Posture guide
Kyphosis is the forward curve of your upper back. Everyone has some; when it's bigger than usual, the upper back looks rounded or hunched. In teenagers it's usually a flexible slouch, sometimes a stiff curve called Scheuermann's kyphosis; in later life it can come from disc wear, weaker back muscles or spinal fractures from osteoporosis.
Exercise can reduce an age-related curve a little: in the best trial, 6 months of classes cut it by about 3 degrees on X-ray. It can't reshape vertebrae that have fractured or grown wedge-shaped. This guide covers the different kinds of curve, the moves from the trials with 3D demos, how to exercise safely with osteoporosis, and why a new hunch or height loss needs a GP.
Most people's upper-back curve measures 20 to 45 degrees. It grows after about 40, faster in women: on average about 43 degrees at 55 to 60 and 52 degrees at 76 to 80. Depending on the definition, 20% to 40% of older adults have a bigger-than-usual curve (hyperkyphosis).
Postural kyphosis is a flexible slouch, mostly in teenagers, that doesn't get worse. Scheuermann's kyphosis is a stiff curve from wedge-shaped vertebrae that forms during the early-teen growth spurt. Age-related kyphosis comes from disc wear, weaker back muscles and sometimes spinal fractures.
A hunch isn't always osteoporosis: only about a third of older adults with the most curved backs had spinal fractures. But a curved upper back, height loss and unexplained back pain can be signs of spinal fractures, and UK guidance is to check for them. See a GP if your back has changed shape.
Across 24 studies, exercise reduced kyphosis by a small amount. In the best trial, 6 months of physiotherapist-led classes three times a week cut the curve by 3 degrees on X-ray, though physical function didn't change and some of the gain was lost after the classes stopped.
Spinal bones that break from osteoporosis heal in a compressed shape, and the NHS says exercises help pain and stiffness but won't improve a structural curve or stop it getting worse.
Avoid sustained, repeated, deep or loaded bending forward, and do back-muscle exercises: 3 to 5 repetitions held 3 to 5 seconds, at least twice a week (UK osteoporosis consensus).
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A flexible rounding that straightens when you stand up straight or lie down; the bones are normal. It's the commonest type, usually seen in teenagers and more often in girls. It's rarely painful and doesn't get worse over time.
A stiff curve that forms when the front of some vertebrae grows more slowly than the back, making them wedge-shaped. It shows up around ages 12 to 15 in boys and a few years earlier in girls, is more common in boys, and affects up to 8% of children, by US estimates.
The curve is sharp, is easiest to see when bending forward, and doesn't straighten when you stand tall. Many curves stay mild and need only check-ups, but it can get worse until growth stops.
In later life the curve can grow from disc wear, weaker back muscles and spinal (vertebral) fractures from osteoporosis. It usually progresses slowly, on average by less than 1 degree a year, and a new spinal fracture adds about 4 degrees.
Congenital kyphosis, where the spine doesn't form properly before birth, is rare and often needs surgery. Kyphosis can also follow an injury or earlier spine surgery, and in older people calcified spinal ligaments (diffuse idiopathic skeletal hyperostosis, or DISH) can stiffen the upper back. These need specialist care.
The reference measure is the Cobb angle on a standing X-ray taken from the side. Measurement error is 3 to 5 degrees, so small changes can be noise.
Definitions vary: more than 40 degrees (the top 5% of young adults), more than 45 degrees (Scoliosis Research Society), or more than 50 degrees (American Academy of Orthopaedic Surgeons). For older adults, whose average is 35 to 42 degrees, 50 degrees or more has been proposed.
The curve averages 20 to 29 degrees through childhood and the 20s and grows after 40, faster in women: from about 43 degrees at 55 to 60 to 52 degrees at 76 to 80.
Clinicians use a kyphometer, a bendy ruler (flexicurve) or the number of blocks needed under your head when you lie on your back. These agree moderately with the X-ray angle. The gap between the back of your head and a wall when you stand against it also tracks the curve, though it reflects your neck too.
A postural curve straightens when you stand tall or lie down; a structural one doesn't. That's one reason a stiff or sharp curve needs a GP.
Stand with your heels and back against a wall. If the back of your head can't reach the wall without tipping your chin up, note the gap and recheck in a few months. In one study, a gap of 6.5 cm or more picked out about 7 in 10 people with a bigger-than-usual curve, but also flagged about 1 in 4 without one.
Measure your height once a year: UK guidance counts 4 cm or more of height loss as a reason to check for spinal fractures. Neither check is a diagnosis.
In 1,407 adults aged 50 to 96, only about 36% of those with the most curved backs had spinal fractures; disc wear was the commonest finding. The authors still advised checking people with a marked curve for fractures.
Osteoporotic spinal bones squash down rather than breaking apart, and heal in 6 to 12 weeks in their compressed shape. Several fractures cause height loss and an outward curve at the top of the spine. Some spinal fractures don't cause the pain you'd expect, and the pain can be mistaken for arthritis.
The UK osteoporosis guideline says most spinal fractures don't come to medical attention. It recommends checking for them in women after the menopause and men aged 50 or over who have lost 4 cm or more in height, have a curved upper back, have taken steroid tablets long term, or have sudden back pain with risk factors for osteoporosis.
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If you notice a new or increasing hunch, height loss or back pain you can't explain, speak to your GP. Osteoporosis medicines reduce the risk of further fractures. Our exercise for osteoporosis guide covers exercise after a spinal fracture.
A review of 24 studies in adults aged 45 and over found exercise reduced kyphosis by a small amount (moderate certainty), improved quality of life a little, and may have eased pain a little; there were no serious side effects, and effects on falls were uncertain. Earlier reviews point the same way, with strengthening likely to matter more than stretching.
Another review, which grouped the trials differently, found programmes of 3 months or less helped older people but judged longer ones ineffective, so how much exercise helps, and over what time, isn't settled.
In the Study of Hyperkyphosis, Exercise and Function (SHEAF), 99 adults aged 60 to 88 did hour-long, physiotherapist-led group classes three times a week for 6 months: back-strengthening, spinal mobility and posture training, plus posture practice at home.
Their X-ray curve fell by 3 degrees compared with a health-education group, roughly the size of the increase one new spinal fracture causes. Their self-image improved, but walking speed and other tests of physical function didn't change, and there were no serious side effects. In the 6 months after the classes stopped, the curve crept back up by 1.6 degrees.
Three months of twice-weekly classes in 101 adults reduced kyphosis measured with a kyphometer by about 5 degrees, but the X-ray change of 1.7 degrees wasn't statistically significant. An earlier pilot in 21 women, with no comparison group, reported a 6-degree reduction and better physical performance after 12 weeks.
In 60 healthy women aged 49 to 65, 2 years of back-strengthening exercise didn't change kyphosis compared with no exercise. Eight years after the programme ended, the exercise group had fewer spinal fractures (1.6% of vertebrae against 4.3%), in a small follow-up of 50 women.
In 118 adults over 60, yoga three times a week for 24 weeks improved one measure of kyphosis by about 5% but not physical performance.
In closely supervised trials of heavy lifting in people with low bone mass, women's standing posture improved more than the comparison group's (6.7 against 1.6 degrees), and men in the heavy-lifting group improved by 3.5 degrees on X-ray, with no new spinal fractures in those groups.
In cohort studies, older people with more kyphosis fell more often, found everyday tasks such as standing up from a chair harder, and died earlier on average. These are associations: other health problems could explain them, and we found no trial showing that reducing the curve changes falls or survival.
A severe curve can cause back pain and make breathing difficult. After spinal fractures, a curved spine can cause breathlessness and a squashed, bloated feeling in the stomach. The UK osteoporosis consensus recommends breathing exercises for symptoms made worse by a marked curve.
The UK osteoporosis consensus recommends exercises that strengthen the back muscles: 3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week. The low cobra and the seated upper-back lift are examples. Without osteoporosis or past spinal fractures, build towards the SHEAF trial's 2 sets of 8 at a "somewhat hard" effort over about 6 weeks.
SHEAF asked people to practise good posture at least three times a day at home. The Royal Osteoporosis Society's posture exercises (sitting and standing tall, chin tucks, shoulders back) use 3 to 5 repetitions or up to 10 holds of 3 to 5 seconds, 2 or 3 days a week.
SHEAF used side-lying and standing back rotations and extensions, and a cool-down that stretched the neck, chest and limbs. Our editorial starting point: open-book rotations, 8 each side; a doorway chest stretch, 2 holds of 30 seconds each side with the elbow at or below shoulder height; breath reaches, 5 breaths, since the consensus recommends breathing exercises for a marked curve.
The trial that reduced the X-ray curve ran three classes a week for 6 months; 3 months twice a week didn't significantly change the X-ray angle. Keep going: some of the gain faded after the classes stopped.
The UK consensus recommends strength exercise, building to 8 to 12 repetitions and up to 3 sets, and balance training to reduce falls. Sit-to-stands, goblet squats and hip-hinge practice suit most people; the older adults and osteoporosis guides have the full plans.
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Low cobra and locust: 3 to 5 lifts held 3 to 5 seconds, at least twice a week (UK osteoporosis consensus), building towards 2 sets of 8 if you have no osteoporosis or fractures (SHEAF trial). Bird dog, 2 sets of 8 each side (SHEAF). Y-T-W raises, 5 of each letter for 2 rounds, and the 45-degree back extension, 2 sets of 8 to 12, only without spinal fractures (our editorial starting points).
3D demoLow cobra (Bhujangasana)Beginner · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoBack extension on a 45-degree benchIntermediate · A bench or boxNo floor needed. Chin tucks and seated upper-back lifts, 3 to 5 holds of 3 to 5 seconds, at least twice a week, and daily at low effort after a spinal fracture (Royal Osteoporosis Society and UK consensus); band rows, 8 to 12, building to 3 sets (UK consensus); wall angels, 8 slow slides, with a small range if your back is very curved (our editorial starting point).
Open books, 8 each side, and seated rotations, 5 each side with arms crossed; breath reaches, 5 breaths; doorway stretch, 2 holds of 30 seconds with the elbow at or below shoulder height; sphinx, 3 holds of 3 to 5 breaths (our editorial starting points, from the SHEAF programme's mobility work and cool-down).
The UK consensus asks people with osteoporosis to avoid sustained, repeated, end-range or loaded bending forward, such as sit-ups, toe touches, roll-downs and lifting with a rounded back. Bend from the hips instead.
Back-muscle exercises are recommended: 3 to 5 repetitions held 3 to 5 seconds, at least twice a week, and daily at low effort after a spinal fracture. The research behind these limits is thin, so they're a precaution as much as a proven rule.
In a small 1984 study, women with spinal osteoporosis who were taught bending-forward exercises had far more new spinal fractures than those taught back-extension exercises (89% of 9 women against 16% of 25). The groups weren't randomised, so treat it as a warning rather than proof.
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Stay as active as you can: movement doesn't affect healing. Do gentle back exercises daily at low effort, keep impact to brisk-walking level, and ask for a physiotherapy referral.
In trials after a spinal fracture, exercise made the Timed Up and Go test (standing up from a chair, walking 3 metres, turning and sitting back down) about 1 second faster; effects on fractures, falls and pain are uncertain.
Our exercise for osteoporosis guide covers the back exercises (its "Straight" section), what to modify when bending, lifting and twisting, and exercise after a spinal fracture in more detail.
With osteoporosis, these train the trunk with the spine still: the dead bug or knee plank in place of sit-ups and crunches, and hip-hinge practice in place of toe touches (the swaps our osteoporosis guide uses).
Postural kyphosis rarely hurts and doesn't progress. Back and core strengthening and posture awareness are the main treatment if it causes symptoms. A review of 9 trials in teenagers and young adults found exercise programmes improved the curve angle.
Exercise and physiotherapy help pain and stiffness, but there's no conclusive evidence that exercise alone changes the curve for good. For teenagers who are still growing, a specialist may prescribe a brace, usually worn until growth stops: in a long-term study of 110 people who wore one consistently, 76 improved.
Surgery is considered for large curves, roughly over 70 to 80 degrees, with pain, or for curves that keep getting worse. One trial in 50 young adults found a specialist exercise method taught by trained therapists (Schroth therapy) improved the curve more than standard exercises over a year.
In one trial, women with osteoporotic spinal fractures who wore a spinal brace for 6 months had 11% less kyphosis, stronger back muscles and less pain. Pooled trials of bracing for 3 months or more in older adults were low quality, and the UK guideline doesn't recommend routine bracing for a new spinal fracture.
Taping reduced kyphosis during standing tasks in a small study, but a review judged it ineffective in older adults. We found no trial of off-the-shelf posture correctors for kyphosis.
No medicine improves the curve itself, but osteoporosis medicines reduce the risk of more fractures. Vertebroplasty and kyphoplasty, which inject bone cement into a broken vertebra, are for a few people with severe, ongoing fracture pain, and they don't strengthen bone.
Start with the kyphosis routine, built from the SHEAF trial, three times a week. Use the chair workout if getting down to the floor is hard, the balance routine for falls, and the strength and bone workouts if you have no recent spinal fractures. The upper-back posture routine suits younger people; with osteoporosis, check its foam roller with a physiotherapist first.
A 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallFor people without recent spinal fractures who are steady on their feet.
A weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekA 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginnerGet emergency help for back pain with any of these:
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Get advice soon (in the US, your doctor or urgent care) for back pain with any of these:
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Book a GP appointment for any of these:
See a GP if you think your child might have kyphosis. A curve can get worse until growth stops, and a stiff, sharp or painful curve that doesn't straighten when standing tall isn't a simple slouch. Rarely, a curve that keeps growing causes weakness, numbness or tingling in the legs, bladder or bowel changes, or difficulty breathing.
A postural slouch straightens when you stand tall. An age-related curve improved by about 3 degrees in 6 months of classes, and fractured or wedge-shaped bones don't reshape.
Only about a third of the most curved older backs had spinal fractures. But a new hunch or height loss still needs checking.
Postural kyphosis rarely hurts and doesn't progress. A stiff, sharp curve is different and needs a GP.
Exercise is recommended: back-muscle work, strength and balance. What changes is avoiding loaded, repeated or deep rounding.
One trial of a spinal brace reduced kyphosis by 11%, but the pooled evidence is low quality, and routine bracing after a new spinal fracture isn't recommended.
It's the natural forward curve of your upper back; most people's measures 20 to 45 degrees. In everyday use it means a bigger curve that makes the back look hunched. The main kinds are postural (a flexible slouch), Scheuermann's (wedge-shaped vertebrae in teenagers) and age-related.
It depends on the kind. A postural curve straightens when you stand tall, but bones that heal compressed after a spinal fracture don't go back, and the NHS says exercises won't improve a structural curve. For an age-related curve, 6 months of classes reduced it by about 3 degrees on X-ray.
Back-strengthening (small face-down chest lifts and the bird dog), posture practice and upper-back mobility: the mix used in the SHEAF trial. Across 24 studies in adults aged 45 and over, exercise reduced kyphosis a little and improved quality of life a little. The kyphosis routine on this page follows that mix.
Avoid deep, repeated or loaded rounding: sit-ups, toe touches, roll-downs and lifting with a rounded back. In a small 1984 study, women with spinal osteoporosis doing bending-forward exercises had far more new spinal fractures than those doing back-extension exercises. Bend from the hips instead.
Sometimes. A curved spine, height loss and unexplained back pain can be signs of spinal fractures, and the Royal Osteoporosis Society advises speaking to your doctor. But in 1,407 older adults, only about a third of those with the most curved backs had spinal fractures.
If the curve is new or increasing, you've lost height, your back has changed shape, or you have new back pain after a minor fall, bend, lift or cough. A child or teenager with a rounded back should see a GP too. Call 999 for weakness or numbness in both legs, or for bladder or bowel changes.
A severe curve can make breathing difficult, and after spinal fractures a curved spine can cause breathlessness and a squashed, bloated feeling. Breathing exercises are recommended for these symptoms. New or worsening breathlessness needs a GP.
For teenagers with Scheuermann's who are still growing, a specialist may prescribe one, and in a long-term study most consistent wearers improved. In older adults, low-quality evidence suggests braces worn for 3 months or more reduce the curve, but routine bracing after a new spinal fracture isn't recommended.
A stiff curve that develops in the early teens when the front of some vertebrae grows more slowly, making them wedge-shaped; it doesn't straighten when you stand tall. It affects up to 8% of children, by US estimates. Exercise helps pain, and bracing during growth or surgery for large, painful curves are specialist options.
A flexible slouch is usually postural kyphosis: it straightens when they stand tall or lie down, rarely hurts and doesn't get worse. Strengthening and posture awareness help if it causes symptoms. See a GP if the curve is stiff, sharp, painful or getting worse.
Older people with more kyphosis fall more often in cohort studies, but that doesn't show the curve causes the falls. Whether reducing the curve prevents falls is unknown; balance and strength training is what cuts falls, as the older adults guide explains.
In 118 older adults, 6 months of yoga three times a week improved one measure of kyphosis by about 5% but not physical performance. With osteoporosis, choose classes that avoid deep forward folds and roll-downs.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Get a curve or hunch that is new or getting worse checked, above all in a growing child or after a fall, and get urgent help for numbness or weakness in the legs or a change in bladder or bowel control. Health disclaimer.
