Tag: kyphosis

Kyphosis Vs Hyperkyphosis

While Scoliosis is the main focus of our clinic, we also treat associated spinal conditions such as Hyperkyphosis – it’s a lesser-known condition, not least because Hyperkyphosis is often a progression of “regular” kyphosis, a common condition that can often be managed through approaches targeting postural adjustments, such as chiropractic or physiotherapy.


What is HyperKyphosis

Scoliosis is a condition of the spine that, ideally should not exist (or should be very small in a healthy individual)  whereas Kyphosis, in and of itself isn’t a problem as a kyphosis is essential for a healthy spine!

The spine is made up of three main sections: cervical, thoracic, and lumbar. When viewed from the front or back, the spine should appear straight (however in scoliosis it appears curved), and when viewed from the side, it has a slight ‘S’ shape.

This S shape is actually a critical characteristic of the spine which allows it to perform its job. The natural curves of the cervical spine (neck) and lumbar spine (lower back) bend outwards and are referred to as ‘lordosis’. The thoracic spine (middle and upper back) features a curve that bends inwards, and this type of curve is referred to as ‘kyphosis’ – so, kyphosis is in fact, a totally normal condition for the spine to exhibit.

So, if kyphosis is a normal inwards bending of the spine, Hyperkyphosis is said to exist when the kyphotic curve becomes excessive, leading to a rounded appearance of the upper back, a “hunched” posture and often, back pain. We are all individuals with a slightly different spinal and physical makeup, it’s therefore hard to say what an “ideal” kyphotic curve is – for most people a healthy figure is between 20 and 45 degrees, but when a curve falls beyond that healthy range, problems can occur.

When a kyphotic curve exceeds approximately 50 degrees, this is referred to as ‘Hyperkyphosis’ – in many circles, the word “kyphosis” is also often used to mean “Hyperkyphosis” which is unhelpful!



Types of Hyperkyphosis

There are three main types of Hyperkyphosis – broken down by cause, these are postural, congenital and Scheuermann’s

Postural kyphosis is the most common type and is associated with the “hunched” posture we often expect in adolescents. While it’s not true that the use of electronic devices actually causes Hyperkyphosis, the terrible posture this tends to promote most certainly can. Postural kyphosis is the simplest diagnosis to treat, since the condition is caused by poor posture and weakened muscles resulting from it – any treatment approach which aims to address this problematic posture will generally resolve postural Hyperkyphosis.

Congenital Kyphosis is more complex – whereas, in postural kyphosis an individual is born with a normal spine that develops an issue through misuse, a person with congenital kyphosis is born with the condition. There are a number of malformations in the spine which fall under the category of congenital Kyphosis – these include vertebrae not forming properly, or multiple vertebrae fusing together into one solid bone, rather than forming separate and distinct vertebrae.

Some congenital Kyphosis cases may benefit from bracing, but the best treatment will vary considerably depending on the individual.

Finally, Scheuermann’s Kyphosis is a structural condition which affects the way that vertebra develop. In a person with a “normal” spine, vertebrae are rectangular in shape – thus, they sit on top of each other in a fairly level alignment. In patients with Scheuermann’s kyphosis, a number of consecutive vertebrae are more triangular in shape, meaning that they naturally want to curve irrespective of the health of surrounding supporting muscle.

Abnormal spinal curvatures caused by this type of kyphosis are often angular, stiff, sharp, and rigid, which is why this form is more complex to treat and can’t simply be corrected with a change of position. Scheuermann’s is more common in boys and is progressive during growth, which is why proactive treatment is so important.



Kyphosis, which treatment is right for me?

The vast majority of Hyperkyphosis cases tend to be postural in nature, so, while expertise is required to provide a suitable treatment there are many approaches that can help. Chiropractic and physiotherapy are two approaches we utilise at the UK Scoliosis Clinic, but any approach which alters the problematic posture will, over time tend to resolve this condition. It’s also true that many kyphosis cases which are visible, or cause pain do not reach the threshold for Hyperkyphosis – you should, however, look to treat the condition as early as possible, since it will tend to progress without intervention -, even if that only means getting some professional advice on improving your workspace to promote good posture.

Congenital cases and Scheuermann’s kyphosis can often benefit from more specialist treatment through a spinal clinic, like the UK Scoliosis clinic. Spinal bracing, similar to that used for Scoliosis can be appropriate in some circumstances – in others, the best approach may still be a manual therapy coupled with postural work although for more complex cases it’s often worth coordinating this through a specialist centre.

Scoliosis and Kyphosis, what’s the difference?

Given our name being the UK Scoliosis clinic you would expect or focus to be on the non-surgical treatment of scoliosis, however, we also work with many patients suffering from another common spinal condition – Kyphosis. But what’s the difference between Scoliosis and Kyphosis?



Kyphosis is the condition which causes what’s sometimes called a “hunchback”, people with this condition tend to hunch forward, and, as you may have already realised, it’s getting far more common today than ever before.

But isn’t the spine supposed to bend forward slightly? – yes, it certainly is, however, when this forward bend becomes too pronounced it can become an issue. As a general guide,  it’s normal to have a mid-back kyphosis (backward c-shape curve) at approximately 40 degrees. Above this, unpleasant symptoms may result.

Typically, patients complain of aching and stiffness in their mid-back and lower back. It worsens when weight-bearing, especially when doing activities that require repeated bending such as gardening. Often, teenagers are noticeably hunched from spending hours on their phones, tablet’s or PC’s – a trend which often worsens into adulthood. Most age groups are at risk of Kyphosis, although there is probably a stronger link with lifestyle than with age per se.


Causes of Kyphosis

Like scoliosis, there can be different underlying causes of kyphosis, but unlike scoliosis, we understand these potential causes well. There are 4 main underlying issues which can lead to Kyphosis, these are:


Postural Kyphosis – is the most common form and the one which is increasing faster than ever before. Postural kyphosis is noticeable, in that it will appear when standing and sitting and disappear when laying face down. Postural kyphosis isn’t a structural problem caused by an abnormal shape of the vertebra that make up the spine, but rather by the supporting muscles and tissues. Over time, as we remain in a slouched position (such as sitting at a desk all day or hunched forward gaming for hours on end) certain muscles become too tight, others become weak and loose, leaving us with a “hunchback” look. Postural kyphosis, disappears when laying face down as the spine is able to return to its normal position, without the need the need for the surrounding muscles muscles to work and support the spine against the force of gravity.


Scheuermanns kyphosis

Scheuermann’s disease – is far less common, and results in an increased kyphosis throughout the teenage years whilst growth is occurring. It is a growth plate disorder in the vertebrae themselves, which causes them to become more wedged and compressed at the front, hence the increase in kyphosis. This will result in structural deformity as the bone formation is altered. Scheuermann’s cannot be “cured” or reversed, however, the right treatment at the right time, can help to significantly reduce the progression of the deformity. Bracing in the right cases has been shown to be a very effective treatment when combined with specific posture exercises.






Osteoporatic fracture, and kyphosis

Osteoporosis of the spine – is a common cause in older individuals – here, the fundamental cause is vertebrae undergoing compression fractures due to a loss of bone strength. Osteoporosis of the spine can cause a large increase in the kyphosis in people over 60. It will often continue to progress with age, thus it is vital that patients keep their posture upright and keep their bones strong for as long as possible. While again, this condition is not “curable” the right management can make a huge difference to the quality of life.






 Spinal malformations & birth defects – account for the majority of the remaining Kyphosis cases – there are a number of conditions which can cause the vertebra to not develop properly. Depending on the underlying condition and the severity, it may need surgical intervention.


Treatment Of Kyphosis

In most cases of Kyphosis, the condition can be treated effectively with specific postural correction exercises & stretches, postural traction and kypho-bracing when necessary. Advanced manual approaches such as Chiropractic Biophysics can be highly effective in resolving Kyphosis cases. Beyond initial treatment, the same approach can be used to manage and reduce the severity of symptoms, often so that the impact on daily life is very little. Only in very severe cases is surgery typically required, and this is usually due to the risk of progression and further complications. Many cases of postural kyphosis can be improved or resolved.

The pictures below show the correction in an adult male with hyper-kyphosis, through the Chiropractic Biophysics technique. The pictures are approximately 1 year apart.

Scheuermann’s disease, and cases related to osteoporosis in particular, can often benefit from part-time bracing with a specialised Kyphosis brace, such as Kyphobrace – in these cases, a “cure” is not possible, but with proper management, it is entirely possible to live a normal and healthy life with Kyphosis.

In senior’s with kyphosis, caused by underlying osteoporosis, further compression fractures become more likely as the spine becomes progressively more hunched. Hence, treatment & exercise programs need to be gentle and designed to help keep patients more upright, improve balance to resist falls, and include nutritional support to help maintain bone strength. Gentle supportive bracing in senior’s can also be effective in helping them stay upright when whey are standing and walking.




Whereas Kyphosis causes “forward hunching” posture, related to an excessive forwards bend in the spine, scoliosis causes a side to side curvature of the spine resulting in a distinctive scoliosis profile.

Unlike Kyphosis, Scoliosis tends more often to be a serious condition which, in most cases, progresses (sometimes rapidly) without proper treatment. While Scoliosis can cause pain, it does not always, and in many cases it is only detected through screening or is noticed by friends of family members during a trip to the beach or when changing clothes. Whereas Kyphosis is quite easy to spot. Scoliosis can progress to a significant degree without any obvious signs, so screening is a very good idea to enable early detection.


Causes of Scoliosis

Whereas the causes of Kyphosis are well understood, and (with a bit of planning) you can reduce your risk through targeted exercise and fitness approaches, most cases of scoliosis have no known cause – in a large number of cases, the condition is described as ”idiopathic” – literally meaning “without known cause”.  The underlying pathologies are therefore:


Idiopathic scoliosis – Idiopathic scoliosis is most commonly found in younger teenagers, with the most at-risk group thought to be between the ages of roughly 11 and 16. Girls are affected more often than boys, but boys can and do develop scoliosis.  While the cause is not currently known, research suggests that genetics may play an important role. It’s also believed that participation in some activities such as ballet or gymnastics, in which there is a contortion of the spine, may hasten or promote the development of scoliosis.


Degenerative Scoliosis – Degenerative scoliosis is a condition typically seen in people over the age of 60. In this case, we do know the cause – degenerative or “de novo” scoliosis is simply caused by wear and tear as we age, involving changing in the shape of the vertebrae and weakening of the spinal ligaments and muscles enabling the vertebrae to twist and turn.


Scoliosis from other causes – Other, less common causes of scoliosis include congenital deformities and problems with the formation of the spine such as hemi-vertebra or butterfly vertebra, and are usually present from birth. Other cases may be caused by underlying neurological and syndromic conditions that may or may not have already been diagnosed.


Treatment for scoliosis

Scoliosis in older individuals (de novo scoliosis) cannot be “cured”, in the same way as kyphosis in older individuals cannot be “cured” – however, similar approaches can be used to significantly reduce the impact of scoliosis on one’s life, and in some instances, it is also possible to reduce the scoliotic curve itself. Scoliosis bracing can be highly effective as a means to achieve this and has also been shown to reduce pain where it exists.

Scoliosis in younger individuals is almost invariably a case of idiopathic scoliosis – the treatment for this depends on the severity of curve at time of diagnosis, but in all cases, the objective is to straighten the spine as much as possible. In cases which are caught very early, when the curve is still small, scoliosis can sometimes be corrected using scoliosis specific exercises – a regime of scientifically based movements and stretches designed to counteract the scoliotic curve. In very young patients (who are not able to perform scoliosis specific exercise) or in larger curves, scoliosis bracing is the preferred method of treatment. While bracing results vary according to the brace type that is used, today a very high number of cases treated with corrective bracing achieve a reduction of the curve down to a “normal” scoliosis value.


Is it Scoliosis, or Kyphosis?

If you’re unsure about an unusual posture or spinal issue you have noticed, an excellent place to start is a professional consultation at the UK Scoliosis Clinic, just get in touch!

Does playing football increase the risk of Kyphosis?

Like Scoliosis, Kyphosis is a common condition which affects the spine. While in scoliosis, the spine is deformed so that It “curves” to the side, in Kyphosis it “bends” further forwards than is ideal. In a normal individual, when the spine and posture are viewed from the side, the ear, shoulder, hip, knee and ankle should all be roughly in alignment, but in Hyperkyphosis sufferer, the head will be noticeable forward and the shoulders hunched.

In a healthy spine, a gentle “s” curve would be visible on an x-ray taken from the side. In the neck (the cervical spine) and lower back (the lumbar spine) these curves have a pattern known as Lordosis, whilst in the mid-back (thoracic spine) the curve is called Kyphosis. Some degree of Kyphosis is completely normal, and required for normal movement – something under 40 degrees is typical. When spinal kyphosis is greater than 45° however, the term “Hyperkyphosis” is used to refer to a spine which is too Kyphotic.


Causes of Hyperkyphosis

The causes of Hyperkyphosis are quite varied and depend on the time in life that they develop.  In adults, Hyperkyphosis is often associated with poor posture but is also sometimes the result of structural factors which involve an alteration to the shape of the thoracic vertebra, causing them to become more wedged.

Wedging of the thoracic vertebra can be caused by congenital vertebra malformations from birth, Scheuermann’s disease in adolescence, osteoporotic fractures in adulthood, thoracic compression fractures due to trauma and spinal tumours and infections.

More recent  research has however suggested that participation in some activities during childhood may also raise the risk of increased kyphosis, and the development of Hyperkyphosis. In the same way that some activities seem to raise the risk of Scoliosis.


Does football cause kyphosis?

Some research suggests that footballers are at a greater risk of Kyphosis

A 2009 study performed a clinical analysis of 102 males age 11-16 who played competitive football at least two to three times per week – the aim was to determine what, if any difference to the spine this activity caused. [1]

During the study, simple measurements of kyphosis were taken using widely accepted methods, just like we use at the clinic. Interestingly, when researchers compared measurements from their test group to a “normal” sample of 180 boys of the same age range, who did not play football, they found a statistically significant increase in the degree of kyphosis – an average of 36.6 in the footballers, vs 33.6 in the non-footballers. [2]

Does this mean that playing football will give you Hyperkyphosis? Not directly – however it does strongly reinforce the importance of working for good spinal health and getting regularly checked by a spinal health professional. 33.6 degrees is just about within the normal limit – but consider many of these same children will probably experience poor posture as they grow older, and the risk of Hyperkyphosis suddenly looks much greater.

Perhaps the most interesting point, however, is that this study goes against the traditional view of Hyperkyphosis being primarily associated with those of us who spend long hours hunched over at a desk – clearly, even those of us who are more active than average are at risk of Hyperkyphosis. Whereas with many conditions, being active and staying healthy can help reduce risk, this is not necessarily the case with spinal disorders such as Kyphosis and, indeed, Scoliosis.

It wasn’t all bad news however – the study investigators also noticed that the footballers showed an overall lower level of low back pain than the non-footballers!


Could I have Hyperkyphosis?

While the symptoms of kyphosis are often considered to be less severe than scoliosis, the condition can have a significant impact on the health of not addressed.

Common signs and symptoms include:

  • Rounding of the shoulders or a “hunchback” appearance
    •       The head is in front of the hips or pelvis when standing
    •       Mid-back aching and stiffness that often worsens with standing and eases when laying down
    •       Tenderness of the spine and surrounding muscles in the mid-back
    •       Tiredness after standing or repetitive bending
    •       In more severe cases difficulty breathing may develop as the lungs become compressed and indigestion, heartburn due to stomach compression


How can we treat Hyperkyphosis

Like Scoliosis, treatments for Hyperkyphosis vary depending on the cause In cases where Hyperkyphosis has developed due to poor posture (that is to say, there is no spinal deformity involved) a scheme of specialised exercises and postural correction work will often be successful.

In cases where the underlying cause is Scheuermann’s disease (learn more about Scheuermann’s here), the  deformity will continue to prefer as the spine grows throughout adolescence – not dissimilarly to the way in which Scoliosis tends to progress. Here, as with Scoliosis, bracing is often the best option, and out Kyphobrace is an excellent choice for this task.

In adult patients who are becoming more hunched forward, a specific spinal rehabilitative programme involving Chiropractic Biophysics can be performed to help strengthen the postural muscles, learn awareness of correct posture and stretch or traction the spine back towards upright posture.

In adults where pain and posture worsen when standing upright, a Kyphobrace worn for periods throughout the day can help to ease discomfort and maintain upright posture, and, combined with corrective training, can eventually remedy the condition.


[1] S Negrini, F Zaina, S Atanasio, C Fusco and M Taiana, Adolescent soccer is correlated with an increase of kyphosis but a reduction of low back pain: a controlled cross-sectional survey Scoliosis20094 (Suppl 2) :O3

[2] S Negrini, F Zaina, S Atanasio, C Fusco and M Taiana, Adolescent soccer is correlated with an increase of kyphosis but a reduction of low back pain: a controlled cross-sectional survey Scoliosis20094 (Suppl 2) :O3