What is it?

Also known as “Dowager’s Hump”, thoracic kyphosis is increased rounding of the upper back.

For some people, a thoracic kyphosis may start as a noticeable lump at the base of the neck, and may progress from there. The rounding of the spine causes increased pressure on the anterior (front) of the vertebrae, which can lead to vertebral degeneration and further rounding. It will also place the head in a forwards position, which may restrain neck movement and limit vision.

As a direct result, a thoracic kyphosis can cause middle back and neck pain, as well as lower back pain as a result of the forwards posture. When there is a significant kyphosis, it can also cause cardiorespiratory and digestive troubles, due to the reduced space in the chest cavity.

It is typically evident in women with osteoporosis, which causes degeneration and wearing of the vertebrae, and leads to rounding of the spine.

What are the causes?

1. Posture, which is the most common type and is usually caused by ‘slouching’. The great news is that exercise, stretching and correcting your muscle imbalances can correct this cause!
2. Degenerative diseases, such as Osteoporosis and Arthritis. These can lead to increased degeneration of the bone and vertebral discs, leading to increased rounding and weakness of the spine. Interestingly though, studies have strongly suggested that rather than osteoporosis being the cause of kyphosis, “postural forces are responsible for initiation of osteoporotic spinal deformity in elderly subjects” (1). This indicates that specific exercises and stretching will play an important role in preventing kyphosis from an early diagnosis of Osteoporosis.
3. Developmental problems, such as Scheuermann’s Disease, a form of juvenile osteochondrosis of the spine.
4. Congenital kyphosis, which occurs with incorrect development of an infant’s spinal column (in utero). Unfortunately surgery at an early age is the most helpful intervention for this cause, especially considering there are likely malformed, or fused, vertebrae.
5. Injury, such as thoracic or rib fractures. These can go on to cause thoracic kyphosis, especially if left untreated, or treated poorly.

What can you do to help?

Posture

Ideally speaking, when sitting or standing, your posture should line up according to the “Plumb line”. This is an imaginary line, from your ear to the outer ankle, passing through the shoulder joint, outer hip, and outer knee. If these parts of your body are aligned, the spine will be in the most ideal position, and there will be no excessive forces placed on the spine.

1. Poor posture (Image TBA)

2. Improved posture (Image TBA)

Stretches

We know that there are some muscle groups that get tight with increased rounding of the spine, and most of them occur around the spine, shoulder blades, neck and front of the shoulders. As a result of tightening, these muscles can become so inflexible that they start to pull the spine into more kyphosis. The main muscle groups we are aiming to stretch include the upper back muscles, upper trapezius, levator scapulae, scalenes, anterior shoulder muscles, and pectorals.

Upper Trapezius/Levator Scapulae Stretch

Sit on hand

Tilt head to opposite side

Turn head to opposite shoulder

Hold for 10 seconds

Repeat every hour

Upper Back & Chest Stretch

Clasp hands behind you

Stretch them backwards, as far as comfortable

Hold 10 seconds, repeat every hour

Pectoral Stretch

Place forearms along the doorframe

Lean forwards (one leg forwards) & feel a stretch through the front of the chest

Hold 10 seconds

Repeat often

Cat Stretch/Child’s Pose

Start on all 4’s, then slowly sit backwards onto the feet

Stretch arms out forwards

Hold 10 seconds

Repeat often

Upper back strengthening exercises

These exercises are based on strengthening the muscles that we know weaken with thoracic kyphosis and with poor posture. The main muscle groups we are aiming to strengthen are those important muscles around the back and shoulder blades, including the back extensors, rhomboids, middle and lower trapezii. Clinical Pilates programs are also an excellent way to target specific weaknesses and improve posture and spinal health.

Prone Scapula Setting (with Arm Lift)

Lie on stomach, with small pillow under forehead

Keep hands on floor & pull shoulder blades down the back & in towards each other

Now lift the hands off the floor, while keeping the shoulder blades still

Lower hands, then lower shoulder blades

Perform 10 times

Half Press-Up

Lie on stomach, with hands under shoulders

Slowly press up with the hands and lift upper back, aiming to lift one vertebra at a time

Keep the stomach on the floor (don’t overextend the lower back)

Slowly lower back down, again one vertebra at a time

Perform 10 times

Thoracic Roller (with Arm Lift)

Lie lengthways along roller, knees bent up

Slowly lift arm up & over your head (aim to keep back flat)

Hold stretch for 10 seconds, slowly bring arms back

Repeat 3 times

Thoracic Extension with Roller

Start lying on stomach, hands over roller

Slowly lift head & upper back off floor, while rolling the roller towards you

Keep shoulders relaxed

Slowly lower back down

Repeat 10 times

As well as the above exercises, which can be performed safely and easily at home, there are some great exercises that require Pilates equipment, in particular the Reformer, Trapeze Table and Multi-Chair. For your interest, we have added a few more photos on the equipment below:

Back Extension (Multi-Chair)

IMAGE TBA

Prone Spine Extension (Trapeze Table)

IMAGE TBA

Cat Stretch (Trapeze Table)

IMAGE TBA

Chariots (Reformer)

IMAGE TBA

At Therapia Physiotherapy and Pilates, we are very aware of the problems caused by thoracic kyphosis, and we have an in-depth knowledge of techniques that will help to combat this issue. If you would like to book an appointment, or to talk to one of our physiotherapists about this, please contact us on (08) 8221 5011, or email us at info@therapia.com.au

Happy stretching!

References:

Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003). “Prediction of osteoporotic spinal deformity”.Spine 28 (5): 455–62