Development and validation of a computational model for understanding the effects of an upright birthing position on the female pelvis

Upright, natural birthing positions, such as squatting, are associated with several clinical benefits, yet recumbent positions are still most common during delivery in most health centres. The biomechanics of birth positioning are not yet fully understood; therefore, our objectives were to develop and validate a computational model that could determine pelvic kinematics under loading conditions resulting from an upright birthing position. A three-dimensional model of the pelvic region was created from MRI scans of a non-pregnant subject. Bones were designated rigid segments with sacroiliac and pubic symphysis joint motion constrained only by contact surfaces and ligaments modeled as non-linear spring elements. Actuating torques at the lumbosacral and hip joints were defined based on motion analyses of squatting. The model was validated by comparing simulation results with data from the literature and in vivo MRI data from three subjects in a kneel-squat position. Good agreement was found between clinical pelvimetry measurements from the squat simulation and MRI data. Differences between simulation predictions were within one standard deviation of mean MRI kneel-squat results for all clinical measurements except one: the predicted increase in bispinous diameter was approximately 1.5 standard deviations less than that of the mean MRI results and still well within physiologic limits according to data in the literature. This model can, therefore, be used to provide further insight into the biomechanics of certain upright birthing positions, such as squatting.     

Adjustment of the fetal head and adult pelvis in modern humans

In nonhuman anthropoids, the anteroposterior (AP) diameters of the fetus are greater than the transverse (TR) diameters and the AP diameters of the pelvic planes are greater than the TR diameters: during labor, therefore, the fetus moves through the birth canal without changing position or orientation. In modern humans, the fetal head at term is encephalized and the fetal chest is flattened. The maternal pelvic inlet is flattened in an AP direction, the sacral promontory and the ischial spines are prominent. As a result, AP<TR at the inlet, but AP>TR at the midpelvis and outlet. In addition, the birth canal presents a marked sacral curvature in the AP direction. The human fetus successfully negotiates the birth canal because the three crucial fetal adaptations: (1) spheroidicity of the presenting part of the fetal head, which allows it to “roll” in the pelvis; (2) mobility of the head and chest in all directions; and (3) a capacity for cranial molding, which adapts fetal head dimensions to pelvic dimensions. The result is that the human fetal head and chest can perform multiple rotational movements in order to always present the greatest fetal diameters to the greatest pelvic diameters. Monkeys show a limited degree of encephalization and suffer from narrow TR pelvic diameters without any possibility of fetal adaptations as shown by humans. Apes also show some encephalization but, because of wider TR diameters in the pelvis, they achieve an easy delivery with no need of fetal adaptations.     

Reconstruction of the STS 14 (Australopithecus africanus) pelvis

The study reports a reconstruction of the sacrum in STS 14 based on extrapolation from the measurements of the first two sacral vertebrae of STS 14 and of the angle formed by the anterior surfaces of their vertebral bodies. Reconstruction is based on comparisons of, and extrapolation from, sacra of Pan troglodytes, Homo sapiens, and Australopithecus afarensis. The reconstructed sacrum has an anterior sacral curvature of 39°. The two ossa coxae were also completed by mirror imaging of one side by the other. With the pelvis completely reconstructed, the pelvic dimensions for the antero-posterior (AP) diameters of the pelvic inlet, midpelvis, and pelvic outlet are 85, 68, and 69 mm and the corresponding transverse (TR) diameters are 109, 88, and 103 mm, respectively. The posterior sagittal diameters in the three pelvic planes are small compared to the anterior sagittal diameters. This analysis indicates that the STS 14 pelvis is platypelloid in the three pelvic planes; i.e., all the AP diameters are smaller than the corresponding TR diameters. This makes the STS 14 pelvis similar to that to Al 288-1, save for a less pronounced degree of platypelloidy at the inlet in the former. © 1995 Wiley-Liss, Inc.     

Postural influence on maternal capillary oxygen and carbon dioxide tension

The effect of posture on maternal capillary blood Po₂ and Pco₂ was studied in pregnant and non-pregnant women. There was a significant decrease of Po₂ (mean 13·0 mm. Hg) and significant decrease of Pco₂ (mean 2·4 mm. Hg) when pregnant women sat up, but these changes did not occur in the non-pregnant. These findings may be relevant to debate on the optimum posture for labour.     

The influence of knee alignment on lower extremity kinetics during squats

The squat is an assessment of lower extremity alignment during movement, however there is little information regarding altered joint kinetics during poorly performed squats. The purpose of this study was to examine changes in joint kinetics and power from altered knee alignment during a squat. Thirty participants completed squats while displacing the knee medially, anteriorly, and with neutral alignment (control). Sagittal and frontal plane torques at the ankle, knee, and hip were altered in the descending and ascending phase of the squat in both the medial and anterior malaligned squat compared to the control squat. Ankle and trunk power increased and hip power decreased in the medial malaligned squat compared to the control squat. Ankle, knee, and trunk power increased and hip power decreased in the anterior malaligned squat compared to the control squat. Changes in joint torques and power during malaligned squats suggest that altered knee alignment increases ankle and trunk involvement to execute the movement. Increased anterior knee excursion during squatting may also lead to persistent altered loading of the ankle and knee. Sports medicine professionals using the squat for quadriceps strengthening must consider knee alignment to reduce ankle and trunk involvement during the movement.     

Soft tissue displacement over pelvic anatomical landmarks during 3-D hip movements

The position, in a pelvis-embedded anatomical coordinate system, of skin points located over the following anatomical landmarks (AL) was determined while the hip assumed different spatial postures: right and left anterior superior and posterior superior iliac spines, and the sacrum. Postures were selected as occurring during walking and during a flexion–extension and circumduction movement, as used to determine the hip joint centre position (star-arc movement). Five volunteers, characterised by a wide range of body mass indices (22–37), were investigated. Subject-specific MRI pelvis digital bone models were obtained. For each posture, the pose of the pelvis-embedded anatomical coordinate system was determined by registering this bone model with points digitised over bony prominences of the pelvis, using a wand carrying a marker-cluster and stereophotogrammetry. The knowledge of how the position of the skin points varies as a function of the hip posture provided information regarding the soft tissue artefact (STA) that would affect skin markers located over those points during stereophotogrammetric movement analysis. The STA was described in terms of amplitude (relative to the position of the AL during an orthostatic posture), diameter (distance between the positions of the AL which were farthest away from each other), and pelvis orientation. The STA amplitude, exhibited, over all postures, a median [inter-quartile] value of 9[6] and 16[11] mm, for normal and overweight volunteers, respectively. STA diameters were larger for the star-arc than for the walking postures, and the direction was predominantly upwards. Consequent errors in pelvic orientation were in the range 1–9 and 4–11 degrees, for the two groups respectively.     

Significance of exercise and bed rest in pregnancy--study on the lying postures of gravidas during sleep (2)

For the purpose of determining the most reasonable lying posture for pregnant women, we investigated the lying positions of both 247 non-pregnant women and 302 pregnant women during sleep. As for the rate of each position during the entire period of observation, 33.2% of the non-pregnant women were in the supine position, 41.2% in the lateral position, 18.4% in Sims' position and 7.1% in the prone position. In the pregnant group, the rate of supine position, simple lateral position and Sims' position was 34.2%, 52.2% and 12.7%, respectively, but the rate of the prone position was limited to 0.8%. All of the gravidas assuming the prone position were at less than 16 weeks of gestation. Non-pregnant women could sleep in a variety of positions, but pregnant women could assume the prone position during sleep only in the stage when the abdomen is not yet prominent or distended. Pregnant women were restricted significantly, either consciously or unconsciously, with progress in gestation.     

Variation of pelvic diameters due to different scanning positions--the experimental study

The distortion of human pelvis X ray scans, due to different scanning positions, can cause huge mistakes in estimation of pelvic diameters. The aim of the study was to quantify distortion of pelvic diameters in relation to scanning inclination angles. Twenty anatomically defined spots on the pelvis of a young male cadaver, freed of soft tissues, were marked with 3 mm metal balls. The digitalized X-ray scans were made with seven different but similar inclination angles, and marked spots were recognized by computer software. Obstetrical-gynecological (Ob-Gyn), horizontal and vertical diameters were measured between marked spots, and percentages of distortion were calculated for each new scanning position. Twenty seven distances on human pelvis from seven X-ray scans varied from -35.9% to 28.3%, on average 0.47%. This study has pointed to a high variation of vertical pelvic dimensions (4.94 +/- 5.73%), consequently making them unreliable in the estimation of general pelvic shape, and low variation of horizontal dimensions (0.92 +/- 0.61%). Generally, the percentage of variation of pelvic dimensions highly increases with inclination angle, in frontal and sagittal plane. Alteration of scanning distance by 4 cm has a weak influence on pelvic diameters. The most reliable Ob-Gyn pelvic diameter was conjugata diagonalis, then diameters obliqua prima and secunda, with an average length deviations of 3.4, 4.0, and 6.0% respectively. The conjugata anatomica was the most unreliable with an average variation of 11.5%.     

A Wider Pelvis Does Not Increase Locomotor Cost in Humans,with Implications for the Evolution of Childbirth

The shape of the human female pelvis is thought to reflect an evolutionary trade-off between two competing demands: a pelvis wide enough to permit the birth of large-brained infants, and narrow enough for efficient bipedal locomotion. This trade-off, known as the obstetrical dilemma, is invoked to explain the relative difficulty of human childbirth and differences in locomotor performance between men and women. The basis for the obstetrical dilemma is a standard static biomechanical model that predicts wider pelves in females increase the metabolic cost of locomotion by decreasing the effective mechanical advantage of the hip abductor muscles for pelvic stabilization during the single-leg support phase of walking and running, requiring these muscles to produce more force. Here we experimentally test this model against a more accurate dynamic model of hip abductor mechanics in men and women. The results show that pelvic width does not predict hip abductor mechanics or locomotor cost in either women or men, and that women and men are equally efficient at both walking and running. Since a wider birth canal does not increase a woman’s locomotor cost, and because selection for successful birthing must be strong, other factors affecting maternal pelvic and fetal size should be investigated in order to help explain the prevalence of birth complications caused by a neonate too large to fit through the birth canal.     

Kinematic, kinetic and EMG patterns during downward squatting.

The aim of this study was to investigate the kinematic, kinetic, and electromyographic pattern before, during and after downward squatting when the trunk movement is restricted in the sagittal plane. Eight healthy subjects performed downward squatting at two different positions, semisquatting (40 degrees knee flexion) and half squatting (70 degrees knee flexion). Electromyographic responses of the vastus medialis oblique, vastus medialis longus, rectus femoris, vastus lateralis, biceps femoris, semitendineous, gastrocnemius lateralis, and tibialis anterior were recorded. The kinematics of the major joints were reconstructed using an optoelectronic system. The center of pressure (COP) was obtained using data collected from one force plate, and the ankle and knee joint torques were calculated using inverse dynamics. In the upright position there were small changes in the COP and in the knee and ankle joint torques. The tibialis anterior provoked the disruption of this upright position initiating the squat. During the acceleration phase of the squat the COP moved posteriorly, the knee joint torque remained in flexion and there was no measurable muscle activation. As the body went into the deceleration phase, the knee joint torque increased towards extension with major muscle activities being observed in the four heads of the quadriceps. Understanding these kinematic, kinetic and EMG strategies before, during and after the squat is expected to be beneficial to practitioners for utilizing squatting as a task for improving motor function.     

Balance assessment during squatting exercise: A comparison between laboratory grade force plate and a commercial,low-cost device

Testing balance through squatting exercise is a central part of many rehabilitation programs and sports and plays also an important role in clinical evaluation of residual motor ability. The assessment of center of pressure (CoP) displacement and its parametrization is commonly used to describe and analyze squat movement and the laboratory-grade force plates (FP) are the gold standard for measuring balance performances from a dynamic view-point. However, the Nintendo Wii Balance Board (NWBB) has been recently proposed as an inexpensive and easily available device for measuring ground reaction force and CoP displacement in standing balance tasks. Thus, this study aimed to compare the NWBB-CoP data with those obtained from a laboratory FP during a dynamic motor task, such as the squat task. CoP data of forty-eight subjects were acquired simultaneously from a NWBB and a FP and the analyses were performed over the descending squatting phase. Outcomes showed a very high correlation (r) and limited root-mean-square differences between CoP trajectories in anterior-posterior (r > 0.99, 1.63 ± 1.27 mm) and medial-lateral (r > 0.98, 1.01 ± 0.75 mm) direction. Spatial parameters computed from CoP displacement and ground reaction force peak presented fixed biases between NWBB and FP. Errors showed a high consistency (standard deviation < 2.4% of the FP outcomes) and a random spread distribution around the mean difference. Mean velocity is the only parameter which exhibited a tendency towards proportional values. Findings of this study suggested the NWBB as a valid device for the assessment and parametrization of CoP displacement during squatting movement.     

The neutral posture of the cervical spine is not unique in human subjects

Cervical spine injuries often happen in dynamic environments (e.g., sports and motor vehicle crashes) where individuals may be moving their head and neck immediately prior to impact. This motion may reposition the cervical vertebrae in a way that is dissimilar to the upright resting posture that is often used as the initial position in cadaveric studies of catastrophic neck injury. Therefore our aim was to compare the “neutral” cervical alignment measured using fluoroscopy of 11 human subjects while resting in a neutral posture and as their neck passed through neutral during the four combinations of active flexion and extension movements in both an upright and inverted posture. Muscle activation patterns were also measured unilaterally using surface and indwelling electromyography in 8 muscles and then compared between the different conditions. Overall, the head posture, cervical spine alignment and muscle activation levels were significantly different while moving compared to resting upright. Compared to the resting upright condition, average head postures were 6–13° more extended, average vertebral angles varied from 11° more extended to 10° more flexed, and average muscle activation levels varied from unchanged to 10% MVC more active, although the exact differences varied with both direction of motion and orientation. These findings are important for ex vivo testing where the head and neck are statically positioned prior to impact – often in an upright neutral posture with negligible muscle forces – and suggest that current cadaveric head-first impact tests may not reflect many dynamic injury environments.     

Ontogeny and evolution of pelvic diameters in anthropoid primates and in Australopithecus afarensis (AL 288-1)

Pelvic diameters (both anteroposterior [AP] and transverse [TR]) were investigated in a series of anthropoid primates. The ratio of diameters (AP/TR) in each of three pelvic planes (inlet, midpelvis, and outlet) was calculated. In addition to the above, the length of the iliac, pubic, and ischial axes and the angles between these axes were determined. The AP/TR ratio at the pelvic inlet is (reported in millimeters, +/- SD, unless otherwise specified) 1.81 +/- 0.27 in New World monkeys (Cebidae) and Macaca mulatta; 1.53 +/- 0.17 in hylobatids and pongids; 0.87 +/- 0.08 in Homo sapiens; and 0.58 in Australopithecus afarensis (AL 288-1). The AP/TR ratio in the midpelvis is 1.61 +/- 0.23 in nonhominid primates (Cebidae, M. mulatta, hylobatids, and pongids), 1.12 +/- 0.11 in humans, and 0.59 in AL 288-1. In monkeys (Cebidae and M. mulatta), hylobatids, pongids, H. sapiens, and AL 288-1, the ratios of the length of the pubic axis over the ischial axis were 0.84 +/- 0.06, 0.95 +/- 0.07, 1.10 +/- 0.15, and 1.46, respectively; the pubis-ilium angles were 96 +/- 11, 120 +/- 10, 131 +/- 11, and 147 degrees, respectively; and the ischium-pubis angles were 106 +/- 11, 86 +/- 8, 96 +/- 7, and 68 degrees, respectively. In none of these pelvic features was AL 288-1 "intermediate" between pongids and H. sapiens. The anatomical peculiarities of the pelvis in AL 288-1 are explained primarily as the result of early adaptation to erect posture, which resulted in the reduction of the distance between the sacroiliac joint and the hip joint. As a consequence, the sacral promontory moved toward the pubic symphysis, and this resulted in shortening of the AP diameter and widening of the TR diameter at the pelvic inlet.     

Growth of the fetus in the abdominal cavity

The ratio pelvic/abdominal cavity is 6.9% in samples of nonhuman mammals and nonhuman primates, and rises to approximately 30% in humans. This relative reduction of the abdomen and increase of the pelvis is associated with a partial or total shift of some organs from the abdomen to the pelvis: rectosigmoid colon, bladder, and genital organs, which are mostly abdominal in quadrupeds and are mostly pelvic in humans. Pregnancy, always abdominal in nonhumans, is pelvic during the first trimester and becomes abdominal later on in humans. Near term the pregnancy expands easily in nonhumans in view of relatively small fetus and relatively large abdominal cavity. But, for the opposite reasons (large fetus, small abdomen), the human pregnancy is limited space-wise during its abdominal expansion. Unlike that of nonhumans, human pregnancy is faced with multiple problems. These include: 1) “squeezing” between the anterior abdominal wall and the lordosis of the lumbar spine; 2) compression of the aortocaval vessels; and 3) forward expansion of the abdomen resulting in reorientation of the trunk during erect posture as the pregnant woman approaches term. All these conditions are responsible for numerous pathological entities that occur during human pregnancy and are almost unknown in nonhuman mammals. © 1993 Wiley-Liss, Inc.     

Truncal changes in children with mild limb length inequality: a surface topography study

Background

Limb length Inequality (LLI) in children and adults may affect posture, gait, and several truncal parameters, and it can cause spinal scoliosis. In literature, however, there is a paucity of assessment of truncal and spinal changes due to mild LLI in children. This report presents children with LLI, and it aims to provide information in pelvic imbalance, spinal posture, and scoliotic curve, using surface topography analysis which is a novel methodological approach for this condition.

Study design

This is an ongoing prospective research study on patient series suffering LLI.

Material and method

Twenty children, attending the Scoliosis Clinic of the department, 7 boys, 13 girls, 9–15?years old, range 7.5–15, mean 15.5?years, having mild LLI, were assessed. The LLI was 0.5 to 2?cm, mean 1.2?cm. There was not any post-traumatic LLI. We evaluated the LLI in correlation to pelvic and spinal posture parameters. The 4D Formetric DIERS apparatus (4DF) was used for the surface topography assessment. The following were assessed: in the coronal plane, the coronal imbalance, the pelvic obliquity, the lateral deviation, and the 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, the 4DF kyphotic angle, the kyphotic apex, the 4DF lordotic angle, the lordotic apex, the pelvic tilt, and the trunk inclination; and in the transverse plane, the pelvis rotation, the pelvic torsion, the surface rotation, and the 4DF vertebral rotation. LLI was measured using a tape. The data were statistically analyzed, and reliability study for the LLI was also performed.

Results/discussion

The LLI was statistically significantly correlated to the 4DF reading of pelvis rotation, pelvic tilt (pelvic obliquity), and surface rotation. The scoliometer readings (angle trunk rotation ATR or trunk inclination ATI) in the lumbar region were statistically significantly correlated to the 4DF readings of pelvic tilt (pelvic obliquity). The normally symmetric truncal parameters were also statistically significantly changed (all these deviating from the line of gravity through the vertebral prominence). Interestingly, LLI was not correlated to the scoliosis angle and the scoliometer reading at the lumbar level.The following 4DF readings are presented: in the coronal plane, the coronal imbalance, pelvic obliquity, lateral deviation, and 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, kyphotic angle, kyphotic apex, lordotic angle, lordotic apex, pelvic tilt, and trunk inclination; and in the transverse plane, the pelvic rotation, pelvic torsion, surface rotation, and vertebral rotation.

Conclusions

Previous studies have reported the results after simulation of LLI in order to evaluate the effects on the pelvic balance and spinal posture parameters. This report is not a LLI simulation study but it presents the effects of mild LLI on truncal changes in the main cardinal planes in children suffering LLI. These changes undoubtedly affect not only the standing truncal posture but also the gait’s economy as well.As mild LLI affects the pelvic balance and spinal posture parameters, our therapeutic approach is that mild LLI (less than 2.0?cm) has to be corrected using shoe elevation, in order to equalize the pelvic obliquity and, consequently, the spinal posture parameters.

     

Sexual dimorphism in the human pelvis: testing a new hypothesis.

Sexual dimorphism in the human pelvis is inferentially related to parturition. Investigators disagree about the identification and obstetric significance of pelvic dimorphism. Benefiting from a large sample of complete skeletons from the Coimbra Identified Skeletal Collection, we show that the dimensions of the true pelvis (birth canal) that are most sexually dimorphic (that is, the dimensions of females are greater than males) are those which are related to biparietal deformation, which often leads to the death of the human neonate. These dimensions are: the anteroposterior diameter of the inlet (index of dimorphism = 108.41), the transverse diameter of the bispinous midplane (index of dimorphism = 117.13) and the transverse diameter of the outlet (index of dimorphism = 112.3). Therefore, sexual dimorphism in the human pelvis is a reflection of differential selection on the two sexes. These results may stimulate further studies with a fresh approach regarding the fossil and comparative evidence for when and how the modern pattern of birth has evolved.     

A biomechanical comparison of the traditional squat, powerlifting squat, and box squat

The purpose of this study was to compare the biomechanics of the traditional squat with 2 popular exercise variations commonly referred to as the powerlifting squat and box squat. Twelve male powerlifters performed the exercises with 30, 50, and 70% of their measured 1 repetition maximum (1RM), with instruction to lift the loads as fast as possible. Inverse dynamics and spatial tracking of the external resistance were used to quantify biomechanical variables. A range of significant kinematic and kinetic differences (p < 0.05) emerged between the exercises. The traditional squat was performed with a narrow stance, whereas the powerlifting squat and box squat were performed with similar wide stances (48.3 ± 3.8, 89.6 ± 4.9, 92.1 ± 5.1 cm, respectively). During the eccentric phase of the traditional squat, the knee traveled past the toes resulting in anterior displacement of the system center of mass (COM). In contrast, during the powerlifting squat and box squat, a more vertical shin position was maintained, resulting in posterior displacements of the system COM. These differences in linear displacements had a significant effect (p < 0.05) on a number of peak joint moments, with the greatest effects measured at the spine and ankle. For both joints, the largest peak moment was produced during the traditional squat, followed by the powerlifting squat, then box squat. Significant differences (p < 0.05) were also noted at the hip joint where the largest moment in all 3 planes were produced during the powerlifting squat. Coaches and athletes should be aware of the biomechanical differences between the squatting variations and select according to the kinematic and kinetic profile that best match the training goals.     

Evidence of a nesting psychology during human pregnancy

In altricial mammals, “nesting” refers to a suite of primarily maternal behaviours including nest-site selection, nest building and nest defense, and the many ways that nonhuman animals prepare themselves for parturition are well studied. In contrast, little research has considered pre-parturient preparation behaviours in women from a functional perspective. Reports in the popular press assert that women experience “nesting” urges, in the form of cleaning and organizing behaviours. Anthropological data suggest that having control over the environment is a key feature of childbirth preparation in humans, including decisions about where birth will take place, and who will be welcome in the birthing environment. Here, we describe the results of two studies, a large online study comparing pregnant and non-pregnant women, and a longitudinal study tracking women throughout pregnancy and into the postpartum period and comparing non-pregnant women at similar time intervals, using a nesting questionnaire that we developed. We found that women exhibit nesting behaviours, including space preparation and social selectivity, which peak in the third trimester of pregnancy. As is the case with nonhuman mammals, nesting in women may serve a protective function.     

Effects of pelvic stabilization on lumbar muscle activity during dynamic exercise

Many commonly utilized low-back exercise devices offer mechanisms to stabilize the pelvis and to isolate the lumbar spine, but the value of these mechanisms remains unclear. The purpose of this study was to examine the effect of pelvic stabilization on the activity of the lumbar and hip extensor muscles during dynamic back extension exercise. Fifteen volunteers in good general health performed dynamic extension exercise in a seated upright position on a lumbar extension machine with and without pelvic stabilization. During exercise, surface electromyographic activity of the lumbar multifidus and biceps femoris was recorded. The activity of the multifidus was 51% greater during the stabilized condition, whereas there was no difference in the activity of the biceps femoris between conditions. This study demonstrates that pelvic stabilization enhances lumbar muscle recruitment during dynamic exercise on machines. Exercise specialists can use these data when designing exercise programs to develop low back strength.     

Evolution of two human skeletal markers of the squatting position: a diachronic study from antiquity to the modern age

Some human skeletal features that were produced through the actions of their bearers during life allow the reconstruction of postures. These can be typical of population groups. For example, tibial retroversion and lateral squatting facets are two skeletal markers closely related to the habit of squatting. The facets and the retroversion are induced by pressure and traction as a consequence of the hyperdorsiflexion of the knees and ankles. The examination of 543 tibiae and tali from French and American archaeological series, and dating between the 1st-20th century AD, reveals changes in squatting posture over time. This study shows that tibial retroversion tends to be a "precocity indicator" of the adoption of this posture, while the lateral squatting facet shows the intensity or regularity of the use of this posture. The results indicate that squatting was a regular behavior used until the end of the Middle Ages, and after this period a progressive decrease occurs. This tendency may be explained by different lifestyles in different time periods.