Table summary of studies testing clinical effectiveness of the rpg method
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1) The document summarizes several studies that tested the clinical effectiveness of the RPG method for treating various musculoskeletal conditions. 2) The studies included randomized controlled trials, case series, case reports and involved hundreds of patients in total. 3) The results showed that RPG treatment improved outcomes related to pain, function, quality of life and posture compared to other interventions or no treatment across different conditions.
Table summary of studies testing clinical effectiveness of the rpg method
- 1. Summary compiled by Laylane Chagas – MSc HCPC MSC, RPG practitioner – rpg.uk123@googlemail.com - www.GPR-PostureCorrection.co.uk Page 1 Summary of studies testing clinical effectiveness of the RPG method Author Study design Condition N (n) Experimental group (n) Control group Outcome measure Results Adorno et al, 2013 Randomized controlled trial PEDro 2/10 Chronic Lower Back Pain 30 (10) 12 RPG 60 min individual sessions supine HAO-ADD and HAC-ADD over 12 weeks (10) 24 Iso-stretching individual 60 min sessions over 12 weeks QoL – SF-36 Q. P – VAS Baseline, 3 months, 2 months follow-up Both treatment approaches reduced pain and improved QoL. Pain reduction was greater when the Iso-stretching + RPG approaches were combined. At 2-month follow-up, RPG method was more efficient for pain reduction and the Iso-stretching group showed more QoL. (10) 12 RPG individual session + 24 Iso-stretching individual session over 12 week Alonso-Blanco et al, 2009 a Prospective cohort study Ankylosing Spondylitis 35 (35) 8 RPG 60 min group session with group design over 8 weeks --- F - BASFI; D - BASDAI QoL - SF-36, F/M - BASMI GROC (Global rating of change) 16 (46%) of patients experienced a successful outcome Alonso-Blanco et al, 2009 b Non-randomized controlled trial Ankylosing Spondylitis 20 (10) 12 RPG 60 min group sessions with group design over 12 weeks (10) Segmental spinal mobilization/ stretching F - Spirometry (FVC, FEV1, FEV1/FVC ratio); F/M- rib mobility Baseline, 3 months RPG group led to greater increase in FEV1/FVC. Both groups improved rib mobility improved. Andrade and Carvalho, 2010 Case report (Poster) Ankylosing Spondylitis 1 (1) 30 RPG individual weekly sessions over 30 weeks --- Postural Assessment; F/M- Schober’s test, Tragus-to-wall distance. Baseline, 15th and 30th sessions RPG led to improvements of spinal mobility in all parameters assessed. No statistical analysis was provided. Apuzzo et al, 2003 Case series (Poster) Lumbar Disc Herniation 40 (40) 22 RPG sessions associated with O2O3 infiltration over 6 months --- P - Valleux points, numeric non-verbal scale for pain; QoL - SF-36 Q. Lasegue test, MRI imaging RPG led to a significant symptom reduction (Valleux points and Lasegue test). 47% of cases had a reduction of the hernia volume. Apuzzo et al, 2014 Observational retrospective cohort study Lumbar Disc Herniation 546 (54) 15 RPG individual sessions (109) 22 O2O3 infiltrations P - VAS At the end of treatment, pain severity was lower in the O2O3 patients than in the RPG-alone patients. After some years of follow-up only the difference between O2O3+RPG and RPG-alone remained significant. (383) 22 O2O3 infiltrations + 15 RPG sessions Barroqueiro and Morais, 2014 Case report Isthmic Spondylolisthesis L5-S1 grade II 1 (1) Weekly RPG 65 min (average) individual sessions over 5 months: supine HAO-ABD, standing HAO- ADD, supine HAC-ABD --- Digitized radiographs measuring slip grade, spinopelvic sagittal alignment and lumbar ROM (baseline and 6 months) After the treatment period, lumbar lordosis, sacral slope and anterior pelvic tilt decreased 17.2°, 16.5°and 15.1° respectively. There was no significant change in lumbar ROM. Basso et al, 2010 Case series Temporomandibular Disorder 20 (10) 10 RPG individual sessions (45 min, 2 postures with individual design over 10 weeks --- RDC/TMD classification Digital photogrammetry with SAPo (v0.68) software RPG decreased the number of cases with articular or disc dysfunction; led to significant decrease of orofacial pain and improvement in 19 of 25 body angle measures. Bonetti, et al 2010 Non-randomized controlled trial Chronic Lower Back Pain 78 (42) 10 RPG 60 min individual sessions with group design over 5 weeks (36) 10 Core muscle stabilization exercise (SE) sessions over 5 weeks D - Oswestry Q, Roland-Morris Q P - VAS F/M - Finger-floor distance Baseline, 3 and 6 months RPG let to significantly greater improvement on disability, flexibility and intensity of pain as compared to a SE program. Borges et al, 2006 Non-randomized controlled trial Healthy male athletes 14 (7) 20 RPG 40 min Standing HAC- ADD posture sessions over 10 weeks (7) Control Group Basketball training routine alone F/M - Photometry and standing reaching test RPG group led to significantly greater flexibility of posterior chain muscles. Borges et al, 2011 Case report Oral Respirator Syndrome 1 (1) 20 RPG 20 min session over 2 months --- Postural Assessment; MS – MIP, MEP F - peak flow, spirometry No statistical analysis. There was an improvement of all measurements. Castro and Lopes, 2003 Case report Chronic back pain 1 (1) 21 RPG individual weekly session over 21 weeks --- Postural assessment using software FisioLogic; Spinal curvatures X-Ray AP; Baseline, 21st week. The computerized assessment by digital photography showed improvements as did the radiologic exams. No statistical analysis performed. Cabral et al, 2007 Non-randomized controlled trial Patellofemoral Syndrome 26 (14) 16 RPG 30 min sessions with group design over 8 weeks (12) Segmentar hamstring and calf stretching sessions each held by 30 s P - VAS, F/M - Finger-floor distance; Knee extension ROM; Q-angle; EMG activity of biceps femoris and gastrocnemius mm; F - Lysholm scale Both groups improved significantly knee functional scores, hamstring flexibility, Q- angle alignment, and flexibility. RPG group led to significantly less pain and greater flexibility gain.
- 2. Summary compiled by Laylane Chagas – MSc HCPC MSC, RPG practitioner – rpg.uk123@googlemail.com - www.GPR-PostureCorrection.co.uk Page 2 Canto et al, 2010 Case series Lower Back Pain 35 (35) 10 RPG 60 min sessions with individual design over 10 weeks --- P - VAS D - Roland-Morris Q RPG treatment improved significantly both VAS and Roland–Morris scores. Chao et al, 2011 Case series Healthy females 8 (8) 6 RPG 10-20 min sessions with group design over 3 weeks --- MS - 4 MIP and MEP Assessment at 1 week, 1 day, Baseline, 1 week RPG led to significant increase of respiratory muscle strength. Results were maintained on 1 week follow-up measurements. Coelho and Nogueira, 2011 Case series (Poster) Asthma 12-14yo males 6 (6) RPG + Conventional physiotherapy individual and group sessions twice weekly --- Not mentioned Improved posture and flexibility and quality of life. No statistical analysis provided. Cunha et al, 2008 Randomized controlled trial Chronic Neck Pain 31 (15) 12 RPG plus myofascial release 60 min sessions with group design over 6 weeks (16) 12 Static stretching + myofascial release 60 min sessions. P – VAS QoL - SF36 Q F/M - cervical ROM Both groups significantly improved pain level, QoL and cervical ROM. There was no difference between groups. Dacca and Furlan, 2000 Case report Lumbar Disc Herniation L4-L4/L5-S1 1 (1) 76 RPG 60 min individual weekly sessions over 20 months --- Postural assessment ROM and functional assessment RPG treatment resolved pain; improved flexibility and muscle strength, and postural alignment. No statistical analysis provided. Di Ciaccio et al, 2012 Case series Lumbar Disc Herniation L4-L4/L5-S1 24 (24) 12 to 19 RPG 60 min individual sessions with group design: Supine HAO-ADD, standing HAC-ADD over 6 months --- D - Quebec Pain Disability Scale P - Numeric Pain Scale Assessment at baseline, 15, 45, 120, and 180 days. RPG led to significantly less disability (55% improvement) and pain (66% improvement). Di Ciaccio et al, 2013 Case report Cervical Disk Herniation C3/C4 1 (1) 8 RPG 60min individual sessions over 8 weeks: supine HAO-ABD and HAO-ADD chosen as per condition. --- P - Numeric Pain Scale (NPS) F/M – Cervical ROM Cervical MRI Baseline, 2 months. At the end of 8 treatment weeks the patient showed improvements of cervical ROM and the NRS score improved from 9 to 2 points. The MRI on 12 months after onset of symptoms showed complete regression of the C3-C4 disc herniation. Durmus et al, 2009 Non-randomized controlled trial Ankylosing Spondylitis 51 (19) 12 RPG 60 min sessions with group design over 12 weeks (19) exercise regime P – VAS; F – BASFI, spirometry, 6-MWD test D – BASDAI Both exercise groups led to significant improvement in all outcomes compared to control. RPG group showed greater improvement in the pulmonary function.(13) control group Fernandez-de- las-Peñas et al, 2005 Randomized controlled trial PEDro 6/10 Ankylosing Spondylitis 40 (20) 15 RPG 60 min group sessions over 4 months (20) 15 group sessions of 20 motion/flexibility exercises over 4 months F/M – BASMI D – BASDAI F - BASFI Pre-post intervention RPG group led to statistically greater improvement in all clinical measures of the BASMI, BASDAU and BASFI. Control group reached significant improvement only at the tragus-to-wall distance and lumbar side flexion. Fernandez-de- las-Peñas et al, 2006 Randomized controlled trial PEDro 5/10 Ankylosing Spondylitis 40 (20) 15 RPG 60 min group sessions over 4 months (20) 15 group sessions of 20 motion/flexibility exercises over 4 months F/M – BASMI D – BASDAI F - BASFI 1-year follow-up Improvements in all mobility measures of the BASMI and BASFI indexes were partially maintained at the 1year follow-up in the RPG group, but not in the control group. Fortin et al, 2012 Inter-rater reliability study Adolescent Idiopathic Scoliosis 5 52 PTs assessed the standing posture from photographs using a posture analysis grid with 23 posture indices (PI); and muscular chain associated with posture alterations. The PTs were also divided into three groups according to their experience in RPG method. Kappa coefficients and the percentage of agreement (%A) were used to assess inter-rater reliability and intra-class coefficients for determining agreement between PTs and experts. The RPG muscular chain evaluation has good reliability for most posture indices. RPG evaluation should help guide physical therapists in targeting affected muscles for treatment of abnormal posture patterns. Fozatti et al, 2008 Case series Stress Urinary Incontinence 25 (25) 24 RPG 50 min individual sessions with individual design, 12 weekly sessions, then 12 fortnightly sessions --- QoL - King’s Health Q Diary of urinary leakage Pelvic floor functional assessment Baseline and 6 months follow-up RPG treatment was effective in treating all parameters assessed. Quality of life, Pelvic floor function and numbers of pad used improved significantly. Fozatti et al, 2010 Prospective controlled cohort study Stress Urinary Incontinence 52 (25) RPG 50 min individual sessions with individual design, weekly sessions over 3 months (17) Pelvic Floor Muscle Training 4 times weekly (1 under supervision, 3 at home) over 3 months QoL - King’s Health Q 3-day voiding diary (daily pad use) Functional Evaluation of the Pelvic Floor (FEPF); Subjective perception of cure Baseline and 6 months follow-up. Both groups significantly improved QoL, FEPF, leaking episodes and daily pad use at baseline and on 6-months follow-up. RPG led to significant greater decrease in leaking episodes and had higher adherence to treatment.
- 3. Summary compiled by Laylane Chagas – MSc HCPC MSC, RPG practitioner – rpg.uk123@googlemail.com - www.GPR-PostureCorrection.co.uk Page 3 Fozatti et al, 2011 Prospective controlled cohort study (Poster) Stress Urinary Incontinence 52 (25) RPG 50 min individual sessions with individual design, weekly sessions over 3 months (17) Pelvic Floor Muscle Training 4 times weekly (1 under supervision, 3 at home) over 3 months QoL - King’s Health Q 3-day voiding diary (daily pad use) Functional Evaluation of the Pelvic Floor (FEPF); Subjective perception of cure 2-years follow-up RPG group still showed significant differences to PFMT group on subjective perception of cure, absence of leaking episodes, use of pad and 3 domains of QoL on 2-years follow-up. No significant difference was found on FEPF. Fregonesi et al, 2007 Case report Adolescent Idiopathic Scoliosis 1 (1) RPG individual sessions over 1 year Patient: 13yo female --- Cobb angle T12-L4 panoramic X-Ray AP; L2 vertebral rotation by Raimondi method No statistical analysis. There was a stabilization of the scoliosis curvature and a 6° decrease of vertebral rotation. Garcia et al, 2011 Randomized controlled trial Healthy adolescents 29 (12) 9 RPG 30 min group sessions each posture kept for 4-10min plus Physical Education class (PE) Patients: 16-17yo (9) 9 Warm-up + 30 min Segmental stretching kept for 15s + PE classes Subjective Q on perception of posture and flexibility; Height; F/M - Finger-floor distance; RPG anterior chain and posterior chain flexibility test (against wall) RPG group led to significantly improved muscle flexibility and self-perception of posture and flexibility, when compared with the other 2 groups.(8) Control – 9 PE classes alone Garrido-Marin et al, 2013 Double-blinded randomized controlled trial Healthy subjects 20 (10) 1 RPG 6min session with Standing HAC-ADD posture (10) 6 min Proprioceptive Neuromuscular Facilitation (PNF) of hamstrings in supine Knee extension ROM at hip 90°flexion F/M - Finger-floor distance Baseline, 5min post intervention. Both groups presented a significant increase of hamstrings flexibility post intervention. The RPG group showed a greater significant change than the PNF group Gil et al, 2011 Randomized controlled trial Pre-natal (20-25 weeks) Lower Back Pain 34 (17) 8 RPG 40 min individual weekly sessions with HAC-ADD and HAC-ABD postures (17) Control – Followed routine recommendations for self- management D- Roland-Morris Q P - VAS The RPG group presented a significant decrease of pain intensity and functional limitation, when compared with the control group. Gomes et al, 2006 Case report Hemiparetic Stroke 1 (1) 10 RPG 50 min individual sessions over 8 weeks --- Postural assessment using software FisioLogic RPG treatment led to an improvement of spinal curvatures and shoulder girdle alignment. Guimaraes et al, 2013 Case series Healthy subjects 15 (15) 15 RPG 40 min individual sessions with individual design, weekly sessions over 8 weeks --- F - peak flow, spirometry Significant increases between the values of all analyzed variables of pulmonary function were found after the treatment period. Heredia et al, 2008 Case series Epidural Fibrosis post Lumbar Laminectomy 18 (18) 15 RPG 50 min individual weekly sessions --- D - Roland-Morris Q; P - VAS Baseline, 3 months and 6 months. No statistical analysis. 56.2% of subjects presented improvement of pain level. Itozaku et al, 2011 Case series Thoracic Hyperkyphosis 2 (2) 8 RPG 60 min individual weekly sessions with individual design over 8 weeks --- QoL – SF-36 Q; Thoracic curvature by digital photograph; MS – MIP and MEP F/M - thoracic expansion Baseline, 8 weeks. There was an improvement in the degree of kyphosis, respiratory muscle strength and QoL. No statistical analysis provided. Lawland et al, 2013 Randomized controlled trial (Poster) Chronic Lower Back Pain 61 12 RPG 60 min weekly sessions over 12 weeks Control group (waiting list under clinical treatment, no physical intervention) P – VAS; D - Roland-Morris Q; Depression – Beck Inventory; QoL – SF-36 Q Baseline, 3 months, 6 months. The RPG group showed significant improvements in pain, QoL and disability. Luz et al, 2008 Randomized controlled trial Lower Back Pain 32 (16) 6 RPG sessions over 2 weeks with supine HAC-ADD and HAO- ADD postures (16) RPG session plus 10 days of continuous use of back abdominal support device P - VAS Both groups presented significant improvement of back pain. There was no statistical difference between groups. Maluf et al, 2010 Randomized controlled trial PEDro 6/10 Temporomandibular Disorder 28 (14) 8 RPG 40 min sessions with group design over 8 weeks (14) 8 Static stretching (SS) held by 30 s in 40 min sessions. P - VAS, Pain threshold EMG activity RPG and SS equally reduced pain intensity, increased pain threshold, and decreased EMG activity of orofacial and cervical muscles. Marques et al, 1994 Case series Fibromyalgia Female 20 (20) RPG individual sessions, ranging from 3 to 11 sessions plus home based exercises --- Postural Assessment P - Self-assessment Q reporting pain level Pain improvement was very good for 65% of patients, moderate for 25%, 10% reported no change. No statistical analysis. Marques et al, 1996 Case report Adolescent Idiopathic Scoliosis 17yo female 1 (1) 16 RPG 60 min individual sessions over 4 months --- Postural Assessment Cobb angle T12-L4 panoramic X-Ray AP; Iliac crests alignment on X-Ray P - Subjective pain report Pain resolved by the end of the 6th session. Cobb angle decreased from 20° to 10° of inclination. Iliac crest alignment discrepancy improved from 1 cm to 0.3 cm. Martins et al, 2005 Randomized controlled trial PEDro 2/10 Pre-natal (>12 weeks) Lower Back Pain 69 (33) 8 RPG 60 min group sessions with 2 postures over 8 weeks (36) Control. Medical advice for self-management for 8 weeks P – VAS, Pelvic and Lumbar provocation tests RPG group had significantly less lumbar or pelvic pain.
- 4. Summary compiled by Laylane Chagas – MSc HCPC MSC, RPG practitioner – rpg.uk123@googlemail.com - www.GPR-PostureCorrection.co.uk Page 4 Marthur and Bhasin, 2013 Non-randomized controlled trial Chronic Obstructive Pulmonary Disease (COPD) 28 (14) Daily RPG 30 min individual sessions over 3 weeks using supine HAO-ABD posture (14) Twice-daily home-based Respiratory Muscle Stretch Gymnastics over 3 weeks QoL – Clinical COPD Questionnaire Both treatment groups equally showed improved in QoL after 3 weeks rehabilitation. Monteiro et al, 2013 Case report Temporomandibular Disorder 1 (1) 24 RPG 30 min individual sessions over a 8 week period: supine HAC-ABD posture --- Surface EMG activity RPG treatment led to a significant reduction in electrical activity in the masseter muscle. Moreira and Soares, 2007 Case series Postural deviation (Shoulder protrusion) 5 (5) RPG 50 min individual sessions with individual design and different duration for each patient --- Shoulder AP and sagittal X-ray, measuring shoulder protrusion and retraction There was no statistical difference among the measurements at baseline and at 4 months. Moreno et al, 2007 Randomized controlled trial Healthy males 20 (10) 16 RPG 30 min individual sessions with group design over 8 weeks (10) control group MS – MIP and MEP F/M - thoracic expansion, abdominal mobility Only the RPG group showed significant improvement in all parameters measured. Moreno et al, 2009 Randomized controlled trial Healthy males 20 (10) 16 RPG 20 min sessions with group design over 8 weeks (10) control group F - Slow/forced vital capacity, and maximal voluntary ventilation Only the RPG group showed significant improvement in all parameters measured. Mota et al 2008 Cross-sectional study Healthy females 9 (9) 1 RPG 9 min individual session: seated HAC-ADD posture --- Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and double product (DP) Pre-, during and post-intervention recovery. The SAP, DAP, MAP and DP values were significantly greater between 3 and 9 min of maintaining the posture in comparison with pre- and post-posture recovery values, returning to resting values within 5 min of recovery. The HR was not statistically different from the pre-posture resting value. Navarro et al, 2005 Non-randomized controlled trial Ankylosing Spondylitis 29 (17) 15 RPG 60 min group sessions over 4 months (12) 15 group sessions of 20 motion/flexibility exercises over 4 months QoL - SF36 Q Both groups significantly improved QoL, with no statistical differences between groups. Oliveri et al, 2012 Comparative study Healthy subjects 30 (10) 1 RPG 15 min session: Standing HAC-ADD posture (10) 1 RPG 15 min session: Supine HAC-ADD postures Paired-transcranial magnetic stimulation (TMS) of motor cortex and recording of motor evoked potentials (MEPs) of biceps femoris, soleus and tibialis anterior muscles The RPG treatment effect was posture- and task-specific: the standing posture increased inhibition in cortical areas controlling flexor muscles while increasing the excitation of cortical areas controlling extensor muscles. The supine posture increased inhibition in cortical areas controlling flexor muscles was not paralleled by excitation of extensor ones. (10) Control 3 min of ergometer exercise Pita et al, 2000 Case report Thoracic Hyperkyphosis 15yo male 1 (1) 35 RPG 60 min weekly individual sessions --- Postural assessment F/M - Finger-floor distance Thoracic curvature X-Ray No statistical analysis. Pain resolved after 5 sessions. Tsp curvature decreased from 55° to 39°. Flexibility improved from 22 cm to 0 cm. Rosario et al, 2008 Randomized controlled trial PEDro 4/10 Healthy females 30 (10) 8 RPG 15 min sessions with group design over 4 weeks (10) 8 segmental 30 s stretching sessions F/M - Finger-floor distance, Active knee extension/hip in 90° flexion MS: isometric muscle contraction Both RPG and segmental stretching groups significantly improved ROM, flexibility, and leg muscle strength.(10) control group Rossi et al, 2011 Randomized controlled trial Healthy females 30 (20) 1 RPG 40 min individual session with group design: Supine HAO-ADD posture (10) Control group Sagittal measurements using Digital photogrammetry with SAPo (v0.68) software A single RPG session led to significant improvement of head and shoulder alignment. Santos et al, 2010 Randomized controlled trial (Poster) Chronic Back Pain 150 (50) 16 RPG individual sessions over 8 weeks (50) 16 Individual Segmental stretching sessions over 8 weeks P – VAS, Pain medication consumption D - Roland-Moris Q QoL - SF-36 Q Assessment at baseline, post-treatment and 2-month follow-up Both treatment groups showed significant reduction in pain level, pain medication consumption, improvement in QoL and function, better than control group. The RPG group showed the largest pain intensity reduction. (50) Control Silva et al, 2012 Non-randomized controlled trial Ankylosing Spondylitis 38 (22) 16 RPG 60 min weekly individual sessions over 4 months (16) 32 40 min Segmental stretching + breathing exercises group sessions P – VAS, D – BASDAI; F - HAQ-S for Functional Capacity; QoL - SF-36 Q; Morning stiffness sensation; F/M - Chin-to- chest distance, Tragus-to-wall distance, Schober’s modified test, fingertip-floor distance, chest expansion. Both groups led to statistically significant improvement for all parameters analyzed. RPG led to significantly greater improvement in morning stiffness, spinal mobility and in the physical aspect component of SF-36.
- 5. Summary compiled by Laylane Chagas – MSc HCPC MSC, RPG practitioner – rpg.uk123@googlemail.com - www.GPR-PostureCorrection.co.uk Page 5 Smania et al, 2003 Cross-over study Cervical Dystonia 4 (4) 30 Individual 60 min sessions 15 RPG + myofascial release / 15 EMG sessions --- Head realignment test (laser pen fixed on helmet) P - VAS D - Disability questionnaire RPG led to therapeutic effects comparable to those of EMG biofeedback. Reductions of disability and of pain were still present on 3-9 months follow-up. Tavares et al, 2009 Case series (Poster) Stress Urinary Incontinence Females >50 yo 13 (13) 12 RPG individual sessions with supine HAO-ADD posture --- Urodynamic study MS – (Pelvic floor) Perina® and vaginal cones QoL - ICIQ-SF Q Postural Assessment RPG led to improvements on urinary continence, pelvic floor muscle strength and quality of life. No significant results were found on the urodynamic study or thoracic curvature. Teodori et al, 2003 Randomized controlled trial Healthy females 20 (10) 1 RPG individual 20 min session using supine HAO-ADD posture (10) control group MS – MIP and MEP F/M - thoracic expansion RPG led to significantly increase in both thoracic expansibility and increased strength of inspiratory muscles. Teodori et al, 2005 Case report Healthy female 1 (1) 1 RPG individual 30 min session using supine and standing HAO-ADD posture History of ankle sprain --- Plantar pressure distribution -Tekscan- Matscan Measurements on baseline, 7 d, 14 d, and 30 d post treatment A single RPG session significantly improved weight bearing symmetry at both baseline and 7 days measurement. Toledo et al, 2011 Randomized controlled trial Non-structural Thoracic Scoliosis 10yo male/females 20 (10) 24 RPG individual 60 min sessions with group design over 12 weeks supine HAO-ADD / HAC- ADD (10) control group Thoracic Cobb angle on X-Ray Postural Assessment RPG group led to significantly decrease of thoracic Cobb angle while the control group showed an increase of spinal curvature. Zuil Escobar et al, 2004 Comparative study Healthy males 60 (30) Football players (30) Controls RPG Postural assessment, including muscle chain flexibility testing Excessive contracture of the posterior muscle chain was found in the lower extremity (hamstring muscles) in the football player group. List of abbreviations: RPG, Rééducation Posturale Globale (Global Postural Re-education); min, minutes; HAO-ADD, hip angle opening-arms adducted; HAC-ADD, hip angle closure-arms adducted; QoL, quality of life; Q, questionnaire; P, pain; VAS, Visual Analogue Scale; F, function; BASFI, Bath Ankylosing Spondylitis Functional Index; D, disability; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; F/M, flexibility/mobility; BASMI, Bath Ankylosing Spondylitis Metrology Index; FVC, Forced vital capacity; FEV1, Forced expiratory volume in 1 second; HAO-ABD, hip angle opening-arms abducted; HAC-ABD, hip angle closure-arms abducted; ROM, range of motion; RDC/TMD, Research Diagnostic Criteria for Temporomandibular Disorders; MS, muscle strength; MIP, maximum inspiratory pressure; MEP, maximum expiratory pressure; AP, anteroposterior; s, seconds; EMG, electromyography; yo, year-old; 6-MWD, six minute walk distance; PTs, physiotherapists; HAQ-S, Health Assessment Questionnaire Disability Index modified for the spondyloarthropathies; ICIQ-SF, International Consultation on Incontinence Questionnaire-Short Form; cm, centimetres; d, days.