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Physical Therapy for Flat Back Syndrome

Frederick Wintermantel, LPTA

I work with the Spine Specialists at Orthopaedic and Spine Center as a Physical Therapy provider, so I see patients with a wide variety of spinal conditions, injuries, and post-surgical rehabilitation needs.  Flat Back Syndrome is a condition that typically arises from another spinal issue, and it involves the lumbar spine losing its normal curvature, so that it becomes flattened. Flat Back Syndrome can cause painful symptoms and dysfunction for the patient who has it, but Physical Therapy has been shown as an effective treatment. 

A normal spinal column, when viewed from the side, looks like a long shallow “S”, with gentle curves at the neck, the thoracic area (between the shoulder blades) and the lumbar region.  These curves help the spine balance the weight of our head and body, so that we can walk and stand upright comfortably, with our head, shoulders, and hips in alignment and balanced over the feet.

When the lumbar curve starts to flatten, due to a degenerating spinal disc, arthritis, ankylosing spondylitis, or other causes, the brain will try it’s best to balance the body.  In doing so, it will cause the pelvis to tilt upward and the head to drop forward, slouched posture.  This awkward stance puts pressure on adjoining spinal vertebrae and discs, muscles, ligaments, and tendons.  Over time, the patient may experience pain from their neck to their lower back, thighs and back of the legs and may have a “hunched-over” appearance. 

After a patient is sent to me for Physical Therapy for Flat Back Syndrome, I do a thorough physical examination, talk to them about their lifestyle, activities, goals, and reasonable expectations for recovery.  We also discuss if surgery is in their future or not.  These are all important considerations in developing a treatment plan.   Based on the patient’s condition, pain level and general fitness level, the PT and I will develop a treatment plan specifically for them and modify it to them as the patient progresses. 

Pain relief is always important for any patient whom I treat.  For Flat Back Syndrome, it is important to relax those tight muscles and to improve range of motion.  I will use gentle range of motion exercises to begin with, personalized hands on treatment, and moist heat along with a home exercise program in the beginning.

The exercises that I most often recommend for Flat Back Syndrome are: lying on your back with gentle hip rocking, glute squeezes, and abdominal bracing, especially in the beginning. We would progress the exercises with increased movement and strengthening, if the patient is showing improvement, increased range of motion and reduced pain levels.

If the patient is not progressing in their treatments and their pain has not gotten better, the patient, myself, the Physical Therapist, and their Orthopaedic physician would talk about possible surgery as a treatment option. If a patient has to have spinal surgery after completing Physical Therapy, I will often see them after surgery to complete their post-surgical rehab program.

The biggest goals I have are decreasing a patient’s pain levels, returning them to the activities they want to perform and helping them to live their best life.

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