Looking at someone straight on the spine should be straight.
Looking at someone from the lateral or side view the spine shows its varying curvature.
In the neck (cervical spine) and the lower back (lumbar spine) are inward curves known as lordosis.
In the thoracic spine, there is an outward curve or kyphosis.
The goal is to have an economical stance and gait that does not require excessive energy.
The curves need to be well-balanced.
The gravity line should fall through:
Like this minimum energy is exerted for standing and walking.
When these curves are not balanced, like what happens with excessive kyphosis in the thoracic spine or loss of normal lordosis in the lumbar spine, the patient may begin to experience symptoms.
Loss of lumbar lordosis or actual kyphosis in the lumbar spine that presents symptoms is named flatback syndrome.
The main symptoms of flatback are:
Symptoms will worsen as the day progresses with fatigue and increasing difficulty to stand up straight with correct posture.
Individuals will flex or bend their hips and knees to get into an upright position.
This is what causes exhaustion as the day goes on.
Some patients also have symptoms of:
Some individuals have neck and upper back pain as they strain to get themselves upright.
Trying to live like this can lead to a disabling condition that requires pain medications, and limits the individual’s ability to perform daily activities.
Flatback syndrome was first described in patients who had been treated with Harrington spinal instrumentation.
This was the earliest type of spine implantation to correct scoliosis.
This instrumentation had a tendency to flatten the normal curve or lordosis in the lumbar spine.
This system was used from the 1960s to the 1980s.
With today’s implant systems and techniques, this problem doesn’t really occur anymore.
But not to knock the system, those treated with Harrington rods did very well for decades.
The spine compensates for the flattening of the lordosis with the normal discs underneath the fused area.
However, when the discs below the fusion would wear out (degenerate), the patients would lose the ability to stand upright and pain would develop.
The diagnosis begins with a patient’s history.
A doctor will look for the common symptoms like the presentation of difficulty standing upright along with back pain.
If there is a history of prior surgery or a disease making them susceptible to the syndrome.
Full standing x-rays will be ordered.
The lateral side view is specifically the side that will be helpful (see x-ray).
The patient stands, knees straight, and the posture can be seen to be stooped forward.
This is depicted by the gravity line/plumb line falling in front of the sacrum.
Finally, MRIs, and CT scans, can be utilized to provide information about the health of the:
Patients should try non-surgical treatment first like:
Conditioning and endurance exercise programs can provide relief. But, if the structural problem is too great for conservative therapy then surgery is an option.
Sometimes low back pain comes out of nowhere, but that sudden twinge in the lower back does have a cause. In some cases, there’s a trigger, like picking up a heavy object/furniture from an awkward position. But sometimes it can be a mystery and a challenge to diagnose.
It is important to know the cause of lower back pain to figure out the proper treatment plan. Otherwise, one could receive treatment for the wrong diagnosis and possibly exacerbate the existing injury.
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The information herein on "Flatback Syndrome and Back Pain" is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.
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Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*
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Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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