Dr. Patricia Yarberry Allen is a collaborative physician. This week, she takes up the problem of kyphosis, the rounding of the back that, in severe cases, forces those with the condition to walk in a bent-over position. How to prevent this? She calls on the expertise of Dr. James Wyss, M.D., P.T., an Assistant Attending Physiatrist in the Department of Physiatry at the Hospital for Special Surgery in New York City. In today’s post he discusses the forward-head/rounded shoulder posture all too often exhibited by computer users. Then he takes up the serious problems brought on by misalignments of the spine.

Dear Dr. Pat:

My mother and her sister never exercised, and now they have really stooped posture. They are both in their late eighties. My mother’s upper back is hunched over, and she can’t wear regular clothes because her waistline has disappeared! She now has to use a walker because she really has trouble looking ahead when she walks. She never fractured a bone; she has some bone loss, but not osteoporosis. Her doctor told her she had a problem that most old women get, something called kyphosis.
I am 57 and am very athletic. I want to do everything I can to avoid my mother’s problem. What causes this terrible change in posture, and how can it be prevented?

Sarah

Dr. Allen Responds:

Dear Sarah:

Postural deformities are a great problem for men and women as they age. I have asked Dr. James Wyss—a New York City physiatrist who specializes in the non-operative management and rehabilitation of common sports, musculoskeletal, and spinal injuries—to answer your questions. Next week, Evelyn Hecht—a certified athletic trainer and a practicing physical therapist specializing in orthopedics, spine, and pelvic floor health—will discuss exercises and physical therapy modalities that can prevent severe postural deformities. It is true that this issue greatly impacts the quality of life of the elderly, and only prevention begun earlier in life can make a difference.

Dr. Pat

Dr. James Wyss Responds:

Dear Sarah:

The typical human posture is erect or upright, and maintenance of good posture is believed to promote better health. (The word posture is derived from the Latin word positura, and essentially refers to the position or alignment of the body.)

Unfortunately, ideal posture can be challenging to maintain, and the poor posture that develops actually requires the expenditure of more energy to perform routine tasks (e.g., sitting or standing) and can lead to fatigue and pain.

As a physiatrist, or doctor of physical medicine and rehabilitation, I’m very much interested in how the body moves and the alignment, or posture, of the body during activities. Many patients come to my office to address “poor posture” or are referred by another physician or health care professional (e.g., physical therapist) for this reason.

The foundation of human posture is the spine; therefore, these patients require a detailed history and physical examination, which includes close inspection of the spine and possibly spinal x-rays to rule out major problems (fracture, instability of the spine). The human spine has four separate curves when viewed from the side: two inward (lordotic) curves and 2 outward (kyphotic) curves that equally balance each other.

Forward Head, Rounded Shoulder: The Hazards of Computer Work

Major or severe postural problems are rarely identified. I commonly discover routine postural problems, such as forward head and rounded shoulder (FHRS) posture from too much computer work. These common problems are treatable with the appropriate lifestyle changes, daily postural exercises taught by a physical therapist, and ergonomic changes that may require the help of an occupational therapist.

I routinely recommend that patients with desk jobs take postural breaks every hour—even just to get up and walk around the desk or to get a drink.  In addition, complementary movement therapies such as Alexander technique or Feldenkrais method can help to restore normal movements and postures. The above lifestyle changes and treatments can be very helpful for all types of postural problems.

Roundback and Curvature of the Spine

Besides the FHRS posture of desk or computer workers, other common postural problems identified in my practice include scoliosis and kyphosis.

Scoliosis refers to a side-to-side curvature of the spine; it usually develops idiopathically (meaning for no known reason) during childhood, genetics may play a role in development, and the condition often remains stable throughout life. Kyphosis, or roundback posture, refers to an increased curvature of the spine from front to back (see the images above). It commonly develops in the thoracic spine (midback) during adulthood, has known causes, and can become progressively worse with time.

Kyphosis is more common in women. It is often feared, since it causes a loss of height and poor posture. Physicians become concerned with severe or worsening forms of kyphosis because the condition is associated with health impairments that include pain, neurological problems, digestive problems, or even difficulty breathing. Causes of kyphosis include weak muscles, poor daily postures (excessive sitting in a slumped position), poor balance, osteoporosis, and spinal degeneration.

Weak muscles, poor daily posture, and poor balance are physical problems that can be addressed through an individualized exercise program. A physician, or more commonly, a physical therapist, can design an exercise program to improve postural awareness, balance, and core strength. A promising physical therapy treatment for certain types of scoliosis and kyphosis is the Schroth method. This method was developed in Germany and has more recently gained acceptance and popularity in the United States.

A common medical cause of kyphosis is osteoporosis, which can lead to compression fractures of the spine. These fractures, which often occur without trauma and are due to brittle bones, will change the shape of the bone and alignment of the spine. This can lead to the onset of kyphosis or worsening of existing kyphosis. Osteoporosis is a preventable medical cause, and can be screened for, diagnosed and treated if necessary by your primary care physician or specialist (endocrinologist, rheumatologist).

The key to treating any postural problem, no matter the cause, is early recognition and treatment. Although back pain usually prompts a visit to a physician that leads to the diagnosis, changes in your appearance, height, or the way your clothes fit are often clues to abnormal posture. If you or others notice these signs, I recommend discussing them with your primary care physician. Referral to a specialist, such as a physiatrist, may be warranted.

Next Monday, licensed physical therapist Evelyn Hecht, a frequent contributor to Women’s Voices, will outline several exercises that can help in preventing the conditions Dr. Wyss describes above.