A neck hump, also known as a buffalo hump or dowager’s hump, is an abnormal fat deposit that develops on the back of the neck, just below the base of the skull. This protruding hump of fat and tissue can range in size from small to quite large and noticeable. A neck hump is often symptomatic of an underlying medical condition and tends to occur more frequently as people age. However, the question remains – what exactly makes up this neck hump? Is it composed of fat, bone, or some combination of both? Let’s take a closer look.
Anatomy of the Neck
To understand what comprises a neck hump, it helps to first review the anatomy of the neck. The neck contains muscles, arteries, veins, lymph nodes, the trachea (windpipe), esophagus, thyroid and parathyroid glands, and cervical vertebrae (the bones of the spinal column in the neck). The seven vertebrae in the cervical section of the spine provide structure and support for the neck and head. These vertebrae do not normally protrude or become enlarged.
Body Fat Distribution
Body fat distribution varies from person to person. Fat cells can accumulate in certain areas of the body more than others due to age, genetics, diet, lifestyle factors, and some medical conditions. As people age, they tend to lose muscle mass and gain fat, particularly in the midsection and sometimes in the neck/upper back region. The terms used to describe where body fat is stored include:
- Peripheral: Arms and legs
- Central: Abdomen and/or chest
- Upper body: Chest, shoulders, upper arms, and neck
People who are genetically predisposed or who have certain hormonal imbalances may be more likely to store excess fat in the neck and shoulder region as they get older. This can create a hump at the base of the neck.
What Causes a Neck Hump?
In most cases, a neck hump is composed primarily of excess fatty deposits, not bone. The protrusion is due to the localized accumulation of excess fat cells in the upper back and neck area which form a hump. However, in some instances, structural changes in the cervical spine’s vertebrae can also contribute to or worsen a neck hump. Potential causes include:
- Weight gain: General weight gain as a person ages often results in extra fat being deposited along the upper back and neck. This creates a fleshy hump at the base of the skull.
- Posture issues: Poor posture such as bending forward of the neck, hunching over, or slouching can make an existing neck hump more prominent. Weak back and core muscles exacerbate poor posture.
- Osteoporosis: Weakening and erosion of the cervical vertebrae due to osteoporosis can result in exaggerated spinal curvature and a more pronounced neck hump.
- Cushing’s syndrome: This endocrine disorder causes cortisol levels to become elevated. Excess cortisol stimulates fat accumulation in the neck and upper back.
- Genetics: Some people are genetically predisposed to storing excess weight and fat in the neck region.
- Lifestyle factors: Lack of exercise, smoking, high-fat diet and excess alcohol consumption can promote development of a neck hump.
In most cases of neck humps, the protrusion is predominantly composed of localized fatty deposits. However, worsening posture, osteoporosis, and vertebral changes can worsen the appearance of a fat-based neck hump in some individuals.
Fatty Neck Humps
Neck humps consisting primarily of fatty deposits tend to have the following characteristics:
- Soft, pillowy feel upon palpation (pushing on the area)
- Ability to “pinch an inch” and grasp the fat between fingers
- Lack of pain or tenderness when palpated
- Grows larger and more prominent with weight gain
- Reduces in size with weight loss and fat loss
A fatty neck hump may start out small. But if ignored and allowed to grow larger through further weight gain and fat accumulation, it can become very pronounced. While unsightly, a primarily fat-composed neck hump is not usually medically concerning on its own.
Bone-Related Neck Humps
In some cases, changes to the cervical vertebrae can contribute to or worsen the protrusion of a neck hump. Signs that bone loss or misalignment may be playing a role include:
- Enlarged or asymmetrical protrusion
- Visible lump right over the vertebrae of the upper spine
- Won’t shrink much with weight loss efforts
- Feels firm and solid to the touch
- Pain when the area is palpated or pressure applied
An asymmetric, swollen neck hump with a harder feel is suspicious for possible bone involvement. Osteoporosis, arthritis and injuries can prompt structural changes in the cervical vertebrae that distort the spine’s shape. In some cases, imaging tests may be warranted to evaluate for spinal issues contributing to a protruding neck hump.
When to See a Doctor
In most instances, a neck hump is simply a cosmetic issue rather than a medical concern. However, it’s a good idea to consult a physician or medical provider if you notice any of the following:
- Sudden formation of a neck hump
- Rapid growth of the protrusion
- Noticeable swelling, redness, warmth or asymmetry
- Severe localized pain and tenderness
- Numbness, tingling or pain radiating down the arms or back
- Dizziness, headaches, vision issues, balance problems
- Weakness or coordination problems in the extremities
The above symptoms may indicate potential compression of spinal nerves, vertebral fractures, infections, or other problems requiring prompt medical diagnosis. Catching these types of issues early is important.
Diagnosing Neck Humps
To diagnose the cause of a neck hump, a physician typically performs:
- Medical history and physical exam
- Palpation of the area to note texture, tenderness, swelling
- Range of motion assessment
- Neurological testing of strength and reflexes
- Postural analysis
Based on findings, the following tests may be ordered:
- Blood tests to check for metabolic disorders
- Dexa scan for bone density
- MRI of the cervical spine
- CT scan
- X-rays of the neck
These tests help differentiate between a fat-based hump and one worsened by vertebral bone issues, nerve impingements, infections, fractures, spinal tumors and other disorders.
Treating Neck Humps
Fatty Neck Humps
Treatment for a fatty neck hump focuses on losing excess weight and body fat. Strategies may include:
- Calorie-controlled, low-fat diet
- Regular exercise – cardio, strength training and stretching
- Stress management
- Avoiding factors that can increase cortisol like smoking and excess alcohol
- Topical fat reduction – Cosmetic procedures like CoolSculpting or Kybella injections can reduce localized submental fat under the chin and upper neck.
With natural weight loss methods or cosmetic fat reduction, the neck hump should slowly shrink over time as the excess fat in the area is metabolized and utilized for energy.
Bone-Related Neck Humps
If osteoporosis or structural issues with the cervical vertebrae are contributing to the protrusion, treatment aims to improve spinal health. Options include:
- Osteoporosis medication like bisphosphonates to increase bone density
- Calcium and vitamin D supplements
- Spinal injections like kyphoplasty to support collapsed vertebrae
- Back bracing
- Physical therapy to improve posture, spine extension, and neck strength
- Exercises like yoga and Pilates to improve flexibility, balance and spinal alignment
- Quitting smoking which elevates osteoporosis risk
Treating any spinal bone loss and degeneration can help minimize worsening of the neck’s protrusion over time.
Improving Posture
Poor posture often makes an existing neck hump look much more pronounced. Working on improving posture through targeted exercises, core strengthening, weight training and even swimming can help straighten the spine. This reduces rounding of the shoulders and neck that exacerbate the appearance of a hump.
Tips for improving posture include:
- Optimize spinal alignment by standing against a wall and positioning head, buttocks and shoulder blades flush.
- Practice chin tucks to stretch the back of the neck. Hold for 10 seconds, repeat several times per day.
- Strengthen the neck by doing slow head tilts to the side against light resistance.
- Improve thoracic extension by placing hands behind the head and pushing elbows back while squeezing the shoulder blades together.
- Perform shoulder retraction exercises like seated rows or band pull-aparts to draw the shoulders back.
- Do seated spinal twists to improve spinal flexibility.
- Strengthen the core with bridges, planks and other abdominal exercises.
A physical therapist can offer personalized posture retraining exercises and stretches.
Cosmetic Correction
For those wanting to reduce the appearance of a neck hump for cosmetic reasons, options beyond weight loss include:
- CoolSculpting: This non-surgical cryolipolysis procedure uses cold temperatures to destroy fat cells in a targeted area like the neck.
- Kybella injections: These dissolve and permanently remove fat cells in the upper neck and under the chin via deoxycholic acid injections.
- Liposuction: Surgical suctioning removes excess fat deposits from the neck hump area for sculpting.
- Neck lift surgery: Excess skin and fat are surgically removed and tightened.
However, the neck hump may gradually return over time without continued healthy lifestyle habits.
Prevention
Preventing neck humps involves maintaining good posture, core strength, bone density and avoiding excess weight gain as you age. Steps to take include:
- Practice good upright seated and standing posture. Avoid slouching.
- Do regular strength training and weight-bearing exercises.
- Get sufficient calcium and vitamin D for bone health.
- Perform balance exercises and yoga for posture and alignment.
- Limit alcohol intake and avoid smoking.
- Treat osteoporosis and medical conditions like Cushing’s syndrome.
- Develop a healthy, portion-controlled eating plan.
- Stay active with a mix of cardio, strength work, flexibility exercises.
Making positive lifestyle changes and staying on top of your health can help prevent and manage neck humps.
Conclusion
In summary, neck humps are primarily composed of excess fatty deposits that accumulate at the base of the skull and top of the back as a person ages. However, worsening posture, weak back muscles, osteoporosis and structural changes in the cervical vertebrae can also contribute to more pronounced humps in some cases. Diagnosing the cause of a neck hump through physical examination, medical history and potential testing enables proper treatment. Losing excess weight, strengthening the back and neck, correcting posture issues, and in some cases procedures like liposuction or neck lift surgery can help reduce the protrusion. While often just a cosmetic nuisance, keeping an eye on sudden growth or changes in a neck hump is wise to rule out potential compression of nerves or other issues requiring medical care. With proper prevention and management, neck humps can often be improved.