Kyphosis is a pronounced increase in the forward curvature of the upper back. A small curve is fairly typical. However, if an individual has an excessive curve, or it causes the spine to become unstable or painful, doctors may need to intervene.

Doctors call an excessive forward curvature kyphosis or sometimes hyperkyphosis. Postural imbalance, irregularities in the spine, or age-related conditions can cause kyphosis. It may not cause any symptoms other than changes in the appearance of the spine.

This article looks at the symptoms, causes, and treatments for kyphosis. It also outlines some exercises people can use to help address the condition.

Sex and gender exist on spectrums. For the purposes of this article, we use “male” and “female” to refer to a person’s sex assigned at birth.

A diagram showing two figures stood in profile. One has kyphosis and the other does not.Share on Pinterest
Illustration by Diego Sabogal

The primary sign of kyphosis is a visible forward curve in the upper part of the spine. It causes the upper back to appear curved over, with the shoulders rounded forward.

In mild cases, the excess spinal curve is not very noticeable. In other instances, a person may look as if they are bending forwards.

Kyphosis often occurs without any other symptoms. However, other symptoms can include:

  • back pain
  • stiffness in the upper back
  • a rounded back
  • tight hamstrings

Doctors find vertebral fractures in around 40% of people with hyperkyphosis. Each vertebral compression fracture may increase the kyphosis angle by 3.8 degrees.

The spine is made up of bones known as vertebrae that stack on top of each other. This structure allows the spine to be supportive and flexible. It also means the spine is vulnerable to damage.

There are several types of kyphosis. The factors that contribute to kyphosis vary depending on the type someone has.

  • Postural kyphosis: This is the most common form of kyphosis. It often starts in adolescence, when the muscles surrounding the spine develop differently due to a postural imbalance, such as slouching. Slouching increases the forward curvature, stretching the extensor muscles and posterior ligaments of the spine, which weaken over time. This can also occur in older adults, due to decreased muscle strength.
  • Scheuermann’s kyphosis: This also tends to develop during adolescence. However, it can become more severe than postural kyphosis. Doctors do not know what causes this form of kyphosis.
  • Age-related kyphosis: This type of kyphosis causes a curve in the spine that progressively gets worse in older age, often as a result of conditions that affect the bones in the spine. A common example is osteoporosis, which causes the bones to lose density and become weaker.
  • Congenital kyphosis: This occurs when the spine does not develop properly before birth, causing kyphosis at birth. It can rapidly worsen with age.

Doctors do not fully understand why some people develop kyphosis while others do not. However, postural kyphosis is more common in:

  • adolescents
  • people over the age of 40
  • females

By contrast, Scheuermann’s kyphosis is more common in males, with twice as many males developing the condition, compared with females. Doctors diagnose most cases between the ages of 13–16 years of age.

Age-related kyphosis affects older adults, especially those with osteoporosis. Older females are more likely to develop osteoporosis after menopause, as low levels of estrogen make the condition more likely.

A doctor diagnoses kyphosis by performing a physical exam. The doctor may ask a person to perform exercises or stretches to assess their balance and range of motion.

Another common test involves laying on a flat surface while a doctor examines the spine. If the spine straightens out, this indicates it is flexible and that the cause is likely to be postural kyphosis rather than a structural issue with the spine. If the spine remains curved, it is likely to be a structural form of kyphosis.

If they find evidence of an inflexible curve during the examination, the doctor may recommend an X-ray or MRI scan to look at the spine’s structure. In more severe cases, they may order other tests, such as a blood test or a lung function test.

Treatment for kyphosis depends on the type of kyphosis and the severity of the curve.

Nonsurgical treatment

For postural kyphosis, nonsurgical treatment may help prevent the appearance of the curve from worsening. It can also help people with Scheuermann’s kyphosis if their spinal curve is less than 70–75 degrees.

Nonsurgical treatment may involve:

  • Observation: In cases of mild kyphosis, a doctor may suggest waiting to see if the curve progresses. If it does not and the curve does not cause any other symptoms, no further treatment may be necessary.
  • Physical therapy: This involves specific exercises that strengthen the back and core muscles, and may help to improve posture.
  • Bracing: In some cases of Scheuermann’s kyphosis, a doctor may recommend a spinal brace if the spine is still growing. Spinal braces support the back while the spine grows into a more typical position, preventing progressive curving.
  • Treatment for underlying conditions: If an older adult has osteoporosis, or another condition that is causing the spine to weaken or change shape, then treating the underlying disorder may stop the progression of the curve. When a doctor identifies osteoporosis early, it is treatable. They may recommend vitamin D supplements, weight-bearing exercise, or for females, hormone therapy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce any pain caused by kyphosis.

Surgical treatment

People with congenital kyphosis, or severe forms of Scheuermann’s kyphosis, may benefit from surgery. The aim of surgery is to reduce the curve of the spine and any associated symptoms, such as pain.

The exact procedure a person receives varies depending on the situation. A common type of surgery is spinal fusion. This involves welding several vertebrae together to form a single segment of bone.

Other surgical procedures for severe kyphosis involve inserting rods, metal screws, and plates into the spine. This helps stabilize the spine and increase the fusion rate for bone grafting. This can reduce the curvature in the upper spine.

These procedures are major surgeries, so doctors typically try nonsurgical approaches first, wherever possible.

Complications with kyphosis can occur in more severe cases. These include:

  • an irreversible curvature in the back
  • persistent back pain
  • respiratory complications
  • heart problems
  • limited quality of life

Kyphosis can also compress or pinch the spinal cord, causing problems with the nerves that supply the legs and lower body. This can lead to:

  • weakness or numbness in the arms and legs
  • loss of bladder control
  • problems with balance

If these symptoms occur in someone with a spinal curve, they must seek immediate medical attention. A doctor may recommend surgery to relieve the spinal compression.

If an individual has surgery to treat kyphosis, there are risks of complications, including postoperative infections and bleeding around the surgical site.

A physiotherapist can recommend exercises and stretches to strengthen the back and abdominal muscles, such as:

Knee rolls

  1. Lie on the floor with the knees bent and feet flat on the floor.
  2. Move the knees slowly to one side until the back feels tense.
  3. Repeat at least five times on each side.

Pelvic tilting

  1. Lie on the floor with the knees bent and feet flat on the floor.
  2. Slowly arch the back, keeping the buttocks and upper back flat on the ground.
  3. Hold the arch for a few seconds before returning to a fully flat position.
  4. Repeat at least five times.

Knees to chest

  1. Laying in the same position as the previous two exercises, bring one knee up towards the chest.
  2. Clasp the hands around the knee and gently pull the knee closer to the chest.
  3. Hold this position for a few seconds, then release.
  4. Repeat at least five times on each leg.

It is not always possible to prevent kyphosis. However, people may be able to reduce the chances of postural kyphosis by maintaining good posture and back health. This may involve:

  • exercising regularly to keep the back and core muscles strong
  • avoiding slouching
  • making sure workspaces and desks are set up ergonomically
  • using chairs that support a healthy sitting position
  • getting enough calcium and vitamin D to maintain bone strength
  • stopping smoking, as this raises the risk for broken bones
  • reduce or avoid alcohol consumption

How to maintain healthy posture while sitting

If someone spends a lot of time sitting, it is important to practice a healthy sitting position. To do this:

  1. Position the chair so that when sat down, both feet can rest on the floor. The knees should be at a 90 degree angle. If the chair is too tall, or a person is using a desk that is too tall, use a foot rest.
  2. Relax the shoulders so they are neither rounded, nor pulled back. Rest the arms on arm rests so they sit at a 90–120 degree angle, and are close to the body.
  3. If using a desk or other surface, make sure it is at the same height as the arms.
  4. Use a chair that supports the curve of the lower back, or if the chair does not have this support, add some using a cushion or back rest.

Remember to take frequent breaks to stretch.

How to maintain healthy posture while standing

To maintain good posture while standing, try:

  • placing the feet shoulder-width apart
  • putting most of the weight onto the balls of the feet
  • standing straight and tall
  • keeping the head level
  • relaxing the shoulders down and back

Cervical kyphosis is a rare issue that affects the cervical spine, which is at the top of the backbone. It causes the neck to curve forwards, which can lead to significant problems.

Individuals with cervical kyphosis may experience neck pain. Because the condition compresses the spinal cord, they may also have sensory and motor problems. The causes of cervical kyphosis include:

A person should talk with a doctor if there is a noticeable curve in their spine or persistent stiffness or pain. They can diagnose the cause. If it is kyphosis, then the doctor will be able to identify which type someone has.

Postural kyphosis does not always need treatment, as it does not involve permanent changes to the bones themselves. Physical exercises may be enough to reduce the curve.

For congenital, age-related, or progressive forms of kyphosis, treatment is often successful if it begins early in the course of the condition. Whether someone has surgery or not, they should receive regular monitoring throughout their lives to check if the curve is progressing or not.

If an individual experiences sudden numbness, tingling, weakness, or bowel or bladder incontinence, they should get emergency medical help.

Kyphosis is where the upper back bends forward due to a pronounced spinal curve. There are several types of kyphosis that have different causes. A common and benign cause is postural imbalance.

Doctors can often effectively treat kyphosis through a combination of nonsurgical options. Mild curves that do not cause other symptoms may not require any treatment. Other options include physical therapy, bracing, and treatment for underlying issues, such as osteoporosis. In more severe cases, a doctor may recommend surgery.