The term “hunchback” describes an excessive rounding of the upper back, medically known as kyphosis. A normal forward curvature in the upper (thoracic) spine ranges between 20 and 45 degrees. When this curvature exceeds 50 degrees, it is classified as hyperkyphosis, resulting in a noticeable hunched posture. Correction depends entirely on the underlying cause, specifically whether the issue stems from poor habits or a structural change in the spine.
Defining Kyphosis and Its Causes
Kyphosis is an exaggerated outward curve of the spine, usually occurring in the chest region. This curvature disrupts the natural spinal alignment, which is designed to balance the head over the pelvis and absorb mechanical stress. The two main categories of kyphosis determine the treatment approach and the likelihood of full correction.
The first category is postural kyphosis, the most common form, often developing during adolescence. This type is attributed to habitually poor posture, such as slouching, which stretches the supporting ligaments and muscles. Postural kyphosis is flexible, meaning the individual can consciously straighten the curvature, and the bony structures of the spine remain normal.
The second category is structural kyphosis, where the excessive curve results from an abnormality in the spinal bones, discs, or ligaments. This form is fixed and cannot be voluntarily corrected. Causes include Scheuermann’s disease, a juvenile condition where the vertebrae wedge at the front, or vertebral compression fractures often linked to osteoporosis in older adults. Other causes involve congenital issues, trauma, or degenerative changes.
Treatment Pathways for Postural Kyphosis
Postural kyphosis, being flexible, responds well to non-invasive methods focused on correcting muscle imbalances and learned habits. Treatment primarily involves physical therapy and posture awareness. The approach centers on strengthening spinal support muscles and stretching muscles that have become tight.
Therapy includes exercises to strengthen the back extensors and core muscles, providing a stable base for upright posture. Strengthening movements, such as the “Superman” or gentle back extensions, encourage the spine toward a neutral position. Stretching exercises target the pectoral muscles in the chest, which often become tight and pull the shoulders forward.
Conscious postural correction, such as the “mirror image” exercise, involves practicing standing tall and tucking the chin to align the head over the shoulders. Ergonomic adjustments ensure workstations support an upright posture, helping prevent the poor habit from returning. Consistent application of these techniques allows strengthened muscles to hold the spine in proper alignment over time.
Interventions for Structural and Severe Kyphosis
Structural kyphosis, involving a fixed vertebral deformity, requires management or surgical correction. For adolescents with Scheuermann’s disease, bracing is common while the patient is still growing. A spinal brace restricts the curve’s progression and is often prescribed for curves between 55 and 80 degrees.
In adult patients, especially those with hyperkyphosis from osteoporosis-related fractures, the focus is on pain management and bone health. Treatment includes anti-inflammatory medications and specific medications to increase bone density and prevent future fractures. Physical therapy maintains flexibility and strength, but it cannot reverse the bony deformity.
Surgical intervention, most commonly spinal fusion, is reserved for severe cases or when the curvature causes complications. For Scheuermann’s kyphosis, surgery is considered when the curve exceeds 75 degrees or when lower degrees cause severe pain unresponsive to conservative treatment. The procedure uses metal rods and screws to realign the vertebrae and fuse them together to stabilize the corrected position.