What is Scheuermann's Disease? What are the signs to look for?

Scheuermann’s Disease is a developmental disorder of the spine. It is also known as Calvé disease and juvenile osteochondrosis of the spine.

Scheuermann's disease causes the abnormal growth of usually the thoracic (upper back) vertebrae, but it can aslo be found in the lumbar vertebrae.

In Scheuermann's disease, one side (the back) of the vertebral body grows normally and the front grows more slowly or abnormally. This leads to a vertebra with a distinct wedge shape. This in turn leads to an increase in the bend in your upper back called an increased dorsal kyphosis.

Along with this wedging of the vertebra there is also a change to the interface between the disc and the vertebra called endplate irregularities. Some of the disc then pushes into the vertebra and these are called Schmorl's nodes and are typically seen on an X-Ray.

These Schmorl's nodes are present for life but are do not appear to cause any problems in the future. People may have an X-Ray when they are older for an unrelated condition and find that they have Schmorl's nodes but have never experienced back pain.

What Causes Scheuermann's Disease?

Scheuermann's disease has a familial tendency and no clear gender predilection. It’s cause is unknown, but appears to be multifactorial.

Factors include: juvenile osteoporosis, malabsorption, infection, endocrine disorders and biomechanical factors including a shortened sternum.

What are the Symptoms of Scheuermann's Disease?

Scheuermann's disease usually causes pain in and around the thoracic spine. It can also lead to an increased thoracic or mid/upper back kyphosis (bend). This can then lead to some restriction in range of movement especially into extension (bending backwards).

The pain can be made worse by activity including sports that require a lot of twisting, or forceful bending or arching backward such as gymnastics, cricket or athletic field events.

How is Scheuermann's Disease Diagnosed?

A simple plain X-Ray is usually sufficient to diagnose Scheuermann’s Disease with it showing the classic wedging of the thoracic vertebrae and sometimes the Schmorl's Nodes.

MRI will show additional detail.

What is Scheuermann's Disease Treatment?

PHASE I - Pain Relief & Protection

Managing your pain is the main reason that you seek treatment. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.

Scheuermann's Disease inflammation it best eased via ice therapy and techniques or exercises that deload the inflamed structures.

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage.

Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen or pain relievers such as paracetamol.

You will need to avoid heavy loading of your thoracic spine and strong bending exercises such as crunches or sit ups.

PHASE II - Restoring Normal ROM, Strength

As your pain and inflammation settles, your physiotherapist will turn their attention to restoring as much range of movement as you can. It is important to regain as much extension as you can.

It is also important to restore or improve the muscles that control the movement and posture in your back. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

Please ask your physio for their advice.

PHASE III - Restoring Full Function

There is no reason why people can not return to full activity including all sports but they may need guidance on returning to activity that involves twisting or strong bending. You will also need to be progressed through exercises to regain sport or activity specific strength as the period of rest can lead to a lot of deconditioning.

PHASE IV - Preventing Future Dysfunction

There are some things that you can do to reduce your chances of having any problems in the future. Maintaining good flexibility in your back and keeping the core muscles strong so that you maintain better posture and good control over the vertebra will all help to limit any future problems.

What is Your Prognosis?

The pain from active Scheuermann’s Disease will eventually pass and for the majority of people they will have no further trouble from their thoracic vertebrae. Some people will have reduced range of movement and if the disease caused significant kyphosis (bend) then they can get ongoing postural issues.

For more information please contact your physiotherapist.

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Other Treatment Options for Scheuermann’s Disease

Sometimes a posture brace is used to help keep the back in as much extension as possible. This works to remind you where your back should be and encourage the correct muscles to work.

Surgery for Scheuermann’s Disease

Rarely the amount of wedging of the vertebra is so great that surgery to restore a better position for the thoracic spine is required. This only occurs it the disease process is significant. Your Physiotherapist will be able to monitor the amount of flexion that you have and if it appears to be increasing to greatly an orthopaedic surgeon may need to make an assessment.

If you have any questions please seek the advice of your physiotherapist.

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Common Scheuermann’s Disease Treatments