Diagnosis and symptoms6 min read
What is kyphosis? Is a hunched back the same as poor posture?
A hunched back is among the appearance concerns patients raise most often. Not every visible hunch is kyphosis in the medical sense, however. This page sets out the boundary between the normal curve and kyphosis, and the two different types.
The normal curve and the kyphosis threshold
The thoracic spine naturally curves forward; this makes room for the rib cage and balances load. Twenty to forty-five degrees is considered normal.
A curve above forty-five degrees is called kyphosis. Measurement is by Cobb angle on a standing lateral spine X-ray.
Not every visible hunch is kyphosis. Rounded shoulders and a forward-shifted head create a hunched appearance even with a normal thoracic curve; the two are assessed separately.
Postural and structural kyphosis
Postural kyphosis is the most common type. The curve corrects markedly when the person is asked to stand tall or lies supine; vertebral structure is normal.
In structural kyphosis the front of the vertebrae has become wedge-shaped and the curve does not correct with a change of position. Scheuermann's disease, developing during growth, is the best-known example.
Kyphosis in older age is usually due to vertebral fractures and osteoporosis. The priority there is assessing bone health.
Symptoms and associated pictures
Fatigue in the upper back building through the day and burning between the shoulder blades are the most common complaints. Pain is usually not proportional to the degree of curve.
Increased kyphosis shifts the head forward and raises load on the neck. Neck pain and tension-type headache are therefore frequently seen alongside it.
In severe kyphosis, rib cage movement can be restricted and respiratory capacity reduced. This appears only at marked angles and is assessed with respiratory testing.
Key points
- A forward curve in the upper back is normal; 20–45 degrees is standard.
- Above forty-five degrees is called kyphosis.
- Postural kyphosis corrects with position; structural kyphosis does not.
- Not every visible hunch is kyphosis.
- Pain is not proportional to the degree of curve.
Frequently asked questions
Can kyphosis be corrected?
In postural kyphosis the curve improves markedly with exercise and changed habits. In structural kyphosis the angle largely stays fixed, though pain, endurance and appearance can be improved.
Is a brace needed?
Not routinely in adults, and prolonged use weakens the back muscles. During growth, bracing can arise in progressive structural kyphosis; the decision rests on the angle and remaining growth.
Does kyphosis reduce height?
Measurable height loss can occur in severe kyphosis. Rapid height loss with age suggests vertebral fractures and osteoporosis and should be assessed separately.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.