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Hyperkyphosis is a spinal deformity causing a forward-curved posture of
the upper back (thoracic spine). Posture refers to the characteristic way you
position your body and our posture changes many times throughout the day due to
a variety of factors, including
- what you are doing and
- how long you
have been doing it
Sometimes, however, a person's posture can cause the
thoracic curvature to become excessive and stiff, making it difficult
to change. Such is the case with hyperkyphosis (sometimes called
“humpback,” “round back,” or “dowager’s hump”).
This condition can
affect people of all ages, but the thoracic curvature most often begins
to increase in people over 40 and continues with advancing age. It is
estimated that 20% to 40% of older adults—both men and women—will develop
What is Hyperkyphosis?
Hyperkyphosis is a spinal deformity that occurs when the natural
forward-curving shape of the upper back becomes excessive. It causes the appearance of rounded shoulders with the head and neck positioned
forward of the trunk.
Unfortunately patients with this condition often have difficulty
standing up straight. The worsening of the curvature is associated with a
higher risk of health problems, including
Hyperkyphosis can result from conditions such as osteoporosis
or thinning bones, and fractures of the vertebrae that result from
osteoporosis or Scheuermann's disease.
That being said, research has found that
two-thirds of people with hyperkyphosis do not have spinal fractures.
Suspected causes for development of this spinal deformity when vertebral
(spinal) fractures are not present are:
Signs and Symptoms
The most prominent symptom of hyperkyphosis most patients notice is the appearance of a rounded back.
- You may not immediately recognize a change in your back posture
because in most cases, the change is gradual over time. Most of the time, it is friends and
family may notice it before you do.
- Other subtle signs can include changes in the way your shirts fit,
feeling like it takes a lot of effort to stand or sit up straight, and
feeling more fatigued with walking and other activities.
CAUTION: If you notice a sudden increase in the
curvature of your back, call your doctor. A sudden change in the curve
of the spine can be associated with other health problems.
Untreated hyperkyphosis can cause:
- Difficulty in the performance of normal tasks such as bathing, getting out of a chair, bending, or walking
- Decreased flexibility and strength of the trunk muscles
- Associated changes in alignment that result in a change of the
body’s center of gravity and increase the energy expenditure necessary
to complete common tasks
- Balance changes due to the shift in the center of gravity that can increase the risk of falls and related injury
- Upper back pain
- Spinal fractures as the condition advances
If you have advanced hyperkyphosis, you may experience:
- Difficulty breathing even though you do not have a history of lung or heart disease
- A lessening of the distance between your lowest ribs and your pelvic
bones; in this case, pulmonary function tests may be prescribed to
measure whether your hyperkyphosis is restricting your breathing
How Is It Diagnosed?
Hyperkyphosis will be assessed first with a visual inspection of your
Your spinal curve may be measured using a flexible ruler or
X-ray. If an X-ray is taken, a radiologist will measure the spinal
angles on the X-ray. If a curve measures greater than 40°, hyperkyphosis
Sometimes spinal changes occur because of fractures due to thinning
bones or a condition called osteoporosis. Of course spinal changes also can result
from degenerative disc disease or arthritis.
These problems are
commonly associated with aging.
Other problems not associated with aging
could also cause a sudden change in posture; however, problems such as a
tumor, infection, or neurologic changes are uncommon. Your doctor may prescribe imaging tests such as X-rays or an MRI of the thoracic
spine to determine whether you have any of these less common conditions
affecting your posture.
If you have advanced hyperkyphosis, you may experience difficulty
breathing even though you do not have a history of lung or heart
disease. You may also notice that there is lessening of the distance
between your lowest ribs and your pelvic bones. In this case, pulmonary
function tests may be prescribed to measure whether your hyperkyphosis
is restricting your breathing.
how our senior physiotherapists can help
We can help rehabilitate the postural changes and functional limitations associated with hyperkyphosis.
We will begin by reviewing your past and present
medical history with you as well as what medications you normally take.
If you report a
- sudden change in your posture
- severe pain or
significant change in your physical function
you will be referred to
your primary care physician. A sudden increase in the rounding of your
back may indicate a more serious health problem.
When a more serious problem is ruled out, we
will perform special tests to assess your unique condition. We will begin by observing, measuring, and recording
- postural alignment
- trunk strength
- range of motion and
- flexibility in movement
If you are experiencing difficulty walking or
keeping your balance, we will observe your movement
and perform tests to determine the level of difficulty, and whether you
have an increased risk of falling.
We will design a treatment program to address your specific needs and goals. Your physiotherapy treatment may include:
- Postural alignment training, stretching, and strengthening exercises
to help reduce the spinal curvature, decrease pain, and prevent the
condition from advancing. Adherence to the prescribed program in the
clinic as well as at home is essential for success. Most often, altering
the way you sit, stand, and complete your daily activities has the
greatest impact on lessening or slowing the progression of the curve.
- Balance exercises and walking (gait) training to increase your tolerance of activity and improve your safety by reducing your risk of falls.
- Education to improve your activities of daily
living and ease your physical functioning. Your physical therapist can
teach you how to safely get in and out of bed, in and out of the
bathtub, or out of a chair, and how to bend and walk with more ease.
- Breathing exercises to help improve your tolerance for physical activity by increasing your lung capacity.
- Myofascial/soft tissue manual therapy (hands-on
massage techniques), and in some cases joint mobilization (gentle
movements guided by your physical therapist) to help improve spinal
- Specialized braces or therapeutic taping to help reduce the angle of the curve.
- Pain management using modalities such as heat therapy, cold therapy, radio-frequency Indiba physiotherapy,
and/or electrical stimulation such as transcutaneous electrical nerve
stimulation (TENS). We will choose what modality
will be most beneficial to you—and help reduce the need for pain
medication, such as opioids.
Remember, all cases of hyperkyphosis are different. Our senior physiotherapist will choose the best treatment options for you based on your
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