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People who have a rounded back or hump (kyphosis) often have a hard time in everyday life. Not only does the extreme curvature of the spine provoke severe pain and loss of movement - patients with a hump are still often stigmatized in society. Appreciative terms like widow's or witch's hump are still common among many, which in addition to the physical illness complaints also provokes mental stress. This article should therefore address the disease on a factual level, serve to educate and point out suitable treatment methods.
It may not be immediately apparent to everyone, but the human spine is relatively susceptible to deviations in its upright posture. This is due to the comparatively relatively short time that humans had in the course of evolution to develop their upright gait. The basis for ensuring upright gait is still the correct functioning of the spinal muscles. An extremely sensitive support mechanism, because if the muscles in the area of the spine are weakened by certain influencing factors, a curvature of the spine posture can hardly be avoided.
Kyphosis now denotes such an unnatural curvature of the spine. In detail, it is a strong expression of the physiological spine curvature in the thoracic and lumbar region with a backward (dorsal) curvature. As a result, the natural S-shape of the spine is severely imbalanced, so that an upright posture is hardly possible without targeted countermeasures. There are different degrees of severity of kyphosis:
- Postural kyphosis - The most common type of kyphosis is characterized by a "slightly" curved posture. It is usually caused by poor posture and is usually still relatively easy to treat. Postural kyphosis can affect both young and older people.
- Scheuermann kyphosis (Scheuermann's disease) - A significantly more complicated variant of kyphosis, also known as Scheuermann's disease, which results in a very extreme curvature of the spine. It is much more difficult to treat than postural kyphosis.
- Congenital kyphosis - This kyphosis is usually the result of congenital malformations of the spine and is therefore already pronounced in infancy. Treatment in the early stages of the disease is very important here in order to weaken the further course of the disease as much as possible.
- Nutritional kyphosis - kyphosis, which arises from malnutrition in childhood and is based on nutrient-related growth disorders in the spine.
- post-traumatic kyphosis - Post-traumatic kyphosis is spoken of if the back of the knee is bent due to accident-related vertebral fractures.
It can be seen that there are numerous causes of a hump, which are either congenital or acquired and can be treated better or worse depending on the severity.
Permanent postural errors as the main cause
The saying "work crooked and hunched" is no coincidence. Because in the past extreme physical work, combined with the constant lifting of heavy loads or a permanently bent posture, was one of the main reasons for the development of kyphosis. At the time, this was more likely to occur in old age when the consequences of working life became apparent in a badly worn and curved spine. In modern times, however, kyphoses have become increasingly common even among younger generations.
Damage to posture in adolescence is really on the rise and particularly favors postural kyphosis. In this context, the starting point for their development is usually a decline in the trunk muscles, which is mainly responsible for the stability of our mid-body. This in turn promotes premature wear of the intervertebral discs and vertebral joints. This results in pain, which leads to further protective or incorrect posture. A vicious circle that can lead to a hump at an early age without early countermeasures.
Regardless of the changes in the average age of patients with postural kyphosis, it should be mentioned that today's lifestyle does not only increase the risk of humping in young people. Basically, modern everyday life has more and more situations for old and young, which promote muscular weakness in the supporting apparatus through incorrect posture or lack of movement and thus promote kyphosis. Which includes
- seated professional activities (e.g. office or computer work),
- seated leisure activities (e.g. computer or console games),
- Muscle tension due to stress,
- forward weight load due to overweight,
- and unhealthy eating habits (nutritional kyphosis).
Illness and accidental kyphosis
When it comes to disease-related kyphoses, genetically caused spinal misalignments must first be mentioned. The congenital kyphosis often has its origin in the wrong development of the vertebral bodies, for example in the case of so-called half, wedge or block vertebrae. Congenital nerve diseases such as cerebral palsy can also be responsible for kyphosis in infancy.
In childhood and adolescence, congenital kyphoses usually take a severe course without suitable counter-treatment. In addition, other forms of kyphosis can also easily manifest at this age, since the child's spine is still growing and therefore reacts particularly sensitively to disruptive factors.
For example, pronounced malnutrition in early childhood can lead to nutritional kyphosis. Malnutrition is not only food shortages, but also an undersupply of the spine with important nutrients such as vitamin D or calcium. In adolescence, in addition to poor posture, clinical pictures such as osteochondrosis also play an important role in the development of a hump. The disease describes a disorder in the conversion of cartilage to bone mass and is the most common cause of Scheuermann kyphosis.
Another bone disease that can be responsible for kyphosis is osteoporosis. In the course of this disease there is a decrease in bone density, which can also extend to the vertebral bodies. If the vertebral bodies lose bone mass as a result of the breakdown processes, they can ultimately collapse under the weight that the vertebrae have to carry (so-called sintering fracture). If several vertebrae lying on top of each other are affected, kyphosis results. Usually, the osteoporosis manifests itself in old age, which makes a corresponding humping especially a suffering of older people.
Various inflammatory and rheumatic diseases, such as ankylosing spondylitis or rheumatoid arthritis, can also lead to kyphosis and moreover cause a more or less pronounced course of the disease. Furthermore are
- Accident trauma,
- and metastases
in the area of the bony spine cannot be excluded as a cause. They usually cause significant instabilities in the vertebral bodies or trigger vertebral collapse, which in turn favors kyphosis.
A hump first of all, of course, stands out due to the visually perceptible, extreme curvature of the spine. As a result, patients often feel disfigured and try to hide their kyphosis in a reflexive manner by sparing them, which in many cases not only exacerbates the curvature, but also indicates the patient's mental suffering. The examination of outsiders, as well as the sometimes disparaging behavior of strangers towards those affected is an all too often underestimated source of psychological problems for kyphosis patients who very often have to struggle with self-uncertainty, social fears and depression.
In addition, there are of course other physical symptoms, such as the severe pain that a rounded back causes in the long term. Restrictions on movement are also to be expected, which are manifested in particular in the reduced freedom of movement of the shoulder blades and in this connection frequently provoke unpleasant muscle tension in the area of the neck muscles. Overall, the following symptoms can be observed in kyphosis:
- clearly curved back,
- Posture problems,
- Restricted movement (especially in the area of the shoulder blades),
- Vertebral inflammation,
- severe back pain,
- Neck tension
- A headache,
- Sleep disorders,
- Sensitivity disorders,
- Disorders in organ function (e.g. heart and lungs),
- social fears,
- reduced self-esteem.
Danger: In particularly severe cases of kyphosis, displacement of the vertebrae can damage the spinal cord or the nerve roots. Sensory disorders up to nerve paralysis are a real danger for patients!
The diagnosis of the spine is usually noticeable from a visual point of view due to the typical image of a spine arched backwards, the squat neck and the shoulders falling forward. Various imaging methods are available for securing the diagnosis and estimating possible causes, with X-ray examination, computer tomography and magnetic resonance tomography being of particular importance. The treating orthopedist also uses various devices, such as protractors, which can determine the degree of hyperkyphosis using the so-called Cobb angle. Inflammation parameters and rheumatoid factors in blood samples can also be determined in the laboratory.
The therapeutic measures for rounded backs are strongly based on the causal process. They are designed to maintain the quality of life of the person concerned as long as possible, to reduce pain and to prevent consequential damage. Since the spine, through its connection to the chest, is also closely related to the respiratory mechanics and the cardiovascular system, measures must also be taken to stabilize the heart and lung function.
Conservative therapy is the cornerstone of the treatment of the rounded back. It is at the forefront of both medicinal and operative treatment strategies and must be continued in the home environment as well, since only then can the quality of life be maintained. The conservative therapy approach consists of several components from physical and occupational therapy as well as orthopedics. In this regard, special muscle training should help to strengthen the core muscles and prevent renewed muscle tension, which contributes to pain relief. In addition, targeted training of the back, abdominal and core muscles can improve posture. The use of adapted orthoses provides further support in this context.
Therapeutic breathing training also falls into the category of conservative treatment measures. Through targeted breathing exercises, the breathing mechanics can be improved and lung function secured. Professional relaxation training is also conceivable, for example in the form of yoga or autogenic training, which again benefits the relaxation of the muscles.
The slight manifestation of kyphosis can have causes that those affected are able to remedy themselves. A reduction in obesity, for example, takes additional strain on the spine. The control of the workplace with regard to back-friendly office chairs, an appropriate height adjustment to the desk or a back-friendly working method, which makes an upright sitting position the goal, also contribute a lot to the improvement of the hump. When dealing with technical devices such as smartphones, tablets, computers and game consoles, it is also particularly important to regularly check the sitting posture, since you tend to bend your back routinely when using it relatively quickly. Last but not least, you should also pay attention to a good lying position during sleep. For this purpose, special back-friendly mattresses and pillows are recommended.
When it comes to a lack of exercise in everyday life, the only effective countermeasure is of course more exercise. Regular physical activity is highly recommended for people with kyphosis. Frequently there are special offers such as aqua gymnastics, where the patient's complaints can be dealt with more intensely.
The medicinal plants devil's claw, comfrey and arnica have had good success in the past for the supportive treatment of back complaints. If osteoporosis is the cause, the supportive use of the Schüßler salt calcium phosphoricum has proven itself. This salt supports the calcium metabolism that is involved in the development of osteoporosis.
In the case of kyphosis, the medicinal approach includes the administration of painkillers and relaxants. The latter help to release existing muscle tension and thus minimize the aggravation of the hump by gentle posture. Anti-inflammatory drugs (e.g. cortisone) are also used to treat inflammatory processes and rheumatic causes of the disease. In the event of malnutrition, dietary supplements such as calcium or vitamin D3 supplements are also conceivable.
Important: The drug groups mentioned are only used for the palliative treatment of kyphosis. To this day, unfortunately, there is no drug that can cure kyphosis itself.
If conservative and drug therapy do not (any longer) show the desired success, surgery on the spine is often indicated. The aim here is to stabilize, straighten and, if necessary, stiffen the affected parts of the spine. For this purpose, wires, plates, pins and screws are introduced into the vertebrae using various techniques.
The doctor in charge provides the indication for a necessary operation, because interventions on the back always carry an increased risk due to the spatial proximity to the spinal cord and should therefore not be carried out lightly.
Diseases in kyphosis: malformations of the vertebral bodies, cerebral palsy, deficiency symptoms, osteochondrosis, osteoporosis, ankylosing spondylitis, Scheuermann's disease, rheumatoid arthritis, tumor diseases. (Ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Barbara Schindewolf-Lensch
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ICD codes for this disease: M40ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.