Dowager's Hump

Dowager's Hump: Also Known as Hunchback

Our back provides support and posture to our body and facilitates the transfer of power to the pelvis and the lower half of the body. The spine is a robust structure made of 24 vertebrae and protects the delicate spinal cord and spinal nerves.

Loss of bone density, i.e. osteoporosis can lead to vertebral fractures that could lead to changes in the spine. So-called wedge vertebrae are formed that can lead to patients developing a curvature in their back often referred to as Dowager’s hump.

The disease progressively gets worse and in advanced cases, a patient’s spine is severely compromised, and mobility is restricted.   

Causes of Dowager's Hump

A Dowager rounded back is an increased curvature of the upper back (the Thoracic spine) and is formally referred to as hyperkyphosis. Some of the most commonly known factors that lead to the condition include:

• Prolonged lack of exercise and poor proprioception over the years can lead to developing a dowager’s hump.

• Long periods of physically intense activity that includes a stooped posture, for example, welders or manual laborers.

• Bad posture resulting from weak back muscles.

• Being overweight.

• Progressing age and long term wear and tear.

• Osteoporosis is one of the major factors that cause a dowager’s hump. As the disease progresses, bone density decreases with age leading to bone porosity and brittleness. The vertebrae, in particular, can then break even under mild loads. The vertebrae collapse, leading to shortening and deformation of the spine with a visible curvature of the back.

• Injury from a fall or accident can also lead to a rounded back.

 

Dowager's Hump Symptoms

A pronounced deformation of the upper body, i.e. developing a curvature of the back, can cause a wide range of symptoms. Some of the most commonly associated symptoms include: 

 An inability to maintain or assume an upright posture while standing or sitting.

• Severely restricted mobility when trying to bend over or reach out with your arms.

• Pain and discomfort under when bearing a load or strain.

• In some more severe cases, the functioning of internal organs is impaired due to the added pressure on the organs from the unnatural curvature of the spine. For example, difficulty breathing because the lungs can no longer expand to their full range. Similarly, digestive and cardiovascular complications can also occur as a result of this pressure.

• As the disease progresses, the pain becomes more pronounced and can radiate to the arms or legs.

• The condition can have debilitating effects on the psychological state of patients. It is common for patients to experience depressive moods as their quality of life drops.

• In chronic cases of osteoporosis, the vertebrae can fracture, leading to the entire spinal integrity becoming compromised. Patients with a dowager’s hump due to osteoporosis are at high risk of further damage to the spine and the curvature getting progressively worse with time and age.

 

Diagnosis of Dowager's Hump

A complete medical history and physical examination is a good place to start and it gives the medical professional a good idea of the risk factors involved. Sophisticated imaging technology like X-rays are used to study the integrity and condition of the spine.

As a rule, it is important to check for Osteoporosis. It is crucial to measure bone density and track it. Doctors achieve this with the so-called T-value by means of X-rays. 

According to the definition of the World Health Organization (WHO), a diagnosis of Osteoporosis can be made if the T-value is at least 2.5 standard deviations below that of a healthy 30-year-old of the same sex. If the measurement results in a T value that is greater than -1, the bone density is in the normal range. If the T-Value lies between -1 and -2.5, doctors may diagnose osteopenia or bone poverty. It is a preliminary stage of osteoporosis.

Dowager's Hump Prevention

The main causes of developing hyperkyphosis are lack of exercise and poor posture. Regular physical exercise is, therefore, one of the most important preventive measures. In special courses, patients learn the correct their posture at work and to practice healthy proprioception. 

Appropriate breathing techniques to increase the breathing volume and relaxation techniques are also helpful. With a regular routine, patients can prevent deformation in the upper body and the formation of a rounded back.

Treatment for Dowager's Hump

Treatment for Hyper Kyphosis is initially carried out conservatively. The aim is to relieve symptoms and prevent the progression of the condition. An effective guideline to follow includes:

• Lifestyle Changes

Improving lifestyle choices can have a significant improvement in the prognosis of Osteoporosis. Losing weight and avoiding drinking and smoking has proven effective in preventing the onset and progression of the condition. Having a nutritious balanced Calcium and Vitamin D rich diet is highly effective.  

• Prescription Drug Therapy

Patients with dowager’s hump experience pain and discomfort due to the condition. Prescribed painkillers like Ibuprofen can help manage the pain and provide some temporary relief. 

• Prescribed Physiotherapy

Prescribed physiotherapy, with the use of targeted exercise, can help strengthen the muscles in the chest and back. It helps a patient regain mobility and help straighten the spine. Breathing exercises to increase the tidal volume and avoid shortness of breath caused by the curved spine. 

• Medical Back Brace

A medical back support/brace is strongly advised in conjunction with these treatments, as it helps correct posture as well as taking pressure off the spine.

If it is early in the progression of the disease, a simple lower back support to correct posture may be all that is required, however, if the condition is more advanced, a more specific brace is usually required.

• Surgical Intervention

• If conservative therapy does not lead to an effective treatment of the issue, surgery may become necessary. It does, however, come with significant risks, in some advanced cases there is a higher risk of long term irreversible damage to the nerves and spinal cord.

• This is especially true in the case of a hunched back resulting from osteoporosis. The inherent weakness of the bones can lead to vertebral fractures with a real risk of puncturing the spinal cord or spinal nerves. Surgery can help prevent this and also reinforce the spine to prevent further vertebrae from fracturing.

• Surgery is only a last resort, and should be thoroughly discussed with a doctor before proceeding down that avenue.

Dowager's Hump Braces & Supports

Bauerfeind has a wide range of medical back braces that have proven instrumental in providing relief to patients, no matter how progressed the condition. Orthoses are often prescribed by surgeons, doctors and physiotherapists for hyper-kyphosis, vertebral fractures and general weakness in the spine arising from osteoporosis.

For milder cases of Kyphosis where the symptoms are only just starting to show, a simpler brace like the LumboLoc Forte is effective at alleviating the symptoms and helping train the patient to adjust their posture.

The dual strapping system allows for targeted unloading of the vertebrae, while the interchangeable pads and anatomically contoured struts correct posture and relieve pain and discomfort.

If there is already a slight rounded back and a vertebral fracture, the Spinova Osteo is recommended. This orthosis straightens both actively and passively, suiting any lifestyle. An anatomically shaped aluminium splint encourages healthy proprioception and an upright posture.

The brace is designed to fit the body using a tension belt system and offers a deep-seated pelvic support, unloading from the hips up to the shoulders. This helps to bring the upper body into an upright posture and, in the event of incorrect posture, encourages straightening it up independently.

This trains the back muscles and counteracts the rounded back and can be effective in mild cases of Dowager’s hump.

In advanced patients or chronic cases, the SofTec Dorso helps with a pronounced rounded back and several vertebral fractures. It also straightens the spine and stabilizes it by counteracting rotational movements.

In the spinal part of the orthosis is a reinforced plate made of carbon and a flexible, breathable knitted fabric. It is easy to put on like a vest and is very comfortable to wear making it perfect for daily use, and is highly recommended to prevent further damage. 

Patients using these orthoses have reported relief from symptoms and can help with a swift recovery, and have been extensively clinically tested to show their effectiveness.