The spine is curved at each of its main sections, and the spinal curves work together to increase the spine’s flexibility, strength, and ability to handle the stress of daily movement and activities. Causes, symptoms, and treatment options will be case-specific and designed around causation, severity, and experienced symptoms.

The spine’s natural curves are important for a number of reasons, and while curve size can vary from person to person, an excessive curvature can be problematic. Hyperkyphosis is diagnosed if the thoracic spine (middle/upper back) has an excessive curve.

As there are both healthy and unhealthy spinal curves, let’s explore the difference.

Healthy and Unhealthy Spinal Curves

The spine is one long structure, but it’s not straight; it’s curved at each of its main sections when looking at the spine from the side view.

The cervical spine refers to the neck and has a natural lordosis (curve type that bends inwards), and the lumbar spine refers to the lower back and also has a lordotic curve.

The thoracic spine is the largest spinal section consisting of the middle and upper back and should have a healthy degree of kyphosis where the spine curves outwards.

The health and function of the spine are shaped by its ability to maintain its healthy curves and alignment; a spine that’s misaligned doesn’t just affect the spine and its immediate surroundings, it can disrupt the body’s overall symmetry and alignment (1).

Healthy curves facilitate the spine’s movement-based design, while unhealthy curves disrupt the spine’s ability to function optimally.

There are a number of spinal conditions that cause a loss of its healthy curves, including scoliosis that causes the spine to bend unnaturally to the side and twist, and hyperkyphosis (aka kyphosis), that causes an excessive curvature in the thoracic spine (1).

If the spine’s healthy curves are in place, its vertebrae are aligned and the spine is balanced and stable, but if an excessive curve develops, this can have a number of effects (1).

Hyperkyphosis

If a person’s thoracic kyphosis becomes excessive, this can cause the mid and upper back and shoulders to round forward excessively (2).

A healthy range of kyphosis falls between 20 and 40 degrees, with hyperkyphosis commonly diagnosed at 45+ degrees.

Hyperkyphosis can develop for different reasons and while a small increase in kyphosis can be asymptomatic and go unnoticed, a significant increase can cause a variety of symptoms including pain, increasing spinal rigidity and tightness in the back, and poor posture.

Causes of hyperkyphosis include chronic poor posture, misshapen vertebrae, low bone density, neuromuscular conditions like cerebral palsy that cause a disconnect between brain-muscle communication, and issues like arthritis (2, 3).

So let’s talk about the different types of hyperkyphosis that can develop: postural kyphosis, Scheuermann’s kyphosis, and age-related kyphosis.

Postural Kyphosis

The cause of hyperkyphosis can shape its severity and symptoms, and the most common cause of hyperkyphosis is postural, and this type is also the simplest to treat.

Postural kyphosis is caused by chronic poor posture and may even develop during adolescence (2).

This type is functional, not structural, so it’s not caused by an abnormality within the spine itself, but rather poor posture and issues with the muscles that support the spine.

Chronic poor posture can introduce adverse spinal tension and uneven pressure to the spine that, over time, can change the position of vertebrae by stretching muscles and ligaments needed for spinal support.

Poor posture is the main cause and symptom of postural kyphosis as the upper back and shoulders round forward excessively, causing a slouching appearance.

Because it’s not structural, postural kyphosis can often be addressed with kyphosis-specific exercise, but in cases where the spine is too rigid to perform and/or respond to exercise, kyphosis-specific bracing may be recommended as an additional treatment option.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis tends to appear during adolescence, but as a structural condition, it’s more complex to treat than postural kyphosis (2, 3).

Scheuermann’s kyphosis is diagnosed when 3 or more vertebrae (bones of the spine) are misshapen; this involves vertebrae developing into a wedge shape, and the uneven pressure can also damage the discs that sit between adjacent vertebral bodies (3).

The spine’s intervertebral discs are key to its health and function, so any condition or issue that disrupts disc health can negatively affect the overall health of the spine in a number of ways, and once a disc starts to degenerate, it’s difficult to restore its health.

Symptoms of Scheurmann’s kyphosis can include various levels of pain shaped by severity, spinal rigidity, and an excessive rounded-forward posture (2).

As growth can trigger kyphosis to get worse in children, bracing is almost always recommended during periods of rapid growth.

Because Scheuermann’s kyphosis is structural, treatment commonly involves a combination of kyphosis-specific bracing and kyphosis-specific exercise rehabilitation (4).

Age-Related Kyphosis

Age-related kyphosis can develop due to the natural effect of gravity on the body.

As the muscles and ligaments that support the spine become weaker, it’s harder for the spine to resist the downward pull of gravity, and in cases where there are changes to bone density (particularly common in females going through menopause), the compressive force of the kyphosis can cause the front of the vertebrae to compress: vertebral compression fractures are also capable of causing wedged vertebrae.

Symptoms of age-related kyphosis include spinal instability, rigidity, pain, poor posture, and disruptions to movement (2).

As we age, there can be a loss of muscle strength, particularly from inactivity, and this can make it increasingly difficult to maintain a balanced and stable spine.

Spinal instability puts adults, particularly older adults, at risk of injury through a fall, so a focus of treatment is always to restore stability to prevent falls and related incident spine fractures.

Bracing may be recommended to stabilize posture in adults and to stabilize the spine following vertebral fractures (4).

Age-related degeneration can also cause the development of excessive kyphosis due to uneven wear and tear on the spine and its discs, contributing to degenerative disc disease.

Treatment options for age-related kyphosis include kyphosis-specific bracing and kyphosis-specific exercise to increase the spine’s support and stability through muscle strengthening (4).

Conclusion

The best way to preserve the spine’s healthy curves as we age is to practice good posture and cultivate a healthy activity level to maintain muscle strength and endurance.

The spine needs to be surrounded by strong and balanced muscles for support and stability so staying active is key to preventing a number of spinal issues/conditions from developing.

Hyperkyphosis causes an excessive curve in the thoracic spine, and its main symptoms include poor posture causing a visible arch in the middle/upper back, accompanied by excessive tightness and rigidity in the back.

If hyperkyphosis is left untreated, it can worsen and become more complex to treat, and part of the ScoliCare approach is to be proactive with treatment; spinal conditions don’t get be

tter with age, so the best time to start hyperkyphosis is immediately following a diagnosis.

The longer kyphosis is left untreated, the more difficult it can be to treat as the spine can become more unstable over time, particularly in aging adults experiencing spinal degeneration.

ScoliCare offers rehabilitative exercise programs that are individualized and kyphosis-specific, along with kyphosis-specific customized bracing that can work together to significantly improve the spine’s kyphosis and posture.

A healthy spine is key to quality of life, so if an unnatural curvature of the spine develops, it needs to be addressed proactively to preserve the health and long-term function of the spine.

While some severe thoracic kyphosis cases can receive a spine surgery recommendation, in many cases, kyphosis-specific exercise, bracing, or a combination of both can significantly improve a patient’s posture and severity of kyphosis.

References:

1. Veintemillas Aráiz MT, Beltrán Salazar VP, Rivera Valladares L, Marín Aznar A, Melloni Ribas P, Valls Pascual R. Changes in spinal alignment. Radiologia. 2016 Apr;58 Suppl 1:115-27. English, Spanish. doi: 10.1016/j.rx.2016.01.007. Epub 2016 Mar 12. PMID: 26976664
2. Lam JC, Mukhdomi T. Kyphosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558945/
3. Scoles PV, Latimer BM, DigIovanni BF, Vargo E, Bauza S, Jellema LM. Vertebral alterations in Scheuermann’s kyphosis. Spine (Phila Pa 1976). 1991 May;16(5):509-15. doi: 10.1097/00007632-199105000-00004. PMID: 2052992
4. Berdishevsky H. Outcome of intensive outpatient rehabilitation and bracing in an adult patient with Scheuermann’s disease evaluated by radiologic imaging-a case report. Scoliosis Spinal Disord. 2016 Oct 14;11(Suppl 2):40. doi: 10.1186/s13013-016-0094-7. PMID: 27785478; PMCID: PMC5073408.