A close look at hyperkyphosis: how it develops, how to manage it
Age-related postural hyperkyphosis is a serious condition characterized by an exaggerated anterior curvature of the thoracic spine that impairs mobility and increases the risk of falls and fractures. Despite the negative implications of hyperkyphosis, its natural history is not fully understood. Hyperkyphosis appears to develop due to a variety of processes, including muscle weakness, degenerative disease or other genetically determined influences. Regardless of the origin of hyperkyphosis, the lives of many in the older population are hindered by it, with approximately 20-40% of seniors suffering from the condition. Fortunately, early intervention and treatment could have major benefits if addressed properly. To get a better idea of the history of hyperkyphosis and to establish the best treatment options, a clinical review was created.
Definition: A small amount of anterior curvature of the thoracic spine is considered normal, resulting from the shape of the vertebral bodies and intervertebral discs, but a kyphosis angle greater than 40º is defined as hyperkyphosis. The kyphosis angle gradually increases with age, and as it increases, quality of life and physical performance level decrease, making early intervention essential.
Measuring kyphosis angle: There are a number of methods to measure the kyphosis angle to determine if hyperkyphosis is present, but the gold standard orthopedic technique is standard lateral spine radiographs, in which two pairs of perpendicular lines are drawn on a radiograph and their cross angle is measured.
Negative impact of hyperkyphosis: The condition can have a slew of detrimental effects on physical performance, the ability to perform activities of daily living and overall quality of life. Women with hyperkyphosis report difficulty rising from a chair without using their arms, poorer balance, slower gait velocity and decreased stair-climbing speed, all of which contribute to a higher risk of falling. In addition, both males and females over the age of 65 with the condition have poorer satisfaction with subjective health, family relationships, economic conditions and their lives in general. The risk of pulmonary death is also higher in elders who suffer from hyperkyphosis.
Risk factors: The specific causes of hyperkyphosis are still yet to be fully understood, but there are a number of impairments that are considered predictors for the condition:
- Vertebral Fractures - Kyphosis increases with the number of vertebral fractures and is more associated with thoracic fractures than lumbar ones. Women with multiple thoracic wedge fractures are at a particularly high risk for hyperkyphosis.
- Degenerative Disc Disease (DDD) - Radiographic findings have also shown many elders with hyperkyphosis to have DDD, and it's suggested that a combination of DDD and anterior vertebral deformities can be another leading risk factor.
- Decreased Mobility - With age, spinal extension mobility naturally decreases, making it harder to stand erect and maintain normal postural alignment. These changes, along with calcification and ossification of ligaments in the thoracic region, may lead to increased kyphosis.
Physical therapy shows strong evidence as primary treatment and prevention option
Proper treatment of hyperkyphosis can lead to a reduction of falls and fractures along with improvements of functional limitations. While there is a lack of effective medical intervention for hyperkyphosis, physical therapy intervention carries evidence that indicates it should be the first step since many causes for the condition are of musculoskeletal origin. Research shows that spinal extensor muscle strengthening exercises are helpful at modifying hyperkyphosis and should be used regularly. Movements that involve flexion stresses on the spine, on the other hand, should be avoided, as they increase fracture risk. PTs have also reported myofascial, spinal and scapular mobilization techniques to improve postural alignment in patients with hyperkyphosis, and are therefore highly recommended. Therapeutic exercises (e.g. lying supine on a foam roller) are other successful exercise interventions. Bracing and taping the back have some level of effectiveness as well, but neither is as beneficial as exercise on the bone, while medications were shown to be minimally effective.
While further research on hyperkyphosis is needed, the present recommendations give practitioners evidence-based interventions to prescribe. Hopefully, in the future, larger RCTs that evaluate the combination of bracing and taping with exercise interventions will provide a more optimal and proven treatment program. Prevention strategies that address risk factors and ways to avoid them are also needed, and with sufficient research and application, the rate of hyperkyphosis in older adults can be significantly reduced.
-Summarized by Greg Gargiulo
-As reported in the June '10 edition of the Journal of Orthopaedic & Sports Physical Therapy