Medical professionals refer to a pathological spinal curvature when its curvature is beyond the normal degree. The spinal curvature occurs as a hunchback, hollow back or scoliosis. Therapy is performed with physiotherapy, aids to support the back or surgically and has a very good chance of recovery in childhood.
What is a spinal curvature?
A spinal curvature is when the curvature of the spine does not conform to the norm. To do this, you need to know that the healthy spine has two curvatures: lordosis and kyphosis. Kyphosis is the backward inclination of the spine in the thoracic region, while lordosis is the forward inclination of the cervical and lumbar spine. If the lumbar and/or cervical spine are excessively curved backward, the affected person has a hollow back. If the thoracic spine is bent forward too much, the result is a hunchback. Both diagnoses are more likely to be seen as symptoms of incorrect posture or lack of exercise than as diseases in their own right. As a rule, no changes or damage can initially be detected in the spine. Another form of spinal curvature is scoliosis, in which there is a lateral bending of the spine with twisting of the vertebral bodies against each other. This condition occurs in approximately two to three percent of the population, affecting more girls than boys.
Causes
The causes of spinal curvature can often be identified as incorrect posture and inadequate movement and associated inadequately trained abdominal and back muscles. Excessive stretching of the spine backwards, as occurs in some sports, can trigger spinal curvature in the form of the hollow back if the predispositions are present. Other causes of hunchback include genetic predisposition, bone disease, osteoporosis and age-related disc wear. A special case of spinal curvature is scoliosis, for which no causes are known. Researchers suspect misaligned trunk muscles with staggered growth of the vertebral bodies as the trigger of the problem. As a result, there appears to be rotation of individual vertebrae and then twisting and lateral bending of the entire spine. Rarely, bone diseases, pelvic obliquity due to unequal leg lengths, muscular or neurological complaints can be identified as causes of scoliosis.
Symptoms, complaints, and signs
A spinal curvature usually remains symptom-free at first. Affected persons perceive it only as a visual blemish, which is why shame sets in at swimming pools or beaches. With increasing age, however, further negative side effects occur if the condition is not treated. These manifest themselves primarily in back pain. Other organs can also be affected by the deformity. A curvature of the back is regularly associated with muscle tension. Signs of wear and tear, which are only to be expected in old age, then appear much earlier. The back hurts regularly, even without strains being present. Visually, many postural defects are possible. For example, the center of the pelvis is located to the right or left of the center of the head in some patients. There is also the possibility that the pelvis is crooked. Sometimes one shoulder protrudes more than the other. The typical S-shape of the spine is no longer present. Often, the ventral portion of the spine shows more growth than usual. The spinal curvature can affect the entire musculoskeletal system. The feet and knees then also suffer from the deformity. In rare cases, a severe deformity has consequences for the internal organs. The heart, kidneys and lungs then exhibit functional disorders.
Diagnosis and course
Spinal deformity is diagnosed on the basis of a physical examination and postural diagnosis. An x-ray is usually also taken to diagnose the shape and severity of the spinal curvature. In the case of scoliosis, an X-ray can also be used to determine appropriate therapeutic measures. If the patient suffers from scoliosis, changes in the spine are visible and palpable. If the scoliosis affects the lumbar spine, for example, the formation of the waist is conspicuous; in the case of thoracic spinal curvature, the ribs protrude on one side. In order to diagnose a postural weakness, the Matthias posture test is performed.The examinee must stand up straight, close his eyes and hold his arms stretched out in front for thirty seconds. If the muscles are working properly, the patient can maintain the posture for the entire period. Muscle weaknesses will show up accordingly.
Complications
Spinal curvature can result in various complications. Whether and which sequelae occur depends on the causes of the scoliosis, the time of diagnosis, and the patient’s age. Complications are most likely to occur if the spine has been curved for many years. For example, prolonged deformity can lead to signs of wear and tear on the spine or intervertebral discs. In most cases, these are accompanied by severe pain. In addition, there is the risk of a herniated disc or increasing spinal column stiffness. Furthermore, other joints such as the hips or knees can be affected by the disease. Some people suffer from complaints in the chest or abdominal region due to a spinal curvature and the associated shortening of the trunk. For example, there is sometimes a reduction in the size of the chest and abdomen, which in turn has a negative effect on organ functions. Most commonly affected are the heart, lungs, intestines and kidneys. A high-grade scoliosis can even result in a danger to life, such as heart failure, if the function of the organs is severely impaired. The risk of complications also exists in surgical procedures to treat a spinal curvature. However, the risk rate is considered to be rather low and amounts to less than five percent. Possible sequelae of scoliosis surgery include pseudarthrosis, metal fractures including loss of correction, spinal cord injury, partial or complete paraplegia, and infections requiring removal of the implant.
When should you see a doctor?
If abnormalities in the child’s physique become apparent during the course of growth and development, they should be observed. If there is a curvature of the spine, the child should be informed about the correctness of physical loads as well as general movements. Regular corrections should be made in everyday life so that long-term damage can be prevented. If the curvature of the spine can no longer be changed by independent measures or if it takes on a permanent form, a doctor should be consulted. If the body is in an incorrect posture, the muscles are in discomfort and there are limitations in the ability to cope with physical stress, a visit to the doctor is necessary. Pain in the back, irregularities in general locomotion, gait unsteadiness or headaches indicate a health disorder. A visit to the doctor is necessary so that the cause can be clarified and subsequently targeted therapies can be carried out to alleviate the symptoms. If there are general functional disturbances, changes in the heart rhythm and a malposition of the feet or knees, a visit to the doctor is also necessary. Complaints of breathing, disturbances of the digestive tract as well as a diffuse pain experience in the organism indicate organic impairments. A doctor should be consulted so that the cause can be clarified. If athletic activities can no longer be performed without discomfort or if the affected person has problems coping with everyday life, he or she needs a physician.
Treatment and therapy
Therapy for posture-related spinal curvatures involves physical and exercise therapy. In particular, abdominal and trunk muscles must be exercised because strong trunk muscles stabilize the spine. However, the patient must not exercise too much, only a slow build-up of the musculature promises improvement of the complaints. Therapy of scoliosis is more difficult. This is based on a timely diagnosis, ideally during puberty. This is because it is only during this time that growth can be positively influenced with conservative and surgical measures. Prior to therapy, the severity of the spinal curvature is defined and therapy is based on this:
A curvature angle below 20 degrees is observed while physiotherapeutic measures are used to promote a healthy posture. For an angle between 20 and 40 degrees, a corset is additionally prescribed, which must be worn daily for two to three years.When the angle of scoliosis exceeds 40 degrees, vertebral segments are surgically stiffened to halt the progression of the disease.
Prevention
Functional spinal curvatures can be prevented by targeted training of the trunk muscles and sufficient exercise. There is no way to counteract scoliosis.
Aftercare
Aftercare is especially important if the spinal curvature or scoliosis has been treated surgically. Following the surgery, the patient is transferred from the intensive care unit to the hospital’s regular ward after a day or two. As a rule, the patient is then gradually allowed to leave the bed again. Postoperative treatment is started early with daily physiotherapy exercises. However, the extent of the operation must be taken into account when considering the scope of physiotherapy. The patient is often given opiates or opioids for the pain that occurs after the surgical procedure. If the surgical treatment is minor, a weaker-acting opioid such as tramadol is usually given. If the pain is more pronounced, stronger analgesics such as piritramide or morphine may be given. It usually takes 12 to 14 days before the patient can leave the hospital after surgery. Healing progresses more quickly the younger the patient. It usually takes six to nine months for the spine to ossify. During this time, the patient must not participate in sports for the first six months. Medical training therapy (MTT) is an exception. Regular check-ups are also an important part of aftercare. It takes about three to six months to complete medical rehabilitation. Children and adolescents often do not need rehab at all.
What you can do yourself
With a spinal curvature, physical exertion should be adapted to the health possibilities. Overexertion of any kind should be avoided. Lifting and carrying heavy loads should be avoided. In addition, the correct movement sequences in everyday life should be trained and optimized. In this way, the performance of everyday tasks can be improved. The adoption of a healthy posture should be independently checked several times during the course of the day to ensure that there is no increase in symptoms. At the same time, it is important not to trigger any secondary diseases through persistent poor posture. One-sided movements as well as rigid postures should be avoided and balancing movements should be performed regularly. Physiotherapeutic exercises can help improve overall health. These should also be used outside of therapy. Sports activities should be tailored to the needs of the organism. The musculature as a whole should be protected from hardening. Massages, warming clothes, avoidance of drafts and stimulation of blood circulation are helpful for this. If the curvature is severe, walking aids have proven effective. These can lead to straightening of the gait and protect against deterioration. In addition, sleep hygiene should be checked. The mattress should not be damaged and its firmness level should be optimized. In some cases, the settings of the slatted frame should be improved for optimal sleep.
