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Thoracic Kyphosis: Solutions for Clients

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

Justin Price is the creator of The BioMechanics Method® Corrective Exercise Specialist (TBMM-CES) program, the fitness industry’s highest-rated specialty certification. There are trained TBMM specialists in over 70 countries helping people alleviate pain and reach their performance goals. He is also the author of several books including the esteemed academic textbook The BioMechanics Method for Corrective Exercise. Justin is a former IDEA Personal Trainer of the Year, founding author of PTA Global, and a subject matter expert for The American Council on Exercise, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men's Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. Learn more about The BioMechanics Method®

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