Kyphosis is an excessive outward curvature of the spine, often described simply as a “hunchback” or “roundback.” While a certain degree of forward curve in the upper back is normal, an exaggerated curve, known as hyperkyphosis, can lead to pain, stiffness, and a noticeable change in posture. The good news is that correction or reversal is often possible, especially when the condition is identified early and managed appropriately. The approach to treatment is highly individualized and depends directly on the cause and rigidity of the spinal curve.
Distinguishing Between Kyphosis Types
The two most common forms of kyphosis are postural and Scheuermann’s kyphosis, which are structurally different. Postural kyphosis, the most frequent type, results from prolonged poor posture, such as habitual slouching. This curve is considered flexible or non-structural, meaning it often corrects itself when a person intentionally stands up straight or lies flat.
Scheuermann’s kyphosis, in contrast, is a structural deformity that typically develops during adolescence. It is characterized by an abnormal, wedge-like shape in at least three consecutive vertebrae, which makes the curve rigid and uncorrectable by simple postural changes. A third, less common type is congenital kyphosis, which involves spinal malformations present at birth and nearly always requires prompt medical intervention or surgery. The initial diagnostic step must establish whether the curve is flexible or rigid, as this distinction guides all subsequent treatment decisions.
Non-Surgical Methods for Reversal
For the majority of individuals, particularly those with flexible postural kyphosis, non-surgical methods form the foundation of reversal. Physical therapy (PT) is the primary tool, focusing on strengthening the muscles that support an upright posture and stretching those that have become tight from habitual slouching. Therapeutic exercises are designed to correct muscle imbalances, specifically strengthening the thoracic extensor muscles in the upper back.
Targeted exercises, like chin tucks and scapular squeezes (drawing the shoulder blades together), actively work to pull the head and shoulders back into proper alignment. Simultaneously, stretching the anterior chest muscles, such as the pectorals, is necessary to counter the forward pull that contributes to the rounded appearance. This type of exercise program can improve function and may significantly reduce the kyphosis angle, especially when performed consistently.
In adolescents who are still growing, bracing may be introduced to prevent the progression of Scheuermann’s curve. A custom-fitted back brace, such as a Milwaukee or supraclavicular brace, is designed to apply hyperextension forces to the spine. The brace is worn until skeletal maturity is reached, aiming to remodel the developing vertebrae and stabilize the curve. Supplementing physical therapy with ergonomic adjustments is also helpful for both types of kyphosis, including setting up a workstation to support a neutral spine and maintaining a healthy body weight to reduce spinal stress.
Surgical Intervention for Severe Curves
Surgical intervention is generally reserved for severe, rigid, or progressive curves that have not responded to conservative treatment. The need for surgery is typically considered when the kyphotic curve exceeds a magnitude of 70 to 80 degrees, particularly in cases of severe Scheuermann’s or congenital kyphosis. Curves of this severity can potentially affect lung function or lead to severe cosmetic deformity.
The most common procedure to correct the deformity is posterior spinal fusion with instrumentation. This involves accessing the spine from the back, using metal rods, screws, and hooks to straighten the curve, and then fusing the affected vertebrae together with bone grafts. The goal of surgery is to restore the spine’s alignment and stabilize the corrected position. While highly effective at correcting the angle, the procedure carries risks and is only recommended when the potential benefits of correction outweigh the inherent complications.
Maintaining Spinal Alignment Long-Term
Maintaining the corrected alignment is necessary to prevent recurrence after active reversal through physical therapy or surgery. Sustained adherence to a prescribed exercise routine is necessary, as the postural muscles require ongoing conditioning to hold the spine in its new, corrected position. This long-term commitment often involves continuing the strengthening and stretching exercises learned during the initial treatment phase.
Beyond structured exercise, maintenance requires a conscious effort to integrate good posture into all daily activities, effectively breaking the habits that contributed to the initial curve. Regularly monitoring posture while sitting, standing, and lifting is important for preventing the slow return of the forward rounding. Regular follow-up appointments with the treating physician, often including imaging, are necessary after reversal to ensure the correction is stable and holding over time.