Proper posture, targeted exercises and healthy bones can help prevent excessive back rounding in older adults.
This article features expert sources.
The outward curve of your upper spine is normal. A stooped-over, head-forward posture is created for some people by the increase in spine curvature with age. It is also known as a roundback, dowager’s hump or hunchback.
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Hyperkyphosis can affect a person’s self-esteem and quality of life. It can lead to physical symptoms, such as reduced mobility and lung capacity, and increase your risks of falls.
If you have age-related hyperkyphosis, the good news is that it can be treated with treatments such as physical therapy, targeted exercises and postural awareness. If you have a healthy spine, you can protect your bones, maintain a upright posture and avoid having a hump in your back.
The lower back (lumbar) spine, the middle (thoracic) spine and the upper (cervical) spine have mild curves. These curves are used to hold up your head and align your body center over your hips.
The body’s balance, symmetry and function can be disrupted by an increase in the curves. Some forms of hyperkyphosis are congenital, some appear in childhood or early adulthood, and others develop later in life among older adults who have normal posture.
The American Academy of Orthopedic Surgeons says a normal measurement is between 20 and 45 degrees. Hyperkyphosis is a curve of more than 50 degrees, with normal maximums of 40 or 45 degrees.
As patients stand, a full spine X-ray can be taken. In some cases, a more detailed image can be provided by aCT scans. Patients are often referred to a spine specialist for initial evaluation and care.
lordosis is the inward C-shaped curve of your spine. This curve can become too extreme. The lower spine has a deep curve that causes the abdomen to protrude and the pelvis to curve backwards and upward.
The C-shape of the spine is a natural part. The head is pushed forward and the spine becomes straight with the result that flexibility and stability is compromised.
If you notice that your spine is rounding, it is important to seek treatment to prevent further curvature as much as possible and minimize the impact on your health, which can be significant.
In the future, people with excessive kyphosis are more likely to have falls, impaired physical function, and deaths. Reduced balance and a weakened spine make it harder to bend or lift and can lead to falls and trauma.
According to Kado, the risk to the individual is worse if the degree of spine curvature is greater.
In one study, Kado looked at the correlation between mortality and curvature rate, using data from X-rays on 9,575 women over 65. She says that women who were hunched over were more likely to die in the next eight years. She notes that only one-third of the people who died had osteoporosis, and that this alone didn’t account for the extra risk.
In many cases it was due to lung conditions such asCOPD, which decreases airflow from the lungs, or pneumonia, which could be due to reduced lung capacity from being hunched, according to Kado.
Wendy Katzman is a professor in the physical therapy and rehabilitation science department at the University of California-San Francisco and she says that stooped posture is not an inevitable part of aging.
It is possible to improve it if it is already developed, according to the researcher who has conducted extensive research on the effects of exercise on preventing and minimizing the effects of kyphosis.
As people get older, they lose their ability to sense where they are in space. The sense of balance is connected with the inner ear’s vestibular system.
She says after the age of 50, we lose visual, vestibular and proprioceptive sensory input. Losing those important sources of sensory information to the brain can affect your ability to know upright alignment.
Exercise to strengthen supporting muscles and maintain flexibility can help improve the health of the body. Actively standing straighter and avoiding slumped sitting make a difference.
There are a lot of different types of kyphosis. Kyphosis is a disease that develops in childhood and progresses in adulthood.
As people get older, their discs wear out, and they start developing worse posture, geriatric kyphosis can occur. He says that it can eventually turn into a structural disease. At this point, your back is rounded.
The upper spine supports the neck. A person can lose their ability to keep their head upright because of that. They may develop a syndrome in which their chin rests on their neck.
It’s like a self-evolving cycle where if you already have curvature of your back, as you get older and develop more osteoporosis, it can cause worsening Kyphosis, if your bones are softer. He says that can cause worsening pain and can make it difficult to treat and manage.
The strength of the bones and muscles is crucial for the support of the spine. Osteoporosis and sarcopenia are two of the top causes of age-related Kyphosis. Risk factors for excessive Kyphosis include:
- Osteoporosis. In osteoporosis, which means ‘porous bone,’ the quality and density of bone decline. Bones become fragile and brittle, making people more vulnerable to fractures. Women are more likely to develop osteoporosis because of hormonal changes during menopause.
- Age-related bone loss. Men can develop kyphosis, too, as bone mass naturally declines after reaching peak bone mass in the early 30s and 40s.
- Sarcopenia. Age-related loss of skeletal muscle mass and strength, called sarcopenia, can begin as early as your 30s and continue to increase with age.
- Being sedentary. A sedentary lifestyle that involves continual sitting and a lack of physical activity is a risk factor for bone-related conditions. Weight-bearing exercise helps maintain healthy bones, while walking promotes balance and good posture. A physical therapist can help you gradually increase your activity level.
- Family history. There appears to be a genetic link to kyphosis, Kado says: “If you have a family member who’s been affected by hyperkyphosis, if you notice it in your own family, you might think a little bit about your own posture.”
- Unneeded weight loss in older adults. For people over 65, losing weight may affect overall bone health and contribute to kyphosis progression. Kado points out.
The exact prevalence of excessive Kyphosis in older adults is uncertain, as definitions aren’t always consistent and many cases may go undetected, but these figures offer perspective:
- It’s estimated that among adults ages 60 and older who live in the community (rather than in a facility like a nursing home, for instance), about 20% to 40% have hyperkyphosis.
- Women experience the sharpest increase in the angle of kyphosis during their 50s, according to a studyof healthy women between 30 and 79 years old, published in the journal Osteoporosis International.
- Kyphosis increased by about 9 degrees per decade in a small study of older adults in Italy, published in November 2019 in the Spine Journal.
Core training, muscle strengthening and flexibility exercises have been shown to help prevent or reduce hyperkyphosis Incorporating the exercises and habits into your fitness routine can be done.
In a six-month randomized controlled trial of adults ages 60 or older who did not have major medical conditions and did not use any assistive devices, those who attended an hour-long yoga class three days per week experienced more improvement in their degree of spinal curvature. All yoga, in general, may not be beneficial since the yoga involved was limited to four specific poses.
A study measuring the degree of thoracic spine curvature among yoga practitioners compared to participants who did not practice yoga was done on healthy adults ages 18 to68. The control group had more pronounced kyphosis than the yoga adherents.
The results of the study suggest that yoga exercises can affect the shape of the anterior-posterior curves of the spine and may be an efficient training method for shaping proper posture in adults.
- Balance. Tree and half-moon poses.
- Dynamic alignment. Triangle pose.
- Leg strength. Chair, high lunge and warrior two and three poses.
- Spinal extension. Upward dog, cobra and locust poses.
If you have low bone density or osteoporosis, you should not do these poses.
- Forward bends like standing forward fold (uttanasana) or seated forward bend (paschimottanasana).
- Plow pose (halasana).
- Deep twists like seated twist (matsyendrasana) and revolved triangle (parivrtta trikonasana).
- Deep hip stretches like pigeon pose (eka pada rajakapotasana).
If you focus on your posture, you will be able to avoid Kyphosis. If you want to prevent your spine from becoming a fixed curve, you need to key into your posture. It’s helpful to reverse that flexed curvature multiple times a day to prevent it from becoming permanent.
Reminders can be set up by text or calendar. In a small, six-week pilot study, older adults with hyperkyphosis received text messages to practice a few simple exercises and pay attention to their posture at least three times daily.
A study published in JMIR Aging shows that a low-tech, easy-to-apply approach can change your posture and physical function.
Look into working with a physical therapist. A physical therapist can help improve your posture. In a six-month study, participants who attended a physical therapist-led group exercise program in three weekly, hour-long sessions had an increased improvement in their posture angle, particularly for those older than 75, compared to participants who only received health education.
American Bone Health is an online resource that illustrates and suggests incorporating exercises like these into your daily routine to improve posture, balance and strength.
- Sit to stand/stand to sit.
- Standing hip abduction, flexion and extension.
- Toe and heel raises.
- Cervical and thoracic extension.
- Standing ‘Y,’ standing ‘W’ and standing’ T.’
- Squat variations.
- Pelvic tilt and bridges.
The outward sign of excessive Kyphosis is a stooped appearance. It can cause a variety of changes and risks. People may notice a change in their spine.
- Losing height. “They’re not as tall as they used to be,” Lowenstein says. “Because as their curvature increases, their head is getting close to the ground.”
- Being off-balance. Forward-leaning can develop, possibly with side-leaning, as well. “Kyphosis can oftentimes happen along with scoliosis,” Lowenstein explains. “So you can start falling off to one side of the other as well as going forward.”
- Problems going from seated to standing. Difficulty getting up from a chair or sitting down is a common example of impaired function, Kado says.
- Rounding appearance. A glimpse at a full-length mirror can be the first indication of spinal rounding, or someone else may remark on the recent change.
- Discomfort. Kyphosis can make daily routines uncomfortable and more difficult.“Sometimes it can be painful sitting at a computer,” Katzman says. A head-forward position can cause headaches and backaches, she notes.
- Pain with comorbidities. Although kyphosis is not necessarily painful in itself, Katzman says, pain can be present, particularly when associated with underlying when it’s associated with underlying fractures or degenerative disc disease.
- Muscle fatigue. Some people have a structural imbalance that causes them to stand forward instead of straight, Lowenstein notes. “They have to expend a tremendous amount of energy to be in that position,” he says. “They often have to use an assistive device like a cane or walker to help them maintain their positioning.” All this “can result in a fair amount of muscle fatigue and also pain.”
- Neurologic pain. In some cases, kyphosis can contribute to compression of the spinal cord or nerve roots, causing dysfunction and pain, Lowenstein says.Kyphosis pain from strained muscles and pinched nerves can radiate, or extend, into the neck, head, back and arms causing tingling or weakness.
- Breathing difficulty. Shortness of breath and decreased lung function can be associated with spinal curvature.
It is never too soon to promote and protect a strong spine. What you can do?
- Determine your bone density. Ask your doctor if tests to measure bone density are appropriate for you. Noninvasive tests include a DEXA scan (dual-energy X-ray absorptiometry) and a quantitative CT scan. If results show significantly low bone density, further medical evaluation and treatment may be indicated. Treatment for low bone density can include medications, dietary changes and weight-bearing exercise.
- Do weight-bearing exercises. If your bones are healthy, resistance training exercises such as deadlifts, barbell squats and overhead dumbbell presses can increase bone strength when performed regularly.
- Incorporate core work. Your core muscles help stabilize the spine. Rowing exercises, resistance-band work and cable machine exercises can target both your back and core.
- Consult with an expert. If you have low bone density or a diagnosed condition like osteoporosis, a physical therapist can suggest gentler exercises that exert less stress on the spine. If you have hyperkyphosis, physical therapists can also recommend effective posture-improvement techniques.
- Avoid undue spinal flexion. Similarly, if you already have hyperkyphosis or related bone conditions, stay away from bending, crunching or twisting exercises. Also, be careful not to slouch throughout the day, which can intensify spinal curvature.
- Eat a balanced diet. A well-rounded eating plan that provides adequate amounts of important nutrients such as calcium, vitamin D and protein is vital to your bone health.
- Talk to a women’s health specialist. A study conducted by Kado, published in the July 2018 issue of the journal Menopause, suggests that older women who’ve undergone hormone replacement therapy may have reduced kyphosis risk. Although HRT is not appropriate for everyone, some women may benefit.
Non-destructive treatment is the main focus with age-related kyphosis. Physical therapy and pain management are mainstays. Some people have braces on their backs, or use walkers.
There are several ways to address pain and discomfort. As they get older, some people begin to develop pain associated with kyphosis. We try physical therapy often. We try to strengthen the muscles through exercise. It can improve their pain and possibly slow the worsening of the kyphosis.
For older adults with a lot of Kyphosis-related pain, pain management consultations can be useful. Sometimes that strategy of working with a pain management consultant and physical therapy can be beneficial.
A pain management consultant can recommend stronger prescription medications or less intrusive treatments for pain.
In cases where patients don’t respond to other treatments, surgery can be discussed.
Sometimes we’ll consider surgical treatment options for patients who develop spine deformities that are not conservative care.
He says that major surgery typically requires a long recovery period. For patients with bone conditions like osteoporosis, surgeons are particularly careful when evaluating potential surgical candidates.
Sources
The U.S. News Health team provides accurate information about health, nutrition and fitness. All of our stories are based on independent sources, such as medical doctors and licensed nutritionists. Read our editorial guidelines if you want to learn more about how we keep our content accurate and trustworthy.
Deborah Kado, MD
The co-director of the Longevity Center at Palo Alto, California, is a physician named Kado who specializes in geriatric medicine.
Wendy Katzman, PT, DPTSc, OCS
A professor in the department of physical therapy and rehabilitation science at the University of California-San Francisco, Cohen is a physical therapist.
Jason Lowenstein, MD
At the Atlantic Health System in Morristown, New Jersey, Lowenstein is the medical director of scolp and spine surgery.
There are back problems, aging, physical therapy, bone joint health, yoga.