The condition is a physical deformity, taking the form of an over-curvature of the thoracic spine (upper back). It is commonly seen among post-menopausal women. It’s an abnormality that causes the back to be more than 40–45 degrees forward.
There are several types of dowager’s humps affecting both young and old. Approximately 75 percent of patients with the condition are unaware they have it.
What causes dowager’s hump (kyphosis)?
Extreme curvature of the spine that forms a hump-like appearance can be caused by many different things. The cause of the condition needs to be determined in order for proper treatment to be initiated. The following are some potential causes:
- Genetic: Genetic abnormalities of the spine can increase the chances of developing dowager’s hump. Patients may even be born with the condition. It’s often caused by a gene malformation that creates an improper development of the vertebral column, leading to its presentation upon birth or its development over time. Unfortunately, genetic causes of kyphosis can be associated with congenital problems, such as kidney or cardiac problems, with treatment for the condition often being surgical. This is the least common type of kyphosis.
- Bad posture: This form of kyphosis develops slowly, as it takes years for over-stretching of the spinal ligaments, which puts pressure on the spinal column. This form of kyphosis often results in an exaggerated outward curve of the lower spine. This is the most common type of kyphosis.
- Osteoporosis: The progressive loss of bone density can lead the bones of the spine to become weaker and likely to bend. Osteoporosis can result from decreases in calcium and vitamin D, thyroid disorders, and aging. The condition can cause the vertebral bones of the spine to fracture, leading to the development of dowager’s hump.
- Compression fractures: Sustaining an acute injury that leads to a fracture of the spinal column can put excess pressure on the bones, causing them to collapse and deform.
Symptoms of dowager’s hump (kyphosis)
The following are signs and symptoms that can accompany dowager’s hump (kyphosis):
- Muscle Fatigue
- Difficulty breathing
- Restriction of lung movement and balance problems
- Changes in posture
- Chronic pain in the back and shoulders
- Spine curve
- Loss in height
- Thoracic kyphosis (hunched back)
- Loss of appetite
- Difficulty sleeping (insomnia)
- Successive crush fractures
- Multiple vertebral compression fractures
- Bulging abdomen
- Falls
- Hip pain
- Stiffness in the back
- Loss of sensation
- Loss of bowel and bladder control
Treatment of dowager’s hump (kyphosis)
The cause of kyphosis will often dictate the type of treatment. However, early treatment is important, especially if it’s identified during adolescence. If kyphosis is allowed to progress in younger patients, it can cause significant problems during adulthood. Routine follow-up visits are also part of effective management.
The following are typical treatments of kyphosis:
- Physical therapy: Usually coming in the form of various exercises, treatment aims to strengthen the patient’s paravertebral muscles—the muscles of the spine. It often requires a great amount of diligence from the patient and a conscious effort is required to correct and maintain proper posture.
- Bracing: A common treatment used in young children, as they are incapable of following through with rigorous physical therapy. This may be combined with physical therapy,
- Surgery: Called vertebroplasty and kyphoplasty, these are two types of surgery that can restore height to the vertebra and eliminate pain. The former is a non-surgical technique that uses a needle in the affected area, while the latter is performed by inserting a balloon through a tube. Both aim to return the damaged part of the spine back to its original state.
Exercises for dowager’s hump (kyphosis)
Certain exercises have been shown to provide some benefit to those suffering from mild cases of dowager’s hump. It is important to keep in mind that these exercises will not cure the abnormal curvature of your spine the first time you do them, but rather, it requires a long-term commitment with gradual changes occurring over weeks, months, or even years.
The following are various exercises that can help improve your posture and reduce the appearance of dowager’s hump. Consistency is key, so it is recommended to repeat these exercises a minimum of three to four times per week.
Release the tight muscles:
Tight muscles can be responsible for pulling the head into an incorrect position, leading to poor posture. The following exercise can help mitigate this problem:
- Sub-occipital (base of skull) maneuver
- Rest your head on a massage ball.
- Make sure the ball is pressing the back on the head at the base of the skull
- Gently rock your head from side to side
- Remember—If it hurts, it’s probably a tight spot!
- Do both sides.
- Duration: one minute per side.
- Sternocleidomastoid (a muscle group found on the side of neck)
- Locate the target areas (on either side of the neck)
- You should be able to feel a prominent band of muscle on each side of the neck.
- Do not to press too deeply, as you may hit other sensitive structures of the neck.
- Gently massage these muscles with a pinch grip.
- Duration: one minute on each side.
Stretch the tight muscles:
Perform these exercises after you have released your tight muscles.
- Sub-occipital (base of skull)
- Tuck your chin in.
- With your chin tucked in, gently pull your head downwards by using your hand on your head
- Aim to feel a stretch at the back of your neck.
- Hold for 30 seconds.
- Repeat 3 times.
- Sternocleidomastoid (a muscle group found on the side of neck)
- Gently tuck your chin in.
- Look to your left and upwards.
- Tilt your head to the right side. You should feel a stretch on the left side of the neck.
- With your right hand, apply pressure to left side of head and pull down to increase the stretch
- Hold for at least 30 seconds. Repeat for opposite side.
- Repeat 3 times.
Loosen up stiff joints:
Kyphosis may make your joints stiff, so loosening them up can help promote good posture.
- Head slides
- Keep your face forward and chin parallel with the ground throughout the movement.
- Slide your head from side to side.
- Aim to feel a strong stretch on the side that you are sliding towards.
- Repeat 20 times.
- Chin tuck with over pressure
- Lie on the floor with your knees bent.
- Tuck your chin in.
- Place your base of your palms on your chin and apply a downward pressure
- Hold for 5 seconds. Repeat 10 times.
Strengthen the weak muscles:
Most cases of dowager’s hump are associated with weak muscles, so by increasing the strength of muscles found in the neck and those involved with posture, you can mitigate most of the negative symptoms associated with kyphosis.
- Chin tucks while lying down
- Whilst lying down, tuck your chin in.
- Try to get the back of your neck to touch the floor.
- Hold for 5-10 seconds.
- Repeat 20 times.
- Chin tucks while standing upright
- Gently tuck your chin in.
- Keep your eyes horizontal as you tuck your chin in.
- Hold for 5-10 seconds.
- Repeat 20 times.
- Chin tucks against gravity
- Lie on your back with your head over the edge of the bed.
- Tuck your chin in.
- Keep your neck in a neutral position.
- Hold for 5-10 seconds.
- Repeat 20 times.