Kyphosis

kyphosis biomechanics , etiology , treatment, physiotherapy management and recent article

1. KYPHOSIS DEFINITION: General term used for excessive backward convexity of the spine. It is the exaggeration of the posterior spinal curve localized to dorsal spine. Also known as arcuata or round back. A condition of over curvature of thoracic vertebrae. This causes bowling of the back called as slouching posture.

2. CAUSES : - Habitual bad posture -Arthritis -Rheumatism -Lung affection -Neuromuscular weakness -Degeneration of vertebral bodies & discs -TB - Ankylosing spondylities - Scheuermann’s disease -Congenital anomalies

3. TYPES Round Kyphosis --Gentle backward curvature of spinal column. --Caused by disease affecting number of vertebra for e.g. Senile Kyphosis . --May be localized to a spinal segment or may be diffuse.

4. Angular kyphosis -- A sharp backward prominence of spinal column. --It may be prominence of only one spinous process because of collapse of only one vertebral body and may occur in compression fracture of vertebra. This is called knuckle. --There may be kyphosis localized to few vertebrae and is known as gibbus , commonly seen in TB.

5. Classification of deformity according to severity 1.First degree kyphosis : -Habitual bad posture is the precipitating factor. -There is no imbalance beween the muscles. 2.Second degree kyphosis -Pectoral muscle becomes short, there by restricting chest expansion resulting in reduced respiratory function. -Longitudinal back muscle,rhomboids & middle trapezius are weakened with loss of tone and are in a stretched position. -Posterior ligament are lengthened with corresponding shortening of anterior structures.This result in posterior laxity. 3.Third degree kyphosis -Wedging of vertebral body may occur. -The deformity gets organized which is a difficult syndrome.

6. Postural adaptations in Kyphosis -Rounded back -Forward head -Flattened chest -Rounded shoulders -Excessive protrusion of scapula

7. BIOMECHANICS -A normal thoracic kyphosis is due to the slight wedged configuration of both of the vertebral bodies and intervertebral discs. Because of this physiological kyphosis ,the thoracic spine is more prone to be unstable in flexion. - The anterior longitudinal ligament & posterior longitudinal ligament is well developed in thoracic region. -Clinicians have noted that ALL is usually thick in certain cases of abnormal thoracic kyphosis (White and panjabi ) -Annulus in this region a s elsewhere is the major factor in maintaining clinical stability.

8. Continued.. ---During excessive dorsal kyphosis ; Compression of anterior vertebral bodies, Increase in intradiscal pressure. Distraction of facet joint capsules and posterior annulus fibers. Stretching of posterior longitudinal ligament & scapular muscle. Shortening of anterior longitudinal ligament and upper abdominal muscle.

9. continued… The biomechanical concept, that relates to problem of instability in kyphotic thoracic spine states that,the greater the wedge of the vertebral body fracture,the greater the moment arm and thus, the greater the bending moment, which tends to produce additional kyphotic deformity and pressure on the spinal cord, particullarly if there are disc or bone fragments in the canal(literature by holdsworth’s ).

10. MANAGEMENT; 1.First degree kyphosis --Relaxation of body especially upper back . --Repeated stretching session of shortened anterior structures by bracing shoulder & maintaining position. --Postural training --Mobilization of spine, scapula & shoulders. --Diaphragmatic & costal breathing exercises to emphasize on inspiration. --Resistive exercise to weak longitudinal & transverse back muscle --Controlled pelvic tilt associated with abdominal & gluteal contractions

11. 2.Second degree kyphosis - Milwaukee brace with pads. -Exercises to improve mobility and respiration to reduce overall impact of deformity. 3.Third degree kyphosis -Bone graft -Spinal cord depression -Spinal stabilization

12. ARTICLE-1 TOPIC: Rehabilitation using manual mobilization for thoracic kyphosis in elderly post menopausal patients with osteoporosis (Journal of rehabilitation medicine, 2010) Ivan etal took 48 postmenopausal patients with osteoporosis and randomly assigned them in two groups. Group 1(n=29),exercise group received 3 months of rehabilitation (18 sessions including manual mobilization, taping & exercises) whereas Group 2(n=19),control group didn’t receive anything. The outcome measures included were spinal-mouse, VAS & Quality of Life. The result concluded that the rehabilitation, manual mobilization can attenuate thoracic kyphosis in elderly patients with osteoporosis.

13. ARTICLE 2 TOPIC: Application of passive transverse forces in the rehabilitation of spinal deformities ; A RCT(Journal,2002) Weiss et al. performed a RCT study where they took 2 group,Gr A(n=126) exercises group & Gr B(n=126) control group. G roup A was provided with passive transverse forces on the deformed body for 4-6 times lasting 20 mins per session . The treatment was carried out for 4-6 weeks .The outcome measure included formetric system . The study concluded that PTF can be useful for deformed spine.