What is kyphosis?

Kyphosis describes the rounded shape of the mid-back. A moderate amount of kyphosis is normal however, in some people, they develop too much kyphosis which is called hyperkyphosis.

Hyperkyphosis can be caused by functional problems such as poor posture, low muscle tone and pain. Hyperkyphosis can also be caused by structural problems such as a fracture of one of the vertebrae or when the vertebrae grow in a deformed manner (the back of the bone grows taller than the front of the bone creating a wedge shape). Sometimes multiple vertebrae develop a wedge shape and this creates a special condition called Scheuermann’s hyperkyphosis.

Depending on the cause, kyphosis may be treated with a specific exercise program. If the kyphosis is large and/or stiff, a specialized kyphosis brace that is custom-made can stabilize and sometimes improve the kyphosis. In extreme cases, surgery may be recommended. We ensure each patient is expertly assessed and given the best options for care.

Hyperkyphosis symptoms

Symptoms of hyperkyphosis may include:

  • Poor posture with an obvious slouch or hunching appearance of the mid-back
  • Consistent pain in the mid-back
  • Tightness or stiffness in the mid-back

If left untreated, hyperkyphosis can worsen over time increasing symptoms and becoming more difficult to treat.

Causes of hyperkyphosis

The causes of hyperkyphosis may include:

  • Poor posture
  • Uneven growth of the vertebrae causing a wedge (Scheuermann’s kyphosis)
  • Low bone density (Osteoporosis) causing compression fracture in the spine
  • Spinal infections
  • Neuromuscular conditions such as cerebral palsy
  • Chronic diseases such as arthritis

Types of hyperkyphosis

There are three main types of hyperkyphosis:

Postural hyperkyphosis

Postural hyperkyphosis is the most common type of kyphosis which usually appears during adolescence. It is a functional type of hyperkyphosis meaning it is not caused by a change of the structure of the boney elements of the spine. Poor posture and/or poor condition of the stabilizing muscles and ligaments of the spine cause postural hyperkyphosis. In most cases, kyphosis-specific exercise is the best way to treat postural hyperkyphosis however in cases where the spine is particularly stiff or in cases where it is difficult for the patient to perform the exercises, kyphosis specific bracing may be used.

Scheuermann’s hyperkyphosis

Scheuermann’s hyperkyphosis appears during adolescence and is a structural deformity of the vertebrae. True Scheuermann’s hyperkyphosis is diagnosed when multiple vertebrae (3 or more) develop a wedge shape. Sometimes the discs in between the wedge vertebrae show some signs of damage. As Scheuermann’s kyphosis is caused by a structural change in the spine a combination of both kyphosis-specific bracing and kyphosis-specific exercise is usually the best way to treat it.

Aging-related hyperkyphosis

As we age there is a natural tendency to develop a hyperkyphosis because gravity is always to pull us down. As muscles and ligaments become weaker, our ability to resist gravity becomes less. In cases where the bone density is low, the compressive force from the hyperkyphosis can cause the front of the vertebrae to collapse. This is known as a compression fracture and causes a wedge-shaped deformity of the vertebrae. The best way to treat age related kyphosis is to maintain a good upright posture and the strength to maintain that good upright posture as we age. Once upright posture is compromised and a hyperkyphosis develops in an older person, it is important to actively treat the hyperkyphosis with kyphosis-specific exercise and/or kyphosis-specific bracing.

How is hyperkyphosis treated?

In the early stages, hyperkyphosis can be treated with kyphosis-specific exercise. If the kyphosis worsens beyond a certain degree, kyphosis-specific bracing is the best non-surgical treatment to help stop the worsening of the kyphosis and in some cases may be able to improve the curve. Surgery may be recommended if the kyphosis progresses beyond the range that can be helped with bracing and exercise.

ScoliCare offers kyphosis specific exercise rehabilitation programs and custom-made kyphosis-specific braces.
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Depending on the type of hyperkyphosis, kyphosis-specific exercises may be helpful. If the kyphosis is flexible, especially when it is a postural hyperkyphosis, specific exercise rehabilitation can be very helpful. When the kyphosis is stiffer, exercise rehabilitation alone may not be enough to improve or stabilise a worsening kyphosis.
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Kyphosis-specific bracing can play a role in both children and adults. In postural hyperkyphosis, bracing is rarely used unless the patient is unable to perform the exercises or the spine is particularly stiff. Kyphosis-specific bracing is almost always recommended in children who have Scheuermann's kyphosis during their period of growth.

In adults, kyphosis bracing can be used to stabilse the posture if it is declining as a result of age. Kyphosis bracing can also be used to stablise the spine following a compression fracture.
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Surgery is generally reserved for the severe cases where non-surgical treatments are not appropriate. Kyphosis surgery is a major spinal surgery with the goal of stabilizing a kyphosis that is worsening over time.
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