The Dowager's Hump: What Is It? What Can Be Done About It?
The Dowager's hump in medical terms is called hyperkyphosis. It is an increase in the forward curvature of the spine -- usually in the lower cervical (neck) and upper thoracic areas. A visible hump appears along the back of the spine and the head juts forward and eventually down if the curve is pronounced enough.

What causes it? And what can be done about it? Doctors and scientists are starting to pay more attention to this problem. It's not that it hasn't been around for a long time. But more of the Baby Boomers have this problem and they are concerned. Experts estimate hyperkyphosis may affect as many as four out of every 10 older adults. And it's not just women who develop this problem. Men are just as likely as women to become stooped over as they age. There is concern for how it looks but even more worrisome is the fact that vertebral fractures and even death may be more likely among folks with this condition.

Let's take a step back and answer the first question. What causes it? It's not entirely clear what causes it -- or if there is just one possible cause. There may be many underlying causes making this a multifactorial problem. Muscle weakness, muscle imbalance, degenerative disc disease, ligament problems, and certain metabolic problems top the list of potential causes. Since it seems to run in families, there could be a genetic link as well.

There are some inherited genetic conditions that include hyperkyphosis. These include Scheuermann disease, osteogenesis imperfecta, Ehlers Danlos syndrome, Marfan syndrome, and cystic fibrosis. Most of these problems directly affect the muscles and bones, but why hyperkyphosis is an outcome remains uncertain.

Usually the person with hyperkyphosis isn't as aware of the problem as others (family and friends) around them. Since it is more obvious when viewed from the side and most people view themselves in the mirror from the front, it can progress quite a bit before anyone seeks help for it. It can be completely asymptomatic (no symptoms), but neck pain and headaches can develop. Even in moderate cases, it can become difficult to lie on the backs comfortably because the head is flexed so far forward.

What can be done to treat this condition? Once again, there are more questions than answers. There haven't been a lot of studies done comparing the results of one treatment approach to another. This is an area wide open for future research. Possible treatment options include bracing, postural exercises, strength training, flexibility training, and surgery.

Even more important is the question: can this problem be prevented? Because hyperkyphosis has been observed in other conditions such as heart disease (e.g., atherosclerosis or hardening of the arteries) and there are an increased number of deaths in people with hyperkyphosis, finding ways to prevent the problem is a good idea. There's been some suggestion that hyperkyphosis isn't just a simple problem of spinal curvature. From a big picture point-of-view, hyperkyphosis may be just one part of a larger number of health issues. It is certainly a signal that other health and functional problems are at hand.

For now, despite the fact that this condition has been around for hundreds of years, what we know about it isn't very much and highly questionable. It's definitely time to take a closer look and get some answers to the many questions.
Hyperkyphosis: A Common, Poorly Understood Condition. In The BACK Letter. July 2009. Vol. 27. No. 7. Pp. 76-77.