Scheuermann’s Disease: Causes, Signs & Treatment Options

Written by Leon Mao
Physiotherapist, University of Melbourne
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Jamie Page
Physiotherapist, Salford University

Man sitting on edge of bed holding lower back in pain

According to the National Centre for Biotechnology Information, approximately 1-8% of people live with this condition globally.[1] This extrapolates to anywhere between 257,000 to 2 million Australians, however most people will only have mild causes without any symptoms. Adolescents between the ages of 12-17 are the most commonly diagnosed age group.[1]

The hunchback deformity from Scheuermann’s disease can vary from person-to-person. Some will have no noticeable spinal abnormalities, while others will have a significant back hump. People with this condition have oddly shaped vertebrae (segments of the spine) which cause the excessive curvature of the spine.

Read on to understand what you should know about Scheuermann's disease; the risk factors, treatment options and expected recovery time.

What is Scheuermann’s disease?

Scheuermann's disease, also known as Scheuermann's kyphosis, is a condition that results in an increased rounding posture of the spine. Kyphosis refers to a curving of the spine that leads to a 'hunchback' or slouching posture, which commonly results in back pain.[2]

The spine has a natural “S” shaped curvature from your neck (cervical spine) down to your tailbone (coccyx). However, in Scheuermann’s disease, the development of the thoracic spine becomes uneven and more pronounced, resulting in a hunchback posture.

What are the symptoms of Scheuermann’s disease?

The primary symptom of Scheuermann's Disease is a noticeable hump in the upper back. This hump is usually associated with pain in the upper back, muscle cramps and general stiffness. This is particularly worse with activities that require a lot of twisting.

Common symptoms of Scheuermann’s disease

  • Hunched back posture

  • Rounding of shoulders

  • Back pain

  • Stiffness of the upper back and neck muscles

  • Muscle cramps

  • Reduced flexibility

  • Tightness of hamstrings

  • Swayback posture.

The lower back (lumbar spine) may also be affected as your spine will try to modify your posture to support the weight of your body. Swayback posturing is the most common secondary postural issue seen in Scheuermann’s disease.

What causes Scheuermann’s disease?

The exact cause of Scheuermann's disease is still unknown; however, researchers believe there is an abnormality in the early stage development of the spine. The vertebrae become wedge-shaped, leading to a curve in the spine known as kyphosis.

Common causes of Scheuermann’s disease

  • Infection

  • Juvenile Osteoporosis

  • Malabsorption or disorders in absorbing nutrients in the diet

  • Endocrine system problems

  • Genetics

Risk factors for Scheuermann’s disease

  • Diseases of the spine or spinal cord

  • Infections such as tuberculosis

  • Poor posture

  • Trauma

Sports that increase the risk of Scheuermann’s disease

Athletes who spend a lot of time playing sports at a young age are prone to postural problems such as thoracic kyphosis.

Sports that use high frontal muscles combined with an immature growing spine may cause imbalance and promote thoracic kyphosis. This may increase the risk of progression of Scheuermann’s disease.

  • Gymnastics

  • Football

  • Hockey

  • Swimming

  • Wrestling

How is Scheuermann’s disease diagnosed?

Scheuermann’s disease can cause back pain and noticeable deformity. Severe postural problems can also result in complications that can affect your breathing. Scheuermann’s disease usually becomes more pronounced and obvious during puberty and is when diagnosis usually occurs.[3]

There are several options available when it comes to diagnosing your back pain as Scheuermann’s disease. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are medical experts when it comes to spinal rehabilitation. They can diagnose spinal problems and effectively treat postural issues that cause pain and discomfort.

An assessment from a physiotherapist is comprehensive and straightforward. Similar to visiting a GP, your physiotherapist will ask vital questions regarding your health and lifestyle. It would be best if you use this time to discuss relevant issues about your back.

After establishing the background of your condition, your physiotherapist will then perform a detailed spinal assessment to determine factors that contribute to the progression of your disease and rule out other injuries.

Your physiotherapist will then create a diagnosis and treatment plan based on your assessment. This whole process will take about 30 to 60 minutes.

You will also be given the details of your program. This will include:

  • Number of treatment sessions

  • List of exercises you need to do at home

  • Strategies to manage the pain and prevent complications

  • Timeline for your total recovery.

How is Scheuermann’s disease treated?

Although Scheuermann's disease is a permanent spinal deformity, patients must still focus on rehabilitation of their spine to prevent progression of the spinal curve and improve their overall function.

There are several options when it comes to treating Scheuermann’s disease. One of the more common and the treatment option referred to by Australian GPs the most is physiotherapy.

Scheuermann’s disease and other spinal conditions are injuries that physiotherapists come across regularly, and the process of creating an effective management plan is straightforward.

Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

Treatment of Scheuermann’s disease will focus on improving your posture and reducing your pain.

Depending on the severity of your Scheuermann’s disease, a physiotherapist may provide you with a combination of the following types of treatments:

  • Flexibility exercises - Includes exercises that will focus on relieving contractures of your hamstring muscles and tightness of chest muscles to improve your posture. It can involve stretching and dynamic exercises.

  • Joint mobilisation - Techniques that your physiotherapist uses on your spinal joints to improve mobility.

  • Therapeutic exercises - Exercises and techniques used to correct impairment and improve overall function.

  • Core stability exercises - Involves strengthening exercises of the spinal muscles to improve stability of the spine.

  • Manual therapy - Hands-on physiotherapy techniques to improve overall joint mobility and allow a greater range of motion.

Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel the difference in just a single session.

Next step - Creating a treatment plan made for you

Following your initial assessment, your physiotherapist will create a detailed treatment plan that will guide you step-by-step to improve your posture and decrease your pain.

Self-care for Scheuermann’s disease

If you have Scheuermann’s disease, here are the best things you can do and avoid

Things to do:

  • Rest

If you are prone to working in front of a computer, take sufficient breaks to stretch your chest muscles.

  • Be mindful of your posture

Always keep in mind that a slouched posture will exaggerate your deformity and lead to pain and other issues.

Keep your shoulder relaxed, down and backed while keeping your ears aligned with your shoulders to promote back straightening (extension).

  • Gentle stretching

Stretch your muscles regularly. In the case of Scheuermann’s disease, you need to stretch your chest and hamstring muscles periodically to prevent tightness and other postural problems.

Things to avoid:

  • Certain sports

Some sports that are associated with jumping and increased stress on the back should be avoided.

Do I need a specialist or surgery?

Younger patients may be required to wear a brace to prevent the progression of the kyphotic curve while growing.

Surgery through spinal fusion can be done for severe cases of Scheuermann’s disease, such as:

  • Kyphosis greater than 75 degrees

  • Severe pain

  • Spinal cord compression

  • Breathing difficulty.

Diagnostic imaging may be done, such as X-Ray severity of thoracic kyphosis. At the same time, MRI and CT scans may also be ordered to prepare for surgery.

Your GP will coordinate with your physiotherapist to aid you in your recovery process.

What is the recovery time / prognosis for elbow pain?

Although Scheuermann’s disease tends not to progress after spinal maturity, postural issues that can complicate your condition should still be addressed.

Patients who undergo spinal fusion surgery for Scheuermann’s disease typically need rehabilitation for at least 8 to 12 weeks. Full recovery can take up to 8 months.

Physiotherapy improves the overall outcome for patients with Scheuermann’s disease treated with or without surgery.

Can Scheuermann’s disease be prevented?

Guaranteeing prevention can be impossible; however, you can improve the outcome by being proactive upon diagnosis.

  • Active exercise: Exercising your spinal stabilisers and back muscles can improve your posture and prevent hyperkyphosis.

  • Practice good posture: Your posture plays a huge role in the mechanics of your spine. Slouching makes your thoracic spine assume a kyphotic posture or hunched back.

  • Bracing: Children with Scheuermann’s disease can benefit from having an external brace to prevent curve progression.

  • Stretching: Stretch your hamstrings and chest muscles frequently to avoid tightness and other postural problems.

Outlook and the main takeaways

Although Scheuermann’s disease is a structural problem and a permanent condition, it is still vital to address underlying issues to improve your quality of life and prevent complications.

Through rehabilitation, people who have Scheuermann’s disease can stay active, healthy and participate in activities they love. Book a time to have your spine assessed by a physiotherapist today.

Anatomy of the spine

Your spine consists of bones that are stacked on top of each other called vertebrae.

The spine has a natural S shape curvature. The cervical and the lumbar segments have concave patterns (lordosis), and the thoracic and sacral segments have convex patterns (kyphosis).

Scheuermann’s disease affects the thoracic segments of the spine. It is a structural deformity that results in increased kyphotic curvature of the thoracic segments.

And since the spinal segments are linked together, this hyperkyphosis of the thoracic spinal segment can be compensated by a lumbar or cervical hyperlordosis.

These postural issues can lead to pain and neurological complications.

Written by Leon Mao
Physiotherapist, University of Melbourne
Published on March 17, 2022
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Jamie Page
Physiotherapist, Salford University
Sources
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Last medically reviewed on March 17, 2022
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