Orthopedics-Online

Hunchback

definition

Under a Hunchback (Latin: hyperkyphosis, Gibbus) one understands one excessive backward curvature of the thoracic spine.
In colloquial language, this is also used by a "Humpback" spoken.

Naturally, there is always a backward convex curvature of the spine in the chest area (physiological kyphosis).

Is the Spine in the thoracic spine area more than 40 ° curved, one speaks of a hunchback (pathological kyphosis).

There is also a distinction between one functional and one fixed shape of the hunchback. While the misalignment in the functional form can still be corrected by compensating movements, in the case of the fixed form it can be corrected by changes bone fixed in this position.

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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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causes

A hunchback can innate (e.g. in the case of malformations of individual vertebral bodies). More often, however, a hunched back occurs first in the course of life.
The reasons for this can be:

Posture damage if posture is incorrect
Degenerative changes in the spine (e.g. osteoporosis)
Injuries to the spine (e.g. Vertebral fracture)
Tumors
Inflammatory diseases of the spine, e.g. Spondylidiscitis

The various causes for the development of a rounded back (Kyphosis) can be broadly divided according to whether they are a innate Round back or one with a lifetime acquired Require rounded back. In general, it must be borne in mind that the Degree of curvature The spine is not the same for every person, so that the respective, individual anatomical conditions from birth can dictate a certain degree of hunched back and hollow back. An excessively hunched back, which is visible from birth, is usually caused by malformations in the skeletal or spinal system. Accordingly, for example, the presence of Block whirling (vertebral bodies fused together) or Semi-vortex (only half-laid, wedge-shaped vertebral bodies) lead to the characteristic curvature of the spine in the chest area. Hunchbacks acquired in the course of life are most common muscular imbalances in the torso area as the cause, caused by a general lack of exercise, incorrect loads in training and permanent, unnatural posture positions in everyday life, both when sitting and standing. This means that if the chest muscles are too strong or shortened and the shoulder muscles and back muscles are too weak, this can lead to a (symptomatic) hunchback in the long run.

However, certain underlying diseases of the skeletal system can also lead to deformations in the thoracic spine area. In (mainly older) people who suffer from osteoporosis, so-called Sintering fractures arise in the individual vertebral bodies, which lead to the affected vertebrae wedge-shaped deform and thus a hunched back can occur. Chronic inflammatory, rheumatic diseases of the spinal column and joint system such as Bechterew's disease or arthritis / polyarthritis can lead to characteristic curvatures due to permanent remodeling processes in the spine. In addition are Developmental Disorderssuch as Scheuermann's disease, also possible causes for the development of a hunched back, so that e.g. Ossification disorders can cause vertebral body deformations and spinal curvatures. In addition, trauma to the thoracic spine (e.g. from accidents) or tumors in the skeletal system (e.g. bone metastases, plasmacytoma) can also cause the formation of a rounded back. However, there are still a small number of completely left over unknown Causes, so that a so-called idiopathic hunchback can be present without a physical cause being able to be proven.

Special shapes of the hunchback

Scheuermann's disease (Adolescent kyphosis):
Due to a disturbance in the ossification, the front and back of the Vertebral bodies unevenly in the chest area, which leads to a rounded back. This condition affects Teenagers, with guys twice as likely to be affected.
ankylosing spondylitis (Ankylosing spondylitis):
A chronic, rheumatic-inflammatory disease leads to stiffening of the lower spine, which often results in a stiffness Round back in the chest area trains. Most often this disease becomes older between 15 and 30 years diagnosed.
Pott‘scher Gibbus (Tubercular spondylitis):
This can be used as a Late complication of tuberculosis occur on the spine.

Symptoms

Pain is one of the typical complaints in people with a pronounced hunchback. Patients who have had a hunched back since early childhood, in particular, often complain of pronounced pain. The symptoms typically intensify after long periods of standing or slow walking.

Patients with a hunchback often suffer from Back pain, partly is also about a headache sued. In addition, in the course Restrictions on movement, but also Sensory disturbances due to damage to the spinal cord occur. The cause of this can be a narrowing of the nerve fibers emerging from the spinal canal. The increasing misalignment of the individual vertebral segments leads to compression of the intervertebral discs and, in the long term, to impairment of the nerve fibers.
In addition, patients with a pronounced hunchback often result in significantly incorrect strain on the muscles in the back area. The consequences are painful muscle tension which are very difficult to remedy without specific therapy. Another reason for the pain with a hunched back is an impairment of the Vertebral joints and the Osseous membranes. Excessive stress on these structures can cause irritation and / or inflammatory processes.

The symptoms are not limited to the area of the back.
The function of heart and lung can be impaired with a pronounced hunchback. Patients also suffer more often sleep disorders and depressions, i.a. because of the cosmetically unfavorable shape of the back.

Pain in a hunched back

A Hunchback Classically leads to a restriction of shoulder mobility.
Due to the incorrect curvature of the spine, the shoulders hang forward and down and the shoulder blades stand back and up.

Due to the wrong posture caused by the Hunchback the neck muscles and back muscles may become tense. Neck and back pain are the result.
The pain is usually aggravated by movement, which is why those affected tend to adopt relieving postures and avoid moving the shoulder and back. Certain movement sequences, such as rotating movements of the body, can lead to the radiation of the pain and trigger lower back pain. Depending on the severity of the hunched back, pain can even spread to the limbs.
In addition, those affected often suffer from insomnia. A frequent consequence of sleep disorders and the hunched back itself are persistent headaches, which can be very stressful.

Diagnosis

The hunchback is often recognized by the doctor when looking at the patient. To objectify the diagnosis, be special x-rays The spine made to the exact Angle of curvature (Cobb angle) to be able to determine.
Computed Tomography or Magnetic resonance imaging are supplementary examinations, some of which Can provide information about the cause.

therapy

Depending on the shape and shape of the rounded back physical therapy, Corsets or Operations applied.

physical therapy:
Is the hunchback slightly pronounced and only functional, specialized physiotherapy can be applied. Here the spine should go through Training of the back and chest muscles be straightened up.
Regular targeted back training can prevent the formation of a hunchback through poor posture.
Daily movement training with targeted muscle exercises and extensive stretch can achieve amazing results with a wide variety of patients. The hunchback can be counteracted in this way within a short time.
When exercising, stretching the large and small pectoral muscles not to be neglected. However, patients should note the different directions of these two muscles. In addition, the large back muscle (M. latissimus dorsi) should be strengthened and stretched in short daily training units.
corset (Orthosis):
If it is more severe, it may be necessary to wear a corset. This will above all in childhood is applied and is intended to balance the hunchback by increasing the growth of the Spine is guided by the corset.
A corset (Technical term: orthosis) is a medical aid that can be used to stabilize, relieve, immobilize, guide and / or correct the spine. With the help of a corset, the patient's spine becomes rounded erect and the individual vertebrae in this way relieved.
To the success of a treatment of the hunchback by wearing a corset, however, it must be ensured that the daily prescribed by the specialist Wearing time must be strictly observed and that the Fit the medical device is checked at regular intervals. Rubbing, chafing and / or pressing areas on the corset not only impair the patient's freedom of movement but can also have a negative impact on the treatment result.
Brace therapy during the Growth phase achieve convincing results. The reason for this is the fact that the growth of the spine can be directed to a desired level by wearing a corset. The hunchback simply grows out as the length increases.
surgery:
In particularly severe cases, an operative measure can improve the hunchback. The Kyphoplasty (Erecting the vertebra with the help of a balloon and introducing bone cement) and the Spinal fusion (Stiffening of vertebral bodies with the help of screws) are methods that be used if vertebral fractures or osteoporosis are underlying the hunched back.
The Kyphoplasty as an operating theater is particularly suitable for patients who have developed a hunched back due to vertebral body fractures. This surgical method is counted as a minimally invasive procedure and is primarily used to repair the damaged vertebra.
The Spinal fusion (Synonym: spinal stiffening), on the other hand, is a surgical procedure in which parts of the spine are stiffened with the help of implants. With the help of this method, a hunched back can be effectively corrected and the patient's symptoms can be alleviated.
In most cases, a hunched back can be treated with the help of so-called conservative (non-surgical) procedures.
Patients, however, at one advancing hunchback suffer with significant deformity of the spine, surgery can be a useful correction method.
However, an operation to correct the hunchback carries some risks. Especially when performing a spinal fusion it can inflammatory processes come in the area of the soft tissues. They are also strong Breathing problems possible. As with any surgery, bleeding and nerve fiber injuries can occur during and after the procedure. In addition, in the case of surgical correction of the hunchback, it should be noted that in around 5% of patients, despite optimal operating conditions, within five years further surgical measures must be carried out.

Hunchback training

A hunchback that Not caused by certain underlying diseases such as Bechterew's disease or Scheuermann's disease, but rather through muscular imbalances caused can be improved or even remedied by targeted muscle training. The so-called functional A hunched back always develops when certain muscle groups (the chest muscles) develop a higher one due to incorrect loading or incorrect posture Resting tension than the muscle groups counteracting them (the shoulder muscles / back muscles). So if the chest muscles are too strong and the back and shoulder muscles too weak, one will develop Imbalance and a permanent, predominant one train on the skeletal system in the direction of the pectoral muscles, so that the characteristic rounded back shape is created. First and foremost, the trapezius muscle, the upper back extensor, is the Serratus anterior muscle and the Romboid muscles too weak and the pectoralis and latissimus dorsi muscles too tense or too strong. Targeted stretching of the chest muscles and muscular strengthening of the weak back muscles (e.g. through deadlifts, rowing) can counteract the hunched back.

Stretching on a hunched back

Regular stretching exercises and Sports exercises train the back muscles and chest muscles and can thus contribute to the straightening and muscular stabilization of the spine.
In the morning, the hunched back can still be very stiff, which is why you should do the stretching exercises in the afternoon or evening. Be careful not to stretch your back too much.Proven exercises are, for example, the so-called back bends, in which a countermovement to the hunched back is performed. The chest is stretched forward and the shoulders pulled back at the same time.

Another back bend, which has a positive effect on the shoulders and back muscles, takes place in a flat prone position. The legs are stretched out and tense. The hands are close to the body and the elbows point backwards. The gaze is directed downwards and the shoulders are pulled back. It is important to do the stretching exercises regularly in order to reduce the hunched back.
Before doing the stretching exercises, the body should definitely be warmed up with a few stretching exercises. Don't stretch too much! This can overwhelm the muscles and have a negative effect on the hunched back. In addition, always ensure that you are sitting correctly in the office, at the kitchen table, etc.
A straight but relaxed posture is recommended here, ideally the shoulders point back and down when sitting correctly. A therapy scheme from physiotherapy is the so-called Schroth - Method, a three-dimensional therapy for the treatment of the hunched back. The pillars of this method are based on:

Straighten up the back muscles
of the Respiratory therapy and from the
Movement strategies

for everyday life. The breathing techniques additionally carried out here help to relax and relieve the incorrectly strained muscles. If you have a hunched back, it is important to start stretching exercises as early as possible in order to counteract any permanent damage to the back at an early stage.

The corset with a hunchback

Another therapeutic option for hunched back is the application of a supporting corset, also medically Orthosis called. It is a stable construction made of pure plastic or a combination of leather and plastic to support the torso. The corset should not be worn alone, but in addition to other treatment measures such as physiotherapy.
It is a medical aid that can be prescribed by the doctor after a detailed examination of the hunched back. The choice of the right corset is usually made jointly by the doctor and the orthopedic technician. The corset makes it possible to correct misalignments through the hunched back and counteract incorrect loads.

The functions of the back should be maintained and pain should be alleviated. There are different versions of the corset, each with corresponding properties. Nowadays, active back orthoses are mainly used. Due to their optimal wearing properties, they are particularly suitable for children. With this form of the corset, the upper body is dynamically straightened by spring tension elements and the spine, muscles and trunk move actively.
In addition, it is very comfortable to wear, in contrast to the traditional rigid back orthoses (passive corset). With these conventional corsets (e.g. Milwaukee corset), a passive stabilization of the back takes place, which in turn suppresses natural movements of the body. This prevents both desirable and harmful moving effects. If the passive back orthosis is no longer to be worn, then muscular build-up training will be necessary. This is not necessary with an active corset.

The OP as the last measure

In severe cases, the hunchback is increasingly progressive and leads to a pronounced deformity of the back, which can lead to the destruction of vertebral bodies.
There are various surgical procedures for stabilizing and realigning the vertebrae. With a so-called kyphoplasty, it is possible to straighten a hunched back, which is usually caused by a vertebral fracture.

This operation is used to straighten damaged vertebrae. A Balloon catheter, a type of probe with a tube system, is inserted into the damaged vertebra and inflated. The vertebra is then filled with cement via the catheter. A similar method is the so-called Vertebroplasty, in which cement is inserted directly into the bone without a catheter.
Surgical intervention is recommended for a hunched back with one degree of curvature over 65 °, with uncontrollable pain and with neurological deficits such as Paralysis or Numbness. If there is a pronounced displacement of the vertebral bodies due to the hunchback, the affected vertebra can be repaired by means of a Screw - rod system retracted to its natural position and stiffened.

Hunchback and hollow back

The hollow back (Hyperlordosis) is, in addition to the hunched back, another incorrect posture of the spine, whereby the area of the lumbar vertebrae is increasingly curved forward so that the belly in front of and the pelvis and chest are shifted behind the body axis. The most diverse possible causes come into question, although an acquired hollow back is more common than one that was congenital from the start. In most of the cases, a muscular imbalance is to blame Bad posture in everyday life (e.g. a lot, wrong sitting, heavy carrying, frequent running / standing on high heels) or Incorrect loads arises during training. A shortened one Hip flexors at the same time too weak Hip extenders and weak abs, back muscles and Vascular muscles in the long run lead to a Shortening tendons and ligaments in the lumbar vertebrae and pelvic area, so that there is permanent curvature of the spine in this area. With a pronounced hollow back, the one behind the Body axis If the chest is displaced, it also gives the appearance of a rounded back. In some cases of severe muscular imbalance along the entire spine, in which the entire trunk muscles are in an imbalance, a hollow back and a hunched back can exist at the same time.