Scheuermanns Disease: Causes, Symptoms & Treatment

Scheuermann’s disease is a disease of the spine that often manifests itself at a growing age. Due to a growth disorder of the vertebral bodies, wedge-shaped vertebrae form, narrowing the intervertebral discs between them. This results in the hunchback with hollow back typical of Scheuermann’s disease.

What is Scheuermann’s disease?

Scheuermann’s disease was discovered by Danish radiologist Holger Scheuermann and named after him. It affects more adolescent males than females. It is estimated that about 10-20% of the population is affected by this growth disorder of the vertebral bodies in a more or less pronounced form. Malformations of the base and top plates of adjacent vertebral bodies occur, mainly in the thoracic vertebrae, resulting in a wedge-shaped formation of the vertebral bodies. As a result, the intervertebral discs located between the vertebral bodies become narrower, leading to various complaints in later years of life. If the thoracic vertebrae are affected by the growth disorder, 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 called osteochondritis deformans juvenilis dorsi.

Causes

The actual causes of this growth disorder are still unknown. However, both a genetic predisposition and external influences are thought to promote the growth disorders. In addition to the genetic predisposition, metabolic disorders and hormonal influences at the age of puberty also seem to play a role. Various external factors, such as poor posture when sitting for hours at a desk in a bent posture or weak muscles due to insufficient exercise, are also considered to favor Scheuermann’s disease. The bent posture causes increased pressure on the front edges of the thoracic spine. Since the growth zone of the vertebral bodies is located in the edge areas, the growth of the vertebral bodies is impaired and slowed down by the increased pressure on the front edge. As a result, the vertebral bodies grow more strongly at the trailing edge than at the leading edge, leading to the formation of wedge-shaped vertebral bodies. This in turn leads to a reduction in the distance between the vertebral bodies, a flattening of the intervertebral discs and a greater risk of fracture of the base and top plates of the vertebral bodies. Another cause of Scheuermann’s disease is considered to be mechanical overuse of the spine, for example in competitive athletes.

Symptoms, complaints, and signs

Scheuermann’s disease is often already externally recognizable to the trained eye 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 thoracic region results in back pain and neck tension, especially in the advanced state. Headaches are also possible. Further muscle tension results from the fact that the spine loses significant mobility in the affected area. In the BWS area, this can also lead to pain in the shoulders and arms. It is also not uncommon for the internal organs to react to the non-physiologically constricted conditions. Thus, in a severe manifestation of Scheuermann’s disease, the lungs cannot develop freely for deep inspiration. 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 lead to problems. A typical symptom is pain in the lower back, which occurs especially when the abdominal muscles are in a weak state of training. Other complications include pain in the legs with significant radiating character, which may be the result of prolapse of disc material into the spinal canal caused by increased hollow back formation.

Diagnosis and course

Back pain in Scheuermann’s disease. Scheuermann’s disease is diagnosed by radiographic diagnosis. The X-ray shows the typical curvature of the spine as well as the wedge-shaped deformed vertebral bodies.At the beginning of the disease, there are hardly any symptoms. As the disease progresses, shoulders are pulled forward and a hunchback develops. The hunchback leads to increased strain on the lumbar spine and the formation of a hollow back. In order to reduce the pain, sufferers often adopt an incorrect posture, which leads to wear and tear on the vertebrae 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, because with the end of the growth phase, the misgrowth also ends.

Complications

Primarily, Scheuermann’s disease leads to a curvature of the spine in the patient. In most cases, this is associated with relatively severe pain, so that those affected suffer from restrictions in movement as a result. The pain can also occur at night and lead to sleep problems or other unpleasant 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 also noticeably restricted and delayed by Scheuermann’s disease. This can also lead to consequential damage in adulthood, which is irreversible in most cases. The treatment of Scheuermann’s disease takes place with the help of various therapies. With these, the pain can be limited and treated relatively well. Special complications do not occur. As a rule, surgical interventions are only performed if the case is severe. The life expectancy of the affected person is also not usually reduced by Scheuermann’s disease.

When should you see a doctor?

Features of the skeletal system should always be examined by a physician. If abnormalities occur within the growth process in children or adolescents, a visit to the doctor should be made as soon as possible. If there is a visual change in the spine, special care must be taken. If a malposition of the body can be perceived, a visit to the doctor is necessary. Back pain or discomfort of the neck should be presented to a doctor. The use of pain medication is generally only recommended in consultation with a doctor, as the risk of side effects or complications is very high. Headaches, musculoskeletal complaints, disturbances in heart rhythm, and problems with the ability to breathe should be examined and treated. If the individual is unable to take a deep breath, there is cause for concern. Severe hollow back formation, restrictions in movement possibilities or a decrease in the usual physical resilience should be discussed with a doctor. If daily school or work obligations cannot be met or participation in sports activities is limited, a doctor is needed. If emotional or mental problems occur due to the visual blemish as well as reduced mobility, a doctor should be consulted. If depressive moods, an aggressive demeanor, or withdrawal from social life occur, consultation with a physician is advised.

Treatment and therapy

In mild cases of Scheuermann’s disease, targeted physical therapy is sufficient. During physiotherapy exercises, a healthy posture is trained and the back muscles are strengthened. Regular exercise is important to counteract the curvature of the spine. Special back exercises, swimming and hiking help to strengthen the muscles and maintain 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. Only in particularly severe cases, when there is already pronounced poor posture and associated severe back pain, surgery may be necessary. In this case, the defective intervertebral discs are removed and replaced by 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 and prognosis

In general, the prognosis for Scheuermann’s disease is favorable if therapy is started early.The deformation of the spine usually develops during puberty and, if left untreated, can lead to more or less severe deformations of the spine (hunchback, scoliosis, hyperkyphosis). For this reason, it is important to make a diagnosis in good time and to carry out regular follow-up checks, during which the so-called “Cobb angle” (a measure of the curvature of the vertebrae) is determined. From this, the measures that can slow down or, ideally, even stop the progression of the spinal deformity are derived. 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 supportive corset. Nutrition should also not be ignored. Deficiency symptoms favor Scheuermann’s disease. With the end of growth, Scheuermann’s disease does not progress further. Secondary damage (herniated discs, postural defects, neurological insensitivity) can nevertheless occur. Important factors here are above all too little exercise, an unfavorable posture (a lot of stooped sitting) and obesity. These generally have a negative effect on the prognosis of Scheuermann’s disease.

Prevention

Prevention of Scheuermann’s disease includes avoiding poor posture in children and adolescents, for example, by adjusting the height of the desk to the height of the body and using an ergonomically shaped chair. Regular exercise strengthens the back and abdominal muscles, supports the spine and promotes healthy posture. Endurance sports such as swimming and running are favorable, while competitive sports and lifting and carrying heavy loads and the associated heavy mechanical stress on the spine should be avoided.

Aftercare

Like therapy, follow-up care for Scheuermann’s disease depends on the extent of the pain, the extent of the hunchback, and the patient’s age. Orthopedists and physical therapists usually work together during follow-up care. However, the patient’s cooperation also plays an important role. For example, he should regularly perform the physiotherapeutic exercises he learns at home in order to promote recovery. The physiotherapeutic exercises take care of shortened chest muscles and prevent unhealthy bent posture. Strengthening of the muscles takes place in the upper back. This in turn has a positive effect on straightening the spine. Both in rehabilitation and in fitness studios a precise execution for muscle strengthening is possible. The risk of injury can also be reduced in this way. For both the affected children and their parents, sports counseling is helpful in addition to the implementation of physiotherapeutic measures. It is important to know which sports have a positive effect and which do not. Water sports such as backstroke are considered beneficial. In contrast, gymnastics, cycling, trampolining and rowing are considered negative. The goal of follow-up care is to stabilize the alignment of the spine to counteract progressive deformity. Excess weight can negatively affect treatment. In most cases, however, there is no need to worry about severe progression of Scheuermann’s disease.

What you can do yourself

The typical complaint pattern of Scheuermann’s disease is closely related 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 around Scheuermann’s disease comes in: The more upright the posture, the greater the sense of 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 attends the prescribed physiotherapy with all its sessions and also conscientiously performs exercises recommended for home use. A corset, which may be prescribed in more severe cases, must also be worn with a high degree of self-discipline. In everyday life, the patient can also do a lot to alleviate or even eliminate the discomfort caused by Mobus Scheuermann. This includes, in particular, strengthening the trunk muscles (abdomen and especially back), which are responsible for straightening the body and thus the spine.This should always be done in consultation with the attending physician or physiotherapist. Strengthening exercises on machines specially designed for these muscle groups in the gym are well suited. 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 as well.