VII Congresso Nazionale SISMES Società Italiana delle Scienze Motorie e Sportive, Padova 2 - 4 Ottobre 2015 SYNERGISTIC TREATMENT OF FLEXOR AND EXTENSOR HIP MUSCLES IN POSTURAL REALIGNMENT FOR PATIENTS WITH FORWARD TRUNK LEAN V. Toniato 4 , F. Combi 2,4, M.G. Cusella De Angelis 1,2,3, L. Spairani 1,2,4  1Department of Public Health, Experimental and Forensic Medicine, Human Anatomy Unit, University of Pavia, Italy 2Laboratory of Functional Anatomy of Exercise, University of Pavia, Italy 3 Centre for Health Technologies (CHT), University of Pavia, Italy 4Rehabilitation Centre of Musculoskeletal Disorders, Torre d'isola (Pavia), Italy BACKGROUND: The Forward Trunk Lean (FTL) is a pathological alteration of the postural alignment in the sagittal plane. It arises gradually and it is a clinical problem affecting a large portion of the general population(1). The causes may be various and the common symptoms are retraction of the hip flexor muscles (Ileopsoas, Rectus Femoris, Gluteus Minimus) and other periarticular connective tissues (capsule, ligaments, tendons). Over time, the shortening process stabilizes, there by blocking the hip in flexion. This involves, in the upright position, an anterior pelvic tilt and an increase in the sacral slope with the activation of the hip extensor muscles, to oppose the pelvic tilt, and the contraction of the erector spinae muscle, with consequent low back pain (2,3,4). A synergistic rehabilitation protocol was implemented in order to restore the physiological lenght of flexor muscles and the function of the extensors. METHODS: A sample of 16 patients with FTL was selected with the use of a scoliometer and subsequently analysed through the raster graphics software Adobe Photoshop. In the preliminary phase (T0) and in the final phase (T1), the following elements were determined: the extension of the hip joint (Thomas Test – TT), the individual reactivity (scala VAS) and the degree of disability (Questionario Roland Morris - RMDQ). The protocol consisted in 15 sessions of 75 minutes each, it included manual therapy techniques, active – assisted - exercises and postural rehabilitation in the gym. RESULTS: 16 patients achieved correction of the FTL, with an average reduction of the distance between the spinous process of C7 and the sagittal vertical axis of – 2,43 cm (30.05%). The ROM in extension showed an average improvement of 8° (TT). There has been a reduction of symptoms (VAS scale) with an improvement of 20 % to 88 % (2 to 7 points on the VAS scale). The degree of disability of the subjects improved of 38% to 100%. CONCLUSIONS:. The improvement in the outcome parameters suggests that the synergistic rehabilitation protocol induced a significant reduction of FTL and related symptoms.  REFERENCE: (1) WM Keyserling et al (1988). Trunk posture and back pain: identification and control of occupational risk factors- Applied Industrial Hygiene, - Taylor & Francis; vol 3 Issue 3 pages 87-92 (2) Gossman. Mr., et al (1982). Review of length associated changes in muscle: Experimental evidence and clinical implications; PhysTher.; 62, 1799 – 1808. (3) Pimenterl do Rosario (2014) Photographic analysis of human posture: a literature review; Journal of bodywork and movement therapies; 18, 56 – 61. (4) O’ Sullivan, Burnett, Dankaerts et al (2006) Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting; Spine 2006; 17, 2009 – 2016. Corresponding author: lorenzo.spairani@unipv.it