Hyperkyphosis is a spinal deformity causing a forward-curved posture of the upper back or thoracic spine. Your posture is the characteristic way you position your body; normal posture changes many times throughout the day. Sometimes, however, a person’s body curvature can become excessive and unchanging. Such is the case with hyperkyphosis (sometimes called “humpback or “round back”). Curvature of the upper back can begin to increase in people after 40 years of age and continue with advancing age. It is believed that 20% to 40% of older adults — both men and women — will develop hyperkyphosis.

What is Hyperkyphosis?

Hyperkyphosis is a spinal deformity that looks like a forward-curved posture of the head, upper back or thoracic spine. It can become excessive over time. The worsening of the curvature is associated with a higher risk of health problems.

Hyperkyphosis can result from conditions such as osteoporosis or thinning bones, and fractures of the vertebrae that result from thin bones. However, research has found that two thirds of people with hyperkyphosis do not have spinal fractures. There are several suspected causes for development of this spinal deformity when vertebral fractures are not present. Hyperkyphosis may result from poor habitual posture, muscle weakness, degenerative disc disease, ligament degeneration, or hereditary factors.

Signs and Symptoms

The most prominent symptom you might notice is the appearance of a rounded back.

If hyperkyphosis is not treated, people can have difficulty performing normal tasks such as bathing, getting out of a chair, bending, or walking. They can also experience balance changes that may result in falls and injury. In some cases, upper back pain may also be associated with the curvature; some people may experience spinal fractures as the condition advances.

When hyperkyphosis is present, you may notice you are:

How Is It Diagnosed?

Hyperkyphosis will be assessed first with a visual inspection of your back. Your spinal curve may be measured using a flexible ruler or x-ray. If an x-ray is taken, a radiologist will measure the spinal angles on the x-ray. If a curve measures greater than 40 degrees, hyperkyphosis is diagnosed.

Sometimes spinal changes occur because of fractures due to thinning bones or a condition called osteoporosis. Spinal changes can also result from degenerative disk disease or arthritis. These problems are commonly associated with aging. Other problems not associated with aging could also cause a sudden change in posture; however, problems such as a tumor, infection, or neurologic changes are uncommon. Your physician may prescribe imaging tests such as x-rays or an MRI of the thoracic spine to determine whether you have any of these less common conditions affecting your posture.

If you have advanced hyperkyphosis, you may experience difficulty breathing even though you do not have a history of lung or heart disease. You may also notice that there is lessening of the distance between your lowest ribs and your pelvic bones. In this case, pulmonary function tests may be prescribed to measure whether your hyperkyphosis is restricting your breathing.

How Can a Physical Therapist Help?

A physical therapist can help rehabilitate the postural changes and functional limitations associated with hyperkyphosis.

Your physical therapist will begin by reviewing your past and present medical history with you, as well as what medications you normally take. If you report a sudden change in your posture, severe pain, or a significant change in your physical function, you will be referred to your primary care physician. A sudden increase in the rounding of your back may indicate a more serious health problem.

When a more serious problem is ruled out, your physical therapist will perform special tests to assess your unique condition. The therapist will begin by observing, measuring, and recording your postural alignment, trunk strength, range of motion, and flexibility in movement. He or she may also measure your spinal curve with a special ruler. If you are experiencing difficulty walking or keeping your balance, your therapist will observe your movement and perform tests to determine the level of difficulty, and whether you have an increased risk of falling.

Your physical therapist can help with a variety of treatment options, including:

Remember, all cases of hyperkyphosis are different. Your physical therapist will choose the best treatment options for you based on his or her evaluation of your specific problem.

Can this Injury or Condition be Prevented?

Research has not shown that hyperkyphosis can be prevented. However, it has shown that maintaining and improving posture and physical fitness can significantly improve hyperkyphosis and prevent it from worsening with the normal aging process.

Protecting your spine in daily activity may also be important in preventing progression or worsening of hyperkyphosis. Your physical therapist may advise you to:

Real Life Experiences

Julie is a 68-year old woman who notices that her shirts are not fitting her well anymore. Her friend notices that she seems to be slumping over, and that Julie’s back looks more rounded. Julie also notices that she gets very fatigued when she is standing up for a long while, and would rather be sitting. Sometimes her upper back aches when she stands or walks a long time, but it gets better when she sits.

Julie decides to see her physician. He observes that Julie has a rounded back. The doctor orders an x-ray and a bone-density test. The results of the tests show that Julie has an increased kyphosis in her thoracic spine, but she does not have any fractures. She has osteopenia — low bone density — but not osteoporosis (thin bones at risk of fracture). The doctor makes dietary recommendations for bone strength, and refers Julie to physical therapy.

Julie’s physical therapist tests her physical strength; flexibility; the range of motion of her back, arms, and legs; and her spinal joint mobility. The therapist also observes her postural alignment and measures the curve of her thoracic spine. The tests show that Julie has lost the ability to fully straighten her back, and that the upper back muscles have become too weak to support her posture well. Also, her neck and shoulder muscles have become tight. The result is difficulty straightening up, difficulty maintaining a straight posture, and fatigue and pain when she spends time in positions without support, such as standing. Balance testing shows a mild loss of balance in walking.

Her therapist prescribes treatment to improve flexibility and strength to better support Julie’s postural alignment. Over several visits, Julie receives treatment that includes manual therapy to improve flexibility of the spinal joints. She also learns exercises to stretch the tight restrictive muscles, strengthening exercises for the upper back and trunk muscles, and walking/balance exercises. Julie practices these exercises every day at home. On her last visit, Julie’s physical therapist measures an improvement in her hyperkyphosis. Julie reports improvement in her tolerance for standing and walking. She no longer experiences fatigue, and her backache has resolved. Julie intends to continue her exercise program now that her physical therapy is completed so that she can prevent any worsening of her hyperkyphosis.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and clinical experience to treat hyperkyphosis. However, you may want to consider:

You can find physical therapists that have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):