Scheuermann’s disease is a relatively common, non-serious spinal developmental disorder. It is also known as juvenile osteochondrosis and Calvé disease. Scheuermann’s disease causes the abnormal growth of usually the upper back vertebrae resulting in a rounded posture or what is known as a hyperkyphotic posture. Our chiropractors see patients with Scheuermann’s disease.
In Scheuermann’s disease, the posterior portion of the vertebral body grows at a normal rate. The anterior portion grows slowly. This imbalance in growth rates leads wedge shaped vertebra. A series of these vertebra will result in the hyperkyphosis or hunch seen in patients with Scheuermann’s.
Along vertebral wedging the end plates of the bone can become sclerotic and irregular. The bone can be weakened and sudden or sustained forces on the spine can result in the discs protruding into the vertebral bodies. When this happens, it is called a Schmorls node. These may or may not cause pain, but sometimes acute pain can result. Once they develop, Schmorl’s nodes are present for life but generally do not cause further problems or irritation. It is not uncommon to see them on Xray when investigating another area without someone ever having had pain in the area.
Causes and Symptoms – What to look out for
Scheuermann’s disease generally effects both males and females equally with individuals that have a family history. There are several other proposed causes but none with enough evidence to have a causative link.
The hallmarks of Scheuremann’s disease are, hyperkyphosis of the mid back, tension and restriction in movement of the mid back and on and off acute and chronic aching type pains. An Inability to extend backwards is another major sign.
Pain can generally be linked back to a certain activity, including sports that require a lot of twisting, or forceful bending or arching backwards such as cricket, gymnastics and football or field events like high jump or pole vault.
Xrays –Scheuermann’s is often discovered by accident
X-Ray’s are usually the gold standard for observing the wedged vertebra. Occasionally an MRI is ordered to look at the complaint in more detail.
How do we treat Scheuermann’s disease – Can a chiro or physio help?
- Treating Scheuermann’s requires a holistic care plan from your chiro or physio. We generally start at pain relief and protection of the area, so it does not worsen. Spinal exercises and hands on care will reduce the loading on the area.
- Different techniques are effective for this. These include ice, TENS, dry needling, soft tissue, gentle manual adjustments and exercises. Avoiding irritation of the area is key, gentle exercise is ok to do if you are being monitored by your health care professional.
- Once pain and inflammation settle focus is on restoring mobility and function. We need to get as much movement into the area as possible. Making sure there is balance in the muscle groups surrounding the area with a focus on regaining correct biomechanics is also the focus.
- Generalised conditioning long term is extremely important. Most people with Scheuermann’s can return to full work and sport after the acute flare up has settled. Maintaining your health and fitness as well as maintenance and preventative care with your chiro and physio will help reduce the chance of further flare ups.
What are the long-term effects of Scheuermann’s – Prognosis and extreme cases
The pain from active Scheuermann’s Disease with the right care is relatively easy to treat, although can take some time to see changes. Remember this disease generally does not result in long term issues, if treated effectively by a chiro or physio.
Very rarely the amount of wedging of the vertebra is so significant that surgery to restore a better position for the thoracic spine is required. Surgery is only a last resort if quality of life has reduced significantly.
Generally, surgery involves spinal fusion which is not recommended as a rule of thumb. Your chiropractor or physiotherapist is trained to assess, treat and monitor you effectively and will only discuss this if conservative care is providing relief. Remember that with all musculoskeletal complaints a holistic approach to care which encourages long term exercise and fitness is crucial.
For more information or if you need help managing your spine give us a call today at Perth Allied Health Clinic. Our team is here to help.