Dowager's Hump: What Causes It and How Can You Reduce It?
A dowager's hump is a visible rounding at the base of the neck. Here the upper back curves forward more than it should. It usually develops over years from poor posture, age-related changes in the spine, or osteoporosis. Understanding the cause is the first step towards reducing it. That often needs a scan of the full spine while you are standing.
Key points
- A dowager's hump is increased forward curving (kyphosis) where the neck meets the upper back.
- Common causes include holding the head forward for long periods, osteoporosis, and wear-and-tear changes in the discs.
- It is different from a buffalo hump, which is a fatty deposit often linked to hormone problems or medicines.
- A standing whole-body scan shows how your spine is aligned under gravity. Scans done lying down can miss this.
- An early assessment helps guide the right exercises, therapy, or further tests.
You may have noticed a rounded bump at the top of your back, just below the back of your neck. Perhaps someone else pointed it out, or you saw it in a photo. The medical term for this increased rounding of the upper back is thoracic kyphosis. It is commonly called a dowager's hump.
Some people worry mostly about how it looks. But this posture change can also cause neck pain, shoulder stiffness, and headaches. The good news is that, depending on what is driving it, there are steps you can take to slow it down or reduce it.
What does a dowager's hump look and feel like?
A dowager's hump usually shows as a clear rounding or bump at the base of the neck. Beyond what you see in the mirror, there are often everyday symptoms that come with it.
A bump or curve at the base of the neck, seen from the side.
Aching or stiffness across the upper back, neck, and shoulders.
Tension-type headaches that start at the base of the skull.
Your head sits clearly in front of your shoulders instead of above them.
What causes a dowager's hump?
A dowager's hump develops when the vertebrae in the upper back slowly shift into a more forward-curved position. Several factors can play a part, and more than one may be involved at the same time.
Desk work, phone use, and slouching by habit strain the upper back over years.
Weakened vertebrae can develop small compression fractures that cause wedging and rounding.
The discs between the vertebrae get thinner with age. This lets the spine curve further forward.
Weak muscles that straighten the upper back struggle to hold the spine upright against gravity.
Your body works as a connected chain. When the upper back rounds forward, the head moves ahead of the shoulders. The lower back and pelvis often make up for this by tilting to keep you balanced. So the visible hump at the top is rarely the full picture.
Is a buffalo hump the same as a dowager's hump?
No. They can look alike from the outside, but a buffalo hump and a dowager's hump have different causes. A dowager's hump is a change in the bones and posture, where the thoracic spine curves forward. A buffalo hump is a pad of fat that builds up between the shoulder blades. It is often linked to long-term steroid use, Cushing's syndrome, or certain medicines.
If your bump feels soft and fatty rather than bony, or if you take corticosteroid medicine, it is worth asking your doctor whether a buffalo hump might be the reason. The difference matters because the way it is managed is completely different.
How is a dowager's hump assessed with a standing scan?
A dowager's hump is best assessed with a scan of the full spine while you are standing, because that is how your body really carries its weight. Scans done lying down relax the muscles and can flatten curves. This hides how serious the problem really is.
An EOS scan captures your whole skeleton, from head to feet, in a single standing image. So the radiologist can see not only the rounding in the upper back but also how your lower spine, pelvis, hips, and legs are making up for it. It uses about 90% less radiation than a standard X-ray, around ten times less.
If you have been told you have a dowager's hump, or you can see one developing, a standing whole-body image can show the full picture of your alignment.
Book a free video consultationStandard X-rays usually focus on one small area, such as the neck or a few thoracic vertebrae. They may confirm that there is rounding. But they do not show how the body is making up for it further down the chain. That pattern is often what drives pain in the lower back, hips, or knees, even though the problem first started in the upper back.
Learn more about how EOS whole-body standing scans work.
How can you reduce a dowager's hump?
How you reduce a dowager's hump depends on its cause and how severe it is. There is no single fix that works for everyone, but several approaches can help.
Posture awareness and exercise
In postural kyphosis, the rounding is driven by habit rather than structural bone changes. Here, targeted exercises can strengthen the muscles that hold the upper back upright. A physiotherapist or exercise specialist can guide you on stretches for the chest and shoulders, along with strengthening work for the upper back. Doing them regularly over weeks and months matters more than doing them hard.
Addressing underlying conditions
If osteoporosis is adding to wedging of the vertebrae, your doctor or specialist may recommend medicine for bone health, weight-bearing exercise, and changes to your diet. Treating the bone weakness can help stop it getting worse.
Changes to your workspace
Adjusting your desk set-up, screen height, and sleeping position can reduce the daily load on your upper back. Small changes, such as raising your screen to eye level, can make a real difference over time.
When surgery is considered
Surgery for a dowager's hump is rare. It is usually only discussed when the curve is severe, rigid, and causing significant pain or problems with daily function. It is a major operation. An accurate scan of the full spine while standing is essential for any surgical planning, so the surgeon can see the true curve under load.
ScanAlign is a diagnostic imaging clinic. We provide the detailed alignment assessment that helps guide whatever path your treating specialist recommends. For more about what a spinal alignment assessment involves, visit our spine page.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help you.
When is MRI a better choice? EOS shows bones, joints, and alignment. If your treating specialist suspects nerve compression, disc problems, or soft-tissue issues behind your symptoms, MRI is usually the better tool. The two types of scan work well together.
Frequently asked questions about dowager's hump
A dowager's hump is increased forward rounding of the upper back. The medical term is thoracic kyphosis. It creates a visible bump at the base of the neck and is often linked to posture, osteoporosis, or age-related changes in the spine.
The most common causes are holding the head forward for long periods, wear-and-tear disc changes, and osteoporosis. Weak muscles in the upper back can also play a part. Sometimes more than one factor is involved.
No. A dowager's hump is a curve in the spine. A buffalo hump is a fatty deposit between the shoulder blades, often caused by steroid medicine or hormone conditions. They look alike but need different approaches.
If the rounding is mainly due to posture and the spine is still flexible, targeted exercises to strengthen the upper back and stretch the chest can help reduce it over time. If there are bony changes, exercise may slow it down rather than reverse it.
No referral is needed. ScanAlign is a private self-pay clinic and you can book directly. We recommend starting with a free video consultation so we can confirm whether an EOS scan is the right next step for you.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. You can find more detail on our FAQs page.
The price for patients travelling from abroad is confirmed during the free video consultation. You can find more on our FAQs page.
When you lie down, gravity is taken away and your muscles relax. This can flatten the curves of the spine and hide how serious the kyphosis really is. A standing scan shows your spine under real, everyday load. This gives a much more accurate picture of your alignment.
Yes. Without treatment, the curve tends to get worse, especially if osteoporosis or ongoing poor posture is a factor. An early assessment helps find the cause, so you can take steps to slow or limit it.
Surgery is rare. It is only considered for severe, rigid curves causing significant symptoms. Most people benefit from exercises, posture changes, and treating underlying conditions. An accurate standing scan is essential if surgery is ever discussed.
See your full spinal alignment
A free video consultation, from wherever you are, lets us understand your situation. We can then confirm whether a standing whole-body scan at our London clinic is the right next step.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- NHS. "Overview: Kyphosis." nhs.uk. Accessed 2024.
- Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. "Age-related hyperkyphosis: update of its potential causes and clinical impacts." Aging Clinical and Experimental Research, 2017;29(4):567-577.
- Deschênes S, Charron G, Beaudoin G, et al. "Diagnostic imaging of spinal deformities: reducing patients' radiation dose with a new slot-scanning X-ray imager." Spine, 2010;35(9):989-994.
This page is general information and not a diagnosis.
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