Kyphosis occurs when there is excessive curvature of the spine, eventually causing a hump-like appearance in the upper back, sometimes also known as Dowager's hump. A Dowager’s hump is a lump or bump, that forms at the base of the neck where the spine has curved forward. Whilst it is natural to have a slight curve on the 7th vertebra of the neck, someone with a Dowager’s hump will have an abnormal curve that is more pronounced.
There are a number of reasons why this may form, but many that exist among young people today, result from bad posture.
The anterior head carriage seen in so many office workers today, is causing a huge pain in the neck, (and shoulders and back). One of the main reasons why a Dowager’s hump has become more prevalent today is due to the increasing amount of time spent in front of a digital screen. Whenever we look down at our phones and screens, we are pushing our heads forwards and causing the upper spine to bend; this is becoming known as ‘text or tech neck‘. The same effect occurs when you spend copious amounts of time in front of a computer screen or sitting at a desk.
Kyphosis is also a common occurrence in between 20 and 40 percent of elderly adults, with the greatest change in the thoracic curve occurring in women between the ages of 50 and 70 years of age
There are however, other causes; some of which being:
Degenerative changes (osteoperosis) - An individual who has Osteoporosis may often have a Dowager’s hump. This is because their bones will be weaker and less dense than the average person. With the weakening of the bones, comes a spinal column which is more susceptible to bending and sitting in the incorrect position resulting in the formation of a hump. This kind of Dowager’s hump is usually seen in older people. A change in diet, such as incorporating more vitamin D and calcium can help prevent this from occurring.
Compression fractures - A spine that has been damaged, deformed or collapsed in a certain way may repair itself in the position of a Dowager’s hump.
Muscular weakness - The human body follows a simple rule; whatever position you place your body in for long periods of time, it will make changes and adapt to that position. The formation of a postural Dowager’s hump is down to your body trying to compensate for a forward head position. Muscular imbalances where the tissues at the front of the neck and shoulders become adaptively shortened, through habitually sitting at a desk or looking down for example, and in response, the muscles that should be responsible for the upright military posture (situated between the shoulder blades; the rhomboids; in a diamond shape over the back, the trapezius; and posterior neck stabilisers), becoming adaptively lengthened and weakened.
Altered biomechanics - injuries to shoulders for example; if not treated and managed with rehabilitative exercises, will alter the position and movement pattern of the shoulder girdle, which plays a huge role in posture.
Genetics - Some people may experience improper development of the vertebral column leading to an abnormal curvature of the spine known as kyphosis. As a result, the curvature of the spine causes a hump on the back to form. This abnormality is usually due to genetic makeup and may exist in other family members.
Many muscles should be considered when examining postural dysfunctions. Those immediately surrounding the spine such as the paraspinals, multifidus and erector spinae are the deep stabilisers, but others, such as the core muscles (rectus abdominus, internal and external obliques) and the muscles surrounding the shoulder girdle (the pectorals, rotator cuffs, trapezius, levator scapulae and deltoids).
UNRAVELLING THE SHOULDER - The Scapula (shoulder blade) – “the silent partner”
The correct position for the Scapula or shoulder blade is back and rotated down. muscles. With the correct engagement of the rhomboid and lower trapezius muscles, a good, upright “military posture”, with shoulders back can be maintained. Seems simple, but for many, work and lifestyle choices are making this incredibly difficult.
As you spend time in a flexed (bent) position, your head begins to retain a forward position. This causes increased stress and weight on your spine and neck. The human head on average weighs 12lbs. This is quite a significant weight if you consider that it is placed on top of your spine. As long as your head is stacked neatly above the spine, the spine will have no problem dealing with this weight.
However, things change if the head is pushed forward. As the head moves into a forward position not only does it increase the weight and stress on the spine (up to 10lbs for every inch forward), but it can create symptoms including;
neck pain,
shoulder pain,
headache,
migraine,
tingling in the hands and fingers,
fatigue,
low back pain,
rounding of the shoulders,
and tight muscles in the neck, upper back and shoulders.
So, with the shoulders dragged into an anteriorly rounded position, the rhomboids (the postural muscles between the medial border of the shoulder blade and the spine) are lengthened and weakened. Of course, to add insult to injury, this may not be equal on both sides, and so any abnormality of the scapulae position, and subsequent deviances from the optimal scapulohumeral rhythm (the movement pattern of the shoulders), therefore results in secondary effects on the function of the shoulder joint, and can be responsible for compensatory overuse of some stabilizing muscles, and weakness in others.
What can you do if you are suffering with these symptoms from postural adaptations?
Here I'm going to offer some simple advice on how you can manage and alleviate your neck, shoulder and back pain, without resorting to pain killers or time off work.
Correct Posture
The head should be directly over the body, creating a straight line from your ear lobe, to the head of the humerus (the lateral aspect of the shoulder), down past the rim of the pelvis, past the outside of the knee and to the ankle bone.
By practicing proper posture and engaging in exercises to strengthen the back and neck, and between the shoulder blades, you can lighten the load. This will give your spine a break. A really useful assessment tool and exercise to practice correcting your posture in the Standing Wall Angel.
The Standing Wall Angel
This is useful to gain mobility through the shoulders. Attempt the arm slide up the wall, while maintaining thoracic control and shoulder extension.
Stand with:
back against a wall
feet hip width apart
heels approximately 2 inches away from wall
feel bottom, some of the lower back and as much of thoracic (mid) spine against wall as possible
depress shoulders (shrug and lower them)
tuck chin in so head is against the wall
Take a breath in and out, focussing on breathing with the diaphragm* (place a hand on your stomach while breathing - if diaphragm breathing, your stomach should go in and out, rather than your chest) * Diaphragm breathing is an essential skill to practice as correct respiration is arguably the most important of all movement patterns. Insufficient activity of the abdominal muscles results in a loss of diaphragmatic support for the spinal column. This can in turn negatively affect the stability of the lumbar spine during lifting or bending activities. Now bring your arms up to the side (abduct) to 90 degrees, and bend at the elbows. Try and maintain the contact of the thoracic spine with the wall as you bring the arms into flexion and abduction. Attempt to place the wrists and thumbs of both hands against the wall. Whilst maintaining this posture and with controlled diaphragm breathing; bend the knees to approximately 40 degrees, then come back to standing. Frequency: 3 Sets; 10 Reps Daily NB: If it is not possible to keep the thoracic spine against the wall, and/or cannot reach the wall with the wrists and thumbs, at a standing position, first aim to improve shoulder mobility and lumbar control by sliding arms up the wall above the head and back to shoulder height again.
Mobility through your shoulders and stability in the core and Lumbar spine will be helpful in managing pain and discomfort.
Maintaining a STABLE SCAPULA, is also essential to prevent shoulder instability and injury, (such as rotator cuff tendinopathy or impingement) and in rehabilitating the shoulder and returning to functional activities.
Just as we adapt to one posture, we can reeducate our muscles by activating, lengthening and strengthening where necessary to re adapt back. This is where a visit to a Sports Therapist can be crucial. In order to identify patterns of movement that may be contributing to your discomfort, your Sports Therapist will carry out a postural assessment and specific tests, from which a clearer picture may be drawn regarding movement pattern dysfunctions. With this in mind, your therapist should then be able to offer a treatment plan and some post care advice, including any necessary stretches or exercises that might be helpful for you to incorporate into your routine.
Scapular Stabilisation:
Scapular stabilisation refers to a set of exercises that;
STRENGTHEN the shoulder girdle muscles to restore normal scapular motion and
CORRECT dyskinesia
Scapular Dyskinesia
This often goes unrecognized in the treatment of shoulder conditions such as impingement syndrome, rotator cuff tendonosis and shoulder instability, but researchers have actually found that it can be responsible for upwards of 70% of shoulder injuries.
Where the scapula is not correctly oriented, there is an ineffective transfer of energy from the trunk to the arm, and we are said to be suffering with Scapular dyskinesia.
Additional stress is then placed on the tissues surrounding the shoulder, (the rotator cuff muscles, tendons and ligaments, the serratus anterior, trapezius group and the rhomboids), which must compensate for a weak link in the chain. This added stress may result in further muscle fatigue and tissue injury about the shoulder.
Muscles involved in scapular stabilisation
In order to allow increased shoulder mobility and retraction, it is firstly important to stretch the muscles at the front of the shoulder and chest.
The main areas to concentrate on are:
the muscles at the front of the shoulder (pecs)
those at the front of the neck (scalenes);
and then concentrate on the activation of the rhomboids, levator scapulae and traps, to retract and depress the shoulder blades
Pectoralis Stretching
Stand within a door frame with hips, knees and feet in alignment
Place one forearm on the side of the door frame bent at 90 degrees and shoulder height
Maintaining a neutral spine and looking forwards, inhale and as you exhale, lean the upper body forwards through the door frame, to create a stretch in the pec area.
Hold for 20 secs and release. Repeat this 3 times, and if possible a couple of times a day.
Trapezius Stretch
In a seated position, take the arm on the side of the shoulder/neck that you are stretching, and either place it behind your back, or hold the underside of the seat. With the other hand, place gentle pressure to the opposite side of your head, easing your ear down towards your shoulder. Hold for 20-30 secs and release. Repeat this 3 times, and if possible a couple of times a day.
Levator Scapulae Stretch
In a similar position to the trapezius stretch, turn your head slightly so now you are looking under your armpit. Now gently apply pressure to the top of your head to ease the muscle into a stretch position. Hold for 30-40 secs, and repeat 3 times.
Try these without pain 3-4 times a day, holding for 20-30 secs.
Standing Row - Controlling Serratus Anterior and the Rhomboids.
These may be strengthened with a scapula retraction exercise such as below.
Take a thera band and place it around a solid object, such as a bedpost, or door knob at about waist level. Each hand should hold an end of the band.
With your elbows at your sides and bent to 90 degrees, pull the band back to move your shoulder blades toward each other. Return to the starting position.
Sets: 3
Reps: 8 to 12 (or until fatigued but not painful)
Progression: If you have good range of motion in your shoulders, try this exercise with your arms lifted out to the sides, with your elbows at a 90-degree angle. Raise the elastic band up to about shoulder level. Pull the band back to move your shoulder blades toward each other. Return to the starting position.
For more information or for a full postural assessment, contact Katie at Breeze Sports Therapy https://www.breezesportstherapy.com/