It’s perfectly normal to have curves in your spine when looking at it from a side view, its design means it’s supposed to be like this, and for good reason. It works better with curves in it.
The spine is designed to absorb shock, pressure and also to make your body function correctly.
Describing the spine simply it would be an S shape, however there can be variances from person to person. Some people may have more of an extreme curve in certain places.
The upper back is an area where changes of spinal shape and posture can occur – due to lifestyle, aging and posture. The upper back is also known as the thoracic spine – comprising of 12 vertebrae starting at your neck and extending down to the lower back.
Hunchback and rounded shoulder postures are common with the upper back and this is where kyphosis comes in.
Kyphosis refers to the outward curve of the upper back / thoracic spine – if someone’s thoracic spine has increased kyphosis, it has more of an outward curve, hunch or rounding of the shoulders than it usually has or the average person has.
Generally, kyphosis of the upper back may not affect most people but others it can cause symptoms.
Pain and dysfunction of the neck, shoulders and upper limbs are all common problems associated with increased thoracic kyphosis.
This article is designed to give you the low down on kyphosis all the way from the anatomy to prevention.
Anatomy of the Back
The spine is divided in to smaller sections and all of these sections have different characteristics. The upper back is known as the thoracic spine. Here are some of the structures involved with the upper back.
Vertebrae
There are 12 vertebrae which are the bones of the thoracic spine. These are 12 rings of bone which house your spinal cord and protect it.
They also supply movement of your upper back – however, this area of the spine is not too mobile. The bones of the thoracic spine are large in nature and robust – in order to help protect vital structures. This natural stiffness is built in to the upper back as means of protection for the spine and neck.
The upper back is mostly compromise of the first few thoracic vertebrae – and in terms of kyphosis – the first 5 vertebrae can become more rounded and lead in to the neck to from more of a hump.
Spinal Discs
Between each bone of the thoracic vertebrae there are structures called discs which are a fibro cartilage structure. The disc tissue is firm, robust and flexible providing adequate movement and protection. These qualities of the discs allow for the neck to move in different directions – however, as mentioned there is a natural stiffness to the thoracic spine and movement is not as full as the neck or the lumbar spine. At the centre of spinal discs lies a softer centre called a nucleus pulposis which helps the spine to move in different directions with the rest of the disc being much firmer.
Nerves
Our nerve roots exit from small openings known as facet joints on the side of the thoracic spine. They then feed off in to the ribs and thorax to help operate our functions such as movement, power, and touch.
Muscles
Larger muscles include the trapezius which begin at the upper back and attaches on to the base of the skull (occiput). Smaller accessory muscles such as the levator scapula which is a small strap like muscle attaching from the shoulder blade up to the base of the skull. The rhomboids and latissimus dorsi also sit on the thoracic spine and cover a large portion of the upper back.
Symptoms of Kyphosis
Symptoms from kyphosis can be varied – as mentioned early, kyphosis is present in a lot of individuals without symptoms.
Thoracic kyphosis simply refers to the shape of the spine – if the spine becomes too kyphotic (increased kyphosis) then this starts to have an impact on function and if the body deems it a threat, it will cause discomfort and pain.
Spinal discs can become overpressure from extreme kyphosis, this will often cause issues with extending the spine back to neutral and can in some cases cause impingement of the thoracic spinal nerves.
Extreme kyphosis also limits spinal movement as the facet joins become shut down and their main job is to rotate and extend. When the thoracic spine goes in to extreme flexion, it makes it difficult for the facet joints to be able to move. This can often be a reason why a kyphotic posture may be difficult to reverse.
Thoracic kyphosis is obviously a condition which will affect the spine but it has a subsequent effect on the shoulders and neck as a result.
Berceuse the scapula sit flat on the back of the thoracic spine – as it rounds, this can have an affect firstly on the scapula, which are designed to slide across the upper back to allow shoulder movement. Secondly, it can affects the glenohumeral joints of the shoulders, which become shut down and this can then affect shoulder movement.
If there is an impairment on the body, it can usually have an effect on the joints or region above and below the area of the problem. The cervical spine (neck) can be impact when the thoracic spine has developed kyphosis. This can often be seen when the neck is held in a protracted or flexed position and causes a hump back style posture.
Prevention of Kyphosis
Kyphosis may not be fully preventable for some people however if you want to try and keep a good posture and reduce the chances of developing kyphosis then try some of these options.
Strengthen your upper back
Weakness in the upper back will lead to poor posture and lack of gaining a neutral posture. Perform regular exercises each week to support your upper back mobility and strength. Strong shoulders are part of the upper back – allowing for your shoulders to sit back in a relaxed position rather than rounding and slumping is key.
Improve your posture
Due to modern lifestyles including lots of computer and phone use – poor upper back posture is common. Movement is key. Take regular breaks from technology or reading and ensure you have a good setup to make it comfortable and correct for your neck – but most importantly have stretching breaks, use the exercises below for guidance.
Control your weight
Increased weight can contribute towards poor posture. Ensure you eat a calorie controlled diet in order to maintain a healthy weight and perform a good amount of exercise.
Sit to Stand Desks
These things are a great invention and can prevent us from being chair shaped! Desks which can be moved to varying heights allow us to stand and work and sit when we feel like it, however they allow us to put ourselves in the best position possible for working.
Causes of Kyphosis
There are many different reasons why thoracic kyphosis can happen in the upper back, some being preventable and some unfortunately aren’t. It is also important to remember that thoracic kyphosis can be present without the person having symptoms or experiencing problems with their function.
Poor Posture
Prolonged positions such as looking down and rounding of the shoulders can contribute to poor posture, over time. Desk based working and repetitive jobs contribute towards long term changes in upper back postures causing thoracic kyphosis.
Obesity
Extra weight on the neck and shoulder areas can have an effect on how the upper back is held, again causing a long term chance of developing thoracic kyphosis. Being overweight is typically a sign of someone being less active and not exercising as frequently. One of the main ways to combat poor posture is to exercise and move frequently.
Spondylolisthesis
This is medical condition where vertebrae can slip backwards slightly causing the spine to change shape and can result in thoracic kyphosis. It can also impact on neck movement, function and pain levels.
Osteoporosis
This is more common in females and over the age of 50. It is thinning of the bones which can cause loss of density and even fracture resulting in change of shape in the spine. The most common fracture is a wedge fracture which can reduce spine height.
Recommended Treatment & Rehabilitation for Kyphosis
Treatment of thoracic kyphosis can be performed with some of the following options:
- Pain Relief – simple pain killers are a good start to managing any pain. Look at the basic options first or see a doctor if you require anything stronger.
- Thoracic Bracing – in extreme cases where pain may be high and the extent of the kyphosis is severe, braces for the upper back can be bought to help encourage a better posture and correct kyphosis.
- Physical Therapy – in some cases where pain and movement are issues, seeing a good physical therapist is a great way to help improve your pain levels and improve your neck movement.
Active Range of Movement
These exercises are very simple. They can be done in standing, sitting or lying down. Simply take your upper back and move it in every direction possible whilst your hands are across your chest.
This helps to improve how the upper back moves moves and can aid reduction in stiffness and soreness. As mentioned previously the upper back is naturally stiffer than the rest of the spine, so mobility work is key.
Upper back extension and rotation movements are the most important to complete
Extension Stretching Using Foam Roller
Simply place a foam roller on the floor and lie down on to it. Position the foam roller underneath your shoulder blades and instead of rolling up and down on it, extend and hinge so that the thoracic spine gains extension, using the roller as a hinge point.
This can be done as much as you want and as frequently as you want. If you work in a sitting role – we recommend doing this daily.
Upper back strengthening
Any type of exercise which strengthens the shoulders, trapezius and latissimus dorsi muscle groups will help to improve your back strength and prevent against poor posture.
Some example exercises to add in could be:
- Shoulder Shrugs – simple shrugging and holding of the shoulders helps to strengthen upper back, shoulders and neck muscles to help contribute towards a stronger neck.
- Seated Row – sitting down, using a cable pulley, pulling weight towards you and pinching the shoulder blades together
- Military Press – using a barbell ideally, add weight that you can manage and press it straight above your head.
- Deadlifts – one of the greatest exercises ever invented. This will do wonders for your posterior chain but also strength.
That concludes our guide to kyphosis – we hope that this has been helpful and that you have enjoyed reading the article. If this has been of help to you and you think someone else could benefit from this then please share it with someone you know.