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Tag: kyphosis

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Physio , , , , , , , , , , , , , , , , ,

Cobb Angle: From Measurement to Treatment Decisions

The Cobb angle is a mathematical measurement tool for assessing the curvature of the spine. Along with physical exams and other tests, how is it used to evaluate scoliosis and kyphosis of the spine?

Cobb Angle

The Cobb angle is used to quantify the curvature of the spine, particularly in conditions like scoliosis. It measures the degree of side-to-side spinal curvature, a deformity called scoliosis. The angle’s size helps determine what kind of treatment is needed. Monitoring may be all that’s necessary for mild curvature. With severe scoliosis, treatment may require spinal fusion surgery. Named for orthopedic surgery pioneer John Robert Cobb, it describes the distance a scoliotic curve may deviate from being straight. (Botterbush K. S. et al., 2023) Generally, it takes at least 10 degrees of deviation from straight before scoliosis is confirmed.

X-Ray and Interpretation

An X-ray is taken to measure the Cobb angle. Side and back views are taken. The healthcare provider or examiner then views the X-rays and locates the most affected vertebra in the curve, called the apical vertebra. In a scoliotic curve, the apical vertebra is the spinal bone with the greatest degree of rotation that takes the biggest curve away from the center of a normal spine column.

Visualizing the Angle

The apical vertebra is where two lines drawn from the X-rays meet. Two lines are drawn along the edge of the top and bottom bones of the curve. The lines extend out as follows:

  • On the top bone, the line starts on the high side, continues along the top edge, and then slopes down according to the angle of the vertebra. (Jin, C. et al., 2022)
  • On the bottom vertebra, the line starts on the low side, continues along the bottom edge, and slopes upward.
  • The Cobb angle is found by measuring the angle of the two intersecting lines where they meet.

Then, the top and bottom vertebrae of the side-to-side curve are identified to create a number for the Cobb angle. These bones have the most tilt but the least rotation and displacement and are located above and below the apical vertebra. Computer software is commonly used to calculate the Cobb angle. (Jin, C. et al., 2022) Treatment is based on the:

10 Degrees Cobb Angle 

Scoliosis is diagnosed when the Cobb angle reaches 10 degrees or more. However, this is not generally considered a significant curvature (American Association of Neurological Surgeons, 2024). In around 80% of cases, the scoliosis is considered idiopathic or without congenital or other underlying causes.

Less Than 25 Degrees Cobb Angle

If a scoliotic curve is less than 25 degrees, individuals may only need to visit their healthcare provider periodically so long as the scoliosis is monitored. These are mild cases, often without symptoms, but there is a chance that the curvature can progress. This usually means reassessing the Cobb angle every four to six months in a growing child or adolescent. (National Scoliosis Foundation, 2015) A 5-degree or more progression can change the diagnosis and treatment. (Jin, C. et al., 2022)

Between 25 and 40 Degrees Cobb Angle

A Cobb angle of 25 to 40 degrees usually requires wearing a back brace and intensive physical therapy. The goal of these treatments is to help halt the curve’s progression. Braces are generally worn 16 to 23 hours every day. (National Scoliosis Foundation, 2015) The healthcare provider will provide a referral for physical therapy. Many report excellent results with the Schroth or other scoliosis-specific exercise methods. A study found that core stabilization exercise programs can decrease Cobb angles in adolescents with idiopathic scoliosis. (Ko K. J. & Kang S. J. 2017)

Scoliosis in Adults

Scoliosis is diagnosed in adults, usually in those who have had the condition, treated or not, that was identified in their youth. A study that followed various cases for 20 years found disease progression occurred in 40% of adults but was usually less than one degree per year. However, degenerative scoliosis can also occur in individuals aged 65 and older. (American Association of Neurological Surgeons, 2024)

40 Degrees or More Cobb Angle

Surgery may be recommended once the Cobb angle reaches 40 to 50 degrees. A spinal fusion is often used to force the curve to stop developing. In adults, surgery may be needed if the angle reaches 50 degrees and they experience complications, such as nerve damage or bowel/bladder dysfunction. Risk factors in adults include older age, a history of smoking, and a diagnosis of other conditions, including being overweight. (American Association of Neurological Surgeons, 2024)

Variations

Variations occur in measuring scoliosis, and it is important to understand the difference between a change in scoliosis and a change in the tools or measurement. Equipment errors, imaging errors, and the subjective reading of the healthcare provider can change the values. (Jin, C. et al., 2022) Scoliosis measurement software and intelligent medical devices continue to improve how scoliosis is evaluated and treated. Physical exams, symptoms, and careful monitoring of changes in posture or function are still critical to an accurate diagnosis. The healthcare provider will explain the Cobb angle and other test results.

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Academic Low Back Pain: Impact and Chiropractic Solutions

References

Botterbush, K. S., Zhang, J. K., Chimakurty, P. S., Mercier, P., & Mattei, T. A. (2023). The life and legacy of John Robert Cobb: the man behind the angle. Journal of neurosurgery. Spine, 39(6), 839–846. https://doi.org/10.3171/2023.7.SPINE23146

Jin, C., Wang, S., Yang, G., Li, E., & Liang, Z. (2022). A Review of the Methods on Cobb Angle Measurements for Spinal Curvature. Sensors (Basel, Switzerland), 22(9), 3258. https://doi.org/10.3390/s22093258

National Scoliosis Foundation. (2015). Scoliosis Media & Community Guide. https://www.scoliosis.org/nsf2/wp-content/uploads/2015/06/ScoliMediaGuide_9June3.pdf

American Association of Neurological Surgeons. (2024). Scoliosis. https://www.aans.org/patients/conditions-treatments/scoliosis/

Ko, K. J., & Kang, S. J. (2017). Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 13(2), 244–249. https://doi.org/10.12965/jer.1734952.476

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , ,

Insights on Kyphosis & Treatment Approaches

Discover effective treatment approaches for kyphosis, its causes and symptoms while enhancing your posture today.

Introduction

How often do you catch yourself slouching after hours at a desk or scrolling through your phone? Do you experience persistent neck strain, shoulder tightness, or upper back discomfort? While many people recognize poor posture as an annoyance, few realize that long-term postural dysfunction can contribute to kyphosis—a spinal condition characterized by excessive forward curvature of the thoracic spine.

As a nurse practitioner with 20 years of experience in physical medicine and musculoskeletal health, I have seen firsthand how kyphosis affects both young and older adults, often leading to pain, mobility limitations, and even systemic complications. With a background that includes chiropractic care integration, I emphasize a multidisciplinary approach to kyphosis treatment, focusing on conservative therapies that address spinal alignment, muscle strength, and postural control.

This article explores the environmental causes of kyphosis, its impact on the musculoskeletal system, and evidence-based treatment strategies, including chiropractic adjustments, physical therapy, and postural rehabilitation.

What is Kyphosis? Understanding the Spinal Deformity

Kyphosis refers to an excessive anterior curvature of the thoracic spine, exceeding 40 degrees. While a mild thoracic curve is normal, excessive kyphosis can lead to visible postural changes, musculoskeletal pain, and even respiratory or gastrointestinal complications in severe cases.

Types of Kyphosis

There are several classifications of kyphosis, each with distinct causes:

  • Postural Kyphosis: The most common type, usually seen in adolescents and office workers, resulting from prolonged slouching and weak spinal musculature.
  • Scheuermann’s Kyphosis: A more rigid spinal deformity due to wedge-shaped vertebrae, typically diagnosed in teenagers.
  • Osteoporotic Kyphosis: Common in older adults due to vertebral compression fractures from osteoporosis.
  • Congenital Kyphosis: A rare condition present from birth due to abnormal vertebral development.

If left untreated, kyphosis can progressively worsen, leading to significant postural, neurological, and functional impairments.

Environmental Factors Contributing to Kyphosis

While genetic predisposition plays a role in kyphosis development, environmental and lifestyle factors significantly contribute to the condition. Understanding these risk factors can help with prevention and early intervention.

1. Poor Posture & Prolonged Sedentary Behavior

Chronic slouching, improper ergonomics, and excessive screen time encourage adaptive shortening of the anterior muscles (pectorals and upper abdominals) while weakening the posterior chain (erector spinae and scapular stabilizers). This imbalance reinforces thoracic kyphosis over time.

2. Sedentary Lifestyle & Weak Core Stability

A lack of functional movement and spinal stabilization exercises leads to postural instability, increasing the likelihood of kyphotic progression. A weak core and underactive back extensors contribute to poor spinal support, leading to excessive forward bending of the thoracic spine.

3. Heavy Backpacks & Improper Lifting Mechanics

In children and adolescents, carrying overweight backpacks can accelerate kyphotic posture by exerting excessive downward pressure on the spine. Similarly, incorrect lifting mechanics in adults (e.g., repetitive forward bending with poor lumbar support) increase spinal stress, contributing to degenerative kyphosis.

4. Osteoporosis & Age-Related Bone Loss

Older adults, particularly postmenopausal women, are at a higher risk of developing osteoporotic kyphosis due to decreased bone density. Compression fractures in the thoracic vertebrae can lead to irreversible spinal deformity, making early bone health management critical.

5. Spinal Injuries & Degenerative Disc Disease

Trauma, herniated discs, and chronic spinal degeneration can disrupt normal vertebral alignment, leading to structural kyphosis. Degenerative changes in the intervertebral discs contribute to spinal instability, loss of disc height, and increased forward curvature of the thoracic spine.

Symptoms & Effects of Kyphosis on the Musculoskeletal System

Kyphosis not only alters spinal alignment but also leads to cascading effects throughout the musculoskeletal system. Depending on severity, symptoms may range from mild discomfort to functional disability.

Common Symptoms of Kyphosis

–Upper Back Pain & Stiffness: Chronic discomfort, particularly between the shoulder blades and mid-thoracic region.
–Limited Mobility & Flexibility: A rigid thoracic spine reduces spinal extension, affecting overall movement.
–Neck & Shoulder Tension: Forward head posture and rounded shoulders cause excessive strain on the cervical spine, leading to cervicogenic headaches and referred pain.
–Muscle Fatigue & Weakness: Over time, kyphotic posture weakens the paraspinal muscles, reducing spinal endurance.
–Breathing & Digestive Issues: Severe kyphosis can compress the thoracic cavity, leading to restricted lung expansion and impaired digestion.

Neuromuscular Impact of Kyphosis

Cervical Involvement: Increased kyphotic curvature forces cervical hyperextension, straining the posterior neck muscles and contributing to occipital headaches, vertigo, and TMJ dysfunction.

Thoracic & Lumbar Impact: Kyphosis can trigger compensatory hyperlordosis in the lumbar spine, increasing stress on the lower back and contributing to disc degeneration and sciatic symptoms.

Biomechanical Dysfunction: Altered gait mechanics, hip instability, and reduced balance have been observed in patients with significant kyphotic curvature (Lorbergs et al., 2017).

Understanding Long-Lasting Injuries- Video

Effective Treatment Approaches for Kyphosis

1. Chiropractic Care for Kyphosis Management

Chiropractic therapy is one of the most effective non-invasive treatments for managing kyphosis-related pain and improving spinal alignment. Research has shown that chiropractic spinal manipulation can improve mobility, reduce pain, and enhance postural stability (Norton et al., 2022).

Key Benefits of Chiropractic Adjustments:

1Spinal Realignment: Chiropractic adjustments restore normal vertebral positioning and reduce excessive thoracic curvature.
–Improved Postural Control: Chiropractic care strengthens postural awareness, spinal mobility, and core stability.
–Reduced Muscle Tension & Nerve Compression: Manual therapy alleviates trigger points, myofascial restrictions, and nerve impingements contributing to kyphotic discomfort.
 –Enhanced Flexibility & Range of Motion: Stretching techniques combined with spinal mobilization restore thoracic extension and shoulder mobility.

2. Physical Therapy & Postural Rehabilitation

Physical therapy plays a crucial role in strengthening the posterior chain, improving spinal stability, and reinforcing proper movement mechanics.

–Thoracic Extension Exercises (e.g., foam rolling, wall angels)
– Core Stabilization & Strength Training (e.g., dead bugs, planks)
– Scapular Retraction & Strengthening (e.g., rows, reverse flys)
–Cervical & Lumbar Postural Corrections

3. Bracing for Kyphosis Correction

In adolescents with Scheuermann’s kyphosis, bracing can help prevent worsening curvature during growth phases.

4. Postural Ergonomics & Lifestyle Modifications

– Ergonomic Workstations: Maintaining neutral spine alignment while sitting reduces kyphotic strain.
– Daily Mobility Exercises: Incorporating yoga, Pilates, or spinal decompression exercises can improve flexibility.
– Weight Management & Bone Health Optimization: Vitamin D, calcium supplementation, and weight-bearing exercises support spinal integrity.

Final Thoughts: Addressing Kyphosis Proactively

Kyphosis is a progressive condition that requires early intervention and a multidisciplinary treatment approach. By combining chiropractic adjustments, targeted physical therapy, and ergonomic modifications, patients can significantly reduce pain, improve posture, and enhance spinal function.

Injury Medical Chiropractic & Functional Medicine Clinic

We associate with certified medical providers who implement the importance of the causes and symptoms of kyphosis. While asking important questions to our associated medical providers, we advise patients to integrate small changes into their daily routine to reduce the effects of kyphosis from affecting the cervical and thoracic areas. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

References

Fortner, M. O., Oakley, P. A., & Harrison, D. E. (2017). Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics((R)): a case report utilizing a multimodal mirror image((R)) rehabilitation program. Journal of Physical Therapy Science, 29(8), 1475-1480. https://doi.org/10.1589/jpts.29.1475

Jenkins, H. J., Downie, A. S., Fernandez, M., & Hancock, M. J. (2021). Decreasing thoracic hyperkyphosis – Which treatments are most effective? A systematic literature review and meta-analysis. Musculoskelet Sci Pract, 56, 102438. https://doi.org/10.1016/j.msksp.2021.102438

Lam, J. C., & Mukhdomi, T. (2025). Kyphosis. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/32644371

Lorbergs, A. L., Murabito, J. M., Jarraya, M., Guermazi, A., Allaire, B. T., Yang, L., Kiel, D. P., Cupples, L. A., Bouxsein, M. L., Travison, T. G., & Samelson, E. J. (2017). Thoracic Kyphosis and Physical Function: The Framingham Study. J Am Geriatr Soc, 65(10), 2257-2264. https://doi.org/10.1111/jgs.15038

Norton, T. C., Oakley, P. A., & Harrison, D. E. (2022). Improving the cervical lordosis relieves neck pain and chronic headaches in a pediatric: a Chiropractic Biophysics((R)) (CBP((R))) case report with a 17-month follow-up. Journal of Physical Therapy Science, 34(1), 71-75. https://doi.org/10.1589/jpts.34.71

Oakley, P. A., Gage, W. H., Harrison, D. E., & Mochizuki, G. (2024). Non-surgical reduction in thoracolumbar kyphosis and sagittal vertical axis corresponding with improved sensorimotor control in an older adult with spinal deformity: a Chiropractic Biophysics((R)) case report. Journal of Physical Therapy Science, 36(11), 756-764. https://doi.org/10.1589/jpts.36.756

Ogura, Y., Dimar, J. R., Djurasovic, M., & Carreon, L. Y. (2021). Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg, 7(3), 422-433. https://doi.org/10.21037/jss-21-54

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