Scheuermann's disease (also known as Scheuermann’s kyphosis) is a condition that affects spinal development, primarily during adolescence. It leads to abnormal growth in the thoracic (upper back) and sometimes the lumbar (lower back) vertebrae. The condition causes the vertebrae to develop unevenly, with one side growing more than the other, creating a wedge-shaped appearance. This can result in an exaggerated curvature of the upper back, known as kyphosis.
In addition to the abnormal vertebral shape, Scheuermann's disease may cause Schmorl's nodes, which are small depressions in the vertebrae formed when the spinal discs push into the bone. While these nodes are typically harmless, they can sometimes be a feature of the disease.
Other terms for Scheuermann’s disease include Calvé disease and juvenile osteochondrosis of the spine. Though it’s most common in adolescents, the condition can also be found in adults.
What is Scheuermann's Disease?
The exact cause of Scheuermann’s disease remains unclear, but it is a structural issue related to abnormal vertebral growth during adolescence, not simply the result of poor posture. Several factors may contribute to the development of the disease, including:
Genetics: Family history may increase the likelihood of developing Scheuermann’s disease.
Hormonal Imbalances: Abnormal hormone levels can affect bone growth and development.
Malabsorption or Endocrine Disorders: Conditions affecting nutrient absorption or hormone production can interfere with bone health.
Biomechanical Factors: Structural anomalies, such as a shortened sternum, may contribute to spinal changes.
Causes of Scheuermann's Disease
Common Symptoms of Scheuermann's Disease
The symptoms of Scheuermann’s disease can vary in severity. Common signs include:
Pain & Stiffness: Individuals often experience discomfort and stiffness in the upper back, especially with physical activity or prolonged periods of sitting or standing.
Increased Kyphosis: A prominent sign of Scheuermann's disease is a noticeable rounding of the upper back, also called thoracic kyphosis. This creates a hunched posture, which may be visible.
Reduced Mobility: A limited range of motion in the spine may also occur, making it difficult to fully extend the back.
Some people may experience no symptoms at all, while others may find that physical activity aggravates the condition.
Diagnosing and Treating Scheuermann’s Disease
Diagnosis Process
To diagnose Scheuermann’s disease, healthcare professionals rely on a combination of physical examination and imaging tests:
X-rays: The primary tool for diagnosing Scheuermann’s disease, X-rays (specifically lateral spine X-rays) reveal the characteristic wedge-shaped vertebrae and increased spinal curvature.
MRI: An MRI may be used for additional imaging if there are concerns about other underlying issues.
Additional Tests: Depending on symptoms, blood tests or bone density scans might be recommended to rule out other conditions with similar signs.
Accurate diagnosis is crucial because conditions like osteoporosis or other forms of spinal deformity can present with similar symptoms.
Treating Scheuermann’s Disease
Treatment for Scheuermann’s disease typically occurs in stages, focusing on pain management, restoring mobility, and preventing future complications.
Managing Pain and Reducing Inflammation
The initial phase of treatment focuses on relieving discomfort and controlling inflammation. Techniques may include:
Ice/Heat Therapy: To reduce inflammation and promote healing.
Acupuncture or Soft Tissue Massage: To ease muscle tension around the affected areas.
NSAIDs: Nonsteroidal anti-inflammatory drugs may be prescribed to manage pain and swelling.
It’s important to avoid activities that place excessive strain on the upper back, such as heavy lifting or vigorous bending.
Improving Range of Motion and Strength
Once pain and inflammation are under control, the focus shifts to restoring flexibility and strengthening the muscles that support the spine. A physiotherapist will guide you through exercises designed to:
Increase Extension: Promote backward bending of the spine to counteract excessive kyphosis.
Strengthen Postural Muscles: Target muscles that support spinal alignment and posture.
Exercise programs are personalised to the patient’s needs and goals, helping to improve posture and prevent future discomfort.
Returning to Normal Function
In the final phase, the goal is to restore full spinal function. This involves gradually returning to everyday activities and sports, while continuing to monitor posture and spinal alignment. A physiotherapist will help design a return-to-activity plan to ensure a safe transition.
Preventing Recurrence
To maintain long-term spinal health, it's crucial to prevent future issues. This may involve:
Regular Stretching: Keeping the back flexible to avoid stiffness and further curvature.
Core Strengthening: Building a strong core to support the spine and maintain proper posture.
Your physiotherapist may also recommend lifestyle changes, such as ergonomic adjustments to prevent strain on the back.
Managing Scheuermann's Disease
The prognosis for most people with Scheuermann’s disease is positive. While symptoms, such as pain, often improve with treatment, some individuals may experience lasting postural changes or limited mobility due to the curvature of the spine. In more severe cases, a posture brace may be recommended to support spinal alignment and encourage proper muscle activation.
Surgery is generally not needed unless the condition is severe and causing significant functional impairment. In such cases, surgical intervention may aim to correct the curvature of the spine. However, this is rare, and most people benefit from conservative treatments such as physiotherapy.
Diagnosing and treating this condition early on is essential to improve outcomes. It is possible that if the condition was severe or not properly managed during adolescence that there can be long lasting pain or stiffness into adulthood.
Working with a physiotherapist is key to managing Scheuermann's disease effectively and ensuring that you maintain a good quality of life, with minimal impact on daily activities.