The Case Of Age Related Kyphosis Or ‘Hunchback’

hunchback, kyphosis

In Whistler where we live; everyone skis and everyone crashes! People get spinal compressions and sometimes compression fractures that they don’t even realize they have. As the years go on spinal curvature or kyphosis (hunch back or hump back)  can develop. Some good news here is that this may be moderated or stopped by active muscle control, exercises and physiotherapy.

Kyphosis is a medical condition of the thoracic or middle/top of a persons spine is curved, usually more than 40 degrees. Like a bridge the thoracic spine gets strength from the wedges being ‘wedged’ into place with each other and as the spine gets more curved that intrinsic strength weakens and at some point it can collapse into disrepair. Many causes exist for this including Scheuermann’s disease, multiple compression fractures  (our common cause) from injury, osteoporosis scoliosis, tumours and more.

Sometimes a  hunched back is caused by poor posture. A person who stands hunched or sits poorly can overload the spine causing muscle pain. This is not structural and more habit and is known as postural kyphosis.

While the spinal curvature may be moderated by active muscle control, thoracic curvature does not appear to be overtly controlled actively, as seen in the lumbar and cervical spines.    When the axial load is increased, the thoracic back extensors do show a higher level of activity compared to the extensors of the lumbar spine, but there is no associated alteration of the thoracic curvature unlike the change in the lumbar curve (Edmondston & Singer 1997).  Instead, the kyphosis is determined mostly by the shape of the vertebral elements and passive constraint of the posterior ligaments (Edmondston & Singer 1997), and is therefore subject to age related changes.  The thoracic kyphosis increases with age (Edmondston & Singer 1997).

A change in vertebral shape by progressive wedging (loss of anterior vertebral body height) occurs with increasing age, increasing the thoracic kyphosis.  The line of gravity lies anterior but close to the thoracic vertebral column which enables axial loading.  However if this gravity line is displaced anteriorly, there is an increased bending load, especially across the mid-thoracic vertebrae situated at the apex of the kyphosis, potentiating wedging of the vertebral bodies (Edmondston & Singer 1997).  Age related changes in the structure and density of the vertebral bodies is likely contributory to wedging (Edmondston & Singer 1997).

Age associated degeneration, and loss of disc height which is already relatively less than in the cervical and lumbar regions, is seen mostly in the mid region of the thoracic spine (Edmondston & Singer 1997, Singer 2004).  Interestingly, thoracic discs are show to have more viscous behaviour then lumbar and cervical discs (Edmondston & Singer 1997).  Therefore age related composition and structural changes may result in greater loss of compliance in the thoracic spine, which is significant due their role in segmental mobility (Edmondston & Singer 1997).

Finally, reduced mobility of the thoracic spine due to age related changes further reduces the ability to modify posture of the thoracic spine, which is already limited compared to the cervical and lumbar spines (Edmondston & Singer 1997).  This would set up a viscous cycle for an increasing kyphosis.

HOW DO I PREVENT OR MANAGE THIS ‘VISCOUS CYCLE OF INCREASING KYPHOSIS’

There are many ways depending upon the individual nature of the problem to address this. Factors such as computer desk set up, chairs and pillows can help with the work situation. Exercises targeted at strengthening the abdominals and spinal extensors can definitely help as well as targeted rolling and extension stretching, stretching the pectorals and anterior abdominals also can help. Fascial release by a trained sports physiotherapist or practitioner is helpful. Physiotherapists also can use spinal manipulation and mobilization  techniques to improve spinal motion as well as specific spinal mobility exercises. Sometimes braces and splits can be of help.  Each person is different so it is important to get a detailed biomechanics assessment by a musculo-skeletal trained physiotherapist or sports physio.

Written by Bianca Matheson, Sports Physiotherapist Back in Action Physiotherapy Whistler BC.

ABOUT OUR TEAM
Back in ACTION PHYSIO WHISTLER, ‘we keep you playing’ a whistler based Physio practice consisting of post-graduate trained specialist Sports Physiotherapists: Mike Conway, Therese leigh and Bianca Matheson. These 3 therapists are presently the sea to sky corridor’s only titled Diploma Sports Physiotherapists and have extensive experience and aim to strive for excellence in the field of sports injury and rehabilitation.

Please note: the above article is for guidelines only and is not intended to replace the therapist/patient relationship. Back in Action Physiotherapy also advises that rapid advancements and research into sports injuries mean articles may be outdated and a consultation is recommended for up to date information on injuries and conditions.