Overview

1. Kyphosis

Causes

• Postural kyphosis: flexible slouched posture, common in adolescents.
• Scheuermann kyphosis: structural adolescent disorder where vertebral bodies become wedge-shaped, producing a relatively rigid angular thoracic curve.
• Osteoporotic vertebral compression fractures, especially in older adults.
• Congenital vertebral abnormalities.
• Trauma, infection, tumor, inflammatory disease.
• Neuromuscular disease or kyphosis after spinal surgery.

Symptoms

• Rounded upper back or visible hump.
• Back fatigue or aching, often after prolonged sitting or standing.
• Stiffness and reduced extension.
• Severe cases: pain, balance impairment, breathing restriction, nerve compression symptoms.

Diagnosis

• History: age at onset, pain, progression, trauma, medication use, osteoporosis risks.
• Examination: posture, flexibility, neurological examination, gait.
• Adam forward-bend test: structural kyphosis remains prominent rather than correcting.
• Standing lateral spinal X-rays with Cobb-angle measurement.
• MRI if neurological signs, infection/tumor suspicion, acute fracture, or unclear diagnosis.
• Bone-density assessment when osteoporosis or fragility fracture is suspected.

Rehabilitation and management

• Education on sitting, screen, backpack, and activity habits.
• Thoracic extension mobility exercises.
• Strengthening of thoracic extensors, scapular stabilizers, and core.
• Stretch tight chest/shoulder muscles and hip flexors.
• Gradual return to sport and regular weight-bearing exercise.

• Physiotherapy improves function, strength, and symptoms but cannot reliably reverse a rigid bony deformity.
• In a growing child/adolescent with a progressive moderate curve, spinal bracing may be considered by a spine specialist.
• Treat osteoporosis and prevent further falls/fractures where relevant.
• Surgery is reserved for severe, progressive, rigid, painful curves, neurological compromise, or major functional impairment. SRS describes surgical consideration in severe painful Scheuermann kyphosis, often around 80 to 90 degrees. SRS guidance

2. Lordosis

Causes

• Postural habit or muscle imbalance.
• Pregnancy or obesity.
• Tight hip flexors with weak abdominal and gluteal muscles.
• Hip flexion contracture.
• Spondylolysis or spondylolisthesis, particularly in adolescents/athletes.
• Neuromuscular disorders, for example cerebral palsy or muscular dystrophy.
• Congenital skeletal disorders.
• Compensation for thoracic kyphosis or altered pelvic/spinal alignment.

Symptoms

• Swayback posture.
• Low-back ache, fatigue, or stiffness.
• Buttock or posterior thigh discomfort.
• Reduced tolerance of standing/walking.
• If related to spondylolisthesis or nerve compression: leg pain, tingling, weakness, or altered gait.

Diagnosis

• Examine standing posture from the side, pelvic position, hip range, abdominal/gluteal strength, and hamstring/hip-flexor length.
• Neurological examination if leg symptoms exist.
• Thomas test can help detect a hip-flexion contracture that may be masked by increased lumbar lordosis.
• Standing lateral X-rays if deformity is marked, persistent, painful, progressive, or associated with suspected spondylolisthesis.
• MRI when persistent radicular symptoms, weakness, bowel/bladder symptoms, infection, malignancy, or other serious pathology is suspected.

Rehabilitation and management

• Treat the cause rather than just trying to “flatten” the back.
• Activity modification during painful flares, not prolonged bed rest.
• Core endurance training, especially deep abdominal control.
• Gluteal strengthening and hip stability work.
• Hip-flexor stretching if shortened.
• Movement retraining for standing, walking, lifting, and sport technique.
• Weight management if excess load contributes.
• Manage underlying hip disease, spondylolisthesis, or neuromuscular condition with specialist input.

3. Scoliosis

Causes

• Idiopathic scoliosis: most common, especially adolescent idiopathic scoliosis. Its exact cause is multifactorial and usually not due to poor posture, heavy bags, or one-sided activities.
• Congenital scoliosis: malformed vertebrae present from birth.
• Neuromuscular scoliosis: cerebral palsy, muscular dystrophy, spinal muscular atrophy, etc.
• Degenerative scoliosis: disc and facet degeneration in adults.
• Functional/nonstructural scoliosis: muscle spasm, leg-length difference, or pain-related posture. This often reduces when the cause is corrected.
• Less commonly: tumor, infection, connective-tissue disorders, syringomyelia, tethered cord.

Symptoms and signs

• One shoulder or hip higher.
• Unequal waist creases.
• One shoulder blade more prominent.
• Rib hump or lumbar prominence on forward bending.
• Clothes hanging unevenly.
• Back ache or fatigue, more common in adults.
• Severe curves: reduced exercise capacity or restrictive lung disease.
• Neurological symptoms are not typical in uncomplicated idiopathic scoliosis and need assessment.

Diagnosis

1. History: onset, growth spurt, family history, pain, neurological symptoms, menstrual/skeletal maturity in adolescents.
2. Physical examination:
   • Shoulder and pelvic height.
   • Waist asymmetry.
   • Adam forward-bend test with scoliometer measurement.
   • Full neurological and skin examination.
   • Leg lengths and gait.
3. Standing full-spine PA and lateral X-rays:
   • Cobb angle quantifies severity.
   • Skeletal maturity helps estimate progression risk.
4. MRI is not routine for every curve, but is considered for atypical features: significant pain, neurological deficit, rapid progression, left thoracic curve, early onset, or abnormal reflexes.

Management and rehabilitation

• Scoliosis-specific exercise under trained physiotherapy supervision, such as Schroth-based approaches where appropriate.
• Three-dimensional postural correction and breathing exercises.
• Core, hip, and trunk endurance training.
• Maintain general aerobic fitness, normal school/sport participation when safe, and confidence in movement.
• Brace education, skin checks, and exercises while using a brace.
• Pain-focused rehab for adults: graded activity, trunk/hip conditioning, sleep and lifting strategies.

Seek urgent medical assessment if any of these occur

• New bowel or bladder dysfunction.
• Numbness around the groin/saddle region.
• Progressive leg weakness, major numbness, or difficulty walking.
• Severe unremitting or night pain.
• Fever, unexplained weight loss, cancer history, or suspected spinal infection.
• Sudden deformity or severe pain after trauma.
• A rapidly worsening curve in a child.