Kyphosis is a medical condition characterized by an excessive forward rounding of the upper back, leading to a stooped or hunched appearance. While some degree of spinal curve is natural, kyphosis refers to a curve that is more pronounced than typical. It is a specific health issue and not considered an unavoidable consequence of growing older.
Causes of Age-Related Spinal Curvature
A primary cause of an exaggerated spinal curve in older adults is osteoporosis, a condition where bones become weak and brittle. This weakness can lead to compression fractures in the vertebrae, where the front section of the bone collapses, creating a wedge shape. When several adjacent vertebrae develop this shape, the spine’s forward curve increases.
Degenerative disc disease is another contributor to age-related kyphosis. Between each vertebra are soft, gel-like discs that act as cushions. With age, these discs can lose water content and shrink, becoming less pliable. This degeneration narrows the space between vertebrae and can worsen the forward tilt of the spine.
The weakening of spinal support muscles also plays a part. Sarcopenia, the age-related loss of muscle mass and strength, affects the extensor muscles of the back. As these muscles weaken, they are less able to counteract gravity, allowing the upper back to round forward.
Identifying Symptoms and Potential Complications
The most apparent sign is a visible rounding or “hump” in the upper back, often accompanied by a gradual loss of height. Individuals may also experience persistent back pain and stiffness in the thoracic spine. These symptoms can develop slowly and may be dismissed as general aches of aging.
A forward-shifted center of gravity can impair balance and increase the risk of falls. Daily activities such as walking, rising from a chair, or looking upward can become difficult and painful as the spinal curve becomes more pronounced.
In severe cases, the rounding of the spine can reduce space in the chest cavity, compressing internal organs. This compression may affect lung capacity, leading to breathing difficulties. The digestive system can also be impacted, with some individuals experiencing acid reflux or trouble swallowing as the altered posture puts pressure on the abdomen.
The Medical Diagnosis Process
A diagnosis begins with a physical examination, where a doctor observes the patient’s posture and assesses their range of motion. The Adams forward bend test, where the individual bends at the waist as if to touch their toes, can help make the spinal curve more prominent for evaluation.
X-rays are the standard imaging study used to visualize the vertebrae and get a precise measurement of the spinal curve. The Cobb angle measurement is used on these images to quantify the degree of curvature. A normal thoracic spine has a curve between 20 and 45 degrees, and a measurement above this range indicates kyphosis.
Because osteoporosis is a frequent cause, a bone density test is often ordered. A dual-energy X-ray absorptiometry (DEXA) scan is a non-invasive procedure that measures bone mineral density. The results can confirm or rule out osteoporosis, which helps guide the management plan.
Treatment and Management Strategies
Treatment for kyphosis in older adults focuses on managing symptoms, preventing progression, and improving quality of life, as complete reversal of a structural curve is uncommon. Non-surgical approaches are the first line of defense and are effective for most individuals.
Physical therapy is a component of management. A therapist designs an exercise program to strengthen the back extensor and core abdominal muscles for better support. Stretching exercises are also incorporated to increase the flexibility of tight muscles in the chest and hamstrings that contribute to a stooped posture.
Pain management often involves over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or applying heat to soothe stiff muscles. If osteoporosis is identified as the cause, treating this underlying condition is a priority. This includes medications to slow bone loss or build new bone, along with calcium and vitamin D supplementation. Surgery is reserved for severe cases where the curve progresses rapidly, causes unmanageable pain, or leads to neurological or breathing problems.