Postural Disorders

Musculoskeletal diseases are a regular occurrence. Discomfort, persistent pain, or incapacity in various components of the musculoskeletal system, including joints, ligaments, muscles, tendons, and structures that support the limbs, neck, and back, are caused by a chronic state rather than an acute incident. Musculoskeletal diseases can affect the neck, shoulder, arm, wrist, upper and lower back, hips, knees, and feet, among other areas. Musculoskeletal diseases are reported to affect 64 to 94 percent of dentists. It has been recorded as high as 50-75 percent among Iranian dentists in three independent studies.

Postural irregularities or poor posture may be to blame for several of these musculoskeletal diseases, particularly in physically demanding industries like dentistry. Poor posture has been defined in a variety of ways. Poor posture is defined by the American Academy of Orthopedic Surgeons as a defective interaction between the various body components that causes additional strain on the supporting structures. Persistent postural flaws can also cause discomfort, agony, and incapacity. Previous research has found a link between changes in sagittal posture and low back pain and neck pain. Pain, on the other hand, has been found to have an influence on normal posture in previous research.

Some related factors may play a significant effect in the etiology and maintenance of musculoskeletal symptoms. Static and dynamic awkward postures, repetitive actions, fine-tuned function, vibrating instruments, inadequate illumination, genetic factors, physical conditioning, emotional stress, and psychological issues are only a few of the reported factors. These characteristics of clinical work are risk factors for prolonged static postures, spinal flexion, and bad posture. Otherwise, age, gender, occupational history, academic degree, dominant hand, working hours, and specialty may all have a role.

In addition to personal implications, earlier research has found that musculoskeletal diseases can have a significant social impact, resulting in decreased working productivity and early retirement.

 

What is the Posture?

In a standing, sitting, or lying position, posture refers to how you hold the body upright against gravity. Good posture refers to how the body is held in a natural position, with the joints properly aligned. The body is under the least amount of stress in this position. Bad posture refers to being out of alignment and putting undue strain on one or more body parts.

If you sit, stand, or lay with bad posture on a regular basis, it can lead to long-term alterations in the body's postural processes, such as:

1. Muscle length and strength

Because of the lack of use, certain stabilizing muscles waste away as a result of poor posture. These under-used muscles frequently become short, compressing the vertebrate's bones.

2. Fast twitch and slow twitch muscle fiber performance

There are two types of muscles in the human body. There are two types of twitches: slow-twitch (still) and quick-twitch (moving). Static muscular fibers are mostly present in the muscle's deeper layers. They do an excellent job of detecting the direction in which the body is placed and making modifications to keep you stable. The majority of phasic muscle fibers are used for movement. Because it depends too much on phasic muscles and not enough on static muscles, poor posture promotes muscle fatigue.

3. Feedback from the nervous system on the current physical posture

The nervous system sends information about the present body posture to the brain via your muscles. The brain does not receive the entire image when you have improper posture for a long period and the static muscles are no longer fully engaged. As a result, phasic muscles contract, creating more muscle fatigue and pain.

 

Kyphosis

When viewed from behind, a typical spine appears straight. A spine damaged by kyphosis, on the other hand, exhibits indications of a forward curving of the backbones (vertebrae) in the upper back area, giving the impression of an excessively rounded or "humpback."

On an X-ray, a diagnostic exam that uses invisible electromagnetic energy beams to create images of internal tissues, bones, and organs on film, kyphosis is described as a curvature of the spine averaging 50 degrees or greater. In the upper back area, the normal spine can curve from 25 to 45 degrees of curvature. A type of spinal malformation is kyphosis.

 

Kyphosis Types

1. Postural kyphosis

Thoracic kyphosis exceeding 50 degrees with normal-shaped vertebrae is known as postural kyphosis or postural round-back. This form of kyphosis is adaptable and responds well to exercise.

2. Scheuermann Kyphosis

Scheuermann's kyphosis is a form of kyphosis in which the vertebrae form a wedge shape. This kyphosis is stiffer and might worsen as a person grows. This affects 0.5 percent of the population, equally affecting men and women.

3. Congenital Kyphosis

A change in the form of one or more vertebrae is assumed in a diagnosis of congenital kyphosis. This variation is apparent from the moment of birth. The child's spine has an outward bend when he or she is born. With time, this curvature may become more obvious.

 

Kyphosis Causes

Kyphosis can be congenital (existing at birth) or acquired (as a result of one or more of the following conditions):

  • Problems with metabolism
  • Neuromuscular disorders
  • Osteogenesis imperfecta, often known as brittle bone disease, is a disease in which bones fracture easily.
  • Spina bifida.
  • Scheuermann's kyphosis is a condition in which the vertebrae in the upper back curve forward; the etiology of Scheuermann's kyphosis is unknown, although it is most frequent in men.
  • Postural kyphosis is the most frequent type of kyphosis; it usually appears in adolescence and might be mistaken for slouching rather than a spinal problem. Exercise is utilized to aid in the correction of posture.
  • Females are more likely than males to have kyphosis.

 

Kyphosis Symptoms

The most prevalent kyphosis symptoms are listed below. However, everyone may experience symptoms uniquely. Among the signs and symptoms are:

  • Shoulder height disparity
  • In comparison to the rest of the body, the head leans forward. There is a difference in the height or location of the shoulder blades.
  • The height of the upper back appears greater than normal when bending forward.
  • Hamstrings (back thigh) muscles that are tight
  • Back discomfort is common, although it is rarely severe enough to interfere with daily activities.
  • Parents and loved ones may make comments about the child's "bad posture" or label the child's posture as a hunchback.

 

Kyphosis Diagnosis

Detailed medical information, physical assessment, and diagnostic testing are used to make the diagnosis of kyphosis. If the patient is a child, the physician obtains the patient's complete gestation and delivery history, as well as whether any other family members have been diagnosed with kyphosis. Because some types of kyphosis are linked to other neuromuscular problems, the physician will also inquire about developmental milestones. Delays in development may necessitate further medical assessment.

The following diagnostic methods may be used:

  • X-rays. A diagnostic test that creates pictures of inside tissues, bones, and organs on film using invisible electromagnetic radiation beams. The curve is measured and evaluated using this test. The angle of the spinal curve is measured by a physician or radiologist using a standing lateral, full-spine X-ray. Hyper-kyphosis is defined as a curve that is exceeding 50 degrees.

The need for early identification of kyphosis is critical for successful therapy. Pediatricians and family physicians, as well as some school programs, check for indicators of kyphosis on a regular basis.

 

Kyphosis Treatment

Except in the case of congenital kyphosis, kyphosis rarely causes injury to the body's vital organs and structures. As a result, treatment is determined by the symptoms that a person is experiencing. Exercises to improve the core muscles and pain-relieving drugs, for example, are used to help those who are in pain. Bracing or postural workouts may be done by persons who are concerned about the curvatures' appearance. Only in the most severe cases of kyphosis is surgery required. 

We examine the child's age and future growth when determining kyphosis treatment. Doctors also examine the degree of deformity and whether or not back pain is present.

Physical therapy is frequently given for minor kyphosis and flexible postural curvature. A regular home exercise program emphasizing core strengthening and back extensor stretching and strengthening is typically effective in treating the kyphosis-related issue of appearance and pain.

In actively growing youngsters, a Milwaukee brace or a supraclavicular brace is used to prevent kyphosis from deteriorating and, in some cases, even correcting it. An orthotist makes the brace when an orthopedic physician prescribes it. Actively growing children with kyphosis curves exceeding 65 degrees should wear a brace. The brace is usually prescribed to be worn for 23 hours a day until the adolescent has reached the end of their growth cycle.

 

Kyphosis Surgical Treatment

An adolescent with significant kyphosis who is experiencing pain or is concerned about their looks may choose to have the deformity corrected by surgery. A posterior spinal fusion with instrumentation is used to treat kyphosis. The procedure itself takes 4 to 5 hours, with 3 to 4 days of hospital stay. At home, the recuperation time is usually 4 to 6 weeks.

The bones and muscles of the spine are exposed by a straight cut down the middle of the back in this procedure. The cut is only as long as the abnormality needs to be corrected. The spine's bones are released and prepped for surgery.

The pedicles are then screwed together with 2-inch titanium screws. A pedicle is a strong bone structure on either side of each vertebra. The vertebral columns' middle is hollow, forming a route for the spinal cord and cerebrospinal fluid to pass through. The spinal cord is protected with extreme vigilance. Pedicle screws are placed utilizing real-time X-ray for guidance, and the activity of the spinal cord is continuously monitored. This is accomplished by attaching electrodes to the child's head to toes and monitoring the impulses back and forth. The spinal cord monitoring is interpreted by a specialist known as a neurophysiologist, who notifies the surgeon of any abnormalities.

The kyphosis is rectified once all of the pedicle screws are in place. This is a surgical maneuver that allows the surgeon to straighten the arch in the spine. The rods, which are constructed of cobalt-chromium, are then inserted through the screws and secured. The patient's own rib is used as a source of bone graft. To generate the spinal fusion, this is cut into small matchsticks and jammed in along the back of the spine.

Finally, sutures that dissolve inside the body are used to seal the muscle layers. Butterfly closures or stitching tapes are used to seal the outermost skin layer. After the skin has stitched itself back together, these adhesive stitches come off on their own.

 

Lordosis (Swayback)

The natural curve of the lower back portion of the spine is known as lordosis. The lower spine will have a deep curvature with an excessive bend, leading the abdomen (stomach area) to protrude and the pelvis (hip areas) to bend back and up. Poor posture, familial genetics (passed down from father or mother), trauma, spinal disorders, or spine surgery can all cause these excessive curves.  Lordosis comes in a variety of forms.

 

Lordosis Types

There are five different kinds of lordosis:

1. Postural lordosis

This is frequently caused by excess weight and a lack of belly and back muscle training. When a person's front weight is excessively heavy, it drags the back forward. When the stomach and back muscles are insufficient, the spine is unable to maintain itself, and the weight pulls the spine forward, causing it to curve forward.

2. Congenital/Traumatic lordosis

Trauma or damage to the spine's connecting ligaments (pars) can cause them to break (fracture), resulting in low back discomfort. Sports injuries are a common cause of problems in youth. This can also be found in adolescents who have been hit by a car or who have fallen from great heights. There may also be a flaw in the way these linkages evolve as they mature, resulting in misshapen and weakened links. They can develop spondylolysis as a result of repetitive actions that stress these weak linkages (break in bone connection).

Whatever caused the break, it requires rest and limited movement to mend. If not, the vertebrae (spine blocks) might shift forward over time, pinching nerves in the spine. The legs may experience discomfort, numbness, stinging, weakness, and dysfunction as a result of this.

3. Postsurgical lordosis 

A laminectomy is a surgical treatment that involves the removal of sections of the vertebrae (spinal bones) to provide passage to the spinal cord or nerve roots. When this is done on numerous levels in the spine, the spine can become unsteady and the normal curve can become hyper-lordotic (overly bent). This is not a frequent issue in adults, but it is more commonly found in children with spinal cord tumors who have had the tumor removed.

4. Neuromuscular lordosis

This category comprises a wide range of conditions and disorders that can result in a variety of spine curvature issues. There are a variety of therapy methods available for each disease.

5. Lordosis Secondary to Hip Flexion Contracture

This is a rare group of people that develop a contracture of the hip joints, which pulls the spine out of position. This contracture can be caused by a number of factors, including infection, injury, or muscle imbalance caused by a range of illnesses.

 

Lordosis Symptoms

The following are some of the signs and symptoms of lordosis:

  • Swayback, with more prominent buttocks
  • When lying on the back on a hard surface, there is a wide space between the lower back and the floor that does not vary when you lean forward.
  • Backache and discomfort
  • Having trouble moving in certain directions

 

Lordosis Diagnosis

An x-ray of the spine and a physical examination are usually all that is required to confirm and follow a patient who may have an aberrant lordosis. A distinct therapy and follow-up plan will be required depending on the causes of the aberrant curve.

 

Lordosis Treatment

Except in the most extreme circumstances, most people with any type of lordosis will not require surgical intervention or treatment. Patients are frequently treated with over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). Physiotherapy exercises are frequently beneficial to back health and flexibility. These exercises should be done on a daily basis and can often be used instead of drugs. Surgery is frequently required in the most severe cases of nerve disorders. It will stabilize the backbones and, with time and the right therapy, it will be able to address some or all of the nerve problems.

 

When Should You Go to Hospital?

If a person's spine curve has gotten so severe that discomfort prevents them from engaging in activities they favor, a spine professional should be consulted to assess the situation. If a kid's ability to walk, stand, or coordinate bladder and bowel movements deteriorate before, during, or after back treatment, this becomes an actual emergency, and the child should be evaluated in the emergency room very away.

When a kid has had vague back discomfort for two weeks or more and has not improved with rest, over-the-counter drugs, ice and/or heat, and reduced activity, a visit to the child's main doctor or a spine consultant should be scheduled as soon as possible.

 

Scoliosis

The spine is commonly referred to as the "backbone," however it is made up of several bones. It is made up of many bones (vertebrae) that are joined by cartilage, a type of elastic tissue. People may flex, extend, balance, and even walk as a result of this.

Scoliosis is a condition in which the vertebrae bend instead of being upright. They can also twist (rotate) like a corkscrew.

Small curves are rarely problematic. However, a worsening curve might be harmful to a person's health. Extremely big curves can harm the joints and induce spinal arthritis. Large curves can cause pain by rubbing the ribs on the pelvis. People with a lot of curvature in their spines may have lung difficulties.

Scoliosis can affect children of any age. Idiopathic scoliosis is the commonest kind of scoliosis. It's commonly discovered when a person reaches puberty.

 

Scoliosis Causes

Idiopathic scoliosis is a medical challenge. Nobody understands why people get it, but studies show that it tends to run in families.

Idiopathic scoliosis isn't caused by anything you do, such as carrying a large backpack, having improper posture, participating in sports, or anything else. You have no choice in whether or not you develop scoliosis. It's a part of your DNA.

 

Scoliosis Signs and Symptoms

Scoliosis can be visible at times. The body might tilt to the left or right due to a bend in the spine. You may appear to be leaning to one side if you have scoliosis. One shoulder may be higher than the other, or one shoulder blade may protrude more than the other. When you bend over, one side of your ribcage may protrude out more if your spine is twisted.

Scoliosis isn't always visible. That's why, as part of the normal checkup, the doctor will perform a scoliosis examination. Scoliosis screening programs are available in some countries.

 

Scoliosis Diagnosis

Make an appointment with the healthcare professional if you suspect you have scoliosis. To help determine a diagnosis, the health care practitioner will examine you and take your health information. Because scoliosis can run in families, a part of the medical history includes inquiries regarding the family's health. Figuring out whether any of the family members have it will assist the provider to determine if you have it as well.

You may be referred to an orthopedic surgeon by the doctor. These practitioners specialize in bone and muscle disorders. They have a lot of experience with scoliosis in teenagers and can tell you if you require treatment.

Scoliosis curves are measured in degrees by healthcare professionals:

  • A moderate curve is one that is fewer than 20 degrees.
  • Between 25 and 40 degrees is considered a moderate curve.
  • A severe curve is one that is greater than 50 degrees.

Curves that are too severe can harm the lungs. Patients and orthopedists may generally work together to avoid curves from reaching this point.

 

Scoliosis Treatment

The majority of mild scoliosis curvatures do not require treatment. If you have a modest curve, you should undergo monthly checks to ensure that it does not worsen. While the bones are still growing, scoliosis is more likely to worsen. As a result, the doctor will want to keep a close eye on you as you become older.

If the doctor thinks the curve will worsen or cause complications, he or she will probably recommend that you use a back brace till you finish maturing. The brace will not make an existing curve disappear, but it will prevent it from worsening. Severe scoliosis may necessitate surgery.

Scoliosis does not have a rapid treatment. It takes time to adjust to a brace or recover from surgery. This can be difficult for some individuals. If you'd like, the medical team can connect you with others who have gone through similar experiences or assist you in finding support groups.

 

Conclusion

Kyphosis, Lordosis, Sway Back, and Flat Back are all terms for postural disorders. Posture difficulties arise when the muscles that keep a proper and straight spine in its standard anatomical position become unbalanced. The spinal column will be pulled down if any of these muscles are either weak or too strong, resulting in bad posture. These posture issues can be initiated and aggravated by genetic variables as well as simple environmental influences including repetitive physical activity such as sitting, sports, studying, or even napping. To maintain proper posture, we must be constantly aware of our posture, problematic gait, and stance while performing efficient posture exercises and therapies.