What Is Kyphosis?

Kyphosis is a condition characterized by an abnormal curvature of the spine. It typically involves a forward curve in the vertebrae at the upper part of the back. This natural curve is present in most individuals to some extent and does not usually cause any pain or postural issues.

However, when the curvature exceeds 50 degrees, it is considered excessive kyphosis or hyperkyphosis, which can lead to discomfort and noticeable postural changes. Excessive kyphosis is often referred to as kyphosis, hunchback, or roundback.

While excessive kyphosis can occur at any age, it is more commonly observed in individuals over the age of 40 due to the natural aging process. Some forms of kyphosis may be identified in infancy or during adolescence, although they are relatively rare.

Types of Kyphosis

There are a few different kinds of kyphosis, primarily defined by the cause of the condition.

Postural Kyphosis

Postural kyphosis develops when the muscles supporting the back and spine are stretched and subsequently weaken over time. It is more commonly observed in younger individuals who frequently slouch or carry heavy bags, putting strain on the muscles and leading to postural imbalances.

In older individuals, postural kyphosis is often associated with age-related muscle weakness, which contributes to poor posture and increases the risk of developing the condition. The weakening of the muscles can further exacerbate the curvature of the spine, leading to an increased likelihood of postural kyphosis.

Scheuermann Disease

Scheuermann disease, also referred to as Scheuermann’s kyphosis or juvenile kyphosis, is characterized by the presence of abnormally shaped vertebrae. This condition typically emerges during the growth phase in adolescence.

Diagnosis of Scheuermann disease commonly occurs during the teenage years, and it is observed more frequently in males than females. The prevalence of Scheuermann disease in the United States is estimated to range from 1% to 8% of the population.

Congenital Kyphosis

Congenital kyphosis is a type of kyphosis that arises from abnormalities in the development of the spine during fetal development. It is characterized by the presence of missing or fused vertebrae. Typically, children with congenital kyphosis are diagnosed once they begin walking and exhibit noticeable symptoms.

Although congenital kyphosis is relatively rare, it can be significantly debilitating and impact a child’s mobility and overall function.

Kyphosis Symptoms

Kyphosis primarily manifests as the abnormal curvature of the spine, resulting in a rounded hump on the back and rounded shoulders. This physical characteristic is the main symptom associated with kyphosis. However, individuals with kyphosis may also experience other symptoms, which can vary in severity and include:

• Back pain: Some individuals may experience pain in the lower or middle back, which can range from mild discomfort to more severe and persistent pain.
  
• Neck pain: In some cases, kyphosis can contribute to neck pain and stiffness, particularly if the abnormal spinal curvature affects the upper back and neck region.
  
• Stiffness: The presence of kyphosis can lead to stiffness and reduced flexibility around the back and spine, making it challenging to perform certain movements comfortably.
  
• Tenderness: The affected area of the spine may be tender to touch, particularly in the region of the abnormal curvature.
  
• Fatigue: Some individuals with kyphosis may experience fatigue or a sense of increased physical effort due to the altered alignment and strain on the back muscles.

What Causes Kyphosis?

Kyphosis can have various causes depending on the type of kyphosis. Here are the main factors associated with each type:

Postural kyphosis:

• Age: Kyphosis is more prevalent in older adults, especially those aged 60 and above. It often progresses more rapidly during menopause. Age-related osteoporosis, which weakens the bones, is a common underlying condition associated with kyphosis in older individuals.
  
• Poor posture: Prolonged slouching, habitual leaning back, and carrying heavy bags can strain and stretch the muscles and ligaments in the back, leading to postural kyphosis.
  
• Spinal injury or disease: Trauma to the spine, as well as various conditions such as arthritis, disc degeneration, tuberculosis, and hormone-related diseases, can contribute to the development of kyphosis.
  
• Other conditions: Kyphosis can arise from conditions affecting spinal growth, muscles around the spine, and overall posture. These may include scoliosis, Paget’s disease, Gibbus deformity (vertebral collapse), muscular dystrophy, cerebral palsy, and spinal tumors, among others.

Scheuermann disease:

• The exact cause of Scheuermann disease is not fully understood, but it is believed to involve genetic factors. In this condition, at least three consecutive vertebrae in the spine wedge together, typically before puberty. The underlying mechanisms and triggers of this abnormal vertebral wedging are still being investigated.

Congenital kyphosis:

• Congenital kyphosis is attributed to abnormal development during fetal growth. It can result from either the absence of one or more vertebrae or the fusion of two or more vertebrae in the spine. These structural abnormalities can lead to progressive kyphosis as the child grows.

Risk Factors

Certain factors can increase the likelihood of developing postural kyphosis or Scheuermann disease. Here are some key risk factors associated with each condition:

Postural kyphosis:

• Age: The risk of developing postural kyphosis tends to increase with age, particularly in individuals over the age of 40.
• Gender: Women, especially after menopause, have a higher risk of developing postural kyphosis.
• Osteoporosis or degenerative diseases: Conditions that weaken the bones, such as osteoporosis, can contribute to the development of postural kyphosis. Other degenerative diseases affecting the spine may also increase the risk.
• Spinal injury: Any past injury to the spine can be a risk factor for developing postural kyphosis.
• Persistent poor posture: Maintaining poor posture over an extended period, such as slouching or adopting an imbalanced stance, can contribute to the development of postural kyphosis.

Scheuermann disease:

• Gender: Males have a higher likelihood of developing Scheuermann disease compared to females, with a male-to-female ratio of approximately 2:1.
• Age: Scheuermann disease typically manifests during adolescence, and the risk is highest during this period.

How is Kyphosis Diagnosed?

When evaluating a suspected case of kyphosis, healthcare providers may employ various diagnostic techniques to confirm the condition and determine its underlying causes. These diagnostic methods may include:

• Physical examination: A healthcare provider will assess your back by observing your posture, checking for any visible curvature, and evaluating your range of motion.
  
• X-rays: X-ray imaging of the spine is commonly used to diagnose kyphosis. X-rays provide a detailed view of the spinal bones, allowing the healthcare provider to measure the degree of curvature and assess its severity.
  
• Pulmonary function tests: These tests measure how well your lungs are functioning and determine if the kyphosis is impacting your breathing and lung capacity.
  
• Magnetic resonance imaging (MRI): An MRI scan may be recommended to obtain detailed images of the spine and surrounding structures. It can help identify any underlying conditions such as tumors, infections, or abnormalities in the nervous system.
  
• Bone density testing: Bone density testing, typically performed through a dual-energy X-ray absorptiometry (DEXA) scan, measures the strength and density of your bones. This test can identify if you have osteoporosis, a condition associated with an increased risk of kyphosis.

Treatments for Kyphosis

Your spine curve will be monitored with ongoing x-ray examinations as your healthcare practitioner addresses your kyphosis. Depending on the cause of your kyphosis and the severity of your symptoms, you may need to undergo a combination of treatments.

Physical Therapy

Physical therapy is indeed a common and effective treatment approach for kyphosis, especially in the early stages. A physical therapist can develop a personalized exercise program to strengthen the muscles of the back and core, improve posture, and increase flexibility. These exercises can help alleviate pain, improve spinal alignment, and slow down the progression of kyphosis.

For postural kyphosis, specific exercises targeting postural correction, such as shoulder blade squeezes, chest stretches, and core strengthening exercises, may be recommended. These exercises aim to restore balance to the muscles and improve overall posture, which can help reduce the curvature.

In the case of Scheuermann disease, physical therapy is often combined with the use of a brace. The brace helps support the spine and limits further progression of the curvature. Physical therapy can complement the use of the brace by focusing on strengthening exercises, stretching, and postural training.

The goal of physical therapy in both cases is to improve function, reduce pain, and enhance overall quality of life. A skilled physical therapist will tailor the treatment plan to the individual’s specific needs and monitor progress over time to make any necessary adjustments.

Back Bracing

A back brace is often recommended as part of the treatment plan for kyphosis, especially in cases of Scheuermann disease or during adolescence when the spine is still growing. The brace aims to provide support to the spine, promote better alignment, and help guide the spine to grow in a more straightened position.

For children and teenagers with Scheuermann disease, wearing a back brace for a significant portion of the day, usually around 16 hours, is commonly recommended. The brace helps to limit the progression of the spinal curvature during growth and can potentially lead to improved spinal alignment over time.

In adulthood, when the spine has reached maturity and growth has stopped, a back brace cannot actively correct the curvature. However, it can still provide some benefits such as pain relief and additional support to the spine. Wearing a brace during certain activities or for a specified period of time, as advised by the healthcare provider, may help alleviate discomfort and promote better posture.

Surgery

In cases of more severe or painful kyphosis, surgery may be recommended as a treatment option. Surgery is typically considered when conservative measures such as physical therapy and bracing have not provided sufficient relief or if the condition is causing significant functional limitations or health complications.

If you are experiencing persistent pain, continued progression of the spinal curve, breathing difficulties, or neurological or cardiovascular symptoms associated with kyphosis, your healthcare provider may suggest surgical intervention. The decision to undergo surgery will be based on a thorough evaluation of your specific condition and the potential risks and benefits of the procedure.

Surgery for Scheuermann disease is relatively uncommon and is typically reserved for individuals with significantly larger or more painful spinal curves, generally exceeding 75 degrees. In such cases, surgery may be performed to correct the curvature and alleviate symptoms.

For congenital kyphosis, early surgical intervention is often necessary to prevent the condition from worsening as the spine grows. Surgery aims to correct the abnormal development of the spine and stabilize the affected vertebrae.

Treatment for Underlying Conditions

Treating the underlying causes of kyphosis is an essential part of the treatment plan. Depending on the specific cause, various interventions may be recommended:

• Osteoporosis: If osteoporosis is contributing to your kyphosis, your healthcare provider may prescribe medications to increase bone density and reduce the risk of fractures. These medications may include bisphosphonates, hormone replacement therapy, or other bone-strengthening medications. They may also advise lifestyle modifications such as a calcium-rich diet and regular weight-bearing exercises.
• Infection or tumor: If an infection or tumor is identified as the cause of your kyphosis, prompt and appropriate treatment is necessary. In the case of an infection, antibiotics or other antimicrobial therapies may be prescribed to clear the infection. If a tumor is present, surgical removal, radiation therapy, chemotherapy, or a combination of these treatments may be recommended, depending on the nature of the tumor.

How to Prevent Kyphosis

To prevent postural kyphosis and maintain a healthy spine, it’s important to incorporate the following preventive measures:

1. Maintain good posture: Practice sitting and standing with proper posture, keeping your shoulders back and your spine aligned. Avoid slouching or hunching forward.

2. Use proper backpacks: When carrying backpacks or bags, use those with wide, padded straps and distribute the weight evenly on both shoulders. Avoid carrying heavy loads that strain your back.

3. Exercise regularly: Engage in exercises that strengthen your back and core muscles, such as back extensions, planks, and exercises targeting the abdominal muscles. Regular exercise helps support your spine and maintain its natural curves.

4. Promote flexibility and mobility: Incorporate stretching exercises into your routine to improve flexibility and mobility of your spine and surrounding muscles. Activities like yoga, Pilates, or gentle stretching can be beneficial.

5. Prevent or treat osteoporosis: As you age, take steps to prevent or manage osteoporosis, which can contribute to kyphosis. Ensure an adequate intake of calcium and vitamin D, engage in weight-bearing exercises, and discuss preventive measures or medications with your healthcare provider.

While it may not be possible to prevent or avoid Scheuermann disease and congenital kyphosis due to their genetic basis, early diagnosis and appropriate treatment can help manage and reduce the severity of these conditions. If you have a family history or concerns about these conditions, it’s important to discuss them with your healthcare provider for proper evaluation and guidance.

Complications

It’s important to recognize and address the potential complications of severe kyphosis. If you experience persistent pain in the chest and back, shortness of breath, weakness or numbness in the legs, decreased bladder or bowel control, reduced mobility, or problems with acid reflux or GERD, it’s crucial to seek immediate medical attention from your healthcare provider. They can evaluate your symptoms, perform necessary tests, and provide appropriate medical care. Timely intervention can help manage and prevent further complications associated with severe kyphosis.

Living With Kyphosis

The impact of kyphosis can vary from person to person, with some individuals living with the condition without significant pain or limitations, while others may experience pain and complications that affect their daily life. It is crucial to explore various treatment options to manage pain and correct the spinal curve.

Physical therapy and targeted exercises can be beneficial in improving posture, strengthening the back and core muscles, and maintaining mobility. These interventions can help alleviate symptoms and enhance overall function. Additionally, seeking social or mental health support can be beneficial for individuals who may feel self-conscious about their appearance due to kyphosis and may benefit from additional emotional support and guidance.

It is important to work closely with healthcare providers to develop an individualized treatment plan that addresses both the physical and emotional aspects of living with kyphosis. By doing so, individuals can improve their quality of life and effectively manage the condition.