Straight
Back Syndrome of Mine
This description has no
relationship to the medical conditions stated below.
Fortunately my initial are also
S.B. and I am known to be a genetically predisposed be having a
straight back aggravated by my early childhood sports activities.
It started to dawn on me that, I
have had several minor spinal stress fractures.
They started affecting me in my
internship.
As a kid I could touch my toes
with hands by bending (while keeping the back straight).
I have long legs particularly
suitable for short distance running and jumping.
I noticed that I was losing this
ability gradually while in the university.
I did lot of long jump and hop
step and jump as part of my training ending with military drill
around the university track daily.
I never practiced short distance
running in the track.
I did that with my dog around
the lake of Kandy.
My dog was my trainer.
I could never beat him and I had
the leash to restrain him when I needed to catch my breath and rest.
On the days (over the weekend) I
wasn't in the campus, I did my running with the dog. My dog was
perfect companion and sporting match and wizard. Unfortunately, dog
died tragically when I went away for my internship. I should have
taken him with me.
I won't tell you the story, I
was told about its death.
I still believe it was cooked up
story to pacify my anger.
He died due to his separation
from its dearly loved master companion.
There was nobody to take him
round the lake.
I did not have a dog for nearly
25 years after this episode.
My campus dog (called the lone
ranger) and roommate of course lasted the full life cycle since I
handed over the dog to Nicholus Uncle who was our physiology
technician.
He was there even when I
returned from UK, in good condition.
My Straight Back Syndrome
started affecting me in my internship with constant back pain. I did
not give up sporting activity but continued on badminton and table
tennis and never running and long jump.
Over time with heat treatment
(we did not have warm hydrotherapy) and constant alert and avoidance
of further damage, I was without pain in about four years.
But
my back became straight and I cannot touch my toes as I used to do as
a kid.
This
gave me an added advantage and
good stead.
I never bend down even to a politician.
Also I never go with bended
knees like an average Sri-Lanka.
When, I went abroad, it was very
useful.
All Asians, who are vociferous in front of the local voters
go bended back and knees when in Western countries.
I always kept my
back straight in front of white men well over 6 foot 6 inches and
most of them thought, I was smart and I never told anybody, I had a
stiff back probably due to spinal fractures or the straight back
syndrome.
But
I regularly went for hydrotherapy which was available free in
hospitals, there. Now
my back does not bend to even monks of BBS. leave alone, the
politicians.
Below are
medical explanations.
Flat
Back Syndrome
Spinal
Curvatures
The human spine has natural curvatures.
When you look at a back from behind, the spine
should be straight and centered over the pelvis. However, when you
look at the spine from the side, the curves are designed to maintain
balance as the spine is behind organs in the chest and abdomen.
The spine has two alternating curves to create an
“S” like shape.
In the neck and low back there is normally an inward
curvature or sway back known as lordosis.
In the thoracic spine and sacrum there is an outward
curvature known has kyphosis or hunchback. These curves normally
balance out each other so that when the patient stands they are well
balanced with their head straight above their hips when viewed from
the side.
Standing in this position minimizes the effect of
gravity and allows the patient to stand with the best posture and use
the least energy when moving or walking.
Flat back
syndrome is an abnormal condition where the spine loses its natural
low back curve to become flat. The spine becomes imbalanced and the
patient leans forward. Patients with flat back syndrome typically
notice troubles standing upright or have ongoing back or leg pain.
Symptoms usually worsen as the day goes on and the patient feels they
lean further and further forward the longer they try to stand
upright. The severity of the symptoms usually depends on the amount
of curvature present and difficulties with standing erect.
In patients with flat back syndrome, a loss of normal
lumbar curvature causes an imbalance of the spine. The patient’s
head begins to lean forward, away from the body and they may have
trouble standing upright.
This imbalance can cause muscle fatigue and pain.
Today,
the term flat back syndrome has been broadened to include any patient
with a decrease in lumbar lordosis causing symptoms.
As
such, flat back syndrome can occur as a result of any condition that
shortens the front portion of the spine, causing the patient to lean
forward.
Flat
back syndrome may develop as the result of the following causes:
Degenerative
Disc Disease,
Lumbar
Post Laminectomy Syndrome,
Compression
Fractures,
Ankylosing
Spondylolitis.
Degenerative Disc Disease:
For some patients, progressive degeneration of the
intervertebral discs or the shock absorbers of the spine may lead to
a loss of height in the front part of the spine. As discs degenerate
the spine begins to lean forward and lumbar lordosis decreases.
The patient may develop pain as a result of the
degenerative disc disease or as a result of the spinal imbalance.
Lumbar Post Laminectomy Syndrome:
Lumbar flat back syndrome may develop in patients
previously treated with a laminectomy or other lumbar surgery to
decompress the spinal nerves to treat stenosis.
These procedures can lead to a decrease in lumbar
lordosis and in some cases spinal instability.
Vertebral Compression Fractures:
Compression fractures are often the result of weak
spinal bones due to osteoporosis. A fracture can lead to loss of
height of the bone in the thoracic and lumbar spine. This may occur
in one bone or in multiple bones throughout the spine, resulting in
flat back syndrome.
Ankylosing Spondylitis:
Ankylosing spondylitis (AS) is a chronic
inflammatory disease that causes stiffness and arthritis throughout
the entire spine. Some patients with AS notice an increasing forward
posture of the spine, including an increase in thoracic kyphosis or
decrease in lumbar lordosis.
This can lead to symptoms of lumbar flat back
syndrome.
Straight
back syndrome (SBS)
Straight back syndrome (SBS) is a
thoracic deformity characterized by loss of the normal upper thoracic
spinal kyphosis. This deformity leads to a reduced antero-posterior
diameter of the chest causing a compression or “pancaking” of the
heart and great vessels so as to appear enlarged. This is accompanied
by a leftward displacement of the heart, resulting in cardiac
murmurs1,
chest pain and tracheal compression.
Mitral
valve prolapse (MVP) has been reported in 64% of patients.
Misdiagnosis
of straight back syndrome as pericardial absence has also been cited.
A
study investigating the relationship between SBS and MVP showed
echocardiograms to be normal in 36% of patients diagnosed with SBS;
however, 58% of these patients demonstrated mitral valve prolapsed.
Despite
the fact that this syndrome has been recognized for over 50 years, it
is not commonly considered as a differential diagnose and thus the
incidence is unknown.
However,
given that this syndrome is often associated with heart symptoms, it
is important that health care practitioners are made aware of SBS and
consider it as a differential diagnosis in a patient presenting with
symptoms that can appear to be cardiac in nature.
This
is especially true in cases of atrial septal defect which can
resemble the symptom picture of SBS.
