Normal Curve of the Spine

Normal Curve of the Spine

Normal Curve of the Spine
 Kyphosis
Excessive outward curvature of the spine, causing
hunching of the back.
Symptoms may include back pain, muscle fatigue,
and stiffness in the back. Most often, these
symptoms remain fairly constant and do not become
progressively worse with time.
 Causes/ Reasons of Kyphosis
 Poor posture (postural kyphosis)
 Abnormally shaped vertebrae (Scheuermann’s kyphosis) – if the vertebrae don't develop
properly, they can end up being out of position
 Abnormal development of the spine in the womb (congenital kyphosis) – if something
disrupts the spine's normal development, two or more vertebrae sometimes fuse together
 Age – as people get older, their spinal curvature can be expected to increase
 Kyphosis can also develop as a result of a spinal injury.
 Poor nutrition
 Accidents
 Other Diseases
 Psychological factors / inferiority complex
 Ill designed furniture
 Nerve disorders
 Muscular imbalance
 Cancer and cancer treatment
 Tuberculosis—lung and spine
 Birth disorders
 Unknown factors
 Types of Kyphosis

These are some of the common types of Kyphosis:-

1. Postural Kyphosis
2. Scheuermann's Kyphosis
3. Congenital Kyphosis.
4. Nutritional Kyphosis
5. Post-traumatic Kyphosis
 Types of Kyphosis……..
1. Postural Kyphosis
Postural kyphosis is the most common type of kyphosis.
This is more common in girls than in boys and is typically
first noticed during adolescence. It is caused by poor
posture and a weakening of the muscles and ligaments in
the back.

These patients can have symptoms of pain and muscle

fatigue.

This type of kyphosis does not lead to a severe curve, and

there is little risk of neurologic, cardiac, or pulmonary
problems.
2.Scheuermann's Kyphosis

This type of kyphosis is the result of a structural deformity

of the vertebrae. It is more common to develop scoliosis
(kyphoscoliosis) with Scheuermann's kyphosis than with the
other types of kyphosis. The reason for this abnormal
wedging of the vertebrae is not well understood.
 3. Congenital Kyphosis.

Congenital kyphosis is the

least common type of
abnormal kyphosis.
This is caused by an
abnormal development of
the vertebrae during
development prior to birth.

This can lead to several of

the vertebrae growing
together (fusing) in kyphosis.
 4.Nutritional Kyphosis

Due to nutritional deficiencies e.g. of Vitamin D

(causing rickets).
 5.Post-traumatic Kyphosis

Resulting from vertebral fractures / Injuries

 Management / Treatment of Kyphosis

1. Consciousness / Education about posture

2. Psychological treatments
3. Exercises
4. Nutrition supplements
5. Braces
6. Neurosurgical treatment
 Lordosis
Lordosis is a condition where there is an increased
inner curvature of the spine. Normally a human
spine displays some amount of lordosis, but if it
increases, then it poses a problem for the
individual.
Lordosis........
The term lordosis means inward
curving of a part of the lumber and
cervical vertebral column.

Excessive lordosis is termed as

swayback or saddle back.

An abnormal forward curvature of

the spine in the lumbar region,
resulting in a swaybacked posture.

Lordotic curves- inward curve of

the lumbar spine just above the
Lordosis……..

People with lordosis seem to be

sticking out their stomachs and
buttocks. During examination of
the patient with lordosis, ask the
patient to lie on his or her back on
a hard surface. Can the patient
slide his or her hand under lower
back, with a little space to spare?
If the patient has lordosis, he or
she will have extra space between
his or her hand and lower back
 Symptoms of lordosis may include:

 C-shape back when seen from a lateral aspect,

with the buttocks being more prominent
 Appearing swayback, with the buttocks being
more pronounced.
 Having a large gap between the lower back and
the floor when lying on your back on a hard
surface that does not change when you bend
forward.
 Back pain and discomfort.
 Problems moving certain ways
 Causes of Lordosis
There are many medical conditions that cause the spine to curve more
than normal. These conditions include:-

 Abnormal growth of bones.

 Spondylolisthesis- the vertebrae in the lower back slip forward.
 Osteoporosis- vertebra become fragile and can easily be broken.
 The inflammation of intervertebral disc.
 Obesity can cause lordosis.
 Kyphosis can lead to lordosis
 Tight lower back muscles
 Excessive visceral fat
 Pregnancy
 Rickets
 Imbalance strength in muscles group (such as weak hamstrings or
tight hip flexors)
 Treatment / Management

 If the lordosis is mild, then treatment is usually not required.

 If the patient is experiencing symptoms or discomfort, then the

patient can enroll in a physical therapy program where exercises
can be done, under the guidance of a therapist, in order to
strengthen the muscles and to increase the range of motion.

 Since lumbar hyper-lordosis is usually caused by habitual poor

posture, rather than by an inherent physical defect like scoliosis
or hyper-kyphosis, it can be reversed.

 This can be accomplished by stretching the lower back, hip-

flexors, hamstring muscles, and strengthening abdominal
muscles.
 Treatment / Management

 If lordosis is detected during childhood, then

braces should be worn to prevent further
worsening of this condition.

 For severe cases of lordosis, which does not

benefit from the above measures, surgery is
required where the spine is straightened using
metal rod, screws or hooks. During surgery, bone
grafting can also be done to promote new growth
and to stabilize the spine.
 Corrective Exercises for Lordosis

Stretches for Lordosis

Hip Flexor Stretch
 Place one knee on the
floor.
 The hips should be
slowly pushed forwards
with the back straight.
 A stretch can be felt.
 Hold this stretch for 20-
30 seconds.
 Repeat 3-5 times, many
times a day.
 Corrective Exercises for Lordosis

Lower Back Stretch

 Lie on the back
with the knees
flexed.
 The knees should
be pulled towards
the back as much
as is comfortable.
 Hold this position
for 20-30 seconds.
 Repeat 3-5 times,
many times a day
 Corrective Exercises for Lordosis
Abdominal Crunch
(simple)
 Lie on the back with
the knees flexed.
 Place the hands up
towards the knees and
back down and raise
the head and
shoulders off the
ground.
 Continue doing this
exercise till the
stomach muscles feel
worked out.
 Rest for a minute.
Try to do 2-3 sets.
 SCOLIOSIS
Scoliosis is a condition that causes the spine to
curve to the side. It can affect any part of the spine,
but the most common regions are the chest area
(thoracic scoliosis) and the lower section of the
back (lumbar scoliosis).
SCOLIOSIS
Scoliosis is a medical condition in which a person's Spine
has a sideways curve. The curve is usually "S" or "C" shaped.
In some the degree of curve is stable, while in others it
increases over time.

Mild scoliosis does not typically cause problems, while

severe cases can interfere with breathing. Pain is typically
not present.

Approximately 80 percent of scoliosis cases are called

"idiopathic" scoliosis, which means that the cause of the
condition is unknown.
Scoliosis……..

Scoliosis occurs in about 3% of people. It most

commonly occurs between the ages of ten and
twenty.

Girls typically are more severely affected than boys.

In most cases, the reasons for the change in shape are

not known but in other cases, cerebral palsy and
muscular dystrophy are factors in the development of
scoliosis.
Scoliosis

The majority of children with scoliosis do not require

treatment as the curve corrects itself as the child
grows.

However, based on the degree of curvature and the

age of the child, a combination of bracing and physical
therapy is often recommended.

A very small number of patients with scoliosis may

require surgery. Complications of scoliosis include
chronic pain, respiratory deficiencies, and decreased
exercise capacity.
 Scoliosis signs and symptoms

Signs:-
The head is slightly off centre.
The ribcage is not symmetrical.
One hip is more prominent than the other.
Clothes do not hang properly.
One shoulder is higher than the other.
The individual may lean to one side.
Uneven leg lengths.
 Signs of Scoliosis

The body may tilt One shoulder may

to one side appear higher

Waist may appear One leg may

uneven or hips elevated appear shorter
than the other
 Scoliosis -symptoms

Constipation due to tightened organs from

curvature
Pain in back, shoulders, and neck and buttock.
Nerve pinching of the leg may cause the legs to cut
out
Limited mobility
Painful menstruation (dysmenorrhoea) because of
a secondary pelvic tilt.
 Causes of scoliosis

Congenital (By birth).

Neuromuscular diseases / conditions - these affect the nerves
and muscles and include cerebral palsy and muscular dystrophy.
Genes - at least one gene is thought to be involved in scoliosis.
Leg length inequality - if one leg is longer than the other, the
individual may develop scoliosis.
Bad posture
Occupation / profession--- carrying backpacks
 Accidents / Traumatic injuries.
Tumors
Unknown reasons (Idiopathic).
Some studies state that – an estimated 65% of scoliosis cases are
Idiopathic, about 15% are Congenital and about 10% are secondary
 Assessment of Scoliosis
Normal Curvature of the Spine-has a curve that is
between 0° and 10°
Scoliosis of the Spine-has a curve that is greater than
10°
 Management / Treatments for Scoliosis

The majority of children with scoliosis have mild

curves and don't need treatment. In such cases, the
doctor will recommend regular follow-ups every 4 to
6 months to monitor the curve of the spine in clinic
and periodically with X-rays.

If the patient has moderate scoliosis and the bones

are still growing, the doctor may recommend a
brace. This will prevent further curvature. Braces are
usually worn all the time, even at night. The more
hours per day the patient wears the brace, the more
 Management / Treatments for Scoliosis

Casting instead of bracing is sometimes used for

infantile scoliosis to help the infant's spine to go back
to its normal position as it grows. This can be done
with a cast made of plaster of Paris.

The cast is attached to the outside of the patient's

body and will be worn at all times. Because the infant
is growing rapidly, the cast is changed regularly.
 Management / Treatments for Scoliosis

Surgery
 Management / Treatments for Scoliosis
Physical Therapy / Exercises / Stretches

Pilates – Conforming to the wall: It's the starting

point of the Scoliosis exercise regime.
Plank: There are several ways of performing planks
as it helps strengthen core muscles.
Spine Release
Yoga Asana.
Breathing Exercise.
 KNOCK KNEES
A person with knock knees has
a large gap between their feet
when they're standing with
their knees together.

Many young children have

knock knees, which tend to be
most obvious at around the
age of four. ... The medical
name for knock knees is genu
valgum.
KNOCK KNEES…….

Small distance between

the ankles is normal, but
in people with knock
knees this gap can be up
to 8cm (just over 3 inches)
or more.

Knock knees don't usually

cause any other problems,
although a few severe
cases may cause knee
pain, a limp or difficulty
walking.
 Causes of Knock Knees
 Injury of the shinbone (only one leg will be knock-
kneed)

 Osteomyelitis (bone infection)

 Overweight or obesity.

 Rickets (a disease caused by a lack of vitamin D)

 Traumatic injuries to Knee.

 Knock Knee Test

To test whether you

have knock knee or not
you have to just stand
on floor forming a "V"
shape and if there is
Small Gap between
your knees then it's fine
but if the gap is too
much or your knees are
touching each other
then you must consult a
doctor.
The degree of knock knee is
determined by an angle called Q angle.
It is angle formed by a line drawn from
the anterior superior iliac spine
through the centre of the patella and a
line drawn from the centre of the
patella to the centre of the tibial
tubercle. The Q angle for men should
be less than 18 degrees with the knee
in extension and less than 8 degrees
with the knee in 90 degrees of flexion
and for Women it should be less than
22 degrees with the knee in extension
and less than 9 degrees with the knee
in 90 degrees of flexion.
 Treatment / Management of Knock Knees

 Vitamin Supplements / Nutritional Assistance

 Surgery
 Correct Posture
 Correct Shoes
 Exercises (Strengthening and Stretchings)
 Yoga
 Exercises
1. Side Lunges
Stand with feet hip-width apart and
arms in front of your chest, and take a
big step sideways to your left. Bend
your knee as your foot comes to the
ground and push your hip backward. As
you feel a strong contraction on your
hip and other thigh, stand up and bring
your feet back to the original position.
Repeat 10-12 times then switch. Hold a
medicine ball in front of your chest for
more resistance. This helps your
abductors, hamstrings and quadriceps.
2. Cable Abduction

This exercise for knock knee

correction helps your outer thighs
and hips with one side of a cable
machine.
Fasten an ankle cuff around your
lower-right leg and keep the setting
low.
Stand with the stack of weight
facing your left shoulder. In an
arcing motion, lift your leg sideways
to your right as high as possible
then lower slowly. Repeat 10-12
times then switch.
3. Side Step-ups

Stand with a weight bench

towards your right. Keep
arms in front of your chest,
put your right foot on the
bench, press down and lift
your body in the air. After
your right leg is straight,
hold for a second then
lower yourself. Repeat 10-
12 times then switch. For
extra resistance, use a
medicine ball.
4. Lying Abduction

Lie on your left side with

your legs one over the
other. Lift your right leg
at an angle of 45
degrees, hold for a
second, and then lower
your leg. Repeat 10-12
times then switch. Hold a
dumbbell against your
thigh for extra resistance.
5. Straight Leg Lift

Lie on your back, torso

relaxed. Keep one leg
straight and the other knee
bent with your foot flat on
the ground. Tighten the
thigh muscles of the straight
leg, lift it about 12 inches
off the floor and hold the
position for 5 seconds and
repeat. Perform this at least
4 times, 2 on each side, to
work your quadriceps.
6. Wall Squats

Stand with a wall facing your

back. With feet shoulder-
width apart, stand slightly
further away from the wall.
Squat to 90 degrees
maximum and hold it for 5-
10 seconds. Contract your
stomach muscles slightly as
you squat. Increase your
holding period as your
strength increases.
Bowlegs
Bowlegs is a
condition in which
the knees stay
wide apart when a
person stands
with the feet and
ankles together.

It is considered
normal in children
under 18 months
Bowlegs……….

Bowlegs is a condition in which your legs appear

bowed-out, meaning your knees stay wide apart
even when your ankles are together.

Genu varum (also called bow-leggedness,

bandiness, bandy-leg, and tibia vara), is a physical
deformity marked by (outward) bowing of the lower
leg in relation to the thigh, giving the appearance of
an archer's bow.
 Causes of Bow Legs

 Rickets, which is caused by deficiency of vitamin D

 Blount's Disease is a medical condition that affects

bone growth, resulting in abnormal growth of the
upper portion of the tibia, or shin bone, leading to
bowed legs. Both toddlers and adolescents can
develop this condition.

 Fractures that do not heal correctly

Causes of Bow Legs

 Bowlegs in adults are usually caused by knee

arthritis, or wearing away of the knee joint
cartilage

 Genetics also plays a role in causing bowlegs,

where some people naturally have a more lateral
curve in their legs. Congenital bowlegs does not
have a known cure, and the persons condition
gets worse as they grow older or with weight
gain as more pressure is applied on the legs.
Causes of Bow Legs

 Abnormal bone development

 Various chemicals and compounds negatively impact

bone growth and general health, especially when if
the adult was exposed to these toxins in their early
years. Fluoride and lead accumulate in the body
over time, affecting the general health and well
being.

 More serious causes of bowlegs in adults include

bone tumours and bone infection
 Symptoms of Bow Leg

 Knees do not touch

when standing with
feet together (ankles
touching)

 Bowing of legs is same

on both side of the
body (symmetrical)

 Bowed legs continue

beyond age 3
 Treatment / Management of Bow Legs
Various approaches can be used to correct bowlegs in
adults, including:-
 Use of braces
 surgery,
 medical prescriptions,
 Physical therapy or special exercises.
 Bowlegs in adults caused by knee arthritis, or
erosion of the knee joint cartilage can be
corrected using braces and drug therapies, such as
anti-inflammatory prescriptions, which relieve
pain caused by cartilage insufficiency.
Treatment / Management of Bow Legs

 Other treatment of bowlegs in adults involves a total joint

replacement surgery, stem cell transplant or grafting to
restore the eroded knee cartilage.

 Correction of bowlegs caused by bone tumors require

specialized diagnosis and treatment, which could also
require a combination of surgery, laser assisted
treatments and chemotherapy. Other Infections of the
bone, such as bacterial infections that result to disfigured
bones can be treated and managed using strong
antibiotics.
Treatment / Management of Bow Legs

Regardless of the treatment or method used to correct

bowlegs in adults, targeted exercises in the form of
professional physical therapy is required to supplement and
enhance treatment.

Physical therapy helps strengthen leg muscles so that the

bowing does not progress quickly. While most exercises will
not considerably correct bowlegs in adults, some practices
such as Pilates and yoga could help improve posture and
decrease the degree of bowleggedness.
 FLAT FEET

A condition in which the foot has an arch that is

lower than usual.

Flat feet (also called pes planus or fallen arches) is a

postural deformity in which the arches of the foot
collapse, with the entire sole of the foot coming
into complete or near-complete contact with the
ground.
 Symptoms of Flat Feet and Fallen Arches

Many people have flat feet and notice no problems and

require no treatment. But others may experience the
following symptoms:

 Feet tire easily.

 Painful or achy feet, especially in the areas of the
arches and heels.
 The inside bottom of your feet become swollen.
 Foot movement, such as standing on your toes, is
difficult.
 Back and leg pain.
 Causes of Flat Feet
 Although usually uncommon, flat feet can
develop as an abnormality in childhood where
your foot’s arch never forms. This abnormality can
also be present at birth and is often hereditary.

 Flat feet usually develops as an adult because of

excessive foot stress. Failing to treat a foot injury
(such as an ankle sprain) without proper healing
time and arch support can lead to flat feet.
Causes of Flat Feet……
 Weakened muscles in the foot, ankles, and lower
leg from aging or weight gain.
 Standing or walking for longer periods of time,
especially in heels or dress shoes.
 Wearing uncomfortable shoes without proper
arch support.
 Foot injuries, such as ankle sprains or broken
bones in your feet.
 Stretched or torn tendons
Causes of Flat Feet……

 Broken or dislocated bones

 Some health conditions, such as arthritis.
 Nerve problems
 Other factors that can increase your risk include:
 Obesity
 Diabetes
 Aging
 Pregnancy
 Test for Flat Feet

You can easily test yourself or your students to see if you

have flat feet. Follow these three steps:
1. Get your feet wet.
2. Stand on a flat surface where your footprint will show,
such as on a concrete walkway.
3. Step away and look at the prints. If you see complete
imprints of the bottom of your feet on the surface, then
you're likely to have flat feet
Test for Flat Feet……

If the arch does not form with toe-

standing or if there is pain, other tests
may be needed, including:

 CT Scan to look at the bones in the

foot

 MRI scan to look at the tendons in

the foot

 X-ray of the foot

 Treatment / Management of Flat Feet
 Wearing comfortable and supportive shoes with insoles that fully
support the arch and help stabilize the heel. Look for shoes that
are comfortable for both work and sporting activities. Insoles add
additional support to your shoes and comfort the arch of your
foot.

 Wearing orthotics that help distribute and minimize pressure in

the foot by providing additional arch support. Orthotics are
custom designed to fit your feet and give you extra support while
walking, standing, and running.

 Using arch inserts and wraps that add extra support to your feet,
especially if your shoes lack existing arch support. Inserts and
wraps help alleviate the pain of flat feet and allow you to last
longer on your feet during the day.
Treatment / Management of Flat Feet

 If non-surgical
treatments are
not working for
you, talk to a
orthopaedic
doctor.
 Surgery can help
stabilize your
foot and ankle
bones and aid
with foot
support
 Exercises for Flat Feet
Heel Raise
Towel Stretch
Calf Stretch
Downward Dog Stretch
Toe Yoga