Common Causes of Kyphosis

1. Fractures:
   Crushed vertebrae caused by fractures, also known as compression fractures, are one of the most common issues leading to kyphosis. These fractures weaken the vertebrae and cause them to collapse at the front, creating a wedge shape that results in hunchback(3)(4).
2. Osteoporosis:
   Healthy bones rely on strong collagen fibers, minerals, and calcium salts. While age-related bone deterioration is normal, excessive weakening leads to osteoporosis, a condition that makes bones porous and sponge-like. When osteoporosis damages the vertebrae, it can cause curvatures or hunchback(3)(4).
3. Disc Degeneration:
   The discs between vertebrae act as cushions but shrink and dry out with age, leading to changes that can trigger hunchback. Degenerative disc disease, which causes calcification and deterioration of the discs, further exacerbates these changes. As the water content of the discs falls below 80% with age, they become more prone to tears and fractures.
4. Congenital Defects:
   Also known as Congenital Kyphosis, this condition develops in the womb due to improper spinal formation. It is more commonly seen in females and worsens until growth stops. Based on the angle and shape of the vertebrae, congenital kyphosis can be classified into three types and is typically treated with surgery.
5. Syndromes:
   Certain syndromes, such as Ehlers-Danlos Syndrome and Marfan Syndrome, can lead to kyphosis. Ehlers-Danlos Syndrome, which primarily affects connective tissue but can also impact blood vessels, skin, and internal organs, is a genetic disorder affecting collagen. Marfan Syndrome is another genetic condition that affects connective tissue, causing protein abnormalities that can impact the bones, muscles, eyes, and heart.
6. Cancer and Cancer Treatments:
   Cancer that affects the spine weakens the vertebrae, contributing to kyphosis over time. Treatments like chemotherapy and radiation therapy can make bones more prone to compression fractures, which can cause spinal curvature and kyphosis(3).
7. Scheuermann’s Disease:
   This structural kyphosis develops during the growth spurt before puberty. Uneven growth of the spinal components causes the vertebrae to form wedge shapes, leading to hunchback. It typically manifests between the ages of 10 and 15, causing pain and difficulty in physical activities.
8. Postural Deformities:
   Postural Kyphosis, also known as positional kyphosis, is one of the most common forms and develops due to poor posture habits. It is entirely preventable and caused by individual behaviors. Without any underlying medical conditions, a person can increase their normal spinal curvature from 35 degrees to 55 degrees due to lifestyle habits. Contributing factors include lack of physical fitness, weak muscles, inadequate exercise, improper sitting habits, spending long hours in poor positions at a desk or computer, and carrying heavy school bags.

What Are the Symptoms of Kyphosis?

The most visible symptom of kyphosis is a postural abnormality where the individual’s head tilts forward, and the back curves outward while standing. Other symptoms vary depending on the severity of the condition. Common signs include:

• Rounded shoulders
• Mild back pain
• A visible hump on the back
• Spinal stiffness
• A feeling of fatigue
• Tightness or tension in the hamstrings

In advanced stages of kyphosis, additional symptoms may appear, such as:

• Weakness in the legs
• Numbness or tingling in the legs
• Difficulty breathing
• Loss of sensation

Diagnosing Kyphosis

Proper diagnosis of kyphosis is as important as its treatment. It’s essential to know when to consult a doctor. Severe kyphosis may be confused with postural kyphosis, which can be corrected with changes in posture. If you suspect kyphosis in your child, you can perform a simple test: ask them to stand up straight. If most of the curvature disappears, the issue is likely postural. However, if the curvature remains prominent, especially in the upper back, you should consult a doctor.

If your child’s attempt to stand straight still leaves most of the curvature, immediate medical attention is necessary for diagnosis and treatment.

What Are the Treatment Options for Kyphosis?

The treatment for kyphosis depends on its type, severity, and the patient’s individual circumstances. Kyphosis exercises may not always suffice, and in some cases, surgical intervention is necessary. Before determining a treatment plan, a doctor will evaluate factors such as the patient’s age, the type and severity of kyphosis, overall health, and whether the patient is still growing. Based on these factors, they will choose between surgical and non-surgical treatments.

For severe conditions like Scheuermann’s kyphosis with a curvature exceeding 75 degrees, intense lower back pain, or congenital kyphosis, surgical procedures such as spinal fusion are common. The primary goal of surgery is to improve aesthetic appearance and reduce the severity of symptoms.

Non-Surgical Treatments

Non-surgical treatments are generally recommended for postural kyphosis and Scheuermann’s kyphosis with a curvature below 75 degrees. These include:

• Observation: Monitoring the patient during growth to track any progression of the curvature.
• Physical Therapy: Strengthening abdominal and back muscles through kyphosis-specific exercises.
• Pain Management: Using non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain.
• Bracing: A kyphosis brace is often used during growth periods to encourage proper posture and support bone development.

Treatment for Postural Kyphosis

Since postural kyphosis is often related to poor posture habits, the treatment focuses on lifestyle adjustments and exercises:

1. Postural Awareness:
   Parents are advised to encourage children to maintain proper posture and educate them about its importance.
2. Adjusting Ergonomics:
   Chairs and desks should be arranged to promote correct sitting posture, reducing strain on the spine.
3. Encouraging Physical Activity:
   Sports and physical activities strengthen the muscles that support the spine, promoting better posture from an early age.
4. Exercises for Adults and Children:
   Regular exercises are crucial for improving posture and alleviating mild back pain. Weak back muscles often lead to poor posture, so exercises should target strengthening these muscles. Weight training and consistent physical activity contribute significantly to better posture and spinal health.

Kyphosis Exercises

These exercises focus on stretching the muscles at the front of the body and strengthening those at the back:

1. Stretching the Front and Strengthening the Back:
   • Stand upright and stretch your arms back as if taking a deep breath.
   • Recline slightly backward while stretching to make the movement easier.
   • You can also clasp your hands behind your neck or lower back while performing this stretch.
2. Strengthening the Shoulders and Back:
   • Lie face down with your toes pressing against the ground.
   • Hold a long stick with both hands and lift it upwards. Push it as far as possible overhead.
3. Stretching Side Muscles:
   • Rest your right hand and elbow against a wall.
   • While keeping your right arm steady, turn your head and body in the opposite direction to stretch.
   • Repeat the same movement with the left hand.
4. Strengthening the Abdominal Muscles:
   • Lie face down, supporting yourself with your toes on the ground.
   • Place your hands beside your shoulders and push your upper body upwards, arching your back for a stretch.

Goals of Kyphosis Treatment

The primary aim of treatment is to prevent progression, improve posture, alleviate pain, and address functional limitations. Early diagnosis and intervention, combined with consistent exercises, can significantly improve outcomes and reduce the need for invasive procedures. If you suspect kyphosis, consult a healthcare professional for proper evaluation and personalized treatment recommendations.