An increased forward curvature of the upper back
What is Kyphosis?
Kyphosis refers to the natural outward curve of the upper and middle spine.
Everyone has some thoracic kyphosis.
The problem occurs when the curve becomes excessive, often called hyperkyphosis.
Kyphosis can be:
- Postural
- Age-related
- Related to vertebral fractures
- Related to osteoporosis
- Present because of spinal development or other medical conditions
It is important to determine the cause, because treatment depends on whether the curve is flexible, structural or related to a spinal fracture.
What are the symptoms?
Some people have no symptoms.
Others may experience:
- Rounded upper-back posture
- Back stiffness
- Upper-back discomfort
- Neck or shoulder discomfort
- Reduced ability to stand upright
- Reduced walking endurance
- Balance problems
- Difficulty looking forward while walking
- Breathing difficulties in severe cases
Significant hyperkyphosis may also be associated with increased fall risk.able.
What is the cause?
Possible causes include:
- Age-related spinal changes
- Weakness of the spinal extensor muscles
- Poor postural control
- Osteoporosis
- Vertebral compression fractures
- Scheuermann’s disease
- Congenital or structural spinal conditions
A new, sudden increase in kyphosis accompanied by significant back pain, particularly after a minor fall or in someone with osteoporosis, should be medically assessed for a possible vertebral fracture.
When should you see a physiotherapist?
Physiotherapy assessment is appropriate if:
- Your posture is progressively becoming more rounded
- You have back stiffness or pain
- You find it difficult to stand upright
- Balance or walking is affected
- You are becoming less active
- You have weakness in the back or legs
- You want to improve posture and functional capacity
Medical assessment is particularly important if kyphosis develops suddenly or is accompanied by significant pain.
How is it treated?
At Elevate, we tailor-make a complete “Road Map” based on the patient’s biopsychosocial status, keeping in mind their concerns and goals to return to the activities they enjoy the most. Treatment depends on the cause.
Physiotherapy may include:
- Spinal extensor strengthening
- Core strengthening
- Shoulder-girdle strengthening
- Hip and lower-limb strengthening
- Thoracic mobility exercises
- Balance training
- Postural awareness
- Functional movement training
- Breathing exercises when appropriate
- Falls-prevention strategies in older adults
Exercise should not simply mean repeatedly “pulling the shoulders back.” The aim is to improve strength, mobility, balance and functional capacity.
A 2024 systematic review found that strengthening programmes were more effective than stretching alone for improving postural alignment in the included studies.
What is the treatment process like?
Stage 1 – Assess the Cause
Determine whether the kyphosis is flexible, structural or associated with another condition.
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Stage 2 – Improve Mobility
Restore appropriate thoracic and shoulder movement.
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Stage 3 – Strengthen
Build spinal extensor, trunk and lower-limb strength.
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Stage 4 – Improve Balance and Function
Practise upright standing, walking and functional activities.
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Stage 5 – Maintain
Continue strengthening and mobility exercises as part of long-term health.
What is the treatment process like?
Postural improvements may begin over several weeks, but meaningful changes in strength, balance and function generally require months of consistent exercise.
If kyphosis is caused by structural spinal changes or vertebral fractures, the goal may be to improve function, comfort and safety rather than completely straighten the spine.
Evidence at a Glance
A 2023 review included 10 studies involving 625 older adults with age-related hyperkyphosis. The evidence suggested that exercise can improve postural control, spinal stability and some measures of kyphosis, although the overall certainty was low to moderate.
A recent systematic review also found an association between hyperkyphosis, impaired balance and increased fall risk in older adults, although the strength of the evidence varies.
The Good News Is
Getting older does not mean you have to accept progressive weakness and loss of function.
Even when the spinal curve itself cannot be completely reversed, strength, balance, mobility and confidence can often be improved.
Recovery Pathway
Identify the cause → Improve mobility → Strengthen → Improve balance → Improve function → Maintain
This information is for general education and does not replace an individual clinical assessment.