The spine has three main natural curvatures that characterize each of the three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back). The spine’s healthy curves enable its strength, flexibility, and optimal function. There are a number of spinal conditions a person can develop that involve a loss of these healthy curves, kyphosis being one of them.
The spine has natural and healthy curves, but these curves can also become over-pronounced. Kyphosis of the spine means there is an exaggerated front-to-back curvature of the upper spine. There are different types of kyphosis, and treatment will depend on condition type and severity.
Before we move on to discussing the specifics of kyphosis, including condition type and severity, let’s touch on some basic spinal anatomy for a better overall understanding of the spine.
Anatomy of the Spine
As mentioned, the spine has three main segments, and when viewed from the side, these segments each have natural curves that give the spine a soft ‘S’ shape; when viewed from the front, the spine appears straight.
Some spinal curves bend inwards towards the body’s center, while others curve outwards, away from the body’s center.
The curves of the cervical spine (neck) and lumbar spine (lower back) curve outwards and are referred to as ‘lordosis’; the curve of the thoracic spine (middle and upper back) curves inwards in a soft ‘C’ shape and is referred to as ‘kyphosis’.
These natural and healthy curvatures of the spine are important for a number of reasons. They help us stay balanced, stand upright, and practice good posture. They also give the spine added strength, flexibility, and enable the even distribution of stress that’s incurred during movement.
If any one of the spine’s natural curves become under- or over-pronounced, it disrupts the spine’s overall biomechanics, which is why postural changes are one of the earliest signs of a number of spinal conditions, kyphosis included.
Vertebrae and Intervertebral Discs
The spine is made up of small bones called vertebrae; they are rectangular in shape and stacked on top of one another to support the spine’s natural alignment. They also connect, via intervertebral discs, to form a canal, which houses the spinal cord and its nerves within.
The intervertebral discs have a tough outer layer and a soft gel-like interior. They sit between adjacent vertebrae and perform many important functions. They cushion the vertebrae so they don’t rub up against one another, generating friction. They enable slight movement of the vertebrae, thanks to the malleable interior, and they act as shock absorbers so stress is distributed evenly throughout the spine during movement.
In a healthy spine, the vertebrae are rectangular-shaped and separated by healthy intervertebral discs that maintain the spine’s natural and healthy alignment; however, a number of spinal conditions can develop that impact the health of individual vertebra, and/or the intervertebral discs, and this can disrupt the spine’s natural alignment and cause an abnormal spinal curvature to develop.
Kyphosis of the Spine
In a healthy spine, the thoracic section would have a natural kyphotic range of between 20 and 45 degrees, but when postural or structural abnormalities develop, the thoracic spine’s natural kyphosis can become outside of this normal range.
When a kyphotic curve is greater than 50 degrees, it’s commonly medically referred to as ‘hyperkyphosis’, but doctors commonly use the term ‘kyphosis’ to describe spinal conditions where the thoracic spine’s natural forward curvature is exaggerated, leading to the appearance of the upper back being excessively rounded.
While kyphosis can develop at any age, it most commonly develops in adolescents, due to the stage of puberty and related rapid bone growth.
As is the case with any type of abnormal spinal curvature, kyphosis can range in severity. While every case is different, generally speaking, the larger the curve, the more severe the condition.
Small kyphotic curves can cause mild back pain, or no pain and/or postural symptoms at all. In larger more-severe kyphotic curvatures, pain and postural changes can be more noticeable and result in the appearance of a visible arch on the patient’s upper back; however, pain is not as common a symptom in children and adolescents, as it is in adults.
As mentioned, not only can kyphosis range in severity, but there are also different types that can develop.
Types of Kyphosis
There are multiple different forms of kyphosis. The three most common are those that affect children and adolescents: postural, Scheuermann’s, and congenital kyphosis.
Postural Kyphosis
Postural kyphosis is the most common type of kyphosis, and this form tends to become noticeable during adolescence.
This type presents clinically as slouching and general poor posture; this form, however, is not associated with structural abnormalities of the spine so is less serious and can be temporary if postural issues are addressed.
Postural kyphosis curves typically have a rounded and smooth appearance, and if a person were to make an active effort to stand up straighter, the kyphotic curve can be corrected.
Postural kyphosis is more commonly found in girls, than boys. It is rarely painful, and as the curve is not progressive, it doesn’t tend to get larger and cause problems later in life.
Scheuermann’s Kyphosis
Named after the Danish radiologist who first described the condition, Scheuermann’s kyphosis is structural in nature, making it more serious than postural kyphosis and more likely to cause problems later in life, if left untreated.
Much like postural kyphosis, Scheuermann’s kyphosis is commonly diagnosed during adolescence and is generally more noticeable in patients who are thinner.
As Scheuermann’s kyphosis is structural, this means the vertebrae of the spine are misshapen, impairing the spine’s ability to maintain its natural and healthy curvatures.
As mentioned earlier, healthy vertebrae are rectangular in shape, allowing them to be stacked neatly in a proper alignment, on top of one another, separated only by the intervertebral discs.
In patients with Scheuermann’s kyphosis, an X-ray from the side will show that a number of consecutive vertebrae are triangular in shape, rather than rectangular. As you can imagine, these misshapen vertebrae disrupt the spine’s natural alignment as their irregular shape causes them to wedge together towards the front of the spine; this decreases the normal disc space and results in an exaggerated forward curvature of the affected area: most commonly the upper region of the thoracic spine.
The curve caused by Scheuermann’s kyphosis is generally angular, sharp, stiff, and rigid. Unlike postural kyphosis, a patient with Scheuermann’s kyphosis won’t be able to correct their abnormal curvature merely by standing up straighter.
While it most commonly affects the thoracic spine, Scheuermann’s kyphosis can also affect the lumbar spine and is more common in boys, than girls. The condition is progressive during growth.
While Scheuermann’s kyphosis can be painful, as it most commonly affects children and adolescents who are still growing, pain is not a common symptom in this age group. If pain is an issue (likelier in adults), it’s most likely to be felt in the most-tilted vertebrae of the curvature: in its apex.
Pain can also be felt in the lower back as the spine tries to compensate for the excessively-rounded upper back by exaggerating the natural inward curvature of the lower back.
Pain also tends to worsen during movement or when standing/sitting for long periods of time.
Congenital Kyphosis
Patients with congenital kyphosis were born with it. It develops due to a malformation in the spinal column that occurs in utero. This can be caused when the spinal vertebrae don’t form properly or when multiple vertebrae don’t form into distinct separate bones, and become, instead, fused together.
Again, every case is different, but congenital kyphosis tends to worsen with growth, as the infant gets older.
Now that we have touched on condition severity and the most common types of kyphosis that can develop, what are some of the symptoms that appear as an exaggerated kyphotic curvature of the upper back develops?
Kyphosis Symptoms
Once again, every case is different, and kyphosis signs and symptoms are likely to vary based on variables such as patient age, condition severity, and the type of kyphosis.
Signs and symptoms of kyphosis can include:
- Rounded shoulders
- A visible arch on the back
- Spinal stiffness/rigidity
- General fatigue
- Tight hamstring muscles
- Problems with the heart, lungs, or other organs in severe cases
As mentioned, while no two cases are the same, when it comes to spinal conditions like kyphosis and related pain, in general, children and adolescents don’t experience a lot of pain related to their condition; this is because these age groups have not yet reached skeletal maturity.
In a body that is growing, the spine is constantly experiencing a lengthening motion which counteracts the compressive force of the curvature.
In adults, however, who have stopped growing, their spines and the surrounding vessels, muscles, and nerves are subject to compression, which can cause varying levels of pain.
Oftentimes, kyphotic curves are detected during routine physicals, and a physical exam and X-ray, when needed, will be part of the diagnostic process.
So you, or someone you care about, is facing a kyphosis diagnosis: what now?
Treatment Options for Kyphosis
As kyphosis most commonly develops in children and adolescents who are facing upcoming unpredictable and rapid growth spurts, one of the main goals of treatment is to stop the curve from progressing, preventing related postural changes.
Although kyphosis is more common in younger people, adults can also develop it as they age and the spine is facing degenerative changes, such as an adult kyphosis patient I treated by the name of Margie, whose story can be viewed here.(Code needs to be copied to the Text tab in WordPress)
The doctor treating the condition will take important patient and condition factors into consideration when crafting an effective treatment plan including patient age and overall health, how much growth the patient has yet to go through, and the severity and type of kyphosis present.
As mentioned, just as the different types of kyphosis have different symptoms and characteristics, they also have different treatment needs.
Treatment for Postural Kyphosis
For postural kyphosis, therapy and exercise is commonly recommended to address the underlying postural problems causing the curve.
As postural kyphosis is not structural, in most cases, once the bad postural habits causing the excessive curvature are addressed, the related kyphosis can be corrected.
Treatment for Scheuermann’s Kyphosis
Again, just as cases of Scheuermann’s kyphosis can range greatly in severity, their treatment needs can also vary.
In general, initial observation plays a role in treatment to determine if, indeed, a patient’s kyphosis is progressing. Children and adolescents who are facing growth are likely to be monitored more closely for progression than adults, as growth is a big trigger for progression in a variety of spinal conditions, including Scheuermann’s kyphosis.
Observation can include periodic visits to the doctor and X-rays scheduled at predetermined intervals, when needed, to gauge a patient’s progressive rate. However, passively waiting while a condition progresses unimpeded is never a good thing. While monitoring is important, I believe in initiating proactive treatment as soon as a condition is diagnosed, as this can increase chances of treatment success.
Proactive treatment needs to be applied in order to stay ahead of the condition’s progressive line. This can include in-office therapy, including kyphosis-specific exercises to address related symptoms like pain, and working towards improving postural symptoms by increasing core strength.
Increasing strength in the abdomen and back takes pressure off the spine and provides it with better support and stabilization.
While a traditional approach to kyphosis treatment often includes observation, bracing, and surgery, there are other treatment options available, and here at the Scoliosis Reduction Center®, I opt for an integrative treatment approach by combining multiple treatment disciplines such as specialized custom-prescribed exercises, stretches, therapies, and corrective bracing, when needed.
These disciplines can also address kyphosis-related pain by keeping the spine and its surrounding muscles as loose and flexible as possible.
In addition, here at the Center, we have access to a traction chair, which successfully uses vibrations to relax the muscles and potentially restores natural curves to the upper back and neck over time.
There are also highly specialized cantilevers and weights that can be an effective aspect of treatment by working towards a more balanced, neutral, and natural overall posture and body position.
While corrections are not always easy to accomplish and can involve a lot of commitment and time, especially in younger patients who are still growing, proactive treatment should be applied as close to the time of diagnosis as possible as there are fewer limits to what we can achieve; once skeletal maturity has been reached, progression has occurred, increasing condition severity and spinal rigidity.
Treatment for Congenital Kyphosis
In cases of congenital kyphosis, I typically attempt to impact the condition, first and foremost, on a structural level. Monitoring is important to determine if, and how fast, a patient’s kyphotic curve is progressing; I accomplish this through a combination of physical examinations and X-rays, when needed.
While treating patients at such a young age comes with its own unique set of challenges, it is possible to comprehensively modify treatment plans that were designed with older children and teens in mind, to address the specifics of treating congenital kyphosis in infants and young children.
Depending on the severity of the individual case, modifications to kyphosis-specific therapy and/or corrective bracing can be applied to address progression and work towards a reduction of the patient’s kyphotic curve.
Conclusion
An exaggerated front-to-back curve, most commonly affecting the upper portion of the thoracic spine, is a kyphotic curve. When this develops, the spinal section’s natural ‘C’-shaped curvature is over-pronounced, and this disrupts the overall health and biomechanics of the spine; it can also give patients the appearance of an excessively-rounded upper back and shoulders.
When kyphosis is diagnosed early, and proactive treatment is applied, many patients can be treated effectively and go on to lead active and healthy lives. However, if kyphosis is left untreated and progresses unimpeded, it can lead to problems later in life, especially once skeletal maturity is reached and the spine becomes vulnerable to the compressive force of unnatural spinal curvatures.
Here at the Scoliosis Reduction Center®, proactive treatment that addresses the specifics of each patient and their kyphotic curve severity and type is available, so if you suspect that you, or a loved one, has an abnormal spinal curvature, don’t hesitate to reach out to us here.
