Thoracic Kyphosis: Everything You Need to Know

“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).

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.

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

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 lumber 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.

Even though hyper kyphosis 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 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.

It will depend on what type of kyphosis you have. Genetics can play a role.

“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. 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 the age of 40, especially for women. In fact, 20% to 40% 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.

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. 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.

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.

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 chiropractor may also ask for a demonstration of balance and coordination.

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?”

A chiropractor 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 a spine specialist will treat problematic kyphosis depends on several factors:

• 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. They might not feel pain, be unaffected in the rest of the spine, and not limited in terms of activity. In fact, even people 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.

The most typical procedure for kyphosis that involves significant pain and limited mobility is chiropractic intervention using mobilisation, manipulation, soft tissue technique (deep tissue massage), and specific adjustments to the affected area.

Most patients respond well to a combination of chiropractic, physical therapy, exercise, and posture improvements. 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.

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.

“Maintaining posture is not the same as treating kyphosis or preventing it. “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.”

Strategies that help strengthen muscles in the back and core and improve balance overall are activities like:

• Yoga

• Tai chi

• Strength training

• Swimming

There’s no perfect posture, so you should be aiming for the alignment that feels the best to you. 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.

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 hyper kyphosis, 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 hyper kyphosis.

TIPS ON HOW YOU CAN HELP SPEED YOUR RECOVERY…

Finally, the process of return to health is a gradual process that involves re-education of your body. The best advice we can give you is to have a long term commitment to your Spinal Health and follow your recommended treatment plan. Remember “it takes time to get sick and time to get well”. Time spent on yourself is an investment in your Health and Wellbeing.

Our Mission is “To Enhance the Quality of your Spinal Health for Life”

CHRIS YOUAKIM | Wellness Chiropractor

1/12 Campbell Crescent | Terrigal 2260 | Phone 0411 963 965