August 15, 2022

A Physical Therapy Guide to Hyperkyphosis (Humpback)

Illustration of a spine with hyperkyphosis

Hyperkyphosis is a condition that affects the spine and can cause a "humpback" appearance. This article will serve as a physical therapy guide to hyperkyphosis, including information on symptoms, causes, diagnostics, treatment options, and prevention measures.

Hyperkyphosis is more common in women and is seen primarily with aging (after the age of 40).1 Treatment typically focuses on managing symptoms and preventing progression, rather than "fixing" the curvature.2

Table of Contents

Understanding Hyperkyphosis vs "Bad Posture"

It's important to understand that there's a difference between hyperkyphosis and "bad posture." Bad posture is often used as an umbrella term to describe any spinal curvature that deviates from what is considered "normal."

However, posture is dynamic and what may be considered bad posture for one person may not be considered bad posture for another. For example, someone with a long torso and short legs may have what appears to be bad posture but, in reality, their posture is quite normal for their body type. Plus, an individual's level of activity, past injuries, and other lifestyle factors can also affect their posture.

On the other hand, someone with hyperkyphosis has a spinal curvature (flexing forward) that falls outside of the range of what is considered normal for their age and gender.

In reality, there is no such thing as "good posture" and "bad posture" especially since good posture typically elicits visions of a flat spine. This is because a healthy spine is curved like an "S" to allow for shock absorption, stability, and mobility. Rather than considering it good or bad, posture is simply a variety of dynamic positions that allow the spine to move and function at its full capacity.3

Symptoms of Hyperkyphosis

The only true symptom of hyperkyphosis, or humpback, is the noticeable change in posture. However, since it typically happens gradually, you may not notice it right away. Eventually, you may notice a change in the way your clothes fit, your height, or that you are having difficulty standing or sitting fully upright.

Over time, many secondary symptoms can develop. The exaggerated curvature of the spine can put pressure on the nerves and muscles in the back, which can lead to pain, muscle spasms, and stiffness.

Other symptoms may include:

  • Fatigue
  • Headaches
  • Difficulty breathing due to changes in rib space
  • Difficulty swallowing due to head and neck position

Causes of Hyperkyphosis

There are many possible causes of hyperkyphosis. Let's review:2

  • Osteoporosis: A condition that causes the bones to weaken and break down over time. As we age, our bones naturally become thinner and less dense (this process is called bone loss). With osteoporosis, this happens at a more rapid rate. In the spine, the thoracic (mid-back) vertebrae are wedge-shaped due to extra pressure on the front of the bones.
  • Scheuermann's disease: A structural deformity of the spine that typically affects adolescents and also leads to wedge shaped vertebrae.
  • Ankylosing spondylitis: An inflammatory disease that can lead to fusion of the vertebrae
  • Spinal tumors or infection
  • Trauma or injury to the spine: From a fall, car accident, sport, or other high impact activity.
  • Degenerative disc disease: An age-related condition in which the discs between the vertebrae lose their height and elasticity.

There is also a lot of debate over whether poor postural habits can contribute. If so, muscle weakness, muscle imbalances, ligamentous changes, and other local changes in spine tissues are likely causative factors as well.

Diagnosing Hyperkyphosis

If you suspect you have hyperkyphosis, the first step is to schedule an appointment with your a CityPT physical therapist. They will ask about your medical history and symptoms. They will also do a telemedicine or in-person physical examination, during which they will assess your posture, strength, coordination, mobility, and spine range of motion. This will all help to determine the correct diagnosis and underlying cause(s).

If needed, imaging tests may also be ordered to get a better look at the spine. These can include X-rays, CT scans, or MRIs. In some cases, a bone density test may also be ordered to check for osteoporosis.

Note: If you notice a sudden change in your posture, seek medical help immediately — this may be indicative of a more serious underlying cause, such as a fracture or tumor.

What to Expect from Physical Therapy for Hyperkyphosis

The main goal of physical therapy for hyperkyphosis is to improve posture and reduce pain, while also reducing risk of excessive curvature progression. This will be done with a combination of treatments, including:

  • Exercises: Focusing on strengthening the muscles in the back and improving spine mobility. Regular movement is essential for a healthy spine.
  • Stretches: Lengthen tight muscles and improve range of motion of the neck (cervical spine), mid-back (thoracic spine), shoulders, and even hips.
  • Manual therapies: Techniques like focused massage and joint mobilization can help reduce pain and muscle spasms. Plus, help improve thoracic spine mobility.
  • Pain management modalities: Ice, heat, and electrical stimulation may also be used to help reduce pain and inflammation short term and get you on track with your program.
  • Ergonomics: Providing tips on how to optimize your spinal curvature with different activities- including ergonomics recommendations for sitting, standing, sleeping, etc.
  • Posture support: If needed, taping, bracing, and other external supports may be used to help with posture and pain (typically reserved for more severe cases)
  • Education: Most importantly, an in-depth review of proper injury management, understanding the cause, how to manage pain, and beyond. Plus, discuss the importance of daily habits for tissue health- such as sleep, diet, and stress management

Most people will see a noticeable improvement in symptoms after just a few weeks of physical therapy. However, it is important to stick with the program to ensure long-term results.

What's Considered "Normal" for Posture?

There is a lot of debate over what is considered a “normal” posture. To complicate things further, there are different types of posture (static vs. dynamic). Plus, posture changes with age as well.4

In general, we want the natural curves of our spine (that create an "S" shape) to support our body weight. Plus, our mid-back (also known as the thoracic spine) is actually meant to be kyphotic (curved) — but how much? The right amount allows our muscles to work efficiently and prevents excessive stress on our joints. Typically, when we have good posture, we should be able to stand up straight with our ears, shoulders, and hips in a line.

Favorite cues that a physical therapist may give you for posture training might include:

  • Act like you're wearing a million dollar necklace
  • Balance your head over your shoulders like you're a puppet with a string
  • Hold your head and neck so that your vision is parallel with the ground

Preventing Hyperkyphosis

So what can be done to prevent hyperkyphosis? Here are some options:

  • Support the spine's natural curves: This means avoiding excessive slouching and hunching over, whether you’re sitting or standing. For example, when sitting, be sure to use a chair that supports your back and keeps your spine in a neutral position.
  • Avoid wearing high heels: They can lead to exaggeration of the spine's natural curve and put extra stress on the back.
  • Maintain a healthy weight: Excess weight puts extra strain on the spine, which can contribute to hyperkyphosis.
  • Exercise regularly: This will help maintain strong muscles that support the spine and keep local tissue extensible. Be sure to focus on exercises that strengthen the back and improve flexibility. They should also help to counteract the positions you spend the majority of your day in.
  • Get enough sleep: This will help your muscles (and other tissues) recover from the day's activities and prevent fatigue.
  • Manage stress: Stress can lead to muscle tension and poor tissue health.

When Should I See a CityPT Physical Therapist for My Posture?

While there is no guaranteed way to prevent hyperkyphosis, following these tips can help reduce your risk. If you are already showing signs of the condition, seek treatment from a CityPT physical therapist today. Early intervention is key to preventing further progression, reducing pain, and maximizing your quality of life.

Get in touch with one of our spine specialists at CityPT to see how they can help you feel your best.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. Fon GT, Pitt MJ, Thies Jr AC. Thoracic kyphosis: range in normal subjects. American Journal of Roentgenology. 1980 May 1;134(5):979-83.

  2. Physiopedia. Thoracic Hyperkyphosis. Physiopedia.com. Accessed August 15, 2022. https://www.physio-pedia.com/Thoracic_Hyperkyphosis 2

  3. George, Alison. Why everything you thought you knew about posture is wrong. News Scientist. Accessed August 15, 2022. https://www.newscientist.com/article/mg25333741-000-why-everything-you-thought-you-knew-about-posture-is-wrong/

  4. Smythe, A., & Jivanjee, M. (2021). The straight and narrow of posture: Current clinical concepts. Australian Journal of General Practice, 50(11), 807–810. https://search.informit.org/doi/10.3316/informit.147194805376098

Want more articles like this?
Stay informed with the latest tips for managing bone, muscle, and joint injuries.
Related Neck Guides