78 yo Patient

78 yo Patient who can’t walk more than 70 feet without upper LB ache that stops her

•Note flexed forward posture
•Bent knee stance
•Hypo-lordotic lumbar spine
•Pain gone with sitting and lying down
•What 6 things cause this deformity?

Flat Back Posturing

•Antalgia secondary to central stenosis. LRS, FS
•Lumbar Degenerative Disc Disease with loss of lordosis (can’t straighten due to loss of lumbar lordosis-flat back syndrome)
•Facet pain/spondylolisthesis (rare)
•Thoracic hyperkyphosis with poor lumbar compensatory mechanism
•Hip, knee flexion contractures,
•Hamstring and gluteal weakness (L5 and S1)