There are three types of spinal curvature: kyphosis, in which the spine of the upper back tilts forward; scoliosis, in which the spine curves either to the left or right; and lordosis, when the lower back arches outward. Such problems can either be present at birth or develop later.
Many people have a small amount of forward rounding of their upper back, but doctors don’t usually consider the problem to be kyphosis unless the degree of rounding is greater than 40 degrees. If the cause of kyphosis is long-standing poor posture or an underlying disease process, the degree of rounding is likely to increase and may cause painful symptoms.
When kyphosis is severe, symptoms may include not just a rounded back but also backache and some breathing difficulties. This last symptom is because the forward tilt of the spine pushes the ribs in toward the lungs and constricts their ability to expand.
What Causes Kyphosis?
When a curvature is present at birth, it’s likely that it’s been caused by a rare developmental problem that fused or distorted the baby’s vertebrae. Kyphosis may also develop during adolescence, especially in girls, when slouching posture stretches the ligaments that support the spine. Scheuermann’s disease, a condition of unknown cause that runs in families and affects more boys than girls, may have the same effect. When kyphosis develops in adulthood, it is usually due to another condition, through poor posture also plays a part. The culprits may be osteoporosis, which sometimes leads to a dowager’s hump; osteoarthritis; rheumatoid arthritis; and ankylosing spondylitis. Occasionally, disorders that affect muscles and connective tissue or tumours may also be responsible.
Good posture is vitally important, especially during late childhood and adolescence, so encourage your children to adopt a correct posture. For adults, physiotherapy may be useful. If you think you’re developing kyphosis, consult a doctor.
While kyphosis is an outward and upward curve of the thoracic spine, scoliosis is a spinal curve in a different plane – either right or left of a normal spine, as seen from behind. In the classic manifestation of scoliosis, the spine comes to adopt either C or S shape.
Scoliosis affects about twice as many girls as boys, and is most likely to develop any time from early childhood through to adolescence.
Other than the curvature of the spine – and sometimes a difference in the apparent height of the shoulders or the hips – there are often no symptoms, though there may be some back pain. In severe cases, the curvature of the spine may affect the movement of the ribs and even the heart, causing shortness of breath and chest pain.
What Causes Scoliosis?
In about 80% pf cases, the cause of scoliosis is unknown, though the condition often runs in families. However, an apparent scoliosis can also result from muscular imbalances caused by poor posture, a discrepancy in leg length or overdevelopment of the muscles on one side of the spine, as is seen in some professional tennis players. Another type of scoliosis – generally referred to as functional scoliosis – can develop as a response to a painful stimulus, such as herniated disc. Or sometimes a severe form of the problem results from a defect in a way that the spinal bones develop in the womb (congenital scoliosis).
Osteoarthritis and osteoporosis can also cause scoliosis if the damage they cause mostly affects one side of the spine.
Scoliosis can generally be prevented only when it is caused by muscular imbalances that are created, and then worsened, by poor posture. In those instances, paying attention to your posture can help stave off the problem. Physiotherapy may help in this situation.
Figuring Out What’s Wrong
X-ray of the spine will be helpful to see the severity of the scoliosis.
Fixing The Problem
Functional scoliosis is treated by addressing the problem causing the muscular imbalance, often by means of physiotherapy. When scoliosis is idiopathic in a young person, a brace may be fitted to stop the curvature from becoming worse as growth continues. Surgery is generally advised for a young person if there are additional symptoms such as pain, breathing difficulty, or heart problems. Depending on the cause, this may involve the realignment of vertebrae followed by spinal fusion to fix them in place, or the removal of osteophytes – bony outgrowths from the vertebrae – formed as a result of osteoarthritis.
The left hand side of the picture shows a natural inward curve of the vertebral column in the lower back. In some people this becomes exaggerated, and in these cases the condition is known as lordosis.
Lordosis can cause pain and limit movement. It also reduces the spine’s efficiency as a shock absorber. As a result, even minor injury can cause damage to muscles, ligament, and vertebrae.
What Causes Lordosis?
Although lordosis tends to run in families, and in some cases can be present at birth as a result of developmental problems in the womb, most cases are caused by bad posture. The problem can also arise in later life as a result of a number of other conditions that cause degeneration of the spinal column, such as osteoarthritis and osteoporosis. Injury to the neck and back can also be a contributory factor.
What Are The Symptoms?
Apart from an unnatural and ungainly posture, neither cervical nor lumbar lordosis usually cause any symptoms, other than mild limitation in movement and sometimes mild discomfort. On rare occasions, severe lordosis may cause pressure on nerves as they leave the spinal cord, causing problems at the nerve’s root.
The most important preventive measure you can take is to be vigilant about maintaining good postures at all times, and to be ready to make necessary adjustments throughout the day.
Figuring Out What’s Wrong
Lordosis is diagnosed by observation and confirmed by X-rays. The doctor will also check on the range of movement of your spine to see if it has become limited in any way.
Fixing The Problem
Often mild lordosis does not require specific treatment. But if the condition is causing pain, you may be advised to take medication or injection. A physical therapy program may be suggested, with the aim of improving your range of movement.
The emphasis of treatment is on correcting your posture and maintaining the improvement by constant vigilance.
Dr Mathew Tung