Spine Kinematics Behavior During the Handstand Posture: A Biplanar Radiographic Analysis

Background/Objectives: The handstand is an exercise performed in many sports, either for its own sake or as part of physical training. Unlike the upright bipedal standing posture, little is known about the sagittal alignment and balance of the spine during a handstand, which may hinder coaching and reduce the benefits of this exercise if not performed correctly. The purpose of this study was to quantify the sagittal alignment and balance of the spine during a handstand using radiographic images to characterize the strategies employed by the spino-pelvic complex during this posture. Methods: Nineteen national-level artistic gymnasts participated in this study and underwent a low-dose biplanar (frontal and lateral) radiograph in both upright bipedal standing posture and during a handstand. Then, 3D reconstruction of the spine, based on biplanar radiographic images, enabled the determination of key pelvic (pelvic incidence, sacral slope, pelvic tilt) and spinal (lumbar lordosis, thoracic kyphosis, T9 sagittal offset) parameters in both postures. Results: The results showed that most gymnasts performed pelvic retroversion during the handstand, which was accompanied by an average decrease in lumbar lordosis, thoracic kyphosis, and T9 sagittal offset. Additionally, lumbar curvature was found to depend on pelvic orientation in upright bipedal standing posture, whereas it was associated with the thoracic spine during the handstand. Conclusions: This study provides new insights into how the spine kinematically adapts to an inverted body load. The results may help coaches and physiotherapists in teaching the handstand or using it to rehabilitate and strengthen the spine through the handstand posture.