...less medical jargon in a 'Quick Glance' format!
Scheuermanns Disease, also known as Kyphosis is a form of osteochondritis.
In this condition, which may affect many different parts of the body, there is a derangement of the normal process of bone growth which occurs when this bone growth is maximal, in late adolescence and young adulthood.
Mild back pain
Tenderness and stiffness in the spine
Round back appearance
Difficulty breathing (in severe cases)
The most common symptoms are pain, stiffness and discomfort in this part of the back, and the diagnosis is confirmed by X-rays which show narrowing of the vertebrae at the front and some tiny punched-out gaps on the lower borders of the vertebral borders called Schmor's nodes.
It is a spinal deformity that can result from trauma, developmental problems, or degenerative disease. This disease can occur at any age, although it is rare at birth.
Adolescent Scheuermanns disease, results from the wedging together of several consecutive vertebrae. The cause is unknown.
In adults, it can be a result of osteoporotic compression fractures, degenerative disease, or slipping of one vertebra forward on another.
Other causes include the following:
Connective tissue disorders
Certain endocrine diseases
Scheuermann's disease can also be seen in association with scoliosis. Risk factors are related to the causes.
The treatment of Scheuermanns disease depends upon the severity of pain and the degree of mechanical changes seen on examination. The pain may become prominent during the growth phase of the spine. When more severe, relative rest from activity is necessary. The traditional treatment was rest, especially in large back braces, however, this treatment was excessive.
The range of treatment is as follows:
. . . Exercises
The back can become very stiff during the active phase of this condition. It is important to attempt to maintain mobility. The thoracolumbar region, most affected by the condition, moves particularly in rotation and so stretching in all ranges, especially rotation, is necessary. Strengthening exercises associated with postural modification is usually very important and specific instructions are required.
. . . Rest
The more the condition is accompanied by pain, back mobility changes, postural deformities and hamstring tightness, the more that rest will be required. This can mean complete rest from active contact sports such as football, and rest from activities requiring repetitive overload, e.g. long distance running, bowling in cricket, gymnastics, ballet dancing, etc.
. . . Physical Therapy
The major role for this therapy in Scheuermanns disease is to assist in providing an exercise program. Physical therapy such as mobilisation and manipulation aimed at the stiffest lower thoracic spine may be tried on 2 - 6 occasions, but the treatment should be performed with care and only continued if improvement is obvious and attributable to physical therapy, rather than to exercises and time. Some Practitioners suggest manipulation to other areas of the spine, eg. the neck or sacro-iliac joints, will help. It is probable that this form of therapy should be avoided.
. . . Day to day activities
General fitness should be maintained. Swimming is probably the best form of exercise, but may not help with pain relief. A modified general exercise program will assist with fitness and the degree of pain and stiffness during and after activity will indicate how much can be done. Sitting is often the most aggravating activity. It is important to find a comfortable posture, especially at school. A lumbar roll may help. If pain is prominent during classes, it may be necessary to stand and do stretching exercises. A light velcro back brace that does not limit mobility may help with pain control. Tablets such as aspirin or paracetamol may be useful during painful times, e.g. during examinations or long periods of study. If the deformity is accompanied by foot deformity, particularly flat feet, then orthotic devices may be required.
. . . Later treatment
As this condition is time limiting, there is no specific treatment if the condition is detected in later life. Sometimes an adult may present with backache. X-rays may be taken which show old Scheuermanns disease changes. No specific inference should be drawn from these x-ray changes, except to say that the effected segments of the spine, usually the thoracolumbar region, will be stiffer than would normally be expected. As pain cannot be attributed to degenerative changes, they are irrelevant in the context of pain origin. If stiffness and/or weakness exists, the treatment may well include physical therapy and exercises.
Scheuermann's disease is just one of the many conditions found in the population incidentally. Treatment should address the signs and symptoms of the presenting condition, and not the incidental radiological findings.