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Anyone who permanently assumes an unhealthy sitting position or often works in a stooped position will sooner or later risk a crooked back. There are also numerous diseases that promote back curvature. Therapy is not in all cases able to make up for the curvature. As a rule, however, targeted treatment measures help, if only for partial correction.
The upright posture of humans is known to be guaranteed by the special structure of the human spine. In contrast to all other vertebrates, this is vertical in humans due to evolution. Beginning at the neck (cervix), the bony vertebrae extend along the chest (thorax) to the lumbar region (lumbar region). Despite the upright course, the human spine is not straight. Rather, it has a natural S-shape, which results from the special arrangement of the individual spine sections. These can be divided as follows:
- Cervical spine (pars cervicalis) - the cervical vertebrae are also called C1 to C7.
- Thoracic spine (Pars thoracica) - the thoracic vertebrae are called Th1 to Th12.
- Lumbar spine (pars lumbalis) - here lie the lumbar vertebrae L1 to L5.
- Sacrum (Os sacrum) - consists of only one vertebral bone.
- Coccyx (Os coccygis) - also has only one bone.
Vertebrae consist of the vertebral body and the vertebral arch. The vertebral arches are connected to each other by the vertebral joints. The vertebral canal (canalis vertebralis), which contains the spinal cord and thus the core of the human nervous system, also runs through the vertebral arches of the vertebrae. The human spine has a total of 24 vertebrae and 23 intervertebral discs that connect the vertebral joints.
In addition, eight to ten vertebrae have grown together to form the two vertebral bones sacral and coccyx. Thanks to the flexible connection between the vertebrae through the intervertebral discs, the best possible mobility of the spine is guaranteed. The upright posture 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 any reason, individual vertebrae will tilt forward or to the side. The resulting curvature of the spine can result in various clinical pictures, including:
- Ankylosing spondylitis,
- Scheuermann's disease,
Behind the colloquial term "crooked back" is actually a whole range of different clinical pictures that bring back curvature as a side effect. The diseases can be congenital or acquired and, depending on the degree of curvature, can significantly restrict the everyday life of the person affected. In terms of causes, there are roughly two categories:
- Causes directly affecting the spine
- Causes not related to the spine
Causes directly affecting the spine
Even though the spine plays a literally important role in the area of posture, it is sometimes very susceptible to numerous health problems. In particular, the influencing factors for a crooked back are very diverse. There are countless disease scenarios from rheumatic and inflammatory diseases of the spine, which provoke a crooked back, to genetically caused deformations that lead to irreparable curvatures of the back, to natural signs of wear and growth disorders of the spine with subsequent tendency to curve. The following disease groups can be roughly named:
- Congenital malformations,
- Growth disorders in adolescence,
- age-related wear of the vertebral joints,
- acquired wear of the vertebral joints,
- Vertebral inflammation,
- Herniated discs.
Malformations and growth disorders
The mechanism behind spinal deformities and growth disorders has not yet been fully explained. However, doctors and experts suspect a genetic component, because clinical pictures such as scoliosis or kyphosis show a clear familial cluster. In addition, there seem to be gender-specific predispositions, because scoliosis is particularly common in young girls.
In order to explain a spinal column that is bent to the side, unequal growth of the muscle and bone parts in the back area is given during the growth phase in scoliosis. This should result in a lateral curvature of the spine deviating from the natural S-shape and a twisting of the individual vertebrae towards each other. Depending on the severity, this curvature can also be seen with the naked eye and show the typical image of a crooked back.
Kyphoses, the strengthening of the natural curvature outwards in the thoracic vertebrae area, are commonly known as humps. They often arise due to vertebral malformations, such as a block or semi-vertebra.
Rheumatism and inflammation
A genetic component is also suspected in the rheumatic and inflammatory disease of the spine, ankylosing spondylitis. In addition, a weakness of the immune system comes into play here, which causes recurrent inflammation of the vertebral joints. As a result, there are deformations, stiffening and functional restrictions in the area of the vertebral bodies.
Scheuermann's disease is a common spinal disease in adolescence, the causes of which are still largely unknown. The disease causes uneven growth of the anterior and posterior parts of the vertebrae in the thoracic and lumbar region and leads to an increase in the disease-related kyphosis. Since twice as many boys as girls are affected, genetic or gender-specific influencing factors are discussed here again.
Joint wear and intervertebral 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 no means limited to the large bones in the legs and arms. The bony parts of the spine can also be affected by osteoarthritis or osteoporosis. The wear always goes hand in hand with a loss of stability in the area of the affected bones and joints, which in the case of the spine naturally means a loss of stability for the 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, forcing patients into a curved, gentle posture. However, the curvature of the back can usually be remedied here after the intervertebral discs have been set back accordingly.
Injuries and acquired spine curvatures
One of the most common causes of back curvature is not due to underlying illnesses in the actual sense, but rather to patient misconduct. We are talking about incorrect posture of the spine in the form of one-sided and excessive stress on the spine, through which the vertebral joints wear out prematurely. This causes damage to posture and ultimately permanent deformations or even breaks in the vertebrae, which are shown in curvatures that are visible from the outside. In this case one speaks of an acquired back curvature.
A crooked back is also acquired if it results from an accident injury. Damaged vertebral bodies or intervertebral discs can be responsible for postural damage. On the other hand, nerves damaged or injured as a result of an accident should not be underestimated as the cause. In the worst case, this leads to nerve paralysis in the area of the spine, which then provokes one-sided loads in the supporting apparatus, which in turn promote a curvature of the back.
Causes not related to the spine
Based on possible accident injuries as the cause of a crooked back, it can be seen that the appearance and stability of the back are not only determined by the bony spine. Basically, it is the result of a complex interplay of muscles, ligaments, nerves and bones. For this reason, diseases affecting the musculoskeletal system, connective tissue or nerves can also lead to a crooked back.
Muscle and nerve disorders
Disorders of the musculoskeletal system and nerves, especially if they occur unilaterally, cause an imbalance in the stress on the back. It is not difficult to guess that this one-sided incorrect loading of the spine can quickly lead to a curvature of the back. This can often be observed with the clinical picture myasthenia gravis. It is a neurological disorder in which the signal transmission between nerves and muscles is disturbed. Affected back muscles can no longer perform their support function for the spine due to muscle weakness, which results in a permanent and one-sided strain on healthy back muscles.
Marfan syndrome, a disease of the connective tissue, often manifests itself in an unnatural curvature of the back, since the disease usually also affects the muscles.
Incorrect strain on muscles and nerves
With regard to incorrect posture, which leads to a crooked back, we should again point out muscular imbalances that cause corresponding posture problems. Because of seat-based activities, our modern everyday life poses more and more risks of getting a crooked back due to unsuitable sitting postures, and this at a young age. While a few decades ago back curvature was more of a problem for the older generation, younger age groups are now increasingly complaining about problems with their back posture.
The cause of the postural problems at a young age is usually a lack of stress on the back muscles. Monotonous and sometimes relatively motionless postures (e.g. sitting in front of the PC for a long time) result in persistent muscle tension, which initially leads to pain and gentle posture, but later also causes permanent postural damage that can make your 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 school time can lay a dangerous cornerstone here, as the amount of learning is becoming more intensive and young people spend more and more time at their desks than outdoors. Furthermore, computer games and game consoles among adolescents and adults have meanwhile sparked a dangerous trend of "crouching in front of the screen", which promotes sedanity and incorrect sitting postures.
- Seat-based activities - Apart from the typical "gambler syndrome" when it comes to crooked sitting postures, the working world is also full of dangers for the back. From service activities such as working in the call center to office work and home office to other activities focused on machines or PCs, there are various risk occupations that favor the development of back curvature.
- Unilateral burden: Not only sitting for long periods of time is a monotonous permanent strain on the spine. Activities that are based on heavy lifting or a bent work posture also have the potential to favor a crooked back. This often results in a one-sided strain on the back muscles, which then causes corresponding deformations of the spine. The same also applies to severe overweight. Sufferers tend to give in to the weight load and often develop a forward bent posture in the long run. The situation is similar for women with an extremely large bust size.
Special case: misaligned legs
The posture has a massive influence 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 misaligned leg can very easily unbalance the position of the spine. For example, if one leg is shorter than the other, this does not only mean problems for locomotives because they usually have to limp a lot. At the same time, an unequal leg length also affects the upright position of the spine. Lateral curvatures of the back are not uncommon here. And also forward curvatures, e.g. by balancing gentle posture, are conceivable in the case of leg misalignments.
The symptoms associated with a crooked back can vary widely. Characteristic is usually a visible posture of the spine, which is curved to the left, right, back or front, coupled with the resulting back pain. These can occur during the movement or only in the resting phases afterwards.
Depending on how strongly the spine is curved, the curvature also affects the sensitivity in the back area. Since important nerve roots flow into the spinal cord, disorders in nerve functionality in the event of spinal misalignment cannot be completely ruled out. And organ displacement and related functional disorders in the body are not uncommon with extreme back curvature. All in all, the following symptoms can be expected if the back is crooked:
- Noticeable curvature of the spine up to the hump,
- Incorrect posture of adjacent parts of the body (e.g. 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 kidneys,
- Sleep disorders.
For the examination and treatment of a curved back, patients should consult an orthopedic surgeon directly. The curvature can then usually be determined by a doctor simply by diagnosing the eye. In order to determine the degree of severity more precisely and to be able to find individual causes for the back curvature, however, further examination measures are usually necessary. An in-depth patient discussion about everyday habits and possible pre-existing conditions can already provide first indications in this regard. The orthopedic surgeon will also do some movement tests to see how flexible the spine and back muscles are.
Imaging methods such as X-ray or CT are then required to actually determine the cause of the curvature. The so-called Cobb angle is an important measure for assessing the severity of a curvature. Named after the American surgeon and orthopedic surgeon John Robert Cobb, this special angle defines natural and unnatural spine curvatures and thus provides information about the severity of a curvature deviation. For example, from a Cobb angle of more than 40 degrees, there is scoliosis. The information obtained through such an angle measurement subsequently gives orthopedic surgeons information about which therapeutic measures are to be initiated.
Therapy for a crooked back is strongly linked to the underlying cause. In addition to conservative therapy, medication and surgery, those affected can also do a lot themselves and do not have to accept the crooked back as fate.
If deformations of the spine are detected early, before they go into an extreme course, a conservative therapy consisting of several sub-steps is recommended before the use of medication and surgery. The main focus is on the prescription of an adapted corset to correct the spine posture and the regular use of physical and occupational therapy measures to strengthen the back and trunk muscles.
- corset: The prescribed support corset is adapted in a company for orthopedic technology and aims to achieve a certain growth control of the spine through regular wear. Accordingly, corsets are mainly used for adolescents. Later, unfortunately, they can no longer prevent growth-related deformation. Nevertheless, the corset is still used to ensure a certain torso stability and, for example, to reduce the risk of impending or inoperable vertebral fractures.
- Physiotherapy and occupational therapy: Physiotherapy and occupational therapy measures pursue different goals when the back is crooked. It is important to be aware that they do not prevent the disease from progressing, but can help those affected to maintain their quality of life and weaken the further course of the back curve. For example, mobility training of the spine helps prevent stiffening. Special exercises also contribute to the stretching and strengthening of the weakened trunk muscles and serve to train postures and stabilize the spinal posture. Special breathing exercises to improve lung function are just as important. Performing the exercises regularly is incredibly important for the best possible therapy success. The initial training should always take place under the guidance of a physical or occupational therapist. This can provide important information so that those affected can later do the exercises at home as often as possible. Overall, in addition to stabilizing posture, physiotherapy and occupational therapy can also help in the long term to give patients a better attitude to life.
- Strengthening of the trunk muscles: The trunk muscles, consisting of back and abdominal muscles, are of particular importance in the context of the curvature of the spine. In the course of the deformation, these parts of the musculature visibly deteriorate, which usually exacerbates the effects of the clinical picture. A focused training under supervision can therefore bring back a large piece of quality of life and further defuse an extreme course of the disease.
In addition to targeted strengthening and stretching exercises, the condition of the patients should also be worked on here. The interaction promotes physiological posture and improves your own body awareness.
- Change of everyday habits: In addition to ergonomic and physiotherapeutic measures, a curved back also plays a key role in everyday life. For example, patients should carefully design their workplace for back-friendly work. Ergonomically shaped seating options and a suitable seat height for the work table are the be-all and end-all for office workers, for example. You also have to check your own sitting position. Regular breaks should then also take place while working to move and thus relieve the troubled spine. Training tips such as yoga or aqua-gymnastics are also a good tip for everyday life. Professional massages are also a treat for the back. However, please make sure that you are only being massaged by trained specialist personnel, because incorrect massage techniques can do more harm than good, especially if you have a curving back.
Other measures in everyday life consist, among other things, of regularly performing trunk-strengthening exercises, such as those shown by the physiotherapist or occupational therapist. Wearing appropriate footwear can also help stabilize the spine posture. This is especially true for people with unequal leg lengths who can best be made with special orthopedic shoes. In order to ensure a lying position that is gentle on the spine at night, it is also important to get a back-friendly mattress and, if necessary, a special pillow. Last but not least, reducing excess weight can also reduce spinal strain.
Spinal column changes and postural damage cause muscle tension and sometimes severe pain, which can, however, be treated with medication. Cortisone can also provide relief in some cases, especially when there is inflammation. In rheumatic diseases such as M. Bechterew, so-called TNF-alpha blockers are used for inflammation treatment, which are able to prevent the inflammatory reactions of the immune system. The treating doctor always checks the benefits and risks of using the appropriate medication in individual cases.
It goes without saying that even medicinal plants and homeopathic preparations cannot treat the crooked back. However, they can alleviate various side effects, consisting of pain caused by muscle tension and bone friction. Comfrey, for example, is known to relieve muscle ailments quite reliably. Andor, arnica and devil's claw are also known to provide good help for back problems. You can easily put extracts of the medicinal plants on a warming envelope and then wrap it around the affected back area. Herbal oils for massage are also a good way to use the medicinal powers.
Tip: Chilli is also becoming increasingly popular in the treatment of back problems. The hot spice has a warming effect on the muscles, which relaxes them and thus relieves painful tension.
If the curvature of the spine is very advanced, the deformations cause severe pain, which can no longer be adjusted with medication. Heart and lung function are often severely impaired, so that surgery is usually unavoidable. Depending on the cause, different surgical techniques are used here. For example, straightening the spine is conceivable by inserting wires, rods, rings or other fixators. The vertebrae can be stiffened by introducing bony material. The reconstruction of destroyed or fractured vertebral bodies is also conceivable as part of an operation.
In the surgical field, the benefits and risks of the operation must be carefully examined, because it is often not enough to operate the spine from the back. The column construction often requires a three-sided access, which is why back operations are generally considered to be very lengthy and therefore even more stressful for those affected. In principle, operations on the back are not only necessary as the causative diseases progress, they are also sometimes used in children and adolescents to keep growth damage (e.g. from scoliosis) as low as possible. However, those affected should not throw the conservative approach overboard even after surgery, because physical and occupational therapy measures can maintain or even restore the quality of life over a long period of time.
Diseases with a crooked back
Kyphosis, lordosis, Bechterew's disease, Scheuermann's disease, scoliosis, spondylitis, herniated disc, arthrosis, osteoporosis, vertebral malformations, vertebral inflammation, growth in the spine, rheumatism, myasthenia gravis, Marfan syndrome, muscular dysbalances (malpositioned legs).
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Barbara Schindewolf-Lensch
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ICD codes for this disease: M40, M41, M43, Q76ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.