Typical X-ray image of a person with Scheuermann
Hyperkyfose
The human spine naturally has a kyphotic curve (rounded upper back) in the thoracic region and a lordotic curve (inward curve) in the lower back. A normal kyphotic curve ranges between 20° and 45°, as measured on a lateral (side-view) X-ray. When the curve exceeds 45°, it is referred to as hyperkyphosis.
Hyperkyphosis can occur as an isolated spinal condition or in combination with scoliosis. In cases where both conditions are present, the diagnosis is called kyphoscoliosis.
Increased kyphosis may be either:
- Postural, caused by poor posture, weak musculature, and suboptimal daily habits, or
- Structural, due to conditions like Scheuermann’s disease.
Hyperkyphosis affects the entire spine, and people often experience pain at the point of the most pronounced curvature, as well as in the lower back and/or neck. This pain pattern is common in both children and adults.
Postural Hyperkyphosis
Postural hyperkyphosis often responds well to physiotherapy and exercise tailored to improve posture and strengthen supporting muscles. In children and adolescents, the curvature is usually flexible and easier to correct. However, with age, the spine becomes more rigid, and the kyphosis may progress.
Adults with hyperkyphosis commonly report:
- Difficulty maintaining an upright posture, especially when sitting
- Shortness of breath during physical activity
- Fatigue in the spinal muscles
- Chronic pain in the back, especially the upper and lower areas
Scheuermann’s Disease
Scheuermann’s disease is diagnosed through a side-view X-ray, showing:
- Increased thoracic kyphosis (>45°)
- Three or more wedge-shaped vertebrae adjacent to each other
- Irregularities in the vertebral endplates, known as Schmorl’s nodes
- Thinner intervertebral discs than normal
Scheuermann’s most often develops in adolescents, particularly during the final phase of their growth spurt.
Over time, posture in individuals with Scheuermann’s may worsen, leading to a forward-hunched stance and increased spinal stiffness. This makes it more difficult to stand upright for extended periods. Breathing can become restricted due to the posture, and the back muscles often become fatigued. Pain may be felt in the lower back, mid-back, and/or neck.
Treatment
With appropriate conservative treatment, it is often possible to prevent the condition from worsening and to reduce existing symptoms. Because the disease presents differently in each person, treatment must be individually tailored.
Treatment may include:
- Physiotherapy-guided exercises
- Spinal mobilization
- Bracing
For children and adolescents still growing, international guidelines recommend bracing when kyphosis exceeds 50° to help slow the disease’s progression.