Thoracic kyphosis

Thoracic kyphosis is the natural outward curve of the upper back. Seen from the side, the twelve vertebrae of the thoracic spine form a gentle curve, rounded towards your back. Everyone has some, and when the curve becomes excessive it is called hyperkyphosis (Lam & Mukhdomi, 2023; Waxenbaum et al., 2026).

The neck and lower back curve the other way, which is called lordosis (see cervical lordosis). In everyday language, hyperkyphosis is what people mean by a hunched or rounded upper back.

What does thoracic kyphosis mean in practice?

The curve is measured as an angle, most precisely with the Cobb method on a side-on X-ray, and also with simpler devices such as a kyphometer (Katzman et al., 2017). Research often treats a curve of 40 degrees or more as hyperkyphosis: the main exercise trial in older adults, for example, enrolled people with a curve of at least 40 degrees (Katzman et al., 2017).

Age matters. In 316 people aged 2 to 77 with no spinal complaints, the curve increased with age, and faster in women than in men (Fon et al., 1980). A clinical review puts the start of this increase at around 40 years of age (Lam & Mukhdomi, 2023).

Postural and structural kyphosis

• Postural kyphosis is flexible. You can straighten it when you choose to.
• Scheuermann kyphosis is structural. Three or more vertebrae in a row are wedge-shaped by at least 5 degrees each. It is usually diagnosed between 12 and 17, often after a parent notices a rounded back, and runs in families. The wedging is what distinguishes it from a flexible postural curve (Mansfield & Bennett, 2023).
• Age-related hyperkyphosis has several causes. Vertebral fractures are one, but 60% to 70% of the most severe cases show no compression fractures. Disc degeneration, weak back extensor muscles and genetics are among the other proposed factors (Roghani et al., 2017).

Shoulder position is part of the picture too. In people without shoulder pain, those with a shorter pectoralis minor differed in how rounded their upper back was (Borstad, 2006).

Does a bigger curve cause back pain?

The research doesn’t show a strong link. A review of 54 studies found no strong evidence that the curves of the spine, seen from the side, are associated with spinal pain. It did find moderate evidence of links with daily function and mortality, though the authors judged these unlikely to be causal (Christensen & Hartvigsen, 2008). In older adults, hyperkyphosis has been linked with poorer physical function and quality of life (Roghani et al., 2017).

Can thoracic kyphosis change?

To a degree. In a trial of 99 adults aged 60 and over with a curve of at least 40 degrees, six months of spine strengthening and posture training led by a physiotherapist, three times a week, reduced the Cobb angle by 3 degrees more than in a group who received health education. Participants in the exercise group also felt better about their appearance (Katzman et al., 2017). In teenagers and young adults, a review of nine trials found improvements in the kyphosis angle with therapeutic exercise, with evidence of fair to good quality (Fernández et al., 2025). Back extensor strength is one of the factors linked with the curve in older age (Roghani et al., 2017), and the main back extensors are the long erector spinae muscles along the spine.

Common misunderstandings

• “A rounded back is always a posture problem.” Not when the bones themselves are wedged, as in Scheuermann disease or after a fracture.
• “A posture corrector will fix it.” What the evidence says about those products is in Do posture correctors work?.
• “I can’t tell without an X-ray.” You can’t measure the angle at home, but the wall posture test is a simple self-check against a wall.

When should you see a doctor?

See a GP if your back has changed shape or has a lump or swelling, if back pain is worse at night or doesn’t improve with rest, or if you have lost weight without trying (NHS). Severe back pain that starts suddenly or gets worse quickly needs an urgent GP appointment or a call to NHS 111 (NHS). A teenager whose upper back seems to be rounding is worth taking to a GP too, since Scheuermann kyphosis is most often diagnosed after a parent notices exactly that (Mansfield & Bennett, 2023).

Bavelu’s upper back sessions, designed and filmed by physiotherapists, include mobility work for this part of the spine.