Prevalence of Kyphosis in Madhya Pradesh: A Study Seeking the Interaction Effect of Region and Gender on Degree of Kyphosis in Madhya Pradesh

The aforesaid statement shows the necessity and validity of the right postures in one‘s life of productivity and efficiency. Yet very few have the aptitude and habit of maintaining good posture. The upright posture which distinguishes human beings from all other animals is the products of perhaps thirty five billion years of human evolution and civilization. Therefore we all need to know about proper posture, postural problems, its different aspects and role in the various spheres of life. It is the high time when we need to educate our people and make them aware regarding the same. In fact the word "posture" comes from the Latin word ―ponere" which means "to put or place."1 The general concept of human posture refers to "the carriage of the body as a whole, the attitude of the body, or the position of the limbs (the arms and legs)." It is the position in which we hold our body upright against gravity while standing, sitting or lying down. Good posture is the position which is attained when the joints are not bent or twisted and the spine is aligned. In its most common usage the word posture refers to the appearance of the human body in relation to the shape of the spine. Any deviation from the required/correct/suitable posture for an activity can be termed as postural

1Poor posture treatment London bridge SE1,Retrieved on 23 June,2011 from : http://www.chirolondon.com/posture%20london%20bridge.shtml

called as postural deformities. The most popular postural abnormalities include forward head, rounded shoulders, excessive thoracic kyphosis and lumbar Lordosis, and Asymmetrical shoulder heights. The most commonly found deformity is Kyphosis. Kyphosis is defined by an excessive outward curve of the spine and may cause a deformity such as a humpback or hunchback. Abnormal kyphosis is more commonly found in the thoracic or thoraco-lumbar (chest area/low back), but can affect the neck too. Patients with excessive kyphosis may appear with a pitched-forward appearance.

Kyphosis affects the sagittal plane, or side view. The thoracic spine should have a gentle rounding behind the shoulders. Normal thoracic kyphosis ranges from 20° to 40° when viewed from the side. If the curvature grows larger than that, the problem of kyphosis initiates. Kyphosis can vary in severity. In general, greater the curve, severe the condition is. Milder curves may cause mild back pain or no symptoms at all. More severe curves can cause significant spinal deformity and result in a visible hump on the patient's back. Kyphosis can affect patients of all ages. The condition, however, is common during adolescence—a time of rapid bone growth. The present study has been constituted by keeping the gender and the impact of being into a specific region on the degree of kyphosis. Here comes the purpose of the study.

• The study was constituted with the purpose to find out whether the degree of kyphosis is equal in all the selected regions of Madhya Pradesh irrespective of the different gender. • The next purpose of the study was to find out the interaction effect of region and gender among the school children of Madhya Pradesh. • Another purpose of the research was to study the association of gender with the status of kyphosis

districts of Madhya Pradesh. The total sample size was 500 school children (125 from each district) studying from different kinds of schools. All the children were ranging into the age group of 10-15 years. Criterion measures. Kyphosis was measured by measuring the spinal curvature. Anyone who have equal to or more than 45 degree of curvature was kept into the category of kyphotic category.

Research Instruments: A flexible ruler (flexicurve) was used to measure the degree of kyphosis. Administration of Test: Each student was asked to come one by one in private ward (with the permission of principal of the concerned school) in the presence of physical education teacher, and remove their shirts off so that the spinous processes of C7 and T12 can be marked with a skin marker. The child was asked to inhale and exhale without forcing out the breath. The flexicurve was carefully conformed to the thoracic spine. The span of the spinal curve was noted down by using the flexicurve ruler. Converting Raw Scores into Degrees: The kyphosis angle was calculated with the trigonometric calculation using the following formula: Statistical test employed: The data was analyzed by descriptive analysis, chi square test and two way factorial Anova. The level of significance was set at .05

Table 1 shows the mean and standard deviation of degree of kyphosis irrespective of the gender and being into the category of kyphotic. Table also gives the percentage of kyphosis prevalent among the school children of different selected regions/districts of Madhya Pradesh

It is clearly visible from the above table that 58 percent of school children in Madhya Pradesh are suffering from kyphosis deformity. The table further reveals that Shivpuri region has the highest percentage of kyphosis followed by Morar and then the Bhopal and Bhind. Below given figure presents the graphical explanations of the above table.

Madhya Pradesh. To find out whether the degree of kyphosis is equal in all the selected regions of Madhya Pradesh irrespective of the different gender, the data was further analyzed with the help of 2×4 way factorial Anova. Table3: Two way Anova table for the data on degree of kyphosis The p-values for gender, region and the interaction (Gender × Region) in table 3 are less than .05 and hence all the three F- values are significant at 5 % level. Thus the null hypothesis for the gender, region and the interaction (Region× Status of Kyphosis) are rejected at 0.05 level of significance. Thereby it may be concluded that there is a significant mean difference of degree of kyphosis among the different regions as well as in different genders. Since the F-values was found significant posthoc analysis was done to analyze the gender and region and the interaction analysis

For row analysis, critical analysis has been obtained by LSD posthoc Test

It is clear from the above table that mean difference of male and female is significantly higher than the critical difference. Hence, it can be concluded that the degree of kyphosis among the male school children in

For column analysis, CD has been obtained by

It can be observed from the above table that mean degree of kyphosis is significantly higher than each other in all districts of Madhya Pradesh except the Bhopal and Bhind, irrespective of the gender.

*Mean difference is higher than the critical difference The above table shows that mean difference of degree of kyphosis among the male and female school children is significantly higher in male children in comparison to female children in all the regions except the Bhind. The results revealed that the female children in Bhind region is having higher degree of kyphosis than the male children. Thus it can be concluded that mean degree of kyphosis is not equally distributed over to different genders in all the selected regions. The table no.7 shows that among male children the highest degree of kyphosis is found in Shivpuri followed by Morar, then Bhopal and at last the Bhind. Similarly, in case of females the highest degree of kyphosis was found among the children of Bhind region followed Morar and Shivpuri and then the Bhopal. The table further shows that mean difference of Bhopal and Morar in female children is lesser than the critical difference and hence it can be concluded that the degree of kyphosis is equally occurring in both the selected districts of Madhya Pradesh. The data was again analyzed to find out the relationships of the selected variables with each other. Table8: Chi Square for the data on incidences of kyphosis in order to find out its Association with Gender The above table is showing the testing of null hypothesis (Ho) i.e. there is no association between gender and the status of kyphosis among the school children of Madhya Pradesh against the research hypothesis that there is a significant association between gender and the status of kyphosis among the school children of Madhya Pradesh. Results revealed significant association, as the calculated chi square ( ) is 10.547 is higher than the tabulated value of chi square (0.05 (1) = 3.841). Thus, it may be concluded that there was a significant association between the genders and the kyphosis among the school children of Madhya Pradesh.

The data was analyzed in the light of set purpose. Accordingly the results revealed that 58 percent of school children were suffering from kyphosis. It was found that Shivpuri district was the most affected district by kyphosis followed by Morar, Bhopal and Bhind. 2×4 way factorial Anova gives a significant p-values for gender, region and the interaction (Gender

genders in the school children of Madhya Pradesh. The posthoc analysis for rows (gender) showed a significant mean difference of degree of kyphosis among the male and female school children. It was found that mean difference of male and female is significantly higher than the critical difference. Hence, it was concluded that the degree of kyphosis among the male school children in Madhya Pradesh is significantly higher than that of their female counterparts. It was also observed in the results that mean degree of kyphosis is significantly different from each other in all the selected districts of Madhya Pradesh except the Bhopal and Bhind, irrespective of the gender. The analysis of interaction effect revealed that degree of kyphosis is significantly higher in male children in comparison to female children in all the regions except the Bhind. The results also showed that the female children in Bhind region are having higher degree of kyphosis than that of the male children. Further it was concluded that mean degree of kyphosis is not equally distributed over to different genders in all the selected regions. The results of further interaction analysis revealed that among male children the highest affected district is Shivpuri followed by Morar, Bhopal and the Bhind. Similarly, in case of females the highest degree of kyphosis was found among the children of Bhind region followed Morar and Shivpuri and then the Bhopal. The table further showed that mean difference of Bhopal and Morar in female children were lesser than the critical difference and hence it can be concluded that the degree of kyphosis is equally occurring in both the selected districts of Madhya Pradesh. The chi square analysis regarding the association test of status of kyphosis with gender resulted in a significant association with each other as the calculated chi square ( ) = 10.547 is significantly higher than the tabulated value of chi square (0.05 (1) = 3.841). Thus, it may be concluded that there was a significant association between the genders and the kyphosis among the school children of Madhya Pradesh.

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Post-Doctoral Research Scholar, SOSPESS, Jiwaji University