Age-Related Hyperkyphosis: Its Causes, Consequences, and Management

Katzman, Wendy B.; Wanek, Linda; Shepherd, John; Sellmeyer, Deborah E.

doi:10.2519/jospt.2010.3099

Cited by 230 publications

(214 citation statements)

References 57 publications

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“…Similarly, the findings cannot be extrapolated to an older population due to the combined effects of age and spinal degeneration on thoracic spine mobility. 11 Accurate identification of the thoracic spinous processes is a potential source of error is this study. Correct identification of thoracic spinous processes through palpation has been shown to be achieved on 68% of occasions, and to within 1 level of the target segment on 95% of occasions.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

Edmondston¹,

Waller²,

Vallin³

et al. 2011

J Orthop Sports Phys Ther

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Mechanical pain disorders in the thoracic spine are commonly associated with impairment of mobility. 5 Thoracic spine movement limitation in individuals with mobility impairment is frequently observed in axial rotation, as well as in the sagittal plane, particularly into extension. 6 Achieving end range motion of the shoulder girdle also depends on adequate extension of the thoracic spine. 12 Consequently, observation and measurement of thoracic spine extension mobility is an important part of the physical examination of patients with thoracic spine or shoulder girdle pain disorders. Movement impairments are typically interpreted in relation to the patient's symptoms and with consideration of the expected range of motion of the region being examined. While the mechanics of thoracic motion segments have been examined in cadaveric and modeling studies, 23,26,34 few studies have examined the global and regional mobility of the thoracic spine in vivo.Normative ranges of sagittal spinal motion have been reported for the lumbar spine 4 but not for the thoracic region. This may reflect the sentiment that "extension mobility of the thoracic region is limited and usually not measured." 10 In cross-sectional studies, extension mobility in asymptomatic individuals has been variously reported as being "almost negligible," while others have recorded motion of between 20° and 40°. 18,22,35 These differences can be attributed to age, measurement technique, and the reference position from which the movement was measured.Thoracic spine mobility has been shown to decrease with increasing age, although this decline is more evident in individuals over 60 years of age. 15,22 Though several computerized spinal T T STUDY DESIGN: Cross-sectional study. T T OBJECTIVES:To examine extension mobility of the thoracic spine in young, asymptomatic adults, with particular reference to the influence of subject position and magnitude of the thoracic kyphosis. T T BACKGROUND: Impairment of thoracic extension motion is commonly associated with mechanical pain disorders in this region of the spine. Knowledge of normal thoracic mobility and the factors that may influence this motion is important in the evaluation and management of thoracic pain disorders. T T METHODS:In 40 asymptomatic adults, the total and regional thoracic extension range of motion was measured using 2-dimensional photographic image analysis. Extension mobility was measured in standing, sitting, prone, and 4-point kneeling.The association between the magnitude of the habitual thoracic kyphosis and extension mobility was also examined. T T RESULTS:When measured from the habitual standing position, the mean range of flexion was 11.5° (3.7°) and mean extension range was 8.7° T T CONCLUSION:When measured from the habitual standing position, thoracic extension range of motion in young individuals is small and poorly correlated with the magnitude of the standing thoracic kyphosis. Unloaded positions (4-point kneeling and prone), compared to positions that load the spine (standing and s...

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Section: Discussionmentioning

confidence: 99%

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

Edmondston¹,

Waller²,

Vallin³

et al. 2011

J Orthop Sports Phys Ther

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“…Sagittal malalignment of the spine, in contrast, has been described as an exaggeration or deficiency of normal LLC or TKC (3) and reported to be a potent generator of pain and disability, as well as associated with suboptimal quality of life (2,4). Hence, strategies that promote optimal alignment of the spine should be a concern for physiotherapists.…”

Section: Introductionmentioning

confidence: 99%

Combined Effects of Postural Education, Therapeutic Massage, Segmental Stretching, and Motor Control Exercise in a 19-Year-Old Male with Chronic Back Pain and Kypholordotic Posture: A Case Report

Ibrahim

Akindele

2018

Middle East J Rehabil Health Stud

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Introduction: Sagittal spine malalignment has been linked with a number of health consequences including pain, disability, and suboptimal quality of life. Case Presentation: We present a 19-year-old male with 3 years history of chronic back pain associated with kypholordotic posture. Upon examination, lumbar hyperlordosis and thoracic hyperkyphosis were mainly associated with muscular imbalance around the chest, upper back, and lumbopelvic-hip region. The patient received treatment comprising postural education (PE), therapeutic massage (TM), motor control exercises (MCE), and segmental stretching exercises (SSE) twice a week for 8 weeks. The patient demonstrated a significant improvement in lumbar lordotic (83.80 to 76.30) and thoracic kyphotic (65.20 to 60.60) curves as measured by flexible ruler, back pain (7.0cm to1.0cm) as measured by visual analogue scale, spine ranges of motion (flexion: 5.2cm to 7.5cm; extension: 3.5cm to 4.7cm) as measured by modified Schober's test, and functional disability (46.7% to 20.0%) as measured by modified Oswestry disability index. Conclusions:The results showed that the combination of PE, TM, MCE, and SSE was effective in improving sagittal spine alignment, back pain, spine range of movement, and function.

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“…Sequelae include impaired pulmonary function, decreased physical function, elevated fracture risk, and an increased risk of mortality [7,8,[16][17][18]. Many have hypothesized that hyperkyphosis may increase older adults' fall risk [19][20][21], potentially through diminished balance [17].…”

Section: Introductionmentioning

confidence: 99%

Kyphosis and incident falls among community-dwelling older adults

et al. 2017

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Summary Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits. Introduction To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Methods Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview. Results Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. Conclusions Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

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Age-Related Hyperkyphosis: Its Causes, Consequences, and Management

Abstract: Our objective is to review the prevalence and natural history of hyperkyphosis, associated health implications, measurement tools, and treatments to prevent this debilitating condition.t LeVeL oF eVidenCe: Diagnosis/prognosis/ therapy, level 5.

Cited by 230 publications

References 57 publications

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

Thoracic Spine Extension Mobility in Young Adults: Influence of Subject Position and Spinal Curvature

Combined Effects of Postural Education, Therapeutic Massage, Segmental Stretching, and Motor Control Exercise in a 19-Year-Old Male with Chronic Back Pain and Kypholordotic Posture: A Case Report

Kyphosis and incident falls among community-dwelling older adults

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