abnormal spinal postures: kyphosis and lordosis

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  • 1. Abnormal Spinal Postures:Abnormal Spinal Postures: Kyphosis andKyphosis and LordosisLordosis Lea VandegriftLea Vandegrift April 18, 2007April 18, 2007

2. 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 abdominalIliopsoas, hamstrings, and abdominal muscles determine standing posturemuscles determine standing posture (1)(1) 3. Diagnoses/DefinitionsDiagnoses/Definitions LordosisLordosis Inward curve of lumbarInward curve of lumbar spinespine (4)(4) May occur in the cervicalMay occur in the cervical spinespine KyphosisKyphosis Outward curve of thoracic spineOutward curve of thoracic spine (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 4. PathologyPathology KyphosisKyphosis Born withBorn with InfectionInfection (TB(TB lung infection) lung infection) Scheuermann's DiseaseScheuermann's Disease Osteochondrosis of vertebraeOsteochondrosis of vertebrae (Bone disease) Boys 10-15(Bone disease) Boys 10-15 NeurofibromatosisNeurofibromatosis -- inherited disorder of tumors ininherited disorder of tumors in skin/nervesskin/nerves Connective tissueConnective tissue disordersdisorders Muscular DystrophyMuscular Dystrophy (MD)(MD) muscle weakness muscle weakness Spina Bifida -Spina Bifida - IncompleteIncomplete formation of part the spine)formation of part the spine) Disk degenerationDisk degeneration Certain endocrineCertain endocrine diseasesdiseases Pagets DiseasePagets Disease - Bone- Bone destruction and regrowthdestruction and regrowth PolioPolio - Viral infection- Viral infection paralysisparalysis LordosisLordosis Most common inMost common in toddlers and girlstoddlers and girls Born withBorn with Benign juvenileBenign juvenile lordosislordosis Non cancerous Non cancerous tumorstumors KyphosisKyphosis ObesityObesity OsteoporosisOsteoporosis AchondroplasiaAchondroplasia -- Improper development ofImproper development of cartilage at epiphysiscartilage at epiphysis DwarfismDwarfism SpondylolisthesisSpondylolisthesis -- Forward displacement of aForward displacement of a vertebravertebra 5. Normal AnglesNormal Angles Normal AngleNormal Angle MeasuredMeasured FromFrom Thoracic KyphosisThoracic Kyphosis 21 3321 33 T3 - T12T3 - T12 Lumbar LordosisLumbar Lordosis 31 -5031 -50 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) 6. LordosisLordosis SwaybackSwayback Exaggerated postureExaggerated posture Buttocks more prominentButtocks more prominent Low back painLow back pain Pain affecting movementPain affecting movement Associated with pregnancyAssociated with pregnancy (Decreases)(Decreases) Space between lower backSpace between lower back and surface when laying onand surface when laying on 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 ifTight hamstring muscles if Scheuermann's DiseaseScheuermann's Disease Difficulty breathingDifficulty breathing (Severe(Severe cases)cases) 7. 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. flex.Measure ROM Flex, ext, lat. flex. Baseline for treatmentBaseline for treatment Neurologic evaluationNeurologic evaluation - Weakness,- Weakness, paralysis, sensations, bowel/bladderparalysis, sensations, bowel/bladder changeschanges Spine X-raySpine X-ray Determine severity of Determine severity of curvecurve MRIMRI - Test for tumors, infection, or- Test for tumors, infection, or neurological symptomsneurological symptoms Pulmonary Function TestsPulmonary Function Tests Assess Assess affect on breathingaffect 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, observeobserve asymmetryasymmetry Baseline before treatmentBaseline before treatment Neurologic EvaluationNeurologic Evaluation Weakness, sensations,Weakness, sensations, bowel/bladder changesbowel/bladder changes Spine X-raySpine X-ray Anterior/Posterior, Anterior/Posterior, Side, Lateral Side BendingSide, Lateral Side Bending Lumbosacral spine X-rayLumbosacral spine X-ray MRIMRI Check spinal cord Check spinal cord 8. EvaluationEvaluation http://orthopedics.seattlechildrens.org/conditions_treated/kyphosis.asp#how KyphosisKyphosis LordosisLordosis 9. Treatment/ManagementTreatment/Management KyphosisKyphosis -- 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 birthPresent at birth - Corrective surgery- Corrective surgery PosturalPostural PT and postural correction PT and postural correction StructuralStructural Medication, bracing Medication, bracing Scheuermann's diseaseScheuermann's disease Initial bracing and PTInitial bracing and PT Surgery for painful curvesSurgery for painful curves >> 6060 degreesdegrees Debilitating deformity/painDebilitating deformity/pain - Surgery- Surgery Multiple compression fracturesMultiple compression fractures - Left- Left alone if there are no neurological problemsalone if there are no neurological problems or painor pain Treat osteoporosis to prevent fracturesTreat osteoporosis to prevent fractures Infection or tumorInfection or tumor - Surgery and- Surgery and medicationmedication LordosisLordosis Does not alwaysDoes not always require medical treatmentrequire medical treatment Evaluation is recommended forEvaluation is recommended for a fixed curvea fixed curve Anti-inflammatory medicationAnti-inflammatory medication Physical therapyPhysical therapy - Increase- Increase strength, flexibility, and ROMstrength, flexibility, and ROM BracingBracing - Control progression of- Control progression of curve in adolescentscurve in adolescents Reduction of body weightReduction of body weight SurgerySurgery Severe curves withSevere curves with neurological involvementneurological involvement No relief from non-surgicalNo relief from non-surgical methodsmethods 10. 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 11. 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 12. KyphosisKyphosis ConservativeConservative Follow doctor/PTsFollow doctor/PTs instructions andinstructions and appointmentsappointments Home exercise programHome exercise program LordosisLordosis ConservativeConservative Follow doctor/PTsFollow doctor/PTs instructions andinstructions and appointmentsappointments Activity restrictionsActivity restrictions Home exercise programHome exercise program RecoveryRecovery SurgerySurgery Prescriptions filled beforePrescriptions filled before surgerysurgery PTPT Follow-up visits withFollow-up visits with surgeonsurgeon SurgerySurgery MedicationMedication Walking encouraged toWalking encouraged to enhance circulation andenhance circulation and healinghealing PTPT Follow up visits with surgeonFollow up visits with surgeon 13. More About KyphosisMore About Kyphosis Treating 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 preventEarly diagnosis reduces the need for surgery- No way to prevent 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 c