abnormal spinal postures: kyphosis and lordosis

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Abnormal Spinal Postures: Abnormal Spinal Postures: Kyphosis Kyphosis and Lordosis and Lordosis Lea Vandegrift Lea Vandegrift April 18, 2007 April 18, 2007

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Page 1: Abnormal Spinal Postures: Kyphosis and Lordosis

Abnormal Spinal Postures: Abnormal Spinal Postures: Kyphosis and Kyphosis and LordosisLordosis

Lea VandegriftLea Vandegrift

April 18, 2007April 18, 2007

Page 2: Abnormal Spinal Postures: Kyphosis and Lordosis

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)

Page 3: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 4: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 5: Abnormal Spinal Postures: Kyphosis and Lordosis

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)

Page 6: Abnormal Spinal Postures: Kyphosis and Lordosis

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)

Page 7: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 8: Abnormal Spinal Postures: Kyphosis and Lordosis

EvaluationEvaluation

http://orthopedics.seattlechildrens.org/conditions_treated/kyphosis.asp#how

KyphosisKyphosis LordosisLordosis

Page 9: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 10: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 11: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 12: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 13: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 14: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 15: Abnormal Spinal Postures: Kyphosis and Lordosis

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

Page 16: Abnormal Spinal Postures: Kyphosis and Lordosis

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.

Page 17: Abnormal Spinal Postures: Kyphosis and Lordosis

Malalignment Malalignment Answers…Answers…

A. Kyphosis

B. Forward Head

C. Flatback

C. Swayback

D. Lordosis

F. Scoliosis