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Thoracic Kyphosis: Solutions for Clients

by Justin Price, MA
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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.

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Justin Price, MA

IDEA Author/Presenter
Justin Price, MA, is the creator of The BioMechanics Method which provides corrective exercise educa... more less
IDEA Fit Tips, Volume 11, Number 3
March 2013

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

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Article Comments

Dr Len Lopez
On Mar 07, 2013
Excellent article, but from a sports medicine perspective, you missed one major point and that is that to counterbalance the kyphosis (muscle imbalance), you need to contract the opposing muscles. Usually short, tight pec muscles are what pull your chest forward - so it is important to work the opposing muscles by doing any type of pulling or rowing motion that activates those upper back muscles.
Liz Horton
On Mar 07, 2013
As a Yoga Instructor, I see this often, especially office workers and those who lift weights. Agree with Dr. Lopez that back exercise is needed to counteract tight pectoral (chest) muscles. I also study advanced Yoga Anatomy which has given me a lot of knowledge on special conditions, especially spinal.
Liz Horton
On Mar 07, 2013
As a Yoga Instructor, I see this often, especially office workers and those who lift weights. Agree with Dr. Lopez that back exercise is needed to counteract tight pectoral (chest) muscles. I also study advanced Yoga Anatomy which has given me a lot of knowledge on special conditions, especially spinal.
Chuck Rowland
On Mar 07, 2013
ETK may also be related to the abdominals, as is the case with competitive cyclists. The overworked which not only propel the cycling gate, stablize the core as well. This pulls down on the rib cage, encouraging the kyphotic condition. In many such cases, eliminating abdominal exercises may be just as important as the pulling or rowing-motion exercises Dr. Lopez is recommending.
Chuck Rowland
On Mar 07, 2013
Correction to second sentence of my original comment: "The overworked abdominals which help propel the cycling gate, stabilize the core, as well"
Michael Saiz
On Mar 07, 2013
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.
Iola Hernandez
On Mar 07, 2013
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.
Jonathan Urla
On Mar 07, 2013
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.
James Knippel
On Mar 07, 2013
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.
Helene Byrne
On Mar 07, 2013
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
Helene Byrne
On Mar 07, 2013

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
Caren Strait
On Mar 07, 2013
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.
Barbara Bruni
On Mar 08, 2013
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.

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