Exaggerated thoracic kyphosis and compensatory lumbar lordosis

1. 2015
Thoracic hyper-kyphosis
and compensatory
lumbar lordosis

3. PATIENT: Age: 21 years old. Profession: Student.
VISUAL INSPECTION
Findings Observations
• Head: Forward.
• Cervical Spine: Hyperextended.
• Scapulae: Abducted.
• Thoracic Spine: Increased flexion
(kyphosis).
• Lumbar Spine: Hyperextended (lordosis).
• Pelvis: Anterior tilt.
• Hip Joints: Flexed.
• Knee Joints: Slightly hyperextended.
• Ankle Joints: Slight plantar flexion
because of backward inclination of the
leg.
• Elongated and Weak: Neck flexors,
upper back erector spinae, external
oblique, middle and lower trapezius
fibers.
Hamstrings are slightly elongated but
may or may not be weak.
• Short and Strong: Neck extensors, hip
flexors, lumbar spine extensors,
pectoralis minor and shoulder
adductors
FUNCTION TEST OF THE SPINE
Range of ACTIVE movement
ACTIVE movement Findings:
• Normal(N)
• Hypermobility (Hpe)
• Hipomobility (Hpo)
Observations
Flexion
- Lumbar
- Dorsal
D12-D8, D3-D1 (Hpo) • Schober Test:
10 cm from S1 to cranial.
Does it increase 4-6cm?
1cm of increment, which shows us a
hipomobility in the low dorsal area.
• Ott Test (cm). 30 cm from C7 to
caudal. Does it increase 8 cm?
Hypomobility in the upper dorsal area.
It has only increased 4 cm.
Extension
- Lumbar
- Dorsal
Distance from chin to bench (cm)
40 cm. Reference data for monitoring
treatment.

4. Right Rotation
- Lumbar
- Dorsal
(N) 55 grades
Left rotation
- Lumbar
- Dorsal
(N) 40 grades
Right lateral flexion
(S1-C7)
- Lumbar
- Dorsal
D7-D4 (Hpo) 40 grades
Left lateral flexion
(S1-C7)
- Lumbar
- Dorsal
D12-D8 (Hpo) 49 grades
Coupled
flexion/extension
movements
Painful? NO
Non coupled
flexion/extension
movements
Painful? NO

5. TRANSLATORY MOVEMENTS
Translatory movements Findings:
• Normal(N)
• Hypermobility (Hpe)
• Hipomobility (Hpo)
Which segment is
Painful?
Elastic Rebound Test
(from caudal to cranial)
(lumbar and dorsal area)
D8-D12 (Hpo)
Palpation by Spinous Process Impulse
(from caudal to cranial )
(lumbar and dorsal area)
L1-L2
D8-D12
Mild discomfort in the
lower back
Rebound test transverse process
(from caudal to cranial)
(lumbar and dorsal area)
D8-D12 (Hpo)
Lateral compression on spinous
process (lumbar area)
(N)
Segmental Instability: Test with
pressure in the abdomen area from
ventral to dorsal (lumbar and dorsal
area)
D8-D12 (Hpo)
Traslatory joint play in lateral lying
position (lumbar area)
(N)
Global Vertebral compression and
Traction
(N)
Lumbar traction
(global and specific segments)
(N)
Rib Mobility in sitting position
Rib Mobility Test in lateral lying
position (dorsal area)
D8-D12 (Hpo)
Measure the circumference of the
chest at maximum inspiration and
expiration (3’6-6 cm)
Cm? 4 cm of difference between max inhalation and
exhalation.(N)
Maximal inhalation 84 cm
Exhalation 80 cm
FUNCTIONAL MUSCLE TESTING
Spine stability and intramuscular
coordination/weakness ( with
sphygmomanometer)
Mm Hg variability from 40 mm Hg?
Yes
Prone position and quadruped position Does the Pt maintain lumbar stability? No

6. ADDITIONAL TEST
Positive- Negative Right Positive-Negative Left
Rolling pincer Which segment? Pain or
mobility restriction. L1-L2
Which segment? Pain or
mobility restriction. (N)
Connective tissues friction test Which segment? Pain or mobility restriction. (N)
NEURAL TEST
Neurodynamic Right (positive or negative) Left (positive or negative)
Lassegue Test (-) (-)
Bragard Test (-) (-)
Slump Test (-) (-)
Femoral Test (-) (-)
Bowstring Test (-) (-)
Is it possible to perform these actions? Yes or no
Squat Test
With difficulty
Heel support Test
With difficulty
Tip Toe
Yes
Lateral Side Support
Yes

7. Procedure Goal
Global lumbar spine traction grade I-II Pain Relief
Prone trunk lift with fit ball, keeping the
arms aligned with her shoulders and
cervical and lumbar spine in neutral.
For the progression of the exercise the
patient can handheld dumbbells.
• Strengthen spinal extensors of the upper back, middle
and lower trapezius
• Scapula and trunk stabilization
• Reduce anterior tightness.
Prone trunk lift to neutral Strengthen spinal extensors
Base muscle contraction (BMC)
Education:
Sphygmomanometer feedback
maintaining contraction of abdominal
and pelvic floor muscles, during the
extension of the hip and knee.
(40 mm of Hg)
Strengthen and improve motor control of spine stabilizer
muscles
Chest stretching and diaphragmatic
breathing on foam roller applying cross
open technique
Lengthen pectoralis muscles, expand ribcage
Prone hip extension/knee flexion using
theraband help
Lengthen iliopsoas and rectus femoris
Sidelying stretching posterolateral spine
muscle
Lengthen quadratus lumborum and paravertebral muscles
Techniques to decrease adhesions within
the fascial sheaths:
• Cupping technique+ diapason
• Skin rolling
Myofascial Release
Postural correction:
• Sit to stand
• Proper lifting techniques.
• Improve spinal proprioception and postural alignment.
• Integrate neutral spine alignment into activities.
• Gentle oscillations.
• Educate the patient in joint
mobilization technique with
wedge.
Increase joint play in restricted areas.
(D8-D12)
Weighted spinal kyphosis orthosis Provides proprioceptive input to facilitate upright postural
alignment

8. Procedure Goal
Spinomed
Provides proprioceptive input to facilitate upright postural
alignment and facilitates spinal extensor muscle activity
Apply therapeutic tape from the
acromioclavicular joint diagonally across
trapezius to T6 bilaterally
Passive support from the tape
(Additional info obtained of PubMed article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907357/#R19)