SCHEUERMANNS DISEASE

The teenager with poor midback posture.

Scheuermanns Disease (really Scheuermann's, but to please the internet gods, the search engines ...) 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:

Thoracic or mid-back. About two thirds of cases.
More seriously, the upper lumbar spine, the remaining one third (2/100 children). This kind may lead to an unstable lumbar spine.

True Scheuermann's disease (5%) involves four or more vertebrae. 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.

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. 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.

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SYMPTOMS

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.

Question: Why is it so often our experience that people will themselves consult a chiropractor, but dare not to bring their children for treatment for such a condition 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!

CAUSE

The cause 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.

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 to the bowels.

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?

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 Scheuermann's. They fairly frequently go together.

X-rays

The increased curve I'm sure is obvious even to your inexperienced eye and, looking more closely, you can see the wedging of the vertebrae, and the fragmentation of the endplates of the bones. This is a mild case!

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.

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. 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.

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 roll, over which the back is gently extended is recommended.

Swimming, particularly breaststroke and backstroke, is excellent.

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