The prone extension test helps distinguish between structural and functional kyphosis. Which pair does it differentiate?

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This test differentiates whether a kyphotic curve is fixed or flexible. When a patient with kyphosis lies prone and the spine is extended, a functional (postural) or flexible kyphosis tends to straighten or reduce the curvature because the deformity isn’t due to rigid bone changes. A structural kyphosis, caused by fixed vertebral wedging or other permanent bony abnormalities, resists this correction, so the curvature remains pronounced. This distinction helps guide management: flexible kyphosis may improve with posture training and physical therapy, while structural kyphosis may require imaging and orthopedic evaluation to address underlying bone problems. The test isn’t aimed at differentiating strain vs neuritis or radiculopathy, nor at distinguishing scoliosis from an antalgic lean.