Hunched back

Dr. Mahdi Saeedi

introduction

Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal.

While some degree of curvature is normal, a curve of more than 60 degrees is considered a sign of kyphosis.

Sometimes kyphosis does not cause any symptoms other than the back appearing abnormally curved or hunched. However, in some cases the condition causes back pain and stiffness, tenderness of the spine and tiredness.

Back pain can be particularly problematic in adults with kyphosis because the body has to compensate for the spinal abnormality.

If you have severe kyphosis, your symptoms may get worse over time. You may also have difficulty breathing and eating.

Causes of kyphosis

Kyphosis is often caused by poor posture during childhood.

It can also be the result of abnormally shaped vertebrae or developmental problems with the spine.

The spine

Your spine extends from your skull to your pelvis. It is made up of 24 individual rectangular-shaped bones called vertebrae, which are stacked on top of one another.

The vertebrae are separated by soft pads, or discs, which act as shock absorbers. The vertebrae are held together by tough bands of tissue called ligaments. Together with the spinal muscles, the ligaments give the back its strength.

In cases of kyphosis, the middle section of vertebrae, known as the thoracic vertebrae, are curved out of position. There are several reasons why the vertebrae can be affected in this way. These are discussed below.

Poor posture

Poor posture in childhood, such as slouching, leaning back in chairs and carrying heavy schoolbags, can cause the ligaments and muscles that support the vertebrae to stretch. This can pull the thoracic vertebrae out of their normal position, resulting in kyphosis.

Kyphosis that is caused by poor posture is known as postural kyphosis.

Abnormal shaped vertebrae

Kyphosis can also be caused when the vertebrae do not develop correctly. They can take on a wedged, triangular shape, rather than the normal rectangular, box-like shape. This leads to the vertebrae being out of position and is known as Scheuermann’s kyphosis.

In people with Scheuermann's kyphosis, the ligaments surrounding the veterbrae can also be thicker than normal which may contribute further to the condition.

It is not known what disrupts the normal formation of the spine. One idea is that the blood supply to the vertebrae becomes disrupted, affecting the growth of the vertebrae. There also appears to be a genetic link, as the condition occasionally runs in families.

Congenital kyphosis

Congenital kyphosis is caused when something disrupts the normal development of the spine before birth. In many cases, two or more of the vertebrae fuse together.

It is often unclear why certain children are affected in this way. However, some cases of congenital kyphosis run in families, so it seems that genetics also play a role in this type of kyphosis.

Conditions that cause kyphosis

Conditions that can cause kyphosis include:

  • osteoporosis – where the bones become weak and fragile and more likely to break (fracture)
  • spondylosis – a term that describes the general ‘wear and tear’ that occurs in the bones, discs and ligaments of the spine as a person gets older
  • spina bifida – a condition where the spine has not formed properly
  • Paget's disease – a condition in which the development of new bone cells is disrupted, resulting in the bones becoming weak
  • neurofibromatosis – a genetic disorder that affects the nervous system
  • muscular dystrophy – a genetic condition that causes progressive weakening of the muscles
  • tuberculosis – a bacterial infection that mainly affects the lungs
  • cancer that develops inside the spine or spreads to the spine from another part of the body

Kyphosis can also sometimes develop as a result of an injury to the spine.

SYMPTOMS

Symptoms of kyphosis include:

  • Difference in shoulder height
  • The head bends forward compared to the rest of the body
  • Difference in shoulder blade height or position
  • When bending forward, upper back looks higher than normal
  • Tight hamstring (back thigh) muscles

The symptoms of kyphosis may resemble other spinal conditions, or be a result of an injury or infection. Back pain, pain down the legs, and changes in bowel and bladder habits are not common symptoms of kyphosis. Always talk to a doctor if you have concerns about any spine condition.

Diagnosing kyphosis

Kyphosis can usually be diagnosed by examining your spine and taking an X-ray.

Examination

During the examination, your GP may ask you to do a number of exercises to assess whether your balance and range of movement are affected.

Your GP may also ask you to lie down so they can see whether the curvature of your spine is caused by bad posture or by a structural problem.

Although it is not always the case, if your spine straightens when you lie down, it is likely that your kyphosis is caused by poor posture (postural kyphosis).

However, if your spine stills curves while you are lying down, it is likely that kyphosis is due to a problem with the structure of your spine, as found in the Scheuermann's or congenital types of kyphosis.

X-ray and scans

An X-ray can usually confirm the diagnosis and determine the cause of the kyphosis.

Further scans are usually only be required if complex treatment, such as surgery, is being planned, or if you have additional symptoms that suggest your nervous system has been affected, such as numbness in your arms or legs.

If you need additional scans you will probably have a:

Adults

If you develop kyphosis in adulthood, it is likely that you will need some additional tests to determine the underlying cause.

The tests you will be referred for will depend on any additional symptoms that you have. They may include:

  • blood tests – which can check for infections such as tuberculosis
  • a bone density scan – which is a special type of X-ray to assess how strong your bones are; this can be useful for diagnosing conditions that cause weakening of the bones, such asosteoporosis or Paget’s disease
  • CT and MRI scans

Treating kyphosis

Most cases of kyphosis do not require treatment.

Kyphosis caused by poor posture (postural kyphosis) can usually be corrected by improving your posture.

If a child has kyphosis as a result of abnormally shaped vertebrae (Scheuermann's kyphosis), it will usually improve when they are fully grown.

If you have mild to moderate kyphosis, it may be possible to control your symptoms using painkillers and exercise.

Medications

Your doctor may suggest:

  • Pain relievers.If over-the-counter medicines — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) — aren't enough, stronger pain medications are available by prescription.
  • Osteoporosis drugs.In many older people, kyphosis is the first clue that they have osteoporosis. Bone-strengthening drugs may help prevent additional spinal fractures that would cause your kyphosis to worsen.

Physical Therapy

Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.

Exercise has not proven helpful for changing the kyphotic curve in the back. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks.

The goals of physical therapy are to help you

  • learn correct posture and body movements to counteract the effects of kyphosis
  • maintain appropriate activity levels
  • maximize your range of motion and strength
  • learn ways to manage your condition

Taping To Correct Upper Back Posture or Kyphosis

Taping will help in correcting the neck and upper back posture. Taping will also help in reducing neck pain using rehabilitation program.

If the taping technique is used in the early phase of rehabilitation program, chances of relieving stress and pain off the neck and back are high. However, long term usage of taping will lead to weakening of the muscles.

Guidelines mentioned below are for only information purposes and should not be tried individually without the assistance of a professional. Seeking professional advice before starting any rehabilitation program is mandatory.

Bracing

Teenagers with mild to moderate kyphosis may need to wear a back brace. The brace is worn while the bones are still growing and prevents the curve getting worse.

You may find that wearing a brace is restrictive at first. However, most people get used to them after a while. Modern braces are designed to be as convenient as possible, so you should still be able to take part in a wide range of physical activities.

You will need to wear the brace until you are fully grown, which is usually around 16 years of age for girls and 18 for boys.

Bracing is not usually recommended for adults who have stopped growing because it will not correct the position of the spine.

Surgery

Surgery can usually correct the appearance of the back and help relieve any painful symptoms. However, as surgery carries quite a high risk of complication, it is only recommended for more severe cases of kyphosis, and where it is felt that the potential benefits of surgery outweigh the risks.

Surgery for kyphosis would usually be recommended if:

  • the curve of your spine is very pronounced
  • the curve is causing persistent pain that cannot be controlled with medication
  • the curve is disrupting your body's other important functions, such as breathing and the nervous system
  • without surgery it is likely that the structure of your spine would deteriorate further