and ages ranging from 18 to 96 years had nil or extremely
low HGS values when assessed using an Eisenhut dynamometer. The 10th percentile for all
included women and all men who were nutritionally at-risk was 0 kgf when the HGS data were
summarised in percentiles by sex, age groups (less than 65 and more than 65), and nutritional
risk. These results might indicate that using this dynamometer to obtain precise readings of low
HGS values is inappropriate.

5 Materials and Methods

1)Source of data-Healthy students

a)Sample population -Student population of age 20 to 25 yrs

b)Place of study- Dr Ravi Patil Institute Of Physiotherapy Belagavi

2)Method of collection of data-

a)study design - Pourposive study design

b)Sampling method- observational method

c)Sample size- 90

Inclusion criteria

-Both male and female

-Students
-Age (20-25yrs)
-Subjects who are willing to

Exclusion criteria

-Spinal surgeries
-Spinal conditions
-Respiratory conditions
-Abdominal surgery
-Subjects who are not willing to participate

Outcome measure
1)Kyphosis
The flexible ruler is moulded over the volunteer's spine. The C7 spinal process was where
the flexible ruler's point was placed. After that, the rule was shaped to resemble the kyphotic
curvature all the way down to T12's spinal process . Next, the spots on the volunteer's spine that
corresponded to C7 and T12 were marked using the flexible ruler.

Transcribing the dorsal spine's structure to the millimetre paper

The flexible ruler was removed from the subject's back while preserving the format of the torso,
and it was then quickly placed over a millimetre paper. C7 and T12 points were marked, and the
millimetre paper was used to sketch the contour of the ruler on the side that was positioned
over the subject's spine.

Definitions of the H, Xmiddle, and X total

A straight line linking the spots comparable to C7 to T12 was traced after the thoracic kyphosis
contour was transferred to the millimetre paper. To determine the point at which the curve and
the line connecting C7 and T12 are farther apart, another straight line that is perpendicular to the
first one was drawn between the C7 and T12 points.
The definition of distance was as follows:
Height (H) is the greatest separation between the curve and the line connecting C7 and T12.
The distance between T12 and the point where H hits the line joining C7 and T12 was used to
calculate Xmiddle. The length of the straight line between C7 and T12 (Figure 2) was Xtotal.

Calculating angles using a 3º degree polynomial

The thoracic kyphosis angle was calculated by entering the values for the Xtotal, Xmiddle, and H
distances—all measured in centimetres on the millimetre paper—into an Excel application. The
following describes the particular mathematical formula that was used:

In order to confirm if data are correct, the following formula was used:

In order to confirm if data are correct, the following formula was used:

The Flexicurve technique and the Cobb's angle were compared using three different analyses.
The first three analyses comprised the first physical therapist's (evaluator 1) results; the second
included the second physical therapist's (evaluator 2) first measurement; and the third included
the average of evaluator 2's two measurements (evaluator 2/2).
2)Handgrip strength ,

The patient is handed a hand dynamometer. The patient is seated with their back supported by
the chair, their arm resting on it, their hand in the mid-prone position, and their wrists out of the
chair. An average of the three trials is taken into consideration. It's examined with both hands.
Strength is assessed between each student's left and right hands.
8) Duration of study- 7 months

Results

References

1) Elbow Position Affects Handgrip Strength in Adolescents: Validity and Reliability of Jamar,
DynEx, and TKK Dynamometers

2) Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity
Accumulation in Americans

3) Is Bilateral Deficit in Handgrip Strength Associated With Performance in Specific Judo Tasks?
4) Using Electronic Handgrip Dynamometry and Accelerometry to Examine Multiple Aspects of
Handgrip Function in Master Endurance Athletes: A Pilot Study

5) A Brief Review of Handgrip Strength and Sport Performance

6) Acute Effects of Partial-Body Cryotherapy on Isometric Strength: Maximum Handgrip

Strength Evaluation

7)Lovell F, Rothstein J, Personius W. Reliability of clinical measu-rements of lumbar lordosis

taken with a flexible rule. Phys Ther. 1989

8)Lundon K, Li A, Bibershtein S. Interrater and intrarater reliabi-lity in the measurement of

kyphosis in postmenopausal women with osteoporosis. Spine. 1998;23(18):1978-85.

9)Hart DL, Rose SJ. Reliability of a non-invasive method for measuring the lumbar curve. J Ortho
Sports Phys Ther. 1986

10)D'osualdo F, Scherano S, Iannis M. Validation of clinical measurement of kyphosis with a

simple instrument, the arcometer. Spine. 1997

11)Korovessis P, Petsinis G, Papazisis Z, Baillousis A. Prediction of thoracic kyphosis using the

De Brunner kyphometer. J Spin Disor. 2001

12)Walker ML, Rothstein JM, Finucane SD, Lamb RL. Relationships between lumbar lordosis,
pelvic tilt, and abdominal muscle performance. Phys Ther. 1987