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The Occiput to Wall Distance is a routine clinical test for thoracic kyphosis and cervical mobility. It is also known as Flesche test.[1]
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[2]
OWD is an easily measurable marker of poor physical function in women.
Method of Use
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, calf, buttocks and shoulders touching the wall i.e. 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[2].
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[4].
Clinical Significance
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.
Changes in postural control may lead to reduced walking speed, since the cautious reduced step length gait, is an obvious response to postural instability[2]
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[5].
Psychometric properties
OWD has shown to have sensitivity 92.31%, specificity 76.47% with the ability to correctly classify up to 83.33%.[5]
OWD had good concurrent validity with the Cobb angles (r = 0.683, P < 0.001) and excellent rater reliability when assessed by well-trained health professionals (ICCs > 0.9, P < 0.001).[6]
Conclusion
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[2].
