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Abnormal Spinal Postures: Abnormal Spinal Postures: Kyphosis and Kyphosis and LordosisLordosis
Lea VandegriftLea Vandegrift
April 18, 2007April 18, 2007
Kyphosis OR Lordosis?Kyphosis OR Lordosis?
Lordosis is also known as swayback, Lordosis is also known as swayback, (2,4)(2,4) pride of pregnancy, or beer bellypride of pregnancy, or beer belly
(5)
Kyphosis is also known as roundback, hunchback, Kyphosis is also known as roundback, hunchback, or Scheuermann's disease. or Scheuermann's disease. (2,3)(2,3)
Iliopsoas, hamstrings, and abdominal Iliopsoas, hamstrings, and abdominal muscles determine standing posture muscles determine standing posture (1)(1)
Diagnoses/DefinitionsDiagnoses/Definitions
LordosisLordosis– Inward curve of lumbar Inward curve of lumbar
spinespine (4)(4)
– May occur in the cervical May occur in the cervical spine spine
KyphosisKyphosis– Outward curve of thoracic Outward curve of thoracic
spinespine (4)(4)
– Curving causes a bowingCurving causes a bowing
*Descriptions of shape, not diseases. (1)
2 out of 3 curves of the spine2 out of 3 curves of the spine
PathologyPathology KyphosisKyphosis Born withBorn with Infection Infection (TB (TB – lung infection)– lung infection) Scheuermann's DiseaseScheuermann's Disease – –
Osteochondrosis of vertebrae Osteochondrosis of vertebrae (Bone disease) – Boys 10-15(Bone disease) – Boys 10-15
Neurofibromatosis Neurofibromatosis - inherited - inherited disorder of tumors in skin/nervesdisorder of tumors in skin/nerves
Connective tissue disorders Connective tissue disorders Muscular Dystrophy Muscular Dystrophy (MD)(MD) – –
muscle weaknessmuscle weakness Spina Bifida - Spina Bifida - Incomplete Incomplete
formation of part the spine) formation of part the spine) Disk degeneration Disk degeneration Certain endocrine diseases Certain endocrine diseases Paget’s DiseasePaget’s Disease - Bone - Bone
destruction and regrowthdestruction and regrowth Polio Polio - Viral infection - Viral infection paralysis paralysis TumorsTumors Association with ScoliosisAssociation with Scoliosis
LordosisLordosis Most common in Most common in
toddlers and girlstoddlers and girls Born with Born with Benign juvenile lordosisBenign juvenile lordosis
– Non cancerous tumors– Non cancerous tumors KyphosisKyphosis Obesity Obesity OsteoporosisOsteoporosis Achondroplasia Achondroplasia - -
Improper development of Improper development of cartilage at epiphysis cartilage at epiphysis DwarfismDwarfism
Spondylolisthesis Spondylolisthesis - - Forward displacement of a Forward displacement of a vertebravertebra
DiskitisDiskitis – Inflammation in – Inflammation in between disksbetween disks
Normal AnglesNormal Angles
Normal Normal AngleAngle
Measured Measured FromFrom
Thoracic Thoracic KyphosisKyphosis 21 – 33º21 – 33º T3 - T12T3 - T12
Lumbar Lumbar LordosisLordosis 31 -50º31 -50º L1 - L5L1 - L5
(7) http://www.ohsu.edu/radiology/teach/kojima/kyphosis.htm
Everyone has a degree of normal curvature.
“The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during
movement.” (6)
LordosisLordosis SwaybackSwayback Exaggerated postureExaggerated posture Buttocks more prominentButtocks more prominent Low back painLow back pain Pain affecting movementPain affecting movement Associated with pregnancy Associated with pregnancy
(Decreases)(Decreases) Space between lower back Space between lower back
and surface when laying on and surface when laying on backback
Signs and SymptomsSigns and Symptoms
KyphosisKyphosis Hunchback or round backHunchback or round back Mild back painMild back pain FatigueFatigue Tenderness of spineTenderness of spine Stiffness of spineStiffness of spine Tight hamstring muscles Tight hamstring muscles
if Scheuermann's Diseaseif Scheuermann's Disease Difficulty breathing Difficulty breathing (Severe (Severe
cases)cases)
TestingTesting KyphosisKyphosis Physical exam by doctorPhysical exam by doctor
Confirm abnormal curve of spineConfirm abnormal curve of spine Palpate abnormalitiesPalpate abnormalities
Measure ROM – Flex, ext, lat. Measure ROM – Flex, ext, lat. flex.flex.
Baseline for treatmentBaseline for treatment Neurologic evaluation Neurologic evaluation - -
Weakness, paralysis, sensations, Weakness, paralysis, sensations, bowel/bladder changesbowel/bladder changes
Spine X-ray Spine X-ray – Determine severity – Determine severity of curveof curve
MRI MRI - Test for tumors, infection, or - Test for tumors, infection, or neurological symptomsneurological symptoms
Pulmonary Function Tests Pulmonary Function Tests – – Assess affect on breathingAssess affect on breathing
LordosisLordosis Physical exam by doctorPhysical exam by doctor
When curvature first noticed?When curvature first noticed? Palpation of abnormalitiesPalpation of abnormalities
Measure ROM, Measure ROM, observe observe asymmetryasymmetry
Baseline before treatmentBaseline before treatment Neurologic EvaluationNeurologic Evaluation – –
Weakness, sensations, Weakness, sensations, bowel/bladder changesbowel/bladder changes
Spine X-ray Spine X-ray – Anterior/Posterior, – Anterior/Posterior, Side, Lateral Side BendingSide, Lateral Side Bending
Lumbosacral spine X-rayLumbosacral spine X-ray MRI MRI – Check spinal cord– Check spinal cord
EvaluationEvaluation
http://orthopedics.seattlechildrens.org/conditions_treated/kyphosis.asp#how
KyphosisKyphosis LordosisLordosis
Treatment/Treatment/ManagementManagement Kyphosis Kyphosis - - Depends on the causeDepends on the cause
*Early treatment in adolescents is *Early treatment in adolescents is important to prevent progressionimportant to prevent progression
Present at birth Present at birth - Corrective surgery- Corrective surgery Postural Postural – PT and postural correction– PT and postural correction Structural Structural – Medication, bracing– Medication, bracing Scheuermann's diseaseScheuermann's disease
Initial bracing and PTInitial bracing and PT Surgery for painful curves Surgery for painful curves 60 60
degreesdegrees Debilitating deformity/pain Debilitating deformity/pain - Surgery- Surgery Multiple compression fractures Multiple compression fractures - Left - Left
alone if there are no neurological alone if there are no neurological problems or painproblems or pain
Treat osteoporosis to prevent fracturesTreat osteoporosis to prevent fractures Infection or tumor Infection or tumor - Surgery and - Surgery and
medicationmedication
Lordosis Lordosis – – Does not always Does not always require medical treatmentrequire medical treatment Evaluation is recommended Evaluation is recommended
for a “fixed” curvefor a “fixed” curve Anti-inflammatory Anti-inflammatory
medication medication Physical therapy Physical therapy - Increase - Increase
strength, flexibility, and ROMstrength, flexibility, and ROM Bracing Bracing - Control progression - Control progression
of curve in adolescentsof curve in adolescents Reduction of body weight Reduction of body weight SurgerySurgery
Severe curves with Severe curves with neurological involvementneurological involvement
No relief from non-surgical No relief from non-surgical methodsmethods
Physical TherapyPhysical Therapy•Combining PT with bracing
•PT benefits patients wearing braces•Exercise is not helpful alone
•Things to work on…•Decrease pain and inflammation•Make daily activities easier and less painful•Improve mobility•Flexibility
•Low back and hamstring muscles•Strengthen abdominals, back, and posture
•The goals of physical therapy are to…•Learn correct posture and body movements •Maximize ROM and strength •Aerobic fitness (Especially kyphosis patients)•Learn ways to manage condition•Home exercise program
For general spine rehab go to... www.allaboutbackpain.com/html/spine_general/spine_general_spine_rehab2.html
Physical Therapy
Video on hamstring stretching… http://www.youtube.com/watch?v=SbAJyCKmUPI
•Helps flexibility of back
•Strengthen legs and buttock
•Stretches abdominal muscles
•Stretches legs
•Strengthens/shapes upper body
•Stretches back
•Stretches hamstrings
Abdominal muscles help stabilize the back by assisting the pelvis and lumbar spine during hip flexion. This prevents increased lordosis. Abdominal work out… www.nismat.org/ptcor/abdominal/index.html
KyphosisKyphosis– ConservativeConservative
Follow doctor/PT’s Follow doctor/PT’s instructions and instructions and appointmentsappointments
Home exercise Home exercise programprogram
LordosisLordosis– ConservativeConservative
Follow doctor/PT’s Follow doctor/PT’s instructions and instructions and appointmentsappointments
Activity restrictionsActivity restrictions Home exercise Home exercise
programprogram
RecoveryRecovery
–SurgerySurgery
Prescriptions filled Prescriptions filled before surgerybefore surgery
PTPT
Follow-up visits with Follow-up visits with surgeonsurgeon
–SurgerySurgery
MedicationMedication
Walking encouraged to Walking encouraged to enhance circulation and enhance circulation and healinghealing
PTPT
Follow up visits with Follow up visits with surgeonsurgeon
More About KyphosisMore About KyphosisTreating and preventing osteoporosis can prevent cases in the
elderly
Hyperkyphosis exceeding the normal range may occur, often due to osteoporosisHyperkyphosis exceeding the normal range may occur, often due to osteoporosis
Gibbus deformity - A form of structural kyphosis secondary to TB
Posterior curve is sharply angled not smooth where the lesion is
Before antituberculous medication was widespread
Scheuermann's Disease is juvenile thoracic kyphosisScheuermann's Disease is juvenile thoracic kyphosis
Cause is unknown, may be familialCause is unknown, may be familial
Early diagnosis reduces the need for surgery- No way to Early diagnosis reduces the need for surgery- No way to preventprevent
Usually begins in females more than males, 12-15 years oldUsually begins in females more than males, 12-15 years old
Disease can cause decreased intervertebral disc space and vertebral wedgingDisease can cause decreased intervertebral disc space and vertebral wedging
Results in a rigid excessive curvatureResults in a rigid excessive curvature
More About LordosisMore About LordosisA flexible curve is not always a concernA flexible curve is not always a concern– Flexible - If individual bends forward the curve reverses itselfFlexible - If individual bends forward the curve reverses itself
Medical evaluation and treatment is needed when the curve does Medical evaluation and treatment is needed when the curve does not movenot move (4) (4)
– Referred to as a fixed rigid, or stiff curveReferred to as a fixed rigid, or stiff curve
Some say it develops during the first 3 years after birth and stops Some say it develops during the first 3 years after birth and stops before the children start to sit, stand, or walk.before the children start to sit, stand, or walk.– Children who never assume the erect position develop lordosis Children who never assume the erect position develop lordosis
to the same degree and at the same time as other children.to the same degree and at the same time as other children.
One of two abnormalities associated with dwarfismOne of two abnormalities associated with dwarfism– Dip in the spine and compressed chestDip in the spine and compressed chest
Stacking chairs are the worst for posture – Found in many schoolsStacking chairs are the worst for posture – Found in many schools– Slope backwards and have short backrestsSlope backwards and have short backrests– Be aware of seats that force the spine into exaggerated Be aware of seats that force the spine into exaggerated
lordosislordosis
ComplicationsComplications Body image problems/Deformity Body image problems/Deformity - - Support system is importantSupport system is important
Poor self esteem and body imagePoor self esteem and body image
• Adolescents especiallyAdolescents especially Wearing a brace is annoying/noticeableWearing a brace is annoying/noticeable Round back/hump may become more noticeable – KyphosisRound back/hump may become more noticeable – Kyphosis Pregnant/beer belly that will not go away - LordosisPregnant/beer belly that will not go away - Lordosis
Back painBack pain Misalignment of the spine causes painMisalignment of the spine causes pain Can become severe and disablingCan become severe and disabling
Breathing difficulties - KyphosisBreathing difficulties - Kyphosis In severe cases the curve inhibits breathingIn severe cases the curve inhibits breathing
Neurological symptomsNeurological symptoms Leg weakness or paralysis due to pressure on the spinal nervesLeg weakness or paralysis due to pressure on the spinal nerves
Works Cited:Works Cited: 1. Errico and Nuzzo. Kyph/Lordosis. Pediatric Orthopedics. 2006. Available at:
www.pediatric-rthopedics.com/Treatments/Kyphosis_Lordosis/kyphosis_lordosis.html. Accessed March 30, 2007.
2. Drake L, AWM Mitchell, W Vogl. Gray’s Anatomy for Students. Philadelphia: Elsevier; 2005.
3. Joseph, T. Kyphosis. MedlinePlus. 2006. Available at: www.nlm.nih.gov/medlineplus/ency/article/001240.htm. Accessed April 3, 2007.
4. Rauch, D. Lordosis. MedlinePlus. 2006. Available at: www.nlm.nih.gov/medlineplus/ency/article/003278.htm. Accessed April 3, 2007.
5. Drawing of Kyphosis vs. Lordosis vs. normal. Fotosearch. Available at: www.fotosearch.com/LIF127/3d708003/. Accessed March 29, 2007.
6. Regan JJ. Lordosis. Spine Universe. 2007. Available at: www.spineuniverse.com/displayarticle.php/article1438.html. Accessed March 30, 2007.
7.Ozonoff MB. Pediatric Orthopedic Radiology. W.B. Saunders Company: Philadelphia. 1992. p68.
8. An HS. Kyphosis. Spine Universe. 2006. Available at: www.spineuniverse.com/displayarticle.php/article1437.html. Accessed March 30, 2007.
9. Mayo Clinic Staff. Kyphosis. Mayo Clinic. 2006. Available at: www.mayoclinic.com/health/kyphosis/DS00681. Accessed April 2, 2007.
10. Prentice WE. Arnhiem’s Athletic Training. New York: Mc Graw Hill; 2003.
Malalignment Malalignment Answers…Answers…
A. Kyphosis
B. Forward Head
C. Flatback
C. Swayback
D. Lordosis
F. Scoliosis