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Excessive Thoracic Kyphosis: More Than Just Bad Posture

Excessive thoracic kyphosis (ETK) 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; intolerances to food 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 and highlights some of its common causes.

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 Compensations

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.

ETK can also result from habitual overpronation, where the feet collapse excessively. When the feet collapse inward, the ankles roll in and the legs rotate toward the midline of the body. This internal rotation of the legs causes the hip sockets to shift backward and the pelvis to rotate forward. This rotation of the pelvis causes the lower back to overarch (excessive lumbar lordosis) and the middle and upper back to round forward so that the body stays balanced (Price 2010).

Myofascial adaptations and restrictions can likewise lead to ETK. For example, changes in the length-tension properties of the biceps muscle, which originates on the outside edge of the scapula and attaches to the forearm, can contribute directly to this imbalance. When the arms are flexed for prolonged periods during activities like cooking, driving and typing, the biceps muscles become chronically shortened. When the arms are subsequently straightened, these muscles cannot lengthen properly. This causes the forearms to pull the shoulder blades forward (via the biceps) on the rib cage. This forward position of the shoulder blades ultimately results in the rib cage dropping forward, causing thoracic kyphosis (Myers 2001).

Environmental Factors

Excessive rounding of the upper back is commonly associated with sedentary lifestyles or occupations that involve lengthy periods of sitting, such as video gaming or computer-based desk jobs. However, some less-obvious environmental stresses can also lead to ETK. Respiratory conditions like asthma, COPD and allergies to air pollutants can affect the body’s breathing mechanisms and the diaphragm’s ability to contract and relax correctly. Rib cage restrictions caused by chronic breathing problems can result in immobility of the thoracic spine and can eventually cause ETK (Rolf 1989).

Food sensitivities are another trigger for excessive thoracic kyphosis. Gluten, lactose, fructose and alcohol intolerances can inflame our digestive tract (Harker 1998). The gut shares connective tissue with other soft-tissue structures and muscles that attach to the spine. As such, chronic inflammation of the gut can cause myofascial restrictions and adhesions throughout the torso, causing ETK.

Exercise/Activity Choices

Exercise and activity choices can also contribute to ETK. Prolonged periods of spine flexion, as required for bike riding and/or indoor cycling, martial arts, freestyle swimming and hobbies like knitting and gardening, are major factors in excessive thoracic kyphosis.

Psychological Stressors

When the brain perceives a threat, whether real or imagined, the body physically prepares to act against the danger—the flight-or-fight response. Typical reactions include tensing the jaw, tightening the abdominals, holding one’s breath and rounding the shoulders (Hanna 1988). Consequently, ongoing psychological stressors—such as career dissatisfaction, relationship troubles, money problems or family issues—can bring about fascial restrictions, neuromuscular adaptations and musculoskeletal changes in the body that result in ETK.

Remedies for Excessive Thoracic Kyphosis

Several strategies can alleviate ETK:

  • corrective exercises
  • dietary changes
  • breathing practice
  • relaxation
  • life coaching

Corrective Exercise

Self-myofascial-release techniques, such as the following, are very effective for decreasing restrictions in the fascia and for improving posture.

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.

Dietary Changes: Pay Attention to Inflammatory Foods

People susceptible to inflammatory foods such as gluten, wheat, lactose, sugar and alcohol should limit the intake of these foods and beverages. Increasing the intake of various anti-inflammatory and/or soothing foods/compounds such as aloe vera, slippery elm and yogurt or other probiotics can improve the health of the gastrointestinal tract and consequently can alleviate ETK.

Breathing and Relaxation Techniques

Diaphragmatic breathing techniques help mobilize the ribcage, strengthen the diaphragm, supply blood to the organs, promote relaxation and decrease stress:

Lower-Rib Expansion

Lie on your back with your knees bent (support your head with a small pillow, if necessary). Place your hands palm-down around the bottom of your rib cage. Practice breathing in and out through your nose. As you breathe in, focus on the lower ribs expanding and pushing into the palms of your hands. Hold the breath (a diaphragmatic contraction) for a few seconds and then slowly breathe out. Do a total of 10–15 breaths every day.

Life Coaching Technique: Know Your Stress Triggers

In addition to causing ETK, mental stress can manifest as muscular pain, breathing problems, dizziness, headaches, gastrointestinal issues and skin problems like hives, eczema and rashes. These symptoms can be red flags for situations that have become detrimentally stressful. Over the period of a week, make a note of each physical manifestation resulting from stress and when each of these issues becomes inflamed or problematic. Also note what you were thinking about or doing when the symptom became more noticeable; for example, “back pain worsening while thinking about a recent argument” or “headache coming on after dealing with a trying client.” Once you become aware of your stress triggers, concentrate on limiting your exposure to these types of situations.


  1. Avatar Kim Cavolo on January 25, 2020 at 10:40 pm

    Can fully correct ETK after identifying the causes?

    • Avatar Justin Price, MA on January 25, 2020 at 11:20 pm

      One needs to first identify the causes and then apply corrective strategies to address these causes to fully alleviate the symptoms of ETK. Long standing and/or severe ETK may have changed the structure of the spine which will be difficult to fully correct. I hope that helps. Justin

  2. Avatar michael pink on February 8, 2020 at 9:19 pm

    is kyphosis most likely caused by obesity or overtraining chest muscles?

    • Avatar Justin Price, MA on February 8, 2020 at 9:30 pm

      Hi Michael,
      Thank you for your question. You are correct that both obesity and over-training chest muscles may be underlying causes of excessive thoracic kyphosis. However, without performing a complete assessment of a client it is difficult to know what other factors are contributing to someone’s musculoskeletal dysfunction. In some cases obesity may be the underlying cause, while in others over-training chest muscles may be more problematic. In other words, every client is different and a complete musculoskeletal assessment is vital to understanding the underlying cause of your clients both structural and movement imbalances. I hope that helps.

  3. Avatar Michael Pink on February 8, 2020 at 9:59 pm

    thank you. it is just a general question, in what is the most likely cause. Which would you say is most likely?

    • Avatar Justin Price on February 9, 2020 at 8:38 pm

      Every person is different. That is why it is essential to assess each person to understand their individual and person specific problems. As such, there is no generic answer to your question.

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