Thoracic hyperkyphosis is a more rounded upper back than usual, where the natural forward curve of the thoracic spine is increased. It can be postural and flexible, structural as in Scheuermann's disease in teenagers, or develop with age and bone changes. Many people have few symptoms, but it can be linked to back pain, stiffness and reduced strength, and exercise can help.
Also known as hyperkyphosis, kyphosis, hunched back, Scheuermann's disease, Scheuermann's kyphosis, dowager's hump
Symptoms
- A visibly rounded upper back or shoulders that sit forward
- Aching or stiffness in the upper or mid back, especially after standing or sitting for long periods
- Difficulty standing fully upright or lying flat comfortably
- Tight chest muscles and reduced upper back movement
- In older adults, reduced balance or a feeling of leaning forward
- In teenagers, a curve that does not straighten when trying to stand tall
Causes and risk factors
- Long periods of slumped sitting and low upper back strength (postural kyphosis, which is usually flexible)
- Scheuermann's disease: wedge-shaped vertebrae that develop during adolescent growth, with a strong genetic component
- Age-related changes in the discs, muscles and posture
- Osteoporosis and spinal (vertebral) fractures
- Less commonly, inflammatory conditions such as ankylosing spondylitis or previous spinal injury
What the evidence says helps
- In adults over 45 with hyperkyphosis, a meta-analysis found that exercise programmes probably produce a small improvement in the curve, along with small gains in back muscle strength, quality of life and pain. No serious harms were reported.1
- Structured exercise programmes of around three months reduced the curve in both younger and older adults in a systematic review, although the quality of evidence was low to moderate.2
- Programmes that focus on strengthening the back muscles appear more useful for reducing the curve than stretching alone.3
- In young women with postural kyphosis, a course of manual therapy and a course of stretching and strengthening exercise gave similar improvements in curve and back strength in one trial.6
- For Scheuermann's disease, most people are managed without surgery through observation, exercise or physiotherapy, and bracing for moderate curves during growth. Surgery is reserved for severe, progressive or very painful curves.45
Things you can try at home
- Build upper back strength with exercises such as rows and gentle back extensions, little and often
- Break up long periods of sitting and change position regularly
- Practise standing tall against a wall, letting your chest open and shoulder blades settle back
- Gently stretch the front of the chest, for example in a doorway
- Keep generally active: walking, swimming and Pilates-style strength work all help
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- See a GP if a teenager's back is becoming more curved, especially during a growth spurt
- See a GP urgently for sudden new back pain or rapid loss of height, especially if you have osteoporosis or are over 50 (possible spinal fracture)
- See a GP urgently if back stiffness is worse in the morning and eases with movement, particularly if you are under 40 (possible inflammatory condition)
- Seek urgent medical help for numbness, weakness or tingling in the legs, unsteady walking or loss of bladder or bowel control
- See a GP if a rounded back comes with unexplained weight loss, fever or night pain
How Apollo can help
We assess spinal movement, strength and posture, and look for factors such as bone health that may need medical input. Care may include hands-on treatment where appropriate, a progressive strength and mobility programme, supervised clinical exercise or clinically informed Reformer Pilates, and advice for daily activities. Teenagers with suspected Scheuermann's disease are assessed by our paediatric osteopath and referred to their GP for imaging or specialist review where needed.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Can a rounded upper back be corrected?
A flexible, posture-related curve often improves with strengthening exercise and moving more. Research shows exercise can reduce the curve by a small amount in adults, and may also help strength and quality of life. Structural curves, such as Scheuermann's, change less but symptoms can still be managed well.
What is the difference between postural kyphosis and Scheuermann's disease?
Postural kyphosis is a flexible curve that straightens when you stand tall or lie flat. Scheuermann's disease is a structural curve caused by wedge-shaped vertebrae that develop during growth, so it does not fully straighten. An X-ray is usually needed to confirm Scheuermann's.
Is a rounded upper back a sign of osteoporosis?
It can be, as spinal fractures from osteoporosis can increase the curve and cause height loss. But many people with a rounded back do not have osteoporosis. If you are over 50 and notice height loss or a changing posture, ask your GP about bone health.
References
- Ponzano M, et al. (2021). Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment. Archives of Osteoporosis. View source
- Jenkins HJ, et al. (2021). Decreasing thoracic hyperkyphosis: which treatments are most effective? A systematic literature review and meta-analysis. Musculoskeletal Science and Practice. View source
- González-Gálvez N, et al. (2019). Effects of exercise programs on kyphosis and lordosis angle: a systematic review and meta-analysis. PLoS ONE. View source
- O'Donnell J, et al. (2023). Scheuermann kyphosis: current concepts and management. Current Reviews in Musculoskeletal Medicine. View source
- Tsirikos AI, et al. (2011). Scheuermann's kyphosis; current controversies. The Journal of Bone and Joint Surgery (British volume). View source
- Kamali F, et al. (2016). Comparison of manual therapy and exercise therapy for postural hyperkyphosis: a randomized clinical trial. Physiotherapy Theory and Practice. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
