Kyphosis

The spine normally has gentle curves, including a mild forward curve in the upper back. Kyphosis means this forward curve is greater than normal, so the upper back looks excessively rounded or hunched. It is sometimes called a rounded back or, when pronounced, a hunchback.

Kyphosis can affect people of any age. It ranges from mild, causing little more than a rounded appearance, to severe curves that cause pain, stiffness, and — occasionally — problems with breathing or nerve function.

Postural kyphosis is the most common and mildest type, related to slouching, and is often flexible and correctable. Scheuermann's kyphosis develops during the teenage growth spurt when the vertebrae grow into a wedge shape, producing a stiffer curve.

In older adults, kyphosis is often linked to osteoporosis, where weakened vertebrae develop small compression fractures and the spine curves forward. Less commonly, kyphosis is present from birth (congenital) due to the spine not forming normally.

The main sign is a visibly rounded upper back, which may be more noticeable when bending forward. Some people have back pain and stiffness, tiredness in the back muscles, or tenderness. Mild kyphosis often causes no symptoms beyond appearance.

In severe cases, a pronounced curve can affect confidence and, rarely, press on the lungs or nerves, leading to breathing difficulty or numbness and weakness. These more serious features are uncommon but should be assessed promptly.

The cause depends on the type. Postural kyphosis comes from habitual slouching. Scheuermann's kyphosis is due to wedge-shaped growth of the vertebrae during adolescence, and its exact cause is not fully understood.

In later life, osteoporosis is a common cause: as bones thin, small compression fractures in the vertebrae let the spine curve forward. Congenital kyphosis results from the spine not developing normally before birth, and other spine conditions or injuries can also contribute.

A doctor examines the spine and posture, often asking you to bend forward so the curve can be seen and assessed. They may check your nerves and, in older adults, consider bone health.

X-rays confirm the diagnosis and measure the size of the curve (the Cobb angle), which helps decide whether treatment is needed. Sometimes an MRI or bone-density scan is arranged to look at the nerves or check for osteoporosis.

Treatment depends on the cause, the size of the curve, your age, and your symptoms. Mild, postural kyphosis is usually managed with exercises and physiotherapy to strengthen the back and improve posture. Pain, where present, is treated with simple measures.

In children and teenagers who are still growing and have a moderate curve from Scheuermann's disease, a back brace may be used to limit progression. Where kyphosis is due to osteoporosis, treating the bone thinning is important. Surgery — usually to straighten and fuse the spine — is reserved for severe or worsening curves, or those causing significant pain or affecting the nerves or breathing.

The outlook is generally good, especially for mild and postural kyphosis, which often improves with posture work and exercise. Scheuermann's kyphosis usually stabilizes once growth finishes, and surgery, when needed, can effectively reduce a severe curve.

Good posture, regular activity, and strong back muscles help protect the spine. In older adults, looking after bone health — through diet, exercise, and treating osteoporosis — helps prevent the spinal fractures that lead to age-related kyphosis.