Kyphosis (Rounded Upper Back)

What kyphosis is

Seen from the side, a healthy spine has three gentle curves: inward at the neck, outward at the upper back (kyphosis) and inward at the lower back (lordosis). Some kyphosis is normal. Doctors use the term "kyphosis" for a curve that is greater than normal, usually measured with the Cobb angle on an X-ray. Between 20 and 45 degrees is typical in adults, and the angle naturally increases with age.

Kyphosis is different from scoliosis, which is a sideways curve. The two can occur together (kyphoscoliosis).

Types of kyphosis

Symptoms

• A visibly rounded upper back, hunched posture or forward head position
• Rounded shoulders
• Upper back pain and stiffness, often worse after standing or sitting for long
• Tight hamstrings, particularly in Scheuermann kyphosis
• Tiredness in the back muscles
• Height loss in osteoporotic kyphosis

Severe curves, usually above 70 to 80 degrees, can compress the chest, causing shortness of breath, early fullness when eating or reflux. Nerve symptoms such as leg weakness are rare but need urgent assessment.

Causes and risk factors

• Posture: long hours slouching at desks, phones and screens, heavy backpacks
• Scheuermann disease: uneven growth at the front of the vertebrae during the adolescent growth spurt; runs in families
• Osteoporosis: weak bones collapse at the front, often painlessly, creating wedge shapes
• Aging: degeneration of discs and weakening of the extensor muscles along the spine
• Ankylosing spondylitis: inflammatory arthritis that fuses the spine in a forward-bent position
• Other: spine infections such as tuberculosis, tumors, trauma, Marfan syndrome and other connective tissue disorders

How kyphosis is diagnosed

1. Examination: your doctor looks at your posture from the side and asks you to bend forward (the Adams forward bend test). A postural curve smooths out, while a Scheuermann curve shows an angular hump.
2. Neurological check: strength, reflexes and sensation in the legs.
3. Standing X-ray from the side: measures the Cobb angle and looks for wedged vertebrae, fractures or abnormal bones.
4. Bone density scan (DXA): if osteoporosis is suspected.
5. MRI or CT: if there are nerve symptoms, a congenital cause, infection or tumor is suspected, or surgery is planned.
6. Lung function tests: for severe curves.

Treatment

Exercise and posture

For postural and mild structural kyphosis, exercise is the main treatment:

• Back extensor strengthening: prone back extensions, "superman" lifts and rows
• Chest and hip flexor stretches: doorway pec stretches, foam roller extensions along the upper back
• Core stability work: planks and bird-dogs
• Posture habits: raising screens to eye level, taking breaks every 30 to 60 minutes, sleeping on a supportive mattress

A physical therapist can tailor a program. In older adults, exercise programs have been shown to modestly reduce the curve and improve balance.

Bracing (growing teens)

Teenagers with Scheuermann kyphosis whose curves are between about 50 and 75 degrees and who still have growth left are often fitted with a brace, such as a Milwaukee-type brace or a modified thoracolumbosacral brace. It is worn for many hours a day until growth ends. Bracing can stop progression and sometimes improve the curve.

Pain relief

Acetaminophen (paracetamol) or NSAIDs such as ibuprofen at the label dose, heat and physical therapy help flare-ups. Avoid long-term NSAID use if you have kidney problems or stomach ulcers.

Treating osteoporosis

Medicines such as bisphosphonates, denosumab or bone-building drugs reduce the risk of new vertebral fractures. Calcium, vitamin D, strength training and fall prevention help too. For very painful recent fractures, vertebroplasty or kyphoplasty (injecting bone cement) is sometimes offered, although evidence of benefit beyond pain medicine is mixed.

Surgery

Spinal fusion with rods and screws can straighten and stabilize the spine. It is considered for:

• curves over about 75 to 80 degrees in Scheuermann kyphosis
• congenital kyphosis that is progressing
• nerve compression
• severe pain that does not respond to other treatment

It is a major operation, and most people with kyphosis never need it.

Outlook

Postural kyphosis has an excellent outlook and does not cause lasting deformity. Scheuermann kyphosis usually stops progressing when growth ends; many adults with it have mild ongoing back pain but lead normal lives. Age-related and osteoporotic kyphosis are linked to falls, reduced mobility and, in severe cases, breathing problems, which makes bone health and exercise important.

Frequently asked questions

Can kyphosis be corrected?

Postural kyphosis can usually be corrected with exercise and better posture habits within months. Structural kyphosis, such as Scheuermann or osteoporotic kyphosis, cannot be fully reversed without surgery, but exercise, bracing in growing teens and bone treatment can stop it getting worse and reduce pain.

What are the best exercises for kyphosis?

Exercises that strengthen the muscles along the back of the spine and stretch the chest work best. Examples include prone back extensions, rows, wall angels, chin tucks, doorway chest stretches and lying over a foam roller. Aim for most days of the week.

Is kyphosis serious?

Usually not. Mild and postural kyphosis cause cosmetic concern and some aching. Severe curves can affect breathing and digestion, and kyphosis caused by osteoporosis signals fragile bones and a higher risk of more fractures. Rapid progression or nerve symptoms need prompt assessment.

What is a dowager's hump?

It is an informal name for a marked rounding at the top of the back in older adults, usually caused by osteoporotic compression fractures that make several vertebrae wedge-shaped. A soft fatty pad at the base of the neck is sometimes called the same thing but is a different issue.

What is the difference between kyphosis and lordosis?

Kyphosis is an outward curve, normally in the upper back. Lordosis is an inward curve, normally in the neck and lower back. Problems arise when either curve is exaggerated. Too much kyphosis gives a hunched back; too much lordosis gives a swayback.