The "hunched back" syndrome

What is kyphosis?

Kyphosis describes the rounded shape of the middle of the back when viewed from the side. A moderate amount of kyphosis is normal, but some people develop too much kyphosis, called hypercyphosis.

Hypercyphosis can be caused by functional problems such aspoor posturepoor low muscle tone and pain. Hypercyphosis can also be caused by structural problems such as a fracture of one of the vertebrae (fall or trauma) or when the vertebrae develop in a deformed way (the back of the bone becomes higher than the front of the bone, creating a wedge or trapezoid shape instead of being rectangular). Sometimes, several vertebrae develop a wedge shape, creating a particular condition called Scheuermann's hypercyphosis or Scheuermann's disease.

Depending on the cause, hypercyphosis can be treated with a specific exercise program. If hypercyphosis is severe and/or stiff, a custom-made decyphotization corset can stabilize and sometimes improve kyphosis. In extreme cases, surgery may be recommended. We take great care to ensure that every patient is properly assessed, so that we can provide you with the best possible recommendations and management options.

-Poor posture with a slouched or bent appearance evident in the middle of the back

-Constant pain in the middle of the back

-Contraction or stiffness in the middle of the back

If left untreated, hypercyphosis can worsen over time, increasing symptoms and becoming more difficult to treat.

Poor posture, such as intensive use of a cell phone.

Uneven growth of the vertebrae, causing trapezoidal deformation of the vertebrae (Scheuermann's disease)

Low bone density (osteoporosis) leading to compression fractures of the spinal column, particularly in women during the menopause.

Spinal infections(rare)

Neuromuscular conditions such as cerebral palsy.

Chronic diseases such as arthritis with a kind of crumbling of the vertebrae.

There are three main types of hypercyphosis:

1/Postural hypercyphosis:

Postural hypercyphosis is the most common form of hypercyphosis, usually developing in adolescence. It is functional, i.e. it is not caused by a change in the bone structure of the spine. Poor posture and/or poor condition of the muscles and ligaments that stabilize the spine lead to postural hypercyphosis.

In most cases, specific postural mirror-image exercises are still the most effective way of relieving and treating postural hypercyphosis. However, in cases where the spine is particularly stiff, or where it is difficult for the patient to perform the exercises, a specific orthopedic cushion called a thoracic retrainer can be used.

2/Scheuermann hypercyphosis:

This is a structural deformity of the vertebrae. True Scheuermann's hypercyphosis is diagnosed when several vertebrae (3 or more) develop a wedge or trapezoidal shape. Sometimes, the discs between the vertebrae show signs of wear. As Scheuermann's kyphosis is caused by a structural change in the spine, the use of specific orthopedic corsets and kyphosis-specific exercises is generally the best way to treat it.

3/Aging-related hypercyphosis

As we age, there is a natural tendency to develop hypercyphosis, as gravity is always intended to pull us down and forward. As muscles and ligaments weaken, our ability to resist gravity diminishes. In cases where bone density is low, the compressive force of hypercyphosis can cause the front of the vertebrae to collapse. This is known as a compression fracture or compression fracture and causes a trapezoidal deformity of the vertebrae. The best way to treat age-related hypercyphosis is to maintain good posture, with regular exercise (working to keep upright and flexible), and a specific corset to relieve and support (a bit like a stake for a young tree). It's important to react quickly, before the situation gets too far advanced. Proactive management of aging hypercyphosis makes perfect sense.

In the early stages, hypercyphosis can be treated with specific postural mirror-image exercises. If the kyphosis worsens beyond a certain degree, we use a kyphobrace-type decyphotization corset from scolibrace. This is one of the best conservative (non-surgical) approaches, the aim being to stop or even improve kyphosis. 

Above a certain threshold, only surgery should be recommended if hypercyphosis progresses beyond our documented efficacy thresholds.

Depending on the type and severity of the hypercyphosis, specific postural mirror-image exercises may be useful. If the kyphosis is soft and flexible, particularly in the case of postural hypercyphosis, physical rehabilitation can be very useful, effective and sufficient. When the kyphosis is more rigid, exercise rehabilitation alone may not be sufficient, and another strategy may be required.

A hypercyphosis-specific corset may be recommended for children and adults.

In postural hypercyphosis, the corset is rarely used, unless the patient is unable to perform the exercises or the spine is too stiff and rigid. The corset is almost always recommended for children with Scheuermann's disease, because during their growth period, we can expect a more significant impact than when their growth is complete.

In adults, the corset can be used to stabilize posture if it declines with age. The corset can also be used to stabilize the spine after a compression fracture.

Surgery is generally reserved for severe cases where conservative treatments are no longer appropriate. Surgery is a major spinal surgery aimed at stabilizing hypercyphosis that worsens over time and can significantly compromise your quality of life.