What is Scheuermann’s Disease?
Scheuermann’s disease is a developmental disorder of the spine. It is also known as Calvé disease and juvenile osteochondrosis of the spine. Scheuermann’s disease causes the abnormal growth of usually the thoracic (upper back) vertebrae, but it can also present in the lumbar vertebrae.
In Scheuermann’s disease, one side (the back) of the vertebral body grows at a regular rate, whereas the front grows more slowly. This growth rate leads to a vertebra with a distinct wedge shape. In turn, this growth rate difference leads to an increase in the bend in your upper back called an increased dorsal kyphosis.
Along with this wedging of the vertebra, there is also a change to the bone-disc interface. These are called endplate irregularities. Some of the intervertebral spinal discs then protrude into the vertebra. These bone depressions are called Schmorl’s nodes. You can visualise it on an X-Ray. These Schmorl’s nodes are present for life but are do not appear to cause any problems in the future. People may have an X-Ray when they are older for an unrelated condition and find that they have Schmorl’s nodes but have never experienced back pain.
What Causes Scheuermann’s Disease?
Scheuermann’s disease has a familial tendency and no apparent gender bias. Its cause is unknown but appears to be multifactorial. Factors include juvenile osteoporosis, malabsorption, infection, endocrine disorders and biomechanical factors, including a shortened sternum.
What are the Symptoms of Scheuermann’s Disease?
Scheuermann’s disease usually causes pain in and around the thoracic spine. This structural change can lead to some restriction in the range of movement, especially into extension (bending backwards). It can also lead to an increased thoracic or mid/upper back kyphosis (bend).
The pain can be made worse by activity, including sports that require a lot of twisting or forceful bending or arching backwards, such as cricket, gymnastics, cricket or athletic field events.
How is Scheuermann’s Disease Diagnosed?
A simple plain X-Ray is usually sufficient to diagnose Scheuermann’s Disease with it showing the classic wedging of the thoracic vertebrae and sometimes the Schmorl’s Nodes. MRI will show additional detail.
Scheuermann’s Disease Treatment?
PHASE I – Pain Relief & Protection
Managing your pain is the main reason that you seek treatment. In truth, it was the final symptom that you developed and should be the first symptom to improve.
Scheuermann’s Disease inflammation is best eased via ice therapy and techniques or exercises that de-load the inflamed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage.
Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen or pain relievers such as paracetamol.
You will need to avoid heavy loading of your thoracic spine and vigorous bending exercises such as crunches or sit-ups.
PHASE II – Restoring Normal ROM, Strength
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring as much range of movement as you can. It is essential to regain as much extension as you can.
It is also essential to restore or improve the muscles that control the movement and posture in your back. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you, specific to your needs.
Would you please ask your physio for their advice?
PHASE III – Restoring Full Function
There is no reason why people can not return to full activity, including all sports, but they may need guidance on responding to action that involves twisting or sharp bending. You will also need to be progressed through exercises to regain sport or activity specific strength as the period of rest can lead to a lot of de-conditioning.
PHASE IV – Preventing Future Dysfunction
You can do some things to reduce your chances of having any problems in the future. Maintaining excellent flexibility in your back and keeping the core muscles healthy to maintain better posture and reasonable control over the vertebra will all help to limit any future problems.
Scheuermann’s Disease Prognosis?
The pain from active Scheuermann’s Disease will eventually pass, and for the majority of people, they will have no further trouble from their thoracic vertebrae. Some people will have a reduced range of movement, and if the disease caused significant kyphosis (bend), they could get ongoing postural issues.
For more information, please get in touch with your physiotherapist.
Scheuermann’s Disease Treatment Options
Sometimes a posture brace is used to help keep the back in as much extension as possible. This brace works to remind you where your spine should be and encourage the correct muscles to work.
Surgery for Scheuermann’s Disease
Rarely the amount of wedging of the vertebra is so significant that surgery to restore a better position for the thoracic spine is required. Surgery only occurs if the disease process is substantial. Your physiotherapist will be able to monitor the amount of flexion you have. If it appears to be increasing too greatly, an orthopaedic surgeon may need to make an assessment.
Common Causes of Upper Back Pain & Injury
Thoracic Spine Conditions
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-Related / Referred Pain
Article by John Miller
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.