Thoracic Hypokyphosis – physio Horsham

Thoracic hyperkyphosis is described as an excessive anteroposterior curvature of the thoracic spine of greater than 40°.

• The angle increases with age and no uniformly accepted thresholds for defining either hyperkyphosis or “normal” thoracic spine changes associated with aging
• More common in females than males

Normal kyphosis angles vary between

• 20° and 40° in the younger public
• 48° to 50° in women and about 44° in men in older populations

Clinically Relevant Anatomy

The thoracic part of the spine natural kyphosis. This thoracic curvature is the result of a slight wedging of the vertebrae.

• The normal degree of thoracic convexity (20-40 degrees) is measured in the sagittal plane.
• Thoracic hyperkyphosis is a defect that is easy to see from the side (lateral view), and occurs when the thoracic flexion curve is over 40°.

Line of Gravity

• In standing postures, the gravity line passes ventral to the vertebral bodies.
• The load of the gravity will increase the thoracic kyphosis.
• Bending forces bring anatomical changes.
• Anatomical changes include – passive constraint of the posterior ligaments; contraction of the deep one-joint muscles and thoracic parts of the long extensors.

Etiology

There is no widely accepted definition of hyperkyphosis therefore the prevalence of hyperkyphosis is not precisely known.

• The prevalence of hyperkyphosis increases with age in women and men, with the greatest change in the angle of kyphosis occurring among women age 50 to 59 years.
• Estimates range between 20 and 40 percent among community-dwelling individuals aged ≥60 years.
• Studies have reported kyphosis increases by about 9 degrees per decade.
• Level of kyphosis increases with age. Often after the age of 40.
• Difference in gender, namely, hyperkyphosis appears commonly more rapidly in women than in men.
• Risk factors also for evolution of thoracic hyperkyphosis include musculoskeletal, neuromuscular and sensory impairments
• Some people have an idiopathic cause.
• Psychosocial factors play a role ie Depression, Anxiety, Insecurity, Despondency.

Biomechanical Factors in thoracic hyperkyphosis

• Higher spinal loads and trunk muscle force in an upright stance. Accelerate the degenerative process and contribute to dysfunction and pain
• Daily activities with poor posture eg protruding head positions and loss of shoulder range induced by slouched sitting; ill-fitting school desks; overloaded backs, and backpacks. 

Clinical Presentation

• Most prominent symptom appearance of a rounded back (an exaggerated anterior curvature of the thoracic spine).
• Change in back posture is mostly gradual over time.
• Thoracic back pain
• Respiratory compromise. Thoracic hyperkyphosis could have detrimental effects on breathing.
• Restricted spinal range of motion
• Osteoporotic fractures.
• Having difficulty getting up from a chair, out of bed, or out of the bathtub
• Walking more slowly
• Feeling “off-balance,” and/or losing your balance, or almost falling
• Feeling more tired than usual (fatigue)
• Having difficulty breathing (in more severe cases).

Management

Physical management should be considered as a first-line approach. 

In terms of medications, antiresorptive or bone-building medications are taken by patients with thoracic hyperkyphosis due to their low bone density or spine fractures. Osteoporosis treatment helps to prevent incident spine fractures, however, no medications have been shown to improve hyperkyphosis.

Physical therapy 

Physiotherapy for thoracic hyperkyphosis, including manual therapy, taping and bracing, should be implemented in an early stage and is regularly a first-line treatment. The main goal of any therapy for patients with thoracic hyperkyphosis is to reduce the excessive antero-posterior curvature as well as improve the physical function and decrease the pain. Recognition and treatment of hyperkyphosis could contribute to a reduced risk of falls, fractures, and functional limitations.

ANRC PHASES OF REHABILITATION 

• Phase 1 – Pain management using modalities such as heat, ice, and electrical stimulation such as transcutaneous electrical nerve stimulation (TENS)and IFT, myofascial release and trigger point therapy.
• ^{Phase 2 – Restoration of range of movement, stretching for the tighten muscles and strengthening for the weaken muscles, breathing exercise (Diaphragmatic breathing) and self-mobilization techniques to expand the ribcage with proper instructions from physio at ANRC Rehabilitation, joint mobilization, postural training, scapular setting exercise, bracing, taping, spinal orthosis if needed.}
• ^{Phase 3 – Mainly concentrating on spinal strengthening exercise along with stretching and breathing exercise, core strengthening exercise, preventive measures with proper instruction from us, postural training, workplace modification.}