Kyphosis, hyperkyphosis and round back: What are its causes, manifestations, treatment?

Kyphosis refers to the natural, normal curvature of the spine. It is present in every person. 

Naming of pathological - pathological , and thus excessive curvature of the spine in the sense of kyphosis =  hyperkyphosis .

An excessively bent spine is not just an aesthetic problem. In more serious cases, it can cause various more or less serious problems.

Will it only be caused by incorrect posture? Or is it necessary to look for the cause deeper? Why do we have a crooked back?

We provide more information after a brief introduction to the backbone issue.

More and more children, adults, and the elderly have difficulty with the spine. It is a problem of civilization, which is associated with the modern age, lack of movement, and a generally sedentary way of life.

Long-term sitting - inactivity may seem attractive for a while, however, for our spine it is literally devastating.

Why is that so?

Muscle and ligament corset weakens. It is not able to functionally support the spine as a whole.
Muscular disbalance causes disease changes across the musculoskeletal system, which results in poor posture and poor movement mechanisms.

These changes have a wide negative effect on vertebrae, intervertebral discs, and other components of the locomotor system.

Constant uneven load, the effect of aging, ie degenerative changes support various disease processes. We also write about some of the articles:

• osteochondrosis - degenerative involvement of the intervertebral disc
• spondylosis - affecting the vertebrae and surrounding soft structures
• spondylarthrosis - involvement of small joints of the spine
• disc hernia - arched, extended plate

The spine is a whole composed of ...

The spine has an important motor function. However, it does not end there. It is also important to support the body, which carries the weight of the organism.

This functional unit consists of vertebrae, intervertebral discs, small intervertebral joints, ligaments, or muscles. Naturally, it is also necessary to think about the nervous system. As the spinal cord passes through the spine, the nerves leading to the whole body recede.

The vertebrae are grouped together. There are 33 to 34 vertebrae in the human spine.

Dividing the spine into several sections:

• the cervical spine  has  7 vertebrae, abbreviated C1 to C7
• the thoracic spine contains  12 vertebrae, ie  Th1 to Th12
• lumbar spine  - has  5 vertebrae, namely  L1 to L5
• sacral spine  -  5  or  6 vertebrae, S1 to S5 (S6)
  • they are fused to the  axes of the sacral, or sacrum
• coccyx  -  4  or  5 vertebrae, namely  Co1 - Co4 (Co5)

In Latin, they are referred to as vertebrae: 

• C - vertebrae  C ervicales 
• Th - vertebrae  Th oracicae 
• L - vertebrae  L umbales 
• S - vertebrae  S acrales 
• Co - vertebrae  Co ccygeae 

The spine makes up about 35% of the length of the human body.
It is referred to in Latin as columna vertebralis. 

There are intervertebral discs between the vertebrae. These serve as a connection of vertebrae. But they also have a locomotor and damping function. This means that their function is:

• shock absorption  when moving, walking, running and jumping
• spinal stabilization
• maintaining balance
• balancing the compressive  and tensile forces, which are distributed over the entire surface of the vertebrae
• participating in the  movement,  bending,  or  rotation of the body

Wondering how many plates we have?

We have 23 pieces of intervertebral discs. 
They fill the intervertebral space from vertebrae C2  and  C3 to L5 and S1. 
Latin: Intervertebral discs. 
It is also known from their designation disks. 

The discs are flexible but rigid. In each section of the spine, they are adapted to their specific functionality. For example, we can move our necks perfectly. On the contrary, we move less with the shaft, however, this section bears the highest load.

In the lumbar part of the spine there are vertebrae and plates of larger dimensions.

The plate consists of two main structures. And that is the ring and the core.

The ring, technically annulus fibrosis, is a flexible wrapper that has multiple layers (similar to an onion). In the part where the plate touches the vertebra, there is also a cover plate, the vertebral endplate, which is important due to innervation and blood flow.

In the interior, there is a nucleus, and thus a nucleus pulposus.

The nucleus does not have a blood supply if its nutrition is largely due to movement. Movement, repeated loading of the surface, alternation of squeezing and releasing, which occurs, for example, when walking. This conditions the flow and flow of fluid inside the disks.

Picture of sponge.
When you squeeze it - you expel the fluid from it.
When the sponge expands to its original size again - it absorbs fluid.

The fluid cycle around the nucleus works similarly. This water contains oxygen and important nutrients for the disc core. Plus, it is necessary to get waste materials from this area as well. 

Disruption of this mechanism contributes to degenerative changes.
So sitting and inactive life = reduced plate nutrition.

It is precisely for this reason that I emphasize the importance of movement in human life.

Likewise, movement is also needed for the muscles and ligaments of the spine. Stiff and shortened muscles do not fulfill their function. This results in muscle imbalance.

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The spine is sigmoid. This bend is natural and is called lordosis, kyphosis, and scoliosis.

The S-shaped shape of the spine is referred to as:

• lordosis
• kyphosis
• scoliosis

The S-shaped shape of the spine is justified in the  support and  carrying of the body weight , in the absorption of shocks  during  movement and in the location of the body's center of gravity.

Lordosis is a curvature forward. This type of curvature is the bent cervical and lumbar part of the spine. Cervical lordosis has 20 to 40 degrees. Lumbar lordosis 40 to 60 degrees.

Kyphosis is in the area of ​​the thoracic spine. It reaches 20 to 40 degrees. The bending character is similar in the cross-section.

Scoliosis is a lateral curvature. This bending of the spine is considered to be up to 10 degrees physiological.
If it is more than 10°, it is a pathological deviation of the spine.

Muscle disbalance

This is a disorder of the musculoskeletal system. It is generally thought of a disorder of function, coordination, balance of muscles , which interact with each other and complement each other when standing or moving.

The disorder can take various forms. An example is excessive tension or, conversely, muscle weakness.

It is caused by uneven loading, incorrect posture, poor movement habits, inappropriate and incorrectly performed sports activity, injury, sedentary lifestyle.

As a result, there are pains of the musculoskeletal system, muscles, joints, spine. On the outside, it can be seen in posture or movement.

In the given issue, we also encounter the designation:

Upper and lower cross syndrome.

Upper to indicate muscle imbalance in the upper half of the body. Lower for that lower half.

In certain muscle groups, a predisposition to disorders is stated, namely their shortening or, conversely, weakening.

Muscle shortening occurs, for example, in muscle groups:

1. neck:
• musculus trapezius - trapezius muscle 
• musculus levator scapulae - scapula lifter
2. muscles of the spine - musculus erectores spinae
3. pectoral muscles - musculus pectoralis
4. musculus iliopsoas - a group of pelvic and lumbar muscles
5. thigh muscles:
• musculus quadriceps femoris - quadriceps thigh muscle
• hamstrings, i.e. the hind thigh muscles, for example the biceps femoris muscle
6. calf muscles - musculus triceps surrae

Weakening, weakening of muscles occurs, for example, in muscle groups:

1. neck benders - musculus colli
2. interscapular muscles - musculus rhomboideus, ie the rhombus muscle
3. abdominal muscles - musculus rectus abdominis, which is a straight abdominal muscle, but also oblique abdominal muscles (musculus obliquus abdominis)
4. sciatic muscles - musculus gluteus maximus, medius and minimus, ie the largest, middle and smallest sciatic muscle
5. foreleg muscles, example of anterior tibialis muscle

Upper cross syndrome

It is a condition of muscle imbalance of the upper half of the body. The muscles are overloaded for a long time, they shorten and weaken. In this case, hyperkyphosis occurs in the thoracic spine.

It is possible to observe:

• cervical hyperlordosis, an extended chin that overloads the muscles and skeleton of the neck
• round back
• shoulders fallen forward
• protruding blades

The result can be pain in the neck, neck, moving to the head, shoulders, arms, upper limbs and between the shoulder blades. Pseudoradicular syndrome in this area may also be associated.

Lower cross syndrome

In this form, there is a muscle imbalance between the muscles of the spine, pelvis and lower limbs. There is a stem hyperlordosis.

This syndrome is more common.

The basis is the shortening and tension of the muscles of the back, pelvis and thighs, while weakening the muscles of the abdomen and sciatic muscles. It is manifested by pain in the back, stem, hips, lower back, and even overloading of the hip joints with the risk of developing coxarthrosis. 

TIP: read the article Lordosis.

Hyperkyphosis is defined as ...

Hyperkyphosis is excessive anteroposterior deflection of the spine. It is evaluated in thoracic kyphosis above 40 degrees.

Degrees of kyphosis:

1. angle of inclination 31 - 40 degrees
2. 41 to 40 degrees
3. 51 to 70 degrees
4. 71 and more degrees

Kyphosis often occurs in scoliosis, in which case it is referred to as kyphoscoliosis.

It most often develops in the thoracic section of the spine. In some cases, it is not visible or so pronounced that a hump forms. It causes various serious conditions, from pain to neurological complications.

Hyperkyphosis is also referred to as a round back. The peak of hyperkyphosis most often occurs between 6 and 8 thoracic vertebrae.

Hyperkyphosis can be congenital, acquired,  postural.

Congenital development already develops during the intrauterine growth of the fetus, as a congenital deformity of the spine. An example is the structural error of vertebrae, their partial or complete growth - synostosis, missing vertebrae, and the like. It accompanies other developmental errors, diseases, and syndromes.

The acquired form develops in childhood.

It can result from osteoporosis, after injury, surgery, rheumatic diseases, vitamin and mineral deficiencies, as a degenerative form of spondylosis, osteochondrosis, and platelet herniation.

It is stated that it most often occurs as a result of postural errors, ie with incorrect posture. Its poor pelvic position, coccyx, contributes to its part, some of which occurs when compensating for hyperlordosis.

Various sources cite muscle imbalance, ie muscle imbalances. It is an imbalance between the muscles that participate in the posture, ie posture. These are also the muscles of the torso.

In a broader sense described as:

The muscles of the back and pectoral muscles are tense, shortened, on the contrary, the muscles of the abdomen are weakened and elongated. The imbalance further affects the muscles of the shoulder blades, pelvis, pelvic floor, and lower limbs.

Summary of the causes of hyperkyphosis:

• spinal cord injury
• surgery on the spine, chest
• degenerative changes such as osteochondrosis, spondylosis, osteoporosis
• hernia disk
• weakening or paralysis of the back muscles, muscle corset
• TB of the bones
• congenital defects, cleft spine
• incorrect posture
• passive lifestyle, inactivity, sedentary lifestyle
• unilateral loading of the spine
• flat-foot
• truncated one lower limb
• hormonal changes during puberty
• rickets, a curve for vitamin D deficiency
• Scheuermann disease
• tumor
• muscular dystrophy
• obesity
• genetic predisposition and familial occurrence

+ multifactorial effect, and thus a mutual combination of several causes.

Scheuermann's disease

A specific form is a so-called adolescent or juvenile kyphosis, also referred to as  Scheuermann's disease.

It is also defined as structural kyphosis in which deformities of the spine, vertebrae, intervertebral discs are present. The basis is damage to the cover plate of the intervertebral disc, wedge-shaped deformity of the vertebrae, and the formation of Schmorl nodules.

This leads to symptoms like:

• hump
• forward torso
• head extension
• shoulder straps
• nipple spacing
• protruding blades
• lumbar hyperlordosis
• changing the position of the pelvis
• disturbed arch of the feet

It affects up to 10% of the child population,
however,
only 1% have a severe stage.
The most common period of onset of symptoms is the age from 9 to 17 years of age.

It affects boys more often. 

The cause of the disease is unknown.

The symptoms of hyperkyphosis depend on the extent of spinal deformity.

Pathological kyphosis has several degrees. The first is not detectable, as it is in the range of up to 40 °. However, as they increase, so do the various symptoms. 

An example is around the back visible to the naked eye. 

Of course, the difficulties do not end here, as it is not just an aesthetic problem.

In the case of severe hyperkyphosis, the risk increases affecting the internal organs in the chest cavity increases. These are the organs of the respiratory and cardiovascular systems, namely the lungs (limitation of respiratory capacity), the heart, and large vessels.

There is a risk of overloading the vertebrae and plates with long-term pathological curvature. Unilateral loading in front of the vertebrae can lead to changes in their structure, as well as the plates, which contributes to their wear and degenerative process. 

Therefore, early detection of hyperkyphosis and its subsequent early treatment is important.
Delay can mean treatment failure. 
The sooner it starts, the higher the presumption of success.

In hyperkyphosis, symptoms such as:

• back pain
  • cervical, thoracic, and stem
• radiating pain to the chest, to the shoulders
  • fear of cardiac problems for heart pain
• pain in hip
  • hip overload, risk of coxarthrosis
• advanced head
• round back, ie excessive bending up to the hump
• forward foregone shoulders
• limitation of momentum, especially in the shoulders and upper limbs
• flattened chest and shortened pectoral muscles
• protruding blades
• bulging belly
• harden and muscle tension
• change of pelvic position - overhanging pelvis
• development of compensatory hyperlordosis in the cervical and lumbar spine
• difficulty breathing and limiting the overall capacity of the lungs
  • especially under load
  • at higher levels and in peace
• neck and stem overload
  • transferring pain to these parts of the back
  • CC and CB syndrome
  • lumbago
  • pseudoradiculopathy
  • in disc herniation and radiculopathy

Also read articles: 
Lumbago
Pseudoradiculopathy
Herniated Disc
Radiculopathy

More serious forms of hyperkyphosis also have a psycho-social impact on the person affected by the disease. Especially for a child in the sensitive period of adolescence.

Diagnosis belongs to an expert in the field of orthopedics, neurology, and pediatrics in children.

The doctor takes a medical history.

An examination follows. He examines the spine with a view, evaluates posture, movement, from different sides - side view, forward bend. It touches the condition of the skin, its sensitivity, muscle strength, muscle stiffness. Evaluates reflexes and neurological status. 

He uses various aids, tests, and methods for the examination (plumb line, rulers, spirit level, screening methods, such as the Adams forward bend test, evaluation of the degree of bone maturity). 

The main imaging methods include X-rays, CT, MRI. Angiological examination in cervical kyphosis.

It is important to recognize whether it is a posture error or a secondary phenomenon in addition to another disease, ie differential diagnosis.

Parents can watch their children: posture, posture, standing, sitting, walking, movement patterns. A smooth bending of the spine in the forward bend, when viewed from the side, can be helpful.

The course of the disease is directly dependent on its form and the extent of kyphosis. In the case of a higher angular deviation, difficulties are assumed across the entire locomotor system.

Of course, the roundness of the back, the typical posture, and the incorrect posture are visible. 

Overload of the spine results in back pain in several sections, from the neck, chest to the trunk and lower back.

Also, excessive bending negatively affects the mechanism of movement when walking. This also overloads the joints of the lower limbs, the hips, so there may be a pain in the hips.

The risk is ...

Vital organs are stored in the chest, which results in corresponding difficulties, such as a reduction in the respiratory capacity of the lungs and a worsening of blood flow. Subsequently, it can also affect the digestive system.

It is difficult to recognize in young children, if in severe form.

The most common period of onset of the first symptoms is the age of the school left. Children crouch for several reasons, which are based on the imbalance of the muscular corset.

This period is characterized by the interplay of several factors, such as:

• long sitting
• rapid growth
• hormonal changes
• lack of physical activity

By about 17 years, the spine is more flexible. Subsequently, it begins to fix - strengthen.

One negative factor is overweight and obesity in young people.