Overview of Flat Back Syndrome

flat back syndrome also known as fixation sagittal unbalanced. In this case, the normal curve of the lower spine decreases or disappears. A major symptom is difficulty standing for long periods of time.

Flat back syndrome may appear at birth. It can also happen for other reasons, including:

  • degeneration or trauma
  • spine surgery

Treatment usually includes physical therapy, braces, or surgery.

This article looks at flatback syndrome, its causes, and diagnosis. It also discusses treatment options.

Symptoms of Flat Back Syndrome

Your spine usually has two curves. The lumbar spine in the lower back and the cervical spine in the neck curve inward.Your thoracic The spine in the upper back curves outward. These curves are part of the natural alignment of the spine. They help you balance and maintain your center of gravity.

When these curves decrease, you may have a hard time standing up straight. You may bend forward, especially at the end of the day. You may even feel like you are falling forward. To stand up straight, you may need to bend your hips and knees and adjust your pelvis.

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In people with flat back syndrome, there is no natural curvature of the lumbar spine. This causes the head and neck to tilt forward, which can make walking and performing daily activities difficult. You may get tired trying to keep your balance.

The body compensates for flat back syndrome by raising the head and neck forward. This can lead to neck, upper back and shoulder strain and chronic pain.

lumbar spine anatomy

Causes of Flat Back Syndrome

Some causes of flat back syndrome include:

  • congenitalmeans it is present at birth
  • ankylosing spondylitisan inflammatory arthritis of the spine
  • Compression fractures of the vertebrae, such as those caused by Osteoporosis
  • Degenerative Disc Disease

Flat back syndrome can also occur after spinal surgery. In the past, this was common after surgery to correct scoliosis (an abnormal curvature of the spine). Devices implanted in these procedures can lead to flat back syndrome, especially as you age. Newer surgical techniques have reduced this complication.


Some people are born with flat back syndrome. For others, it develops over time due to conditions such as arthritis.

Diagnosing Flat Back Syndrome

First, your doctor will ask about your medical history, including any spinal deformities or back surgery. You will also undergo a medical examination, including:

  • musculoskeletal exam
  • nervous system exam

A gait test assesses how well you walk. This is done because your gait may have changed to compensate for the loss of spinal curvature.

Finally, X-ray imaging will help your doctor understand how your spine is aligned. Other possible sources of symptoms need to be considered before a diagnosis can be confirmed.


Your doctor will take a medical history and perform a series of physical exams. X-rays can help confirm the diagnosis.

Treating Flat Back Syndrome

Treatment for flat back syndrome usually begins with exercise and physical therapy. This usually includes stretching and strengthening exercises to improve posture. The goal is to reverse the muscle imbalance pattern that keeps the lower back flat.

Exercises to strengthen the core, glutes, back, neck, and back shoulder muscles include:

  • plank
  • side leg raise
  • chest stretch
  • Sit row at the gym or pull ups
  • back extension
  • Hamstring and Abdominal Stretch

Gentle hamstring stretches are a great way to improve lumbar alignment. Hold each stretch for about 30 seconds. Repeat three to five times once or twice a day.

Your physical therapist can recommend exercise and other forms of therapy. This may include bracing for better support.

Some patients may require surgical correction. There are several options, including:

  • knotted wedge Osteotomy
  • pedicle osteotomy
  • Posterior spinal resection

When to see a healthcare provider for back pain


Flat back syndrome is usually treated with exercises that strengthen the neck, back, and core muscles. In rare cases, surgery may be required.


Flat back syndrome is caused by a loss of curvature of the lower spine. It can appear at birth or as a result of surgery or medical conditions.

People with flat back syndrome lift their head and neck too far forward. This can cause pain and difficulty with balance.

Flatback syndrome can be diagnosed with a medical history, physical examination, and X-ray imaging. Treatment usually includes physical therapy and exercise, but sometimes surgery is required.