What Causes Scheuermann’s Disease?

The exact cause remains uncertain. Researchers believe several factors may contribute to changes in vertebral growth during adolescence.

Potential influences include inherited characteristics, growth-related changes in the vertebral endplates and differences in how the developing spine responds to mechanical loading.

There is no reliable evidence that everyday slouching alone causes the structural changes associated with Scheuermann’s disease.

However, long periods in one position, unsuitable exercise loads or limited muscular endurance may aggravate symptoms in some people.

What Are the Symptoms of Scheuermann’s Disease?

Symptoms vary considerably. Some people have a noticeable spinal curve but little pain. Others experience persistent aching, stiffness or fatigue.

Common features include:

• Increased rounding of the upper or middle back
• A relatively rigid spinal curve that does not fully straighten
• Dull or aching upper back pain
• Stiffness after prolonged sitting or standing
• Muscle fatigue during study, work or daily activities
• Reduced spinal mobility in some movements
• Neck or lower back discomfort associated with altered movement demands

Symptoms may become more noticeable during rapid growth, prolonged study, driving, lifting or sport. However, spinal shape alone does not reliably predict how much pain someone will experience.

Scheuermann’s Disease in Teenagers and Adults

Teenagers and Growing Adolescents

Scheuermann’s disease is often first noticed during adolescence, when spinal growth is rapid. Parents may observe a rounded upper back that remains visible when their teenager tries to stand upright.

Some teenagers experience pain during sport, long periods of sitting or other activities. Others have few symptoms.

Assessment during growth is particularly important when the spinal curve appears to be increasing. A doctor may recommend imaging, monitoring or specialist review, depending on the clinical findings.

For further guidance, see our article on back pain in children and teenagers.

Adults with Scheuermann’s Disease

Adults may continue to have a structural kyphotic curve after growth finishes. Some remain comfortable and active, while others experience back stiffness, muscle fatigue or pain during certain activities.

Physiotherapy can focus on managing symptoms and improving movement, strength and physical capacity. However, exercise does not reverse established vertebral wedging.

How Is Scheuermann’s Disease Diagnosed?

Diagnosis usually combines a clinical examination with appropriate spinal imaging.

A physiotherapist or doctor may assess:

• Standing spinal posture and curve flexibility
• Thoracic and lumbar spine movement
• Pain location and symptom behaviour
• Muscle strength, endurance and flexibility
• Neurological function when clinically indicated
• Growth stage, activities and family history
• The effect of symptoms on school, work, sleep and sport

Standing spinal X-rays can help confirm structural changes, measure the spinal curve and identify characteristic vertebral wedging.

Traditionally, diagnostic criteria include wedging of at least five degrees in three consecutive vertebrae, although interpretation also depends on the wider clinical and radiographic findings.

MRI is not routinely required for every person. A doctor or specialist may arrange it when symptoms, neurological findings or other features warrant further investigation.

For general medical information, see MedlinePlus: Kyphosis.

How Is Scheuermann’s Disease Managed?

Management depends on the person’s age, skeletal maturity, spinal curve, symptoms and functional needs.

Many people manage the condition without surgery. Physiotherapy, activity modification and exercise may help symptoms and physical function. Growing adolescents with more significant curves may also require medical monitoring or specialist bracing.

Physiotherapy for Pain and Function

Physiotherapy aims to improve comfort, movement and physical capacity. Treatment does not reshape the wedge-shaped vertebrae, but it may help people manage the effects of the structural curve.

A physiotherapy programme may include:

• Education about the condition and symptom management
• Exercises to improve comfortable spinal mobility
• Progressive back, trunk and shoulder blade strengthening
• Muscular endurance training
• Advice about sitting, studying, work and sport loads
• Graded return to activities limited by pain or fatigue
• Manual therapy for selected symptoms when appropriate

The treatment plan should reflect the individual’s clinical presentation rather than follow a fixed sequence of rehabilitation phases.

Mobility and Strength Exercises

Exercises may target comfortable thoracic movement, shoulder blade control, trunk strength and general physical conditioning.

Depending on assessment findings, a programme might include gentle thoracic mobility, resistance-band rows, trunk endurance exercises and progressive functional strengthening.

Exercise should remain comfortable and appropriate for the person’s symptoms, growth stage and spinal characteristics. Forceful attempts to straighten a rigid curve are not recommended.

See our posture exercises guide for general movement and strengthening principles. These exercises do not replace individual assessment or correct structural vertebral wedging.

Activity and Load Management

Many people with Scheuermann’s disease can participate in school, work, gym exercise and sport. Restrictions are not automatically required because someone has a kyphotic curve.

However, symptoms may respond to adjustments in training volume, repeated lifting, prolonged sitting or other aggravating activities.

Useful strategies may include:

• Changing position regularly during long study or work sessions
• Adjusting training loads when symptoms increase
• Building strength and endurance gradually
• Maintaining regular, comfortable physical activity
• Reviewing workstation setup when sitting is aggravating
• Allowing appropriate recovery between demanding activities

The aim is to improve activity tolerance without creating unnecessary fear of normal spinal movement.

Can Bracing Help Scheuermann’s Disease?

Prescribed spinal bracing may be considered for selected adolescents who are still growing, particularly when the structural curve is more pronounced or progressing.

A spinal specialist considers the curve size, skeletal maturity, flexibility, symptoms and risk of progression before recommending a brace.

When appropriate, a brace is individually prescribed and fitted. Its purpose is to influence spinal alignment and curve progression during remaining growth.

Bracing is generally less effective for changing an established structural curve once skeletal growth is complete.

When Is Specialist or Surgical Treatment Considered?

Medical or spinal specialist review may be appropriate for adolescents with significant or progressing curves, substantial symptoms or concerns about spinal development.

Surgery is uncommon. Specialists may consider it for selected people with severe deformity, substantial persistent symptoms, progression or neurological complications.

The decision requires a careful assessment of potential benefits, risks, curve characteristics and the person’s circumstances. Most people with Scheuermann’s disease do not require surgery.

When Should You Seek Medical Advice?

Arrange a physiotherapy or medical assessment if spinal pain, stiffness or fatigue regularly limits school, work, sport, sleep or daily activities.

Children and teenagers with an increasing or relatively rigid spinal curve should have medical assessment rather than relying on posture exercises alone.

What Is the Long-Term Outlook?

Many people with Scheuermann’s disease remain active and manage their symptoms successfully.

The structural spinal curve generally remains after skeletal growth finishes. However, pain and physical function can improve even when the vertebral shape does not change.

Long-term outcomes vary according to curve severity, symptoms, general health and individual circumstances. Some adults experience ongoing stiffness or back discomfort, while others have few limitations.

In growing adolescents, monitoring may be important to identify changes in the spinal curve before skeletal maturity.

Physiotherapy can support long-term movement confidence, strength and activity participation without promising to straighten the structural curve.

What Can You Do Day to Day?

Most people benefit from maintaining regular movement and finding practical ways to manage activities that aggravate their symptoms.

• Stay physically active within your comfortable limits.
• Change position during prolonged sitting or study.
• Build general strength and muscular endurance progressively.
• Adjust activities if symptoms become more persistent.
• Avoid repeatedly forcing the spine into painful end-range positions.
• Follow any medical monitoring or bracing advice provided during adolescence.

There is no single ideal posture that everyone must hold throughout the day. Comfortable movement, physical capacity and sensible activity planning are generally more useful than rigid posture correction.

Our posture guide explains how movement habits, strength and daily activities influence comfort.

Related Spinal Conditions and Information

What To Do Next

If you or your teenager has persistent upper back pain, stiffness or a changing spinal curve, an assessment can help clarify the likely cause and appropriate next steps.

A physiotherapist can assess movement, symptoms and functional limitations. They can also recommend medical review when imaging, growth monitoring or specialist assessment may be appropriate.

Where physiotherapy is suitable, management may include individual exercise advice, strengthening, activity planning and symptom-management strategies.

References

1. O’Donnell JM, Wu W, Youn A, Mann A, Swarup I. Scheuermann Kyphosis: Current Concepts and Management. Current Reviews in Musculoskeletal Medicine. 2023;16(11):521–530. doi:10.1007/s12178-023-09861-z.
2. Sebaaly A, Farjallah S, Kharrat K, Kreichati G, Daher M. Scheuermann’s kyphosis: update on pathophysiology and surgical treatment. EFORT Open Reviews. 2022;7(11):782–791. doi:10.1530/EOR-22-0063.
3. Scheuermann Disease. StatPearls. National Center for Biotechnology Information.

FAQs About Scheuermann’s Disease