What Is Kyphosis?
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Medically reviewed by Katrina Carter, DPT
Kyphosis is a condition that affects the shape of the spine. It’s defined by a curve in the vertebrae, or back bones, at the top of the spine.
Most people experience some degree of kyphosis in the upper spine. A curve of about 20 to 45 degrees is normal and typically does not cause pain.
When the spinal curve becomes greater than 50 degrees, this is considered hyperkyphosis, or excessive kyphosis, which can cause pain and postural problems. Excessive kyphosis is often referred to as simply kyphosis, and may also be called hunchback or roundback.
Excessive kyphosis can happen at any age, but people over 40 years old are more likely to experience it as a result of the typical aging process. Some types of kyphosis are diagnosed shortly after birth or during adolescence, but they are rarer.
Types of Kyphosis
There are a few different kinds of kyphosis, primarily defined by the cause of the condition.
Postural Kyphosis
Postural kyphosis occurs after the muscles of the back and spine are stretched and then begin to weaken. Younger people are more likely to experience postural kyphosis from slouching or carrying heavy bags. In older people, muscle weakness that creates poor posture is more likely to cause the condition.
Scheuermann Disease
Scheuermann disease, also known as Scheuermann’s kyphosis or juvenile kyphosis, is caused by abnormally shaped vertebrae. The condition develops during growth in adolescence.
Most people with Scheuermann disease receive a diagnosis as a teenager, and it’s more common among males than females. Estimates of the prevalence of Scheuermann disease in the U.S. range from 1% to 8% of the population.
Congenital Kyphosis
Congenital kyphosis occurs from problems during fetal development that result in missing or fused vertebrae. Most of the time, children with congenital kyphosis are diagnosed once they begin walking. This kind of kyphosis is uncommon but can be very disabling.
Kyphosis Symptoms
The main symptom of kyphosis is the spinal curvature, which may give the appearance of a rounded hump on the back and rounded shoulders. Some people with kyphosis only have this symptom, while others may also experience:
Back pain in the lower or middle back
Neck pain
Stiffness around the back and spine
Tenderness around the spine
What Causes Kyphosis?
A wide range of factors can cause kyphosis, and they vary depending on the type of kyphosis.
Postural kyphosis can be caused by the following:
Age: Approximately 20-40% of people age 60 and over have kyphosis, and it progresses more quickly during menopause. Many people who experience kyphosis due to age have underlying osteoporosis, a condition that weakens bones, which can cause fractures in the person's vertebrae. Muscles around the back also weaken with age.
Poor posture: Over time, slouching, consistently leaning back, and carrying heavy bags can stretch muscles and ligaments, leading to kyphosis.
Injury or disease of the spine: Injuring your spine can cause kyphosis, as can a range of conditions including arthritis, disc degeneration, tuberculosis, and certain hormone-related diseases.
Other conditions: Conditions that affect how the spine grows, muscles around the spine, and posture can cause kyphosis. These may include scoliosis, Paget disease, Gibbus deformity (collapse of vertebrae), muscular dystrophy, and cerebral palsy, among others. Tumors around the spine may also cause kyphosis.
Both Scheuermann disease and congenital kyphosis are caused by unknown genetic factors. Scheuermann disease happens when three or more vertebrae in a row wedge together sometime before puberty. However, why and how this happens is still being studied.
Congenital kyphosis is caused by abnormal development in the womb. Either one or more vertebrae can fail to develop, or two or more vertebrae may not separate from each other. These missing or fused portions of the spine lead to kyphosis that may worsen over time.
Risk Factors
You may be more likely to develop postural kyphosis if you:
Are over the age of 40
Are a woman, especially after menopause
Have osteoporosis or another degenerative disease
Have injured your spine
Have persistent poor posture
Males are twice as likely to develop Scheuermann disease than females.
How is Kyphosis Diagnosed?
If your healthcare provider suspects you might have kyphosis, they’ll begin by doing a physical examination of your back. They can also perform tests that measure any changes in your reflexes or nervous system responses. They may do further testing, including:
X-rays of your spine
Pulmonary function tests to measure the impact of the kyphosis on your breathing
Magnetic resonance imaging (MRI) to see if a tumor, infection, or condition of the nervous system is present
Bone density testing to identify if you may have osteoporosis
Treatments for Kyphosis
As your healthcare provider treats you for kyphosis, they will continue to check your spinal curve using x-rays. Your treatment may include one or several methods, depending on the type of kyphosis you have and the severity of your symptoms.
Physical Therapy
Physical therapy is a common early kyphosis treatment to improve back and core strength, improve posture, and reduce pain. Certain types of exercises aimed to correct posture have been shown to additionally reduce the curve, particularly for younger people with postural kyphosis.
If you have Scheuermann disease, your provider will likely recommend physical therapy in combination with a brace.
Back Bracing
In addition to physical therapy, your healthcare provider may prescribe a back brace. This is usually recommended for children and teenagers, especially those with Scheuermann disease. When used in adolescence, a back brace can help guide the spine to grow straighter and provide spinal support.
In adulthood when the spine has stopped growing, a brace itself cannot correct a spinal curve. However, back braces can provide pain relief and extra support for adults with kyphosis.
Most people wear their brace for at least 16 hours throughout the day.
Surgery
Surgery is used to treat more severe or painful cases of kyphosis. If your pain is not improving, your curve is continuing to grow, or you’re experiencing difficulties with breathing, your healthcare provider may recommend surgery. You may also need surgery if you develop neurological or cardiovascular symptoms as a result of kyphosis.
People with Scheuermann disease rarely receive surgery. They may consider surgery if the spinal curve is significantly larger than typical (greater than 75 degrees) or particularly painful.
People with congenital kyphosis often require surgery early after diagnosis to prevent the condition from getting worse.
Treatment for Underlying Conditions
Your treatment plan may include specific methods to treat the underlying causes of your kyphosis. For example, if you have osteoporosis, your healthcare provider may recommend medications to strengthen your bones and prevent fractures in your spine. If an infection or tumor is causing your kyphosis, your healthcare provider would need to address the infection or tumor immediately using medication or surgery.
How to Prevent Kyphosis
To prevent postural kyphosis, it’s important to:
Avoid slouching
Avoid carrying heavy bags and use proper backpacks
Exercise regularly to strengthen your back and core muscles
Engage in activities that promote stretching and mobility, like yoga
Take steps to prevent or treat osteoporosis as you age
Because Scheuermann disease and congenital kyphosis likely caused by genetics, it’s not possible to prevent them. However, early diagnosis and treatment, such as back bracing for Scheuermann disease and early surgery for congenital kyphosis, may reduce the severity.
Related: 9 Ways To Improve Your Posture as You Age
Complications
Over time, if left untreated, severe kyphosis can result in complications. Specifically, you might experience:
Persistent pain in the chest and back
Shortness of breath
Weakness or numbness in the legs
Decreased bladder or bowel control
Reduced mobility
Problems with acid reflux or gastroesophageal reflux disease (GERD)
If you experience these complications, seek care from your healthcare provider right away. They may require additional tests or urgent medical care.
Living With Kyphosis
Kyphosis can range from mild to severe, so each person’s experience can be very different. Many people live with kyphosis without experiencing significant pain or limitations in mobility or other functions. People with more severe kyphosis may have pain or complications that interfere with daily life.
However, there are many treatment options to manage pain and correct your spinal curve. It's important to maintain your mobility through physical therapy and exercises that improve your posture, back, and core strength.
Some people with kyphosis, particularly children and teens, may be self-conscious of the way their back looks and avoid social situations. If this is the case, it’s important to seek social or mental health support.
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