How would you adapt the massage routine for someone with Kyphosis?

Massage can be helpful for ScoliOSis and Kyphosis, however, you must be sure to get yourself a masseuse that is familiar with Kyphosis, I use a masseuse that I trust and she knows I have ScoliOSis and that she can only touch certain parts of my body - due to pain, over the last few years we have become very used to one another and I trust her completely.

Treatment options for Kyphosis

Treatment Options

1) Observe for progression: If there is a minimal curve present and they are still skeletally immature; If they are skeletally mature and symptomatic and not pushing for correction of a cosmetic deformity no prolonged follow-up is necessary.

2) Postural exercises are often recommended however these have no scientific validation. Importantly they do no harm and do not dramatically affect the patient's lifestyle. Exercises include hamstring and pectoral stretching, postural awareness and trunk strengthening.

3) Cast and/or bracing. This is often prolonged and psychologically traumatic for the patient. It also requires a lot of time, effort and resources.

The Milwaukee brace was used in skeletally immature patients with a kyphosis of greater than 45 degrees. This requires a dedicated orthotist, regular assessment and alteration of the brace. Patients nearing the end of skeletal growth (Rissers sign) can be successfully treated with bracing unlike idiopathic scoliOSis patients at this stage.

The brace is ideally worn for 23 hours a day for the first year and then nighttime only for the second year. Patient compliance often reduces this to 16 hours per day. Modifications i.e. low profile neckpiece or an under arm corrective orthosis try to avoid the social stigma of a visible brace above the collar line. Bracing is rarely used nowadays as the treatment is often felt to be worse than the disease.

The use of traction is minimal but has been used in the past prior to fitting the brace.

4) Surgery. Indications: As progression in adulthood is rarely a problem the indications for surgery are not fixed. Typically patients, who are unhappy with their appearance, are skeletally mature and whose kyphosis measures at least 60 degrees can be considered for surgery. Importantly these patients must understand the magnitude of the surgery, the risks involved in even the most experienced hands and the likelihood that the kyphosis may not be able to be corrected to an unnoticeable degree. Surgical correction is not common for Scheuermann's kyphosis.

Patients rarely present with neurological signs. Those that do should have surgery to correct their kyphosis after having MRI studies to out rule other causes or exacerbating factors. It should be noted that unlike cord compression from stenosis of the spinal canal, laminectomy has no alleviating effect.

The 'Gold standard' for surgical correction of a thoracic kyphosis is anterior discectomy and grafting via a thoracotomy plus posterior spinal instrumentation. Initially treatment by posterior fusion and/or instrumentation had problems with long term stability. Rods fractured or bent and loss of correction occurred. Modern posterior instrumentation uses stiffer rods and segmental fixation. Anterior disc excision and grafting provides increased stability.