Thoracic Kyphosis: Solutions for Clients

by Justin Price, MA on Feb 21, 2013

Excessive thoracic kyphosis is a disproportionate forward rounding or curvature of the middle and upper back, also known as the thoracic spine (Kendall, McCreary & Provance 2005). ETK is an extremely common musculoskeletal imbalance brought on by prolonged time in some postural positions; exercise and/or activity choices; environmental factors; myofascial dysfunction; food allergies and/or other allergic reactions; and psychological stress.

Symptoms of ETK include musculoskeletal aches and pains, breathing problems, limited function, impaired athletic performance, gastrointestinal upsets and increased mental stress (Rolf 1989; Myers 2001; Hanna 1988; Price 2010). This article shows you how to identify ETK, highlights some of its common causes and provides ways to address the problem.

Identifying Excessive Thoracic Kyphosis

Excessive thoracic kyphosis is inherently linked to rib cage function because each rib attaches to a vertebra of the thoracic spine. The following musculoskeletal assessment can show whether you or your clients have ETK.

Rib-to-Spine Assessment

Place the index finger of one hand on the sternal notch, the indentation between your collarbones at front of your throat. Then place the index finger of your other hand on the vertebrae immediately below the ones that stick out most at the base of your neck. Turn your head to the side and look at the position of your fingers in a mirror. Ideally, your fingers should be at approximately the same height. If the finger on the front of your chest is lower than the finger on the back of your neck, your thoracic spine has rounded forward and your rib cage has dropped, meaning you have ETK.

Possible Causes of Excessive Thoracic Kyphosis

The most common causes of ETK include the following:

  • musculoskeletal compensations
  • environmental factors
  • exercise/activity choices
  • psychological stressors

Musculoskeletal imbalances anywhere in the body can cause ETK. For example, moving the head forward of its optimal position to focus on a small object like a handheld electronic device causes the thoracic spine to round forward in order to help hold up the head (Kendall, McCreary & Provance 2005). This is akin to having a large fish on the end of a flexible fishing rod. The rod will bend forward to accommodate the extra weight. Over time, this forward-head position can lead to ETK.

Remedies for Excessive Thoracic Kyphosis

Several strategies can alleviate ETK:

Corrective Exercise

Self myofascial release techniques are very effective for decreasing restrictions in the fascia and for improving posture.

Exercise 1: Two Tennis Balls on Upper Back
This self-massage technique promotes extension in the thoracic spine.

Lie on the floor on your back with knees bent. Place a tennis ball on either side of your spine in line with the bottom of your shoulder blades. Use a large pillow to support your head so you don’t feel too much pressure from the tennis balls. Bring your arms across your chest and hug yourself. Find a sore spot and maintain pressure on it until it releases (10–15 seconds). Then move the balls to another sore spot by scooting your butt and body down so the balls roll up your spine. Bring the pillow with you each time you scoot. Spend about 2–3 minutes each day on the entire area.

For additional techniques that can help clients with ETK, plus a full reference list, please see “Excessive Thoracic Kyphosis: Much More Than Just Bad Posture” in the online IDEA Library or in the January 2013 issue of IDEA Fitness Journal.

IDEA Fit Tips, Volume 11, Issue 3

© 2013 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

About the Author

Justin Price, MA

Justin Price, MA IDEA Author/Presenter

Justin Price, MA, is the creator of The BioMechanics Method which provides corrective exercise education for health and fitness professionals. He is also an IDEA Personal Trainer of the Year and an e...


  • Log In to Comment
  • Robson Nascimento

    Strengthening the antagonists, stretching the agonists, breathing, etc. will not help without neuromuscular reeducation. We must reeducate the CNS to send the right signals, otherwise, strong antagonists will not hold the spine in the desirable position.
    Commented Jan 08, 2014
  • Justin Price

    Thank you all for your great comments! Based on the large number of people providing feedback, it is obvious that ETK is a prevalent and far-reaching problem. I urge you all to keep up the great work in helping your clients alleviate the aches and pains assciated with this very common musculoskeletal imbalance.
    Commented May 31, 2013
  • Barbara Bruni

    I agree with Jonathan that teaching the correct mechanics of costal breathing is a great place to start. It helps to bring awareness to their posture. And Chuck brings to light a much overlooked area - upper abdominals (rectus) way too tight and overworked. It is pretty difficult to train an ETK client into extension without increasing their lumbar lordosis since the thoracic cage is so rigid. If we keep strengthening the opposing muscles without freeing up the ribcage we will just get even tighter shoulders/neck. In my Pilates and myofascial release practice one of my favorite starting places is a simple exercise where I place a medium sized ball behind their upper back while they are supine. I place pillows under their head to accomodate their cervical spine as needed. Keep their knees bent. The idea is to stretch the anterior chest wall not to increase the lordosis. They love it because it feels so good and they can do it at home too. Oh yeah - no more crunches! There are many neutral spine abdominal strengtheners to choose from instead.
    Commented Mar 08, 2013
  • Caren Strait

    Another thing to keep in mind with older adults and anyone with osteoporosis is that the hyperkyphosis may be the result of wedge fractures in the thoracic vertebra. Just something to consider if you work with older clients.
    Commented Mar 08, 2013
  • Helene Byrne

    As a pre and post natal exercise specialist, I work to prevent/lessen the kyphotic posture which pregnancy induces. I have found that stretching the pectorals, while the humerus is in external rotation, to be the most effective first step to aligning the upper spine closer to the neutral position. BeFit-Mom
    Commented Mar 08, 2013
  • Helene Byrne

    As a pre and post natal exercise specialist, I work to prevent/lessen the kyphotic posture which pregnancy induces. I have found that stretching the pectorals, while the humerus is in external rotation to be the most effective first step to aligning the upper spine closer to the neutral position. BeFit-Mom
    Commented Mar 08, 2013
  • James Knippel

    Awesome article that is very culturally needed since everyone shows signs because of always being pulled by gravity and sucked in by our computers. Great comments too, but just a note--specificity of cause, individual's muscleo/skeletal structure, age and severity of symptoms guide us towards whatever solution might be needed.
    Commented Mar 07, 2013
  • Jonathan Urla

    It is an interesting topic and one that I deal with on a daily basis with my Pilates clients. My comment would be that before working on strengthening antagonistic muscles in the back, one should first teach the client to breathe deeply. Breathing fully with the rib cage is directly related to the flexibility of the thoracic spine. If the ribcage is immobile, it won't matter how much you strengthen the opposing muscles, the spine won't straighten. First get the client to sit comfortably as straight as they can. Then have them practice expanding the ribcage with the inhale, and feeling a lift in sternum. Then with the exhale, have them try to feel the ribs relax in, but without losing the added height of the sternum. Practice at least 5 breaths. Then, proceed to extension exercise the also stretch the anterior pec and deltoid muscles. Focusing on using the breath to help posture on all exercises is key.
    Commented Mar 07, 2013
  • Iola Hernandez

    Ladies who have large breasts also experiment ETK. Have no funding to correct and have to deal with large breasts pulls down the rib cage and creates kyphotic condition.
    Commented Mar 07, 2013
  • Michael Saiz

    Great Article Justin, I would agree with Dr. Len Lopez, antagonistic muscle groups ie: Teres Minor & Major, Trapezius, Omohyoid, Supraspinatus should be strengthened to help pull the shoulder back along with core strengthening exercises.
    Commented Mar 07, 2013
  • View Previous Comments

Trending Articles

Mindful Walking

Walking can be more than just moving physically from one location to another. It can be a metaphor for your larger life journey. Things you&...

Nuts and Peanuts Reduce Cardiovascular Risk and Prolong Lifespan

While there have been numerous studies in recent years touting the health benefits of nuts and peanuts, new research published online March ...

Smooth Move: Creative Additions to Consider for Smoothies

When looking for a quick breakfast or post-workout nourishment, almost nothing beats a smoothie. Whirl in the right ingredients and the blen...

Cut Risk of Alzheimer’s with MIND Diet

Conservative adherence to a new diet, appropriately known by the acronym MIND, could significantly lower a person’s risk of developing Alzheimer’s disease, according to a paper published o...

Yes, You CAN Develop Better Eating Habits

Analogous to laying out your exercise gear so it’s the first visual reminder you have of your commitment to exercise each day, imagine...

7 Ways to Help a Client Boost Adherence

Once a client has decided to make nutritional changes to support weight loss, you can play a key role in developing an action plan that is m...

20 IDEA World-Renowned Presenters Share Advice on Success and Happiness

We asked some of this year’s most influential and motivating IDEA World Fitness Convention™ presenters to share the single piece of advice they would give another fitness/health pro to hel...

Recipe for Health: Picadillo-Stuffed Peppers

If you don’t believe that authentic Mexican cookery is “whole” and healthy, you need to take a deep dive into Mexico: The Cookbook (Phaidon 2014), the first truly comprehensive bible...

The Reason Your Clients Don't Acieve Their Goals

Lots of people hire personal trainers or join group fitness classes hoping to lose weight. Yet many fail to meet their goals. New research suggests that “progress bias”—overestimatin...

Rice-Cooking Technique Cuts Calorie Absorption in Half

In a molecular gastronomy-meets-lab-science moment, researchers at the College of Chemical Sciences in Colombo, Sri Lanka, have discovered a...