BY – PRATIGYA DEUJA
DEFINITION:
 General
term used for excessive backward
convexity of the spine.
 It is the exaggeration of the posterior spinal
curve localized to dorsal spine.
 Also known as arcuata, round back or kelso’s
hunchback.
 A condition of over curvature of thoracic
vertebrae.
 This causes bowing of the back called as
slouching posture.
CAUSES:
 -Habitual bad posture









-Arthritis
-Rheumatism
-Lung affection
-Neuromuscular weakness
-Degeneration of vertebral bodies & discs
-TB
-Ankylosing spondylitis
-Scheuermann’s disease
-Congenital anomalies
TYPES

Round Kyphosis
--Gentle backward curvature of spinal column.
--Caused by disease affecting number of vertebra for e.g.
Senile Kyphosis.
--May be localized to a spinal segment or may be diffuse.
--Dowager’s hump- 5/6 vertebra go for kyphosis. Mostly
seen in elderly and in post-menopausal women who have
osteoporosis.
 Angular
kyphosis
--A sharp backward prominence of spinal
column.
--It may be prominence of only one spinous process because of
collapse of only one vertebral body and may occur in
compression fracture of vertebra. This is called knuckle.
--There may be kyphosis localized to few vertebrae and is
known as gibbus, commonly seen in TB or some vertebral
fracture.
--Gibbus hump- 1-2 vertebra go for kyphosis.
Classification of deformity according to severity
1.First degree kyphosis:
-Habitual bad posture is the precipitating factor.
-There is no imbalance beween the muscles.
2.Second degree kyphosis
-Pectoral muscle becomes short, there by restricting chest
expansion resulting in reduced respiratory function.
-Longitudinal back muscle, rhomboids & middle trapezius are
weakened with loss of tone and are in a stretched position.
-Posterior ligament are lengthened with corresponding
shortening of anterior structures. This result in posterior laxity.
3.Third degree kyphosis
-Wedging of vertebral body may occur.
-The deformity gets organized which is a difficult syndrome.
Postural adaptations in Kyphosis
-Rounded back
-Forward head
-Flattened chest
-Rounded shoulders
-Excessive protrusion of scapula
BIOMECHANICS
-A normal thoracic kyphosis is due to the slight wedged
configuration of both of the vertebral bodies and intervertebral
discs. Because of this physiological kyphosis, the thoracic spine
is more prone to be unstable in flexion.
-The anterior longitudinal ligament & posterior longitudinal
ligament is well developed in thoracic region.
-Clinicians have noted that ALL is usually thick in certain cases of
abnormal thoracic kyphosis (White and panjabi)
-Annulus in this region as elsewhere is the major factor in
maintaining clinical stability.
Continued..
---During excessive dorsal kyphosis ;
 Compression of anterior vertebral bodies, Increase in intra
discal pressure.
 Distraction of facet joint capsules and posterior annulus
fibers.
 Stretching of posterior longitudinal ligament & scapular
muscle.
 Shortening of anterior longitudinal ligament and upper
abdominal muscle.
continued…
The biomechanical concept, that relates to problem of
instability in kyphotic thoracic spine states that, the
greater the wedge of the vertebral body fracture, the
greater the moment arm and thus, the greater the bending
moment, which tends to produce additional kyphotic
deformity and pressure on the spinal cord, particularly if
there are disc or bone fragments in the canal(literature by
holdsworth’s).

Thoracic spine biomechanics;
---Movements available are flexion, extension, lateral
flexion, rotation and coupled motion.
---In upper thoracic-lateral flexion and rotation are
coupled in same direction.
---In lower thoracic-lateral flexion and rotation are
coupled in opposite direction.
---The erector spinae act eccentrically until approximately
two thirds of maximal flexion has been attained at which
point they become electrically silent. This is k/A flexionrelaxation phenomenon.
MANAGEMENT;
1.First degree kyphosis
--Relaxation of body especially upper back .
--Repeated stretching session of shortened anterior
structures by bracing shoulder & maintaining position.
--Postural training
--Mobilization of spine, scapula & shoulders.
--Diaphragmatic & costal breathing exercises to
emphasize on inspiration.
--Resistive exercise to weak longitudinal & transverse
back muscle
--Controlled pelvic tilt associated with abdominal &
gluteal contractions.
2.Second degree kyphosis
-Milwaukee brace with pads.
-Exercises to improve mobility and respiration to reduce
overall impact of deformity.
3.Third degree kyphosis
-Bone graft
-Spinal cord depression
-Spinal stabilization
ARTICLE-1
TOPIC: Rehabilitation using manual mobilization for thoracic
kyphosis in elderly post menopausal patients with osteoporosis
(Journal of rehabilitation medicine, 2010)
Ivan et al. took 48 postmenopausal patients with osteoporosis and
assigned them randomly in two groups. Group 1(n=29),exercise
group which received 3 months of rehabilitation (18 sessions
including manual mobilization, taping and exercises) whereas,
Group 2 (n=19),control group didn’t receive anything. The
outcome measures were spinal-mouse, VAS and Quality of Life.
The result concluded that rehabilitation, manual mobilization can
attenuate thoracic kyphosis in elderly patients with osteoporosis.
ARTICLE 2
TOPIC: Application of passive transverse forces in the
rehabilitation of spinal deformities ; A RCT(Journal,2002)
Weiss et al. performed a RCT study where they took 2
group, Gr A(n=126) exercises group & Gr B(n=126) control
group. Group A was provided with passive transverse forces
on the deformed body for 4-6 times lasting 20 mins per
session . The treatment was carried out for 4-6 weeks .The
outcome measure included formetric system. The study
concluded that PTF can be useful for deformed spine.
1)Mobilization of the thoracic spine in
hyperextension especially in case of direct
stiffness; segmental exercises.
 Passive postures in prone or quadruped position.
 Stretching of the anterior intervertebral ligament in a
supine position with apex of kyphosis or block.
 passive postures with at the end active extension.
 Facet joint mobilization in the three planes
combining active and hyperextension lateral bending
and rotation with with active hyperextension. The
relaxation must be global and three dimensional.
2)Global stretching
3) Neuromuscular control and equilibrium
4)Stretching of anterior thorax muscles and hamstring in case
of indirect stiffness.
5)Pilates exercises are also useful for lengthen/tension
imbalance in the body with weak? Abdominal muscles,
tight chest and hamstring muscles and a weak
overstretched upper back.
6) Integration postural correction.
7) Stretching of anterior thorax muscles and hamstring in
case of indirect stiffness.
8) Extensor spinal and abdominal muscles strengthening in
corrected position.
9) Back education.
10) Muscular reharmonization.
11) Breathing exercises for costovertebral mobility.
Ergonomics



Staffel’s 90 degree rule in sitting.
In case of thoracolumbar kyphosis, there is often a
horizontalization of the sacral slope with stable pelvis
incidence at 53 degree. In this cases, ergonomic
kneeling chair can be used.
In case of accenuated kypho-lordosis, there is often an
increase of the inclination of the sacral slope. If the
pelvic incidence is normal at 53 degree, we can use a
triangular cushion slightly tilted backward.
1)JOINT STRUCTURE AND FUNCTION -- CYNTHIA C. NORKIN
2)CLINICAL BIOMECHANICS OF THE SPINE—WHITE AND
PANJABI
3)JOURNAL OF REHABILITATION MEDICINE