Posture Program for Kyphosis

What you are treating

Kyphosis is the natural forward rounding of the upper back. Too much of it makes a teenager look slouched even when standing tall, and it comes in two kinds. Postural kyphosis is flexible: it straightens out when the child lies down or stands up straight on request. Scheuermann's kyphosis is structural: the front of several vertebrae grow a little less than the back during the growth spurt, so the bones become slightly wedge-shaped and the curve does not fully straighten on command. Both are common, both are usually painless or mildly achy, and both respond to the same program. Scheuermann's is measured on a side X-ray; a curve over about 45 degrees is more than normal.

The goal is a strong, mobile upper back and a child who knows how to stand tall without thinking about it. Most teens never need more than this.

The daily program

About 15 minutes a day, every day, through the growth spurt. It works best when it becomes a habit like brushing teeth.

• Thoracic extension over a roll: lie on your back with a foam roller or a firm rolled towel across the upper back, knees bent, hands behind the head. Let the upper back arch over the roll for 20 to 30 seconds, then move the roll an inch and repeat, covering the stiff part of the upper back. Three positions.
• Prone extension: lie face down, hands at the sides, and lift the chest and head a few inches off the floor while squeezing the shoulder blades together. Hold 5 seconds. 10 repeats, building to 20. This is the single most important exercise.
• Shoulder-blade squeezes and rows: squeeze the shoulder blades back and down, hold 5 seconds, 10 times. Rows with a band, 3 sets of 12.
• Wall angels: stand with the back, head, and arms against a wall, and slide the arms up and down like making a snow angel, keeping contact with the wall. 10 slow repeats.
• Chest and hip flexor stretches: a doorway chest stretch and a kneeling hip flexor stretch, 30 seconds each side. Tight muscles at the front pull the body forward.
• Hamstring stretch: tight hamstrings go with Scheuermann's and tilt the pelvis. 30 seconds each side, twice.
• Core in neutral: planks and bird-dogs, so the lower back does not arch to compensate.

Posture through the day

• Screen height at eye level. Phone held up, not looked down at.
• A backpack with both straps, worn high, under about 15 percent of body weight.
• A chair with back support and feet flat on the floor. Stand up and reset the shoulders every 30 minutes.
• "Tall through the top of the head" is a better cue than "shoulders back," which teens cannot hold for long.

Sports and activity

Everything is allowed. Swimming (freestyle and backstroke), rowing, climbing, gymnastics, volleyball, and any sport that pulls the shoulders back is good for kyphosis. Heavy overhead lifting and loaded forward bending are the only things I limit in a painful Scheuermann's curve while it settles.

When a brace helps

For Scheuermann's kyphosis in a child who is still growing with a curve of roughly 55 to 70 degrees, a brace worn most of the day for a year or two can improve the shape of the wedged vertebrae, not just hold them, because the bones are still growing. That is different from scoliosis bracing. The brace is combined with the exercises above, and we check the curve every four to six months.

When surgery is discussed

Rarely. A curve above about 75 degrees that keeps growing, pain that does not settle with the program, or a curve causing nerve symptoms can be reasons to talk about surgery. The operation is a posterior spinal fusion of the rounded segment, and the results are good. For nearly every teen I see with kyphosis, the program above is the treatment.

Pain that needs a visit

Most kyphosis pain is a dull ache at the top of the curve after sitting or activity. Pain that wakes your child at night, pain in the low back, leg symptoms, or a curve that looks sharp and angular rather than smoothly rounded should be checked.

Learn more

Pediatric Orthopaedic Society of North America, Kyphosis: orthokids.org (opens in a new tab)

My guide to Scheuermann's kyphosis.

More for families

OrthoKids · POSNA

POSNA's OrthoKids: illustrated, family-friendly information on this condition.

Open on OrthoKids (opens in a new tab)

Scan for the OrthoKids page

This plan is general guidance for Dr. Wey's patients and their families and does not replace the advice we discuss in clinic about your child's specific curve.