Question

My 81-year-old father, who is slightly underweight, but physically active and mentally alert, has begun to walk stooped over. He says it's simply easier not to keep upright His doctor dismisses this as "gravity". Could it be a calcium deficiency? Would physical therapy help/ He's done calisthenics, including sit-ups, all his life, but no exercises specifically aimed at strengthening his back. Any thoughts?

Answer

It sounds as if you father may have a condition called kyphosis. This is a progressive spinal disorder that can affect adults in their latter years. This disorder may cause a deformity described as humpback or hunchback. His doctor is correct to relate this disorder to gravity. As we age the interspaces between the vertebrae become narrower and the bones are compressed by gravity from walking upright for many years in gravity.

Kyphosis in the thoracic spine means an exaggerated kyphotic angle (i.e. bending out, backwards) from the spine's normal gentle kyphotic curve. Normal lordotic curves (i.e. bending inwards) in the neck and lumbar regions may also be lessened to contribute to the overall pitched-forward posture. The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.

Kyphosis is not associated with calcium deficiency or any other vitamin or mineral deficiency. There may be some contributing osteoporosis but this would be normal for his age.

Kyphosis is classified as either postural or structural. Postural means the kyphosis is attributed to poor posture, usually presenting a smooth curve, which can be slowed, stopped, or even corrected by the patient improving his/her habitual posture. Structural kyphosis is caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or muscles. Kyphosis with a structural pathology may require medical intervention because the patient alone cannot control curve progression.

Analgesics and anti-inflammatory medication may be used to provide relief if your father has any pain or discomfort. Padded orthoses (braces, etc) can be used to control pain, but these do not control curve progression. Your dad, being 81 years old, probably would not benefit from any braces or straightening devices. In fact these may do more harm than good at his age.

Continuing to be active is the best thing for him at this time. This allows the muscles and tendons to remain flexible. He also should sit upright in a chair and exhibit good posture. He is not a candidate for corrective surgery or orthopedic appliances.