Biomechanics of Kyphosis!!

[gcoe]

Hi JP

I am not sure if I really understand your question. But I will do my best to rephrase things. If I have gone off on a tangent message me again. Here goes

• It makes it a difficult to be specific if you don't know the cause of the kyphosis and also the state of the cervical and lumbar spinal regions. Knowing that it is congenital nails it down a bit but there are probably lots of pathologies and therefore lots of causes of congenital kyphosis.
• Knowing when the kyphosis started to develop and if if got worse as the patient grew might help.
• A good saggital image such as an MRI might reveal such things as bony malformations. I take it you practice in Palestine so would I be right in assuming assuming expensive tests like this may be tightly rationed? Even a saggital plain X-ray may reveal a lot. If the kyphosis is marked and multi segmental then one would expect that there is some disturbancece of growth of the vertebral bodies.
• In life a key function of the spine is to keep the head upright and the eyes oriented straight ahead for survival, occupational and social functions. So if we have a marked thoracic kyphosis we can compensate and keep the head upright by increasing the lordoses at the lumbar and cervical spines. To do this we have to constantly work the muscles I outlined above. In this case the cervical and lumbar deformities are imbalances are compensatory. However it is also possible that underlying pathology involves the lumbar and/or cervical spines so that the increased kyphois na d lordoses are part of a total pattern
• One approach I am familiar with is that regardless of the underlying pathology you can evaluate and assess the movement impairment syndromes - a departure from the more medical model but instead concentrate on the relative muscle imbalances at the various mobility sgments. This is the kinesio-pathological model advocated by Shirley Sahrmann. the goal here is realistic correction of the deformity - so you aren't going to "cure" your patient of the kyphosis as if there is an underlying boney problem.

Instead you set about preventing a down ward spiral of increased deformity and eventual, directional hyper mobility and degeneration that is likely to result from the altered biomechanics. You therefore work particularly on strengthening within the inner range the weak muscles that oppose the tight and and overly developed weak muscles. In addition you need to work on improving the motor control of a a better posture so the patient utilises what you gainAnd once you have achieved some gain eg 6 weeks might achieve something, there you need to facilitate and advice a lifetime maintenance program me.

You haven't said very much about the patient so I don't know if this is really appropriate. If the patient is a child you will need to approach this differently and more creatively and perhaps a paediatric physio could better advise you.

Hope this helps.