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Is Life Turning You Kyphotic? Here’s How to Prevent It

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The spine supports the torso and allows the head to stay upright, keeping the gaze towards the horizon. Proper alignment in the sagittal plane helps maintain the torso in the correct position with minimal energy expenditure and optimal load distribution along the spine.

Over time, particularly in older adults, a forward imbalance tends to develop, causing the torso to lean forward. Researchers have identified the age range of 50 to 60 as the period when this imbalance typically begins to manifest, progressively worsening with age. Compensatory mechanisms then come into play, creating a vicious cycle involving the pelvis and the entire spine, leading to specific degenerative changes.
The pelvis tilts backward, lumbar lordosis decreases, and the upper torso bends forward. In some cases, these changes in sagittal alignment occur rapidly and progressively, developing into pathological conditions.
Certain factors may exacerbate this, such as the presence of scoliosis, disc disorders leading to reduced lordosis, or stiffness in the spine. Severe kyphosis or kyphosis resulting from vertebral fractures also contribute to forward collapse, as does weakness in the spinal extensor muscles, leading to forward lean.

Now, let’s consider our daily activities.
Most of what we do involves looking downward or at least keeping the head tilted forward. For example, how much strain is placed on the cervical vertebrae when the head is tilted forward at 30 degrees? (Keep in mind that when we look at our phones, we usually tilt our heads much more than 30 degrees.)

At this angle, the discs experience 400% more stress compared to when the head is upright and looking forward. The natural tendency towards forward collapse, combined with daily activities that increasingly involve static, flexed postures and potential degenerative spinal conditions, accelerates the forward tilt of the torso. This forward imbalance results in pain, reduced spinal functionality, fatigue, aesthetic concerns, and, most importantly, a decline in quality of life.

What Can We Do?

  1. Resist Gravity: Throughout the day, whether standing or sitting, make an effort to sit or stand up straight and hold this position for a few seconds.
  2. Engage in Regular Physical Activity: Any type of exercise is beneficial, but activities that engage the trunk extensor muscles are especially helpful. Don’t stop moving! It’s also a good idea to vary your exercises over time, which will benefit your back as well.
  3. Seek Medical Advice: If you notice yourself leaning forward when tired, especially in the evening, or if those around you point out that you’re becoming more stooped, it’s time to seek a medical evaluation.

…And if life pushes us forward? Let’s straighten it out!

Scoliosis and posture: the two go hand in hand

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Let us start with one thing we know for sure: idiopathic scoliosis is not a postural complaint, but rather a progressive spinal disorder that causes three-dimensional deformation of the vertebrae.

Although it is still not clear exactly why scoliosis occurs, its progression is known to be due, in part, to the force of gravity (i.e., the force of gravity does not cause the disorder, it simply helps it to progress).

Let us try to explain this in simple terms: our spine is like a tower of building bricks that serves to support us, and the bricks distribute evenly the weight it has to bear. If we have scoliosis, some of our bricks are not correctly shaped.
As a result, they are not properly aligned and our tower (spine) may have curve(s) in it. A spine with curve(s) is no longer able to distribute evenly the weight it has to bear; indeed, this presses down harder on the inside of the scoliotic curve, and less on its outside. 

If our spine is well supported, this effect can be lessened, because the support allows the blocks to realign, and this, in turn, reduces the extent of the curve(s). Conversely, without support, the bricks will slide even further to one side, increasing the angle of curvature and shortening the trunk even more.

What does all this mean? That our scoliotic curve will worsen more rapidly unless we continually correct it.

This is why the exercise-based treatment method used at Isico is based on the principle of SELF-CORRECTION: affected youngsters learn to intervene independently to control and align their spine as correctly as possible, thereby countering its tendency to collapse in the direction of the scoliotic curve.

Let us consider another aspect. On a spinal X-ray, we can measure the degrees of curvature present. The angle of curvature is actually the sum of two components: the deformity itself and the effect of postural sagging in the direction of the curve. The contribution of this second component is largely dependent on our capacity for “self-correction”.

How can we distinguish between these two components, i.e., actual bone deformity and postural sagging, so as to be able to intervene effectively on each of them? Again, on an X-ray, but in this case, it must be taken with the patient lying down, so that the degrees of curvature caused by postural sagging disappear, and all that can be seen, and measured, are those due to the deformity itself.

One study, now rather old but still valid, published in Spine in 1976 (Standing and supine Cobb measures in girls with idiopathic scoliosis, G Torell, A Nachemson, K Haderspeck-Grib, A Schultz), showed that postural sagging in scoliosis causes, on average, 9 degrees of curvature (ranging from 0 to a maximum of 20), and that the degrees attributable to postural failure are independent of the severity of the curve. Another interesting study published in Spine, in this case in 1993 (Diurnal variation of Cobb angle measurement in adolescent idiopathic scoliosis, M Beauchamp, H Labelle, G Grimard, C Stanciu, B Poitras, J Dansereau), shows that back “fatigue” can also affect the Cobb angle. In this study, youngsters with moderate to severe scoliosis (an average of 60 Cobb degrees) were X-rayed in the morning and then in the evening. The X-ray taken in the evening showed an average 5-degree increase in curve severity.

What should we do in treatment terms? Clearly, exercises alone cannot alter the actual bone deformity resulting from the scoliosis, which needs to be treated with a combination of exercises and brace wearing.
Nevertheless, specific exercises and self-correction can do a lot to address the problem of postural sagging. And if this “sagging” is responsible for an increased Cobb angle, we need to work hard at our exercises in order to “eat away” at (reduce) the part of the curve that is due to this component.

My kid is always slouching: bad posture or a medical problem?

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In today’s digital age, the incredible exponential curves of technological growth and innovation are increasingly reflected in curves of another kind, namely those affecting our spines, as we assume various odd and unnatural positions when using our electronic devices.  

Parents are the first to notice their youngsters’ tendency to adopt these awkward and unattractive positions. The most frequent is the hunched back position, where the upper spine, shoulders and head are bent forward in relation to the rest of the body.
Consequently, we now see countless humps like that of Quasimodo, the famous “Hunchback of Notre Dame”.

The tendency to slouch or adopt slumped postures is prevalent among the young. Youngsters (and adults too) often assume incorrect postures simply because it is easier and requires less effort.
As a result, they allow the force of gravity to take its toll on their backs without trying to counteract it. 
Some situations, however, require careful assessment, as incorrect postures can sometimes indicate a spinal disorder.

Initially, it is up to parents to check their children’s backs, and if they have any doubts at all, they should seek the opinion of expert medical spine specialists.

How do you tell the difference between incorrect posture and a spinal disorder?

If you have the youngster stand in front of you with his/her back exposed and look at him/her sideways on, you should immediately notice the classic shape of the back, created by two natural and opposing curves; starting from the base of the spine and moving upwards, you will see the first, lower curve.
Known as lumbar lordosis, this is a physiological curve in which the lumbar spine appears more anteriorly positioned and concave. Immediately above it, you will see that the dorsal spine instead shows a posterior convex curve.

In normal conditions, these two curves are harmonious and not too pronounced. However, if, on observing the youngster, you notice that one curve is more pronounced or protruding or that both are marked, then this could be a sign of a spinal disorder. In such cases, screening by a qualified professional or a consultation with a specialist spine doctor is strongly recommended.

In the same way, you might notice that the youngster’s back appears flat, with the physiological curves barely visible or not visible at all. This profile, too, can indicate the presence of a spinal disorder.

The spinal disorder most commonly associated with the rounded back or hunchback posture is hyperkyphosis, i.e. excessive curvature of the thoracic spine, evident on clinical examination as posterior protrusion of a section of the thoracic spine, often with the protruding vertebrae clearly visible under the skin.  

But how can a parent distinguish between incorrect posture and hyperkyphosis, a fairly frequent condition among youngsters?
Incorrect posture is always easily remedied simply by reminding the youngster to stand up straight: indeed, in this case, this action is enough to straighten his/her back completely.
In the presence of a spinal disorder, on the other hand, he/she will show more or less marked stiffness: even when he/she tries to stand up straight, part of the spine will remain curved due to the disease having stiffened his/her back.

Long kyphosis is another frequent vertebral alteration. In this case, the thoracic convexity extends down as far as the lumbar vertebrae, invading the space normally occupied by the upper part of the lumbar lordotic curve: the back, therefore, presents with a long convexity that reaches down to the base of the back.

Dorsal hyperkyphosis and long kyphosis are sometimes caused by Scheuermann disease, which is characterised by a wedge-shaped deformity of the vertebral bodies with anterior thinning of the vertebrae.
This makes it difficult and sometimes impossible for affected youngsters to hold their back straight: as a result, they become curled up like hedgehogs, and unfortunately, their growth exacerbates the vertebral deformity.

Conclusion

Like scoliosis, spinal deformities in the sagittal plane must be diagnosed early to allow timely and effective treatment. Families have the important task of trying to spot spinal disorders instead of simple cases of poor posture. Whenever they are in any doubt, they should always contact a specialist spine doctor for a proper diagnosis and necessary treatment.