The teenager with poor midback posture.
Keywords: Scheuermanns Disease, back pain, teenagers, chiropractic help
Really Scheuermann's, but to please the internet gods and the search engines, alas the poor apostrophe, occurs in about 5% of adolescents and, untreated, leads to rounded shoulders and poor posture, and a deep nagging ache, usually in the midback. It is the most common cause of an anterior curve (kyphosis) in teenagers. There are two forms:
True Scheuermann's disease (5%) involves four or more vertebrae. At least that was the old rule.
However, milder forms involving one to three vertebrae are relatively common, and also should be taken seriously.
Deformity of the spine in differing degrees is the norm, but they lead to an increasinly likelihood of debilitating back pain, especially when associated with injury, poor muscle tone and lack of exercise. The television... enemy number one of the body.
Notice how the vertebrae take on a wedged shape... leading to a kyphosis, or increased midback curve, as seen from the side.
As parents we should always think Scheuermann's disease if we are constantly telling our child to straighten up, only to see them slump back into poor posture, or if they are also complaining of back pain. Untreated this condition can sometimes be nasty, though mostly in its milder forms it is more irritation than serious disease.
It has been scientifically proved that carrying heavy bags on one shoulder adversely affects this condition, and may even cause it.
Typically we are looking at the stooped, round-shouldered teenager who is always complaining of back ache, usually between the shoulder blades, but also in the lower back.
Occasionally, Scheuermanns disease causes a severe scoliosis.
Most commonly parents bring their child to their chiropractor because they have been complaining of backache for some months, even years. Typically in the mid teens. The pain is usually a deep, dull ache rather than sharp or incapacitating. Often they will have been massaging the child's back on a regular basis for some months.
This deep upper back pain can also be a pinched nerve in the neck. Thus a careful and thorough examination is needed.
Question: Why is it that people will confidently themselves consult a chiropractor, but dare not to bring their children for treatment for such a condition as this until it is too late? An ounce of prevention ... in fact in some countries you still require a medical referral for your child to consult a chiropractor. If anything it should be the other way around!
Look at your child... could even the gardener with a keen eye notice the developing kyphosis? But Mom and Dad miss it?
The cause of Scheuermanns Disease is unknown. It could be related to diet, and it may be hereditary. Often in one generation, the condition is mild, perhaps affecting one or two vertebrae, and not really significant. Then, in a child in the next generation (or a sibling), for unknown reasons, perhaps diet, perhaps injury, possibly a bad desk, obesity, or lack of exercise, it is much worse. Not just poor posture, but also back pain.
Fragmentation of the cartilage and bony end plates of the vertebrae occurs resulting in 'wedge-shaped' vertebrae, and so the kyphosis (anterior curve) increases. It is known that the disc has no blood supply in the adult, and decreased nutrition of the bone and cartilage may be a cause. It has been proved that exercise helps, and lack of exercise may be one of the causes.
Spinal Cord pressure very rarely occurs in Scheuermanns disease,
but nerve irritation and increase in stomach complaints and ulcers has
been proved to be associated with this condition. Bombardment of the
spinal cord by impulses from nociceptors in the joints adversely affects
the autonomic nervous system, altering the secretion of digestive
juices and the blood supply.
A simple test
Look at your teenager from the side. Compare him or her with other members of the family. (It occurs equally in boys and girls). Is the curve in the midback obviously increased?
From the side...
Secondly, standing behind your child, ask them to bend forwards and touch their toes. Look over their back. Is one side of the ribcage obviously higher than the other? Note well: this is a scoliosis, which may, but certainly does not always accompany a case of Scheuermanns disease. They fairly frequently go together.
The increased curve I'm sure is obvious even to your inexperienced eye and, looking more closely at these X-rays, you can see the wedging of the vertebrae, and the fragmentation of the endplates of the bones. This is a mild case!
Type II: In the LUMBAR SPINE
Less commonly, fortunately, Scheuermanns disease occurs in the lumbar spine. Then, it's far more serious, particularly if it's associated with another anomaly. This man has such a variant in his back: he has six lumbar vertebrae instead of five. The result: a man of 40 odd, he has had debilitating back for fifteen years. Fortunately, after six Chiropractic treatments, he declares that the pain is about 30% less. Miracle? No, it's hard work for his chiropractor (me), and hard work for him (lots of rehab exercises). Either that or suffer, I know of no other alternative.
Exercise has been proved to help with the treatment of Scheuermanns disease, but contact sport like rugby and karate are forbidden. The vertebral endplates are fragile leading to fragmentation of the bone and cartilage. Obviously trauma in the growing child must be avoided.
For the Type II Scheurermann's disease, involving the upper lumbar spine, a lifetime of back exercises is absolutely vital. Only five minutes a day will give your child the best payback of any five minutes s/he spends. Your chiropractor will advise you.
Notice how the end plate defects have produced a nasty scoliosis in the neck of the patient above. Little wonder he was complaining this morning of neck pain, rather than Scheuermanns disease back pain.
Standing behind your sitting child, is one shoulder obviously much higher than the other?
One helper is ...
A sloping desk which encourages your child to sit upright, both at school and at home is essential. Long periods in a slumped postion places more pressure on the already complaining joints.
Ways to improve posture are important for everyone, if you looking for natural solutions for muscle pain, but absolutely vital for those suffering from Scheuermanns disease.
Gentle chiropractic adjustments of the spine are beneficial, increasing the movement and nutrition of the joints, but heavy manipulations should be avoided.
Specific exercises to strengthen the muscles between the shoulder blades are advised. For example, hook a bicycle tube over a strong post, holding it in both hands with the elbows at the sides. Now step backwards until the tube is tight. Force the shoulder blades together, and simultaneously pull the shoulders backwards (retraction). Repeat in three reps of ten (3x10).
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Using a soft roll, over which the back is gently extended is recommended. It helps reduce the kyphosis and mobilises the joints of the spine, bringing in fresh nutrients to the cartilage end plates.
Not just at the gym, but at home on a daily basis.
Swimming, particularly breaststroke and backstroke, is excellent.
Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.
Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
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You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
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