Humpback (medical term, hyperkyphosis) is a spinal deformity that leads to a forward-curved posture of the upper back (thoracic spine). Under normal circumstances our posture changes often throughout the day. However, there are instances where an individual’s body curvature may become excessive and unchanging, leading to humpback. This curvature of the upper back can start to become more pronounced after age 40 and continue as we get older. It is estimated that 20% to 40% of older adults–both men and women–will develop humpback. And today’s Smartphones are one prime example of why people will develop this condition at a relatively young age unless they are very aware of their posture!
What Exactly Is Humpback?
Humpback is a spinal deformity that is characterized by a forward-curved posture of the head and upper back. It may get progressively worse over time, and that worsening is often associated with a higher risk of health problems. It can result from certain conditions such as osteoporosis (thinning bones) as well as fractures of the vertebrae due to the thin bones. According to research, however, only about one third of individuals with humpback actually have spinal fractures. There are several theories as to why humpback develops when vertebral fractures are not present–among them are degenerative disc disease (DDD), ligament degeneration, muscle weakness, poor habitual posture, or hereditary factors.
What Are Some Symptoms Of Humpback?
The most obvious and prominent symptom you may notice is the appearance of a rounded back. However, family and friends may notice it well before you do as you may not recognize a change in your back posture initially since, in most cases, the change is very subtle and gradual over time. In the event that you do notice a sudden increase of a rounded back it is wise to consult your doctor as a sudden change in the curvature of the spine can be associated with other health problems.
If the humpback goes untreated, normal activities such as bathing, walking, bending, or getting out of a chair can become extremely difficult. Changes in balance are not uncommon which can lead to falls and injury. In some cases, upper back pain can result from the curvature, and some individuals may experience vertebral fractures as the condition advances.
When humpback is present, you may notice things like you are:
- Walking slower
- Fatigued (feeling more tired than normal)
- Having trouble arising from a chair, getting out of bed, or getting out of the bathtub
- Losing your balance, almost falling, or feeling “off-balance”
- Having trouble breathing (in more severe cases)
How Is Humpback Diagnosed?
The first step would be a visual inspection of your back. Your spinal curve could be measured with a flexible ruler, or it could be diagnosed on X-ray (if an X-ray is taken, the curve will be measured by a radiologist)–Humpback (hyperkyphosis) is confirmed if the curve measures greater than 40 degrees.
Problems such as a tumor, infection, or neurologic changes are rare–more common is that the spinal changes are a result of thinning bone (osteoporosis) that may or may not result in a fracture or fractures. Other common causes are arthritis and degenerative disc disease (DDD), which are very common problems in individuals over age 50.
In the event that your humpback is advanced you may have breathing difficulties (even though you do not have a history of heart or lung disease). You may also notice that the distance between your pelvis and your lowest ribs is decreasing. In this instance your doctor may order pulmonary function tests just to confirm or rule out that your humpback is, in fact, restricting your breathing.
How Can Physical Therapy Help?
Your Physical Therapist can help rehabilitate your functional limitations and postural changes associated with humpback, and should begin by reviewing your past and present medical history. In the event that you noted a sudden change in your posture, severe pain, or a major change in your physical function you will be referred to your doctor. As mentioned previously, a sudden increase in the rounding of your back can mean a more serious health problem.
Once a more serious problem is ruled out your Physical Therapist should perform specific tests to assess your individual condition. This often starts with observing, measuring, and recording your postural alignment as well as trunk range of motion and strength. In the event that you are having difficulty walking or keeping your balance, your Physical Therapist should perform tests to determine the level of difficulty and whether you are at an increased risk for falling.
There are at least 7 ways in which Physical Therapy can help by providing various treatment options, including:
- Specific exercises designed to reduce the curvature in your spine (kyphosis) and decrease any pain
- Postural alignment training, which consists of flexibility and strengthening exercises to assist in reducing the curvature and keeping the condition from progressing. These exercises will focus on upper back strength, as well as strengthening of the shoulders and hips
- Breathing exercises to increase your lung capacity to help improve your tolerance for physical activity
- Manual Therapy (Hands-on), which may include soft tissue massage, myofascial release, and joint mobilization to help improve spinal flexibility
- Patient education to help you to improve your activities of daily living, such as how to safely and efficiently get out of a chair, get in and out of bed or the car, get in and out of the bathtub, and how to bend and walk with less discomfort and more ease
- Balance exercises and gait training to gradually increase your tolerance of physical activity as well as improving your safety by decreasing your risk of falls.
- Specialized braces or therapeutic taping to help in decreasing the angle of the curve
Can Humpback Be Prevented?
Research to date has shown that humpback, unfortunately, can not be prevented. However, it has shown maintaining and improving posture, in addition to keeping physically fit, can significantly prevent humpback from getting worse due to the normal aging process. In addition, protecting your spine in your normal everyday activities may also be extremely important in preventing progression of humpback. There are a number of things your Physical Therapist can advise you to do (or not do), including:
- Avoiding carrying heavy objects
- Not bending forward when you cough or sneeze (trying to maintain an upright posture)
- Avoiding bending too far from the waist or twisting your trunk too far
- Changing how you get into and out of bed (most notably, rolling onto your side before you sit up or lie down)
- Avoiding any exercises that involve excessive bending forward such as toe-touches, sit-ups, or crunches
- Making environmental changes to help with postural support, such as using a back cushion and sitting in a supportive chair
- Maintaining bone health to prevent thinning bones (osteoporosis) which can lead to spinal fractures and humpback (which would require that you get adequate amounts of calcium and Vitamin D)
If you think that you or someone you know has signs and symptoms of humpback, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com and schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!