Dowager’s Hump: What is it? And How Can You Treat And Prevent It?

Dowager's Hump, also known as hyperkyphosis or kyphosis, is an excessive curvature of the spine. Read our guide to treatment, prevention and exercises.

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Pamela Q. Fernandes Doctor and Medical Writer

Dowager's hump is estimated to affect two out five people above the age of 55. There are a number of things that can cause you to develop a Dowager's hump. The most common sources are degenerative diseases or muscle weaknesses. Regardless of the cause, it negatively affects your quality of life.

Early intervention and treatment of this condition can alter its course and provide many health benefits. In this guide we offer evidence-based options to treat Dowager's hump and help you prevent it from getting worse.

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Content

What Is Dowager’s Hump?

Dowager's hump or hyperkyphosis is an excessive curvature of the spine. Usually, this occurs in the thoracic or chest curve of the spinal column. Often it is also simply called kyphosis, which is a forward curvature of the spine.

The thoracic spine

The spine has a natural curve. If you look at a 3-D model of the spine, you'll notice that it has a convex curve in the chest area. This is due to the natural shape of the spinal bones and the discs between them. At 40 degrees of curvature, the spine is considered healthy as it falls in the 95th percentile of spine measurements in young adults. Curvatures of over 40 degrees are deemed problematic and can create a small hump at the back of the neck.

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From childhood till the age of 30, the angle of the spine changes due to the increased weight on it - from 20 degrees to 29 degrees. After you turn forty, the angle rapidly increases as the degenerative processes of aging begin.

Because osteoporosis (weakening of the bones) is more common in women, so is Dowager’s hump. With osteoporosis you get weaker spinal bones, which leads to a higher disposition towards Dowager's hump.

Among men, the average curvature angle is around 44 degrees. In women, it can range from 3 degrees at age 55 to 52 degrees at age 80. You'll notice that people get shorter as they age. The average person loses about half an inch with every decade due to the compression of the spine.

Measurement Of Hyperkyphosis

The gold standard for measuring hyperkyphosis is an X-ray. These radiographs are the best tool for orthopedic assessment of the thoracic or chest kyphosis angle. If the person can't stand for some reason, they can do a supine radiograph, but the lateral or sideways X-ray is the best.

The kyphosis angle (or "Cobb's angle") is measured by drawing perpendicular lines on the radiograph. The line extends through the upper endplate of the vertebral body, where the thoracic curve starts at the T4 vertebrae and the lower endplate of the vertebral body at the end of the thoracic curve at T12 vertebrae.

The kyphosis angle

Common Causes Of Dowager's Hump

Dowager's hump has not received the kind of scientific attention, osteoporosis, stroke, and cancer receive. Because it's considered part of the normal "aging" process, it hasn't been studied in great detail. As a result, the causes of Dowager's hump haven't been fully described. Yet, a few common causes for its occurrence have been identified

Degenerative Disc Disease

In many people with Dowager's hump, radiographic findings have revealed degenerative disc disease. The majority of older adults who do have Dowager's hump tend to have degenerative disc disease, without evidence of vertebral fractures or osteoporosis.

Vertebral Fractures

As the number of vertebral fractures increases, the kyphosis becomes more pronounced. This applies more so for thoracic/higher vertebral fractures than lower/lumbar fractures. Women who have multiple anterior thoracic wedge fractures have very prominent kyphosis. If you’ve had vertebral fractures in the past, you are at risk of developing Dowager's hump.

Vertebral fracture

If you have Osteoporosis the daily stress on the spine can cause it to develop compression fractures and vertebral wedges. Osteoporosis is a condition where the bones soften and become weak, due to a lack of dietary calcium and vitamin D. With time, as the number of wedges increase, the density of the bone mineral decreases. This leads to more compression fractures. This creates a vicious circle that increases the likelihood of getting hyperkyphosis.

Weak Muscles

Weak spinal extensor muscles are associated with Dowager's Hump, according to studies. We have large back muscles holding up the spine. In post-menopausal women in good health, the weaker the spinal muscles, the higher the kyphosis angle. Exercise can strengthen the spinal muscles and thus hold the spine erect. This will help maintain the natural curvature of the spine. If you think only the spinal muscles can affect the spine, think again. In reality, posture is affected by many muscles of the body.

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Impaired Mobility

Age affects many of the contributing, ligaments, joints, muscles, and connective tissues, all of which affect posture. How they may contribute to kyphosis is not yet identified. However, with decreased spinal mobility, the ability to maintain a good posture and stand erect is reduced.

Genetics

Birth defects can cause kyphosis. If you were born with spinal defects, it can cause you to have a kyphotic spine later in life. One of these is Scheuermann's disease or Scheuermann's kyphosis. Commonly seen in boys, it can cause kyphosis. Here, the curvature increase occurs before the pubertal growth spurt occurs and can severely affect the spine.

Symptoms Of Dowager’s Hump

Dowager's Hump

Physical and Functional Symptoms

Excessive hyperkyphosis can severely affect your physical and functional limitations. Women who have a severe Dowager's hump have difficulty simply raising themselves from a chair. You will also have a reduced balance, slower gait, require a broader stance to support yourself, and cannot climb stairs quickly. As a result, you might be more prone to falls. Osteoporotic women tend to have a higher postural sway which also adds to their risk for falls.

If you have Dowager's hump, then your overall level of functioning is affected. You have difficulty doing necessary activities around the house and their scores when it comes to activities of daily living are much lower compared to their healthy peers. If you're developing Dowager's hump, you might also notice the following symptoms:

  • Muscles fatigue easily
  • Gradual postural changes
  • Chronic pain in the back, neck, and shoulders
  • Loss in height
  • Multiple vertebral compression fractures
  • Protruding abdomen
  • Repeated falls
  • Back stiffness
  • Pain in the hips
  • No sensation in the chest area

Respiratory Symptoms

If you have Dowager's hump, you might experience difficulty breathing. The added kyphosis puts pressure on your lungs, affecting their expansion and thus breathing. Breathing exercises and focusing on strengthening spinal muscles can help you to breathe fuller.

Digestive Symptoms

Severe progression of the Dowager's hump can compress your digestive tract. As a result, you may have trouble with swallowing.

Psychological Symptoms

Dowager's hump is disfiguring. Since most people don't understand how it occurs and that it's a part of natural aging, you may have to suffer labels such as "hunch-back" etc. All of this can psychologically affect you. In younger adults, it can lead to shame, aggression, and anxiety. Older individuals might feel isolated socially, and you may even feel depressed.

Quality of Life

With limited mobility and physical deformity, some women report physical difficulties with everyday living. If you're a woman with Dowager's hump, you may also require more adaptation and have higher fears about your ability to function. Overall, men and women who live with this condition, are less satisfied with their health, functioning, relationships, and economic conditions. As a result, you might limit your outdoor activities and public life, and this impairs your quality of life and level of functioning. Don't let Dowager's hump from living your best life. Have yourself diagnosed and then treated.

Diagnosing Dowager's Hump

Apart from Xray's, your doctor might suggest doing a CT scan, and an MRI may be recommended. He will do this is to evaluate your bones, the disc, the disc space, and to rule out any tumors or secondary causes of your symptoms. The doctor may also conduct a thorough physical examination.

Treating Dowager's Hump

There are many treatment options for Dowager's hump. They range from physiotherapy to surgery. The sooner you treat it, the more effective you will be in halting its progression. Studies have shown that with the right exercises and treatment, Dowager's hump can be halted from getting worse if identified and treated early. Here's a look at some of them.

Physiotherapy And Example Exercises

Physiotherapy is the mainstay of the treatment of Dowager's hump. If you take medications or get surgery, the muscles, joints, and bones that assist and make up your spine need to be strengthened. Your treatment choice will vary depending on the severity, but it will have to be supplemented with physiotherapy if it isn't your primary treatment choice.

Exercises for treating Dowager's hump

  1. Standing back curve I

    To start with you should improve the strength of the spinal muscles, which in turn will improve the flexibility of your spine. The following exercise is great for this purpose.

    Standing back curve I
    10 reps x 1 sets

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    • Stand with your legs slightly spread, and hold your arms by your side.
    • Bend your upper body with your hip until you are angled at 45 degrees.
    • Curb your back slowly and then straighten it again.
    • Perform 10 repetitions.
  2. Lying glute stretch

    Next, the hip extensors can be trained, followed by the ankle. The lying glute stretch exercise is great for the hip extensors, and sitting foot stretches are good for the ankle.

    Lying glute stretch
    30 sec. x 3 sets

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    • Lie on your back and grab your knee with the hand on the same side.
    • Use the other hand to slowly pull your lower leg and knee towards the opposite shoulder.
    • Make sure your knee is bent at a 90-degree angle.
    • Repeat the exercise with both legs.
    • Keep the stretch for 30 seconds with both the left and right leg.
    • Perform 3 sets.
  3. Sitting foot stretches I

    sitting foot stretches I
    10 reps x 3 sets

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    • Sit on a chair with your legs bent.
    • Place the exercise band under the foot just behind the toes.
    • Grab the exercise band with one hand and tighten it.
    • Move your foot up and down while holding the exercise band to create resistance in the downward movement.
    • Go as far as possible in both directions.
    • Perform 3 sets of 10 repetitions with each leg.
  4. Side lying glute curve VI

    You can also do the thoracic side-lying glute-curve stretch to extend the range of motion of the hip extensors and rotator muscles which will increase the expansion of your chest.

    Side lying glute curve VI
    15 reps x 1 sets

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    • Lay down on one side.
    • Bend the lower leg to stay stable.
    • Let the top leg stretch slightly backwards, and turn it so that the heel is at the top.
    • Lift your leg slowly and hold the position for 2-3 seconds.
    • Then slowly lower your leg.
    • Perform 15 repetitions with each leg.
  5. Lunge

    Additional exercises that strengthen the muscles groups will include lunges, presses, and bridge exercises. The following video shows you how to perform the lunge exercise.

    Lunge
    15 reps x 3 sets

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    • Stand with your weight evenly distributed between both legs.
    • Take a long step forward with one leg.
    • Bend your knee and ankle while moving forward, then push back to the initial position.
    • Make sure the knee is moving straight forward in the direction of your toes.
    • Perform 3 sets of 15 repetitions with each leg.
    • It should feel similar with both legs.

Postural correction

You can also work on correcting your posture. This can be done while sitting or standing, with arms by the side or raised behind the head. Stand in front of a mirror and visualize the lengthening through the crown of your head as you lift your chest. Try to keep a neutral spine throughout the day. This will require conscious practice.

Bracing

In children, teenagers, and young adults, a brace can be worn for about two hours per day. This usually halts the progression of the kyphosis as the bones are still growing and can be molded to reduce spine curvature. A weighted spinal kyphosis orthosis can be worn by older adults, especially when they're moving. A brace also facilitates an upright posture, which helps reduce the number of falls.

Taping

During any of your physiotherapy exercises, you can also use tape. You can apply the therapeutic tape from the highest point of your shoulder joint diagonally across the trapezius muscle to the T6 vertebrae on both sides. This provides passive support to the spine.

Taping during three individual static standing tasks that lasted 40 seconds demonstrated good results. It revealed they had reduced kyphotic angle almost immediately after the task - compared with people who had sham taping or no taping at all.

Medicine

There's no medication to fix the bent spine. Painkillers and narcotics are prescribed to keep your pain at bay. As you exercise, you'll realize that with the stress relieved from the spine, the pain will ease, and your requirement on pain medications will wane.

Spinal fusion Surgery

For individuals with hyperkyphosis, more than 50 degrees, surgery might be warranted. If you're also experiencing nervous systems deficits like pinching of the nerve roots as they emerge from the spinal column or damage to the spinal column itself, doctors may recommend surgery.

One of the most common surgical procedures done is spinal fusion surgery. It is basically like a "welding" procedure where two vertebrae are fused, so they heal and move like a single solid bone. Fusion will take away some spinal flexibility. However, since few bones are involved, it doesn't affect mobility and motion.

Preventing Dowager's Hump

Stop Smoking

Smoking is a risk factor for osteoporosis. The nicotine in tobacco slows down your production of bone cells. It also affects the absorption of calcium. It stimulates the production of cortisol, which accelerates the breakdown of bones. Studies have shown that one year after quitting smoking, the bone density will improve considerably.

Stop smoking, eat healthy and limit alcohol consumtion

Eat A Healthy Diet

A diet rich in calcium and vitamins will produce strong bones. Also, lay off the soda. Especially colas. They contain an ingredient called phosphoric acid that affects bone mineral density. Phosphoric acid tends to leach calcium from the bones. Additionally, caffeine has also been linked to lower bone mineral density.

Cut Down Alcohol

Alcohol can also affect bones. It interferes with the absorption of vitamin D from the gut, which in turn affects calcium absorption. Also, alcohol lowers the production of estrogen and testosterone. Both these hormones contribute to the ability to build bones and bone cells.

Stave off Osteoporosis

You can do with a regular intake of calcium. The recommended daily absorption of calcium is 1,000 milligrams (mg) a day for women ages 50 and younger and men. In women over 50, 1,200 mg for women per day is the requirement. As we age, bone density drops. It drops further without the bone-building effect of estrogen. Along with calcium, make sure you get 800 IU of Vitamin D, which helps in the absorption of calcium.

Exercise

Weight-bearing exercises and stretches are key to staying flexible. They also help maintain stronger joints, ligaments, and connective tissue. Weight-bearing exercises will also strengthen the bones.

In a randomized trial studying 60 post-menopausal women, the benefits of exercises were reinforced. The angle of kyphosis and strength of the back extensor muscles improved among women even with the most severe kyphosis, including those with significant weakness of the spinal extensor muscles, as scientists' findings showed.

The woman did 10 repetitions of face-down trunk extension exercises five times a week for a year while wearing a weighted backpack. After a ten-year follow-up among these same women, the rate of vertebral fractures was much lower, even though the women had stopped the exercises in the intervening ten-year period.

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You can progress to adding small weights in the backpack. Instead of a weighted backpack, you can use handheld dumbbells and do the same exercise by bending your elbows bent and keeping your hands by your ears. Do three sets.

Correct Posture Early

While this may seem like silly advice, few of us think of it consciously. Square your shoulders and sit straight. Stand erect. Be mindful of your posture. Whether you're carrying a backpack, or having dinner, watch how you slouch. Maintaining an erect posture requires the active involvement of multiple muscle groups from your back down to your hips.

Prevent hearing Loss and Check your Vision

Since hearing and vision contribute to our posture, check them at every physical exam to ensure you have good vision and hearing. Treat any secondary disease that affects them like diabetes, hypertension, and infections.

Do's and Don't in Dowager's Hump

Here are a few do's and don'ts while you fix Dowager's hump.

Do’s

  • Maintain a good posture while you exercise. Keep your spine neutral. Don't slouch over.

  • Strengthen core stabilizing muscles like your obliques and transversus abdominis muscles. These muscles provide the counterbalance to your spine. They run diagonally and horizontally but keep your spine stable.

  • While coughing or sneezing, keep your back in a neutral position. Try and maintain the natural curves of your neck and back. Here's how to do this: stretch your neck, imagine you're making the crown of your head longer.

  • When you bend and lift heavy objects, bend at the hips and knees, keeping the purpose close to your body.

  • While you get off the bed, roll off your side, before sitting up.

Don’t’s

  • Avoid using exercise machines that curl up the spine. This includes seated rowing machines.

  • Avoid crunches and traditional sit-ups. The goal is to extend the spine. Crunches and sit-ups tend to compress the spine, which is the last thing you want to do if you already have Dowager's hump.

  • It's easy to forget during routines of daily life. Often, we do things automatically without thinking. Repeated motions of spine curling activity gradually affect our spine and their curvature.

  • Avoid leaning over and doing a pelvic tilt while standing.

  • Avoid forceful trunk flexion as happens during a cough.

  • Don't twist the spine while lifting objects.

  • Don't sit up directly from a horizontal position.

  • Don't bend over to reach anything.

Dowager's Hump Can Be Fixed

Dowager's Hump is NOT inevitable. You won't get it simply because you age. You get it when you become inactive, inflexible, and immobile.

The existing evidence supports the use of exercise, spinomed bracing, and taping interventions. Used together, they can undoubtedly reduce hyperkyphosis. In turn, leading to an improved quality of life and reduced risk of future fractures in both men and women.

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About the author

Pamela Q. Fernandes is a doctor, author and medical writer. Having practiced preventive and family medicine for the last ten years, she's a keen advocate of health education and preventive medicine in her medical practice.