pathology: kyphosis/hyperkyphosis

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Kyphosis/hyperkyphosis (hunchback, humpback, gibbus)

Definition of

Physiologically, there is a certain degree of kyphosis in the thoracic spine and in the os sacrum; what is meant here is hyperkyphosis, i.e. a hunchback, usually of the thoracic spine, also known as a hump if severe. A curvature of the thoracic spine of more than 40° is considered pathological. A distinction is made according to structure:

  1. Functional kyphosis: is usually compensatory for other misalignments of the spine, but can be compensated for
  2. Fixed/structural kyphosis: can no longer be compensated for due to bony changes in the vertebral bodies

and by shape:

  1. Arcuate kyphosis: arch-shaped, spanning many spinal segments
  2. Angular kyphosis: angular kyphosis affecting only one or two segments, usually caused by trauma, inflammation or tumors

ICD M40 ff and others

Cause

  1. congenital due to vertebral malformations such as block vertebrae (fused together) and hemivertebrae (triangular in lateral profile, i.e. ventral or dorsal without height)
  2. Sintered fractures in osteoporosis resulting in wedge vertebrae
  3. Osteomalacia
  4. Scheuermann’s disease (usually 12th – 17th year)
  5. Ankylosing spondylitis
  6. WS tuberculosis
  7. Arthritides
  8. WS traumas

Predisposing

– Behavior

  1. Lack of exercise
  2. sedentary work
  3. Psychological factors influencing attitude such as shyness, depression

– Musculoskeletal system

  1. Weakness of the back muscles, reduced stability

Diagnosis

  1. Determination of the Cobb angle (Cobb actually invented this in the frontal plane to measure scoliosis: Angle between the normal of the top plate of a more caudal vertebra and the base plate of another caudal vertebra, usually Stagnara angle between TH4 and TH12)
  2. Eye diagnostics

Symptoms

  1. Generally asymptomatic to asymptomatic
  2. Increased tendency to protrusion and prolapse in the lumbar spine and cervical spine in the long term
  3. possibly more difficult or limited inspiration
  4. Decrease in body size
  5. Possibly limited shoulder flexibility
  6. Possibly back or neck pain
  7. Resting posture, as movement often worsens
  8. Pain may radiate into the extremities
  9. possibly sleep disorders
  10. possibly persistent headaches

Complications

  1. Disc hernias with radicular symptoms
  2. Spinal canal stenosis
  3. Facet syndrome
  4. Expression of compensatory lumbar spine hyperlordosis
  5. Expression of additional Scheuermann ’s scoliosis
  6. In post-Scheuermann’s syndrome, tendency to chronic back pain
  7. Increased risk of spondylarthrosis and disc hernias

Therapy

  1. Specific stretching and strengthening exercises to compensate for muscular imbalances
  2. Training of postural awareness
  3. KG
  4. Postural gymnastics
  5. Indications for surgery:
  6. Filling with bone cement for wedge vertebrae

Asana practice and movement therapy

The treatment of functional hyperkyphosis of the thoracic spine must take into account the structure of the lumbar spine. If hyperlordosis is present there, treatment of the hyperkyphosis of the thoracic spine will hardly be successful in the long term if the lumbar hyperlordosis is not also treated. The conditions there, such as frequently shortened hip flexors and possibly hypotonic or weak hip extensors, then require urgent treatment.

The thoracic spine itself is mainly improved by two measures: promoting extensibility and promoting (strengthening) the extending muscles, i.e. the autochthonous back muscles. The former can be excellently achieved with prolonged passive stretches in which the gravitational force of a partial body weight extends the supported or unsupported thoracic spine. This category includes the hyperbola, increased back extension, shoulder opening on the chair and lying on the roller. Strengthening is achieved through all postures in which the thoracic spine is actively extended with or against the force of gravity. Gravity does not play an overriding role here, rather the flexibility restrictions of other joints involved in the posture. In salabhasana, for example, the autochthonous back muscles work against the force of gravity of a larger partial body weight (upper body with head and arms on one side, pelvis and legs on the other side), which also has a large effective lever arm on both sides, cranial and caudal, especially in the variant with the arms in an overhead position. The same applies to the 3rd warrior pose and, in relation to the supported partial body weight, to the right-angled uttanasana. The bridge (urdhva dhanurasana) also extends against gravity in relation to the supporting body structures, which can be seen as a fixed point, but the hip and shoulder joints also generally offer great resistance to the movement, so that gravity is no longer a dominant factor. In postures such as upavista konasana with block, gravity plays an even smaller role and only the body’s internal ventral muscular resistance is worked against.