My Child Can’t Stand Up Straight! Or Is It a Hunchback?

We have researched kyphosis, also known as hunchback in everyday language, from A to Z for you…

What is kyphosis?

Kyphosis, known as hunchback in everyday language, is in fact an advanced form of the natural curvature present in our bodies. We all know that our backs are slightly curved and our lower backs are slightly hollowed. A curvature seen in the back is considered natural up to a certain degree. If this curvature in the back region, or at the junction of the back and lower back, exceeds 50 degrees, it can be referred to as kyphosis. Although kyphosis may appear to be merely a cosmetic problem, it also brings with it very serious psychological problems such as depression, a decline in school performance, communication problems with parents, and difficulties with social adaptation.

When does kyphosis occur?

In kyphosis, which is seen more often in adolescent boys, spinal growth does not occur as it should. Our vertebrae are rectangular in shape. Our spine grows as a result of these vertebrae growing equally on all sides. However, from around age 10, deformities begin to appear, particularly in the back and at the junction of the back and lower back. That is, while the spine grows fully from the back, growing less from the front causes it to take a triangular rather than rectangular shape. In this case, the child is unable to stand up straight. Some back pain may occur. The deformity becomes more pronounced between ages 15 and 16, and unfortunately, a visit to a doctor becomes necessary around ages 16–17. It is at this stage that the hunchback on the child’s back becomes visible.

How is kyphosis diagnosed?

Through a clinical examination and a simple X-ray, it can be determined whether the hunchback seen in your child is a bone deformity or a postural disorder. Parents have a very important role here. Especially in childhood, we may have been subjected to remarks from our parents such as ‘Stand up straight, or you’ll end up with a hunchback.’ In fact, this guidance is correct. If the child, when reminded to stand up straight, adopts a correct posture and is able to maintain it, this hunchback is a temporary condition. However, if the child is unable to maintain the position despite trying to stand correctly and reverts to the previous posture, this must be taken seriously and a specialist should be consulted. If kyphosis is dismissed as a postural disorder that will correct itself over time, it progresses. It is a problem that can be solved with non-surgical methods, but it becomes a problem that can only be solved with surgery. Therefore, parents need to be much more attentive.

How is it treated?

Once a diagnosis of hunchback is made, a treatment plan is determined according to its severity. If the hunchback can be brought under control and corrected with non-surgical treatment methods, the condition is monitored through a plan that includes physical therapy applications such as exercise, posture training, muscle strengthening, strengthening of the abdominal and back muscles, performing crunches, reverse crunches and push-ups, and repeating these movements throughout the day. However, if the desired result is not achieved despite applying all these exercises and physical therapy movements, and the degree of curvature continues to increase, brace treatment is started. Brace treatment is an important, difficult treatment that requires attention. A brace suited to the location and severity of the hunchback is determined through the joint work of a brace technician and a spine surgeon and custom-designed for the individual. Depending on the severity of the hunchback, these braces may need to be worn without interruption for 10–20 hours until skeletal growth is complete. A custom-fitted brace used under appropriate conditions can correct the condition without the need for surgery. However, if a hunchback does not improve despite bracing, surgical intervention is required. In our country, unfortunately, because kyphosis is misperceived as a postural disorder that will pass on its own, patients generally feel the need to see a doctor around ages 16–17, when the hunchback has already become visible. As a result, surgery for such conditions takes place at ages 16–18. Our wish is to detect kyphosis at a stage when surgery is not needed and to provide the necessary treatment with non-surgical methods. With today’s advanced anesthesia techniques and intensive care units, the risk of complications in surgery has fallen below 2%. Post-operative mobility varies depending on the severity of the hunchback and its location. Because movement is eliminated in the section of the spine where screws are placed, the earlier kyphosis surgery is performed, the more freedom of movement is preserved. Surgery is performed to cover the shortest possible segment so that the patient’s range of motion is not restricted. One day after surgery, the patient is helped out of bed and walked, and mobility is increased as the days pass. Because the screws used are very strong, a brace is not used except in very rare cases. The patient may begin sports activities such as swimming and cycling within 4–6 months.

What can happen if kyphosis is not treated?

When kyphosis is not treated in time, it is a disease that adversely affects not only the lower back and back region but also the internal organs. In people with kyphosis who do not receive the necessary treatment, the rib cage becomes deformed as they age and begins to compress the heart and lungs. By impeding adequate oxygen exchange, it also slows the heart’s ability to pump blood and begins to adversely affect all organs. Because kyphosis also increases the hollow in the lower back, as it progresses it reduces the flexibility of the lower back and also paves the way for lumbar disc herniation, thoracic disc herniation, muscle pain in the muscles that keep the spine upright, and arthritis.

Is it possible to protect our children from kyphosis?

The loads we place on our children’s backs are not a direct cause of kyphosis; however, remember that they accelerate the onset and development of kyphosis! To this end;

Make sure your child uses backpacks that do not exceed 8–10% of their body weight (4–6 kg).

Make sure they carry their bag in the middle of their back.

Adjust the bag straps so that they do not extend below the back region.

Advise them to carry bags on both shoulders rather than one, with the support centered in the middle of the back.

Arrange the home study environment so that they stand up straight. Choose a study desk and a chair with back support that are appropriate for their age and development.

Make sure they sit in the correct position while working at the desk.

Make sure they take a break every 30–45 minutes during study sessions to do stretching exercises.