From childhood till the age of 30, the angle of the spine changes due to the increased weight on it - from 20 degrees to 29 degrees. After you turn forty, the angle rapidly increases as the degenerative processes of aging begin.
Because osteoporosis (weakening of the bones) is more common in women, so is Dowager’s hump. With osteoporosis you get weaker spinal bones, which leads to a higher disposition towards Dowager's hump.
Among men, the average curvature angle is around 44 degrees. In women, it can range from 3 degrees at age 55 to 52 degrees at age 80. You'll notice that people get shorter as they age. The average person loses about half an inch with every decade due to the compression of the spine.
Measurement Of Hyperkyphosis
The gold standard for measuring hyperkyphosis is an X-ray. These radiographs are the best tool for orthopedic assessment of the thoracic or chest kyphosis angle. If the person can't stand for some reason, they can do a supine radiograph, but the lateral or sideways X-ray is the best.
The kyphosis angle (or "Cobb's angle") is measured by drawing perpendicular lines on the radiograph. The line extends through the upper endplate of the vertebral body, where the thoracic curve starts at the T4 vertebrae and the lower endplate of the vertebral body at the end of the thoracic curve at T12 vertebrae.
Common Causes Of Dowager's Hump
Dowager's hump has not received the kind of scientific attention, osteoporosis, stroke, and cancer receive. Because it's considered part of the normal "aging" process, it hasn't been studied in great detail. As a result, the causes of Dowager's hump haven't been fully described. Yet, a few common causes for its occurrence have been identified
Degenerative Disc Disease
In many people with Dowager's hump, radiographic findings have revealed degenerative disc disease. The majority of older adults who do have Dowager's hump tend to have degenerative disc disease, without evidence of vertebral fractures or osteoporosis.
Vertebral Fractures
As the number of vertebral fractures increases, the kyphosis becomes more pronounced. This applies more so for thoracic/higher vertebral fractures than lower/lumbar fractures. Women who have multiple anterior thoracic wedge fractures have very prominent kyphosis. If you’ve had vertebral fractures in the past, you are at risk of developing Dowager's hump.
If you have Osteoporosis the daily stress on the spine can cause it to develop compression fractures and vertebral wedges. Osteoporosis is a condition where the bones soften and become weak, due to a lack of dietary calcium and vitamin D. With time, as the number of wedges increase, the density of the bone mineral decreases. This leads to more compression fractures. This creates a vicious circle that increases the likelihood of getting hyperkyphosis.
Weak Muscles
Weak spinal extensor muscles are associated with Dowager's Hump, according to studies. We have large back muscles holding up the spine. In post-menopausal women in good health, the weaker the spinal muscles, the higher the kyphosis angle. Exercise can strengthen the spinal muscles and thus hold the spine erect. This will help maintain the natural curvature of the spine. If you think only the spinal muscles can affect the spine, think again. In reality, posture is affected by many muscles of the body.
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Impaired Mobility
Age affects many of the contributing, ligaments, joints, muscles, and connective tissues, all of which affect posture. How they may contribute to kyphosis is not yet identified. However, with decreased spinal mobility, the ability to maintain a good posture and stand erect is reduced.
Genetics
Birth defects can cause kyphosis. If you were born with spinal defects, it can cause you to have a kyphotic spine later in life. One of these is Scheuermann's disease or Scheuermann's kyphosis. Commonly seen in boys, it can cause kyphosis. Here, the curvature increase occurs before the pubertal growth spurt occurs and can severely affect the spine.
Symptoms Of Dowager’s Hump
Physical and Functional Symptoms
Excessive hyperkyphosis can severely affect your physical and functional limitations. Women who have a severe Dowager's hump have difficulty simply raising themselves from a chair. You will also have a reduced balance, slower gait, require a broader stance to support yourself, and cannot climb stairs quickly. As a result, you might be more prone to falls. Osteoporotic women tend to have a higher postural sway which also adds to their risk for falls.
If you have Dowager's hump, then your overall level of functioning is affected. You have difficulty doing necessary activities around the house and their scores when it comes to activities of daily living are much lower compared to their healthy peers. If you're developing Dowager's hump, you might also notice the following symptoms:
- Muscles fatigue easily
- Gradual postural changes
- Chronic pain in the back, neck, and shoulders
- Loss in height
- Multiple vertebral compression fractures
- Protruding abdomen
- Repeated falls
- Back stiffness
- Pain in the hips
- No sensation in the chest area
Respiratory Symptoms
If you have Dowager's hump, you might experience difficulty breathing. The added kyphosis puts pressure on your lungs, affecting their expansion and thus breathing. Breathing exercises and focusing on strengthening spinal muscles can help you to breathe fuller.
Digestive Symptoms
Severe progression of the Dowager's hump can compress your digestive tract. As a result, you may have trouble with swallowing.
Psychological Symptoms
Dowager's hump is disfiguring. Since most people don't understand how it occurs and that it's a part of natural aging, you may have to suffer labels such as "hunch-back" etc. All of this can psychologically affect you. In younger adults, it can lead to shame, aggression, and anxiety. Older individuals might feel isolated socially, and you may even feel depressed.
Quality of Life
With limited mobility and physical deformity, some women report physical difficulties with everyday living. If you're a woman with Dowager's hump, you may also require more adaptation and have higher fears about your ability to function. Overall, men and women who live with this condition, are less satisfied with their health, functioning, relationships, and economic conditions. As a result, you might limit your outdoor activities and public life, and this impairs your quality of life and level of functioning. Don't let Dowager's hump from living your best life. Have yourself diagnosed and then treated.
Diagnosing Dowager's Hump
Apart from Xray's, your doctor might suggest doing a CT scan, and an MRI may be recommended. He will do this is to evaluate your bones, the disc, the disc space, and to rule out any tumors or secondary causes of your symptoms. The doctor may also conduct a thorough physical examination.
Treating Dowager's Hump
There are many treatment options for Dowager's hump. They range from physiotherapy to surgery. The sooner you treat it, the more effective you will be in halting its progression. Studies have shown that with the right exercises and treatment, Dowager's hump can be halted from getting worse if identified and treated early. Here's a look at some of them.
Physiotherapy And Example Exercises
Physiotherapy is the mainstay of the treatment of Dowager's hump. If you take medications or get surgery, the muscles, joints, and bones that assist and make up your spine need to be strengthened. Your treatment choice will vary depending on the severity, but it will have to be supplemented with physiotherapy if it isn't your primary treatment choice.
Medically reviewed by Timothy Gossett, M.D. — Written by Jill Seladi-Schulman, Ph.D. on September 17, 2019
- Symptoms
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You may have heard of a “dowager hump,” but this isn’t a medical term or even an acceptable term. It refers to a curving of the spine that can result in an upper back that appears rounded or hunched.
The appropriate medical term for this type of condition is kyphosis.
Continue reading as we explore more about kyphosis, what causes it, and how it can be treated.
Language mattersMany people find the word “dowager” offensive because it has been a negative and insulting way to refer to older women.
Using appropriate medical terms for health conditions is important because outdated and hurtful terms generalize and stereotype individuals with medical conditions. Kyphosis, for example, can actually affect individuals of any gender or age.
The human spine has a natural curvature. These curves help us to stand upright and stay balanced while doing so.
Kyphosis happens when the angle of the spine is out of the typical range. The condition can vary in seriousness. Generally speaking, the greater the curve of the spine, the more severe the symptoms are.
The symptoms of kyphosis can include:
Although rare, more severe symptoms can occur as the spine continues to curve over time and compress other parts of the body, such as the lungs, nerves, and digestive tract.
Severe complications of kyphosis can include:
A variety of factors can lead to the development of kyphosis. They include:
Poor posture
Poor posture can include things like:
- slouching or hunching, such as at a computer or in front of a TV
- leaning back in chairs
- carrying heavy loads on your back, such as a backpack full of books
Postural kyphosis is a common form of kyphosis that’s generally mild. People with postural kyphosis can often correct the condition by practicing good posture.
Spinal injuries
Some spinal injuries, such as fractures, can damage the spine and affect its curvature.
Conditions affecting the bones or spine
Underlying bone or spinal conditions can also lead to kyphosis, particularly in older populations. Some examples of these conditions include degenerative disk disease and osteoporosis.
Aging
Curvature of the spine begins to increase naturally with age. It’s estimated that the prevalence of kyphosis in older adults ranges from 20 to 40 percent.
In addition to bone and spinal conditions, other factors that naturally occur with aging can contribute to the development of kyphosis, including:
- Decreased mobility. This can affect the muscles and ligaments in the back as well as posture and positioning.
- Muscle strength. Studies have reported that weakened back muscles, specifically the spinal extensors, are correlated with an increased kyphosis angle in women older than 60.
- Sensory changes. Decreased input from the senses, which can include things like vision, touch, and spatial awareness, can also affect posture and positioning of the head or neck.
Developmental conditions
Sometimes kyphosis can occur as a congenital condition. This happens if the spine doesn’t develop properly prior to birth.
Kyphosis can also occur when the spine doesn’t develop properly during a growth spurt. This is called Scheuermann’s kyphosis. Instead of rectangular-shaped vertebrae, people with this condition have vertebrae that are more triangle-shaped. This causes increased spinal curvature.
Cancer
Cancer of the spine can lead to weakening of the vertebrae, possibly contributing to kyphosis. Additionally, chemotherapy and radiation treatments for cancer can have a similar effect.
To diagnose kyphosis, your doctor will first perform a physical examination. They’ll record your height, examine your back, and may also press on your spine to see if there’s any pain or tenderness.
Then, they’ll ask you to bend forward with your arms hanging down freely, like you’re reaching to touch your toes. This helps them to better see the curve of your spine.
You may also be asked to lie down. This can aid your doctor in determining if your kyphosis is caused by bad posture or by a structural problem in the spine. The spine may straighten while lying down in people with postural kyphosis.
An X-ray can help determine the amount of curvature in the spine. If your doctor wants more detailed images, they may also use a CT scan or MRI.
In cases of severe kyphosis, your doctor may perform other tests to see if your condition is affecting other parts of your body. These can include tests that evaluate lung and nerve function.
When to see your doctorIn some people, mild kyphosis may not cause symptoms. But if you start to notice an increase in pain, numbness or weakness, or spinal curvature, make an appointment with your doctor.
There are several treatment options for kyphosis, depending on your overall health and the severity of your condition. Your doctor will work with you to develop an appropriate treatment plan.
If you’re concerned about your kyphosis and don’t already have a primary care provider, you can view doctors in your area through the Healthline FindCare tool.
treatment options for kyphosisSome possible treatment options include:
- Proper posture. For people with postural kyphosis, attention to good posture, such as sitting up straight, can help correct the spinal curvature. Ergonomics may also help.
- Exercise. Getting regular exercise can help strengthen the muscles in your back.
- Yoga. Yoga can help you to increase flexibility and strengthen the muscles in your back and core.
- Pain relief. Over-the-counter (OTC) pain medication can help to ease back pain that’s associated with kyphosis. If these don’t help with pain, your doctor may prescribe a stronger medication.
- Treating underlying conditions. If you have an underlying condition such as osteoporosis, your doctor will focus on treating it to prevent your kyphosis from getting worse.
- Bracing. Using a back brace can help keep spinal curvature from worsening, particularly in younger people who are still growing. Your doctor will let you know when and for how long you should wear the brace.
- Physical therapy. Your doctor may recommend that you work with a physical therapist to perform exercises and stretches that can help improve your condition.
- Surgery. People with severe kyphosis or complications from kyphosis may need surgery to reduce the curve in their spine. This is often performed using spinal fusion.
The outlook for kyphosis can depend on several factors. These include your overall health, your age, and the severity of the condition.
If it’s detected early, many people who have kyphosis can go on to live active lives and may not require surgery. Regular doctor’s appointments may be necessary to monitor the condition and make sure that spinal curvature isn’t worsening.
Kyphosis can worsen with age, which is why early detection is so important. Severe kyphosis can cause complications, such as problems with movement or balance and breathing difficulties. These cases may require treatment with surgery.
Kyphosis is a condition where the spine curves at an increased angle, causing a rounding or hump to form around the upper back or shoulders. There are many possible causes of kyphosis, including aging, poor posture, and spinal conditions.
In the past, kyphosis was referred to as “dowager’s hump”. However, this isn’t a medical term and is no longer acceptable to use. Even though kyphosis is common in older adults, it can occur in people of all ages.
If identified early, kyphosis can often be managed without surgical intervention. If you notice an unusual curve in your upper back or shoulders that has increased over time, see your doctor to discuss your condition.
Last medically reviewed on September 17, 2019
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