How To Get Rid Of A Hunched Neck

Many of my patients are concerned that they will develop a Dowager's Hump. As a result, I often get asked by patients, both young and old, how to prevent or how to get rid of Dowager's Hump.

How to Get Rid of Dowager's Hump

In this blog post on how to get rid of Dowager's Hump we cover several important topics:

Definition.
Causes.
Symptoms.
Can you experience pain?
How to measure kyphosis.
How can you avoid, prevent, treat or get rid of it?
Should you use a brace?
Are there sleeping positions or pillows that will help?
Recommended exercises.
Time to correct your posture.

Let's start with a definition of a Dowager's Hump.

This article was last updated on August 20, 2020

What is a Dowager's Hump

Dowager's Hump is not a term often used when I went through a Physical Therapy school. I looked the term up and it happens that a dowager is somebody like Violet Crawley — Lady Grantham in "Downton Abbey". Lady Grantham is formally known as Dowager Countess of Grantham, the widow of the Earl of Grantham.

does lady grantham have a dowager's hump?

The "hump" part of the term refers to the pronounced kyphosis that you see many women (perhaps Dowagers) have. As the elderly woman's posture deteriorated, a hump would develop on the back of their upper thoracic spine and became known as a Dowager's Hump.

Neck Hump or Buffalo Hump

You might also hear the terms neck hump or buffalo hump to describe a Dowager's Hump. Don't worry. They all refer to the same thing.

Hyperkyphosis

The proper medical term for Dowager's Hump is hyperkyphosis. Hyperkyphosis describes an excessive curvature of the thoracic spine. It is also known as hunchback. The accepted and current standard for the definition hyperkyphosis is a kyphosis angle in excess of 50 degrees.(1)

Dowager's Hump not necessarily associated with osteoporosis or spinal fusion. But it is something that many, many people worry about from as young as 15 years old to as old as 115 years old. People are concerned about their posture — and rightfully so.

I tell clients who are worried about Dowager's Hump, that they should be mostly just concerned about their posture. I instruct them on what to do to correct or optimize their posture and hopefully avoid Dowager's Hump or, in the case where people have progressed too far, reverse Dowager's Hump. We're going to cover that in more detail later in this blog post.

What Causes Dowager's Hump

That leads us into the next question my clients have: what causes Dowager's Hump. There are three major causes.

Poor Posture Habits

During the times of Downton Abbey, Dowager's Hump was brought on by aging and fatigue (and sometimes osteoporosis or poor posture). Today, Dowager's Hump is a result of the poor posture caused by stooping over devices (such as the iPhone), slouching in front of computers, sitting in soft chairs, and our laissez-faire attitude in schools and at dinner tables.

dowager's hump picture young girl

No longer are children or young people encouraged to sit up tall. It's quite common today to see people hanging out and young people sitting in a slouched position. The photo of the young woman to the right clearly shows the slouching position seen so often in day-to-day life — especially in light of new mobile devices.

These habits create significant challenges for you, and for us as Therapists, when you want to change and optimize your posture. This is because all of a sudden, the causes, which is just habitual slouching, become something that you need to habitually unlearn.

Compression Fractures

In the population I serve, I will see women who have had multiple compression fractures of their vertebrae. When that happens, then the vertebrae become wedged. The vertebrae no longer has a flat edge on each end, but rather the front of the vertebrae takes on that wedge shape. That wedge encourages the spine to take on that deformity or the Dowager Hump shape.

dowager's hump

The photo above of the older gentleman (with his face obscured for privacy reasons) is someone with severe Dowager's Hump.

There are a few other medical conditions that are associated with the dowager's hump or the kyphotic posture but the major causes are poor posture and compression fracture.

What people tend to worry about is a big fatty pad that sometimes people will behind their neck. Well, the body is very intelligent. If you have to hold up an 11-pound head all day long, then the body is going to try to create more strength in this area by laying down more tissues. The fatty pad is your body's way of trying to deal with the forward head posture.

Scheuermann's Disease

Scheuermann's disease is a disease of the young that persists into adulthood. It develops in adolescence when the spine is growing. During this developmental period your spine fails to develop normally and you develop an exaggerated rounded mid or lower back (hunched back).

One third of people with Scheuermann's disease also develop scoliosis. Pain is a symptom that often appears later in the disease process. Difficulty bending backwards (doing upward dog pose or sphinx pose) is another symptom.

If you suspect that you or a person you love may have Scheuermann's disease, you should speak to your doctor. An X-ray will confirm the disease and Physiotherapy is recommended

How to Have a Perfect Posture

Posture is the foundation of all movement and exercise. This is why I developed the online course, Perfect Posture in 30 Days.

how to improve your posture course by physical therapist

Perfect Posture

A perfect posture has many benefits.

Reduces your risk of back, neck and shoulder pain.
Improves balance and the reduces the chance of a fall.
Promotes a positive self-image.

Posture and Osteoporosis

Good postural alignment is especially important for individuals with osteoporosis and low bone density.

Simple movements you do everyday can lead to small fractures to the spine.

For example, poor postural alignment when you cough, sneeze, or reach for something can cause micro trauma to the spinal column. Over time, these micro traumas can add up and eventually lead to vertebral compression fractures.

A poor posture contributes to balance issues. As a result, individuals with osteoporosis and low bone density are at risk of a macro trauma to the spine because of balance problems.

The Source of Poor Posture

Why don't more of us have a perfect posture? Because many of the activities we do in today's modern world involve forward flexion.

Activities such as reading in bed, using a mobile phone, gaming, texting, sitting for hours hunched over a laptop computer, knitting, crocheting, and many more encourage forward flexion.

Many people take this forward movement into their exercise and leisure activities. Unfortunately, this reinforces poor postural alignment.

Unless we make adjustments to our environment or correct our posture, over time we weaken and stretch certain muscles and tighten other muscles. This muscular imbalance leads to poor postural alignment.

We need to fix this imbalance, modify our movements so that we can get the posture we want.

How to Achieve a Perfect Posture

Many of us do not know how to get and keep a perfect posture. To have a good posture we need to learn the fundamentals of good posture, know what exercises promote postural alignment, and how to bring good posture into our day to day activities.

This is why I created Perfect Posture in 30 Days. This course addresses each of these areas and shows you how to develop a perfect posture, how to modify your daily activities, and how to make your perfect posture a permanent part of your life.

Perfect Posture in 30 Days will improve your posture, boost your confidence, and allow you to live a pain free life.

Dowager Hump Symptoms

How do you know if you have Dowager's Hump and what are the Dowager Hump symptoms you should be concerned about? Dowager Hump symptoms include:

Shallow breathing.
Problems breathing.
Indigestion.
Pelvic floor problems.
Rotator cuff problems.
Tennis elbow.
Carpal tunnel.
Neck problems.
Jaw problems.
Headaches.

dowager's hump illustrated — Dowager's Hump

Stand Tall with Perfect Posture

One of the reasons I'm dressed like this (in the video) is to show you what happens when I alter my posture. Then you'll see some of the symptoms that people are concerned about.

If I'm standing tall, my arms rest by my side. They're not resting in front of me. They're resting alongside my body.

I have a natural little arch at the small of my back, my mid-back is fairly flat, and I have a small arch in the back of my neck. My ear is lined up over the middle of my shoulder.

When I do that, my organs have lots of space to do what they love to do. I can take nice full breaths and open my ribs. This allows me to suck in my stomach, engage my deep core muscles, and support my pelvic floor.

Dowager Hump Symptoms from Poor Posture

When I hang out with my arms in front of me, it gets harder for me to be able to hold in my tummy. This in not an optimum posture and it is very tiring.

When you are in this posture, the ribs start pushing down and your liver, stomach, and all your intestines get crushed into a smaller smaller space.

This can cause Dowager Hump symptoms like:

Shallow breathing.
Poor indigestion.
In addition, all this pressure makes it harder on your pelvic floor.
The forward shoulder posture can cause rotator cuff problems, tennis elbow, and carpal tunnel problems.
Dowager Hump can put pressure on the suboccipital muscles at the base of our skull and cause neck problems, jaw problems, and headaches.

There are studies that put healthy college-age students in this forward posture for 15 minutes. This brief and small change to their posture caused neck pain and headaches.

Dowager's Hump Pain

My clients often ask, "Should I worry about my poor posture and Dowager's Hump causing pain?" The answer is a definite yes. Dowager hump can lead to shoulder problems, tennis elbow, carpal tunnel, headaches, neck pain, and jaw pain.

Kyphosis Measurement for Dowager's Hump

How do you know for sure if you have Dowager's Hump or a poor posture? Is there an agreed-upon standard for kyphosis measurement that you or your Therapist can use to get the definitive answer?

There are sophisticated ways of kyphosis measurement with x-rays but that approach is generally not accessible to many people.

Fortunately, a group of researchers(2) recently had a very clever idea and found a simple way to measure kyphosis — our forward head posture — without expensive equipment. They developed a technique called hyperkyphotic measures using distance to wall.

How to Do the Kyphosis Measurement

Here is how they do a kyphosis measurement.

Line up — heels, sacrum, mid-back, and as much as ahead as possible — flat against a wall.
For purposes of today's video, we're just using the post here on my pulley system.
If you're a clinician watching this, or if you want to do this for yourself, you could use a flat wall.
You want to measure the distance between your C7 and the wall.
How do you figure out where C7 is? Let's find C7.
Take your index finger and place it down your neck.
Come to one bony prominence, a bony bit here that sticks out more than the others — that's usually your first thoracic.
Our spine goes from cervical to thoracic — so that's the first thoracic.
Look for the last cervical or C7.
Take your third finger and place it just above.
As you bring your head down, and then bring your head back up, the bone that you were feeling should disappear underneath your fingers.
If the bone disappears, that is your C7.
That is what you're going to measure when you come up to the wall.
Go up against the wall and feel the distance between your vertebrae and the post.
I have roughly a finger width.
Determine that width in centimetres.

Scoring the Kyphosis Measurement Results

Here are the guidelines to determine your level of kyphosis or Dowager's Hump:

Very mild kyphosis is considered anything under five centimetres.
Between 5.1 and eight was considered moderate.
Eight centimetres or above is considered severe.

If you score between very mild to moderate, this would be an opportune time to start focusing on changing your alignment for the better. Because if you wait until it gets severe, and when that distance is more in the range of eight centimetres or more, then that also was shown to have a higher rate of fractures of the vertebrae.

This technique is useful for both clinicians and individuals because sometimes we lose track of what good posture is today because so many people have bad posture. This is one way for you to check in on yourself and go, "How is my posture doing today or this month?"

This kyphosis measurement technique is easy and accurate. Before the availability of this technique, we used to rely solely on measuring the distance between the head and the wall. Our goal is to encourage the lengthening or retraction of the neck and this new kyphosis measurement technique fits the bill. This is what we consider optimum alignment of the head and neck. We will cover that in more detail when we get to the exercise section in this post.

Dowager's Hump Treatment Options

What are the recommended treatments for fixing a Dowager's Hump or your bad posture?

I would like to say that you could do neck hump treatment all by yourself. And for the most part, if you're in the early stages of kyphosis (as measured by the kyphosis measurement technique described above), you certainly can.

But I would be doing a disservice to myself as a clinician, and all the other wonderful therapists out there if I said you didn't need our help.

Let's walk through some of the Dowager's Hump treatment options I recommend to my clients.

Neck Hump Treatment and How to Get Rid of Dowager's Hump

A manual Physical Therapist (therapists that use their hands) can use a number of treatment options to correct a Dowager's Hump and regain your good posture. These include:

Myofascial release.
Taping.
Specific mobilization or movements of the vertebrae that have been stiff for a long time.

How to Avoid Dowager's Hump

There are a number of things that you can do to avoid a Dowager's Hump. We will cover these here. If your posture has already become kyphotic, these techniques will help considerably before your work with the manual therapist.

Sitting Posture

Time to talk about sitting posture.

When your knees are higher than your hips, it's very hard to sit up straight. When your knees higher than your hips it tilts your pelvis back, flattens your lower back. By flattening that nice little arch that once existed in the back, the rest of the back wants to fall forward and then the head follows.

The very first thing you can do to correct your sitting posture in sitting is to alter the surface that you're sitting on. Look at where your knees are relative to your hips.

I often have to sit on the edge of chairs. By doing so, my knees drop down below the height of my hips. That allows me to tilt my pelvis forward.

I can encourage that process a little bit more by rolling up a little blanket and placing it in underneath my sit bones.

Dyna Disc

There are also devices such as a Dyna Disc or a sit-in disc. They're inflatable discs that are actually covered in cloth or a little bit warmer fabric that you place under your pelvis to tilt your pelvis forward.

dynadisc for sitting posture Each of these things encourage a re-creation or support of the little arch in the small of your back so that all of your vertebrae line up. This alignment then allows your head to come back over your shoulder.

Soft Sofas

Another recommendation is not to use soft sofas because they don't have the proper support for your posture.

This leads us to driving. The seats in cars and planes are poorly designed for the human body. You have to use the same techniques I described to correct your posture when driving or flying.

Even though cars often come with lumbar rolls, they're frequently not in locations where your body needs them. You have to deflate the one in the car and bring your own lumbar roll.

Supports for Your Back While Sitting and Driving

There are a lot of different rolls you can purchase that support your back. Other low cost options include simply using

A little scarf.
Extra mittens in the wintertime.
A paper towel roll.

Once you set your best sitting posture before starting to drive, adjust your rearview mirror so that it is your reminder that if you don't see behind you, then you've slouched back down.