Your spine (or backbone) is your body’s central support structure, it therefore connects different parts of your musculoskeletal system. Your spine helps you sit, walk, twist, and bend. The gradual curves of the human spine allow the body to absorb many shocks and stresses daily. It is a delicate balance, though, and if part of the spine curves too much, pain and limited mobility may occur.
This type of curvature problem is known as Scheuermann’s disease (also known as Scheuermann’s kyphosis). It can lead to a rounded upper back, sometimes called a humpback. Scheuermann’s disease is among the most frequent sources of back pain in younger patients, alongside pain more likely to follow either exertion or long periods of inactivity.
Patients may hear the name ‘Scheuermann’ used for other conditions, such as changes in the disc spaces of the lumbar spine at a young age, typically called juvenile disc disorder. Other similar terms oftentimes used are Calvé disease and juvenile osteochondrosis.
To understand the process of how Scheuermann’s disease begins developing, it is helpful to know the structure of the upper spine. This disease occurs most often in the upper back, also called the thoracic spine, but occasionally develops in the lower back as well (which is the lumbar spine). When the disease is located in the lumbar spine, the deformity is normally not as obvious, however, the lumbar deformity causes greater pain, more limitation on movement, and an increased likelihood of the condition continuing into adulthood.
Overall, Scheuermann’s disease begins before puberty – it isn’t known what exactly triggers the abnormal growth, but there are some theories speculating that the bone may have been injured at some point, or that the area was too weak before puberty.
Causes & Symptoms
Scheuermann’s disease can be caused by different things. In most cases, the exact cause remains unknown. Doctors theorize that this disease tends to run in families. Certain causes linked to Scheuermann’s disease include:
- Poor posture.
- Trauma resulting in a spinal fracture that is left untreated.
- Spinal infections such as osteomyelitis.
- Metabolic conditions like diabetes.
- Spinal tumors.
Symptoms generally develop between the ages of 10-15, which include the following:
- Redness on the skin where the affected curvature is presented and rubs against the back of a surface (such as a wall or the back of a chair).
- Pain worsening by activities involving twisting, bending or arching backward (such as participating in sports activities like gymnastics, skating, dancing, or other sports that require these types of movements).
- Having trouble exercising.
- Having the feeling of losing balance.
- Tightness and muscle stiffness, especially when sitting for an extended period of time.
- Tight hamstrings.
- Back pain or backache.
Severe damage to the lumbar spine or thoracic spine due to Scheuermann’s disease is rare, however, it is possible for Scheuermann’s disease to develop in a way that the spinal cord or internal organs are harmed. For instance, if the lungs become compressed by severe forward posture, it can lead to breathing problems.
Who gets Scheuermann’s Disease?
Certain risk factors linked to Scheuermann’s disease include the following:
- Age – One of the most common risk factors for Scheuermann’s disease is age. Symptoms caused by this disease start to present themselves in patients ages 10-15, while bones are still growing. If left untreated, Scheuermann’s disease can continue until adulthood (ages 20 and older).
- Gender – Scheuermann’s disease is equally affected in both males and females. However, another underlying disease known as kyphosis (similar causes to Scheuermann’s disease) tends to affect males rather than females.
- Family history – Most researchers have suggested that this disease can be passed down in families. Studies have shown multiple families who have passed the disease through the inheritance of certain types of genes. The genetic link is uncommon but remains under investigation.
- Birth defects – Spinal bones that do not develop properly before birth can cause Scheuermann’s disease.
- Syndromes – Scheuermann’s disease in children can also be associated with certain syndromes, such as Ehlers-Danlos syndrome and Marian syndrome.
How Does it Affect You? How Serious is it?
Severe Scheuermann’s disease can lead to numerous amounts of complications for those who are left untreated. Some of these complications are:
- Childhood osteoporosis – Studies have found that some patients with Scheuermann’s disease had mild osteoporosis (decreased bone mass) even though they were very young. Other studies did not show problems with osteoporosis.
- Biochemical changes – Scheuermann’s disease might include biochemical changes in the collagen that make up the end-plates altering bone growth, above-average disc height, and increased levels of growth hormone.
- Limited physical functions – Scheuermann’s disease is associated with weakened back muscles and difficulty doing tasks such as walking and getting out of chairs. The spinal curvature can also make it difficult to gaze upward or drive and can cause pain when you lie down.
- Digestive problems – Severe Scheuermann’s disease can compress the digestive tract, causing problems such as difficulty swallowing foods.
- Body image problems – Patients with Scheuermann’s disease may develop a poor body image from having a rounded back or from wearing a brace to correct the condition.
- Breathing problems – Severe Scheuermann’s disease can put pressure on the lungs.
- Surgery is rarely required for Scheuermann’s disease, however, there are certain situations in which it may be needed. It may be considered for patients who are suffering from severe deformities, such as a curvature of more than 75 degrees for thoracic kyphosis if neurological deficits are present and if the pain is caused by the deformity. The primary goal of the surgery is mainly to reduce the deformity, and possibly lessen pain or neurological symptoms.
Recommended Treatment & Rehabilitation
During the diagnosis of Scheuermann’s disease, a healthcare provider begins by completing a medical history and physical examination, which include the following:
- Forward bending test – The patient is asked to bend forward at the waist. This may reveal either a kyphosis or Scheuermann’s disease.
- Palpation – Also called a hands-on examination, this helps determine any spinal abnormalities by feel. When Scheuermann’s disease is present, the thoracic area of the spine is overly curved from the side.
- Range of motion – A physician assesses the degree to which the patient can bend forward, back, and side-to-side.
After a physical examination, an X-ray of the spine will be needed. If the issue is simply due to postural problems, nothing else abnormal will appear after the results of an X-ray. However, if the kyphosis is due to Scheuermann’s disease, the X-ray will show three or more adjacent vertebrae that are wedged together by at least five degrees each.
Generally, there isn’t a “normal” range for kyphosis of the thoracic spine since everyone’s anatomy is unique. Therefore, in some cases, a doctor will recommend Magnetic Resonance Imaging (MRI) to rule out an infection or a tumor that could be causing the pain; pulmonary function tests may also be done if breathing seems to be affected.
Exercise and physiotherapy are often recommended in conjunction with bracing. While exercise will not correct the deformity, it can be helpful in maintaining flexibility and alleviating back pain and fatigue. Here are some exercise examples that you can try to help ease symptoms linked to Scheuermann’s disease:
This type of exercise is performed by lying on the floor and is suitable for the muscles of the neck that are often stretched out and weakened. Firstly, pull your chin back toward the floor, as if you’re trying to make a double chin. Then, hold for 15 seconds before repeating 5-10 times a day.
The ultimate goal of this exercise is to stretch the tight muscles of the chest and strengthen the weak muscles of the back. Begin by standing tall, knees soft, core well-engaged, chest upright, and shoulder blades back and down. As you are left in an ideal posture, raise your arms up into a Y position with your thumbs pointed behind you. Finally, in this position, take 2-3 deep breaths, focusing on maintaining this posture on exhale. Repeat this method 3-5 times a day.
Thoracic spine foam rolling
Lie on the floor with a foam roller under you, across your mid-back. Next, gently roll up and down on the foam roller, massaging the muscles of your back and thoracic spine. You can perform this exercise with your arms extended over your head in the same life extension position.
Mirror image exercise
Stand tall against a wall. Tuck your chin slightly and bring your head back directly over your shoulders. Feel as if you are bringing your shoulder blades back and down. Hold this position for 30 seconds to 1 minute, repeating 2-3 times a day.
The important role of physiotherapy in Scheuermann’s disease is to assist in providing a great amount of relief and lessening further symptoms linked to the disease. Physiotherapy such as mobilization and manipulation aimed at the stiffest lower thoracic spine may be tried, but the treatment should be performed with care and only continued if the improvement is obvious and attributable to physiotherapy, rather than to exercises and time. Some physiotherapists suggest manipulation to other areas of the spine (such as the neck or sacroiliac joints) will help.
If the curvature progresses for more severe cases, a back brace may be required to help straighten the spine. The brace is designed to hold the spine straight with shoulders pulled back and the chin upright. Bracing helps take pressure off the vertebrae, allowing for growth of the bony area in the front of the vertebrae to catch up with the growth in the back.
Alternative & Homeopathic Treatment
Overall, most patients will not require surgery and can learn to cope with their condition through other types of treatment such as alternative and homeopathic treatment. The following treatments will help ease any symptoms associated with Scheuermann’s disease, such as the following:
Ice and heat application
Alternative heating pads and ice packs on the spine may help reduce inflammation and improve blood flow to the affected areas. These benefits may help relieve tension in fatigued back muscles and improve mobility temporarily.
Anti-inflammatory medications like ibuprofen may help mitigate symptoms of pain and limit inflammation and swelling in the back.
The more the condition is accompanied by pain, back mobility changes, and hamstring tightness, the more that rest will be required. This means avoiding activities such as contact sports and overloading heavy objects.
Diet and nutritional meals
Bone weakness contributes to many cases of Scheuermann’s disease. By eating a diet that supports your bone strength, you can prevent or treat osteoporosis and osteopenia as well as reduce the chance of continued spinal compression fractures that can worsen the disease.