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Unlike in scoliosis or kyphosis in people who suffer from a flatback, visually the spine seems to be okay. Usually the spine has a cervical  lordosis (forward curvature), a slight thoracal kyphosis (curvature to the back) and a lumbar lordosis again. People with a flatback miss the natural S-shape of the spine, which usually provides a spring / damping and uniform distribution of forces. They run as  they had a stick in their back. This stresses vertebral bodies and intervertebral discs very strong from top to the bottom, whereby the discharge of the facet joints is not sufficiently possible.

With a flat back one has a perfectly straight path and a stiffened posture of the neck and thus also of the head. Over the top goes with every step , especially when running, a little damped shock wave through the body. This stress and force on the discs and joints lead to accelerated wear/degeneration. Especially the discs are missing the spring mechanism , which is important for nutrition and removal of metabolic products, as the discs have no blood vessels but are supplied with oxygen and nutrition and "purified" by diffusion  .

Those who suffer from this type of attitude usually has severe pain, which are usually just as bad as those in people who suffer from scoliosis or kyphosis. For the formation of a flatback, there are different causes. Frequently posture is important particularly among young people. Growth spurt, muscle imbalances, lack of exercise  unergonomic seats etc. can lead to biomechanically unfavorable deformation of the spine. The then acting leverage can amplify the whole process. Finally, the patients focus may shift forward, what he compensates by bending thr knees slightly. This posture problem became usually symptomatic in adulthood, when it comes to increased stress and forces which increase wear and degeneration on the intervertebral discs and joints.

Treatment is primarily conservative with physiotherapy and special functional training, ie balance exercises on unstable underground. Furthermore, stretching and normalisation of different muscular imbalances in the hip, lumbar and pelvic region are performed. For severe pain due to secondary changes in the intervertebral discs and joints minimal ivasive methodes can be applied with local injections or surgery of a herniated disc. The aim of all treatment is to restore the sagittal profile and the spine balance. In severe cases, surgical correction may be required.