The phrase “dowager’s hump” refers to an excessive forward rounding of the upper back, medically known as cervicothoracic kyphosis or hyperkyphosis. This noticeable curve forms where the neck meets the upper back, around the C7 and T1 vertebrae. While a slight forward curve in the thoracic spine is normal, an exaggerated curvature can cause stiffness, pain, and a hunched appearance. This article examines the root causes of this spinal change and details the non-surgical and medical routes available to address and potentially correct the excessive curvature.
Defining the Condition and Its Causes
The spine naturally possesses gentle curves that help balance the body and absorb shock. When the forward curve in the thoracic region becomes too pronounced, it is classified as hyperkyphosis. This change shifts the head forward of the shoulders, requiring the body to work harder to maintain an upright stance. Determining the cause of the curvature is the first step toward treatment, as fixability depends on whether the condition is functional or structural.
A postural or functional kyphosis is the most common form, resulting from chronic habits like habitually slouching over a desk or looking down at a mobile device (“text neck”). Over time, the upper back muscles weaken, and the chest muscles tighten, allowing the spine to adapt to a rounded position. Since the underlying bone structure remains healthy, this type of kyphosis is flexible and responds well to corrective exercises and changes in habit.
Conversely, structural kyphosis involves a fixed deformity in the spinal column that cannot be corrected by simply improving posture. The most frequent cause in older adults is osteoporosis, which leads to vertebral compression fractures. These fractures cause the front of the vertebrae to collapse into a wedge shape, permanently tipping the spine forward. Other structural causes include Scheuermann’s disease, where adolescent vertebrae grow into a wedge shape, and congenital issues. Structural forms are rigid and typically require medical intervention for management or correction.
Non-Surgical Paths to Correction
For individuals whose hump is primarily caused by poor posture and muscular imbalances, non-surgical intervention offers high potential for correction. This approach focuses on restoring muscle strength, improving flexibility, and modifying daily habits that contribute to the forward slouch. The goal is to reverse the muscle adaptations that allowed the excessive curve to form.
Physical therapy is the most effective defense against postural kyphosis, starting with an assessment to identify specific muscular weaknesses and tightness. Personalized exercise programs strengthen fatigued muscles and stretch restrictive ones. A primary focus is strengthening the upper back extensors, such as the rhomboids and middle trapezius, which pull the shoulders back and maintain upright posture.
Targeted exercises rebuild the muscular support system. Chin tucks (cervical retractions) help realign the head over the shoulders and strengthen deep neck flexors. Scapular squeezes involve drawing the shoulder blades together to activate and strengthen the upper back muscles. To address tightness, doorway pectoral stretches lengthen the chest muscles, allowing the shoulders to settle into a neutral position.
Beyond exercises, attention to daily ergonomics and posture modification is necessary to prevent progression. Adjusting a workstation so the computer screen is at eye level prevents habitual forward leaning. Monitoring posture and periodically performing simple movements, like standing against a wall, helps retrain the body for better spinal alignment. Consistent effort leads to a gradual reduction in the visible hump and associated discomfort.
Medical Management and Surgical Options
When excessive curvature is caused by a structural issue, such as advanced osteoporosis or a congenital deformity, the approach shifts toward medical management or surgical correction. The initial step involves diagnostic imaging, typically X-rays, to accurately measure the spinal curve and identify underlying bone pathology, such as wedge-shaped vertebral compression fractures. This process distinguishes a flexible postural issue from a fixed structural one.
Medical Treatment
Medical management primarily involves treating the root cause of the structural changes. For kyphosis resulting from osteoporosis, prescription medications increase bone density to prevent future compression fractures and stop curve progression. Pain associated with the condition is often managed with nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers.
Spinal bracing is occasionally recommended, but its effectiveness is mostly limited to adolescents with Scheuermann’s kyphosis who are still growing. For adults with fixed structural kyphosis, bracing is generally not used to correct the curve. It may be prescribed for temporary pain relief and support, but the rigidity of the adult spine makes reshaping the bones unlikely.
Surgical Options
Surgical intervention is typically reserved as a last resort for severe cases. This includes curves that are progressive, cause persistent, intractable pain, or compromise vital functions like breathing or neurological health.
The most common procedure is spinal fusion, a major operation that permanently realigns and stabilizes the affected section of the spine. This involves using metal rods, screws, and bone grafts to fuse the vertebrae together in a straighter position. Procedures like vertebroplasty, which injects bone cement into fractured vertebrae, may also be used to stabilize painful compression fractures and prevent further collapse.