Everything to Know About Treating and Managing Kyphosis

Kyphosis is a condition in which there is excessive curvature of the spine. It is sometimes called “round back” or “hunchbacked.” The term “thoracic kyphosis” is also used to describe kyphosis because it affects the thoracic spine (mid to upper spine). It causes a reverse C-shaped curve toward the chest. 

Kyphosis types include postural kyphosis, congenital kyphosis, and Scheuermann’s kyphosis. All three types are manageable and treatable. If the kyphosis curve exceeds 50 degrees, this is referred to as hyperkyphosis. Excessive curvature may affect sitting and standing comfortably. 

Depending on the severity and type of kyphosis, the condition might be reversible. This might be the case if bad posture is the cause and kyphosis is not structural. Bone abnormalities, disc problems, and issues with nerves, ligaments, and muscles can lead to structural kyphosis. 

This article will cover the treatment goals for kyphosis, its causes, who is at risk, diagnosis, and more. 

Goals of Kyphosis Treatment

Kyphosis is a treatable condition. Treatment goals for the condition include the following:

• Pain management: Managing kyphosis pain and discomfort includes medications, physical therapy, and other pain-relieving strategies.
• Improving posture: Improving your posture could potentially improve your spine’s curvature and reduce pain.
• Preventing progression and complications: Sometimes, kyphosis can be progressive, and treatment can help to reduce progression and complications. Complications linked to the condition include neurological problems, respiratory troubles, and compression fractures. 
• Enhancing function: Physical therapy can help improve your spine strength, flexibility, and range of motion. It can also strengthen the muscles surrounding the spine to boost overall function and mobility. 
• Managing underlying causes: Successful kyphosis treatment includes treating an underlying cause of kyphosis, such as osteoporosis (a condition of decreased bone mass and density), ankylosing spondylitis (inflammatory spinal arthritis), spinal infection, or tumor.
• Improving the quality of life: Kyphosis has been linked to a loss of independence, decreased quality of life, and morality in older adults. Treatment aims to improve life quality through pain reduction, improving posture, and restoring function and mobility. 

What Causes Kyphosis Changes of the Spine?

Kyphosis causes spinal curvature at the top of the back to appear more rounded than what might be considered normal. Natural curvature of the spine is 20 to 45 degrees. Anything above this range is greater than the norm. The greater the curvature, the more severe the condition. 

The most common causes of kyphosis are years of poor posture (postural kyphosis) and structural changes of the vertebrae—the small bones of the spine (Scheuermann’s kyphosis). The condition also develops after a spinal injury or surgery.

Some rare causes include skeletal dysplasias, neuromuscular disorders, and abnormalities in vertebral development (congenital kyphosis). The most common cause of adult kyphosis is osteoporosis.

Postural Kyphosis

Postural kyphosis is the most common type of kyphosis. It usually becomes noticeable in the teen years. Slouching and poor posture lead to muscle and ligament stretching around the bones of the spine. That stretching puts the vertebrae out of place, causing a rounded shape of the back.

The curvature in postural kyphosis is round and smooth. It can often be corrected by maintaining a straight posture.

Postural kyphosis affects more children assigned female at birth than those assigned male. It usually does not cause pain, and the curve is not progressive, so it will not lead to complications or additional problems.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is named after the Danish radiologist who first revealed the condition. With this type of kyphosis, the vertebrae are wedge-shaped. These wedge-shaped bones will curve the spine forward and cause it to appear rounded.

Prevalence for this type of kyphosis ranges from 0.4% to 8.3%. The condition seems more common in people assigned male at birth. The average age of onset is between 10 and 12 years of age, but adult onset is also possible.

Scheuermann’s kyphosis, especially in teens and younger children, is sometimes linked to scoliosis, an abnormal sideways curvature of the spine. 

Researchers think Scheuermann’s kyphosis has a genetic component because it tends to run in families. More research is needed to determine what genetic mutations might be linked to the condition and how they may be passed on through the generations. 

Congenital Kyphosis

Congenital kyphosis is a type of kyphosis a person is born with. According to the Scoliosis Research Society, there are two types—failure of formation and failure of segmentation. Congenital kyphosis does not appear to have a genetic or inherited component and occurs without any known cause. 

The failure-of-formation kyphosis type affects one or more spinal bones, often at the thoracolumbar spine—the area between the thoracic cage (rib cage) and the lumbar spine (low back). This malformation will be visible at birth as a bump on the baby’s spine and worsens as the baby grows.

The failure-of-segmentation kyphosis type occurs when two or more spinal bones fail to separate and form correctly. This type of congenital kyphosis is typically diagnosed when the child is older, usually once they start walking. 

Skeletal Dysplasias

“Skeletal dysplasia” is the medical term for disorders that affect bone development, neurological function, and cartilage growth. These conditions can lead to abnormal growth of the spine and kyphosis.

The most common types of skeletal dysplasias are achondroplasia, osteogenesis imperfecta, thanatophoric dysplasia, and pseudoachondroplasia.

Neuromuscular Disorders 

Kyphosis is sometimes the result of neuromuscular disorders. Such conditions include cerebral palsy and Parkinson’s disease. 

Other Causes 

Adult kyphosis often affects the thoracic spine but can also affect the lumbar and cervical spine. Symptoms and severity will vary based on the shape of the back, how significant the deformity might be, if there are nerve problems, and the extent of pain symptoms. 

Osteoporosis is the leading cause of adult kyphosis, especially after menopause. Trauma or injury to the spine, spinal surgery, or other spinal treatments might also contribute to the condition. Adult kyphosis might also be congenital (present at birth).

Degenerative spine changes (wear and tear) are another cause of adult kyphosis. The underlying cause is typically spinal arthritis or disk degeneration. 

While rare, kyphosis can result from a spinal or soft tissue tumor.

Kyphosis can also occur after a spinal surgery. For example, someone who has had lumbar fusion surgery may experience kyphosis above the fusion because of stress between the fused and non-fused spine areas. 

Ankylosing spondylitis (AS), an inflammatory autoimmune bone disease that might cause spinal bone fusion, can lead to kyphosis. This is mainly due to spinal stiffness, leading the spine to curve forward. People with AS might also experience lesions on the spinal bones that can affect spinal alignment. Spinal fractures that weaken the spine are another cause of kyphosis in people with AS. 

Kyphosis Age: How Old Are People at Diagnosis?

Postural kyphosis is common in adolescents and people over age 40. On the other hand, the age of onset for Scheuermann’s kyphosis is between 10 and 12.

Older adults are most commonly affected by age-related kyphosis, especially if they have osteoporosis. Low levels of estrogen following menopause can lead to osteoporosis. 

Testing and Scans

A diagnosis of kyphosis can be made with a physical exam. Your healthcare provider will also want to know about symptoms experienced and whether there is a family history of spinal disorders. They may ask you to perform movements and stretches to examine your balance and motion. 

An Adam’s forward-bend test can diagnose childhood kyphosis. This test helps your child’s healthcare provider see if there is a slope, curvature, or other spinal abnormalities. With this test, the child bends forward with their feet together, knees straight, and arms hanging loosely. 

Another test involves lying down to see the spine’s curvature. If the spine becomes straightened when lying down, posture is often the cause. But other conditions might be to blame if the spine is still curved.

If your healthcare provider sees a spinal curvature during the physical exam, they may refer you for imaging, including X-rays and magnetic resonance imaging (MRI). Imaging can look at the spine’s structure. If the curvature has affected breathing or caused other symptoms, additional tests may be done, including blood work or lung function tests.

Signs of Mild Kyphosis 

Mild kyphosis might cause mild symptoms, or it can be asymptomatic (no symptoms). It causes the back to appear slightly curved or hunched.

Symptoms of mild kyphosis include:

• Back pain
• Spine stiffness and tenderness 
• Fatigue 
• Tight hamstrings (muscles at the back of the thighs)
• Rounded shoulders 

Nonsurgical Treatment for Mild Kyphosis 

Mild kyphosis is treated nonsurgically. Treatment can be helpful for most people with mild kyphosis, and the condition will not significantly affect their quality of life.

Physical therapy, spinal manipulation, and proper posture can help correct postural kyphosis and reduce pain and stiffness in the spine. Bracing can help reduce curvature progression.

Your treatment options for mild kyphosis might include:

• Pain relievers: If you experience pain due to spine curvature, your doctor will recommend over-the-counter medicines, including Tylenol (acetaminophen), Advil (ibuprofen), and Aleve (naproxen sodium). 
• Physical therapy: A physical therapist can teach you exercises and stretches that improve the spine’s flexibility and relieve back pain.
• Bracing: A brace might help slow kyphosis progression. Bracing is recommended for children and teens while their spinal bones grow. The specific type of brace and how long it can be worn daily will depend on the severity of the curve. Most children will wear the brace until they achieve full skeletal maturity and have finished growing.
• Proper posture: Proper posture with sitting and standing can help to improve and even correct curvature in postural kyphosis. Correct posture maintains spinal curves and does not increase the spine’s curve. It puts the head above the shoulders and the tops of the shoulders just above the hips.
• Chiropractic care: Spinal adjustment might be an option for improving spinal movement and curvature. Spinal or chiropractic adjustments are techniques chiropractors perform using their hands or instruments to apply controlled, sudden forces to the spinal joints.

Chiropractic care is typically combined with stretching and strengthening exercises and other therapies, including low-frequency electrical stimulation and ultrasound for pain management. 

One 2016 study examined how chiropractic spinal manipulative therapy affected thoracic spine symptoms, including curvature of the spine related to kyphosis. Researchers have found that spinal manipulation combined with stretching and strengthening exercises could effectively treat and manage postural kyphosis.

Signs and Symptoms of Severe Kyphosis

If you have severe kyphosis, symptoms will get worse over time. The curvature might lead to significant spinal deformity and a visible back bump. 

Signs and symptoms of severe kyphosis might include:

• Persistent pain
• Weakness, numbness, and tingling of the legs
• Loss of sensation 
• Bladder and bowel habit changes 
• Shortness of breath and other breathing troubles 

Surgical Treatment for Severe Kyphosis 

Surgery is considered when nonsurgical treatments have not helped manage pain or prevent kyphosis from getting worse. Surgery might be considered for kyphosis for curves greater than 70 to 75 degrees or if a person is experiencing severe back pain.

Spinal fusion surgery is often used to correct curvature in people with severe kyphosis. With this procedure, the surgeon will line up the spinal bones and fuse them to restrict movement. They will then fill the spaces between the vertebrae with bone pieces and use metal screws, plates, or rods to hold the spine in place to facilitate healing. 

Recovery Period 

Depending on how extensive your surgery is, you may be out of bed and headed home the next day. You may be advised to wear a brace, but bracing is not always necessary.

If you have a more extensive procedure, are an older adult, or have other health conditions, you may need to stay in the hospital for at least a few days. Physical therapy starts once the bones have had time to heal, typically three to six months later. 

Like any surgery, spinal surgery comes with a risk for complications. This could include ongoing pain, function impairment, a flat-back deformity, or pseudoarthrosis.

A flat-back deformity causes loss of normal spinal curvature in which the spine is straight, leading to a stooped-forward appearance and problems with standing up straight. The term “pseudoarthrosis” means there is motion between two bones that have healed or fused, causing pain that worsens over time. 

Managing Progressive Kyphosis  

Bracing has been found to slow down kyphosis progression. A back brace can push the spine backward and reduce the rounded posture. 

Research on bracing and physical therapy shows it can effectively halt kyphosis progress. One 2017 study found combining both therapies can halt Scheuermann’s kyphosis progression by up to 97.5%. The study’s authors further note that bracing can be helpful for most kyphosis types in which skeletal maturity has not yet occurred.

Posture Accessories and Support 

Poor posture can lead to many health problems, including back and neck pain, headaches, and body fatigue. Practicing good posture can help reduce problems, but it might not be enough. Consider posture correctors and accessories to further improve back health and keep posture in check.

Posture correctors can help pull the shoulders back and align the spine properly. Other devices include braces, posture corrector sensors, and apparel (shirts and bras). Additional options can be part of an ergonomic workstation, including ergonomic office chairs, adjustable desks, and split keyboards.

Summary 

Kyphosis is a curvature of the spine that sometimes causes the back to appear rounded. Excessive kyphosis curvature is anything over 45 degrees. The condition is classified as mild or severe.

Mild kyphosis can go many years without symptoms, but symptoms can include back pain, stiffness, and tenderness. Severe kyphosis can cause persistent pain, weakness and numbness of the legs, bladder and bowel problems, loss of feeling, and breathing troubles.

Kyphosis types are sometimes classified by their causes, including postural, Scheuermann’s, and congenital. Causes include bad posture, aging, genetics, osteoporosis, and arthritis. 

A healthcare provider can diagnose kyphosis with a physical exam, family and medical history, and imaging. The condition can be treated nonsurgically with physical therapy, bracing, pain relievers, and spinal manipulation. In severe cases, kyphosis can be treated with spinal fusion surgery.