What is Scheuermann's disease?
Scheuermann's disease is a condition which presents as a postural abnormality characterized by excessive curvature of the upper back (thoracic spine). It is an osteochondrosis of the spine, meaning it affects the bony growth and development of the spine at the growth plates. These changes occur during adolescence at a time of rapid growth and may present as acute back pain, although often it may be asymptomatic and not picked up until later in life. This condition affects boys more often than girls.
Cause of Scheuermann's disease
The cause of Scheuermann's disease is not known.
Signs and symptoms of Scheuermann's disease
Patients with this condition may experience acute upper back pain and stiffness particularly during a period of rapid growth. Symptoms are often mild to moderate and generally are exacerbated with increased physical activity. Postural abnormalities such as an excessive curvature of the upper back (thoracic kyphosis), and possibly a secondary compensatory excessive lumbar lordosis (increased arch in the lower back) may also be evident. Occasionally patients with this condition experience no symptoms.
Diagnosis of Scheuermann's disease
An X-ray is usually required to confirm the diagnosis of Scheuermann's disease. If an X-ray demonstrates wedging of 5 degrees or more at three adjacent vertebrae then diagnosis of Scheuermann's disease is made.
Treatment for Scheuermann's disease
Most patients with this condition progress well with appropriate physiotherapy. Treatment is primarily aimed at preventing progression of the postural deformity. This usually involves postural exercises, stretches and strengthening exercises as well as physiotherapy treatment. A postural brace can also assist in preventing progression of the condition.
Patients with this condition should also rest from any activity that increases their pain and try to maintain optimal posture as much as possible (or if this is painful, as close to optimal posture as able, pain free) (figure 1). Activities which may encourage poor posture or place large amounts of stress on the upper back should generally be minimized. These may include: slouching, bending forwards, shoulders forwards activities and heavy lifting. Resting from aggravating activities ensures the body can begin the healing process in the absence of further damage. Once the patient can perform these activities pain free a gradual return to these activities (whilst maintaining good posture) is indicated provided there is no increase in symptoms.
Physiotherapy for Scheuermann's disease
Physiotherapy treatment for patients with this condition is vital to ensure an optimal outcome and assist in preventing progression of the postural deformity. Treatment may comprise:
- soft tissue massage
- postural taping
- postural bracing
- dry needling
- exercises to improve posture, core stability, strength & flexibility
- ergonomic advice
- clinical Pilates
Other intervention for Scheuermann's disease
Despite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately or experience continued postural deformity. In these instances, other intervention may be required. This may include further investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, postural bracing, assessment from a specialist or sometimes surgery. The treating physiotherapist can advise if these interventions may be required and will refer to the appropriate medical authority if it is warranted clinically. Surgery may be indicated if the kyphosis (curvature of the upper back) is greater than 50 degrees or if signs of spinal cord irritation are present.
Exercises for Scheuermann's disease
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 5 times daily and only provided they do not cause or increase symptoms.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back straight. Squeeze your shoulder blades together as hard and as far as possible pain-free (figure 2). Hold for 5 seconds and repeat 10 times.
Figure 2 – Shoulder Blade Squeezes
Extension Over Chair
Begin sitting tall on an appropriate chair (the top of the back rest should end at the level of your mid back). Place your hands behind your neck and gently arch backwards over the chair, looking up towards the ceiling. Move until you feel a mild to moderate stretch pain-free (figure 3). Repeat 10 times.
Figure 3 – Extension Over Chair
Place your foot on a step or chair. Keep your knee and back straight, lean forward at your hips until you feel a stretch in the back of your thigh / knee (figure 4). Hold for 15 seconds 4 times at a mild to moderate stretch pain-free. Repeat on each leg.
Figure 4 – Hamstring Stretch (Left Leg)
Physiotherapy products for Scheuermann's disease
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
- Postural Supports
- Ice Packs or Hot Packs
- Lumbar Supports (for optimal sitting)
- Protective Tape (for postural taping)
- Foam Rollers (for self massage)
- Spikey Massage Balls (for self massage)
To purchase physiotherapy products for Scheuermann's disease click on one of the above links or visit the PhysioAdvisor Shop.
Find a Physio for Scheuermann's disease
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