Thoracic Hyperkyphosis, informally known as “Dowager’s Hump,” is a medical condition involving an exaggerated outward curvature of the spine in the upper back, creating a noticeable rounded appearance. While a slight forward curve is a natural and healthy part of spinal anatomy, hyperkyphosis occurs when this curve becomes excessive. Treatment success depends on the underlying cause, which ranges from chronic poor posture to significant bone disease. Fortunately, a combination of lifestyle changes and medical oversight can often mitigate the condition and prevent its progression.
Understanding the Condition
The human spine features three natural curves, including the gentle outward curve in the upper back (thoracic region) called kyphosis. This normal curve typically measures between 20 and 45 degrees, providing balance and shock absorption for the body. Hyperkyphosis is diagnosed when this angle exceeds 45 to 50 degrees, causing the upper back to round forward excessively.
The condition is categorized into two main types: flexible and fixed kyphosis. Flexible, or postural, kyphosis means the curve can be voluntarily corrected by standing straight or lying down. Fixed, or structural, kyphosis indicates a rigid curve where the shape of the spinal bones has changed, making it impossible to straighten the spine fully through conscious effort.
Primary Causes and Contributing Factors
The causes of an exaggerated spinal curve fall into habitual and structural categories. Postural kyphosis is the most common form, especially among younger individuals, resulting from chronic slouching or a sedentary lifestyle. Habits like prolonged sitting, leaning over a computer, or constantly looking down at a mobile device (“tech neck”) stretch ligaments and weaken the muscles maintaining upright posture.
Structural hyperkyphosis involves an actual change in the shape of the vertebral bones. The most frequent cause in older adults is osteoporosis, which leads to vertebral compression fractures. These fractures cause the front part of the spinal bones to collapse and become wedge-shaped, angling the spine forward.
Another structural cause, particularly in adolescents, is Scheuermann’s disease. Here, the vertebrae grow unevenly during a growth spurt, resulting in a fixed, sharp, and angular curve. This developmental disorder is defined by the wedging of three or more adjacent vertebrae by five degrees or more. Age-related degenerative disc changes also contribute as the cushioning discs between the vertebrae thin and collapse.
Non-Surgical Strategies for Reduction
For cases resulting from poor posture or mild structural change, a targeted non-surgical approach can reduce the severity of the hump. Physical therapy is foundational, focusing on reversing the muscle imbalances that pull the body into a rounded position. This treatment involves a dual approach: strengthening weakened back muscles and stretching tight chest muscles.
Specific exercises restore mobility to the stiff upper spine, such as thoracic extension movements performed over a foam roller or chair back. Strengthening targets upper back muscles, like the rhomboids and middle trapezius, using techniques such as the “shoulder blade squeeze” to pull the shoulders back. Simultaneously, stretching the pectoral and anterior shoulder muscles releases tension contributing to the forward-rounded posture.
Lifestyle adjustments complement physical therapy by preventing the curve from worsening. Improving workplace ergonomics, such as raising a monitor to eye level and ensuring adequate lumbar support, helps break the cycle of prolonged slouching. Maintaining a healthy body weight and engaging in regular core-strengthening activities like Pilates or walking also stabilize the spine and provide better trunk support.
When Medical Intervention is Necessary
Medical intervention is necessary when hyperkyphosis is fixed, severe, or caused by an underlying disease. For adults linked to osteoporosis and compression fractures, pharmacological treatment is a priority to prevent further bone loss. Medications, such as bisphosphonates, help increase bone density and reduce the risk of future fractures.
For adolescents with Scheuermann’s kyphosis, specialized bracing may be recommended if the curve is between 60 and 75 degrees and the patient is still growing. The thoracolumbosacral orthosis (TLSO) brace is designed to hold the spine in a straighter position to prevent the curve from progressing until skeletal maturity is reached.
Surgical correction is reserved for the most severe structural cases, typically when the curve exceeds 70 degrees, or when the deformity causes intractable pain, neurological symptoms, or compromises lung function. The most common procedure is spinal fusion, where curved vertebrae are realigned, stabilized with metal rods and screws, and fused into a single bone segment. For acute compression fractures, minimally invasive procedures like kyphoplasty or vertebroplasty inject bone cement into the collapsed vertebra to restore height and stabilize the fracture.