What Is Flat Back Syndrome?
To understand Flat back Syndrome, it is important to understand the anatomy of the spine. The spine of the human body has its own natural curves. Now, when you look at the spine from behind then it would look straight with its center over the pelvis but when you look at the spine from the side you can see a distinct curve which the spine requires to maintain balance as it is located behind organs like the chest and the abdomen. Normally, the spine has two curves which give it an “S” shape. In the neck, there is an inward curve whereas in the thoracic and lumbar spine there is an outward curve. The inward curve is called as lordosis and the outward curve is called as kyphosis. These curves normally balance out each other so that when an individual stands he or she is well balanced and does not fall and even walk and run without falling.
Now coming to Flat back Syndrome, this is a condition in which an individual does not have the normal curve that the spine has but has a flat back.(1) Because of this, the spine becomes unbalanced and the individual tends to lean forward when standing or walking. People with Flat back Syndrome will have trouble standing in attention or straight and will have constant pain in the legs and back. This pain worsens as the day goes on and more pressure is put on spine due to the daily routines of the individual and the patient tends to lean more and more as the day goes on. The severity of the symptoms of Flat back Syndrome depends on how much curve the spine has and how much difficulty the individual faces with standing straight and how much muscle pain and fatigue the individual will experience.
What Are The Causes of Flat Back Syndrome?
As of today, the term Flat Back Syndrome is quite broad and also includes cases in which there is even a slight decrease in normal lordosis resulting in symptoms. Thus, any condition that shortens the front part of the spine causing an individual to lean forward can be called as Flat Back Syndrome. Some of the causes of Flat Back Syndrome are:
Degenerative Disc Disease: In some cases, progressive degeneration of discs may lead to loss of disc height in the front part of the spine. As we age, the discs starts to degenerate and as such we start to lean more forwards to keep ourselves balanced and hence the lumbar lordosis decreases. The individual may have pain either as a result of the degenerative condition or as a result of the spinal imbalance.
Lumbar Postlaminectomy Syndrome: Flat Back Syndrome is commonly seen in people who have a prior history of having undergone lumbar laminectomy or other surgeries to decompress the nerves in the lumbar spine for treatment of lumbar stenosis. Such procedures can cause a decrease in lordosis and hence cause Flat Back Syndrome.
Vertebral Compression Fractures: Compression Fractures are often caused due to osteoporosis which is a degenerative condition of the bones and joints. Compression fracture can cause loss of disc height in the thoracic and lumbar spine resulting in Flat Back Syndrome.
Ankylosing Spondylitis: This is a chronic inflammatory disease condition which leads to stiffness and arthritis throughout the spine. This in turn may lead to decrease in the lordosis and in turn causing Flat Back Syndrome.
How is Flat Back Syndrome Diagnosed?
To diagnose Flat Back Syndrome, a detailed history of the patient will be taken. Radiological studies will be conducted to look at the curvature of the spine. The symptoms experienced by the patient will typically be difficulty standing straight and pain in the back and legs. The physician will also inquire about whether the patient has a prior history of any lumbar surgery. Radiological studies will confirm the definite cause of Flat Back Syndrome whether it be osteoarthritis or a compression fracture of the spine.
How is Flat Back Syndrome Treated?
Treatments for Flat Back Syndrome may be both conservative as well as surgical. Conservative approach is tried first to treat Flat Back Syndrome.(2) This approach involves appropriate exercise routine including aerobic fitness, weightbearing exercises, and core muscle strengthening.
Physical therapy and spinal manipulation may also be recommended for flat back syndrome depending on the severity of the patient’s symptoms.
Medications like NSAIDs may be given for control of pain caused by Flat Back Syndrome. In most of the cases, a stringent exercise routine and endurance programs are good enough to get rid of the symptoms of Flat Back Syndrome. In people with arthritis or nerve impingement, spinal injections may be of benefit.
Surgical reconstruction will be required for those individuals who come under the severe range of Flat Back Syndrome. The aim of the surgical procedure is to get rid of the patient’s pain and realign the spine in such a way that a normal curve is restored as much as possible. Surgery is done when conservative approaches fail to improve the patient’s symptoms and their condition seems to be worsening with each passing day. Surgery will also be recommended for individuals who have deformity to such an extent that it starts to compress the spinal nerves causing severe pain in the back along with numbness, weakness, tingling and paresthesias. Again the main goal of the surgery is to realign the spine as much as possible so that the patient gets as much relief as possible from symptoms of Flat Back Syndrome.
Exercises to Fix Flat Back Syndrome
Some of the exercises that are recommended for Flat Back Syndrome are:
Stretching Exercises to Fix Flat Back Syndrome: To loosen up the spine and restore the normal spinal curve the patient should perform at least three sets of hamstring and abdominal stretches so that pressure is taken off of the spine.
For stretching the hamstrings, you need to lie down on the floor with one thigh pulled up towards the waist and the other leg resting on the floor. You should keep the knee bent and pointing upwards of the leg that is closer to the waist. Now gently straighten the knee and hold the thigh with the hands and maintain this position until a slight stretch is felt. Hold this position for a couple of seconds. Perform three sets of 10 to 20 repetitions.
For stretching the abdomen, lie down on an exercise ball on your back. Keep the feet on the floor and make sure that the back is fully supported. Hold the stretch for about half a minute. Do this two to three times a day.
Strengthening Exercises to Fix Flat Back Syndrome: To do this exercise, lie on your stomach on the floor with the arms extended overhead. The toes should be pointing away from the shins. Breathe out and tighten the abdominal muscles. Now, slowly raise the arms and lift both legs off the ground by just a couple of inches. Try and keep both arms and legs extended as you lift like you are reaching to the walls in front and behind you. Maintain this position for a few seconds. Take some breath in and slowly lower the arms and legs. Make sure there is no movement in the hips or low back when doing this exercise. If doing both the arms and legs at the same time is tough for you, you can try doing it with one leg and one arm first and then progress to both arms and both legs.
Wall Bend Exercise for Flat Back Syndrome: For improvement of the arch of the back, you can do this exercise. To do this, you need to stand about one feet away from the wall with your back towards the wall. Stretch your arms overhead and bend backwards until you touch the wall. Increase your distance from the wall as symptoms dictate and as you are able to tolerate it.
Back Arching: This exercise is done for improvement of the curve of the back and to make the spine loose. To do this exercise, lie on the floor with a medicine ball under the back. Roll the lower back over the ball gently. Move about a feet and perform this about five times forwards and backwards.