Scheuermann’s &
Postural Hyperkyphosis

Kyphosis is a spinal disorder in which an excessive forward curve of the spine results in an abnormal rounding of the upper back.

The condition is sometimes known as “round-back” or—in the case of a severe curve—as “hunchback.” Kyphosis can occur at any age but it is common during adolescence.


Postural hyper-kyphosis, the most common type of Kyphosis, usually becomes noticeable during adolescence. Clinically it is noticed as poor posture or slouching but is not associated with severe structural abnormalities of the spine. The curve caused by postural-kyphosis is typically round and smooth and can often be corrected by the patient when asked to “stand up straight.” Postural-kyphosis is usually more common in girls than boys. This curve type needs to be carefully monitored because it can become a structural curve leading to permanent deformity if not managed.

Scheuermann’s Kyphosis, like postural-kyphosis, often becomes apparent during the teen years. However, Scheuermann’s kyphosis can result in a significantly more severe deformity than postural-kyphosis, because there is a structural component.

Rowan Berkowitz at work

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is caused when there is a structural abnormality in the spine. An x-ray from the side will show that in patients with Scheuermann’s kyphosis several consecutive vertebrae have a more triangular/wedged shape, rather than the norm of a rectangular shape. This irregular shape causes the vertebrae to wedge together toward the front of the spine, decreasing the normal disk space and creating an exaggerated forward curvature in the upper back. Scheuermann’s kyphosis usually affects the upper (thoracic) spine but can occasionally develop in the lower (lumbar) spine – where the thoracic curve meets the lumbar curve.

The condition is more common in boys than girls and stops progressing once growing is complete. Scheuermann’s kyphosis can sometimes be painful. If pain is present, it’s commonly felt at the highest part or “apex” of the patients’ curve. Pain can at times also be present in the lower back, which is a result of the spine trying to compensate for the rounded upper back, by increasing the natural inward curve of the lower back. Activity can make the pain worse, as can long periods of standing or sitting.

Modern state-of-the-art
Kyphosis brace designs

Reclination brace

The traditional way of treating a kyphosis-affected spine was with the Milwaukee brace – but the compliance was poor due to the visibility, which led to poor compliance and as a result, poor outcomes. This led to the perception that bracing didn’t work.

Today, state-of-the-art technology is used, and the latest designed back braces do not use distraction but rather decompression. The back brace is also professionally fitted, which greatly improves compliance. When worn at prescribed times, it can be effective at straightening a kyphosis-affected spine and preventing further curvature.


What are common forms of treatment for hyper-kyphosis?

Once the abnormal spine deformity has been detected, the specific vertebrae and angles involved would be recorded. At times exercise is used to try and delay progression or even to reverse the deformity, but in other cases, nothing may be done. Repeat x-rays will be done after six months to see if the deformity has progressed. If there is no sign of progression, then the same ‘treatment’ is continued and re-checked in another six months.


If the curve sizes of the abnormal spine are beyond satisfied measurements, then observation alone will not be sufficient. Bracing is recommended either for full-time use or night-time use. Bracing is designed to slow down and stop the progression and reduce the deformity. A very important element of this method is a specific physiotherapy program.  


Surgery is never easily considered, but in some cases, and despite the best attempts at bracing, the curves of the spine abnormality progress to such an extent that only surgical intervention can stop the progression. Spinal surgery is extensive, and this type of surgery halts the growth of the spine in the areas of the fusion. For these specific cases, surgery will only be considered, if needed, towards the end of the growth phase.

What is hyper-kyphosis?

Also known as roundback or hunchback, Kyphosis is a condition in which the spine in the upper back has an excessive curvature. Should you have Kypnosis there may be a visible hump on your upper back, and from the side, your upper back may be noticeably rounded or protruding. People with kyphosis will appear to be slouching and have noticeable rounding of the shoulders. Kyphosis can lead to excess pressure on the spine, which may cause pain. It may also lead to breathing difficulties due to pressure put on the lungs.

What causes hyper-kyphosis?

Hyper-Kyphosis can affect people of all ages, and it rarely occurs in newborns since poor posture is usually the cause. Hyper-Kyphosis caused by poor posture is called postural kyphosis.

Poor posture in childhood, like slouching, leaning back in chairs, and carrying a heavy schoolbag, may cause the ligaments and muscles that support the vertebrae to stretch. That can pull the thoracic vertebrae out of their normal position, which can then result in kyphosis. Other potential causes of hyper-kyphosis can include:

  • aging, especially if you have poor posture
  • muscle weakness in the upper part of the back
  • Scheuermann’s disease, which occurs in children and has no known cause
  • Scoliosis
  • arthritis or other bone deterioration diseases 
  • osteoporosis, or when there is a loss of bone strength due to age
  • an injured spine 
  • slipped discs
What are the treatment options for hyper-kyphosis?

The treatment for kyphosis will depend on the severity and underlying cause. Treatment could include regular x-rays to monitor progression on the curve, physical therapy, and a back brace. For congenital kyphosis, which is a severe case of Scheuermann’s kyphosis, spinal fusion surgery may be recommended to relieve pain and correct the curvature. Getting treatment to help correct the curvature of your spine could help reduce the risk of complications later on in life, including arthritis and back pain.