Treatment of lumbar kyphosis

Patients diagnosed with PDSI are usually elderly women who have multilevel degeneration of the disc and facet in the lower lumbar region, poor bone quality, as well as atrophy and fatty degeneration of the lumbar and paraspinal extensor muscles. [1] Therefore, conservative treatment, such as exercise and physiotherapy, including carrying a backpack, is recommended as the first line of treatment. 

But at present, medicine, especially in the field of rehabilitation of lumbar kyphosis , has taken a huge step forward, so today the list of treatment procedures is not limited to exercise therapy. But today there are a number of other innovative means and methods of the physical development of people. Yogotherapy, yoga for the spine, and wellness techniques of qigong are becoming very popular. Of particular interest is the special section - yoga for the spine, aimed at treating various pathologies of the spine, as well as the prevention of its diseases and deformities. Applied treatment position, rhythmic and isometric gymnastics, static and dynamic, breathing, meditation exercises. They use specially developed dynamic complexes aimed at developing the spine, strengthening muscles, and solving specific problems.

Various physical exercises are combined with massage techniques, body relaxation, physiotherapy, and assistive devices. Assign special corsets, bandages.

A popular trend today is body-oriented therapy. The essence of this technology is that work is carried out not only with the physical body, but also with the psychological structures. An important role is given to the correction of the psychoemotional state. This approach is due to the fact that every problem, pathology in the human body is the result of the impact of some kind of mental trauma, unexposed emotion, stress. During the consultation, a specialist will help a person return to the origins of the problem and solve it. Accordingly, the problem goes away on the physical level.

Qigong, Chinese wellness practices, numerous breathing exercises, which are also aimed mainly at the spine, are well established. Slavic practices and gymnastics are becoming increasingly popular: “Ladaniya”, “Fire Dance”, “Lazhenie”, “Alive”, “Triglav Complex”, and the author’s technique S. Ovcharenko “Spheres”, “Dance of the Five Beasts”, “Dance of the Black Lynx”, “Great Dance”.

Of the methods of physiotherapeutic treatment, ultrasound, microcurrents, waves of various lengths, electrophoresis, cryoprocedures, thermal procedures, and electrical treatments are widely used.

Swimming, water aerobics, and hydrotherapy have a positive effect. The Scottish shower, Charcot's shower, shower-fan, Jacuzzi, hot tubs, wipes, dousing, pine baths, special procedures in the bath, sauna, Turkish hammam are widely used in practice.

Many people choose running, Nordic walking, breathing practices, meditation, joint gymnastics and wellness complexes for the spine from qigong, hatha yoga, gymnastics as therapeutic and prophylactic means.

Various thermal procedures, electrical procedures, lighting procedures are shown. The complex therapy includes massage, active-passive gymnastics. Along with the classic massage, prescribe a segmented reflex massage, reflexology, acupuncture, acupressure (shiatsu).

To strengthen and consolidate the effect will help compresses, wraps. Natural resources are widely used in the treatment of spinal diseases, for example, acupuncture (acupuncture), apitherapy (treatment with bee stings), hirudotherapy (treatment with leeches) are used.

It is useful to combine physical exercises and massage with swimming, water aerobics, as these procedures allow you to tone the muscles. Hydro procedures are used (dousing, rubbing, Sharko shower, hydromassage, jacuzzi).

Many patients are shown aromatherapy, oiling, exposure to therapeutic oils. Staying in a salt room, massage using special oils, incense, positively affects the condition of the spine. Apply various types of stretching, stretching on ribbons, aerial yoga. In complex therapy, it is necessary to include relaxation, meditation, autogenic training.

Various types of gymnastics are widespread: fitball gymnastics, stretching gymnastics, body gymnastics, rhythmic gymnastics, psycho-gymnastics.

Drug therapy is rarely used, and mainly as an adjuvant or symptomatic. Surgical methods are radical methods of intervention, they are used only as a last resort, with the ineffectiveness of other methods.

Physiotherapeutic treatment

For the treatment of kyphosis in the lumbar region, various traditional and non-traditional methods of physiotherapy are used:

• ultrasound treatment, microcurrents,
• exposure to waves of various lengths,
• electrophoresis (mainly using this method, calcium, magnesium, anti-inflammatory or analgesic drugs are administered),
• thermal procedures
• electrical procedures
• light procedures
• reflexology,
• acupuncture.

Exercises for lumbar kyphosis

With lumbar kyphosis, exercises are the main treatment method. They should be performed regularly, from 1 to 3 times a day. We can recommend a set of 10 exercises that have the maximum effect on the lower back.

• Exercise number 1. Full yogic breathing.

Start your practice with a breathing exercise - full yogic breathing. To do this, you must sit evenly, with legs crossed in front. Hands relaxed, kneeling. The back is as even as possible, reaching up. We begin to take a slow breath, filling the whole stomach with air. After the stomach is full, we begin to fill the chest with air, gradually expanding it. After that, we fill the clavicle zone, trying to breathe in as much air as possible.

After we have finished a full breath, we make a full exhalation: first we blow off the stomach, releasing air from it as much as possible. Then lower the chest, releasing air as much as possible. After that, lower and relax the collarbone zone, releasing all the air from the body as much as possible.

This is one complete respiratory cycle. Such cycles must be performed at least 15, gradually increasing their number. There is no need to rush. Perform the exercise should be slow, thoughtful, relaxing as much as possible, listening to your feelings. Better to do less, but better.

• Exercise number 2. Deflection in the lower back.

Slowly raise your hands up, leaving your palms connected. We bring out our hands above our heads, we separate our palms, we hold our hands forward with our palms, as if turning them to the Sun. Hands and palms should be approximately shoulder width apart. After that, we make a small deflection in the lower back, we deviate. No need to strive to make the largest possible deflection. The condition should be comfortable and relaxed.

• Exercise number 3. Qigong breathing.

We become even, arms are lowered along the body, legs are shoulder-width apart. Feet stand parallel to one another. With an inhalation, we slowly move our arms away from the side, while bending our elbows. Imagine that we are a big ball that is filled with clean air, inflates. However, as the arms are pulled to the sides, we slowly squat, slightly bending the legs at the knees. We stand in this position for 3-5 minutes, listen to our breathing, control it for even 1 - the stomach goes outside, inflates. Take a deep breath. At the expense of 2 - the stomach is deflated, lowered. We exhale.

• Exercise number 4. Tilt to the side.

We become even, arms along the body, pubescent, legs straight. Then we spread our legs as wide as possible to the sides, one leg unfold perpendicular to the other. Raise your arms to the sides, keep it flat (parallel to the floor). We make an inclination to the side. The hand is lowered to the foot, which is perpendicular. The other hand rises. Thus, the arms should be on one straight line, together with the legs they form a large triangle. We turn the head, look up at the upper arm.

• Exercise 5. Steady posture.

Feet bring, connect them. Hips, knees, shins, feet should be connected, we make an inclination forward, trying as much as possible to lie with a chest, a stomach, a forehead on legs. We entwine the legs with our hands. Then we slowly rise upward, straightening the back vertebra behind the vertebra, starting from the lower back and ending with the cervical region.

• Exercise number 6. Pose on balance.

We put our legs as wide as possible. Hands are spread apart. Lower one hand down, touch the ground. Raise the second hand so that it forms an even line with the other leg. Raise the foot opposite the lowered hand so that it is parallel to the floor. Between the legs there should be a 90 degree angle.

• Exercise number 7. Twisting in the lower back.

We sit in a pose with legs crossed, we place our hands crosswise: the right hand is on the left knee, the left hand is on the right knee. Raise one hand up, hold it straight in front of you. Cross - turn in the direction of this hand, clockwise. At the same time, we try to keep our shoulders straight, in one line. We return to the starting position. Repeat the exercise the other way in the same way.

• Exercise number 8. Warm-up for the lower back, sacrum and kobchik.

You need to sit down a little. In this case, the legs should be slightly bent at the knees. To make the exercise easier, imagine that your fawn has a tail extension. This makes the exercise easier. It is necessary to take a deep breath, and then raise the “tail” along with the calf and gluteal muscles, while trying to bend the lower back as much as possible. On the exhale - “press the tail”, trying to lower it as low as possible. The loin should be as straight as possible, the pelvis pulled forward.

• Exercise number 9. Rooting.

Get straight. Connect the feet, toes, toes. Line your body as evenly as possible. Keep your hands strictly along the hips, down. Close your eyes, relax, focus on your feelings. Check that your legs are joined, staying flat. Start to stagger slowly. Move slowly, smoothly. Imagine that you are a strong, powerful tree that goes deep into the ground, stands firmly and confidently. As you exhale from the back, the pain goes away with the exhale, goes deep into the ground. The tree grows even more rooted in the ground. On inspiration, warm, bright energy fills your body, rises along the roots of a tree, and goes into the back.

• Exercise number 10. Bon.

This exercise is meditative and relaxing. Often kyphosis is formed due to the fact that a person has overstrained muscles of the lower back. This entails deformation of the muscle layer, and then of the spine itself. Perform the exercise in a relaxed atmosphere and at least 30 minutes.

Its essence is simple. It is necessary to sit down, align your back as much as possible, stretch the spine from the top of the head to the feline. Imagine. That the spine is a pillar, a rod that holds the entire body on itself. The legs must be bent, the feet folded, pressed one to the other. Heels, feet, fingers - tightly pressed. Knees should be sought to lower to the floor. Cross your arms, connect the two thumbs at the top, and place them loosely on your legs, closer to the pelvis.

Close your eyes, distract from everything else, focus only on the inner sensations. Try to relax as much as possible, relax the whole body. Imagine your muscles relaxing and slowly flowing down your spine. There is silence in your head, not a single thought bothers you. Breathe slowly, smoothly. Do not move. After minutes, slowly open the chapter, stretch, exit the position.

Surgery

Surgical treatment for PDSI is considered in patients who complain of difficulty walking or experience insurmountable pain in the lower back and both legs with severe sagittal imbalance (kyphotic deformity) when conservative treatment is already ineffective. [2]  Other surgical indications described in previous studies were:

1. severe atrophy of the muscles of the back during x-ray examination,
2. lack of severe osteoporosis and 
3. the desire of the patient for surgical treatment. [3]

Some authors have described other surgical indications of PDSI cited by Lee et al. These include notable clinical signs called the “four main signs”, such as difficulty walking due to leaning your body forward, inability to keep things in front of you, elbow support for washing dishes or faces, and difficulty climbing on slopes. 

Basically, treatment of lumbar kyphosis is a traditional, comprehensive treatment that includes drugs, physiotherapy, physiotherapy, massage, swimming. Surgical treatment methods are used in an emergency, in case of urgent need. Radical intervention is permissible only if other treatments are ineffective. Surgical intervention is indicated if, if an infringement of the nerve, spinal cord has occurred. Indications for surgery may be disc protrusion, intervertebral hernia, purulent-septic process, inflammation, necrosis.