Kyphosis Physiotherapy

Kyphosis is an excessive forward curvature of the upper spine — a rounded upper back. It is not one condition. A flexible, postural kyphosis, common in younger people, can often be actively corrected and responds best to exercise. A structural kyphosis, such as Scheuermann's disease in adolescents, involves a fixed change in the shape of the vertebrae. And an age-related kyphosis in older adults is often linked to weakening muscles and to osteoporotic vertebral fractures. The right role for physiotherapy depends entirely on which of these you have — which is exactly what the surgical assessment is for.

For flexible and mild kyphosis, and for supporting posture and strength in most people, exercise-based rehabilitation is a sensible, low-risk first-line approach. For structural adolescent kyphosis, physiotherapy is usually an adjunct to monitoring and, in some cases, bracing. For a fixed, severe or progressing deformity, or one causing significant pain or, rarely, neurological symptoms, a surgical opinion becomes relevant. My job is to place you correctly on that spectrum. Physiotherapy and surgery are complementary parts of the same pathway, not alternatives competing with each other.

A physiotherapy programme for kyphosis, delivered by a therapist, is generally directed at strengthening the muscles that extend and support the spine, stretching tight structures at the front of the chest, improving postural awareness so a more upright position can be held, and maintaining mobility and balance. In older adults, strengthening the back extensor muscles is a particular focus. The aim is to improve posture, comfort and function; in flexible curves it may improve the curve itself, while in fixed curves the realistic goal is symptom control and preventing further deconditioning.

There is reasonable evidence that targeted exercise helps age-related hyperkyphosis. A randomised controlled trial of spine-strengthening and posture training in older adults found a modest but measurable reduction in the kyphosis angle and improvements in self-image, though benefits for general physical function were less consistent. Systematic reviews support exercise for improving hyperkyphotic posture. For structural adolescent kyphosis, the evidence for physiotherapy alone is weaker and of lower quality, and exercise is generally used alongside monitoring or bracing rather than as a stand-alone corrective treatment. The honest summary is that exercise can help posture, strength and comfort, with modest effects on the curve in flexible cases, and that expectations should be realistic.

Physiotherapy is low-risk and worthwhile for most people with kyphosis. As a surgeon, I would encourage review if the deformity is clearly progressing, if it is causing significant or worsening pain that is not settling, if you notice new numbness, tingling, weakness or problems with walking or with bladder or bowel function (which are uncommon but important), or if an older person's rounded back is associated with sudden new back pain, which can indicate a vertebral fracture. These situations warrant proper assessment rather than exercise alone.

• —Katzman WB et al. Study of Hyperkyphosis, Exercise and Function (SHEAF): spine-strengthening exercise RCT in older adults. (PMC5873977)
• —Bansal S et al. Exercise for improving age-related hyperkyphotic posture: a systematic review. (PMC3997126)
• —7th SOSORT consensus paper: conservative treatment of idiopathic and Scheuermann's kyphosis. (PMC2890418)
• —SOSORT — Management of spinal deformities and evidence of treatment effectiveness. (PMC5759105)