Biomechanics of Kyphosis!!

[junior_physiotherapist]

Well,

May kindly here I can ask for any feedbach regarding the biomechanics of postural kyphosis [wether its structural or aquired].............

In particular regarding the point of thoracic kyphosis the normal response of the body will be lordosis at lumbar ?and then anterior pelvic tilt!! Is the the correct sequence for biomechancic?


Any help would be much appreciated

Thanks in advance ........

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[gcoe]

I think your questions are a bit hard to answer as there is no one condition and no one iundrelying pathology. It is a very complex set of problems and so ther is no one simple biomechanical adaption. If you are talking about purely postural changes due to movement impairment syndromes and where there is no underlying pathology such as Schuermanns then increased thoracic kyphosis tends to go with increased lumbar and cervical lordoses. theris likely to be length related weakness of the erector spinae at the thoracic level and protracted, downwardly rotated shoulder girdles with length related weakness of the lower and mid trapezii. The patient is likely to have limited full active forward elevation of the shoulders due to lowrer trap weaknesses and tightness of the pectoral muscles, lat dorsi etc.at the neck the neck extensors and sternocleido mastoid may be overdeveloped producing a poke chin position while the deep nck flexors are weak. At the lumbar spine there is likely to be over developed erector spinae but weakness of the lower abdominals and the hip may also have muscle changes. As you say the pelvis may be tilted anteriorly. But what causes what or is it a total motor pattern.

But you have to assess for all these things

[junior_physiotherapist]

Thanks alot of Gcoe . ............actually the physician referall did not include the cause of kyphosis,,,,,,,but its a congenital problem.............
all the findings u mentioned above are there..........but sorry still miss the point regarding:[so would u please re-formulate them in other words]

at the neck the neck extensors and sternocleido mastoid may be overdeveloped producing a poke chin position while the deep nck flexors are weak. At the lumbar spine there is likely to be over developed erector spinae but weakness of the lower abdominals and the hip may also have muscle changes. As you say the pelvis may be tilted anteriorly. But what causes what or is it a total motor pattern.


thanks once again for all.............

[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.

[junior_physiotherapist]

Gcoe.................many thanks for your kind replies

Subjective information:

sex: female age: 23yrs right handedness occupation: computer programr
Diagnosis: thoracic kyphosis
x-ray: AP view and L-view for the thoracic area
other health problems: none!

Objective information:

Posture: forward head posture, with jaw retruted back,rounded shoulders with internal rotation attitude [thus reflects which are tight and fascilated muscles]
angle of kyphosis:......i dont know how it would be measured
sensation:......
Respiratory function: cant able to take deep breath and/or hold it for seconds
tall: considers short!! [used to wear high heel]
gait pattern: fast walking with shoulders rounded and pushed forward!!

P.S.........I think MRI is expensive not only in Palestine but all over the world........ According to the patient case,the physician decide if the patient needs further investigation.....................




Thanks once again for all................appreciated

[Dr Damien]

Dear Junior_physiotherapist

The difference between structural and acquired deformities?

well, simple really, can the patient correct her posture to what is seemingly a near normal posture? if she can, then this is a postural syndrome,
If she cant, then some aspects of her posture is structural...

you havent said what the clinical problem is really, there are so many people walking about with less than optimal postures, I would say perhaps 99.9999% of the population with no problems...
so again I ask what is the clinical problem...

Pain?, you mentioned breathing difficulties? is this because of her posture (which i believe is contributing) or does she have an underlying respiratory condition...?is she a smoker? whats the family history like?
what does she want herself? postural advice...? again...is it pain?

if you suspect that the problem is structural and she is hoping for cosmetic treatment then you can attempt to correct what you see...otherwise send her to a surgeon and let her go...

without a clinical/functional problem...i dont see why this patient is coming to you anyway...I have a bad posture...i am a fast walker, i cant hold my breath deeply for too long, but i am not seeing a physio...

cheers

[gcoe]

Hi JP

I forgot about this recent article I read but you may find this useful for your patient. It examines the reliability of a measure for kyphosis using a two readings from a bubble inclinometer. if you don't have a bubble inclinometer it is a very useful goniometry device to purchase and there are multiple protocols available for various measures of posture and ROM of different body segments. Personally I prefer it to a standard arm goniometer.
The background to the article also covers some of the health issues that people with kyphosis may experience so that and the reference list may be quite informative

BioMed Central | Full text | Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain

[junior_physiotherapist]

Gcoe, Dr Damine............many thanks for yours replies