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Scheuermann's Disease - A Disease or Not?

Alot of conditions have long and sometimes scary names. Scheuermann’s disease is one such condition.

It occurs in children and is quite common, quoted in some studies as occurring in 25% of all children to varying degrees. Although the condition has an horrific name, it is not a terrible problem. Scheuermann's disease usually becomes apparent at school with the advent of some deformity, and it can be accompanied by backache and stiffness, usually aggravated by sitting. During the onset, the child's posture often changes. The back curve may become exaggerated and the child who develops the condition is often told by his parents and teachers not to slouch. The backache can be in the middle and lower back.

The condition was originally described by Scheuermann, who stated that the diagnosis was established if there was wedging of vertebral bodies, in association with other changes, including intervertebral disc space narrowing, Schmorl's nodes, and deformity. These changes can occur with or without pain. Small changes in the growing parts of the vertebrae may be seen. These changes may persist and predispose the lower thoracic spine to degenerative changes later in life.

Scheuermann's disease usually lasts as a symptomatic pain producing problem between 6 months and 3 years. It is a problem in growing adolescent, and once the growth is finished the condition recovers. The function of the spine and hamstring muscles is usually mildly affected in the long term, emphasizing the need for rehabilitative exercises.

Treatment

The treatment of Scheuermann's 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 Scheuermann's 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 Scheuermann's 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.

The concepts presented here are entirely the author's own (unless expressly stated) and do not represent the thoughts or ideas of any other person.

© Charlie Kornberg. All rights reserved. No part of this web page, or related accompanying pages, may be reproduced without the prior permission of the Author.