PT on the Net Research

Mild Kyphosis


Question:

My client has mild kyphosis in her upper back. What exercises do you suggest?

Answer:

Thank you for your question. I am in fact working with a client as we speak with the same condition. There are many things you can do to help. The first thing I would do is an RNT movement screen. Anette Lang has a great article about screening your clients before you work with them. You should determine if the kyphosis is limiting the amount of spinal rotation available to your client. It is my assumption that it will.

Provided that she does not have any spinal conditions diagnosed by a physician, the first thing I would have her do is mobilize her upper back on a foam roller. Have her place the foam roller perpendicular to her thoracic spine. Then have her roll up and down through the thoracic region while supporting her head all the while. After a couple minutes of moving, have her just relax in one spot around T-5 and focus on letting the arms that are supporting her head drop down towards the floor.

The goal is to have her elbows eventually touch the ground on either side. Do not force this to happen. Let gravity and nature take its course. If she complains of any numbness or tingling down her arms, it is time to refer out to a specialist. The next step is stretch out the neck and to strengthen the deep cervical flexors. The group we want to target most is the supra and infra hyoid musculature. I would bet that if you had her do full crunches off a stability ball that the first thing that would fatigue would be her neck.

A full crunch means that the client starts with the back of her head on the ball. The first motion is to bring the head toward the feet while keeping the chin tucked as much as possible. I tell the client to try to touch their chin to the top of their sternum. Although this is close to impossible, it will give her a good visual cue. I would guess that her sternocleidomastoid (SCM) is dominant. When the SCM is dominant, the smaller, deeper cervical flexors become dormant. This will cause the head to be held in a forward carriage position.

This head position will quite commonly lead to the kyphosis. We need to attack the issue from its roots rather than put a band-aid on it. The next step is to be sure to engage the inner unit. Please refer to Paul Chek’s article The Inner Unit (see "related articles" at right) to fully understand the way to turn on the transverse abdominus to engage the inner unit. This will protect the spine and ensure the pelvis to be in a good position to accept load. This is a technique that should be reinforced anytime she needs to produce force. The last and possibly most important exercise to be done to reverse the kyphosis is the prone cobra.

This is done either over a stability ball or from the ground. The key to this exercise is to do a back extension and at the same time externally rotate the humerus while keeping your arms as close to your sides as possible and keeping your head in neutral alignment with your spine. They do this pose in many yoga classes but far too often they ask the students to raise their head as far as it can go. I strongly recommend to keep the head in a neutral alignment. These three tips will get your client on her way to a better functioning back and a lot less stress on her spine. These tips can actually be used on anyone even if they don’t have an issue with kyphosis.