Thoracic Hyperkyphosis

What is Thoracic Hyperkyphosis?

As we all have learnt about the evolution of man, how we all use to walk on all

4s (Quadruped stance) and over the period of years of evolution in human race

we started walking on our two legs (Bipedal stance). As the evolution took

place and our species evolved, our spine slowly started to develop to allow for a

straighter, more upright posture. Our spine curvature today is in proper

alignment and maintains ‘S’ shape curvature. Normal thoracic kyphosis

maintains this ‘S’ shape whereas in thoracic hyperkyphosis this ‘S’ shape spine

gets disturbs and becomes a ‘C’ shape.

Thoracic Hyperkyphosis is also known as hunch back.

The normal thoracic kyphosis angle in the younger population is in between 20

degrees to 40 degrees. Thoracic curvature greater than 40 degrees considered to

be a hunch back or thoracic hyperkyphosis {1} .

Whereas in older population the normal thoracic kyphosis Cobb’s angle is 48

degrees to 58 degrees in females and in males it usually 44 degrees {2} .

Whenever there is an excessive load on your spine like prolonged standing

unsupported sitting etc, the thoracic region take the maximum load. Due to

these bending forces on the spine there is excessive load on the soft tissues like

ligaments and muscles {3} .

What causes thoracic kyphosis?

Age related changes- the thoracic angle increases with age; it is 50% in men

and 65% in females above 65 years of age. Increase in thoracic kyphosis may

typically due to osteoporosis and degeneration in the spine due to age but

studies suggests that up to 70% of patients with age-related hyperkyphosis do

not suffer from decreased bone mineral density {4} .

Poor Posture-

Weakness in upper back and shoulder blade muscles resulting in poor posture

may also result in hyperkyphosis at the thoracic level. People who have

sedentary jobs which demands prolonged sitting in front of laptop or desktop

are more prone to kyphosis.

A study done to analyze posture of Fibromyalgia syndrome (FMS) in women

compared with healthy subjects to establish if posture assessment could be

useful to characterize the syndrome. The study concluded that FMS female

population present an altered trunk posture and an inability to maintain trunk

position. Since this does not appear to be influenced by a more or less active

lifestyle, specific treatment programs are needed to manage this clinical

condition {5} .

Daily activities with poor posture e.g. protruding head positions and loss of

shoulder range induced by: slouched sitting; ill-fitting school desks;

overloaded backs, and backpacks {5} .

Congenital (At birth defect) causes- There can be a bone defect present in the

thoracic spine at birth resulting in increasing in the Cobb’s angle {6} . As the age

increase so as the hunch back.

The common type of kyphosis present at birth which worsens by age is

Scheuermann’s kyphosis (SK).The true cause of SK remains unclear;

however, various theories include growth irregularities, mechanical factors,

genetic factors, and/or poor bone quality as the causes {7} .

Kyphosis can be a result of Scoliosis. A study was done to determine the

different risk factors for development of proximal junctional kyphosis (PJK) in

patients with adult scoliosis, this study concluded that increased age, as well as

increased body mass index, is a risk factor for the development of PJK. The

proximal extent of the construct is also shown to be a risk factor for PJK, but

fusion to the sacrum is a risk factor only if fusion extends to the proximal

(Thoracic spine)TS. Moderate PJK was observed with under correction of the

sagittal balance and severe PJKs with overcorrection of the sagittal balance {8} .

What are the symptoms?

The common symptom in kyphosis is the hunch back or round back. Back

pain, muscle fatigue and weakness in the upper back and scapular muscles

may be present. In rare cases, kyphosis can lead to compression of the spinal

cord with neurologic symptoms including loss of sensation in the upper limbs,

or loss of bowel and bladder control.

Severe cases of thoracic kyphosis can also limit the amount of space in the chest

due to the tightness in the anterior chest muscles and cause cardiac and

pulmonary problems leading to chest pain or shortness of breath with

eventual pulmonary and/or heart failure.

How to manage thoracic kyphosis?

Medical management- Antiresorptive or bone building medications can be

prescribed to the patients with kyphosis. Antiresorptive type of medications

helps in slowing or blocking reabsorption of bone.

Surgical interventions like Osteotomy, vertebroplasty or kyphoplasty can be

depending upon the severity of the condition.

Physiotherapy management- the first approach while managing the kyphosis

should be physiotherapy which may include Thoracic manual therapy, upper

back scapular muscle strengthening exercises, tapping, bracing, breathing

exercises and self stretching techniques.

Thoracic mobilization techniques using Original Kaltenborn concept wedge

used to mobilize the thoracic spine in the patients with thoracic hyperkyphosis

{9} .

Upper back and scapular muscle strengthening exercise to manage the muscular

weakness.

Kyphosis is becoming more common due to our modern lifestyle and our longer

life expectancy. Taking precaution at a younger age can help prevent formation

of Kyphosis. Once the hyperkyphosis develop there are ways to reverse the

changes at the spinal level thus improving the posture and thus slowing down

the long term effects of the condition. .

References-

1] Fon GT, Pitt MJ, Thies Jr AC. Thoracic kyphosis: range in normal

subjects. American Journal of Roentgenology. 1980 May 1;134(5):979-83.

2] Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in

older persons. Annals of internal medicine. 2007 Sep 4;147(5):330-8.

3] Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical

considerations for manual therapy. Manual therapy. 1997 Aug 1;2(3):132-43.

4] Perriman DM, Scarvell JM, Hughes AR, Lueck CJ, Dear KB, Smith PN.

Thoracic hyperkyphosis: a survey of Australian physiotherapists.

Physiotherapy Research International. 2012 Sep;17(3):167-78

5] Sempere-Rubio N, Aguilar-Rodríguez M, Espí-López GV, Cortés-Amador S,

Pascual E, Serra-Añó P. Impaired Trunk Posture in Women With

Fibromyalgia. Spine (Phila Pa 1976). 2018;43(22):1536-1542.

doi:10.1097/BRS.0000000000002681.

6] de Mauroy JC. Kyphosis physiotherapy from childhood to old age.

InPhysical Therapy Perspectives in the 21st Century-Challenges and

Possibilities 2012 Apr 5. IntechOpen.

7] Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis,

Management, and Selecting Fusion Levels. J Am Acad Orthop Surg.

2019;27(10):e462-e472. doi:10.5435/JAAOS-D-17-00748.

8] Sebaaly A, Sylvestre C, El Quehtani Y, et al. Incidence and Risk Factors for

Proximal Junctional Kyphosis: Results of a Multicentric Study of Adult

Scoliosis [published correction appears in Clin Spine Surg. 2018

May;31(4):184]. Clin Spine Surg. 2018;31(3):E178-E183.

doi:10.1097/BSD.0000000000000630.

9] Hwangbo PN, Hwangbo G, Park J, Lee S. The Effect of Thoracic Joint

Mobilization and Self-stretching Exercise on Pulmonary Functions of Patients

with Chronic Neck Pain. J Phys Ther Sci. 2014;26(11):1783-1786.

doi:10.1589/jpts.26.1783