Kyphosis.
What is kyphosis?
Kyphosis refers to an exaggerated forward curvature of the thoracic spine — the upper and mid back — producing the characteristic rounded or hunched posture that is one of the most recognisable spinal presentations in clinical practice. A small degree of thoracic kyphosis is normal and necessary — the thoracic spine is naturally kyphotic. The term kyphosis in a clinical context refers to curvature that exceeds normal limits and produces functional or structural consequences.
The Cobb angle — measured on standing lateral X-ray between the most tilted vertebrae — is the standard measure of kyphosis severity. A thoracic Cobb angle exceeding 40 to 45 degrees is generally considered clinically significant, though symptoms and functional impact are as important as the degree of curvature.
Types of kyphosis
Understanding the type of kyphosis is essential because it directly determines what physiotherapy can and cannot achieve.
What are the symptoms?
Managing kyphosis often requires addressing underlying conditions that can contribute to it, such as osteoporosis. Symptoms depend on the severity and type. Mild kyphosis often produces no pain — the person may be unaware until the postural change is noticed by others or identified on imaging. More significant kyphosis produces thoracic back pain and fatigue from the increased demand on the posterior spinal muscles required to maintain upright posture against the deforming gravity load. Shoulder tightness, reduced shoulder elevation and shoulder impingement are common associated complaints. In severe kyphosis, particularly when associated with vertebral fractures or progressive conditions, reduced respiratory capacity from rib cage restriction and spinal cord compression in rare cases can develop.
How can physiotherapy help?
Physiotherapy plays a valuable role in managing kyphosis, particularly in cases of postural kyphosis and mild to moderate structural forms.
The cornerstone of physiotherapy for kyphosis is thoracic extension mobility and thoracic extensor strengthening — directly targeting the range of motion restriction and muscle weakness that both contribute to and result from the kyphotic posture. Thoracic joint mobilisation improves segmental extension mobility in the stiffened segments, creating the physical capacity for improved alignment that exercise can then sustain. Active thoracic extension and thoracic rotation exercises progressively challenge and improve this mobility.
Muscle strengthening targets weakness in the back and core that contributes to kyphosis. A physiotherapist designs a personalised exercise program for the thoracic extensors, lower and middle trapezius, and rhomboids — muscles that actively resist the gravitational load pulling the thoracic spine into flexion.
Tight muscles in the chest and shoulders contribute to the forward curvature. Stretching exercises improve flexibility in these areas, allowing for a more extended and upright posture. Pectoralis minor and major stretching, anterior chest wall mobility, and intercostal stretching complement the active extension work.
Breathing exercises optimise lung function and respiratory efficiency in cases where kyphosis has reduced chest expansion. Coordinating thoracic extension with inhalation — using the natural expansion of the ribcage during breathing to drive thoracic extension — is a clinically useful technique that bridges breathing and postural rehabilitation.
For adolescent Scheuermann's kyphosis, Schroth-based scoliosis and kyphosis-specific exercises provide a more targeted and evidence-based rehabilitation approach than generic posture exercises.
For older adults with degenerative kyphosis and osteoporosis, the rehabilitation approach is modified to account for vertebral fragility — high-impact and flexion-loading exercises are avoided, and extension-strengthening is emphasised within safe loading parameters.
xercise physiology contributes to bone health programming and cardiovascular conditioning for this population. Our Balance and Bones exercise classes are specifically designed for older adults managing osteoporosis and associated postural changes.
Clinical Pilates is an excellent vehicle for kyphosis rehabilitation — the emphasis on thoracic extension, scapular control and body awareness is directly aligned with the rehabilitation goals, and exercises can be precisely modified for different kyphosis types and severities. Real time ultrasound assists in retraining the deep thoracic and cervical stabilisers where activation has been disrupted by the prolonged postural loading pattern.
Our physiotherapists Yulia Khasyanova and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in spinal conditions and postural rehabilitation and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Kyphosis refers to an exaggerated forward curvature of the thoracic spine — the upper and mid back — producing the characteristic rounded or hunched posture that is one of the most recognisable spinal presentations in clinical practice. A small degree of thoracic kyphosis is normal and necessary — the thoracic spine is naturally kyphotic. The term kyphosis in a clinical context refers to curvature that exceeds normal limits and produces functional or structural consequences.
The Cobb angle — measured on standing lateral X-ray between the most tilted vertebrae — is the standard measure of kyphosis severity. A thoracic Cobb angle exceeding 40 to 45 degrees is generally considered clinically significant, though symptoms and functional impact are as important as the degree of curvature.
Types of kyphosis
Understanding the type of kyphosis is essential because it directly determines what physiotherapy can and cannot achieve.
- Postural kyphosis is the most common and most reversible type. It develops from habitual postural habits — prolonged sitting, screen use, desk work — and produces a rounded thoracic spine that the person can actively correct when asked. The underlying bony vertebral structure is normal on imaging. Physiotherapy is highly effective for postural kyphosis and can produce meaningful and lasting improvement in curvature, pain and function. Postural kyphosis is predominantly a soft tissue and muscle imbalance problem, and addressing these with exercise and movement retraining directly addresses the underlying cause.
- Scheuermann's kyphosis — structural kyphosis of adolescent onset — involves wedge-shaped deformity of multiple adjacent vertebrae that cannot be fully corrected with voluntary extension. Unlike postural kyphosis, the structural changes in the vertebral bodies persist regardless of muscle activity. Physiotherapy is the primary management for mild to moderate Scheuermann's kyphosis, aiming to slow progression, reduce pain and maintain function, but cannot restore normal vertebral shape. See our dedicated Scheuermann's disease page for more detail.
- Degenerative kyphosis develops in older adults from age-related disc degeneration, vertebral compression fractures, and facet joint deterioration that progressively reduce the height of the anterior vertebral column and increase thoracic flexion. It is most prevalent in women, particularly those with osteoporosis, where vertebral compression fractures can produce rapid and significant kyphotic change. The relationship between kyphosis and osteoporosis is bidirectional — kyphosis increases fall risk, which increases fracture risk, which worsens kyphosis.
- Congenital kyphosis results from abnormal vertebral development in utero and may require surgical correction depending on severity and progression.
- Secondary kyphosis can develop from a range of conditions — neuromuscular diseases, ankylosing spondylitis, Parkinson's disease, prolonged corticosteroid use — where the primary condition drives the spinal deformity.
What are the symptoms?
Managing kyphosis often requires addressing underlying conditions that can contribute to it, such as osteoporosis. Symptoms depend on the severity and type. Mild kyphosis often produces no pain — the person may be unaware until the postural change is noticed by others or identified on imaging. More significant kyphosis produces thoracic back pain and fatigue from the increased demand on the posterior spinal muscles required to maintain upright posture against the deforming gravity load. Shoulder tightness, reduced shoulder elevation and shoulder impingement are common associated complaints. In severe kyphosis, particularly when associated with vertebral fractures or progressive conditions, reduced respiratory capacity from rib cage restriction and spinal cord compression in rare cases can develop.
How can physiotherapy help?
Physiotherapy plays a valuable role in managing kyphosis, particularly in cases of postural kyphosis and mild to moderate structural forms.
The cornerstone of physiotherapy for kyphosis is thoracic extension mobility and thoracic extensor strengthening — directly targeting the range of motion restriction and muscle weakness that both contribute to and result from the kyphotic posture. Thoracic joint mobilisation improves segmental extension mobility in the stiffened segments, creating the physical capacity for improved alignment that exercise can then sustain. Active thoracic extension and thoracic rotation exercises progressively challenge and improve this mobility.
Muscle strengthening targets weakness in the back and core that contributes to kyphosis. A physiotherapist designs a personalised exercise program for the thoracic extensors, lower and middle trapezius, and rhomboids — muscles that actively resist the gravitational load pulling the thoracic spine into flexion.
Tight muscles in the chest and shoulders contribute to the forward curvature. Stretching exercises improve flexibility in these areas, allowing for a more extended and upright posture. Pectoralis minor and major stretching, anterior chest wall mobility, and intercostal stretching complement the active extension work.
Breathing exercises optimise lung function and respiratory efficiency in cases where kyphosis has reduced chest expansion. Coordinating thoracic extension with inhalation — using the natural expansion of the ribcage during breathing to drive thoracic extension — is a clinically useful technique that bridges breathing and postural rehabilitation.
For adolescent Scheuermann's kyphosis, Schroth-based scoliosis and kyphosis-specific exercises provide a more targeted and evidence-based rehabilitation approach than generic posture exercises.
For older adults with degenerative kyphosis and osteoporosis, the rehabilitation approach is modified to account for vertebral fragility — high-impact and flexion-loading exercises are avoided, and extension-strengthening is emphasised within safe loading parameters.
xercise physiology contributes to bone health programming and cardiovascular conditioning for this population. Our Balance and Bones exercise classes are specifically designed for older adults managing osteoporosis and associated postural changes.
Clinical Pilates is an excellent vehicle for kyphosis rehabilitation — the emphasis on thoracic extension, scapular control and body awareness is directly aligned with the rehabilitation goals, and exercises can be precisely modified for different kyphosis types and severities. Real time ultrasound assists in retraining the deep thoracic and cervical stabilisers where activation has been disrupted by the prolonged postural loading pattern.
Our physiotherapists Yulia Khasyanova and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in spinal conditions and postural rehabilitation and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
