Scheuermann’s Disease

Scheuermann's Disease

Scheuermann’s Disease is a hereditary disease that mainly affects growing boys between the ages of 13 and 16 years. It is the most common postural abnormality of the spine in young athletes. Children complain of acute pain in the upper back and in later years the upper spine (thoracic) may become hunched or rounded.

On this page:

  • Signs & symptoms
  • Causes & anatomy
  • Treatment

Symptoms of Scheuermann’s Disease

Symptoms of Scheuermann’s disease consist of pain in the upper back (thoracic area of the spine), but may also be felt lower down towards the top of the lumbar spine. It affects children between the ages of 13 and 16. Symptoms in the lower thoracic and lumbar area are more common in athletes than children who are not so physically active.

Initially, children will feel acute pain in the upper back but in later years, as the disease progresses the thoracic spine (upper back) becomes more rounded with a ‘hunched’ appearance. This postural abnormality is known as kyphosis. As a result, the lower back may curve inwards excessively to compensate, known as lumbar lordosis.

An X-ray will show irregularity or wedging of the growth plates of the vertebrae in the spine. A ‘wedging’ of 5 degrees or more at three adjacent vertebrae will confirm the diagnosis of Scheuermann’s disease.

Causes of Scheuermann’s disease

Scheuermann’s disease is one of a group of diseases known as Osteochondrosis. Osteochondrosis is a disease of the joints and is common in children during a rapid growth phase. There is an interruption of the blood supply to the growth plate of the bone (called the epiphysis), which causes necrosis (dying) of the bone, then later the bone re-grows. The defect may occur in just a few of the thoracic vertebrae or may affect the entire segment. Scheuermann’s disease is diagnosed by X-ray, where at least 3 adjacent thoracic vertebrae have wedging of at least 5 degrees.

Bone structure, growth plate

Treatment of Scheuermann’s Disease

Treatment for Scheuermann’s disease is to manage and prevent the postural deformities progressing.

What can the athlete do?

If Scheuermann’s disease is suspected then see a doctor who can confirm the diagnosis and advise on treatment and management.

To help prevent the progression of postural deformities such as kyphosis and lumbar lordosis exercises to stretch the hamstring muscles and strengthen the core abdominal muscles. Wearing a back brace or support to help prevent or decrease kyphosis and lordosis.

What can a doctor do?

A doctor will X-ray the spine to confirm the diagnosis. They may prescribe a corset or back support if the disease is progressing quickly. Joint mobilization and sports massage to the upper spine may help relax muscles and reduce pain. In severe cases where kyphosis in the upper spine is greater than 50 degrees, or if signs of spinal cord irritation are present then surgery may be indicated. A professional therapist may use joint mobilizations or sports massage techniques to relieve symptoms.

Upper back taping

A simple upper back taping technique may help support the upper spine and encourage correct posture. The following guidelines are for information purposes only. We recommend seeking professional advice before beginning rehabilitation.

Tape and equipment – You will need one roll of 1.5 inches (3-4cm) or similar zinc oxide tape which is nonelastic. If you have a very hairy back you may need to shave to prevent discomfort when removing the tape -also to provide a better surface for the tape to stick to. Use this taping technique in the early stages of rehabilitation to encourage good posture and take some stress off the back. Do not rely on it long term as this will lead to muscle weakness.

Step 1 – Stand or sit in an upright position with shoulders back. Place one strip of tape from the bottom of the neck, down the back, pulling gently downwards when applying the tape.

Step 2 – Place another strip of tape the other side of the neck in the same way.

Step 3 – Repeat this process on the first side coming from the front of the shoulder down the back.

Step 4 – Repeat step 3 on the other side of the back to complete the process.

This taping technique will aid in posture correction and help temporarily take the strain off the upper back and neck. Use in the short term for pain relief and to assist in educating about maintaining the correct posture. Avoid using it for more than a few days as the athlete may get to rely on it and muscles may start to weaken.

Exercises

Stretching the hamstrings

straightleg

Exercises to stretch the hamstring muscles are particularly important. Bent leg hamstring stretch on the back targets the muscle fibres closer to the hip whereas the straight leg hamstring stretch targets the fibres nearer the knee. Lie on your back and pull the leg over keeping the knee very slightly bent until a gentle stretch is felt at the back of the leg. Again this should not be painful. Perform 3 sets of 10 seconds once or twice a day.

Read more on hamstring stretching exercises.

Core strengthening

Core stability is the name given to the strengthening of the corset of muscles surrounding the back and abdomen. Core exercises have become a staple of elite and amateur level athletes not just for injury prevention but to enhance performance as well.

The muscles of the core are known as the powerhouse muscles and provide a solid base upon which all other muscles can work upon to initiate movement. A comprehensive strengthening program of these core muscles can be used for injury prevention, rehabilitation, and sports performance enhancement.

Read more on core strengthening exercises.

References

  • Sward L. The thoracolumbar spine in young elite athletes. Current concepts on the effects of physical training. Sports Med 1992;13(5):357–64.
  • Urrutia J, Narvaez F, Besa P et al. Scheuermann’s disease in patients 15-40 years old: A study to determine its prevalence and its relationship with age and sex using chest radiographs as a screening tool. J Orthop Sci. 2019 Jan 23. pii: S0949-2658(19)30002-8
This article has been written with reference to the bibliography.