A flat back is a deformation of the spine in that it extends in a straight line from the top cervical vertebra to the pelvis. Normally, the spine is subject to a natural curvature with the purpose of cushioning our daily movements. While in the cervical region there is a forward curvature, in the thoracic region there is a backward curvature. In the lumbar region, the spine in a healthy person curves forward again as in the cervical region. The flat back can therefore not take over the function of cushioning due to this missing S-curvature. This leads to pain in the affected person.
What is a flat back?
A flat back is usually recognizable by an exceptionally bolt-straight posture and a stiffened neck. These manifestations are caused by the lack of or below-average S-curvature of the spine, which in most cases mainly affects the lumbar region. The flat back is particularly noticeable when lifting heavy objects. Here, the pressure of the load can no longer be distributed evenly, resulting in overloading of the intervertebral discs and joints. The result is severe back pain. Children also suffer from this phenomenon very often. From this, in addition to the main symptom of back pain, listlessness, fatigue and irritability can develop.
Causes
There are many causes of a flat back. On the one hand, this deformity can be triggered by poor posture. This is particularly common during adolescence, as the spine is still growing during this period. Here, an abnormally increased backward curvature of the thoracic spine or even a hump can develop during this critical growth phase. The disease is also known as Scheuermann’s disease and can also be the cause of a flat back. Temporary posture errors in youth thus become permanent, since the spine is oriented to this incorrect posture in its further development. Furthermore, other diseases of the spine such as rickets lead to this phenomenon. This is a vitamin D metabolic disease that leads to softening of the bones, and thus the bones can not withstand the daily load. For example, they may deform into a straight line, contrary to the natural S-curvature. But surgical errors, such as the incorrect placement of implants in the spine, can also deform a healthy back in the direction of a flat back.
Symptoms, complaints and signs
Externally, a flat back appears to be flawless. The back is not curved forward (lordosis) or backward (kyphosis). However, it also lacks the physiological S-shape of the spine, in which the thoracic vertebrae curve slightly outward and the lumbar vertebrae curve inward. A person suffering from a flat back appears bolt upright and stiff. With the normally slightly curved spine, the forces are cushioned from top to bottom. This is particularly advantageous when carrying heavy loads. However, this cushioning is absent in the case of a flat back. Even when simply standing or walking, the full load of the upper vertebrae presses on the vertebrae below. This leads to increased wear of the vertebral bodies. The high pressure on the lower vertebrae also prevents their optimal nutrient supply. The result is severe pain, which is especially aggravated when lifting heavy objects. The pain of a flat back is comparable to the pain of pronounced kyphosis or scoliosis. Without treatment, it can quickly lead to severe wear and tear of the vertebral bodies with significant limitation of mobility. In addition to back pain and restricted mobility, affected patients often suffer from fatigue, listlessness and poor performance. The consequence of this is a deterioration in quality of life, which can also lead to depression and further mental illness.
Diagnosis
Flat back is considered in itself only a symptom. Thus, the diagnosis is made on the basis of an underlying condition, although other presenting symptoms should also be considered. In general, the affected person has an abnormally straight posture. This must be confirmed by X-rays taken by the physician. In the next step, the causes of this symptom must be investigated.Triggers can be, in addition to the already mentioned causes such as rickets or errors in performed fusion operations, also intervertebral disc diseases or the atypical Scheuermann’s disease. In the case of disc-related diseases, the physician should perform an MRI.
Complications
With a flat back, the patient suffers from relatively severe pain. These can occur either under stress or in the form of pain at rest, severely restricting the patient’s daily life. As a rule, there is also a restriction of movement and thus a decrease in the quality of life. In many cases, patients also complain of fatigue and listlessness. It is not possible to compensate for the fatigue with sufficient sleep, so the patient feels weakened and has a general feeling of illness. Children can also suffer from a flat back and are thus restricted in their physical development. The pain usually has a negative effect on the psyche, so that most of those affected also suffer from depression and other mental complaints. The pain usually also causes increased irritability and aggressiveness. These factors can have a negative impact on the environment and social contacts. The treatment of flat back is usually carried out with the help of various exercises. In this process, no further complications occur. In severe cases, surgical interventions may be performed. The course of the disease is usually positive and does not affect life expectancy.
When should one go to the doctor?
Although treatment for flat back is not always necessary, it should still be performed to avoid further complications and discomfort in the daily life of the affected person. The patient should always see a doctor for this condition if there is severe back pain in everyday life. This occurs mainly when lifting heavy objects or during everyday movements. Therefore, if this pain occurs without a particular reason and especially permanently, a visit to a doctor is necessary in any case. The back loses its typical S-shape, so that the affected person suffers from a stretched-out back. A visit to a doctor is always necessary for this complaint as well. The diagnosis and treatment of the disease can be done by an orthopedist or by a general practitioner. In some cases, however, sufferers rely on surgical intervention to relieve the discomfort. Various exercises and therapies can also help alleviate the discomfort of this condition. With early treatment, the likelihood of a positive disease outcome increases.
Treatment and therapy
Only after the causes of flat back are clarified, an appropriate therapy can take place. In this process, flat back can usually be identified as a symptom of another underlying disease. Alternatively, it may be a result of a postural deformity during adolescence. Rarely, surgery is performed for treatment. The exception to this is a secondary change in the intervertebral discs and joints that has already occurred, in which case damaged discs are surgically removed and the spine can be corrected and stabilized with metal plates and screws. However, these surgical interventions are only performed in cases of severe flat back. Also, permanent therapy is often not necessary for flat back. In most cases, a few balance and equilibrium exercises on an uneven surface are sufficient to restore spinal balance. The patient learns to control his posture and, in addition, the muscles are strengthened. This also maintains the mobility of various spinal segments, preventing stiffening of the body. In the case of acute complaints, conservative treatment methods such as physiotherapeutic treatment according to Brügger are used. In this holistic therapy based on neurophysiology, individual dysfunctions of the locomotor system are analyzed and the pain and disturbing factors are treated. But also stretching exercises of the thigh muscles or a compensation of the muscular imbalance in the hip, lumbar and pelvic area can be treatment methods for the diagnosis of flat back. However, if the flat back remains untreated for a longer period of time, it becomes difficult to restore the normal curvature by simple exercises.
Outlook and prognosis
The prognosis of flat back depends on the extent of existing symptoms and the causative disease present. Affected individuals who suffer from no other impairments, such as pain or limited range of motion, have a good outlook. In most cases, the health of these patients is stable and will cause few problems over a lifetime. If the flat back is due to postural damage, the time of diagnosis and the intensity of the damage are decisive for the healing process. The younger the affected person is and the smaller the defect, the more likely it is that health will improve. With targeted training and exercise sessions, symptomatic relief can be achieved. Freedom from symptoms is quite possible if the patient cooperates well. In some cases, surgical intervention is necessary. In this case, the prognosis is individual and depends on the existing damage. The aim is to reduce the symptoms and thus optimize the patient’s well-being. A cure is not always achieved. Many patients have to undergo lifelong stretching exercises and other physiotherapeutic training to maintain their health and at the same time counteract any deterioration. In the case of metabolic disease or surgical defects, the prognosis must be evaluated according to individual circumstances. There are good treatment options for both that lead to improvement or recovery.
Prevention
To prevent a flat back, it is advisable to regularly exercise the back and abdominal muscles with suitable exercises such as trunk lifts, front supports or iso-crunches. In addition, care should be taken to maintain correct posture, whether sitting or standing, through educational measures. Suitable seating furniture, especially in the office, can positively support this.
Aftercare
In many cases, the flat back is so pronounced that it cannot be brought into the physiologically correct shape. Therefore, aftercare should be seen as a lifelong process where measures are taken to optimally counteract the flat back. The right people to contact are the family doctor and the orthopedist, but guidance from physiotherapists is also helpful. Specialized sports therapists and rehabilitation sports instructors are also the right address for flat backs. Because targeted training is the measure that is particularly important in connection with the flat back. The aim is to bring the flat back as close as possible to the normal S-shape of the spine. This is often best achieved through regular strength training. The core muscles of the abdomen and lower back should be strengthened, as should the chest muscles and the muscles of the upper back. Targeted stretching training is also important. Here, shortened muscles such as those of the back of the thighs or the chest are gently stretched. Footwear is also important as part of follow-up care. This is because if the S-shape of the spine is not as pronounced as it should be due to the flat back, the natural buffer function is missing. Cushioned shoes offer additional protection for the intervertebral discs in this case. Barefoot running helps to strengthen the arch of the foot and additionally absorb shocks well.
What you can do yourself
To combat flat back, there are a few simple exercises that are easy to incorporate into everyday life. For the first exercise, the sufferer gets down on their knees and hands and allows the area of the back to sag where the curvature of the spine is missing. This favors the mobility of the spine. This position is held for between two and two and a half minutes. Pads under the hands help take the weight off the arms. For the second exercise, the person sits down on his heels. Then he or she lowers the upper body until the forehead touches the floor. A backward curve should now be noticeable in the area of the thoracic spine. The position is held for two minutes. The third exercise against the flat back is started as in the second. While sitting on the heels, the head is overstretched backwards. The hands help with gentle pressure on the forehead. On the front of the body, this two-minute exercise stretches that which is in the way of the curvature of the spine. The overstretching of the head can also be done as a fourth exercise while lying down with a mediroll in the neck. By means of these exercises, life with a flat back can be made easier in everyday life.They can be performed quickly and easily, and do not pose any dangers. It is only important to release the position of an exercise slowly so as not to damage the muscles. If problems arise or support is needed, it is recommended to consult a physiotherapist.
