European Journal of Pediatrics

, Volume 177, Issue 9, pp 1327–1334 | Cite as

Spinal posture changes using dynamic rasterstereography during the modified Matthiass test discriminate between postural weak and strong healthy children (10–14 years): a pilot study

  • Inke Marie AlbertsenEmail author
  • Barbara Brockmann
  • Karsten Hollander
  • Jan Schröder
  • Astrid Zech
  • Susanne Sehner
  • Ralf Stücker
  • Kornelia Babin
Original Article


The aim of this pilot study was to investigate whether the clinical Matthiass test can be objectified by means of dynamic rasterstereography in children. We aimed at discriminating between postural weak and strong children. Dynamic rasterstereography was used to capture sagittal spinal posture changes during the modified Matthiass test (mMT). Primary outcomes were spinal posture changes (trunk inclination, kyphotic and lordotic angles) during the test. Two-step cluster analysis was run jointly on the three primary outcomes. Data of 101 healthy children (10–14 years, 46% girls) were assessed. Cluster analysis identified two groups of participants with significantly different postural performance levels during the mMT (low vs. high performers). Low performers showed a higher increase in backward lean, as well as kyphosis and lordosis (4°–5°, respectively) when compared to high performers. The two performance groups were age-, BMI-, and activity-matched.

Conclusion: This pilot study established preliminary normative data on spinal posture changes during the Matthiass test (high performers) and provided corresponding cutoff values for postural weakness (low performers). These results could provide a basis for future longitudinal and interventional studies targeting long-term consequences of childhood postural weakness and the prevention of back pain.

What is Known:

• The prevalence of postural insufficiencies in children is high.

• No consensus exists about the postural assessment in children.

• A common clinical test to identify postural insufficiency is the Matthiass test yet criticized for its subjective assessment.

What is New:

• This pilot study objectified the modified Matthiass test by rasterstereography and statistically identified two groups of healthy children with different postural performance levels.

• It established preliminary normative data on spinal posture changes and provided corresponding cutoff values for postural weakness.


Dynamic rasterstereography Postural insufficiencies Children Spinal posture changes Modified Matthiass test Two-step cluster analysis 



Kyphotic angle


Lordotic angle


Modified Matthiass test


Spinal posture changes between the 1st and 30th second of the mMT


Trunk inclination angle


Authors’ contributions

Inke Marie Albertsen was fully involved in the conception of the study, acquisition, analysis and interpretation of data, and drafting and revising of the work

Barbara Brockmann was fully involved in the conception of the study, acquisition, and analysis of data

Karsten Hollander was fully involved in the conception of the study, analysis and interpretation of data, and drafting and revising of the work

Jan Schröder was fully involved in interpretation of data, and revising of the work

Astrid Zech was fully involved in the conception of the study, and revising of the work

Susanne Sehner was fully involved in the conception of the study and statistical analysis of data

Ralf Stücker was fully involved in revising of the work

Kornelia Babin was fully involved in the conception of the study, and revising of the work


This project is part of the Barefoot LIFE-study which is funded by the Ministry for Science and Research in Hamburg (grant number LFF-FV13).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study and their parents (or legal guardians). All procedures performed involving human participants were in accordance with the ethical standards of the local ethics committee (ethical approval number PV4971) and with the 1964 Helsinki declaration and its later amendments.


  1. 1.
    Albertsen IM, Dettmann K, Babin K, Stücker R, Schröder J, Zech A, Hollander K (2018) Spinal postural changes during the modified matthiass test in healthy children. Orthopade.
  2. 2.
    Bejia I, Abid N, Ben Salem K, Letaief M, Younes M, Touzi M, Bergaoui N (2005) Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study. Eur Spine J 14(4):331–336CrossRefPubMedGoogle Scholar
  3. 3.
    Betsch M, Furian T, Quack V, Rath B, Wild M, Rapp W (2015) Effects of athletic training on the spinal curvature in child athletes. Res Sports Med 23(2):190–202CrossRefPubMedGoogle Scholar
  4. 4.
    Betsch M, Wild M, Jungbluth P, Thelen S, Hakimi M, Windolf J, Horstmann T, Rapp W (2010) The rasterstereographic-dynamic analysis of posture in adolescents using a modified Matthiass test. Eur Spine J 19(10):1735–1739CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cudré-Mauroux N, Kocher N, Bonfils R, Pirlet M, Meichtry A, Hilfiker R (2006) Relationship between impaired functional stability and back pain in children: an exploratory cross-sectional study. Swiss Med Wkly 136(45–46):721–725PubMedGoogle Scholar
  6. 6.
    Drerup B, Ellger B, Meyer zu Bentrup FM, Hierholzer E (2001) Functional rasterstereographic images. A new method for biomechanical analysis of skeletal geometry. Orthopade 30(4):242–250CrossRefPubMedGoogle Scholar
  7. 7.
    Drerup B, Hierholzer E (1994) Back shape measurement using video rasterstereography and three-dimensional reconstruction of spinal shape. Clin Biomech (Bristol, Avon) 9(1):28–36CrossRefGoogle Scholar
  8. 8.
    Furian TC, Rapp W, Eckert S, Wild M, Betsch M (2013) Spinal posture and pelvic position in three hundred forty-five elementary school children: a rasterstereographic pilot study. Orthop Rev (Pavia) 5(1):7CrossRefGoogle Scholar
  9. 9.
    Gordon-Larsen P, Nelson MC, Page P, Popkin BM (2006) Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 117(2):417–424CrossRefPubMedGoogle Scholar
  10. 10.
    Hollander K, van der Zwaard BC, Braumann KM, de Villiers JE, Venter R, Zech A (2016) The effects of being habitually barefoot on foot mechanics and motor performance in children and adolescents aged 6-18 years: study protocol for a multicenter cross-sectional study (barefoot LIFE project). J Foot Ankle Res 9(1):36CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ihme N, Goßen D, Olszynska B, Lorani A, Kochs A (2002) Can an insufficient posture of children and adolescents be verified instrumentally? Z Orthop Ihre Grenzgeb 140(4):415–422CrossRefPubMedGoogle Scholar
  12. 12.
    Klee A (2008) The relevance of the "Armvorhalte test" according to Matthiaß. Z Orthop Ihre Grenzgeb 133(3):207–213CrossRefGoogle Scholar
  13. 13.
    Kowalski K, Crocker P, Donen R (2004) The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. College of Kinesiology University of Saskatchewan, SaskatoonGoogle Scholar
  14. 14.
    Kreuder S (2009) Investigation of the reliability of Matthiass posture test. Physioscience 5(1):19–25CrossRefGoogle Scholar
  15. 15.
    Lafond D, Descarreaux M, Normand MC, Harrison DE (2007) Postural development in school children: a cross-sectional study. Chiropr Osteopat 15(1):1CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lippold C, Segatto E, Végh A, Drerup B, Moiseenko T, Danesh G (2009) Sagittal back contour and craniofacial morphology in preadolescents. Eur Spine J 19(3):427–434CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Mahlknecht J (2002) The KIL-system for qualitative and quantitative evaluation of posture in lateral view. Z Orthop Ihre Grenzgeb 140(6):615–620CrossRefPubMedGoogle Scholar
  18. 18.
    Mahlknecht JF (2007) The prevalence of postural disorders in children and adolescents: a cross sectional study. Z Orthop Unfall 145(3):338–342CrossRefPubMedGoogle Scholar
  19. 19.
    Mellin G, Poussa M (1992) Spinal mobility and posture in 8- to 16-year-old children. J Orthop Res 10(2):211–216CrossRefPubMedGoogle Scholar
  20. 20.
    Mohokum M, Mendoza S, Wolf U, Sitter H, Paletta JR, Skwara A (2010) Reproducibility of rasterstereography for kyphotic and lordotic angles, trunk length, and trunk inclination. Spine (Phila Pa 1976) 35(14):1353–1358CrossRefGoogle Scholar
  21. 21.
    Morgenstern M, Sargent JD, Hanewinkel R (2009) Relation between socioeconomic status and body mass index. Arch Pediatr Adolesc Med 163(8):731–738CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA, Nissinen MJ (2005) Development of spinal posture in a cohort of children from the age of 11 to 22 years. Eur Spine J 14(8):738–742CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Prange S, Schmitz A, Schulze-Bertelsbeck D, Wallny T, Schumpe G, Schmitt O (2002) Ultrasound topometric measurements of thoracic kyphosis and lumbar lordosis in school children with normal and insufficient posture. Z Orthop Ihre Grenzgeb 140(2):160–164CrossRefPubMedGoogle Scholar
  24. 24.
    Salminen JJ, Erkintalo M, Laine M, Pentti J (1995) Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine (Phila Pa 1976) 20(19):2101–2107CrossRefGoogle Scholar
  25. 25.
    Schroeder J, Reer R, Braumann KM (2015) Video raster stereography back shape reconstruction: a reliability study for sagittal, frontal, and transversal plane parameters. Eur Spine J 24(2):262–269CrossRefPubMedGoogle Scholar
  26. 26.
    Schülein S, Mendoza S, Malzkorn R, Harms J, Skwara A (2013) Rasterstereographic evaluation of interobserver and intraobserver reliability in postsurgical adolescent idiopathic scoliosis patients. J Spinal Disord Tech 26(4):E143–E149CrossRefPubMedGoogle Scholar
  27. 27.
    Schulte TL, Hierholzer E, Boerke A, Lerner T, Liljenqvist U, Bullmann V, Hackenberg L (2008) Raster stereography versus radiography in the long-term follow-up of idiopathic scoliosis. J Spinal Disord Tech 21(1):23–28CrossRefPubMedGoogle Scholar
  28. 28.
    Stallknecht SE, Strandberg-Larsen K, Hestbæk L, Andersen AN (2017) Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the danish national birth cohort. Eur J Pediatr 176(6):807–814CrossRefPubMedGoogle Scholar
  29. 29.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296CrossRefGoogle Scholar
  30. 30.
    Widhe T (2001) Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. Eur Spine J 10(2):118–123CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Wirth B, Knecht C, Humphreys K (2013) Spine day 2012: spinal pain in Swiss school children epidemiology and risk factors. BMC Pediatr 13(1):159CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric Orthopedics, Altonaer Children’s HospitalUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Sports and Exercise Medicine, Institute of Human Movement ScienceUniversity of HamburgHamburgGermany
  3. 3.Department of Sports and Rehabilitation MedicineBG Trauma Hospital of HamburgHamburgGermany
  4. 4.Institute of Sport ScienceFriedrich Schiller University JenaJenaGermany
  5. 5.Department of Medical Biometry and EpidemiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  6. 6.Department of OrthopedicsUniversity Medical Center Hamburg-EppendorfHamburgGermany

Personalised recommendations