Types of kyphosis
Postural kyphosis is the most common and most favorable option: the bend is flexible, a child or adult can easily straighten upon request, and lying on the back the deformity disappears. Scheuermann's disease develops in adolescence, when the anterior sections of several vertebrae grow more slowly than the posterior ones and acquire a wedge-shaped shape: the back becomes rigidly rounded and it is no longer possible to straighten completely, and pain often appears. Congenital kyphosis is associated with a malformation of the vertebrae. In older people, osteoporotic kyphosis develops due to compression fractures of the vertebral bodies.
- Postural - flexible, corrected by force
- Scheuermann's disease - wedge-shaped vertebrae in adolescents
- Congenital - a malformation of the vertebrae
- Osteoporotic - due to compression fractures
- Post-traumatic and post-operative
Symptoms
The main complaint is appearance: round back, shoulders drooping forward, head protruding; in older people, a noticeable hump in the upper back. Pain does not always occur: with the postural form it is usually absent or it appears during prolonged sitting; with Scheuermann's disease it is localized in the area of the apex of the bend and intensifies towards the end of the day; with osteoporotic fractures it can be acute and severe. Severe kyphosis limits the mobility of the chest and the depth of breathing, and in the elderly it affects balance and increases the risk of falls. A noticeable decrease in height is an important sign of vertebral fractures.
- Round back and stoop
- Shoulders slumped forward, head protruded
- Back muscle fatigue
- Chest pain at the end of the day
- Limitation of breathing depth in case of severe deformation
- Decreased height in the elderly
- Balance imbalance
Diagnostics
The doctor examines the back in a standing position, from the side and when bending forward, assessing whether the bend disappears during extension and in a lying position - this is what distinguishes the flexible form from the structural one. An X-ray of the thoracic region in a lateral projection allows you to measure the amount of bending and see the wedge-shaped deformation of the vertebrae, characteristic of Scheuermann's disease. In the elderly, if osteoporosis is suspected, densitometry is performed and the vertebrae are assessed for compression fractures, and vitamin D and calcium metabolism are checked. MRI is ordered for neurological symptoms and suspected other causes.
- Bend Flexibility Inspection
- X-ray of the chest in lateral projection
- Measuring the amount of kyphosis
- Densitometry for suspected osteoporosis
- Vitamin D, calcium, phosphorus
- MRI for neurological symptoms
- Measuring growth over time
Treatment in adolescents
With postural kyphosis, the basis is physical therapy: strengthening the extensor muscles of the back and scapular muscles in combination with stretching the pectoral muscles and the back of the thigh, which is often shortened. The result depends on the regularity, and not on the intensity of individual courses. For Scheuermann's disease with moderate deformity and ongoing growth, the doctor may prescribe a corset, which is worn according to a certain pattern to slow down the progression; its effectiveness is higher while the growth zones are open. Loads are not prohibited, but axial exercises with heavy weights are limited. Surgery is rarely considered in cases of severe deformity with persistent pain or neurological impairment.
- Therapeutic exercise as a basis
- Strengthening the back extensors and shoulder blade muscles
- Stretching the pectoral muscles and hamstrings
- Corset according to indications for Scheuermann's disease
- Swimming and activity without axial overload
- Workplace organization
- Surgery for severe deformity and pain
Treatment and prevention in adults
In older people, the main task is to treat osteoporosis, otherwise the deformity will increase with each new fracture. The doctor prescribes drugs that increase bone strength, as well as calcium and vitamin D in selected doses. A mandatory part is exercises to strengthen the back muscles and balance training, which reduce the risk of falls, as well as making the house safe: remove slippery rugs and wires, provide lighting and handrails. Quitting smoking and limiting alcohol improve bone health. Sharp bending forward while lifting heavy objects is undesirable with osteoporosis due to the risk of compression fracture.
- Examination and treatment of osteoporosis
- Calcium and vitamin D as prescribed by your doctor
- Back muscle strengthening exercises
- Balance training and fall prevention
- Safe organization of life
- Quitting smoking, limiting alcohol
- Avoid sudden bending with heavy weights
- Regular monitoring of bone growth and density