Kyphosis: Diagnosis, Symptoms, Treatment, and More!

For the spine to function optimally, it needs to be able to maintain its natural curves and healthy alignment, and there are a number of spinal conditions that involve a loss of its healthy curves; kyphosis is one of them.

The thoracic spine features a kyphotic curve. Kyphosis refers to a spinal curve that bends outwards, away from the body’s center. If a person’s level of kyphosis becomes excessive, it can cause the upper back and shoulders to become excessively rounded-forward.

To better understand how a loss of the spine’s healthy curves affects it, let’s explore some basic spinal anatomy, and why the spine is curved in the first place.

A Healthy Spine

A healthy spine will appear straight when viewed from the front and/or back, but will take on a soft ‘S’ shape when viewed from the sides, and this is because the spine is naturally curved at each of its main sections.

There are three main spinal sections: the cervical spine (neck), thoracic spine (middle/upper back), and the lumbar spine (lower back).

Each of the spine’s sections has unique roles to play in maintaining the spine’s strength, function, and biomechanics.

The cervical spine has to support the weight of the head and is the bridge between the brain and the rest of the body.

The thoracic spine is the largest spinal section so is the most vulnerable to a number of spinal conditions, and the lumbar spine is particularly vulnerable because it has to support the weight of the entire trunk, the spinal sections above, and its vertebrae feel the effects of lifting, bending, and twisting motions; this is why it’s said that everyone will experience lower back pain at some point in their lives.

The spine consists of vertebrae (bones) that are stacked on top of one another in a straight and neutral alignment, and in between each pair of adjacent vertebrae sits an intervertebral disc.

The discs of the spine are key structures; in fact, their deterioration is a contributing factor in the development of a number of spinal conditions, especially as the discs are generally the first spinal structures to feel the effects of degeneration (degenerative disc disease).

The discs consist of two main parts: a soft and gel-like interior, known as the nucleus, and a tough and durable outer layer, known as the annulus, and are mainly made of collagen, proteoglycans, and water.

As the discs don’t have their own vascular supply, it can be difficult to reverse disc damage/deterioration once it’s occurred.

The discs are an essential part of the spine’s ability to maintain its natural curves because they give the spine structure (adjacent vertebrae attach to the disc in between), provide cushioning to prevent friction during movement, combine forces to increase the spine’s flexibility, and act as the spine’s shock absorbers.

The spine’s natural curves make it stronger, more flexible, and better able to absorb and distribute mechanical stress incurred during activity and movement, and now that we have a basic understanding of what the structure of a healthy spine looks like, let’s move on to address its specific curvature-types.

Kyphosis and Lordosis

The spine has two main curvature types: kyphosis and lordosis.

The thoracic spine features a kyphotic curve, which is a spinal curve that bends backwards, away from the body’s center, and the cervical and lumbar spinal sections feature lordotic curves that bend inwards, towards the body’s center.

While the size of these curves can vary from person to person, if a person’s kyphosis or lordosis become under- or over-pronounced, this can be problematic.

A healthy range of thoracic kyphosis would fall between 20 and 40 degrees, with what’s known as hyperkyphosis commonly diagnosed at 45-50+ degrees.

When the spine’s healthy curves are in place, its vertebrae are stacked on top of one another in a straight and neutral alignment as they should be, but if an unhealthy curve develops, some of its vertebrae have become unnaturally tilted, and this can affect the entire spine.

So if a person is diagnosed with hyperkyphosis, it can affect the spine, its surrounding muscles, nerves, and the entire body as uneven forces are being introduced, so let’s explore the types of symptoms an excessive thoracic kyphotic curve is associated with.

Kyphosis Symptoms

Now, there are different types of kyphosis, which we’ll be exploring next, so symptoms can vary from one patient to the next based on a number of different patient/condition variables like severity and causation.

If the thoracic spine has an excessive kyphotic curve, the upper back and shoulders can take on a rounded-forward appearance, with the development of a noticeable arch on the upper back.

In addition, some common symptoms of hyperkyphosis can include:

• Uneven shoulders (one sitting higher than the other)
• Uneven shoulder blades (one protruding more on one side than the other)
• Forward head posture (forward shift in posture also includes the head)
• Tight hamstrings
• Back pain
• Changes to balance, coordination, and gait (because the body’s center of gravity has shifted unnaturally)
• Digestive issues (more common in severe cases)
• Bowel and bladder issues (more common in severe cases)
• Lung impairment (severe and very-severe cases)

As mentioned, there are different types of kyphosis, and this is determined by causation; different types of kyphosis have different treatment needs because a condition’s underlying cause has to be addressed to be treated effectively.

Types of Kyphosis and Treatment Options

We’ve discussed some general symptoms of hyperkyphosis, so let’s now explore the different types of kyphosis, with a focus on symptoms specific to each type, along with its specific treatment needs.

The most common types of kyphosis are postural kyphosis, Scheuermann’s kyphosis, and congenital kyphosis, and as postural is the most prevalent, we’ll start there.

Postural Kyphosis

Postural kyphosis is the most common type and is the simplest to treat because it’s not a structural condition, meaning it’s not caused by a structural abnormality within the spine itself.

So a change in posture and/or body position can alter the excessive kyphotic curve, and postural kyphosis is caused by chronic poor posture like slouching that, over time, can cause the ligament and muscles that surround and support the spine to become excessively stretched.

When the muscles that surround the spinal vertebrae are weak and non-supportive, it can affect their position and contribute to the development of an unnatural spinal curve, like hyperkyphosis.

Postural Kyphosis Treatment

Because postural kyphosis is non-structural, it’s the simplest type to treat.

As a postural condition, if a patient were to make an active effort to improve their posture and stand up straight with their shoulders back, the excessive kyphosis could be reduced back to within a healthy range.

In conditions that are structural, a change in posture and/or position don’t impact the curve because it’s the bones themselves that are misshapen in some way.

Postural kyphosis can affect all ages but it’s common during adolescence due to the classic adolescent slouch.

Most cases of postural kyphosis can be addressed with physical therapy that improves muscle strength so the spine can be optimally supported, posture, and body positioning.

In addition, certain therapeutic exercises and stretches are known to activate specific areas of the brain for improved brain-body communication.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is a structural condition so is far more complex to treat than postural kyphosis.

Scheuermann’s curves are rigid and immovable and are most often diagnosed during adolescence with kyphotic curves that are greater than 45-50 degrees, with at least 3 adjacent vertebral bodies with a 5-degree wedge factor and present with small disc herniations: Schmorl’s nodes.

Symptoms of Scheuermann’s kyphosis tend to be severe because the condition can be severe, and it’s thought that growth is the trigger for its development.

Symptoms can include a pitched-forward posture, fatigue and lethargy (takes more energy to try and maintain an uneconomical gait and posture), pain in the middle/upper back, and no change in position can change a structural kyphotic curve.

Although rare and more common in severe and very-severe cases, lung impairment can become a related complication as the unnatural spinal curve can mean less room for the lungs to function optimally within.

Scheuermann’s Kyphosis Treatment

As a structural condition, again, Scheuermann’s kyphosis is more complex to treat  because it has to be impacted, first and foremost, on a structural level, and this can be worked towards through condition-specific chiropractic care.

Each treatment plan has to be customized to address important patient/condition factors such as condition severity, a patient’s level of spinal flexibility, patient age (skeletal maturity), and these factors also tend to shape the types of symptoms a patient will experience.

Particularly with early detection, many cases of Scheuermann’s kyphosis can be treated nonsurgically, and here at the Scoliosis Reduction Center, I often see kyphosis and scoliosis presenting together so I have experience treating both.

I developed a non-surgical treatment approach because I feel this is the best way to preserve as much of the spine’s overall strength, health, and function as possible.

Particularly with young patients, monitoring them throughout growth is important to see how the spine is responding, and through an integrative approach, I combine multiple complementary treatment disciplines so conditions can be impacted on every level.

Condition-specific chiropractic care is applied in an effort to reposition the kyphotic curve’s most-tilted vertebrae so they are in a straighter position, a healthier alignment with the rest of the spine, and aren’t rounded forward excessively.

In-office therapy can help with strengthening the spine’s surrounding muscles so they can better support the spine, and customized exercises can help improve posture, keep the spine loose and flexible so it’s more responsive to treatment, and activate certain areas of the brain for improved communication between the brain and body.

Corrective bracing can help by pushing the spine into a straighter position, and home exercises can help patients establish a home-rehabilitation program to further stabilize and heal the spine.

So through monitoring, I can observe not only how the spine is responding to growth, but also how it's responding to treatment, and then I can adjust treatment plans accordingly by adjusting the different treatment disciplines.

Congenital Kyphosis

In cases of congenital kyphosis, infants are born with the condition as it involves the development of a malformed spine.

In structural spinal conditions that are progressive, meaning it is their nature to get worse over time, it’s often growth that is the trigger, and as infants have so much growth to get through before they reach skeletal maturity, monitoring for progression is key.

Infants born with congenital kyphosis also have to be closely monitored for signs of any other abnormalities.

In most cases, it’s when an infant starts to move around on their own that the condition is noticed, and when it’s discovered at birth, this is when the excessively-rounded forward spine is visible as a lump in the upper back.

In a healthy spine, its vertebrae are rectangular in shape and aligned in a straight and neutral position, but if they are misshapen, the spine’s ability to stay aligned is compromised and an unnatural spinal curve can develop.

The vertebrae are connected by an elastic tissue (cartilage), and when congenital kyphosis develops, the front edges of one or more of the upper spine’s vertebrae develop atypically.

In many cases, the vertebrae are more triangular, than rectangular, in shape, and this can make the vertebral bodies wedge together, which can cause them to shift forward and develop into an excessively-rounded curvature.

As a structural condition, congenital kyphosis is another type that’s complex to treat.

Congenital Kyphosis Treatment

In many cases of congenital kyphosis, because of the condition’s severity and the danger of rapid progression due to growth, surgery is recommended.

When surgery is not necessary, monitoring through growth and treatment is key, and adjusting treatment plans to account for the unique challenges of treating patients at such a young age is important.

Chiropractic care, core strengthening, and bracing in older children can be effective at impacting the condition on a structural level, but the reality is that when severe, congenital kyphosis can require kyphosis surgery.

Kyphosis Surgery

Like all surgical procedures, spinal surgery comes with its share of risks, but as the brain and spine work together to form the central nervous system (CNS), spinal surgery does carry some particularly-serious potential risks, side effects, and complications.

As a complex communication network that facilitates brain-body communication, the CNS is involved in the function of virtually every part and system at work within the body, so when possible, non-surgical treatment options should be explored first, and this is what I offer patients of the Center.

In cases of structural kyphosis that haven’t responded to non-surgical treatment (chiropractic care, physical therapy, corrective bracing, and rehabilitation), surgery can be recommended as the best, and/or only, remaining recourse.

Factors that determine how a patient will respond to treatment can include condition severity (size of the kyphotic curve), progressive rate, balance, equilibrium (spinal stability), and whether or not neurological issues/symptoms have developed.

In addition, where along the spine the excessive kyphosis develops is important and determines severity: thoracic kyphosis is classified as severe with curves of 80+ degrees, and thoracolumbar kyphosis is considered severe when the curvature size exceeded 60-70 degrees.

With cases of thoracolumbar kyphosis that involve both the lower thoracic spine and the upper lumbar spine spine, they tend to cause more-noticeable visual symptoms so are considered severe at 60-70 degrees.

If a person’s kyphosis hasn’t stopped progressing with non-surgical treatment, and the kyphotic curve is continuing to grow in size and severity, surgery can be recommended to manage progression.

Also, if a person’s balance and coordination have been affected to the point of interfering with their ability to perform daily tasks and responsibilities, this is another factor that can lead to a surgical recommendation.

When the spine rounds forward excessively, a person's center of gravity shifts, and if balance and coordination are overtly affected, surgery can help rebalance and stabilize the spine.

Neurological Symptoms and Kyphosis Surgery

Another key factor in whether or not surgery is recommended is determined by the presence of neurological symptoms.

Remember, the spine and brain work in tandem to form the body’s central nervous system, so an unnaturally-curved spine can cause symptoms felt throughout the body, particularly when nerves are involved.

There are 31 pairs of spinal nerves, and when there is a high degree of nerve involvement (uneven pressure compressing the spinal nerves), symptoms of numbness, tingling, weakness, and in severe cases, issues with bowel/bladder function can develop.

If a spinal nerve is compressed, either at its root, where it exits the spine, or anywhere along its pathway, it can cause a variety of sensations and/or movement issues, depending on the nerve that’s compressed.

When/if neurological symptoms start, this is another indicator that the condition is particularly severe, might not respond to non-surgical treatment, and spinal surgery might be recommended and/or needed.

Conclusion

The spine is a key structure of human anatomy; it helps us to stand upright, practice healthy posture, engage in a wide range of flexible movement, and works with the brain to facilitate communication throughout the body.

As such, spinal conditions don’t just affect the back; they can cause symptoms felt throughout the entire body.

In order for the spine to function optimally as it was designed, it needs to maintain a healthy range of curvature degrees and a neutral and straight alignment of its vertebrae; if the spine loses a healthy curve, it responds by putting in a bad curve, and regardless of where it’s located, it can disrupt the biomechanics of the entire spine.

Kyphosis refers to how the thoracic spine bends outwards, away from the body’s center, in a reverse ‘C’ shape, and when a person’s kyphosis becomes excessive, this can be diagnosed either as kyphosis and/or hyperkyphosis.

Hyperkyphosis means a person’s degree of curvature doesn’t fall within a normal range, and their excessive kyphotic curve can make the upper back and shoulders excessively rounded-forward.

This change in posture/body position introduces uneven forces to the body, shifting its center of gravity, and can lead to the development of forward head posture (FHP) and a host of other issues.

Common symptoms of hyperkyphosis can include back pain, a noticeable arch on the upper back, a pitched-forward posture, tight hamstring muscles, and when neurological symptoms are present, tingling, numbness, weakness, and even bladder/bowel issues can develop.

When kyphosis is detected early, there are fewer limits to what can be achieved, particularly if a lot of progression hasn’t occurred because as an unnatural spinal curve gets bigger, the spine becomes increasingly rigid, and that can make it less responsive to treatment and harder for some patients to perform key therapeutic exercises as part of treatment.

Here at the Center, I’ve treated kyphosis cases of all types and severity levels, and when it comes to effective treatment, being proactive is key, and I achieve this by starting treatment as close to the time of diagnosis as possible.

While kyphosis surgery can, indeed, address the structural aspect of the condition, spinal surgery is always an invasive procedure that comes with some serious risks, and as the risks are there, they should be considered carefully.

When detected and treated early, before a condition has been left to progress over time, there are fewer limits to what can be achieved with non-surgical treatment.

So if you are noticing changes to balance and gait and an excessively rounded-forward appearance of the upper back and shoulders, this does warrant the need for further testing, so don’t hesitate to reach out for guidance and support.