Many people notice that as they age, they have a tendency to be “hunched over” when they stand or walk. Perhaps they have tried to correct this and stand up straight but feel that it is difficult and even painful. These same people typically also note that they have become shorter as they age. This is often a source of concern and frustration for people because they feel a loss of pride with a change in posture and stature and they feel that it may be related to the loss of vitality and activity that they have also experienced with age.
What causes a hunched over posture?
Fortunately, we know that there is often an anatomical cause for these changes with age, and we also know that there are treatments.
Lumbar Facet Arthropathy
Lumbar facet arthropathy is a medical term for arthritis in the spine, and it is one of the most common reasons why people feel more comfortable when hunched over as they age. This arthritis is typically present in the back portion of the spine, where there are multiple joints that allow you to bend forward and backward. With age, these joints become arthritic and painful. Typically, the first symptom that people notice is that it hurts when they lean back. This is because with the lumbar facet joints become narrower with leaning back. Eventually, these joints become so arthritis that they are bone-on-bone, even when you are simply standing up straight. To create more space, people will find themselves leaning forward.
Compression fractures are a cause of both height-loss as well as hunching over. The spine is made up of bone, and bones tend to become thinner with age. As the bone thins, it can no longer hold up under stress and can become compressed. Due to body mechanics, these compression fractures occur more frequently in the front of the spine than in the back. This can contribute to feeling hunched over. Unfortunately, people that experience one compression fracture are more likely to have multiple compression fractures. While we can never fully restore the height of a compressed vertebra, we can sometimes partially restore the height and help prevent additional compression fractures from occurring.
Lumbar Spinal Stenosis
Lumbar spinal stenosis refers to a narrowing around your spinal cord. The spinal cord is housed in a protective structure called the spinal canal. This runs from your brain all the way to your tailbone. As people age, inflammation throughout the spine leads to bony overgrowth and thickened ligaments. Since your lumbar spine (the low back portion) bears most of your weight, it tends to develop the boniest overgrowth and the thickest ligaments. This can put pressure on your spinal cord and cause pain, especially when you’re standing or walking for prolonged periods. Due to natural biomechanics, this pressure can be relieved by leaning forward. Many people find themselves leaning forward when they walk and even relying on walkers and shopping carts to help them lean forward and relieve the pressure on their spinal cord. Doctors even learn about this in medical school and call it, “the shopping cart sign.”
What can I do?
The first step is to talk to your doctor. You may need x-rays or even an MRI. These tests can help determine why you are hunched over.
Fortunately, there are treatments for these issues. Whether it’s selectively cauterizing painful nerves, restoring height to a compressed vertebra and injecting cement so that it doesn’t get worse, injecting steroids around a compressed spinal cord, or even supporting the spinal canal so that it isn’t pressuring the spinal cord, there are safe and minimally-invasive treatments available – and many of these can even be done in your doctor’s office.
David G. Currie, MD