Treatment of lumbar kyphosis

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

But at present, medicine, especially in the field of rehabilitation of lumbar kyphosis, has made a huge step forward, so today the list of treatment procedures is not limited only to exercise therapy. But today there are a number of other, innovative means and methods of physical development of a person. Yoga therapy, yoga for the spine, health methods of qigong are gaining immense popularity. Of particular interest is a special section - yoga for the spine, aimed at treating various pathologies of the spine, as well as preventing its diseases and deformations. Treatment is used by position, rhythmic and isometric gymnastics, static and dynamic, breathing, meditative exercises. They use specially developed dynamic complexes aimed at developing the spine, strengthening muscles, solving specific problems.

Various physical exercises are combined with massage techniques, relaxation of the body, physiotherapy, and auxiliary means. Special corsets and bandages are prescribed.

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

Qigong, Chinese health practices, numerous breathing exercises, which are also mainly aimed at the spine, have proven themselves well. Slavic practices and gymnastics are becoming increasingly popular: "Ladanie", "Dance of Fire", "Lazhenie", "Zhiva", "Triglava Complex", the author's method of Ovcharenko S.V. "Spheres", "Dance of the Five Animals", "Dance of the Black Lynx", "Great Dance".

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

Swimming, aqua aerobics, and hydrotherapy have a positive effect. The Scottish shower, Charcot shower, fan shower, jacuzzi, hydromassage baths, rubdowns, dousings, pine baths, special procedures in the bathhouse, sauna, and Turkish hammam are widely used in practice.

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

Various thermal procedures, electrical procedures, and light procedures are indicated. Massage and active-passive gymnastics are included in the complex therapy. Along with classical massage, segmental-reflex massage, reflexology, acupuncture, and point massage (shiatsu) are prescribed.

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

It is useful to combine physical exercises and massage with swimming, aqua aerobics, since these procedures allow you to tone your muscles. Hydrotherapy procedures are used (dousing, rubbing, Charcot's shower, hydromassage, jacuzzi).

Many patients are recommended aromatherapy, oiling, and treatment with medicinal oils. Staying in a salt room, massage with special oils, and incense have a positive effect on the spine. Various types of stretching, stretching on bands, and aerial yoga are used. Relaxation, meditation, and autogenic training must be included in the complex therapy.

Various types of gymnastics have become widespread: fitball gymnastics, stretching gymnastics, body gymnastics, rhythmic gymnastics, psychogymnastics.

Drug therapy is used rarely, and mainly as an auxiliary or symptomatic means. Surgical methods are radical methods of intervention, used only as a last resort, when other methods are ineffective.

Physiotherapy 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 different lengths,
• electrophoresis (this method is mainly used to administer calcium, magnesium, anti-inflammatory or pain-relieving drugs),
• thermal procedures,
• electrical procedures,
• light treatments,
• reflexology,
• acupuncture.

Exercises for lumbar kyphosis

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

• Exercise No. 1. Complete yogic breathing.

Begin the practice with a breathing exercise – full yogic breathing. To do this, you need to sit up straight, with your legs crossed in front. Your hands are relaxed, resting on your knees. Your back is as straight as possible, stretching upward. Start taking a slow breath, filling your entire stomach with air. After your stomach is full, start filling your chest with air, gradually expanding it. After that, fill your collarbone area, trying to inhale as much air as possible.

After you have finished taking a full breath, exhale fully: first, deflate your stomach, releasing as much air as possible. Then lower your chest, releasing as much air as possible. After that, lower and relax your collarbone area, releasing as much air as possible from your body.

This is one full breathing cycle. You need to do at least 15 of these cycles, gradually increasing their number. There is no need to rush. The exercise should be done slowly, thoughtfully, relaxing as much as possible, listening to your feelings. It is better to do less, but better.

• Exercise #2. Lower back bend.

Slowly raise your arms up, keeping your palms together. Raise your arms above your head, separate your palms, and hold your hands with your palms facing forward, as if turning them toward the Sun. Your arms and palms should be about shoulder-width apart. After that, bend your lower back slightly, then lean back. You don't need to try to bend as much as possible. Your condition should be comfortable and relaxed.

• Exercise No. 3. Qigong breathing.

Stand straight, arms down along the body, legs shoulder-width apart. Feet stand parallel to each other. With an inhale, slowly move your arms to the side, bending your elbows. Imagine that you are a big ball that is filled with clean air, inflating. At the same time as your arms are moved to the sides, slowly squat, slightly bending your legs at the knees. Stand in this pose for 3-5 minutes, listen to your breathing, control it on the count of 1 - the stomach comes out, inflates. Take a deep breath. On the count of 2 - the stomach deflates, goes down. Exhale.

• Exercise #4. Side bend.

Stand straight, arms along the body, lowered, legs straight. Then spread your legs as wide as possible to the sides, turn one leg perpendicular to the other. Raise your arms to the sides, hold them straight (parallel to the floor). Bend to the side. The hand goes down to the leg that is perpendicular. The other hand goes up. Thus, the arms should be on one straight line, together with the legs they form a large triangle. Turn your head, look up, at the upper hand.

• Exercise 5. Stable pose.

We bring our legs together, connect them. The hips, knees, shins, feet should be connected, we bend forward, trying to lie with our chest, stomach, forehead on our legs as much as possible. We wrap our shins with our arms. Then we slowly rise up, straightening our back vertebra by vertebra, starting from the lower back and ending with the cervical region.

• Exercise No. 6. Balance pose.

Place your feet as wide as possible. Spread your arms to the sides. Lower one arm down, touching the ground. Raise your other arm up so that it forms a straight line with the other leg. Raise the leg opposite to the lowered arm so that it is parallel to the floor. There should be a 90-degree angle between your legs.

• Exercise #7. Twisting in the lower back.

We sit in a cross-legged position, place our hands crosswise: the right hand on the left knee, the left hand on the right knee. Raise one hand up, hold it straight in front of us. Cross - turn towards this hand, clockwise. Try to keep your shoulders straight, on one line. Return to the starting position. Repeat the exercise in the other direction in the same way.

• Exercise No. 8. Warm-up for the lower back, sacrum and coccyx.

You need to squat slightly. Your legs should be slightly bent at the knees. To make the exercise easier, imagine that your coccyx has a continuation in the form of a tail. This makes the exercise easier. You need to take a deep breath, and then lift the "tail" together with the coccyx and gluteal muscles, trying to bend the lower back as much as possible. As you exhale, "press the tail", trying to lower it as low as possible. The lower back should be as straight as possible, the pelvis pulled forward.

• Exercise No. 9. Rooting.

Stand up straight. Connect your feet, toes, fingers. Build your body as straight as possible. Keep your hands strictly along your hips, lowered down. Close your eyes, relax, concentrate on your sensations. Check that your legs are connected, remain straight. Start to slowly stagger. Move slowly, smoothly. Imagine that you are a strong, powerful tree whose roots go deep into the ground, standing firmly and confidently. As you exhale, the pain leaves your back with the exhalation, goes deep into the ground. The tree grows even more deeply into the ground with its roots. As you inhale, warm, light energy fills your body, rises through the roots of the tree, goes into your back.

• Exercise No. 10. Bon.

This exercise is meditative and relaxing. Often kyphosis is formed due to the fact that a person's lumbar muscles are overstrained. This leads to deformation of the muscle layer, and then the spine itself. The exercise should be performed in a calm environment and for at least 30 minutes.

The essence of it is simple. You need to sit down, straighten your back as much as possible, stretch your spine from the crown to the tailbone. Imagine that the spine is a column, a rod that holds the whole body. You need to bend your legs, put your feet together, press one to the other. Heels, feet, toes - tightly pressed. You need to try to lower your knees to the floor. Cross your arms, connect two thumbs at the top, and place them loosely on your legs, closer to the pelvis.

Close your eyes, distract yourself from everything extraneous, focus only on your internal sensations. Try to relax as much as possible, relax your whole body. Imagine how your muscles relax and slowly flow down your spine. There is silence in your head, no thought disturbs you. Breathe slowly, smoothly. Do not move. After a few minutes, slowly open your eyes, stretch, and come out of the position.

Surgical treatment

Surgical treatment of PDSI is considered in patients who complain of difficulty walking or experience intractable pain in the lower back and both legs with severe sagittal imbalance (kyphotic deformity) when conservative treatment is no longer effective.[ 2 ] Other surgical indications described in previous studies were:

1. pronounced atrophy of the back muscles on X-ray examination,
2. absence of severe osteoporosis and
3. the patient's desire for surgical treatment. [ 3 ]

Several authors have described other surgical indications for PDSI, which were cited by Lee et al. These include prominent clinical signs called the “four cardinal signs,” such as difficulty walking due to forward trunk bending, inability to hold things in front of the body, using the elbows to wash dishes or faces, and difficulty climbing slopes.

Basically, the treatment of lumbar kyphosis is a traditional, complex treatment that includes medications, physiotherapy, exercise therapy, massage, and swimming. Surgical treatment methods are used as a last resort, when there is an urgent need. Radical intervention is permissible only if other treatment methods are ineffective. Surgery is indicated if a nerve or spinal cord is pinched. Indications for surgery may include disc protrusion, intervertebral hernia, purulent-septic process, inflammation, and necrosis.