Kyphosis: Symptoms, Types, Causes and Treatment Options

01Basics

What is kyphosis?

Everyone’s spine has gentle curves. The NHS describes kyphosis as a curve in the spine that makes the top of the back look hunched or rounded: the upper spine has a bigger curve than usual. MedlinePlus describes it as a curving of the spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture.

Kyphosis can occur at any age, although it is rare at birth. Treatment may not be needed unless the curve is severe or causing problems. The NHS advises against self-diagnosing: see a doctor if you are worried. Our guide on dowager’s hump covers a related change at the base of the neck.

02Types

Types of kyphosis

The NHS describes three main types:

• Postural kyphosis: the most common type, usually caused by bad posture and often seen in teenagers.
• Scheuermann’s kyphosis: the back of the vertebrae grows faster than the front, so the bones become wedge-shaped and the spine curves. MedlinePlus says it appears in young teens, its cause is unknown, and it stops once growth stops.
• Congenital kyphosis: a baby’s spine does not develop properly and curves as the child grows. It is rare.

In adults, the curve often has other causes, described below. Kyphosis is not the same as scoliosis, a sideways C- or S-shaped curve, although MedlinePlus lists scoliosis among the conditions that can be associated with it.

03Symptoms

Symptoms of kyphosis

The main sign is a hunched or rounded upper back, and the shoulders may also look rounded. With only a slight curve there may be no other symptoms. If the curve is more noticeable or gets worse, it can cause:

• back pain, which MedlinePlus says is most often felt in the middle or lower back
• tenderness and stiffness in the spine
• fatigue
• in severe cases, very bad back pain and difficulty breathing

Some people also feel more self-conscious about how their back looks, which MedlinePlus lists among the possible consequences of untreated kyphosis.

04Causes in adults

Causes in adults: posture, bones and other conditions

The NHS says kyphosis is often caused by bad posture or a problem with the structure of the spine, and can also follow a spinal injury or conditions such as arthritis and osteoporosis. MedlinePlus lists these causes in adults:

• degenerative diseases of the spine, such as arthritis or disk degeneration
• fractures caused by osteoporosis (osteoporotic compression fractures)
• injury
• one vertebra slipping forward on another (spondylolisthesis)
• previous spinal surgery or fusion

Less common causes include hormone diseases, connective tissue disorders, infections such as tuberculosis, muscular dystrophy, Paget disease, tumors and other conditions. Because the causes are so varied, a rounded back that is new or getting worse in an adult deserves a medical check. MedlinePlus notes that treating and preventing osteoporosis can prevent many cases of kyphosis in older adults.

05Assessment

How kyphosis is assessed

The NHS advises seeing a GP if you think you or your child might have kyphosis. The GP may refer you to a specialist (an orthopedic surgeon), who may examine your back while you bend forward to see how severe the curve is and how flexible you are, and check your arms and legs.

MedlinePlus explains that the exam also looks for nervous system changes below the curve, such as weakness, paralysis, changes in sensation or reflexes. Tests may include:

• a spine X-ray
• an MRI scan, if a tumor, infection or nerve symptoms are possible
• a bone density test, to check for osteoporosis
• lung function tests, if kyphosis affects breathing

Before the appointment, it helps to note any loss of height or change in the curve you have noticed, previous fractures, conditions or medicines that affect bone health, and the everyday tasks that have become harder. This helps the team discuss bone health and realistic goals.

06Treatment

Treatment: pain relief, physiotherapy and braces

Treatment is usually only needed if kyphosis causes problems, and it depends on the cause and the severity of the curve. Options listed by the NHS include:

• pain relief for back pain; check with a doctor or pharmacist which type suits you
• physiotherapy to help improve posture and relieve back pain and stiffness
• a brace, a rigid support worn around the torso, to help straighten the spine in children with mild to moderate Scheuermann’s kyphosis, only under specialist supervision

MedlinePlus adds that compression fractures from osteoporosis can be left alone if there are no nerve problems or pain, but the osteoporosis needs treatment to prevent new fractures. Children with kyphosis may have regular hospital check-ups, because the curve can get worse until they stop growing.

07Exercise

Exercise and physiotherapy: what they can and cannot do

You should be able to exercise with kyphosis, and the NHS says strengthening your core muscles, around the tummy and lower back, can help. If you are new to exercise or have not exercised for a while, speak to a health professional first.

Physiotherapy exercises can reduce back pain and stiffness, but the NHS is clear that they will not improve the curve in the spine or stop it getting worse. Exercise programs that promise to straighten a structural curve go beyond what the evidence in these sources supports. Our guide on posture exercises has general ideas for postural habits.

In our physiotherapy practice in Bilbao we work with adults on back pain, stiffness and strength after a medical assessment, with realistic goals for daily life (consultations are in Spanish).

08Surgery

When surgery is considered

Surgery to straighten the spine may be considered if the curve is severe, getting worse or causing very bad pain. The NHS notes that spinal surgery is usually only done if the benefits outweigh the risks. According to MedlinePlus:

• congenital kyphosis needs corrective surgery at an early age
• in Scheuermann’s disease, surgery is sometimes needed for large, painful curves
• surgery is needed if nervous system symptoms or constant pain develop
• kyphosis caused by infection or tumor needs prompt treatment, often with surgery and medicines

Whether surgery is right is an individual decision made with a spinal specialist.

09Sources

Where the sources differ

Most common cause. The NHS emphasizes bad posture: postural kyphosis is the most common type. MedlinePlus barely mentions posture and focuses on Scheuermann’s disease in teens and on structural causes in adults, such as osteoporotic fractures and degeneration.

Outlook in adults. MedlinePlus says that if kyphosis is due to degenerative joint disease or multiple compression fractures, surgery is needed to correct it and improve pain. The NHS presents treatment as usually needed only when there are problems, with surgery for severe or worsening curves. In practice, the decision depends on symptoms and the individual assessment.

Where pain is felt. MedlinePlus says pain in the middle or lower back is the most common symptom; the NHS speaks of back pain and stiffness without specifying the area.

10Summary

In summary

Kyphosis is an increased curve of the upper spine that gives a hunched or rounded back. The main types are postural, Scheuermann’s and congenital; in adults, osteoporotic fractures, degeneration and injury are common causes.

Many people need no treatment. Pain relief and physiotherapy can ease pain and stiffness but do not straighten the curve; braces help some teenagers with Scheuermann’s kyphosis; surgery is reserved for severe, worsening or painful curves and nerve problems. Get a curve that is new, worsening or causing leg symptoms or breathing problems checked.