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Abnormal Spinal Postures:

Lordosis

Kyphosis and

Lea Vandegrift
April 18, 2007

Kyphosis OR Lordosis?
Kyphosis is also known as roundback, hunchback,
or Scheuermann's disease. (2,3)
Lordosis is also known as swayback, (2,4)
pride of pregnancy, or beer belly

Iliopsoas, hamstrings, and abdominal


muscles determine standing posture (1)

(5)

Diagnoses/Definitions
2 out of 3 curves of the spine
2 out of 3 curves of the spine

Lordosis

Kyphosis
Outward curve of thoracic
spine (4)
Curving causes a bowing

Inward curve of lumbar spine


(4)

May occur in the cervical


spine

*Descriptions of shape, not diseases. (1)

Kyphosis

Born with
Infection (TB lung infection)
Scheuermann's Disease

Osteochondrosis of vertebrae
(Bone disease) Boys 10-15
Neurofibromatosis - inherited
disorder of tumors in skin/nerves

Connective tissue
disorders
Muscular Dystrophy (MD)
muscle weakness
Spina Bifida - Incomplete
formation of part the spine)

Disk degeneration
Certain endocrine diseases
Pagets Disease - Bone
destruction and regrowth
Polio - Viral infection
paralysis

Tumors
Association with Scoliosis

Pathology

Lordosis

Most common in
toddlers and girls
Born with
Benign juvenile lordosis
Non cancerous tumors

Kyphosis
Obesity
Osteoporosis
Achondroplasia - Improper
development of cartilage at
epiphysis Dwarfism
Spondylolisthesis Forward displacement of a
vertebra
Diskitis Inflammation in
between disks

Normal Angles
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)

Normal
Angle

Measured
From

Thoracic
Kyphosis

21 33

T3 - T12

Lumbar Lordosis

31 -50

L1 - L5

(7)

http://www.ohsu.edu/radiology/teach/kojima/kyphosis.htm

Signs and Symptoms

Kyphosis

Hunchback or round back


Mild back pain
Fatigue
Tenderness of spine

Stiffness of spine
Tight hamstring muscles if
Scheuermann's Disease
Difficulty breathing (Severe
cases)

Lordosis

Swayback
Exaggerated posture
Buttocks more prominent
Low back pain
Pain affecting movement
Associated with pregnancy
(Decreases)

Space between lower back


and surface when laying on
back

Kyphosis

Testing

Physical exam by doctor


Confirm abnormal curve of spine
Palpate abnormalities

Measure ROM Flex, ext, lat.


flex.

Lordosis

Baseline for treatment

When curvature first noticed?


Palpation of abnormalities

Spine X-ray Determine severity of


MRI - Test for tumors, infection, or

Pulmonary Function Tests Assess


affect on breathing

Baseline before treatment

Neurologic Evaluation
Weakness, sensations,
bowel/bladder changes

neurological symptoms

Measure ROM, observe


asymmetry

curve

Physical exam by doctor

Neurologic evaluation - Weakness,


paralysis, sensations, bowel/bladder
changes

Spine X-ray Anterior/Posterior,


Side, Lateral Side Bending

Lumbosacral spine X-ray


MRI Check spinal cord

Evaluation

Lordosis

Kyphosis

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

Treatment/Manageme
nt Lordosis
Kyphosis

- Depends on the cause


*Early treatment in adolescents is
important to prevent progression
Present at birth - Corrective surgery
Postural PT and postural correction
Structural Medication, bracing
Scheuermann's disease

Initial bracing and PT


Surgery for painful curves 60 degrees

Does not always


require medical treatment
Evaluation is recommended
for a fixed curve
Anti-inflammatory
medication
Physical therapy - Increase
strength, flexibility, and ROM

Bracing - Control progression


Debilitating deformity/pain - Surgery
of curve in adolescents
Multiple compression fractures - Left
alone if there are no neurological problems Reduction of body weight
or pain
Surgery
Treat osteoporosis to prevent fractures
Severe curves with
Infection or tumor - Surgery and
neurological involvement
medication
No relief from non-surgical
methods

Physical 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

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

Stretches back
Stretches hamstrings

Helps flexibility of back


Strengthen legs and buttock
Stretches abdominal muscles

Stretches legs
Strengthens/shapes upper body

Video on hamstring stretching http://www.youtube.com/watch?v=SbAJyCKmUPI

Recovery

Kyphosis
Conservative
Follow doctor/PTs
instructions and
appointments
Home exercise program

Surgery
Medication
Walking

encouraged to
enhance circulation and
healing
PT
Follow

up visits with

Lordosis
Conservative
Follow doctor/PTs
instructions and
appointments
Activity restrictions
Home exercise
Surgery
program

Prescriptions filled
before surgery
PT
Follow-up visits with
surgeon

More About Kyphosis


Treating and preventing osteoporosis can prevent cases in the
elderly
Hyperkyphosis 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 kyphosis
Cause is unknown, may be familial
Early diagnosis reduces the need for surgery- No way to
prevent
Usually begins in females more than males, 12-15 years old
Disease can cause decreased intervertebral disc space and vertebral wedging

More About Lordosis


A flexible curve is not always a concern
Flexible - If individual bends forward the curve reverses itself
Medical evaluation and treatment is needed when the curve does
not move (4)
Referred to as a fixed rigid, or stiff curve
Some say it develops during the first 3 years after birth and stops
before the children start to sit, stand, or walk.
Children who never assume the erect position develop lordosis
to the same degree and at the same time as other children.
One of two abnormalities associated with dwarfism
Dip in the spine and compressed chest
Stacking chairs are the worst for posture Found in many schools
Slope backwards and have short backrests
Be aware of seats that force the spine into exaggerated lordosis

Complications
Body image problems/Deformity - Support system is important

Poor self esteem and body image


Adolescents especially

Wearing a brace is annoying/noticeable

Round back/hump may become more noticeable Kyphosis

Pregnant/beer belly that will not go away - Lordosis


Back pain

Misalignment of the spine causes pain

Can become severe and disabling


Breathing difficulties - Kyphosis

In severe cases the curve inhibits breathing


Neurological symptoms

Leg weakness or paralysis due to pressure on the spinal nerves

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. Grays 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. Arnhiems Athletic Training. New York: Mc Graw Hill; 2003.

Malalignment
Answers
A. Kyphosis

C. Swayback

B. Forward
Head

D. Lordosis

F. Scoliosis
C. Flatback