Posture and disease

There are many diseases that cause distortion in body pose and posture. In many cases, you can tell just by how a patient is sitting, lying or walking what disease he or she suffers from. If we were to start this discussion by talking about the disease I see the most often in my practice, we would start with osteochondrosis of the spine, or spondylosis. I have some good news for you: osteochondrosis itself does not distort the spine!

When a person suffers from osteochondrosis, his or her spinal cartilages age, dehydrate, and erode. Splits or cracks appear in the intervertebral discs. You can read about this and other processes in detail in my book, “33 Vertebrae or I Love My Osteochondrosis.”  Some patients complain of acute low back pain or lumbago. The reason for this is usually inflammation in a tear of an intervertebral disc. A patient with this condition tries to avoid any movement; even turning over in bed causes severe pain. In some cases, the back can be straight, but in other instances it curves so much that it can be seen from the side. There are a lot of clear illustrations at the website WWW.SPINANORMA.RU that explain the origin of a disc hernia. You can see in those images that, in most cases, a disc herniation is asymmetric and occurs on one side of a disc. That’s why a hernia irritates nerves on one side of your body, and the back becomes crooked because of pain. If you suffer from spinal curvature in combination with severe pain, you should think of the possibility of an intervertebral hernia causing this, and the necessity of visiting a doctor. 

Our grandparents were different from us in many ways, but they were also very much the same. The posture that was straight in their youth was changed by their old age. Many of them said that they became shorter as they became older.  But it really was not the years, but disease that made them shrink. The most frequent reason of the body lowering and an elderly person’s posture curving is osteoporosis. In osteoporosis, bone tissue becomes less firm because bone mass is being lost. Bones become fragile. As a result, even ordinary loading can lead to a fracture. Vertebrae are especially vulnerable. They consist mostly of spongy bone.

If you look at a vertebra under a microscope, you will see that this bone resembles foam rubber or similar three-dimensional structures. The cells of spongy bone usually contain bone marrow. If there is more bone destruction than bone renewal, then the situation is changing. The number of bone bridges decreases, and bone cells grow. Only some bone bridges can bear body weight and are slowly squeezed together. Vertebrae become shorter, they compress together, and an elderly person’s back starts to look round. A hump develops. Of course, the person “grows” shorter as well. If a person loses one inch in height, compared to his or her younger days, the risk of osteoporosis is quite high.

According to statistics, approximately every third woman and every twelfth man suffer from osteoporosis after the age of 50. If an elderly man was easily injured, for example, fell down from the height of his own body and broke an arm or a leg, he should be evaluated for osteoporosis. X-ray densitometry of skeletal bones, or a DEXA scan, is considered to be the most accurate way to do this.  Other analyses, including the analysis of calcium levels in the blood, are totally useless. Only a doctor who specializes in the treatment of osteoporosis, for example, a rheumatologist, can conduct this examination correctly.
Vertebral compression can happen not only gradually, year after year, but also suddenly, and compression fractures are actual fractures of the spine.  When this happens, a person will complain of sudden and acute back pain. These are typically caused by an awkward movement or by lifting. If back pain is intense and does not resolve in several days, a fracture should be suspected, especially if the person is elderly. In cases like this, an X-ray image is not enough to diagnose a fracture correctly. This is because the patient can have both old and new factures of the vertebrae, and it is almost impossible to tell them apart on a plain X-ray. That is why both an X-ray and magnetic resonance tomography will be needed to find out whether a vertebral fracture is old or new. Of course, if the fracture is new and acute, the procedure of vertebroplasty will be very effective. This is a procedure to repair and strengthen a vertebra with cement, simply by injecting it through a needle. You can learn more about this on the website WWW.SPINANORMA.RU.

If you look more closely at the people around you, you will notice that it’s not just older people who have a “hump.” Young people can also suffer from spinal deformities. The most common reason young people stoop is Scheuermann’s disease. This condition is also called juvenile kyphosis. Teenagers suffer most often from this disease and their parents think their child is stooping because of poor posture. Instead, the reason for Scheuermann’s lies in features that were inherited from the child’s parents. In this disease, the mid-thoracic vertebrae change their form into a trapezoid shape, intensifying thoracic kyphosis.  In order to hold their head straight, a person with Scheuermann’s disease has to straighten their head and neck to such an extreme, that it seems like they are drawing the head into the shoulders. This disease is often accompanied by a posture disorder. The person is embarrassed of the curved back and stooping and so withdraws into them self even more. This causes psychological isolation and it can affect the whole being. It is essential that a young person develop the correct posture to compensate for this painful spinal curvature. Fortunately, Scheuermann’s disease curvature is usually moderate or of a small degree.  

Another posture disorder typically occurs in the elderly, but people in their 30s and 40s can also suffer from it.  As aging occurs, many people start noticing that they begin to stoop when they walk. It’s easier for them to walk like this because bending over as they walk helps them get rid of pain in the low back and legs. They often have to make stops, about every 600 feet, because of pain. Rest, especially in a sitting position, makes them feel better, and then they can continue walking for another 600 feet. Then they rest again.  The reason for this type of gait is narrowing of the spinal canal where nerve roots are located.

Spinal joints and ligaments start to grow excessively over time. It’s necessary for the body to be able to bear the excessive loading that occurs during activities like athletic training or extreme sports. But this also causes the joints to restrict the spinal canal and causes a gradual narrowing. The so-called “yellow ligament” is especially prone to this over-growth. It contains many elastic fibers and it really is yellow in color! This ligament stretches and becomes thinner while bending, and the spinal canal is also wider in this position than it is when a person is standing upright. That is why many patients notice that pain in the back, buttocks or legs diminishes when they bend forward or squat down. It’s because they are stretching the lower back. The yellow ligament is really stretched, and the distance between the nerves enlarges. In a vertical or straight position, the ligament is shorter and thicker, making the spinal canal narrower. That is why it is so hard for these patients to maintain a straight posture. They can hardly bear vertical loading. They try to sit more and walk less. Spinal stenosis is an awful disease that can even cause leg paralysis! Fortunately, it is possible to help these patients with non-traumatic microsurgery to widen the spinal canal.  The patient starts to feel better in just a few hours. Their pain diminishes, posture straightens, and movements become free. We perform these operations even for people who are 90 years old!

Posture disorders are related not only with an exaggeration of spinal curves, but also with their flattening or disappearance. Many diseases, in particular, rheumatic inflammatory spine injuries, cause the slow ossification of thin spinal ligaments. The patient’s back starts resembling a flat and rigid board. We can see on the X-ray image of this patient that the vertebrae have grown into one immovable column that looks like a bamboo stem. It almost seems that the patient has swallowed a stick! That’s how stiff and immobile his spine is!  This disease can easily be diagnosed at the late stage. It’s usually called spondylarthritis. But in the initial phase, it’s often impossible to know what kind of disease is present. The patient sees their doctor multiple times over the years and is treated for “osteochondrosis of the spine,” even though spondylarthritis is successfully treated with other methods and medicines. So, if you notice your back is not as flexible as it used to be, don’t wait until your spine becomes as stiff as a stick! See a spine specialist to treat you before this occurs! 

In the past, tuberculosis was the most frequent cause of a humped back. Most of us know that this disease affects the lungs, but the organism that causes the infection, tubercle bacillus, can affect any organ, even the eye. Bones can be affected as well. Tuberculosis “erodes” the vertebrae. Then spondylitis forms, the spine suddenly becomes curved and a hump appears.

Now days, people are very conscientious about their appearance and don’t like it when a small “hump” grows at the base of their neck. Stout people have this hump especially often. I would like to tell you that it’s not real. It’s a false hump. This is not spine deformation, but normal deposits of fat near the spinous process of the seventh cervical vertebra, where all the shoulder girdle muscles are attached. That is why plump women who work sitting down often complain that this “hump” “really aches.” Sometimes even to touch it causes unbearable pain. The best treatment for this is massage or regular exercise. However, if the person doesn’t improve their posture, the pain will return after a massage because, when the body is in the wrong position, the ligaments will become strained and inflamed again.  The only permanent solution is for these people to improve their posture while working. 

Many people know about their disease and believe it is impossible to change their situation.  This is not true! There are some painful disease circles in every case of skeletal disease. Let’s look at osteoporosis, for example. Year after year, as a result of this disease, slowly the spine becomes more curved and a hump develops. If a person did not get used to maintaining correct posture, then they will start stooping. The muscles that are supposed to help the bones keep the spine straight aren’t strong, so they don’t work, and the person begins stooping even more. So the vicious circle is locked in place: the curved bones make the muscles weaker, and the weak muscles cannot maintain the skeleton. The muscles suffer from any condition that is associated with spinal curvature. So, even in a case when spinal curvature is caused by a disease, a patient has to begin with posture correction. This will make the muscles work and compensate for the curvature by improving the position of the spine and even improving the outward appearance.

Summary

• Different diseases and conditions can cause posture defects.
• Elderly people, especially women after the age of 65, must be evaluated with the help of X-ray densitometry (DEXA Scan) for spondylosis.
• Even if the spine is severely injured, exercises for posture correction can significantly improve the patient’s condition.