It’s perfectly normal and natural for the human spine to have certain curves: for instance, both the lumbar and neck sections bend inward in what’s known as a lordotic curve. The thoracic section, on the other hand, has a kyphotic curve in that it moves outward. Having these curves in the spine maintains a balance for the torso as it rests over top of the pelvis.

However, when the curve in the thoracic section of the spine—the kyphotic curve—is so sharp that it causes the back to bow, a condition of kyphosis is occurring, and the individual will exhibit a hunched over or slouching posture. In severe cases, when the kpyhotic curve is too drastic, serious problems can result, including pain and damage to local organs and tissue.

There are several reasons why a kpyhotic curve may develop: if the individual has experienced a trauma to the spine from an accident, for instance, or if they suffer from a degenerative disease or a vertebral compression fracture. Additionally, kyphosis can result from chronic conditions and diseases such as spina bifida, paralysis, problems with connective tissue and even tumors.

The most seen form of this condition is known as postural kyphosis, which occurs when ligaments in the spine are unduly stressed and strained from an individual exhibiting poor posture. This form of kyphosis is particularly prevalent in adolescent females, and while it doesn’t cause pain or lingering problems it does interfere with the normal growth of vertebrae.

Adolescent boys ages 12 to 15 are most likely to develop Scheueremann’s Disease, a form of kyphosis marked by a reduction in space within the intervertebral discs and “wedging,” the result of which is a severe curve in the middle of the back. Mild scoliosis may accompany this disease, as may moderate pain.

The last form of kyphosis—congenital—develops prenatally and is distinguished by a spinal column that grew in an irregular fashion. Abnormal formation of bones is common and fusing of vertebrae may occur. Unfortunately, congenital kyphosis tends to get worse with time, and in the most severe cases can cause paralysis.

The signs of a kyphosis are easy to notice: there will be a tenderness and lack of mobility in the back accompanied by pain and chronic tiredness. Visually, the patient will display a posture accented by a rounded back, and, in the most serious cases, may be dealing with breathing problems.

A test in which the patient bends forward is the first part of a physical exam for kyphosis. During the test, the physician can determine visually if there is any abnormalities in the curve of the spine. Then, the patient will typically lie down flat—if the spine curve looks normal, bad posture is the likely culprit for the condition; if the curve is prevalent, there are problems with the structure of the spine. Follow up physical examinations will check for any drastic changes in the body such as weakness or a loss of sensation in the area directly below where the curve is occurring. And of course imaging studies will be utilized to determine the extent of the curve, the form the kyphosis is taking and what treatment options will work best.

Depending on how sharp and dangerous the curve is—as well as what point in body development the patient has reached—treatments may include long-term observation to ensure the condition doesn’t worsen coupled with physical therapy and, in some cases, physical bracing. And surgery may be necessary if these conservative courses of treatment fail to alleviate the condition or if the curve is so extreme as to cause other serious problems in the body.