Scheuermann’s disease is a disease of the spine that often manifests itself during growth. A growth disorder of the vertebral bodies forms wedge-shaped vertebrae, which narrow the intervertebral discs. This creates the rounded back with hollow back that is typical of Scheuermann’s disease.
What is Scheuermann’s disease?
Scheuermann ‘s disease was discovered by and named after Danish radiologist Holger Scheuermann. It affects more male than female adolescents. It is estimated that around 10-20% of the population is affected by this growth disorder of the vertebral bodies to a greater or lesser extent. See growtheology for Comprehensive Guide to Craniopharyngioma.
Malformations of the base and cover plates of adjacent vertebral bodies occur, mainly in the thoracic vertebrae area, which lead to a wedge-shaped formation of the vertebral bodies. This narrows the intervertebral discs between the vertebral bodies, which leads to various complaints later in life.
If the thoracic vertebrae are affected by the growth disturbance, the typical hunchback with hollow back and spinal curvature develops. If, on the other hand, the vertebral bodies of the lumbar spine are affected, a flat back develops. Scheuermann’s disease is also known as juvenile dorsi deforming osteochondritis.
Causes
The actual causes of this growth disorder are still unknown. However, one suspects both a genetic predisposition and external influences that favor the growth disorders. In addition to genetic predisposition, metabolic disorders and hormonal influences in puberty also seem to play a role.
Various external factors, such as incorrect posture when sitting at a desk for hours in a bent position or weak muscles due to insufficient physical activity, are also considered to be conducive to Scheuermann’s disease. The bent posture creates increased pressure on the front edges of the thoracic spine. Since the growth zone of the vertebral bodies is in the edge areas, the growth of the vertebral bodies is impaired and slowed down by the increased pressure on the leading edge.
As a result, the vertebral bodies grow more at the rear edge than at the front edge, resulting in the formation of wedge-shaped vertebral bodies. This in turn leads to a reduction in the distance between the vertebral bodies, to a flattening of the intervertebral discs and to a greater risk of fracture of the base and cover plates of the vertebral bodies. Another cause of Scheuermann’s disease is mechanical overloading of the spine, for example in competitive athletes.
Symptoms, Ailments & Signs
For the trained eye, Scheuermann’s disease can often be recognized externally by a clear rounding of the thoracic spine and a possibly compensating hollow back in the area of the lumbar spine. The symptoms and complaints associated with Scheuermann’s disease can be derived directly from the external appearance.
The strong forward curvature in the chest area results in back pain and neck tension, especially in the advanced stage. Headaches are also possible. Further muscle tension is caused by the fact that the spine in the affected area clearly loses mobility. In the thoracic spine, this can also lead to pain in the shoulders and arms.
The internal organs also often react to the unphysiologically constricted conditions. In severe cases of Scheuermann’s disease, for example, the lungs cannot unfold freely for deep inhalation. Cardiac arrhythmias and stomach problems are also among the late symptoms of Scheuermann’s disease.
The lumbar spine often compensates for the curvature of the thoracic spine by creating a pronounced hollow back and hypermobility. This can also cause problems. A typical symptom is pain in the lower back, which occurs particularly when the abdominal muscles are under-trained.
Further complications are pain in the legs with a clearly radiating character, which can be the result of a herniation of intervertebral disc material into the spinal canal caused by the increased formation of a hollow back.
Diagnosis & History
Back pain in Scheuermann’s disease.
The diagnosis Scheuermann’s disease is made by X-ray diagnostics. The X-ray shows the typical curvature of the spine and the wedge-shaped deformed vertebral bodies.
At the beginning of the disease, there are hardly any symptoms. Later, the shoulders are pulled forward and the back is rounded. The hunchback causes increased stress on the lumbar spine and the formation of a hollow back. In order to reduce the pain, those affected often assume a poor posture, which leads to signs of wear and tear on the vertebral bodies and impairment of the muscles, tendons and ligaments.
In most cases of Scheuermann’s disease, however, the full development of the clinical picture does not occur, since the growth phase has ended with the end of the malgrowth.
Complications
First and foremost, Scheuermann’s disease leads to a curvature of the patient’s spine. In most cases, this is associated with relatively severe pain, so that those affected suffer from restricted movement. The pain can also occur at night and lead to difficulty sleeping or other uncomfortable feelings and depression. It is not uncommon for the pain from the back to spread to other regions of the body.
The back pain itself significantly restricts the patient’s everyday life and leads to a significantly reduced resilience of the patient. Furthermore, the growth of children is noticeably restricted and delayed by Scheuermann’s disease. This can also lead to consequential damage in adulthood, which in most cases is irreversible.
The treatment of Scheuermann’s disease takes place with the help of various therapies. This allows the pain to be limited and treated relatively well. There are no particular complications. As a rule, surgical interventions are only carried out if the case is serious. The life expectancy of those affected is usually not reduced by Scheuermann’s disease.
When should you go to the doctor?
Special features of the skeletal system must always be examined by a doctor. If there are any abnormalities during the growth process in children or adolescents, a doctor should be consulted as soon as possible. There is a special duty of care when there is an optical change in the spine. If a bad posture of the body can be noticed, a doctor’s visit is necessary.
Back pain or neck discomfort should be presented to a doctor. Taking pain medication is generally only recommended in consultation with a doctor, as the risk of side effects or complications is very high. Headaches, musculoskeletal problems, cardiac arrhythmias and breathing problems must be examined and treated.
If the sufferer is unable to breathe deeply, there is cause for concern. A strong hollow back, restricted mobility or a decrease in the usual physical resilience should be discussed with a doctor. If everyday school or work obligations cannot be met or if participation in sporting activities is restricted, a doctor is needed. If emotional or mental problems occur due to the visual flaw and reduced mobility, a doctor should be consulted. In the case of depressive moods, an aggressive appearance or a withdrawal from social life, it is advisable to consult a doctor.
Treatment & Therapy
In mild cases of Scheuermann’s disease, targeted physiotherapy is sufficient. In the physiotherapy exercises, a healthy posture is trained and the back muscles are strengthened. It is important to exercise regularly to counteract the curvature of the spine.
Special back exercises, swimming and hiking serve to strengthen the muscles and ensure a healthy posture. It is also helpful to wear a corset during the growth phase, which forces the upper body into a healthy posture and promotes healthy growth of the vertebral bodies.
Surgery may only be necessary in particularly severe cases, when there is already a pronounced bad posture and the associated severe back pain. The defective intervertebral discs are removed and replaced with pieces of bone previously removed from the ribs or the iliac crest. However, this surgical method is only successful in about half of all cases and involves certain risks.
Outlook & Forecast
In general, the prognosis for Scheuermann’s disease is favorable if treatment is started early. The deformation of the spine usually only occurs during puberty and, if left untreated, can lead to more or less severe deformations of the spine (humpback, scoliosis, hyperkyphosis).
Therefore, a timely diagnosis and regular follow-up, in which the so-called “Cobb angle” (a measure of the vertebral curvature) is determined, is important. From this, further measures are derived that can slow down the progression of the spinal deformity or, ideally, even stop it.
Targeted training of the back muscles through appropriate physiotherapy has a favorable effect on the prognosis. Sports that strengthen the back muscles (such as swimming) can also have a positive effect on the symptoms and development of the spine. Very good results are achieved with the use of a supporting corset. Diet should also not be neglected. Deficiency symptoms favor Scheuermann’s disease.
With the end of growth, Scheuermann’s disease does not progress any further. However, secondary damage (herniated discs, poor posture, neurological discomfort) can still occur. Important factors here are above all too little exercise, an unfavorable posture (a lot of hunched over sitting) and being overweight. These generally have a negative effect on the prognosis of Scheuermann’s disease.
Prevention
Preventing Scheuermann’s disease includes avoiding poor posture in children and young people, for example by using a desk that is appropriate to their height and an ergonomically shaped chair. Regular exercise strengthens the back and abdominal muscles, supports the spine and promotes a healthy posture. Endurance sports such as swimming and running are beneficial, while competitive sports and lifting and carrying heavy loads and the associated heavy mechanical stress on the spine should be avoided.
Aftercare
Just like the therapy, the follow-up treatment of Scheuermann’s disease depends on the extent of the pain, the extent of the rounded back and the age of the patient. Orthopedists and physiotherapists usually work together as part of aftercare. The patient’s input also plays an important role. So he should regularly do the physical therapy exercises he is learning at home to speed up recovery.
The physiotherapeutic exercises ensure a shortened chest musculature and prevent an unhealthy crooked posture. The muscles in the upper back are strengthened. This in turn has a positive effect on straightening the spine. Precise muscle strengthening is possible both in rehabilitation and in fitness studios. This also reduces the risk of injury.
In addition to carrying out the physiotherapy measures, sports advice is helpful for both the affected children and their parents. So it is important to know which sports have a positive effect and which do not. Water sports such as backstroke are considered cheap. Artistic gymnastics, cycling, trampoline jumping and rowing are rated negatively.
The goal of follow-up care is to stabilize the alignment of the spine to counteract progressive deformity. Being overweight can negatively affect the treatment. In most cases, however, no severe forms of Scheuermann’s disease are to be feared.
You can do that yourself
The typical symptoms of Scheuermann’s disease are closely linked to posture. In many cases, this means that the more hunched the patient sits or stands, the more pain is reported. This is where self-help for Scheuermann’s disease comes in: The more upright the posture, the greater the well-being and often the better the therapeutic success of conventional medicine and physiotherapy. For this reason alone, the patient can help himself if he consistently follows the prescribed physiotherapy with all its sessions and also conscientiously carries out exercises recommended for at home. Even a brace, which may be prescribed in more severe cases, must be worn with great self-discipline.
In everyday life, the patient can also do a lot to alleviate or even eliminate the symptoms caused by Mobus Scheuermann. This includes, in particular, strengthening the trunk muscles (abdomen and especially the back), which are responsible for straightening the body and thus the spine. This should always be done in consultation with the treating doctor or physiotherapist. Strengthening exercises on the machines in the gym that are specially designed for these muscle groups are very suitable. Swimming or walking train not only the back muscles but also endurance. When lying down while sleeping or reading, it is often helpful to repeatedly assume the prone position.
