Dowager’s Hump: Causes, Kyphosis Exercises and Can It Be Reversed?

01What

What is a dowager’s hump?

Doctors call an exaggerated curve of the upper back hyperkyphosis, usually defined as a curve greater than about 40 to 50 degrees on an X-ray. “Dowager’s hump” traditionally describes this curve in older women with osteoporosis, but people also use it for a fleshy bump at the base of the neck where the neck meets the upper back. That fat pad, sometimes called a buffalo hump, has different causes and is covered separately in medical guides. This article focuses on the spinal curve.

02Causes

Causes

• Postural kyphosis: years of slouching, desk work and phone use, with tight chest muscles and weak upper back muscles.
• Osteoporosis: small compression fractures of the vertebrae cause them to become wedge-shaped, increasing the curve and reducing height.
• Age-related changes: disc degeneration and loss of muscle strength.
• Scheuermann’s kyphosis: a structural curve that develops in adolescence.
• Other causes: previous spinal injury or surgery, arthritis such as ankylosing spondylitis, and some congenital conditions.

03Symptoms

Symptoms and effects

• A visible rounding of the upper back and forward head position.
• Stiffness and aching in the upper back, neck and shoulders.
• Fatigue in the back muscles after standing or sitting.
• Height loss, particularly with osteoporotic fractures.
• In severe cases, reduced lung capacity, balance problems and a higher risk of falls.
• Neck strain from looking up; see neck muscle strain.

04Diagnosis

How it is assessed

A clinician looks at your posture standing and lying, measures the curve, and checks whether it straightens when you stand tall or lie flat. X-rays measure the curve and show wedged vertebrae or other structural causes. If osteoporosis is suspected, a bone density scan (DEXA) and blood tests may be arranged. A sudden increase in curve or height loss in an older adult often points to a new vertebral fracture.

05Exercises

Exercises for dowager’s hump and kyphosis

• Chin tucks: glide the head straight back, hold 5 seconds, 10 times; helps forward head posture.
• Wall angels: stand with back and head against a wall and slide the arms up and down, 10 times.
• Prone back extension: lying face down, lift the chest a few centimetres, hold 3 seconds, 10 times.
• Thoracic extension over a foam roller or rolled towel placed across the upper back, 1–2 minutes.
• Rows and reverse flys with a band: strengthen the muscles between the shoulder blades, 3 × 12.
• Doorway chest stretch: 30 seconds, 2–3 times.
• People with osteoporosis should avoid loaded forward bending and twisting, and ideally follow a programme designed by a physical therapist.

06Reverse

Can a dowager’s hump be reversed?

It depends on the cause. A flexible, posture-related curve can improve considerably with regular exercise, posture changes and strength training over several months. In a randomised controlled trial in older adults with hyperkyphosis, a targeted programme of spine-strengthening exercise and posture training led to a measurable reduction in the curve compared with controls. Curves caused by vertebral fractures or structural changes cannot be fully straightened by exercise, but strengthening can reduce pain, improve function and help prevent progression.

07Daily

Daily habits that help

• Raise screens to eye level and use a headset rather than cradling the phone.
• Take short movement breaks every 30–45 minutes.
• Sit with your back supported and feet flat.
• Carry bags evenly or use a backpack.
• Build strength with regular resistance exercise and stay active.
• Support bone health with adequate calcium, vitamin D, weight-bearing exercise and not smoking; see the NHS guide to osteoporosis in the sources.

08Cases

Three common situations

• Office worker in their 30s with a rounded upper back: almost always postural and very responsive to chin tucks, upper back strengthening and workstation changes.
• Woman in her 70s who has lost 4 cm in height and has a new hump: needs assessment for osteoporosis and vertebral fractures before starting exercise.
• Teenager with a stiff, rigid curve: Scheuermann’s kyphosis should be considered; see a doctor for assessment.

09Who

Who is most at risk?

Postural kyphosis is common in people who spend long hours at desks, students and those who rarely do upper body strength training. Osteoporotic kyphosis is most common in postmenopausal women and older men, particularly those with low body weight, a family history of osteoporosis, long-term steroid use, smoking, heavy alcohol use or previous fractures. Starting strengthening exercise early is one of the best ways to reduce the risk.

10Summary

Key points to remember

• Dowager’s hump is an exaggerated upper back curve (hyperkyphosis).
• Posture, muscle weakness and osteoporosis are the main causes.
• Flexible curves improve with targeted exercise; structural curves less so.
• Height loss or sudden back pain in older adults needs a check for fractures.