kyphosis biomechanics , etiology , treatment, physiotherapy management and recent article

1. DEFINITION:
 General term used for excessive backward convexity of the
spine.
 It is the exaggeration of the posterior spinal curve
localized to dorsal spine.
 Also known as arcuata or round back.
 A condition of over curvature of thoracic vertebrae.
 This causes bowling of the back called as slouching
posture.

2. CAUSES:
 -Habitual bad posture
 -Arthritis
 -Rheumatism
 -Lung affection
 -Neuromuscular weakness
 -Degeneration of vertebral bodies & discs
 -TB
 -Ankylosing spondylities
 -Scheuermann’s disease
 -Congenital anomalies

3. TYPES
 Round Kyphosis
--Gentle backward curvature of spinal column.
--Caused by disease affecting number of vertebra for e.g.
Senile Kyphosis.
--May be localized to a spinal segment or may be diffuse.

4.  Angular kyphosis
--A sharp backward prominence of spinal
column.
--It may be prominence of only one spinous process because of
collapse of only one vertebral body and may occur in
compression fracture of vertebra. This is called knuckle.
--There may be kyphosis localized to few vertebrae and is
known as gibbus, commonly seen in TB.

5. Classification of deformity according to severity
1.First degree kyphosis:
-Habitual bad posture is the precipitating factor.
-There is no imbalance beween the muscles.
2.Second degree kyphosis
-Pectoral muscle becomes short, there by restricting chest
expansion resulting in reduced respiratory function.
-Longitudinal back muscle,rhomboids & middle trapezius are
weakened with loss of tone and are in a stretched position.
-Posterior ligament are lengthened with corresponding
shortening of anterior structures.This result in posterior laxity.
3.Third degree kyphosis
-Wedging of vertebral body may occur.
-The deformity gets organized which is a difficult syndrome.

6. Postural adaptations in Kyphosis
-Rounded back
-Forward head
-Flattened chest
-Rounded shoulders
-Excessive protrusion of scapula

7. BIOMECHANICS
-A normal thoracic kyphosis is due to the slight
wedged configuration of both of the vertebral bodies
and intervertebral discs. Because of this physiological
kyphosis ,the thoracic spine is more prone to be
unstable in flexion.
-The anterior longitudinal ligament & posterior
longitudinal ligament is well developed in thoracic
region.
-Clinicians have noted that ALL is usually thick in
certain cases of abnormal thoracic kyphosis (White
and panjabi)
-Annulus in this region as elsewhere is the major factor
in maintaining clinical stability.

8. Continued..
---During excessive dorsal kyphosis ;
 Compression of anterior vertebral bodies, Increase in
intradiscal pressure.
 Distraction of facet joint capsules and posterior annulus
fibers.
 Stretching of posterior longitudinal ligament & scapular
muscle.
 Shortening of anterior longitudinal ligament and upper
abdominal muscle.

9. continued…
The biomechanical concept, that relates to problem of
instability in kyphotic thoracic spine states that,the
greater the wedge of the vertebral body fracture,the
greater the moment arm and thus, the greater the bending
moment, which tends to produce additional kyphotic
deformity and pressure on the spinal cord, particullarly if
there are disc or bone fragments in the canal(literature by
holdsworth’s).

10. MANAGEMENT;
1.First degree kyphosis
--Relaxation of body especially upper back .
--Repeated stretching session of shortened anterior
structures by bracing shoulder & maintaining position.
--Postural training
--Mobilization of spine, scapula & shoulders.
--Diaphragmatic & costal breathing exercises to
emphasize on inspiration.
--Resistive exercise to weak longitudinal & transverse
back muscle
--Controlled pelvic tilt associated with abdominal &
gluteal contractions

11. 2.Second degree kyphosis
-Milwaukee brace with pads.
-Exercises to improve mobility and respiration to reduce
overall impact of deformity.
3.Third degree kyphosis
-Bone graft
-Spinal cord depression
-Spinal stabilization

12. ARTICLE-1
TOPIC: Rehabilitation using manual mobilization for thoracic
kyphosis in elderly post menopausal patients with osteoporosis
(Journal of rehabilitation medicine, 2010)
Ivan etal took 48 postmenopausal patients with osteoporosis and
randomly assigned them in two groups.
Group 1(n=29),exercise group received 3 months of
rehabilitation (18 sessions including manual mobilization, taping
& exercises) whereas Group 2(n=19),control group didn’t
receive anything. The outcome measures included were spinal-
mouse, VAS & Quality of Life. The result concluded that the
rehabilitation, manual mobilization can attenuate thoracic
kyphosis in elderly patients with osteoporosis.

13. ARTICLE 2
TOPIC: Application of passive transverse forces in the
rehabilitation of spinal deformities ; A RCT(Journal,2002)
Weiss et al. performed a RCT study where they took 2
group,Gr A(n=126) exercises group & Gr B(n=126) control
group. Group A was provided with passive transverse forces
on the deformed body for 4-6 times lasting 20 mins per
session . The treatment was carried out for 4-6 weeks .The
outcome measure included formetric system. The study
concluded that PTF can be useful for deformed spine.