Scheuermanns Disease

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 or kyphosis in teenagers. There are two forms:

  1. Thoracic or mid back in about two thirds of cases.
  2. More seriously, it can also occur in the upper lumbar spine; the remaining one third, or roughly 2 per 100 children. This kind often leads to an unstable lumbar spine, especially if it's associated with a scoliosis.



True Scheuermann's disease, 5 percent of people remember, 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 increasing likelihood of debilitating back pain, especially when associated with injury, poor muscle tone and lack of exercise; the television is enemy number one of the body, and the mind too.

Notice how the vertebrae take on a wedged shape leading to a kyphosis, or increased midback curve, as seen from the side.

So, what are the signs?

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.

And the symptoms, what are they?


Here's an interesting 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 when it comes to back pain!

Look at your child; even the gardener with a keen eye would notice the developing kyphosis. But did mom and dad miss it?

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.


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.

Here's 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 does your child's back look like this?


Just poor posture?

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.


Teenager back pain

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: Scheuermanns disease 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.


Treatment

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.



If you watch sport, it's fun but blows your mind

When you play at it, it's recreation and builds your body

Only when you work at it does it become simply sublime.



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).



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.


Computers and cellphones make great servants, but who would want to serve under one? They make lousy masters.

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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

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. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
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.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.