The human spine normally comprises 3 curvatures – one in the neck, one in the mid back and the third in the lower back. Looking at the back from behind, the spine should look straight and sit in the middle of the pelvis. From the side, the neck (cervical) and the lower back (lumbar) have curves which look like the letter ‘C’ called lordosis, and the middle back (thoracic) and tailbone (sacrum) the curves look like an inverted ‘C’. These curves create a natural ‘S’ shape in the entire spine when you look at it from the side. The spine sits behind our organs and these curves are designed in such a way to maintain balance when we are standing. We are always encouraged to sit up with a straight back and it is important to ensure that the normal curvature of the spine is preserved to avoid abnormal pressure on different parts of the spine. Slouching forward all the time, or bad posture can cause these spinal curves to either straighten up or get enhanced – either way it is a problem which can cause pain or discomfort. One such condition is called flat back syndrome.
Flat back syndrome is when the spine has lost its lower back curve and has flattened out. This creates an imbalance in the body and to reverse that, the patient leans forward. They usually find it difficult to straighten their back or stand upright. This causes ongoing aches and pains in the spine and can sometimes cause pain in the legs as well. Patients usually report worsening of symptoms as the day goes by, because the more they stand, the further they lean. The human head is the heaviest part of the body, hence with an anterior head carriage the patient finds it more difficult to stand upright. This imbalance can cause further loss of the normal lumbar curve as well as lack of energy, fatigue, discomfort and pain.
Signs and Symptoms:
- Can be hereditary
- Upper back looks very flat
- Shoulder blades look long and straight
- Anterior head carriage
- Hunched back
- Lack of energy
- Fatigue
- Back pain
- Discomfort
- Due to the reduced space in the chest, patients may present with respiratory or heart-related symptoms as well.
Causes:
- Degenerative Disc Disease – commonly referred to as wear and tear in the spinal bones.
- Lumbar post Laminectomy syndrome – surgery to decompress the spinal nerves to treat stenosis can often lead to flat back syndrome as a result.
- Compression fractures – a fracture shortens the height of the bone in the spine and leads to flat back syndrome
- Ankylosing Spondylitis – chronic inflammatory condition
For severe cases of flat back syndrome, Harrington rods and surgery can correct the spinal curvatures and the person regains their balance and stability. However, this can lead to early degeneration in the spinal bones due to unnatural straightening of the spine. If your child or family member has an obvious flat back and they carry their head forward, then it is recommended that they get their back checked with a chiropractor or their local GP.
References:
Boody, B.S., Rosenthal, B.D., Jenkins, T.J., Patel, A.A., Savage, J.W., & Hsu, W.K. (2017). Iatrogenic Flat back and Flat back Syndrome: Evaluation, Management, and Prevention. Clinical spine surgery, 30 4, 142-149.
Dr Sarkaw Mohammad
Chiropractor
www.hillcrestspinal.co.nz