Diseases

Krummer back - causes and therapy

Krummer back - causes and therapy / Diseases

Curved spine

Anyone who permanently assumes an unhealthy posture or often works in a stooping position sooner or later risks a crooked back. Likewise, there are numerous diseases that promote a spinal curvature. Therapy is not always able to make up for the curvature here. However, targeted treatment usually helps, albeit only partially.


contents

  • Curved spine
  • definition
  • The spine directly related causes
  • Non-spinal causes
  • symptoms
  • diagnosis
  • therapy
  • Diseases with a crooked back

definition

The upright posture of man is known to be guaranteed by the special structure of the human spine. In contrast to all other vertebrates, this evolution is perpendicular in humans due to evolution. Beginning at the neck (cervix), the bony structure of vertebrae extends along the chest (thorax) to the lumbar area (regio lumbalis). Candle straight is the human spine despite the upright course but not. Rather, it has a natural S-shape, resulting from the particular arrangement of the individual spinal column sections. These can be subdivided as follows:

  • Cervical spine (pars cervicalis) - the cervical vertebrae are also called C1 to C7.
  • Thoracic spine (pars thoracica) - the thoracic vertebrae are referred to as Th1 to Th12.
  • Lumbar spine (pars lumbalis) - here are the lumbar vertebrae L1 to L5.
  • Sacrum (Os sacrum) - consists of only one vertebral bone.
  • Tailbone (Os coccygis) - also has only one bone.
Natural S-shape of the spine, resulting from the special arrangement of the cervical, thoracic, lumbar, coccyx and tailbone. (Image: 7activestudio / fotolia.com)

Vertebrae consist of the vertebral body and the vertebral arch. The vertebral arches are connected to each other through the vertebral joints. Through the vertebral arches of the vertebra also runs the so-called spinal canal (canal vertebralis), which contains the spinal cord and thus the core of the human nervous system. Overall, the human spine has 24 vertebrae and 23 discs connecting the vertebral joints.

In addition, eight to ten vertebrae are fused in the course of evolution to the two vertebral cross and tailbone. Thanks to the flexible connection between the vertebrae through the intervertebral discs, the best possible mobility of the spine is guaranteed. The upright position of the spine is also ensured by a series of muscles and ligaments, which give the spine elements additional stability.

If the spine now loses stability for some reason, individual vertebrae tilt forward or sideways. The resulting curvature of the spine can lead to various clinical pictures, including:

  • kyphosis,
  • lordosis,
  • ankylosing spondylitis,
  • Scheuermann's disease,
  • scoliosis,
  • spondylitis

    • .

The colloquial term "crooked back" actually hides a whole series of different clinical pictures, which bring about a backward curvature as a side effect. The diseases can be innate or acquired and sometimes considerably restrict the everyday life of the person affected, depending on the severity of the curvature. In terms of origins can be roughly divided into two categories:

  1. The spine directly related causes
  2. Non-spinal causes

The spine directly related causes

Although the spine plays a literal role in posture, it is sometimes very susceptible to numerous health conditions. In particular, the factors influencing a crooked back are very diverse. From rheumatic and inflammatory diseases of the spine, which provoke a crooked back, about genetically induced deformations, which lead to some irreparable back curvatures, to natural signs of wear and growth disorders of the spine with subsequent curvature tendency, there are countless disease scenarios here. Roughly we can name the following disease groups:

  • Congenital malformations,
  • Growth disorders in adolescence,
  • Age-related wear of the vertebral joints,
  • acquired wear of the vertebral joints,
  • vertebral inflammation,
  • Herniated discs.
If the spinal column loses stability and there is a curvature, this can lead to diseases such as B. also have a ban slab result. (Image: Henrie / fotolia.com)

Malformations and growth disorders

The mechanism behind spinal deformities and growth disorders has not yet been conclusively explained. Physicians and experts, however, suspect a genetic component, because diseases such as scoliosis or kyphosis have a significant familial accumulation. In addition, there seems to be gender-specific predispositions, as scoliosis is more common, especially in young girls.

To explain a side-curvature of the spine, uneven growth of muscle and bone in the back area during growth is cited in scoliosis. This should lead to a deviating from the natural S-shape, lateral curvature of the spine and a rotation of the individual vertebrae to each other. Depending on the severity, this curvature can also be seen with the naked eye and show the typical picture of a crooked back.

Kyphosis, that is, the enhancement of the natural curvature to the outside in the thoracic region, are commonly known as humps. They are often due to vertebral malformations, such as a block or hemivertebra.

Rheumatism and inflammation

In the rheumatic and inflammatory disease of the spine, ankylosing spondylitis, a genetic component is also suspected. In addition, weakness of the immune system, which causes recurrent inflammation of the vertebral joints, also comes into play here. As a result, deformations, stiffening and functional restrictions occur in the area of ​​the vertebral bodies.

Scheuermann's disease is a common spinal disease in adolescence whose causes are still largely unknown. The disease causes uneven growth of the anterior and posterior vertebral portions of the thoracic and lumbar vertebrae and results in an increase in disease-related kyphosis. Since twice as many boys as girls are affected, genetic or gender-specific influencing factors are discussed again here.

The rheumatic and inflammatory disease of the spine, ankylosing spondylitis, causes recurrent inflammation of the vertebral joints and, as a result, deformities, stiffening and functional limitations. (Image: anetlanda / fotolia.com)

Joint wear and disc problems

Not only the large joints such as knee, hip and elbow joints, but also the small joints in the spine can be affected by joint wear. The same applies to bone wear, which is by far not limited to the large bones in legs and arms. The bony parts of the spine can also be affected by osteoarthritis or osteoporosis. The wear is always associated with loss of stability in the affected bones and joints, which means in the case of the spine, of course, a loss of stability for posture.

The same applies to a herniated disc, in which the intervertebral discs of the spine detach from their original place. The dislocation is usually associated with severe pain and forces patients so in a curved restraint. However, the spinal curvature can usually be repaired here after the discs have been adequately returned.

Injuries and acquired spinal curvatures

One of the most common causes of a backbone is not based on underlying diseases in the true sense, but rather on a misconduct of the patient. We are talking about malpositions of the spine in the form of unilateral and too strong stress on the spine, through which the vertebral joints wear prematurely. This results in postural damage and ultimately permanent deformations or even fractures on the vertebrae, which manifest themselves in externally recognizable curvatures. One speaks in this case of an acquired back curvature.

Also acquired is a crooked back when it comes from an accidental injury. Damaged vertebral bodies or intervertebral discs may be responsible for the postural damage. On the other hand, accidentally damaged or damaged nerves should not be underestimated as a cause. In the worst case, this leads to a nerve paralysis in the area of ​​the spine, which then provokes unilateral loads in the supporting apparatus, which in turn favor a spinal curvature.

Acquired back curvature due to malposition of the spine in the form of unilateral and excessive stress on the spine. (Image: Africa Studio / fotolia.com)

Non-spinal causes

Based on possible accidental injuries as the cause of a crooked back, it can be seen that the appearance and the stability of the back are not only determined by the bony spine. Basically, it is the result of a complex interaction of muscles, ligaments, nerves and bones. For this reason, diseases that affect the muscular system, the connective tissue or the nerves can lead to a crooked back.

Muscle and nerve disorders

Musculoskeletal and nervous system disorders, especially if they are unilateral, cause an imbalance in the strain on the back. It is not difficult to guess that this one-sided strain on the spine can quickly lead to a curvature of the back. This is often observed in the clinical picture Myasthenia gravis. It is a neurological disorder in which the signal transmission between nerves and muscles is disturbed. Due to muscle weakness, affected back muscles can no longer perform their supportive function for the spine, resulting in a permanent and one-sided burden on even healthy back muscles.

Also the Marfan syndrome, a disease of the connective tissue, often manifests itself in an unnatural curvature of the back, as the disease usually also affects the muscles.

Improper loading of muscles and nerves

With regard to bad postures, which lead to a crooked back, it should be pointed out again at this point on muscular imbalances that cause corresponding postural problems. Due to seat-bound activities, modern everyday life in particular harbors more and more risks of dealing with a crooked back due to inappropriate sitting postures, and this at an early age. While the back curvature was a problem of the older generation a few decades ago, younger age groups are increasingly complaining about problems with their back posture.

The cause of the postural problems at a young age is usually a lack of use of the back muscles. By monotonous and sometimes also relatively immobile postures (for example, permanent sitting in front of the PC) it comes here to a sustained muscle tension, which initially leads to pain and restraint, but later also ensures permanent postural damage that can make the back crooked. Such a scenario is favored by the following everyday factors:

  • lack of exercise - The modern world is full of everyday activities that have little to do with physical work or exercise in general. Even the school days can lay a dangerous foundation here, as the learning load is becoming more intense and young people spend more and more time at the desk than in the open. In addition, computer games and game consoles have sparked a dangerous trend of "crouching in front of the screen squatting" among teenagers and adults alike, encouraging lethargy and improper posture.
  • Seat-bound activities - Apart from the typical "gambler syndrome" in terms of crooked sitting posture, the working world is full of dangers for the back. From service activities such as working in the call center via office work and home office to other activities focused on machines or PCs, there are various risk occupations that favor the development of back bends.
  • Unilateral loadNot only long periods of sitting pose a monotonous continuous strain on the spine. Also, activities that rely on heavy lifting or a stooping posture have the potential to favor a crooked back. Often, this results in a one-sided load on the back muscles, which then causes corresponding deformations of the spine. The same applies, moreover, for a strong overweight. Affected people tend to give in to the weight load and often develop a forward bent posture. The situation is similar for women with an extremely large bust size.
Even schooling can be a dangerous foundation for later back problems, as learning becomes more and more intense and young people increasingly spend time at their desk instead of outdoors. (Image: vectorfusionart / fotolia.com)

Special case: leg malposition

The leg posture has a massive impact on the posture of the spine. Since the legs support the pelvic girdle, the back of which is known to be formed by the sacrum, a leg malalignment can very easily unbalance the spine. For example, having one leg shorter than the other does not just mean having problems with locomotion, as they usually have to limp heavily. At the same time, an uneven leg length also affects the upright position of the spine. Laterally inclined curvatures of the back are not uncommon here. And also forward curves, e.g. by compensatory restraint, are conceivable in leg deformity.

symptoms

The symptoms associated with a crooked back can be very different. Characteristically, however, is usually a visible, left, right, back or front curved posture of the spine, coupled with the resulting back pain. These can occur during the movement or only during the rest periods afterwards.

Depending on how strongly the spine is curved, the curvature also has an effect on the sensibility in the back area. Since important nerve roots in the spinal cord lead to disturbances in the nerve function in vertebral deformities can not be completely ruled out. And also organ displacements and associated dysfunctions in the body are not uncommon in extreme back curvature. All in all, the following symptoms must be expected with a crooked back:

  • Noticeable curvature of the spine up to the hump,
  • Absence of adjacent body parts (for example head, pelvis or legs),
  • muscle tension,
  • back pain,
  • morning stiffness,
  • Inflammatory reactions (e.g., arthritis),
  • premature joint wear,
  • bone loss,
  • nerve disorders
  • Dysfunction of the eyes, lungs, heart and kidney,
  • sleep disorders.
The symptoms associated with a crooked back can vary greatly, ranging from muscle tension and inflammatory reactions to sleep disorders. (Image: Antonioguillem / fotolia.com)

diagnosis

For the examination and treatment of a curved back, patients should consult an orthopedist directly. The curvature can usually be determined by a mere gaze diagnosis. In order to determine the severity more precisely and to be able to find individual causes for the back curvature, however, further investigation measures are usually necessary. An in-depth discussion with the patient about everyday habits and possible pre-existing illnesses can already provide some pointers in this regard. Similarly, the orthopedist will perform some exercise tests to see how flexible spine and back muscles are.

To actually determine the cause of the curvature, imaging procedures such as x-rays or CT are then necessary. An important measure for assessing the severity of a curvature is the so-called Cobb angle. Named after the American surgeon and orthopedist John Robert Cobb, this particular angle defines natural and unnatural spine curvatures, providing information about the severity of a curvature deviation. For example, from a Cobb angle of more than 40 degrees, scoliosis is present. The information obtained by such an angle measurement then give orthopedists information about which therapeutic measures are to be initiated.

therapy

The therapy for a crooked back is strongly linked to the underlying cause. In addition to conservative therapy, as well as medications and surgeries, sufferers can also do a lot themselves and do not have to accept the crooked back as a fate.

Corsets are mainly used by adolescents. By regularly wearing a certain growth control of the spine is to be achieved. (Image: Dan Race / fotolia.com)

Conservative therapy

If deformities of the spine are detected at an early stage before they develop into an extreme course, a conservative therapy consisting of several steps is recommended before the use of medications and surgeries. The main focus is on the regulation of an adapted corset to correct the spinal column and the regular use of physiotherapeutic and ergotherapeutic measures to strengthen the back and trunk muscles.

  • corset: The prescribed support corset is adapted in an operation for orthopedic technology and has the goal to achieve a certain growth control of the spine by the regular wearing. Accordingly, corsets are mainly used by adolescents. Unfortunately, they can no longer prevent a growth-related deformation later. Nonetheless, the corset is still used to provide some torso stability and, for example, reduce the risk of impending or inoperable vertebral fractures.
  • Physiotherapy and occupational therapy: Physio- and ergotherapeutic measures have different goals for a crooked back. It is important to realize that they can not prevent the disease from progressing, but can help those affected maintain their quality of life and reduce the further course of their backbone. For example, a mobility training of the spine helps prevent their stiffening. Special exercises also contribute to the stretching and strengthening of the weakened trunk muscles and serve to posture training and stabilization of the spine posture. Equally important is a special breathing exercise to improve lung function. Regular exercise is incredibly important for the best possible treatment success. The initial training should always take place under the guidance of a physiotherapist or occupational therapist. This can give important information so that those affected can do the exercises as often as possible at home later on. Overall, physiotherapy and occupational therapy in addition to the posture stabilization can help in the long term to give patients a better sense of life.
  • Strengthening the core muscles: The trunk muscles, consisting of the back and abdominal muscles, are of particular importance in the context of spinal curvature. In the course of the deformation, these parts of the musculature visibly deteriorate, which usually further aggravates the effects of the disease. A focused training under guidance can therefore bring back a great deal of quality of life and further defuse an extreme course of the disease.

    In addition to targeted strengthening and stretching exercises should also be worked on the condition of the patients here. The interaction promotes the physiological posture and improves one's own body perception.

  • Change of everyday habitsIn addition to ergo and physiotherapeutic measures, a curved back also plays a decisive role in one's own everyday behavior. For example, patients should carefully design their workplace for back-friendly work. Ergonomically shaped seating and a suitable seat height to the work table are here, for example, for office workers are the alpha and the O. Also, the own sitting posture to control. During work, there should be regular breaks to move and so relieve the plagued spine. A good tip for everyday life are also training offers such as yoga or aqua gymnastics. Likewise, professional massages are a blessing for the back. Please make sure to be massaged only by trained professionals, because wrong massage techniques can do more harm than just use with existing back curvature.

Further measures in everyday life include, among other things, the regular performance of exercises that strengthen the hips, as demonstrated by the physiotherapist or occupational therapist. Wearing adjusted footwear can also help stabilize spinal posture. This is especially true for those with unequal leg length who are best prepared for orthopedic specialty shoes. It is also important to get a back-friendly mattress and, if necessary, a special pillow in order to ensure a spine-free reclining position at night. Last but not least, the reduction of obesity can reduce the spine burden. Measures in everyday life such as professional massages should only be carried out by trained specialist staff. Especially with an existing back curvature, this can do more harm than good. (Image: javiindy / fotolia.com)

Medical therapy

Spinal changes and postural damage cause muscle tension and sometimes severe pain, which are medically treatable. Also, cortisone in some cases, especially when an inflammation is underlying, provide relief. In rheumatic diseases such as M.Bechterew come for inflammatory treatment and so-called TNF-alpha-blockers are used, which are able to suppress the inflammatory reactions of the immune system. The attending physician always checks the benefits and risks of using the appropriate medication in individual cases.

Medicinal herbal treatment

It goes without saying that even medicinal plants and homeopathic preparations can not treat the crooked back. However, they can alleviate various side effects, consisting of pain due to muscle tension and bone friction. For example, comfrey is known to correct muscle problems quite reliably. Andorn, arnica and devil's claw are also known to help with back problems. Extracts of medicinal plants can easily be placed on a warming envelope and then wrapped around the affected back. Similarly, herbal oils for massage are a great way to use the medicinal plant powers.

Tip: Chili is also becoming increasingly popular in the treatment of back problems. The spicy spice has a warming effect on the muscles, which relaxes them and thus dissolves painful tension.

Operative therapy

If the curvature of the spine is very advanced, the deformations cause the greatest pain that can no longer be adjusted by medication. Also, cardiac and pulmonary function are often severely impaired, so that surgery is usually unavoidable. Depending on the cause, various surgical techniques are used here. It is conceivable, for example, a spine straightening by the introduction of wires, rods, rings or other fixators. Stiffening of the vertebrae is possible by introducing bony material. And also the reconstruction of destroyed or fractured vertebral bodies is conceivable within the scope of an operation.

In the surgical field, the benefits and risks of surgery should be thoroughly examined, as it is often not enough to operate the spine from the back. The pillar design often requires a three-sided access, which is why back surgery is generally considered to be very tedious and therefore even more stressful for those affected. Basically, back surgery is not only necessary with the progression of the underlying disease, but sometimes it is also used in children and adolescents to minimize growth damage (such as scoliosis). However, those affected should not throw the conservative approach overboard even after the operation, because with physiotherapy and occupational therapy measures, the quality of life can be maintained over a long time or even restored.

Diseases with a crooked back

Kyphosis, lordosis, ankylosing spondylitis, Scheuermann's disease, scoliosis, spondylitis, herniated disc, arthrosis, osteoporosis, spinal deformities, vertebral inflammation, growth disorders in the spine, rheumatism, myasthenia gravis, Marfan syndrome, muscular dysbalances, leg malalignment. (Ma)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)