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Thoracic Hyperkyphosis

Original Editors - Bo Hellinckx, Matthias Steenwerckx, Fien Selderslaghs, Mirabella Smolders and Wout Theys

Top Contributors - Farah Elzanaty, Lucinda hampton, Bo Hellinckx, Kim Jackson, Alexandra Stead, WikiSysop and Vidya Acharya

Introduction

Kyphosis is the forward curvature of the thoracic spine. The shape of the vertebrae and the intervertebral discs form this curvature, while paraspinal muscle strength maintains it in standing position. Thoracic hyperkyphosis occurs when the antero-posterior curvature of the thoracic spine becomes excessive. It is present when the kyphosis angle exceeds the normal ranges.[1] Clinicians have not yet established a clear threshold for hyperkyphosis. Despite evidence suggesting that normal individuals have a curvature that often exceeds 40°, this value is widely used in clinical practice as the cut-off for normality.[1][2][3]

Generally, clinicians define age-related hyperkyphosis as a Cobb angle of 50◦ or more in standing position.[1]

In younger adults, the “normal” range falls between 20° and 40° of curvature using the Cobb angle measurement of kyphosis. After the fourth decade of life, the kyphosis angle begins to worsen and increases above 40°this progression is known as age-related hyperkyphosis.[2]

Clinically Relevant Anatomy

The thoracic vertebrae of the spine have a natural kyphosis.[4] The thoracic curve is concave anteriorly (kyphotic), extending from T2-T12, and results primarily from the wedge shape of the thoracic vertebral bodies.[5] Clinicians measure the normal degree of thoracic convexity (20-40°) in the sagittal plane using the Cobb angle; commonly, the angle between T4 and T12 is used.

Thoracic hyperkyphosis is most visible from the side (lateral view) and occurs when the thoracic curvature exceeds 40°, as this is the widely used clinical threshold.[6][3][2]

Biomechanics

In standing, the line of gravity passes anterior to the thoracic vertebral bodies, placing a constant flexion moment on the thoracic spine.[1] This gravitational load acts to increase the thoracic kyphosis angle over time, and the resulting anterior shift in body mass effectively increases the moment arm between the spine and the weight it supports above.[7] In response, the posterior spinal structures, including the posterior ligaments and deep spinal extensor muscles, must generate greater force to maintain upright posture, placing sustained mechanical demand on these tissues.[1][8]

An exaggerated kyphotic curvature significantly increases spinal compressive loading and trunk muscle force requirements during upright stance, accelerating degenerative changes to the vertebrae and intervertebral discs, and contributing to pain and functional decline.[7] Sustained exposure to poor postural habits, including prolonged forward head positions during screen use, slouched sitting and carrying excessive loads, generates repetitive mechanical stress on the spine, driving progressive postural kyphosis over time.[9]

Aetiology

Hyperkyphosis can be classified according to its underlying cause. A distinction is present between congenital kyphosis, postural kyphosis, kyphosis caused by Scheuermann's disease and age-related hyperkyphosis:

  1. Scheuermann’s Disease:[10] Also known as juvenile kyphosis is a structural form of hyperkyphosis, affecting adolescents typically in the ages from 12-15 years.[11] It is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence period.[12] The discordant mineralisation of the vertebral endplate and ossification during growth and development causes an anteriorly wedged vertebral body leading to kyphosis.[13]
  2. Postural Kyphosis:[10][12] Most frequent form in young adults where there are no vertebral deformities present. Several factors make adolescents and young adults a potential risk group for postural hyperkyphosis. These factors include poor ergonomics at work and school, sedentary lifestyles, high external loads on the spine and emotional stress.[14][15][16]
  3. Congenital Kyphosis[10]: Bone defect detected at birth. If the spine does not form or its segments don't separate properly in utero, it can become a sharp angulation that is visible by looking at the skin.[1]
  4. Age-related Hyperkyphosis:[17][18][2] Kyphosis angle increases with age, resulting in age-related hyperkyphosis. Vertebral fractures are present in no less than 40% of the persons with hyperkyphosis,[19] and with each vertebral fracture the kyphosis angle increases with 3.8°.[20]

Epidemiology

The precise prevalence of hyperkyphosis remains unknown. However the condition is estimated to affect approximately 20% to 40% of adults aged 60 years or older.[1][2][21]

  • Hyperkyphosis is not limited to older adults as there is a 38% incidence of hyperkyphosis in individuals aged 20-50 years[22], though incidence increases with age.[2][23]
  • Degree of kyphosis increases with age, especially after the age of 40.[2]
  • While thoracic kyphosis impacts both sexes, the condition increases at a higher rate in women, particularly during the menopause years when compared with men.[24][2]A systematic review shows that hyperkyphosis seems to vary depending on ethnicity, age, and the body references used to measure it.[25]
  • In a 15-year retrospective cohort study of older women, kyphosis progressed 2.6° between the baseline and 3-year follow-up and an even greater 7.1° between the baseline and 15-year follow-up measurement.[20][26]
  • Some individuals have an idiopathic cause.[18][27][28]
  • Psychosocial factors also play a role such as Depression, Anxiety, Insecurity, Despondency.[29][30]

Clinical Presentation

Hyperkyphosis of the thoracic spine appears in a postural or structural form. Patients may also present with a combination of both alignment impairments, which include:


1. Postural impairments are flexible and respond to positional changes or cues to change alignment.[31]

2. Structural impairments are rigid due to changes of the bony structures that persist regardless of the position of the individual as in Scheuermann’s kyphosis.[13]

When there is a combination of structural and postural alignment impairments, postural correction may only be partially successful. Kyphosis that starts as a postural fault may become a structural impairment later on.[31]

Individuals with thoracic hyperkyphosis may present with any combination of the following features:

  • Most obvious sign is the cosmetic deformity seen by the appearance of a rounded back (an exaggerated curvature of the thoracic spine).[3][2]
  • Increase in forward head posture over time.[32][33]
  • Reduced spinal range of motion.
  • Thoracic back pain that is usually worse with movement and fatigue.
  • Difficulty breathing in severe thoracic hyperkyphosis.[8][34]
  • Osteoporotic vertebral fractures.[35]
  • Functional decline such as having difficulty getting up from a chair, out of bed, or out of a bathtub.[36]
  • Higher Risk of Falling.[37] Hyperkyphosis is associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults.[38] Yet, there is inconsistent evidence available regarding the relationship between kyphosis and balance.
  • Impairement of respiratory function in older adults, especially women with hyperkyphotic posture,places them at greater risk of earlier mortality due to pulmonary disorders such as pneumonia and chronic obstructive pulmonary disease.[2][39]
  • As the kyphotic angle increases, the mortality rate inflates, the evidence suggests this mortality risk to be multifactorial.[2] Kado et al.[40] suggests that women with hyperkyphosis and those who have a vertebral fracture have a greater risk of mortality than women affected by either hyperkyphosis or vertebral fractures alone. Hyperkyphosis could be an indicator of other physical dysfunctions, mobility impairments, falls and fracture risk that increase in the geriatric population and incur increased risk of mortality.[40]

Differential Diagnosis

The diagnosis of thoracic hyperkyphosis is established by clinical examination and confirmed by standing lateral spine X-ray. Some individuals may develop the same magnitude of hyperkyphosis from different processes, which leads to a common misinterpretation.[3] [2]

Conditions to be considered in the differential diagnosis include:

  1. Scheuermann’s disease[13]
  2. Osteoporosis [20]
  3. Vertebral fracture [19]
  4. Degenerative disc disease
  5. Ankylosing Spondylitis

Diagnostic Procedures

Starting point of any diagnostic investigation of the thoracic spine is plain radiography. Anteroposterior and lateral radiographs are essential.[41] [42] Anteroposterior radiographs are useful for the evaluation of the vertebral bodies, while the lateral radiographs are more helpful in assessing vertebral body height, disc height, endplate irregularity, erosions, and alignment.[41]

  • Cobb angle measurement from lateral spine radiograph is the current gold standard for quantifying thoracic kyphosis. Initially, the Cobb angle was developed to assess scoliosis angles. By modifying the direction of radiographic imaging from frontal to sagittal projection, the Cobb angle became useful to assess kyphosis angles.[24] The Modified Cobb angle is the gold standard for measuring thoracic kyphosis using radiography (X-ray) due to its proven accuracy in assessing spinal curvature, its ability to provide detailed images of bone structures, and its widespread use in clinical practice as a reliable tool for diagnosis.[24] It is measured by drawing a line through the superior endplate of T4 and a second line through the inferior endplate of T12. At the intersection of these two lines, the Cobb angle can be measured.[2]
  • Skin-surface methods for measurement of the kyphotic curve, are the Debrunner kyphometer, the flexicurve ruler and the pantograph.[43] A systematic review and meta-analysis assessing the validity, reliability and clinical usefulness for instruments measuring kyphosis states that the Analog Inclinometer, Flexicurve Angle and Index, Photogrammetry, and Spinal Mouse are valid and reliable for evaluating thoracic kyphosis in the sagittal plane. Furthermore the analysis of the instrument´s utility suggests using the Analog Inclinometer, Flexicurve Angle, and the Smartphone app to measure thoracic kyphosis in the sagittal plane in clinical settings.[44]
  • The pantograph consists of a tripod-supported vertical strut to which an articulated bar is fixed and which has an arm that is able to follow the dorsal surface while moving up and down. This arm is positioned over the C7 spinous process and follows the spinous processes to L5 at constant speed. A laser beam ensures the proper positioning of the pantograph and the subject. The motion is recorded using software so that the dorsal outline is representable on a computer screen, and lordotic and kyphotic curves are automatically measured.[45]
  • The Debrunner kyphometer: The kyphometer is a protractor device where the two arms are placed at the top and bottom of the curve of the thoracic region and we read the angle from the protractor.[2][43]
  • The flexicurve angle and index: Is a moldable plastic device, placed in the C7 and the L5-S1 lumbosacral space. A kyphosis index is then calculated by using the width of the thoracic curve divided by the length of the thoracic curve multiplied by 100.[2][43]
  • To examine the neurological system for patients with hyperkyphosis, reformatted CT scans and MR images to display the overall curvature of the spine and give clear image of whether there is cord compression or not.[42]

Outcome Measures

  • The Visual Analogue Scale is a measurement instrument that measures the intensity of various symptoms such as the severity of pain.[48]

Clinical Examination

Observation

Examiners initiate the assessment from the standard anatomical position, ensuring the person stands erect with the feet parallel, toes pointing forward, and the head, eyes, and arms positioned naturally. From the sagittal view, the examiner can readily identify moderate to severe cases by the pronounced rounding of the upper back. Transitioning to the frontal plane (anterior view), the clinician evaluates bilateral shoulder symmetry. From the posterior view, the examiner observes scapular position, symmetry and any evidence of winging or asymmetrical elevation.[1]

Palpation

The examiner palpates the spinous processes of the thoracic vertebrae, the paraspinal musculature bilaterally, and the costovertebral joints to identify areas of localised tenderness, muscle guarding or segmental stiffness.[1] Palpation of the thoracic spine and paraspinal muscles frequently elicits tenderness, and patients may concurrently experience referred pain in the shoulder.[30][50]

Range of Motion

For the range of motion of the thoracolumbar spine, the normal values are 90 degrees for flexion, 30 degrees for extension, lateral side bending, and rotation. In people with hyperkyphosis, the examiner should expect a loss of thoracic extension range of motion and increased stiffness during movement, particularly in extension, which is the direction most directly limited by the structural and postural changes associated with hyperkyphosis.[1]

The examiner should also perform Adam's Forward Bend Test, in which the person bends forward with the knees straight and the hands pointing towards the floor. Viewing the thoracic spine from behind and from the side, this test assists in identifying a concurrent scoliosis, which may co-exist with hyperkyphosis and in distinguishing postural from structural kyphosis. Structural kyphosis remains fixed and accentuated on forward bending, whereas postural kyphosis corrects partially.[51]

Active shoulder range of motion should also be assessed in flexion, abduction, external rotation, and internal rotation bilaterally. Reduced shoulder range of motion and scapular dyskinesis, are consistent clinical findings in this population and should not be attributed to primary shoulder pathology without first considering the thoracic spine as a contributing factor.[52]

Function

Since Hyperkyphosis is associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults and with lower physical function in older women.[36][38] The examiner should assess functional capacity as part of the clinical examination. Functional assessment should include observation of the person rising from a chair, their gait velocity, and their base of support during walking, all of which may be affected by the forward shift in centre of gravity associated with increasing kyphotic angle.[21] The Timed Up and Go (TUG) test, is a practical screening tool for fall risk in this population, it measures the time taken to rise from a standard chair, walk three metres, return and sit down.

Neurological Screening

When evaluating patients who present with neurological symptoms, such as pain, paraesthesia or weakness, the physiotherapist must conduct a brief neurological screening. This includes dermatomal sensory testing, myotomal strength testing, and upper limb tension tests, to exclude nerve root compression or cord compression as co-existing conditions.[51]

Respiratory Assessment

Thoracic hyperkyphosis may compromise respiratory function, manifesting as shortness of breath (dyspnea) and reduced vital capacity,[1] therefore the examiner should assess chest expansion, by using a tape measure at the level of the axilla during maximal inspiration and expiration. Reduced chest expansion is a clinically meaningful finding in people with moderate to severe hyperkyphosis and referral for formal spirometry, should be considered.[53]


Propioception and Postural Awareness

The examiner should assess the person's awareness of their own spinal alignment. A 2026 cross-sectional study demonstrated that people with postural hyperkyphosis have significantly impaired proprioception (joint position sense) at the thoracic spine and significantly more negative body image compared to asymptomatic controls, supporting the inclusion of proprioceptive assessment and postural awareness evaluation as routine components of clinical examination.[54]

Medical Management

Conservative management should remain the first-line approach for thoracic hyperkyphosis, with minimally invasive and surgical interventions reserved for patients who fail to respond, or who present with documented curve progression, intractable pain or neurological compromise.[1]

Pharmacological Management

Pharmacological treatment primarily addresses the underlying causes of hyperkyphosis, most commonly osteoporosis, rather than reducing the kyphotic angle directly. Current evidence confirms that antiresorptive medications do not correct the thoracic curvature itself, but do reduce the risk of new vertebral compression fractures, which are a major driver of curve progression in older adults.[1]

Agent selection should reflect individual patient risk profiles, fracture history, tolerability, and adherence capacity. A 2024 randomised controlled trial comparing annual intravenous zoledronate with twice-yearly subcutaneous denosumab in patients with acute osteoporotic vertebral compression fractures found that both agents significantly reduced bone turnover markers and improved bone mineral density over 12 months, with no statistically significant difference in fracture recurrence between groups. [55] The choice between agents should therefore rest on patient-specific factors including renal function, tolerability, and likelihood of long-term adherence.

Patients receiving denosumab require clear counselling that abrupt discontinuation carries a significant risk of rebound vertebral fractures. Sequential bisphosphonate therapy with zoledronate should follow cessation to prevent rapid bone mineral density loss, and clinicians should incorporate this risk explicitly into the informed consent process.[56]

Patients should understand that pharmacological management targets fracture prevention and bone health, but no medication currently available reduces an established kyphotic curvature.[1]

Minimally Invasive Surgical Interventions

When painful osteoporotic vertebral compression fractures fail to respond to conservative management, clinicians consider percutaneous vertebral augmentation, performed as either vertebroplasty or balloon kyphoplasty, as an appropriate minimally invasive intervention.[57] Both techniques share a common procedural basis, where the surgeon injects bone cement percutaneously into the fractured vertebral body under continuous fluoroscopic guidance, with kyphoplasty first deploying an inflatable balloon tamp to create a cavity before cement injection, whilst vertebroplasty delivers cement directly without prior cavity formation.[58]These procedures aim to stabilise the fracture mechanically, reduce pain, and partially restore anterior vertebral body height, though the optimal choice between them remains subject to ongoing clinical debate.[59]

The two techniques carry distinct risk profiles that should inform the decision. A large propensity-matched analysis of 7,528 matched pairs of patients aged 50 years and over found that vertebroplasty carried a higher risk of short-term neurological complications, including spinal cord compression and radiculopathy, whilst kyphoplasty was associated with a higher one-year risk of subsequent vertebral fractures.[58] Neither procedure reliably corrects the established kyphotic angle in the long term, and patients should receive clear information about this limitation before proceeding.[1]

Surgical Management

Major surgical intervention is appropriate only for a carefully selected minority of patients in whom conservative and minimally invasive measures have failed, and in whom at least one of the following indications is present: a kyphotic curve exceeding 75°, documented curve progression causing unacceptable deformity, intractable pain refractory to all other management, or neurological compromise secondary to spinal cord compression.[1]

Posterior spinal instrumented fusion combined with Ponte osteotomies, which is a posterior column shortening technique, achieves deformity correction without anterior surgery in most patients. A study reporting outcomes at a median follow-up of 12.3 years in 26 patients with idiopathic hyperkyphosis or Scheuermann’s kyphosis found good clinical outcomes in 24 of 26 patients, with no hardware failures, supporting posterior-only correction as a durable approach when the correct distal fusion level is selected. Extending fusion to the sagittal stable vertebra is critical to minimising the risk of junctional kyphosis at long-term follow-up.[60]

Major corrective surgery carries a significant perioperative complication rate. Decisions must account for bone quality, overall health status, patient goals, and the experience of the surgical centre. Intraoperative neurological monitoring is essential throughout all hyperkyphosis correction procedures given the proximity of instrumentation to the spinal cord.[60]

Physiotherapy Management

Physiotherapists should consider conservative management as the first-line approach for individuals with thoracic hyperkyphosis, prioritising exercise-based interventions before progressing to bracing or surgical referral.[9]The main goals of physiotherapy management are to reduce the excessive thoracic curvature, improve physical function, decrease pain, and reduce the risk of falls and fractures.[1] Recognition and treatment of hyperkyphosis could contribute to a reduced risk of falls, fractures, and functional limitations.[2]

Exercise Therapy

Current evidence strongly supports the use of therapeutic exercise as an effective intervention for reducing the thoracic kyphosis angle and improving associated outcomes across all age groups. A 2025 systematic review of nine randomised controlled trials found that all included studies reported significant improvements in thoracic kyphosis angle following exercise, with additional benefits observed in balance, quality of life, and pain in adolescents and young adults.[9]

Clinicians should tailor exercise programmes to the individual, considering their age, capacity, and the structural or postural nature of their hyperkyphosis. Exercise modalities with the strongest current evidence include the following.

Schroth-Based Three-Dimensional Exercises

Physiotherapists should consider Schroth-based three-dimensional (3D) exercises as a preferred exercise modality for postural hyperkyphosis. A randomised controlled trial by Özdemir Görgü and Algun demonstrated that Schroth-based exercises produced significantly greater improvements in thoracic kyphosis angle, lumbar lordosis angle, balance, and quality of life compared to standard postural corrective exercises and an information-only control group.[61] These findings support the superiority of 3D exercise approaches over conventional postural correction alone.

Comprehensive Corrective Exercise Programmes

Physiotherapists should structure exercise programmes comprehensively, incorporating postural perception training alongside stretching and strengthening components. Elpeze and Usgu demonstrated that a comprehensive corrective exercise programme, which included postural awareness training, produced significantly greater improvements in kyphosis angle and dynamic balance than a localised corrective exercise programme alone.[62] This evidence highlights postural awareness training as a key component of effective exercise programmes for hyperkyphosis.

Home-Based Exercise

Where supervised physiotherapy access is limited, physiotherapists should consider prescribing home-based kyphosis-specific exercise programmes. Li et al.[63] demonstrated that a six-week home-based programme in older adults significantly reduced the kyphosis angle by 12.0° in relaxed standing (p<0.001), whilst also improving pain, self-image, and five physical performance measures. High adherence rates of 100% for supervised sessions and 94% for home sessions indicate that home-based exercise is a feasible and effective model for older adults with hyperkyphosis.[63]

Exercise Combined with Bracing

Bracing should always be provided in combination with exercise, as passive bracing alone produces inferior outcomes. A large randomised controlled trial by Gheitasi et al.[64] involving 180 adolescents over a 24-week intervention, demonstrated that combined corrective exercise and bracing produced a mean reduction of 15.5° in Cobb angle, compared to 8.8° with bracing alone and a 1.2° increase in the control group.[64] These findings provide strong evidence that exercise substantially augments the effect of bracing and should be prescribed as a routine adjunct.

Wearing a semi-rigid backpack type thoracolumbar orthosis (TLO) for short periods during the day (e.g., 2-4 h) over 3 months not only modifies kyphotic posture but also can enhance back muscle performance in older adults with hyperkyphosis by counteracting trunk flexion and kyphotic posture by applying the biomechanical principles of the three-point pressure system.[65]

Spinomed and biofeedback posture trainer (BPT) were both effective in improving balance performance, with similar improvements demonstrated by both orthoses.[66] Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.[66]

Thoracic Manual Therapy

Physiotherapists may use thoracic manual therapy techniques such as mobilisation with movement (MWM) to address reduced thoracic mobility and support respiratory function in patients with hyperkyphosis.[67] Jung et al.[68] conducted a randomised controlled trial demonstrating that both manual therapy and mechanical massage significantly improved the thoracic kyphosis angle, extension range of motion, and back extensor strength over an eight-week period, with no significant difference between the two interventions.[68] This suggests that mechanical massage may offer a viable and accessible alternative to hands-on manual therapy in clinical settings where resources are limited.

Furthermore, physiotherapists should be aware that thoracic mobilisation produces measurable respiratory benefits. Jung et al. demonstrated that thoracic mobilisation over eight weeks significantly increased diaphragmatic excursion during deep breathing and improved forced vital capacity in individuals with thoracic hyperkyphosis.[69] Clinicians should therefore incorporate breathing assessment and respiratory exercises into their management plans, particularly for patients presenting with respiratory compromise.

Balance Training and Falls Prevention

Physiotherapists should routinely address falls risk when managing hyperkyphosis in older adults, given that hyperkyphosis impairs balance and increases fall incidence in this population.[21][38] A 2025 PROSPERO-registered systematic review of 19 studies confirmed that hyperkyphosis is consistently associated with impaired balance and elevated fall risk in adults aged 60 years and over, directly supporting the inclusion of balance assessment and gait training within physiotherapy programmes.[21]

Sedaghati et al.[70] demonstrated that corrective exercises produced durable improvements in postural alignment, balance, and fear of falling in hyperkyphotic older adults with a history of falls, further reinforcing the central role of exercise-based physiotherapy in falls prevention for this population.[70] Physiotherapists should consider validated tools such as the Timed Up and Go test and the Berg Balance Scale to screen for falls risk and monitor progress throughout treatment.

Postural Awareness and Education

Physiotherapists should integrate postural awareness training and patient education into all hyperkyphosis management programmes. Evidence supports the use of visual, auditory, and tactile feedback strategies including mirror work, therapist cueing, and therapeutic taping to support the development of self-correction skills in standing and sitting postures.[62] Clinicians should educate patients on ergonomic principles, activity modification, and the importance of continued self-management to prevent further progression of the hyperkyphotic curvature.

Conclusion

Proper posture is essential for healthy human living. It has been suggested that maintaining an ideal upright posture is one of the most critical indicators of the musculoskeletal and movement systems’ health.[71] Hyperkyphosis incidence increases with age, but is not limited to older adults.[22] Besides calculating the modified Cobb´s angle from plain radiography, now there are other skin-surface tools that are valid, reliable and clinically useful.[44] The conservative management remains the first-line approach for individuals with thoracic hyperkyphosis.[1]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review. Front Endocrinol (Lausanne). 2020 Jan 24;11:5. doi: 10.3389/fendo.2020.00005. PMID: 32038498; PMCID: PMC6993454.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res. 2017 Aug;29(4):567-577. doi: 10.1007/s40520-016-0617-3. Epub 2016 Aug 18. PMID: 27538834; PMCID: PMC5316378.
  3. ↑ 3.0 3.1 3.2 3.3 Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352–360. doi: 10.2519/jospt.2010.3099.
  4. ↑ Soames Nigel, Palastanga Roger. Anatomy and Human Movement:Structure and Function. Seventh Edition. Elsevier. 2018
  5. ↑ Standring S, editor. Gray's anatomy: the anatomical basis of clinical practice. 42nd ed. Philadelphia (PA): Elsevier; 2021.
  6. ↑ Ackland TR, Elliott B, Bloomfield J. Applied anatomy and biomechanics in sport. Human Kinetics; 2009.
  7. ↑ 7.0 7.1 Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. J Bone Miner Res. 2012 Oct;27(10):2144-51. doi: 10.1002/jbmr.1658. PMID: 22589006; PMCID: PMC3431452.
  8. ↑ 8.0 8.1 Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical considerations for manual therapy. Manual therapy. 1997 Aug 1;2(3):132-43.
  9. ↑ 9.0 9.1 9.2 Fernández LF, Rodríguez-Gude C, de Oliveira IM. Effect of Therapeutic Exercise on the Management of Hyperkyphosis in Adolescence and Young Adulthood: A Systematic Review. Physiother Res Int. 2025 Jul;30(3):e70078. doi: 10.1002/pri.70078. PMID: 40474601; PMCID: PMC12141983.
  10. ↑ 10.0 10.1 10.2 de Mauroy JC. Kyphosis physiotherapy from childhood to old age. InPhysical Therapy Perspectives in the 21st Century-Challenges and Possibilities 2012 Apr 5. IntechOpen.
  11. ↑ Murray PM, Weinstein SL, Spratt KF. The natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. 1993 Feb;75(2):236-48. doi: 10.2106/00004623-199302000-00011. PMID: 8423184.
  12. ↑ 12.0 12.1 Bezalel T, Carmeli E, Levi D, Kalichman L. The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann's Patients: A Randomized Controlled Trial. Asian Spine J. 2019 Jun;13(3):490-499. doi: 10.31616/asj.2018.0097. Epub 2019 Jan 24. PMID: 30669825; PMCID: PMC6547400.
  13. ↑ 13.0 13.1 13.2 Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg. 2019 May 15;27(10):e462-e472. doi: 10.5435/JAAOS-D-17-00748. PMID: 30407981.
  14. ↑ Feng Q, Wang M, Zhang Y, Zhou Y. The effect of a corrective functional exercise program on postural thoracic kyphosis in teenagers: a randomized controlled trial. Clin Rehabil. 2018 Jan;32(1):48-56. doi: 10.1177/0269215517714591. Epub 2017 Jun 14. PMID: 28610442.
  15. ↑ Özdemir Görgü S, Algun ZC. A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises. Disabil Rehabil. 2023 Jun;45(12):1992-2002. doi: 10.1080/09638288.2022.2083244. Epub 2022 Jun 12. PMID: 35694970.
  16. ↑ Toprak Çelenay Ş, Özer Kaya D. An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study. Turk J Med Sci. 2017 Apr 18;47(2):504-513. doi: 10.3906/sag-1511-155. PMID: 28425239.
  17. ↑ Perriman DM, Scarvell JM, Hughes AR, Lueck CJ, Dear KB, Smith PN. Thoracic hyperkyphosis: a survey of Australian physiotherapists. Physiotherapy Research International. 2012 Sep;17(3):167-78.
  18. ↑ 18.0 18.1 Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. journal of orthopaedic & sports physical therapy. 2010 Jun;40(6):352-60.
  19. ↑ 19.0 19.1 Schneider DL, von Mühlen D, Barrett-Connor E, Sartoris DJ. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol. 2004 Apr;31(4):747-52. PMID: 15088302.
  20. ↑ 20.0 20.1 20.2 Kado DM, Huang MH, Karlamangla AS, Cawthon P, Katzman W, Hillier TA, Ensrud K, Cummings SR. Factors associated with kyphosis progression in older women: 15 years' experience in the study of osteoporotic fractures. J Bone Miner Res. 2013 Jan;28(1):179-87. doi: 10.1002/jbmr.1728. PMID: 22865329; PMCID: PMC3693545.
  21. ↑ 21.0 21.1 21.2 21.3 Gasavi Nezhad Z, A Gard S, Arazpour M. The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review. Gait Posture. 2025 May;118:154-167. doi: 10.1016/j.gaitpost.2025.02.005. Epub 2025 Feb 12. PMID: 39978050.
  22. ↑ 22.0 22.1 González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS One. 2019 Apr 29;14(4):e0216180. doi: 10.1371/journal.pone.0216180. PMID: 31034509; PMCID: PMC6488071.
  23. ↑ Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014 Jan;95(1):129-40. doi: 10.1016/j.apmr.2013.06.022. Epub 2013 Jul 9. PMID: 23850611; PMCID: PMC3997126.
  24. ↑ 24.0 24.1 24.2 Fon GT, Pitt MJ, Thies AC., Jr Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol. 1980;134:979–983. doi: 10.2214/ajr.134.5.979.
  25. ↑ Zappalá M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res. 2021 Jul 9;16(1):447. doi: 10.1186/s13018-021-02592-2. PMID: 34243795; PMCID: PMC8268398.
  26. ↑ Katzman WB, Vittinghoff E, Ensrud K, Black DM, Kado DM. Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study. J Am Geriatr Soc. 2011 Jan;59(1):96-100. doi: 10.1111/j.1532-5415.2010.03214.x. Epub 2011 Jan 3. PMID: 21198460; PMCID: PMC3696343.
  27. ↑ Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P, Kotwicki T, Maruyama T, Minozzi S. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012 Dec;7(1):3.
  28. ↑ Ashton-Miller JA. Thoracic hyperkyphosis in the young athlete: a review of the biomechanical issues. Current sports medicine reports. 2004 Jan 1;3(1):47-52.
  29. ↑ Fon GT, Pitt MJ, Thies Jr AC. Thoracic kyphosis: range in normal subjects. American Journal of Roentgenology. 1980 May 1;134(5):979-83.
  30. ↑ 30.0 30.1 Lewis JS, Valentine RE. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC musculoskeletal disorders. 2010 Dec;11(1):39.
  31. ↑ 31.0 31.1 Sahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines-e-book. Elsevier Health Sciences; 2010 Nov 19.
  32. ↑ Zane MK. Physical Therapist’s Guide to Hyperkyphosis (Humpback) in Adults. American Physical Therapy Association. 2014;188.
  33. ↑ Zaina F, Atanasio S, Ferraro C, Fusco C, Negrini A, Romano M, Negrini S. Review of rehabilitation and orthopedic conservative approach to sagittal plane diseases during growth: hyperkyphosis, junctional kyphosis, and Scheuermann disease. Eur J Phys Rehabil Med. 2009 Dec 1;45(4):595-603.
  34. ↑ Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine. 1994 Jun;19(11):1250-5.
  35. ↑ Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS. The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporosis international. 2011 Jun 1;22(6):1897-905.
  36. ↑ 36.0 36.1 Roghani T, Allen DD, Gladin A, Rahimi A, Mehrabi M, Rezaeian ZS, Farajzadegan Z, Katzman WB. The Association Between Physical Function and Hyperkyphosis in Older Females: A Systematic Review and Meta-analysis. J Geriatr Phys Ther. 2024 Apr-Jun 01;47(2):85-96. doi: 10.1519/JPT.0000000000000371. Epub 2024 Jan 9. PMID: 36827693.
  37. ↑ van der Jagt-Willems HC, de Groot MH, van Campen JP, Lamoth CJ, Lems WF. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr. 2015 Mar 28;15:34. doi: 10.1186/s12877-015-0018-z. PMID: 25888399; PMCID: PMC4414293.
  38. ↑ 38.0 38.1 38.2 Koelé MC, Willems HC, Swart KMA, van Dijk SC, Lips P, de Groot LCPGM, van der Cammen TJM, Zillikens MC, van Schoor NM, van der Velde N. The association between hyperkyphosis and fall incidence among community-dwelling older adults. Osteoporos Int. 2022 Feb;33(2):403-411. doi: 10.1007/s00198-021-06136-6. Epub 2021 Sep 8. PMID: 34495374; PMCID: PMC8813677.
  39. ↑ Ordu Gokkaya NK, Koseoglu F, Albayrak N. Reduced aerobic capacity in patients with severe osteoporosis: a cross sectional study. Eur J Phys Rehabil Med. 2008 Jun;44(2):141-7. PMID: 18418334.
  40. ↑ 40.0 40.1 Kado DM, Lui LY, Ensrud KE, Fink HA, Karlamangla AS, Cummings SR; Study of Osteoporotic Fractures. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009 May 19;150(10):681-7. doi: 10.7326/0003-4819-150-10-200905190-00005. PMID: 19451575; PMCID: PMC2711520.
  41. ↑ 41.0 41.1 El-Khoury GY, Whitten CG. Trauma to the upper thoracic spine: anatomy, biomechanics, and unique imaging features. AJR. American journal of roentgenology. 1993 Jan;160(1):95-102.
  42. ↑ 42.0 42.1 Naidich TP, Castillo M, Cha S, Raybaud C, Smirniotopoulos JG, Kollias S. Imaging of the Spine: Expert Radiology Series, Expert Consult-Online and Print. Elsevier Health Sciences; 2010 Aug 27.
  43. ↑ 43.0 43.1 43.2 Barrett E, McCreesh K, Lewis J. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review. Man Ther. 2014 Feb;19(1):10-7. doi: 10.1016/j.math.2013.09.003. Epub 2013 Oct 26. PMID: 24246907.
  44. ↑ 44.0 44.1 Nepomuceno APFA, Cury AC, Pinheiro LSP, Sabino GS, Souza TR, Fonseca ST, Ocarino JM, Resende RA. Validity, reliability, and clinical usefulness of instruments for measuring thoracic kyphosis: a systematic review and meta-analysis. Braz J Phys Ther. 2025 Sep-Oct;29(5):101246. doi: 10.1016/j.bjpt.2025.101246. Epub 2025 Aug 7. PMID: 40780025; PMCID: PMC12355107.
  45. ↑ Giglio CA, Volpon JB. Development and evaluation of thoracic kyphosis and lumbar lordosis during growth. J Child Orthop. 2007 Sep;1(3):187-93. doi: 10.1007/s11832-007-0033-5. Epub 2007 Jul 28. PMID: 19308494; PMCID: PMC2656721.
  46. ↑ Wiyanad A, Chokphukiao P, Suwannarat P, Thaweewannakij T, Wattanapan P, Gaogasigam C, Amatachaya P, Amatachaya S. Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis? Musculoskelet Sci Pract. 2018 Dec;38:63-68. doi: 10.1016/j.msksp.2018.09.010. Epub 2018 Sep 25. PMID: 30278368.
  47. ↑ Bohannon RW, Tudini F, Constantine D. Tragus-to-wall: A systematic review of procedures, measurements obtained, and clinimetric properties. J Back Musculoskelet Rehabil. 2019;32(1):179-189. doi: 10.3233/BMR-171090. PMID: 30248033.
  48. ↑ Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of pain. 2003 Sep 1;4(7):407-14.
  49. ↑ Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, Williams JI. The Quebec Back Pain Disability Scale. Measurement properties. Spine. 1995 Feb;20(3):341-52.
  50. ↑ Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, Shishido H, Kikuchi S, Konno S. Association between kyphosis and subacromial impingement syndrome: LOHAS study. J Shoulder Elbow Surg. 2014 Dec;23(12):e300-e307. Epub 2014 Aug 5. PMID: 25107600.
  51. ↑ 51.0 51.1 Kaspiris A, Spyrou I, Marougklianis V, Afrati SR, Sakellariou E, Varsamos I, Karampinas P, Vasiliadis E, Pneumaticos SG. Insights into the Pathophysiology of Scheuermann's Kyphosis: From Structural Deformities to Genetic Predisposition and Underlying Signalling Pathways. Biomolecules. 2025 Dec 30;16(1):56. PMID: 41594596; PMCID: PMC12839117.
  52. ↑ Manoso-Hernando D, Bailón-Cerezo J, Angulo-Díaz-Parreño S, Reina-Varona Á, Elizagaray-García I, Gil-Martínez A. Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis. PeerJ. 2024 Jun 26;12:e17604. PMID: 38948223; PMCID: PMC11214432.
  53. ↑ Eftekhari E, Sheikhhoseini R, Salahzadeh Z, Dadfar M. Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial. BMC Geriatr. 2024 Mar 6;24(1):234. PMID: 38448857; PMCID: PMC10918978.
  54. ↑ Çakir, B., Özdemi̇r Görgü, S. Associations between postural kyphosis and tactile sensation, proprioception, and body image in young individuals: an analytical cross-sectional study. BMC Musculoskelet Disord 27, 425 (2026).
  55. ↑ Son S, Oh MY, Yoo BR, Park HB. Comparison of the Efficacy of Zoledronate and Denosumab in Patients with Acute Osteoporotic Vertebral Compression Fractures: A Randomized Controlled Trial. J Clin Med. 2024 Apr 1;13(7):2040. doi: 10.3390/jcm13072040. PMID: 38610804; PMCID: PMC11012809.
  56. ↑ Lee CC, Wang CY, Yen HK, Hung CC, Lai CY, Hu MH, Wang TM, Li CY, Fu SH. Zoledronate Sequential Therapy After Denosumab Discontinuation to Prevent Bone Mineral Density Reduction: A Randomized Clinical Trial. JAMA Netw Open. 2024 Nov 4;7(11):e2443899. doi: 10.1001/jamanetworkopen.2024.43899. PMID: 39527056; PMCID: PMC11555552.
  57. ↑ Li Y, Wang X, Sun J, Ma M. Optimal management for osteoporotic vertebral compression fractures: a network meta-analysis. J Orthop Surg Res. 2025 Aug 30;20(1):810. doi: 10.1186/s13018-025-06233-w. PMID: 40886030; PMCID: PMC12398152.
  58. ↑ 58.0 58.1 Belt NG, Lee A, Sanghvi P, Mistovich RJ, Belding J. Comparative Long-Term Outcomes of Vertebroplasty Versus Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Propensity-Matched Analysis. Cureus. 2025 Nov 9;17(11):e96438. doi: 10.7759/cureus.96438. PMID: 41376721; PMCID: PMC12688411.
  59. ↑ Korovessis P, Syrimpeis V, Korovesis A, Dimakopoulos G. Incidence of new osteoporotic adjacent vertebral body fractures. A comparison between conservative treatment and vertebral body augmentation (vertebroplasty, kyphoplasty): a systematic review and meta-analysis. Front Surg. 2025 May 20;12:1594217. doi: 10.3389/fsurg.2025.1594217. PMID: 40463618; PMCID: PMC12129978.
  60. ↑ 60.0 60.1 Scaramuzzo L, Giudici F, Velluto C, Barone G, Meluzio MC, Zagra A, Proietti L. Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area. J Clin Med. 2024 Nov 12;13(22):6799. doi: 10.3390/jcm13226799. PMID: 39597943; PMCID: PMC11595179.
  61. ↑ Özdemir Görgü S, Algun ZC. A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises. Disabil Rehabil. 2023 Jun;45(12):1992-2002. doi: 10.1080/09638288.2022.2083244. Epub 2022 Jun 12. PMID: 35694970.
  62. ↑ 62.0 62.1 Elpeze G, Usgu G. The Effect of a Comprehensive Corrective Exercise Program on Kyphosis Angle and Balance in Kyphotic Adolescents. Healthcare (Basel). 2022 Dec 8;10(12):2478. doi: 10.3390/healthcare10122478. PMID: 36554002; PMCID: PMC9778671.
  63. ↑ 63.0 63.1 Li WY, Lu J, Dai Y, Tiwari A, Chau PH. A feasibility study on home-based kyphosis-specific exercises on reducing thoracic hyperkyphosis in older adults. Int J Nurs Sci. 2023 Mar 21;10(2):133-141. doi: 10.1016/j.ijnss.2023.03.007. PMID: 37128480; PMCID: PMC10148263.
  64. ↑ 64.0 64.1 Gheitasi M, Bayattork M, Kolur MK. Adding corrective exercises along with bracing for postural hyperkyphosis among adolescents: A randomized controlled trial. PM&R. 2023;15(7):872-880. doi:10.1002/pmrj.12877
  65. ↑ Keshavarzi F, Azadinia F, Talebian S, Khalkhali Zavieh M, Rasouli O. Effect of a semi-rigid backpack type thoracolumbar orthosis on thoracic kyphosis angle and muscle performance in older adults with hyperkyphosis: a randomized controlled trial. Disabil Rehabil. 2023 May;45(9):1488-1497. doi: 10.1080/09638288.2022.2065541. Epub 2022 Apr 22. PMID: 35452347.
  66. ↑ 66.0 66.1 Eldemir K, Eldemir S, Ozkul C, Guclu-Gunduz A. The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis. Gait Posture. 2024 Jun;111:136-142. doi: 10.1016/j.gaitpost.2024.04.019. Epub 2024 Apr 21. PMID: 38691976.
  67. ↑ El Gendy MH, Mohamed SR, Taman SE, Hussein HM, Abu El Kasem ST. Short term effect of spinal mobilization with movement (MWM) on pulmonary functions in nonsmokers with thoracic hyperkyphosis: a randomized single-blinded controlled trial. J Man Manip Ther. 2023 Apr;31(2):64-71. doi: 10.1080/10669817.2022.2075203. Epub 2022 May 26. PMID: 35616265; PMCID: PMC10013426.
  68. ↑ 68.0 68.1 Jung SH, Hwang UJ, Ahn SH, Kim JH, Kwon OY. Effects of Manual Therapy and Mechanical Massage on Spinal Alignment, Extension Range of Motion, Back Extensor Electromyographic Activity, and Thoracic Extension Strength in Individuals with Thoracic Hyperkyphosis: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2020 Nov 23;2020:6526935. doi: 10.1155/2020/6526935. PMID: 33299454; PMCID: PMC7707944.
  69. ↑ Jung SH, Hwang UJ, Ahn SH, Kim JH, Kwon OY. Does mobilisation of the thoracic spine using mechanical massage affect diaphragmatic excursion in individuals with thoracic hyperkyphosis? J Back Musculoskelet Rehabil. 2022;35(3):517-523. doi: 10.3233/BMR-210143. PMID: 34657875; PMCID: PMC9198757.
  70. ↑ 70.0 70.1 Sedaghati P, Ahmadabadi S, Goudarzian M. Evaluation of the durable effects of corrective exercises on the postural alignment and stability in hyperkyphotic elderly with a history of falls. BMC Geriatr. 2022 Jun 30;22(1):545. doi: 10.1186/s12877-022-03210-4. PMID: 35773652; PMCID: PMC9245289.
  71. ↑ Salsali M, Sheikhhoseini R, Sayyadi P, Hides JA, Dadfar M, Piri H. Association between physical activity and body posture: a systematic review and meta-analysis. BMC Public Health. 2023 Aug 30;23(1):1670. doi: 10.1186/s12889-023-16617-4. PMID: 37649076; PMCID: PMC10470156.

 

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