Occiput to Wall Distance OWD

Original Editor - Lucinda hampton

Top Contributors -  

Objective[edit | edit source]

The Occiput to Wall Distance is a routine clinical test for thoracic kyphosis that has been in use for many years.

  • The occiput-wall distance (OWD) cannot substitute highly accurate clinical measures of kyphosis such as Cobb's angle, OWD has been extensively used in epidemiological studies.
  • It has been associated with depressed mood, postural instability, muscle weakness and disability in older women, and may account for a large percentage of the dyspnea and restrictive/obstructive respiratory dysfunction that often remains unexplained in older persons[1]

This one minute video is very instructional


Intended Population[edit | edit source]


The OWD may be abnormal in kyphosis (forward curvature of the upper thoracic spine) due[3]

The occiput-wall distance (OWD), has been associated with postural instability, osteoporosis, disability and depression.[1]

OWD is an easily measurable marker of poor physical function in women.

Method of Use[edit | edit source]

The OWD is measured by having an examinee stand with the back against a wall keeping the posture as straight as possible and with the heels, buttocks and shoulders touching the wall ie standing with both heels and the sacrum against the wall, and with the lower orbital margin and upper margin of the acoustic meatus on the horizontal plane[1].

  • While looking forward, the examinee also attempts to have the back of the head (the occiput) touch the wall as well.
  • In most normal individuals in this standard position, the occiput will touch the wall and the OWD measurement will be zero.
  • If the occiput does not touch the wall, then the OWD is measured with a ruler.
  • A value greater than 2 cm. is considered to be abnormal[3].

Clinical Significance[edit | edit source]

In both men and women, walking speed and balance were found to be more severely compromised with higher OWD values.

  • This relationship explained by the biomechanical effects of changes in OWD: in particular, the kyphotic posture of the upper dorsal and cervical spine results in anterior displacement of the center of gravity, and is followed by compensatory widening of the base of support and lumbar hyperlordosis.
  • This adaptive strategy leads to the balance impairment and involves a consequent increase in the risk of falls.
  • Chris-benson-yx-iJFybOBQ-unsplash.jpg
    Changes in postural control may lead to reduced walking speed, since the cautious reduced step length gait, is an obvious response to postural instability[1]
  • Current lifestyles of many people means they spend considerable time in an excessive flexion posture using computers and social media, this can accelerate the development of hyperkyphotic spine in young individuals. The condition can influence general appearance, self-confidence, musculoskeletal problems and work effectiveness of these individuals. Effective early detection (using OWD) and monitoring this condition may prevent or minimize serious consequences and to clearly indicate effectiveness of the treatments.
  • OWD can be used to detect the risk of developing hyperkyphosis in many target populations eg school children, office workers and community-dwelling people, OWD > 5 cm had the best predictive ability for the risk of developing a kyphosis (sensitivity 92.31%, specificity 76.47% with the ability to correctly classify up to 83.33%)[4].

Conclusion[edit | edit source]

Thoracic kyphosis, assessed using Cobb's angle, has been proved to be associated with poor physical fitness, osteoporosis, and the risk of falls.

Measuring Cobb's angle requires radiologic equipment and therefore this measure is not easily performed.

OWD cannot substitute for Cobb's angle because it does not directly measure the curvature of the spine at a given point, but quantifies the effect of altered curvature.

Thus, OWD is unlikely to reflect kyphotic posture as accurately as Cobb's angle. However, the well-recognized association with several measures of physical limitation confirmed makes OWD a valuable tool for eg treating thoracic kyphosis, epidemiological research[1].

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Antonelli-Incalzi R, Pedone C, Cesari M, Di Iorio A, Bandinelli S, Ferrucci L. Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study. Aging clinical and experimental research. 2007 Jun 1;19(3):207-12.Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651517/ (last accessed 28.4.2020)
  2. University of Ottawa OWD Available from:https://www.youtube.com/watch?v=rOR70O_zTdA (last accessed 28.4.2020)
  3. 3.0 3.1 Centers for Disease Control and Prevention. National health and nutrition examination survey. Available from:https://wwwn.cdc.gov/Nchs/Nhanes/2009-2010/ARX_F.htm#Protocol_and_Procedure (last accessed 28.4.2020)
  4. Wiyanad, Arpassanan & Thaweewannakij, Thiwabhorn & Wattanapan, Pattra & Sooknuan, Thanat & Mato, Lugkana & Amatachaya, Pipatana & Amatachaya, Sugalya. (2017). Appropriate Occiput-wall Distance to Screen for a Risk of Kyphosis. Available from:https://www.researchgate.net/publication/315773559_Appropriate_Occiput-wall_Distance_to_Screen_for_a_Risk_of_Kyphosis/citation/download (last accessed 28.4.2020)