Children becoming "hunchbacks" due to addiction to digital screens

A 16 year young boy studying in 11 standard in Delhi had been experiencing a hunchback deformity for the last 3 years. His deformity was so prominent and progressive that he started feeling shy and would refuse to got to school too. Therefore, it not just affected his personality but studies as well. On investigations, the boy was diagnosed with a deformity of the spine known as Kyphosis. 

Kyphosis can spread due to a congenital problem in spine and the deformity can progress further if not treated on time, it can increase pressure on the lungs and the heart, which can result in repetitive sickness with lung infections and morbidity. 

Hunchback or Hunched back is a condition where there is exaggerated forward rounding of the upper back. In a typical case, the head and shoulders shift forward, the chest curls inwards and the spine crunches from a healthy S-curve to a less healthy C position as the pelvis tilts forward. Though the hallmark of old age; hunchback is a condition commonly seen among youth and young teenagers these days, especially the ones between 9-18 years old. Blame it on their sedentary lifestyle or poorer posture due to spending more time on small digital screens. And, the situation is alarming because what initially starts out as a mild case of bad posture when children are young, slowly begins to develop into hunched back and shoulders. 

Causes and Concern

The main cause of hunchback is weak abdominal muscles from years of sitting in a hunched position. This places uneven pressure on the discs, the cushioning pads between the bones of the lower back, causing them to become compressed and painful. Patients having osteoporosis develop age-related hunchback too. And not many people are aware that hunchback condition, if not treated, progresses into the full-fledged hyperkyphosis of a dowager’s hump, and numerous other health issues alongside. Also, as hunched back compresses the rib cage, so resultantly, many people with hyperkyphosis suffer from shortness of breath and other breathing issues. In extreme cases and especially women suffering osteoporosis are more likely to suffer fractures; the more hunched the back, the greater the risk. It may also cause anxiety and depression, increased risk of cardiovascular or lung disease, and Type 2 diabetes. 

Stages of Hunchback

The hunched back of dowager hump develops in stages, and the earlier you take step to improve or reverse dowager’s hump, the greater the results. The early stages of hyperkyphosis appear as a forward head posture, in which the head moves forward of the gravitational center line of the body. As the head moves forward, the shoulders typically begin to get hunched as well. At this stage the hunched back can be easily improved or even reversed. Once the condition grows into the hunched back of a full-fledged dowager’s hump, it becomes more difficult to work with, and for best results, you’d be advised to seek help of a professional physiotherapist, or yoga therapists. 

Cure and Therapies

With children and youth, it's important that they learn the correct way to sit, especially when they’re using a computer. Parents should teach them to keep their arms relaxed and close to their body and place arms on the desk when typing. Also, make sure the top of the screen is in sync with the eyebrows and the chair is titled slightly forward, allowing the knees to be lower than the hips and the feet to be flat on the floor. Using a laptop or tablet away from the desk will encourage a bad posture. So avoid teenagers to use these portable gadgets. 

For youth and elderly people, exercises such as stretching exercises often help to improve the flexibility of the spine. Youngsters can emphasise on strengthening the abdominal muscles as they help to improve the posture. Practicing yoga is considered beneficial for improving and developing good body posture. Yoga also helps in improving balance; strengthening the core muscles and helping you maintain a proper body alignment. 

While standing proper posture can be achieved by finding your center. A proper standing posture also gives you an air of confidence. When sitting, always keep your shoulders straight and squared, your head upright, and your neck, back, and heels should be in alignment. Always keep both feet on the ground. Similarly, take care of your posture while driving and performing other day-to-day activities. 

Surgical procedures are recommended and done only if the curvature of the spine is exaggerated such as seen in severe hunchback and especially if it is pinching the spinal cord or the nerve roots. Surgery helps in reducing the degree of the hunchback curvature. The most common procedure done is called spinal fusion where two or more of the affected vertebrae are permanently connected. The complications for spinal surgery are quite high and include: Infection, bleeding, pain, arthritis, nerve damage and degeneration of the disc. A second surgery may be required if the initial surgery has failed to rectify the problem.

Therefore, understanding the importance of good posture at a very early age is essential to maintain a healthy mind and body. 

Dr Satnam Singh Chhabra

Director Neuro Spine Surgery, Sir Gangaram Hospital





Source : Kashmir Monitor , 2nd Feb 2017 

Joan Smalls suffers from scoliosis

Joan Smalls is known for strutting down the catwalk, but few know she suffers from a debilitating disorder.

“I have scoliosis so I have to try and maintain a strong core because of my back,” she told ES magazine.

Scoliosis is a curvature of the spine. Cases in girls are 10 times more likely to deteriorate and require treatment, according to WebMD. And as the 5’9″ model describes, it can be difficult to manage given her busy modeling career.

“It’s pretty severe and hurts when I sit or stand for long periods of time,” said the 28-year-old runway queen. “I got it when I grew up really fast when I was 12.”

To maintain her fit frame, she sticks to a daily workout regime that involves Thai kickboxing training. “I always feel like every couple of years I want to learn new destreza — a new skill,” she explained. “I wanted to learn how to box, but proper boxing. I wasn’t doing it for cardio, I was doing it because I wanted to learn how to throw a punch and feel empowered.”

Smalls says he father could have taught her those skills. “My dad was a black belt in the Marines but he never taught us properly how to fight,” she said.

When it comes to her career, Smalls said she’s not doing any of it for the glitz and the glamor. “I always viewed it as an experience and an opportunity to one, make money and, two, use what God gave me and enjoy what I have around me and make the most out of it.”

Source : Page Six , 16th Feb 2017 

Physical therapy can improve spine curvature in teens with scoliosis

Teenagers with scoliosis have seen improvement from a new regimen of specialized physical therapy exercises developed by researchers at the University of Alberta in Edmonton.

The researchers behind a new study are calling for exercise management to be added to the standard of care for patients in Canada after the results from a randomized trial show that six months of Schroth physiotherapy offered significant improvement for the majority of patients in the study.

“Currently patients diagnosed with scoliosis are either monitored for progression, treated with a brace, or, in severe cases, offered surgery,” Sanja Schreiber, a member of the University of Alberta’s Faculty of Rehabilitation Medicine, said. “Our study showed that 88 per cent of patients who did the Schroth physiotherapeutic scoliosis-specific exercises showed improvements or prevented progression in their scoliosis curves over six months compared to 60 per cent in the group receiving only standard of care.”

The 30- to 45-minute daily home program, alongside weekly supervised sessions, was shown to have positive effects on pain, body image, and muscle endurance for teenage participants.

“These short term results are clinically significant and show that Schroth physiotherapy exercises could help many patients with scoliosis if this type of conservative management is added to the standard of care,” Eric Parent, associate professor of physical therapy in the Faculty of Rehabilitation Medicine, said. “The Schroth group showed improved muscle endurance by increasing the average holding time by 32.3 seconds after three months, while the controls increased by only 4.8 seconds.”

Source : Life Science Daily , 30th Jan 2017

Surgery Essential to Manage Scoliosis in Children, Study Says

Surgery is the only option to definitively manage scoliosis in children with cerebral palsy (CP), according to a recent review in the Journal of Spine Surgery. The study also detailed post-operative outcomes for the patients.

There is a strong link between having CP and developing scoliosis. The condition is estimated to occur in 21% to 64% of CP patients, according to “The Management Of Scoliosis In Children With Cerebral Palsy: A Review.” In children, scoliosis most often occurs between the ages of 10 and 18.

According to the authors, spasticity, muscle weakness, and poor muscle control contribute to spinal anomalies.

CP patients have two distinct types of scoliotic curves. Group-I involves double curves with a thoracic (middle back) and lumbar (lower back) component. These curves are most often seen in ambulatory patients with minimal pelvic obliquity (an abnormal pelvic tilt). Group-II involves single thoracic or lumbar curves that are more pronounced. They occur more frequently in quadriplegic patients, and almost all involve significant pelvic obliquity.

Hip contractures, leg-length discrepancy, or both may contribute to pelvic obliquity.

Children with CP and scoliosis can be treated by nonsurgical means, but studies suggest those measures only delay surgery.

“The aim of non-surgical management of scoliosis in CP is to improve sitting control and reduce or modify curve progression without the need for surgical intervention,” the researchers wrote. “There is a paucity of evidence for the use of modern bracing techniques. However, more recent studies suggest bracing improves sitting balance and trunk support, which provides better control of the head and neck as well as enhanced use of the upper limbs as they are not required to support the trunk in the sitting position.”

Intrathecal baclofen (ITB) pumps, which continuously deliver medication into the spinal fluid, have been shown to improve spasticity and pain, but it is not clear whether they can worsen scoliosis.

“Surgery remains the only option for the definitive management of scoliosis in CP,” the team wrote. “The aims of surgical correction include achieving a balanced spine, prevention of curve progression and improvement in functional quality of life.”

The authors noted that surgery should be carefully planned by a multi-disciplinary team and include a physical examination, and laboratory and imaging tests.

Post-operative complications involving the respiratory system frequently occur in children with CP, the team noted, as can implant complications and infections.

“The use of pre-operative non-invasive ventilation (NIV) training to strengthen respiratory muscles has shown promise in improving outcomes in patients with neuromuscular disease following spinal surgery,” the team wrote.

Studies have reported that parents and caregivers are typically satisfied with the results of surgery, with a majority willing to recommend it to others.

“Quality of life is perhaps the most important outcome measure in any postoperative CP patient. In a systematic review, the evidence suggests an improvement in postoperative quality of life in CP patients who underwent scoliosis surgery,” the authors wrote.

Source : Cerebal Palsy News Today , 30th Jan 2017 

Government hospital shows the way in hi-tech surgery _ BANGALURU

Manav (name changed), 14, was born with scoliosis, a deformity in spine where his backbone was bent towards the right with an angular curvature of 65 degrees. It was impossible for him to walk straight; he also faced breathing trouble as his right lung was compressed under the pressure of his crooked backbone.

The deformity was detected when he was 9 years old and he was prescribed physiotherapy and bracing. As he grew, the deformity attained a severe form requiring a surgery. Manav was admitted to the Sanjay Gandhi Institute of Traumaand Orthopaedic (SGITO) and that changed things for the better. All thanks to a procedure that used advanced 3-dimensional printing technology, rarely used in private multi-specialties.

The immediate aim was to prevent further progression of Manav's deformity and correct the curve to as much normal as possible. "Surgery for scoliosis is tricky as it requires screws to be placed through the spinal cord to straighten it. Incorrect placement of screws can be devastating," Dr Venugopal S, neuro-surgeon at SGITO, said.

"Recognition of complex anatomical structures is difficult to attain from simple 2-D radio-graphic views. The 3-D models of patients' anatomy allow doctors to get familiarize with it without even touching them. Getting to know the patient's body before entering the operation theatre allows planning the exact approach, predicting bottlenecks and even testing procedures before-hand," he added.

Post the six-hour-long surgery, Manav is completely fit.

Dr B G Tilak, director at SGITO, said: "Implementing new technologies in healthcare should become more common in government hospitals. More doctors should take up new techniques. Patients reaching government hospitals should not miss innovative ways of treatment."

Complex procedure

Placing the screw at the right places on the spinal cord during the surgery was a challenge. A 3-D printed patient-specific guide customized with 3-D printers was used to help doctors. "In complex surgical procedures of severe deformities, it is difficult to find the entry point for the screws to straighten the cord and prevent further bent. The 3-D printing technology is accurate, and time and cost effective," Dr Venugopal said.

While implementation of 3-D printing technology is mostly seen in oral, facio-maxillary and plastic surgeries, treating a spine disorder using the same and that too, in a government hospital was challenging.

Source : TOI , 10th Jan 2017