Excessive thoracic kyphosis is a greater than normal sagittal deviation in spinal alignment, or posterior curvature of the spine. Kyphosis is the normal alignment in the thoracic spine; however, in this module, the term kyphosis refers to the excessive type. The development and progression of thoracic kyphosis varies depending on the underlying cause of the deformity, and it can be seen in pediatric and adult patients. The severity of the kyphosis typically determines the severity of symptoms and impairment in functional mobility. In milder cases, patients appear slouched, whereas with more severe deformities, patients may have a clearly visible hump in the thoracic region. Forward head posture and increased cervical and lumbar lordosis are common. Patients sometimes experience a gradual onset of intermittent back pain and impaired mobility. A kyphotic posture can lead to a variety of musculoskeletal impairments, including tightening of anterior chest muscles and weakening of upper back muscles. Hip flexor contractures can also develop, further reducing the patient’s ability to stand upright. With severe kyphosis patients may have difficulty breathing. Common causes in adults include osteoporosis, degenerative changes, and poor posture. Improper formation or segmentation of the spinal cord (congenital kyphosis) and Scheuermann’s disease are causes of kyphosis in the pediatric population. Patients with less severe deformities are likely to benefit from conservative treatment, whereas individuals with larger, fixed deformities often require surgical intervention. Physical therapy interventions focus on pain management, strengthening, stretching, functional mobility, gait and balance training.