Flatback syndrome is a form of postural distortion in which the normal inward lumbar curve is straightened out. This creates a pattern of muscle tension and use that can lead to chronic back pain. When the spine loses its curve, your body has to compensate for the loss of flexibility in the lower back by using the hips and knees differently when you bend forward, bend down and perform other common movements. Flatback syndrome can, then, lead to pain in other areas of the body as well.
The cause of flatback syndrome is sometimes structural. People may develop the postural distortion after having surgery to correct a scoliotic curve. They may also develop the condition due to vertebral fractures, degenerative discs or an arthritic disease called ankylosing spondylitis. In these cases, treating the postural distortion requires treating the underlying cause. But for some people, the cause isn’t in the spine. Years of poor posture and improper body mechanics can lock in the dysfunctional pattern of muscle use and tension, flattening out the lower back and creating pain.
The pattern commonly associated with flatback posture is weak psoas and lumbar extensor muscles combined with tight hamstrings. The psoas are hip flexor muscles that stretch between the thigh bone and the lumbar vertebrae; when weak, they fail to exert a downward pull on the front of the pelvis. Lumbar extensor muscles extend, or arch, the back; when weak, they fail to maintain the inward arch. When the hamstrings are tight, they pull the pelvis down in back and inhibit normal, proper body mechanics.
If muscle imbalances are causing flatback syndrome, then treatment should center on restoring balance to the muscles of the legs, pelvis and back. Tight muscles need to be relaxed, and weak ones, strengthened. Foam rolling the hamstrings is a good idea; muscle tension that has been present for some time requires more work than simple stretching. Foam rolling applies deep, sustained pressure to the muscle and its surrounding connective tissue to force relaxation.
Next, work on strengthening the psoas and lumbar extensor muscles. Seated leg lift holds and the bird-dog core exercise are good ways to do this.
Another exercise method that holds promise for flatback treatment is inclined treadmill walking. In one study, eight participants performed two sets of exercises a day for one week on an inclined treadmill. Researchers measured hamstring length, extensor muscle endurance and anterior pelvic angle both before and after the week of treatment. All outcome measures improved significantly. See more on the study at www.jstage.jst.go.jp.