Hyperkyphosis: massage methods, stretching exercises and mobility

1. General information about incorrect posture
2. What is thoracic hyperkyphosis
3. Symptoms of thoracic hyperkyphosis
4. How do we know if we have thoracic hyperkyphosis? 
5. The most common cause of thoracic hyperkyphosis
6. Muscle imbalances in thoracic hyperkyphosis 
7. How to improve your posture

• Massage methods
• Stretching and mobility exercises
• Muscle strengthening exercises
• Tips for avoiding incorrect positions

General information about incorrect posture

Incorrect posture is increasingly common nowadays, not only among adults, but also among children, who, due to the development of technology and the use of various devices, are gradually starting to develop poor posture. Aspects of modern life, such as using a smartphone, sitting in front of a laptop, and slouching against the back of a chair, are important factors affecting body posture. Prolonged use of these devices leads to the head tilting forward and the development of what is known as a "hump."

You will now notice that many young people have a curved upper back, otherwise known as thoracic hyperkyphosis.

Although everyone is susceptible, and incorrect posture has practically become something normal, the consequences are more severe than you might think.

In this article, we will talk about the "hump" and why you cannot ignore this posture if you have it or see it in your children. Then, we will explain how to correct it with exercises that can straighten it out. Please note that the purpose of this article is to address thoracic kyphosis caused by muscle imbalances, and not structural problems, such as arthritis, bone deformities, or hyperkyphosis caused by Scheuermann's disease. If thoracic kyphosis is caused by any of these problems listed, we advise you to undergo some more thorough investigations.

What is thoracic hyperkyphosis? 

Thoracic kyphosis is the technical term for the usual "hunched" position, where the upper part of the back is rounded and the chest is pulled inward. Instead of standing up straight as in a normal, healthy posture, a person with thoracic hyperkyphosis will be leaning forward and will have to tilt their head up and back in order to maintain a normal visual line, which can also lead to vision problems. The thoracic spine is the region of the spine that extends from the neck down to the abdomen.

Symptoms of thoracic hyperkyphosis

A rounded upper back is the main symptom of hyperkyphosis. Kyphosis can cause pain in the upper back area, especially with certain movements, due to compression of the intervertebral space or the nerves. Stiffness in the spine can also occur due to degeneration of the intervertebral discs. Thoracic hyperkyphosis and stiffness of the thoracic spine can cause a forward head position. As the spine rounds, the pelvic area also suffers, especially the hamstring muscles, which shorten and stiffen. In severe cases, hyperkyphosis can cause pressure on the lungs and can lead to breathing problems.

The good news about thoracic hyperkyphosis is that it can be corrected. You need to address it as early as possible, because the more time passes, the harder it is to correct and the more problems it can cause.

Here are a few reasons why you should take this postural problem seriously:

Spinal problems

If you don't fix your hyperkyphosis problem, you are also predisposed to other associated problems, such as lumbar hyperlordosis, which is an excessive curvature in the lumbar area. When the upper back is rounded, the lumbar area also begins to curve in the opposite direction, leading to excessive "S"-shaped modeling of the spine in the sagittal plane. The vertebrae are designed to sit one on top of the other in a vertical column with physiological curves. When there is excessive curvature throughout the entire spine, the intervertebral discs must absorb much more shock. This increases the risk of spinal health problems, because the increased "load" on the discs can restrict the blood flow that keeps them healthy.

Neck pain and forward head posture

To compensate for the rounded back, you have to bring your head forward in order to maintain an upright position. Your back is meant to support the weight of your head, but with a forward head position, the neck bears almost all the weight. In fact, just a few centimeters of forward head position can double or triple the weight load on the cervical spine. Like cervical hyperlordosis, the extra weight and unnatural position put the health of your spine at risk. It also causes tension in the neck muscles, which can lead to neck pain and headaches.

Affects appearance and confidence

In addition, thoracic hyperkyphosis doesn't look good on anyone, and appearance can also affect how we feel. The way you carry yourself physically translates into who you are as a person, in terms of confidence and self-worth. No one wants to have this type of posture, especially as a child or teenager. Fixing your posture is a very important aspect when it comes to getting a good start in life.

Gets worse with age

As you age, thoracic hyperkyphosis predisposes you to neurological problems caused by restricted blood flow to the brain. It has been shown that there is a risk of fractures in the elderly due to the way it affects mobility. The longer you have thoracic hyperkyphosis, the more it will worsen over time.

How do we know if we have thoracic hyperkyphosis?

It is fairly easy to tell if you or your child has thoracic hyperkyphosis. Thoracic hyperkyphosis is just one of the many posture problems you can have, but it is also the most common one. You may only have forward shoulders and internal rotation, but not hyperkyphosis. When the shoulders are protracted and internally rotated, the shoulder blades also stick out instead of lying flat against the chest wall. This can give the impression of a "hump," but it is not necessarily thoracic hyperkyphosis. To diagnose hyperkyphosis, you only need to look at the spine, and the best way to do this is to compare it against a wall.

Test to determine hyperkyphosis:

1. Stand with your back against a wall
2. Press your back against the wall so that the entire spine is in contact with it, from the neck down to the tailbone area
3. Avoid arching your lower back in order to press the upper part against the wall. Maintain a neutral spine.

If you cannot press your entire spine against the wall, due to curvature at the thoracic level, you may have thoracic hyperkyphosis.

The most common cause of thoracic hyperkyphosis

As discussed above, the main cause is maintaining incorrect posture for a long period of time. Thoracic hyperkyphosis involves an imbalance between the back muscles and the chest muscles. This usually happens over time, due to maintaining poor posture. When we sit with a rounded back and leaning over with our head above a smartphone, the chest muscles are shortened and contracted while the back muscles are long and stretched. Over time, the muscles adapt to these positions. Because the chest muscles are contracted, and the shoulders are also pulled forward, the chest begins to collapse inward. At the same time, the muscles in the upper back area lose their tone and are not strong enough to counteract the position. The chest muscles remain shortened and contracted as long as we don't stretch enough. It takes about 20 minutes for the muscles to develop tension and, as a result, bring about deformities through changes in posture. To fix your posture, you need to address these muscle imbalances.

Muscle imbalances in thoracic hyperkyphosis 

In particular, the pectoral muscles, the upper abdomen, and the front part of the intercostal muscles are the shortened muscles, and also the most affected in thoracic hyperkyphosis. First of all, it helps to stretch these muscle groups.

The weak and overstretched muscles are those of the spinal erectors. Along the spine, we have small stabilizing muscles that make up the erector spinae group. The thoracic erector spinae supports the thoracic spine and is affected when we have hyperkyphosis.

How to improve your posture

For this, you need a multifunctional approach. First, you need to discover the causes that led to this incorrect posture; second, you need to perform mobilizations and release tension from the soft tissues, such as the muscles; and third, you need to strengthen a particular muscle area. If we take these things step by step, we will achieve the desired results.

It is very important to observe poor posture in our children, whether it involves the limbs, but especially the spine: whether we're talking about sitting at a desk doing homework, or about free time spent playing on a phone, tablet, or simply on the floor with toys, we need to pay attention to how we sit and how we hold our backs during these activities.

As a way of approaching the exercises that you can or cannot do with your child once you notice that they have problems, you should first ask for the advice of a specialist. This is because many of the exercises only work in certain combinations. For example, crunches alone are not recommended, because they perform trunk flexion, and thus we would already be working a part of the musculature that is already under tension.

Massage methods

Massage to release tension in the muscles around the spine is always a first step in correcting the curvature. Through massage, we bring a large supply of blood to that area and can thus relieve tension in it; we can also use various instruments for this purpose. But be very careful when using them on children's sensitive skin. This type of massage is called myofascial release. We can also use self-massage techniques, especially for older children and teenagers. Here are a few ideas:

• Ball massage – the ball needs to be firm, like a tennis or golf ball. Lie on your back with 2 balls placed on either side of the spine at the level of the shoulder blades, and roll on these balls. To apply even more pressure to the area, we can lift the pelvis off the floor. It can be a little painful, but by practicing this massage daily, we can relax the muscles a great deal.
• Ball massage at the pectoral level – here we target the muscles on both sides of the body located between the shoulder and the sternum. There are various ways to do this; the gentlest method is to do this massage with the opposite hand. To apply more pressure using body weight, try doing it against a wall and rolling the ball against it. The same thing, but with much greater pressure, can be done lying face down with the ball between the floor and the pectoral muscle.
• Ball massage at the abdominal level – besides the chest, the abdominal muscles also suffer, so we can also perform this myofascial release massage here. Lying face down with the chest up and the elbows supporting the body's weight, place a ball under the muscles of the upper abdomen on one side. Here we can adjust the pressure on the muscles by shifting the body's weight. Make sure the pressure is never strong. Gently roll the ball up and down along the abdomen and then move it to the other side.

Stretching and mobility exercises

Stretching the spine is the key point in its mobility. This is achieved by mobilizing the intervertebral joints. Daily stretching makes the spine much more flexible. Just as important in the treatment of hyperkyphosis is chest stretching. This is recommended to be performed at least 3 times a day.

1. Upper back – for this stretch, you need to force the back to flex in the direction opposite to the kyphosis by pushing your hands into a wall. Position your hands above your head on a wall, push your hands into the wall while bringing your pelvis forward. It's important here to try to keep the lumbar spine in as physiological a position as possible.
2. Thoracic extension – for this stretch, you need a foam roller to force the upper back into extension. This is a slightly more intense exercise than the one above, because the roller puts a lot of force on the spine. Lie on your back with the foam roller under your shoulder blades, hands behind your head, letting your body work with its own weight. The pelvis stays on the floor, and try to keep the lumbar spine in as neutral a position as possible.
3. Abdominal stretch – releasing tension in the abdominal muscles helps the spine reach as neutral a position as possible. It is performed from a yoga position called Cobra, which stretches not only the abdominal muscles but also the chest muscles. Lie on your stomach with your legs together, palms on the floor level with your shoulders, and elbows up. Raise your body off the floor as high as possible with your elbows extended, without lifting your hips off the floor. With emphasis on stretching the upper back area and lifting the chest toward the ceiling.
4. Chest stretch – this stretch of the pectoral muscles is very helpful in correcting hyperkyphosis and is very simple to perform; you only need a doorway. Stand in a doorway, with your palms on the door frame and your elbows at 90 degrees, and lean forward to feel the stretch in the pectoral area and the front part of the shoulder.

Muscle strengthening exercises

Strengthening the back muscles causes them to contract, so that they help you keep the spine in an upright position, instead of allowing it to curve. These strength exercises are easy to do at home and should be performed daily.

• Superman – in this exercise, the abdominal muscles stretch while the back muscles contract. It is a bodyweight exercise; all you need is a mat. Lie on your stomach with your arms extended in front of you, alongside your ears. In a single motion, lift your arms, legs, and chest off the floor, as high as possible. Hold for 2-3 seconds and slowly return to the starting position. If this is too difficult at first, you can do this exercise with your arms alongside your body.
• T-Hold, Y-Hold, and Cobra posture – holding the T and Y positions involves holding light weights and raising the arms while keeping the upper body lifted. It is similar to the Superman exercise, but much more difficult because there is added weight and only the upper body is lifted. If it is still too difficult, it can also be performed without weights. Lie face down on a mat with a weight in each hand, lift your chest off the floor, allowing the lumbar spine to curve but still trying to keep it as neutral as possible. The arms are held so that they form the letter "T" for 3-5 seconds. The same thing is done, but this time the arms form the letter "Y," the latter being slightly more intense.
• Wall Press – this exercise is very effective in strengthening the spinal muscles. From a standing position with your back against a wall, arms with elbows bent at 90 degrees and pressed against the wall or as close to it as possible. Extend your chest and bring your shoulder blades together while raising your arms above your head without losing contact with the wall. Perform this arm movement at least 10 times, accompanied by breathing.

Tips for avoiding incorrect positions

In the article above, we talked about a few exercises that can help you correct hyperkyphosis, through simple exercises performed at home, but regularly. However, the most important thing in succeeding with these is to avoid, as much as possible, positions that favor curvature of the spine. By avoiding poor habits and positions and training the muscles, we can correct and maintain a spine with physiological curves. A very important aspect is to be persistent in performing the exercises; usually, however long it takes the body to become deformed, it takes about the same amount of time, or a little longer, to recover.

Here are a few tips:

• Avoid sitting in a chair with your back against it and your seat far forward
• The position at the desk should be one with your feet on the floor and a 90-degree angle between your calf and thigh. A lumbar support would also be useful for supporting the lumbar spine
• Sleeping on your back can help you a great deal
• Become aware of your posture throughout the day so that you can correct it as often as possible
• Limit the hours children spend using a smartphone
• Thoracic hyperkyphosis can also be aggravated by excessive crunches performed without subsequent stretching, or without completing the workout with exercises to tone the back muscles
• Throughout the hyperkyphosis correction program, avoid crunches that involve trunk flexion

Centrokinetic is the place where you will find answers and clear solutions for your movement problems. The clinic dedicated to osteoarticular conditions is divided into the following specialized departments:

• Orthopedics, a department made up of a highly experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, senior physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and in ankle and foot surgery.
• Pediatric orthopedics, where children's sports conditions (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis), and foot deformities (hallux valgus, hallux rigidus, clubfoot, flat valgus foot, cavus foot) are treated.
• Neurology, which has a state-of-the-art department, where consultations, electroencephalograms (EEG), and electromyographies (EMG) are performed.
• Medical recovery for adults and children, a department specialized in the recovery of performance athletes, in spinal conditions, in the recovery of children with neurological and traumatic conditions. Our experience is extremely extensive, having treated over 5000 performance athletes.
• Medical imaging, the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal conditions, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

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