Extreme Thoracic Kyphosis (Dowager's Hump)

Extreme thoracic kyphosis can be a big problem with an aging clientele, and asking some background questions can help you figure out what the prognosis looks like. Is there a history of osteoporosis and/or vertebral body fracture? Often times this posture takes root earlier in life, but gets compounded with age by a crush fracture of one or more thoracic vertebral bodies. This gives them a wedge-shape and the curve accelerates rapidly from there. If there is a history of fractures, then keep in the back of your mind that your force will need to stay lighter, because bone resilience will be lowered. If your client is younger, then you can work deeper. Opening up the front net from anterior chest to front arm lines and down to hip flexors is needed. You may need to prop with pillows for comfort in supine--laying flat is often too much to ask of the tight anterior structures. Gentle dishrag work would be great. Opening up the back side of the neck is also necessary. As the thoracic spine bends forward, the client will tip their head into cervical hyperextension and shorten the back side of the neck. Those muscles are highly overworked in a mechanically disadvantaged position, so they need some love. Again, super gentle if there is a history of reduced bone density. Along with stretching, consider strengthening for postural stability (can they use the new range you just opened up?), as well as breathing work. Learning to open up the rib cage and and use the diaphragm is a big piece of the puzzle.