Abnormal Spinal Postures:

Kyphosis and Lordosis

 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

Kyphosis Lordosis
– Outward curve of thoracic spine (4) – Inward curve of lumbar spine (4)
– Curving causes a bowing – May occur in the cervical spine

*Descriptions of shape, not diseases. (1)

 Kyphosis
 Born with Pathology
 Infection (TB – lung infection)
 Scheuermann's Disease –
Osteochondrosis of vertebrae  Lordosis
(Bone disease) – Boys 10-15
 Most common in toddlers
 Neurofibromatosis - inherited
disorder of tumors in skin/nerves and girls
 Connective tissue disorders  Born with
 Muscular Dystrophy (MD) –  Benign juvenile lordosis
muscle weakness – Non cancerous tumors
 Spina Bifida - Incomplete  Kyphosis
formation of part the spine)  Obesity
 Disk degeneration  Osteoporosis
 Certain endocrine diseases  Achondroplasia - Improper
 Paget’s Disease - Bone development of cartilage at
destruction and regrowth epiphysis  Dwarfism
 Polio - Viral infection   Spondylolisthesis -
paralysis Forward displacement of a
vertebra
 Tumors
 Diskitis – Inflammation in
 Association with Scoliosis 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 – 33º T3 - T12

Lumbar Lordosis 31 -50º 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  Lordosis
 Stiffness of spine
 Swayback
 Tight hamstring muscles if
Scheuermann's Disease  Exaggerated posture
 Difficulty breathing (Severe  Buttocks more prominent
cases)  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. 
 Baseline for treatment
 Neurologic evaluation - Weakness,
paralysis, sensations, bowel/bladder
changes
 Spine X-ray – Determine severity of
curve
 MRI - Test for tumors, infection, or
neurological symptoms
 Pulmonary Function Tests – Assess
affect on breathing
Lordosis
 Physical exam by doctor
 When curvature first noticed?
 Palpation of abnormalities
 Measure ROM, observe
asymmetry
 Baseline before treatment
 Neurologic Evaluation –
Weakness, 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/Management
 Kyphosis - Depends on the cause Lordosis – Does not always
 *Early treatment in adolescents is require medical treatment
important to prevent progression  Evaluation is recommended for
 Present at birth - Corrective surgery a “fixed” curve
 Postural – PT and postural correction  Anti-inflammatory medication
 Structural – Medication, bracing  Physical therapy - Increase
strength, flexibility, and ROM
 Scheuermann's disease
 Bracing - Control progression of
 Initial bracing and PT
curve in adolescents
 Surgery for painful curves  60
degrees  Reduction of body weight
 Debilitating deformity/pain - Surgery  Surgery
 Severe curves with
 Multiple compression fractures - Left
neurological involvement
alone if there are no neurological problems
or pain  No relief from non-surgical
methods
 Treat osteoporosis to prevent fractures
 Infection or tumor - Surgery and
medication
 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

•Helps flexibility of back

•Stretches back •Stretches legs
•Strengthen legs and buttock
•Stretches hamstrings •Strengthens/shapes upper body
•Stretches abdominal muscles

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

 Recovery

 Kyphosis  Lordosis
– Conservative – Conservative
 Follow doctor/PT’s
 Follow doctor/PT’s
instructions and
instructions and
appointments
appointments
 Activity restrictions
 Home exercise program
 Home exercise program
–Surgery –Surgery
Medication
Prescriptions filled before
Walking encouraged to surgery
enhance circulation and PT
healing
Follow-up visits with
PT
surgeon
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
Results in a rigid excessive curvature
 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. 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.
 Malalignment Answers…

A. Kyphosis C. Swayback

B. Forward D. Lordosis
Head

F. Scoliosis
C. Flatback