Kyphosis Causes, Symptoms, Diagnosis, Treatment, and Prevention

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The Universal Guide to Kyphosis: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Kyphosis?   |    Causes   |    Symptoms   |    Diagnosis   |    Treatment  |    Prevention   |    FAQs   |    Sources

"Sit up straight! Stop slouching!" You’ve probably heard those words enough that you straightened your back a little just reading them. (No judgement. We did, too).

KyphosisKyphosis is a curve in the upper back. The thoracic spine naturally curves, but sometimes it's too much.

Well, it turns out the posture police are wrong about this one—to a point. Your spine isn't meant to be ramrod straight. In fact, even a slight hunch – known in medical terms as kyphosis – isn't usually cause for concern.

"When you look at the way the upper back rounds, you'll see considerable variation from person to person," says Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. "There's a big range of 'normal' when it comes to this degree of rounding forward.”

When you hunch out of your normal range, you could have some back discomfort. In severe cases – known as hyperkyphosis – you may have more serious symptoms such as pain and limited mobility.  

What is Kyphosis?

Quick spinal anatomy lesson: There are three sections to the spine, called cervical, thoracic, and lumbar.

The cervical spine is at the top, and involves vertebrae that move your neck. The thoracic is in the middle of your back. The lumbar spine is your lower back. (Some think of the lowest part, your sacrum and tailbone, as a fourth section.)

Each section has a natural curve to it. Kyphosis relates to the curve in the thoracic spine. 

Scoliosis, kyphosisKyphosis, on the right side is demonstrated as a hump-like curve in the upper back. Photo Source: 123RF.com.

Even though hyperkyphosis is the term for an abnormal curve, doctors tend to use "kyphosis” for both normal and abnormal curvature. In the category of problematic kyphosis, there are three main types:

  • Postural: This is the most common form. As the name implies, postural kyphosis is caused by poor posture. Although you want to follow the natural curves of your spine instead of keeping it perfectly straight, slouching too much can be just as bad or worse. It usually occurs in adolescents, and girls develop it more often than boys. This is different from scoliosis, another spinal condition that develops in adolescents. In scoliosis, the spine curves to one side as opposed to forward.
  • Scheuermann's: Named after the Danish radiologist who first described it, Scheuermann’s kyphosis, or Scheuermann’s disease, also starts around adolescence. In general, it happens when the front of the vertebrae doesn’t grow as fast as the back, so the bones start to form a wedge shape. Scheuermann’s can be more serious than postural kyphosis and involve the lumbar spine as well. It’s more common in boys than girls, and it stops progressing when a teen has finished growing.
  • Congenital: The rarest form of kyphosis, this type is diagnosed at birth and is caused during fetal development. In congenital kyphosis, vertebrae fuse together rather than separate normally.

What Causes Kyphosis?

It will depend on what type of kyphosis you have. Genetics can play a role, says Kaliq Chang, MD, interventional pain management specialist of the New York- and New Jersey-based Atlantic Spine Center.

"If you look at the curvature in the backs of your relatives, you can see how much that particular degree of kyphosis can be inherited," he says.

Other disorders that could raise your risk include:

  • Compression fractures: These injuries can be a big culprit for kyphosis, especially if you have a fracture that causes the vertebrae to collapse toward each other. Osteoporosis—when your bones become thin and weak—makes compression fractures much more likely.
  • Degenerative spinal arthritis: Like any kind of arthritis, the kind in your spine can create stiffness and may get worse over time.
  • Ankylosing spondylitis: A form of inflammatory arthritis, ankylosing spondylitis usually strikes in early adulthood.
  • Muscular dystrophy: This genetic condition causes weakening of the muscles, including the ones around the spine.
  • Spinal tumor: Whether or not a tumor turns out to be cancerous, it can cause compression and affect your flexibility, causing that hunched-forward posture.

Age is another major factor. As you start losing bone density, that can put more pressure on spinal discs, Dr. Chang says. Subsequent compression can cause the spine to curve forward into hyperkyphosis.

A study in the Journal of Orthopaedic & Sports Physical Therapy found that kyphosis angle tends to increase after age 40, especially for women. In fact, 20 to 40 percent of men and women in that camp have kyphosis, with women experiencing a more rapid progression.

But remember, just because you're getting a little more hunched doesn’t mean you’ll have uncomfortable symptoms.  

What Are the Symptoms of Kyphosis?

Symptoms of kyphosis may include:

  • Fatigue
  • Mild back pain
  • Rounded upper back
  • Spine tenderness and/or stiffness

In more severe cases, patients report shortness of breath, chest discomfort or pain, and/or numbness, weakness and/or tingling in the legs.

"Many times, with more advanced kyphosis, people may mistake symptoms for a heart attack or ongoing heart issues," says Dr. Anand. That's because the symptoms like chest pain and breathing troubles overlap with cardiovascular problems. This isn't a common occurrence, but he says it can happen. Quick reminder: Whether you have advanced kyphosis or not, chest pain and shortness of breath should send you to the ER.

In the case of kyphosis, though, these are caused by compression. As the spine hunches forward, the shoulders broaden out and drop downward, reducing the amount of space inside the chest cavity.

Numbness and weakness in the legs is often related to compressed spinal nerves, and often caused by compacted vertebrae. Tingling can occur when the nerves are released (through stretching, for example), which might put more space between the vertebrae.

How Is Kyphosis Diagnosed?

A spine specialist can determine if your kyphosis requires treatment. The evaluation includes:

  • Your medical and family history
  • An in-depth physical and neurological examination
  • Imaging tests such as X-rays computed tomography (CT) scan, or magnetic resonance imaging (MRI)

In the physical exam, the doctor looks at your back and feels your spine for abnormalities. There will be some gentle pressing on muscles to see if any are tender. You'll also bend forward and the doctor will look from the side, which is the best angle for seeing a rounded curve. The neurological portion involves testing your nervous system, usually with a tool like a reflex hammer. This isn't painful, it simply checks that your nerves are functioning well. Your doctor may also ask for a demonstration of balance and coordination.

Kyphosis diagnosisA physical exam is a critical part of diagnosing kyphosis.

If previous imaging studies of the kyphosis are available, the spine specialist will compare the older images to the newest.

The imaging studies are used to measure the size or angle of the kyphosis. Previous imaging studies can help track the rate of curve size progression—and answer the question, "Is the curve growing larger?" Other tests may include bloodwork, pulmonary function testing (to measure lung capacity), and  bone mineral density testing.

A doctor may even be able to tell just by how you stand and sit how severe your kyphosis is – though of course that alone won’t lead to a diagnosis. If you can't stand up all the way straight, or you're having trouble with balance, your doctor may consider treatment – or stepping up your current treatment.

How Is Kyphosis Treated?

How a spine specialist will treat problematic kyphosis depends on several factors, says Dr. Chang, with these as the three main questions:

  • Does it hurt?
  • Does it impair your movement?
  • Does it prevent you from doing what you want or need to?

Some people can have a considerable hunch and still be functional and pain-free, research has noted. They might not feel pain, be unaffected in the rest of the spine, and not limited in terms of activity. In fact, one study found that even people aged 65 and older weren't affected by kyphosis if they were relatively healthy in general. For those cases, treatment would be minimal, if anything, unless it's bugging you to feel overly hunched.

For people who are experiencing pain or problems with kyphosis, the next step is to determine the cause, because treatments will address those root issues:

  • Postural: Because the cause here is due to posture, that's the first line of treatment to correct the situation, says Dr. Chang. That might mean physical therapy and strength training.
  • Scheuermann's: This form can be treated with physical therapy and mild pain medications most of the time, but if the patient is still growing and the spinal curve measures at least 45 degrees, a brace is often recommended.
  • Congenital: Surgery done during infancy can help treat the disorder, especially since the condition typically worsens as a child grows.
  • Kyphotic spinal curves: With other causes, such as degenerative arthritis or spinal infection, the change may be gradual. When that happens, a doctor will measure the spine curvature over time to see the rate of progression, Dr. Chang says. When it's greater than 75 degrees, surgery may be needed to treat the deformity and stabilize the spine. Before that point, someone with worsening kyphosis will likely be treated with physical therapy, specific home exercises, and pain medication.

"About 40 to 60 degrees of curvature is the most common range of normal," says Dr. Anand. "Sometimes, you can even be up to 70 and still not need treatment. But in general, when you get up past 60, that's when we want to start talking about potential interventions." Although it's challenging to figure out your exact degree of curvature without an exam, Dr. Anand says you'll see rounding in the upper back when you look in the mirror with a side view.

The most typical procedure for kyphosis that involves significant pain and limited mobility is spinal fusion, which can prevent further progression, reduce the degree of the curve, and alleviate back pain if that's an issue. This type of surgery involves fusing together affected vertebrae so they heal into a single bone, limiting motion and preventing further curvature. Only the affected vertebrae are fused together—usually with other small pieces of bone, metal plates, rods, or screws—which leaves the rest of the spine able to move normally.

Most patients respond well to a combination of physical therapy, exercise, and medication. Even in cases that eventually require surgery, most patients are able to return to normal activities without restrictions. Exercise, in particular, can offer a big-time boost—after all, not only do you get more mobility in your spine, but you also stack all those other benefits like better cardiovascular health and improved mood. That's a win-win-win.

Can Kyphosis Be Prevented?

Unless the kyphosis is caused by poor postural habits, there isn't much you can do in terms of prevention. Make sure your core muscles stay strong and you're doing all the right things for good bone density as you age, such as getting enough calcium and vitamin D and doing some sort of resistance training to strengthen your bones., However, early treatment can help prevent kyphosis from progressing and causing spinal deformity. That doesn't mean constantly re-aligning your posture, though, Dr. Anand adds.

 

Yoga roll to good postureUnless the kyphosis is caused by poor postural habits, the onset cannot be prevented. Photo Source: 123RF.com.

"Maintaining posture is not the same as treating kyphosis or preventing it," he says. "There's a lot of hype right now about products that 'remind' you to sit up straight or put your shoulders back, but keep in mind that overcompensating can give you a different back issue."

Constantly trying to "straighten up" can actually put at you risk for too much lordosis, when there's excessive inward curvature of the spine. Instead of aggressive, ongoing tweaks, Dr. Anand suggests strategies that help strengthen muscles in the back and core and improve balance overall, activities like:

  • Yoga
  • Tai chi
  • Strength training
  • Swimming

Focusing on your core muscles—which wrap around your lower back, hips, and belly—can create a supportive, natural "girdle" that improves alignment overall. One study emphasized that strengthening, rather than stretching, is a key way to prevent kyphosis.

"There's no perfect posture, so you should be aiming for the alignment that feels the best to you," he says. "That means you feel like you can breathe properly, your shoulders are relaxed, and there's no tightness in your neck and back. That will look different for everyone."

FAQs

What is the cause of kyphosis?

Some degree of kyphosis is a natural part of the curvature of your spine. How much that curves will depend on factors like genetics and age. When it becomes a problem, called hyperkyphosis, that can be the result of issues like compression fractures, arthritis, inflammation, and conditions like muscular dystrophy. But just because you're getting a little more hunched doesn’t mean you’ll have uncomfortable symptoms. 

What happens if kyphosis is left untreated?

If you're experiencing pain and reduced mobility because of kyphosis, that could cause the curve to get worse. If left untreated, you could start to develop more of a "hunchback" than before.

Is kyphosis reversible?

Depending on the reason you're experiencing kyphosis, the condition is treatable and often reversible, especially if your kyphosis is in the beginning stages.

Is dowager's hump the same as kyphosis?

Yes, they're the same. Other terms are hunch back, postural kyphosis, and hyperkyphosis.

Sources

Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352-360. doi:10.2519/jospt.2010.3099

OrthoInfo: Kyphosis (Roundback) of the Spine. https://orthoinfo.aaos.org/en/diseases--conditions/kyphosis-roundback-of-the-spine

Mayo Clinic: Kyphosis. https://www.mayoclinic.org/diseases-conditions/kyphosis/symptoms-causes/syc-20374205

Lorbergs, A., et al. Thoracic Kyphosis and Physical Function: The Framingham Study. J Am Geriatr Soc. 2017; 65(10): 2257-2264. doi: 10.1111/jgs.15038

Gonzalez-Galvez, N., et al. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. 2019; 14(4). doi: 10.1371/journal.pone.0216180

Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review. Front Endocrinol (Lausanne). 2020;11:5. Published 2020 Jan 24. doi:10.3389/fendo.2020.00005

Lewis, J.S., Valentine, R.E. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC Musculoskelet Disord 11, 39 (2010). https://doi.org/10.1186/1471-2474-11-39

Yaman O, Dalbayrak S. Kyphosis and review of the literature. Turk Neurosurg. 2014;24(4):455-65. doi: 10.5137/1019-5149.JTN.8940-13.0. PMID: 25050667.

Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. J Back Musculoskelet Rehabil. 2014;27(1):7-16. doi: 10.3233/BMR-130411. PMID: 23948845.

Lowe TG. Scheuermann's kyphosis. Neurosurg Clin N Am. 2007 Apr;18(2):305-15. doi: 10.1016/j.nec.2007.02.011. PMID: 17556132.

Updated on: 11/24/20
Neel Anand, MD
Kaliq Chang, MD
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Anatomy of Kyphosis

Easy-to-understand explanation of normal spinal anatomy and how kyphosis can change parts of the spine. Article explains why we have curves in our spine and the different complex components of the spine, such as vertebrae, discs, and nerves.
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