Mid & Upper Back

What It Is

Two line drawings of the upper body from the side, showing the chest, shoulder and upper back muscles as the shoulders round forward. — Rounded shoulders from the side — the front tightens and the upper back is left holding the load.

Hyperkyphosis is a curve in the spine that makes the upper back bend forwards too much, so that it looks hunched or rounded (NHS, 2025). Over the course of time, it can become quite excessive, and it's not uncommon to see it in older people. A worsening curve is linked with poorer physical function and a higher risk of falls (Koelé, Lems and Willems, 2020).

Hyperkyphosis can sometimes be called an "increased kyphosis". One should keep in mind that having a kyphosis is normal: the upper back naturally curves forward, and to not have a kyphosis would be considered abnormal (American Academy of Orthopaedic Surgeons, n.d.).

There Are a Number of Reasons Why It Happens

1. Poor Posture

Postural kyphosis is the most common type of kyphosis. It is usually caused by poor posture or slouching and often affects teenagers (NHS, 2025). The curve is usually smooth and can often be corrected by standing up straight (American Academy of Orthopaedic Surgeons, n.d.).

2. Scheuermann's Disease

Also called Scheuermann's kyphosis, this is a structural problem in which the backs of some of the vertebrae (the bones of the spine) grow faster than the fronts during childhood and the teenage years. This makes the vertebrae wedge-shaped and causes a forward curve in the upper back (NHS, 2025; American Academy of Orthopaedic Surgeons, n.d.). Unlike postural kyphosis, it can't be corrected just by standing up straight (American Academy of Orthopaedic Surgeons, n.d.).

3. Hereditary

Sometimes hyperkyphosis occurs in families, with children developing the "same spine as their parents". Research suggests that inherited factors play a part (Koelé, Lems and Willems, 2020).

4. Weak Back Muscles

An increased kyphosis is linked with weakness of the muscles that straighten the back (Katzman et al., 2010). Staying active and keeping these muscles strong is important.

5. Degenerative Disc Disease

Wear and tear to the discs between the vertebrae can cause them to thin, especially at the front, and this is linked with a greater forward curve in the spine (Katzman et al., 2010).

6. Osteoporosis

Osteoporosis (thinning of the bones) can lead to small fractures of the vertebrae, which can make the spine curve forward more (NHS, 2025; Katzman et al., 2010). However, not everyone with hyperkyphosis has a fracture: studies of older adults have found that only around 40% of those with the most severe curves have spinal fractures (Katzman et al., 2010).

Arthritis and spinal injuries can also cause kyphosis (NHS, 2025).

Hyperkyphosis Anatomy

The spine has a natural inward curve in the neck and lower back, known as a lordosis. The opposite of a lordosis is a kyphosis, which is the natural outward (rounded) curve of the upper back, or thoracic spine (American Academy of Orthopaedic Surgeons, n.d.). A normal upper back curve is about 20 to 45 degrees, and a curve of more than 50 degrees is called hyperkyphosis (American Academy of Orthopaedic Surgeons, n.d.). The ability of the spine to stay in position depends on many parts working together. All of the vertebral bodies in the spine need to be strong enough to adequately support the head and maintain the normal shape of the spine. Ligaments, facet joints and soft tissues in the back and neck have to be strong. The back muscles have to be capable of resisting the effects of gravity that works to pull the head forward. If any damage is sustained to any of these areas, kyphotic deformities can occur.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Hyperkyphosis

Treatment is usually only needed if the curve is causing problems (NHS, 2025). Exercises to strengthen the back muscles can help, but improvement is usually gradual (Katzman et al., 2010; Koelé, Lems and Willems, 2020). I can assess your posture, movement, strength and balance, and help with hands-on work and a back-strengthening programme. See the My Approach tab for how I work.

1. Physical Therapy

A physical therapist will help rehabilitate the postural changes and limitations that are associated with the condition, and physiotherapy can help improve posture and relieve back pain and stiffness (NHS, 2025).

2. Pilates/Yoga

Yoga, and similar classes such as Pilates, can be useful for improving the posture associated with an increased kyphosis, and some studies suggest yoga may help (Katzman et al., 2010; Koelé, Lems and Willems, 2020). Both help with flexibility and muscle strength. Strengthening your core muscles (the muscles around your tummy and lower back) can also help (NHS, 2025).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Brace: a rigid support worn around the body, used for some children with Scheuermann's kyphosis, under the supervision of a specialist (NHS, 2025).
Surgery: an operation to straighten the spine, considered only if the curve is severe, getting worse or causing very bad pain (NHS, 2025).
See your family doctor or nurse practitioner if you think you or your child might have kyphosis, or if a curve is getting worse, causing a lot of back pain or making it hard to breathe (NHS, 2025).

How I can help (see the My Approach tab)

Hands-on work for a tight chest, shoulders and neck and a stiff upper back
Exercises to strengthen the muscles that hold you upright
Posture, breathing and everyday movement advice

Tips

Avoid repetitive forward bending if you do it a lot during the day. When bending or lifting, bend at the hips and knees and keep your spine in a neutral position (Katzman et al., 2010).
Keep your back in a neutral, upright position when sneezing or coughing, for example by hugging a pillow or placing your hands on your knees. Avoid bending forward forcefully (Katzman et al., 2010).
Change the manner in which you get out of bed. Rolling onto your side before sitting up, rather than sitting straight up from lying down, avoids putting forward-bending stress on your spine (Katzman et al., 2010).
Make any necessary changes in your environment to help support the posture, such as using a supportive chair or back cushion when sitting. I can give you specific recommendations for your condition.
Avoid exercises requiring a great deal of bending forward, such as crunches, sit-ups and toe-touches (Katzman et al., 2010).
Ask me about posture correction exercises, or back extension (back-straightening) exercises (Katzman et al., 2010).

Treatment

My Approach

Line drawing of the ribcage from the front with the dome of the diaphragm beneath it. — The diaphragm under the ribs — the muscle the breathing work is trying to get moving again.

A rounded upper back can be a habit the muscles have settled into, or structural, where the bones themselves have changed shape, as in Scheuermann's or after spinal fractures from osteoporosis. Massage can't change the shape of the bones, so with a structural curve I treat what comes with it: aching, tight or tired muscles, stiffness, and strain on your neck and shoulders. With a postural curve, we also work on opening things up and building the strength to hold you upright.

I start by asking about your health history and any medicines, then assess your posture, how your spine, ribs and shoulders move, your back strength and flexibility, and your balance and walking. If thinning bones or a fracture are possible but haven't been checked, I'll ask you to see your family doctor or nurse practitioner first. Please bring any X-ray or scan reports you have.

Hands-On Treatment

Warmth, then myofascial work, trigger point work and contract-relax stretches for the chest, the front of the shoulders and the neck
Gentle mobilisation of the stiff joints of the upper back and ribs, never with quick thrusts
Brisk work and cool applications for the overstretched, sore muscles between the shoulder blades, rather than stretching them
If your bones are thin, lighter pressure and no forceful joint work

Work on the chest wall muscles is only with your informed consent and a written consent form, and you can say no at any time.

Exercise and Habits

Back extension and shoulder blade strengthening, starting face down with just your body weight and building to light weights
A doorway chest stretch at three arm heights, each held for at least 30 seconds
Balance work if you feel unsteady on your feet
Breathing into your belly rather than the top of your chest
Breaking up long spells in one position, lifting your breastbone gently, and support for your low back when sitting
A home programme between visits

What to Expect

Typical Course

Typical course: Most people come weekly for about 6 weeks, sometimes twice a week at the start, then we reassess and space visits out as you manage more on your own. Expect aches and stiffness to ease and posture habits to improve gradually over several weeks to a few months of regular exercise; with a structural curve, the aim is comfort and function rather than changing the curve.

What I Focus On

Assessment

Chest & Shoulder Release

Upper-Back Mobility

Back & Shoulder Blade Strength

Posture & Breathing Habits

Sources

References

NHS (2025) Kyphosis. Available at: https://www.nhs.uk/conditions/kyphosis/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Kyphosis (roundback) of the spine. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/kyphosis-roundback-of-the-spine/ (Accessed: 7 October 2026).
Katzman, W.B. et al. (2010) 'Age-related hyperkyphosis: its causes, consequences, and management', Journal of Orthopaedic and Sports Physical Therapy, 40(6), pp. 352–360. doi: 10.2519/jospt.2010.3099.
Koelé, M.C., Lems, W.F. and Willems, H.C. (2020) 'The clinical relevance of hyperkyphosis: a narrative review', Frontiers in Endocrinology, 11, p. 5. doi: 10.3389/fendo.2020.00005.

Massage therapy · Kitchener–WaterlooHyperkyphosis

What It Is

There Are a Number of Reasons Why It Happens

1. Poor Posture

2. Scheuermann's Disease

3. Hereditary

4. Weak Back Muscles

5. Degenerative Disc Disease

6. Osteoporosis

Hyperkyphosis Anatomy

Self-Care & Treatment

How to Treat Hyperkyphosis

1. Physical Therapy

2. Pilates/Yoga

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Habits

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooHyperkyphosis

What It Is

There Are a Number of Reasons Why It Happens

1. Poor Posture

2. Scheuermann's Disease

3. Hereditary

4. Weak Back Muscles

5. Degenerative Disc Disease

6. Osteoporosis

Hyperkyphosis Anatomy

Self-Care & Treatment

How to Treat Hyperkyphosis

1. Physical Therapy

2. Pilates/Yoga

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Habits

Typical Course

References

Related Conditions

Hyperlordosis

Headaches

Thoracic Outlet Syndrome

Shoulder Impingement Syndrome

Book a session