Hypokyphosis

[darrin90]

Hello forum members. This is a thread for all of you with hypokyphosis. Please post info and pictures regarding hypokyphosis. Since there is very little information on the internet about hypokyphosis this is a thread where we can share our knowledge of the desease. I got scolisosis and hypokyphosis and from own experience it can be a painfull combination. The problem is that ortopedic doctors seems to be more interested in the frontal plane of the spine, instead of looking at the sideview.

Here is the most understandable facts I found about hypokyphosis when I browsed the web:

"Hypokyphosis is the opposite of hyperkyphosis, which is known as "hunchback" or "roundback". Hypokyphosis is a condition where lack of thoratic kyphotic curvature leads to a "big gap" between the shoulders, where the kyphotic angle in the sagittal plane is under 10 degrees. Hypokyphosis is often associated with ideopathic scoliosis, and the combination of these two conditions can cause a lot of stress on the upper back, leading to moderate back pain. Hypokyphosis is known to decrease lung capacity and the vital capacity by putting pressure on the lungs. Today the only known threatment available for hypokyphosis is surgery, where it is often corrected with good results."

If you know something worth knowing about scoliosis, please post it here :) And please excuse my english, I'm norwegian...

[tonibunny]

I've heard it's very common - I was told by my surgeon that most people with thoracic scoliosis have hypokyphosis to some extent. A lot of people (and some doctors) get confused because they have a rib hump and assume they have kyphoscoliosis because of that, when in fact the hump is caused purely by rotation; if you derotated the spine completely, it would actually be hypokyphotic.

This may just be one surgeon's opinion, Linda will be able to tell you if it's the general consensus.

[Ballet Mom]

My daughter has never been told she has hypokyphosis. But her back definitely has a fairly deep depression between her shoulder blades that is quite noticeable. She has had no pain or breathing difficulties though. She does have a thoracic curve.

I actually noticed that there is a huge variation in people that don't have scoliosis also, so there is a great deal of variety in the shapes of peoples spines. A couple of the ballet students in my daughter's class also have quite depressed areas between their shoulder blades, although I don't believe they have scoliosis, but who knows. I checked out everyones' backs when I noticed my daughter's "gap" in her back!

Sorry I can't be of more help in your discussion.

[leahdragonfly]

Hi Darrin,

You may get more replies if you post a specific question--don't worry about your English, it is just fine.

I have mild thoracic scoliosis treated with a brace as a teenager. I am very hypokyphotic too and have a big dip between my shoulder blades. The hypokyphosis does not bother me though, pain-wise.

You can view my x-rays on my thread about my second opinion recently. Here is a link: http://www.scoliosis.org/forum/showthread.php?t=11105 You can find my x-rays if you tab down through the thread. The lateral shows the hypokyphosis.

Take care,

Gayle

[Writer]

The Scoliosis Research Society defines hypokyphosis as "a kyphosis of the thoracic spine less than the normal range" on their definitions page.

I think this is called "hollow back" or thoracic lordosis by Christa Lehnert-Schroth in her book. There are some drawings, photos and exercises for it in there.

See also her website:

http://www.schroth-skoliosebehandlung.de/

Online I find an article on idiopathic thoracic lordoscoliosis which appears to be the same thing.

http://www.ejbjs.org/cgi/content/abstract/57/7/972

[Pooka1]

As Toni mentioned, I think hypokyphosis is a fairly common accompaniment to thoracic scoliosis. Although our surgeon never mentioned it, I saw a medical report for one of my daughters which stated she was hypokyphotic.

Before their surgery, my kids never had pain from this to my knowledge.

Surgery corrected this in both my kids and they now have a normal balance in the sagittal plane also in addition to the coronal plane.

[Pooka1]

(emphasis added)

http://www.ncbi.nlm.nih.gov/pubmed/10598991


J Spinal Disord. 1999 Dec;12(6):489-95.
Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis.

Suk SI, Kim WJ, Kim JH, Lee SM.

Seoul Spine Institute, Inje University Sanggye Paik Hospital, Korea.
Abstract

This study verified the efficacy of segmental pedicle screw fixation in restoring thoracic kyphosis in persons with hypokyphotic scoliosis. Fifty-one patients were divided into three groups by the degree of preoperative thoracic hypokyphosis and fixation method used: the hypokyphosis-hook (HH), hypokyphosis-screw (HS), and normal kyphosis-screw (NS) group. They were compared after a minimum follow-up period of 2 years. Preoperative thoracic kyphosis of 4.1 degrees +/- 8.6 degrees, 8.1 degrees +/- 5.6 degrees and 27.3 degrees +/- 9.8 degrees in the HH, HS, and NS groups were restored to 14.5 degrees +/- 10.2 degrees, 27.3 degrees +/- 11.3 degrees, and 28.3 degrees +/- 13.7 degrees, respectively. The difference between the HH and HS groups was significant (p = 0.000). The HS and the NS groups did not differ (p = 0.16). This indicates that segmental pedicle screw fixation was more effective than multiple hooks in restoring kyphosis in patients with hypokyphotic scoliosis and created kyphosis similar to that in patients without preoperative hypokyphosis.

You bend the rods with the appropriate curvature and screw them down. I'm not sure why the ability of screws to restore normal kyphosis would ever be in doubt but what do I know. This seems like publishing a paper showing that setting broken arm bones works.

[Ballet Mom]

The Scoliosis Research Society defines hypokyphosis as "a kyphosis of the thoracic spine less than the normal range" on their definitions page.

I think this is called "hollow back" or thoracic lordosis by Christa Lehnert-Schroth in her book. There are some drawings, photos and exercises for it in there.

See also her website:

http://www.schroth-skoliosebehandlung.de/

Online I find an article on idiopathic thoracic lordoscoliosis which appears to be the same thing.

http://www.ejbjs.org/cgi/content/abstract/57/7/972


Writer,

Thanks for the info about exercises in the Schroth book. I guess I will have to actually buy the book at this point!

[darrin90]

Today I stumbled upon an article named "Posterior to Anterior Thoracic Spinal Adjusting in the Scoliosis Patient Is Contraindicated by Spinal Biomechanics". It contains some really interesting information about the sagittal plane in patients with scoliosis: (http://www.theamericanchiropractor.com/articledetail.asp?articleid=1036&category=10

"Thoracic hypokyphosis with increasing axial rotational instability is claimed to be a primary factor for the initiation of Idiopathic Scoliosis."

"Thoracic lordosis is the predominant component of the disease."

"When median plane asymmetry (flattening or, more usually, reversal of the normal thoracic kyphosis at the apex of the scoliosis) is superimposed during growth, a progressive idiopathic scoliosis occurs."

"Those patients who had scoliotic deformity with typical vertebral rotation only in thoracic spine (ST group), showed significant decrease compared to normal persons in thoracic kyphosis, but no difference in lumbar lordosis. However those changes in sagittal curvature were not found in FT group patients, who had scoliotic deformity without vertebral rotation. In conclusion, it is not the frontal curvature but the vertebral rotation which influenced the sagittal curvature of spine in patients with idiopathic scoliosis."



The article also claims that its possible to reduce the scoliosis curvature by using a "correct adjustment force" called "anterior dorsal adjustment" by correcting the hypokyphosis:

"By re-establishing the normal sagittal curves, the scoliosis has been reduced in nine intensive office visits"

What are your thoughts on this?

[darrin90]

Here is a X-ray showing my hypokyphosis in the sagittal plane. Notice that the normal kyphotic curvature is severely decreased.

763

[Pooka1]

Today I stumbled upon an article named "Posterior to Anterior Thoracic Spinal Adjusting in the Scoliosis Patient Is Contraindicated by Spinal Biomechanics". It contains some really interesting information about the sagittal plane in patients with scoliosis: (http://www.theamericanchiropractor.com/articledetail.asp?articleid=1036&category=10

Woggon has no relevant training because hs is a chiro. Like his other written work, this article is likely stem to stem nonsense.

Here is Chirobase, a division of Quackwatch devoted to exposing nutty and dangerous chiro quackery.

http://www.chirobase.org/

Here's some stuff written by an honest chiro blasting his colleagues...

http://www.sciencebasedmedicine.org/?p=4068

Four important Q&As...

http://www.sciencebasedmedicine.org/?p=59#more-59

Is chiropractic a science? No.
Is chiropractic based on neurology, anatomy and physiology? No.
Are chiropractors doctors of the nervous system? No.
Does chiropractic improve health and quality of life? No.

[Pooka1]

A systematic review of manipulative "therapy"

http://www.ncbi.nlm.nih.gov/pubmed/18211702


RESULTS: We founded 145 texts, but only three papers were relevant to our study. However, no one of the three satisfied all the required inclusion criteria because they were characterized by a combination of manual techniques and other therapeutic approaches.

CONCLUSION: The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis.

There has never been any serious data on chiro treatments of scoliosis. The Clear chiros admit they have no evidence and go on to say none is needed at this point. They want to be judged not on evidence of efficacy but on their experimental approach. But they have no training in research.

[darrin90]

Thanks for replying Pooka1. I also think that there is a lot of misinformation and lack of evidence in the article. I find the threedimensional threatment from Scroth to be the best non-surgical threatment for scolisos and hypokyphosis. The rotational breathing exercises are really interesting, and the three-blocks principle where you divide the back into the pelvic shift, the rib-cage shift and the shoulder/neck shift is useful when you are doing these exercises.

What are your thoughts on my sagittal x-ray I posted earlier in this thread?

[Pooka1]

Thanks for replying Pooka1. I also think that there is a lot of misinformation and lack of evidence in the article. I find the threedimensional threatment from Scroth to be the best non-surgical threatment for scolisos and hypokyphosis. The rotational breathing exercises are really interesting, and the three-blocks principle where you divide the back into the pelvic shift, the rib-cage shift and the shoulder/neck shift is useful when you are doing these exercises.

Well Schroth certainly has been around the longest.. since 1921. Schroth and other forms of PT hopefully can help folks with pain which keeps some off the surgery table.


What are your thoughts on my sagittal x-ray I posted earlier in this thread?

My main thought is that I am completely unqualified to comment. :)

Moving beyond that thought, I agree you are hypokyphotic. Do you have pain from this? What type of scoliosis do you have and what is your Cobb angle?

[darrin90]

Well Schroth certainly has been around the longest.. since 1921. Schroth and other forms of PT hopefully can help folks with pain which keeps some of the surgery table.



My main thought is that I am completely unqualified to comment. :)

Moving beyond that thought, I agree you are hypokyphotic. Do you have pain from this? What type of scoliosis do you have and what is your Cobb angle?

Yes I have a lot of daily pain from my hypokyphosis and the muscular instability caused by it. I have a right convex thoracic curvature measured to be 40 degrees Cobb's angle.

I just measured my hypokyphotic curvature in the sagittal plane to be around 6 degrees Cobb's angle. Kyphotic curvatures under 10 degrees Cobb's angle is named hypokyphosis, while curvatures from 10 to 40 degrees Cobb's angle is named normokyphosis (the normal kyphotic curvature), while curvatures over 40 degrees is named hyperkyphosis, or just kyphosis.

I can also mention that I have the characteristic rib-hump on my convex side, moderate thoracic vertebral rotation and anatomic leg length inequality of 6mm (I am compensating by using orthotic compensation implantation OCLLI)

[Pooka1]

Wow very interesting.

Can I ask how you know it is the hypokyphosis and not the scoliosis that is causing the pain?

While a 40* thoracic curve doesn't normally cause pain in kids, I don't know the deal for adults. And there are adult testimonials about pain in sub-surgical curves associated with scoliosis.

[darrin90]

Wow very interesting.

Can I ask how you know it is the hypokyphosis and not the scoliosis that is causing the pain?

While a 40* thoracic curve doesn't normally cause pain in kids, I don't know the deal for adults. And there are adult testimonials about pain in sub-surgical curves associated with scoliosis.

I have been told by my ortopedic specialist that scoliosis shouldn't cause any pain. Therefore I believe that my hypokyphosis is the source of my upper back back. But its possible that the combination of my hypokyphosis and scoliosis is causing muscular imbalance and putting pressure on my nerves, which lead to pain.

I was told by my doctor that some specially designed back exercises would help me deal with my pain, so I was sent to a physical therapist. The problem is that the exercises have not helped me much.

So I'm trying to do some rotational-breathing exercises designed by Scroth to help me re-rotate my ribs and increase my pulmonary function. It is also claimed that the Scroth method may help patients with bad sagittal curves, so I'm hoping this will help me.

[darrin90]

Since I got hypokyphosis I feel that it might be naturally for me to try to correct (or bend) my back to a more kyphotic posture. So what might be a bad posture for some(people with hyperkyphosis aka. "hunch back"), may be an excellent posture for me. Do you guys have any tips for sleeping positions, sitting positions or standing posture for me which can increase my kyphotic curvature in the thoratic spine? I know this sounds a bit weird, but I'm willing to do almost anything(yes literarly anything to correct my back). So if any postural habits could be developed I'm glad to know. :)

[darrin90]

Did some torso rotational strenghting excercises with a medicine ball yesterday, and I felt the immediate effect it had on my back. After just one work out session my pain is almost eliminated. I'm planning doing the TRS and RAB (Rotational angular breathing) excercises every day, and hope that it will reduce my back pain, re-rotate my torso, increase my vital capacity and decrease my curvature.

Do you think combining TRS and RAB excercises is a good way to train for people with scoliosis?

[Pooka1]

Did some torso rotational strenghting excercises with a medicine ball yesterday, and I felt the immediate effect it had on my back. After just one work out session my pain is almost eliminated. I'm planning doing the TRS and RAB (Rotational angular breathing) excercises every day, and hope that it will reduce my back pain, re-rotate my torso, increase my vital capacity and decrease my curvature.

Darrin90, excellent news! PT is known to help with pain in some patients and I am glad you got such fast relief! Maybe that means you can completely control your pain from now own. PT has a better track record for some pain than surgery.


Do you think combining TRS and RAB exercises is a good way to train for people with scoliosis?

I have no idea but we have a rehab doctor (muscle physiology) who posts here. Dr. Kevin McIntire. He is the only living person who has published research (as a first author) on TRS. He is also the only guy who can come close to answering that question among the players in this sandbox. He investigated TRS w.r.t. stopping progression in AIS but he is likely to know about the ability of TRS to stop pain in adults also because TRS was his dissertation.

Again, congratulations on your success in finding a PT therapy that works so well for your pain.

[Ballet Mom]

Since I got hypokyphosis I feel that it might be naturally for me to try to correct (or bend) my back to a more kyphotic posture. So what might be a bad posture for some(people with hyperkyphosis aka. "hunch back"), may be an excellent posture for me. Do you guys have any tips for sleeping positions, sitting positions or standing posture for me which can increase my kyphotic curvature in the thoratic spine? I know this sounds a bit weird, but I'm willing to do almost anything(yes literarly anything to correct my back). So if any postural habits could be developed I'm glad to know. :)

I don't suppose you'd want to take some gymnastics classes? They develop quite a rounded posture apparently. :)

Of course, they usually train all day during the growth stages, so remodeling probably takes place prior to the stopping of growth. So I don't know if it would be the same in adults. But perhaps the way they hold themselves might help over a long period of time...who knows? Maybe watch some gymnastics videos to see how they hold their posture.

http://www.gymnasticsrescue.com/posture.htm

[Writer]

Great to hear you've been able to reduce your pain, darrin! Your orthopedist has told you the prevailing opinion about scoliosis-related pain in his discipline, which stems from large studies, but I know all kinds of evidence to the contrary, including my own condition. Fortunately pain can often be controlled pretty quickly if the therapist knows what he or she is doing.

You can help yourself to a certain degree with some knowledge of Schroth exercises, but if you get in front of a Schroth physical therapist you will be surprised what s/he sees in your body and exercise performance that you don't, or have overlooked. There's a list of a dozen Schroth therapists in the USA at Christa Lehnert's website which I cited above. Even a couple sessions, including of course a thorough physical examination, could help you a lot. Average cost is only around $100/hour. I get docked close to $300 for 15 minutes with my MD dermatologist.

On another topic from above, I would be suspicious of anything that most chiropractors write. There are some that are better than the pack, but by and large their orthodoxy is pretty Mickey Mouse, including newer developments like CLEAR, which Woggon invented.

Bascially Woggon has things upside down, quite literally. He thinks that the:

"biomechanical [element of scoliosis] begins with anterior head translation, the loss of the cervical lordosis, and the lever arms it provides. This causes the body to try to compensate by creating the curves measured by the Cobb angles at the thoracic and lumbar levels." (Article "I Want to Change the World" in The American Chiropractor, vol 32/5.

This is a crock of manure, which does not take lower extremities into account. The etiology of scoliosis is complex and varied (as different as asymmetrical sports training and cerebral palsy), but many common causes are more likely to be associated with abnormal developments in the lower extremities (feet & legs) and pelvis, which is the foundation that the spine rests upon. Schroth says that you have to fix the pelvis position before you can start on the spine. That makes much more sense.

As for gymnastics classes, they're like yoga in that they are intended for people with straight, symmetrical bodies. They may help, but there may be some exercises that would make a scoliosis worse, and you have to know a lot about exercise therapy to distinguish them. Even the scoliosis-therapy specialists among the yoga teachers do not know the difference, in my observation.

[darrin90]

For about 1 week now I have been sleeping on my side. This has drastically reduced my upper back pain and I am sometimes totally painfree! Before I used to sleep on my stomach and this caused a lot of stress on my upper back leading to severe back pain. So for people with hypokyphosis and upper back pain I strongly suggest that you try to change your bad sleeping positions, and sleep on your side.

[darrin90]

Does anyone on the forum know if doctors and surgeons take secondary disorders like hypokyphosis into account, when they are considering threatment options for ideopathic scoliosis? My doctor did mention that I got kyphosis (althought he didn't mention that it was HYPOkyphosis, not HYPERkyphosis), but I think he did focus to much on the angle of my curvature. The only thing he did was showing me the X-rays on his monitor and telling me that I didn't need surgery. :confused:

[LSKOCH5]

There is some great info in here, very happy this forum and threads like this exist where others share their experience. In our 2nd opinion a few days ago, Dr Cronen explained that Jacob has lordosis in addition to the scoliosis. He's been on pain for what we thought was 4 months but found out at that appt he'd been in pain all last year but didn't want to tell us. We've had several ppl tell us that scoliosis shouldn't cause pain, which made him feel like they thought he was faking. Unbelievable. Now I read that it causes pain for most of you as well. Since he's a stomach sleeper, we will work on changing that to at least side. Dr did recommend pt for ESP the rhomboid, which ironically has always been my trouble spot when I stop working out. Does it resolve itself w the scoli surgery or is there an additional step? Thanks all of you for sharing.

[Pooka1]

There is some great info in here, very happy this forum and threads like this exist where others share their experience. In our 2nd opinion a few days ago, Dr Cronen explained that Jacob has lordosis in addition to the scoliosis. He's been on pain for what we thought was 4 months but found out at that appt he'd been in pain all last year but didn't want to tell us. We've had several ppl tell us that scoliosis shouldn't cause pain, which made him feel like they thought he was faking. Unbelievable. Now I read that it causes pain for most of you as well. Since he's a stomach sleeper, we will work on changing that to at least side. Dr did recommend pt for ESP the rhomboid, which ironically has always been my trouble spot when I stop working out. Does it resolve itself w the scoli surgery or is there an additional step? Thanks all of you for sharing.

That's a crime that your son thought he might be accused of faking pain. Outrageous. Some surgeons are coming to the realization that scoliosis can cause pain in kids. I posted a blog entry from Dr. Hey saying this is being recognized more and that he realizes scoliosis can cause pain in kids.

The situation with kids is not the same as with adults where I suspect it is unusual NOT to have pain if left untreated. But I don't know that. I can only go by the testimonials but, of course, this is probably not an accurate cross-section and might be (heavily?) weighted towards adults with some issue, mostly pain. It could still be most adults have no pain. Who knows.

My one daughter had pain around her right shoulder blade prior to surgery. I suspect that was due to her curve moving very fast (5* a month for at least 5 months). That did NOT resolve right after surgery but did after several weeks. She and her sister are both pain free as are most kids who are fused per the testimonials at least.

Per the testimonials and what went down with my daughters, for what it is worth, my impression is as follows:

1. virtually no kids are in pain after the post op period.
2. most adults see a significant reduction in pain.
3. some adults and a vanishing number of kids eventually have more pain if there is some issue with the fusion (pseudoarthrosis, wrong levels, going below L3, PJK, etc.).

You should ask your surgeon. I think he will be able to give you an accurate picture on pain in kids after the recovery period.

Good luck.

[LSKOCH5]

Pooka- so glad your girls are paid free now. Reassuring thoughts on the pain going away postop. Btw the main culprit on the pain issue was a knowitall teacher whose son "had scoli that was no big deal and there's no pain." Her tune changed somewhat when she learned he needed surgery but Fortunately today was his last dayin that woman's class.

[Pooka1]

Pooka- so glad your girls are paid free now. Reassuring thoughts on the pain going away postop. Btw the main culprit on the pain issue was a knowitall teacher whose son "had scoli that was no big deal and there's no pain." Her tune changed somewhat when she learned he needed surgery but Fortunately today was his last dayin that woman's class.

Yeah there seems to be no lack of lay "super-geniuses" when it comes to scoliosis. Best to ignore them, try not to stare, and just move on. :-)

But seriously, your surgeon can tell you what to expect based on his experience with all the other patients. This sandbox, though it has actual testimonials, may not be representative. We just can't know and so must not assume it is representative.

You can do this as can your son. :-)

[LindaRacine]

Scoliosis generally does not cause pain in kids, but that by no means, means that your child is faking. I keep thinking that someday, one of the pediatric surgeons will figure out why a small subset of patients have pain when the others don't.

[Elisa]

My son had terrible back pain before his two surgeries/traction and compared his pain to a stabbing, burning sensation, like someone was sticking a hot knife in his back, so obviously some kids DO experience pain with scoliosis. That said, he did have a monster curve so perhaps that was the determining factor.