The visible protrusion sometimes called a “scoliosis hump” is clinically known as a rotational deformity or rib prominence, a common physical sign of scoliosis. This three-dimensional spinal condition involves a sideways curve and a twisting of the vertebrae, which causes visible asymmetry. Addressing this prominence requires a targeted medical approach that focuses on actively unwinding the spinal rotation. Specialized interventions, including physical therapy, bracing, and surgery, are designed to reduce the deformity and improve cosmetic appearance. These approaches focus on correcting the structural misalignment rather than relying on general exercise.
Understanding the Rib Hump
The appearance of a rib hump is directly linked to the complex, three-dimensional nature of scoliosis, where the spine curves laterally and rotates around its vertical axis. As the spine twists, the attached ribs move along with the rotated vertebrae. On the convex side, this torsion pushes the ribs backward and upward. This protrusion creates the noticeable prominence on the back, often apparent during the Adam’s forward bend test.
This vertebral rotation is a key component of the deformity in the thoracic spine. The severity of the rib hump is determined not only by the degree of the sideways curve, but also by the extent of the underlying vertebral rotation. Since the rib cage is distorted by the twisting spine, treatment must aim at de-rotating the trunk, not just straightening the spine. The prominence is often a primary concern for patients due to its impact on body symmetry and clothing fit.
Specialized Physical Therapy for De-Rotation
Non-invasive management of the rotational deformity often involves specialized physical therapy methods, known as Scoliosis Specific Exercises (SSEs). The Schroth Method is a widely recognized SSE approach that targets the three planes of the scoliotic curve—sagittal, frontal, and transverse—with a focus on de-rotation. This technique teaches patients to actively correct and stabilize their posture. The core principle involves performing individualized exercises while maintaining an elongated and unwound trunk alignment.
A central component of Schroth therapy is corrective rotational breathing, sometimes referred to as Rotational Angular Breathing (RAB). This specialized technique uses the lungs as an internal corrective force. Patients inhale into the collapsed, concave side of the rib cage, which helps expand the compressed areas and push the ribs outward. This internal expansion mobilizes the thorax and physically de-rotates the spine from the inside out.
The exercises are highly specific to the individual’s curve pattern, ensuring muscular forces are applied precisely where needed for maximum correction. By strengthening the trunk muscles while holding a corrected posture, the patient trains the body to maintain a more symmetrical alignment throughout daily activities. Consistent adherence can help reduce the prominence of the rib hump and improve overall trunk symmetry, particularly in growing adolescents. Over time, the goal is for the corrected posture to become automatic, potentially preventing further curve progression.
Bracing and External Corrective Measures
For growing patients with moderate curves, custom bracing is often employed to prevent curve progression and actively reduce the rotational deformity and rib hump. Modern orthoses, such as the Rigo-Cheneau brace, are designed on three-dimensional principles that acknowledge the rotational nature of scoliosis. Unlike older, passive braces that primarily squeezed the torso, these newer models apply corrective forces in a specific three-point pressure system.
The brace uses strategically placed pressure pads on the convex side, combined with open areas, or “relief zones,” over the concave side. This design allows the body and spine to shift into the open spaces, effectively unwinding the rotated trunk. The pressure applied to the prominent rib area guides the ribs and spine back toward a more neutral alignment.
The therapeutic effect of this bracing technique is to induce a de-rotational force, aiming to reduce the rib prominence and improve cosmetic appearance. The custom design ensures the brace fits the unique contours of the patient’s specific curve pattern, maximizing corrective potential. When worn as prescribed (typically 18 to 20 hours per day during the growth phase), the brace can achieve significant in-brace correction of both the lateral curve and the rotational deformity.
Surgical Options for Hump Reduction
When non-operative treatments are unsuccessful or the spinal curve is severe, surgical intervention becomes the most definitive method for addressing the rib hump. Spinal fusion surgery, the primary procedure for severe scoliosis, involves implanting rods, screws, and bone grafts to straighten and stabilize the spine. This procedure typically includes direct vertebral rotation (DVR), which mechanically unwinds the vertebrae during correction.
The correction of the underlying spinal curve and rotation through fusion usually results in a significant reduction of the rib hump. However, in cases of stiff or severe thoracic curves, the ribs may remain structurally deformed even after the spine is straightened. To address this residual prominence, a secondary procedure called thoracoplasty, or rib resection, may be performed.
Thoracoplasty involves the partial removal of a segment of the ribs on the prominent convex side of the back. This procedure is done specifically for cosmetic improvement and can be performed concurrently with spinal fusion or as a separate, later operation. Studies show that adding rib resection to a spinal fusion can nearly double the amount of rib hump correction compared to fusion alone, significantly improving a patient’s self-image scores.