Scheuermann's disease - juvenile kyphosis

CLScheurmannovaNemocDo you have an adolescent in your environment or family who is significantly stooping his/her back? In most cases “slouching” is in reality a wrong body posture. During regular check up doctors should remember the possibility that it could be Scheuermann’s disease, which is not just a case of wrong body posture, but it is a structural defect to work on.

Scheuermann’s disease appears usually between 12th and 17th year of life, and boys are usually affected 5x more likely than girls. Occurrence of this illness is quite high - around 20%.

Scheuermann’s disease is a structural defect of the spine, which usually occurs in the age of adolescence growth. The cause is not very clear, usually it is caused by growth disorder of the vertebrae in the age when the growth begins to end. There is a gradual deformation of the vertebral bones, lowering of the intervertebral discs and by nearly one half of the cases appear Schmorl’s nodes. Simply said, there is a gradual backwards curvature of the thoracic spine (kyphosis) in the moment when the mechanical requirements and pressure “outrun” its maturation. And the spine reacts to it with curvature-kyphosis.

The most serious consequences for statics and dynamics of the spine is the so called “low-form” of the disease, that is when the peak of the kyphotic curve is on the transition between the thoracic and lumbar spine, and consequently appears compensation in form of hyperlordosis (excessive bending in the area of the lumbar spine) predispositioning the individual to herniated intervertebral discs in the transition area between the lumbar and thoracic spine.

You can see the difference between correct and normal curvature of the spine (picture 1) and excessive backwards curvature of the thoracic spine - hyperkyphosis (picture 2).

HOW TO DISTINGUISH SCHEUERMANN’S DISEASE FROM NORMAL INCORRECT BODY POSTURE?

CLKyfozyDuring the examination we notice the advanced thoracic kyphosis (formation of a hump) which is continuous. Pain is rather unique, it arrives later with a much faster entry of natural degenerative changes. Patient has shortened chest muscles, which creates an image of shoulders protruding forward, towards the chest.

Distinguishing incorrect body posture is done by placing the patient down on the stomach on a hard math. Incorrect body posture can be easily straightened, but kyphosis of the thoracic spine remains by individuals suffering from Scheuermann’s diseases.

After evaluating the condition, X-ray images are taken, they are usually taken in standing position, from a profile position. We consider the curvature deformity above 5°, that is when we consider the deformity of 3 and more vertebrae positive, as well as kyphosis with 40°. Then we observe the irregularity of the covering surfaces and formation of Schmorl’s nodes. The intervertebral discs are usually narrowed.

This disease is at first manifesting with incorrect body posture. Gradually it gets worse and the peak of the curvature is not in the center of the thoracic spine, but beneath the shoulder blades. At this point, the affected individual does not feel any problems, but it appears later that there is bigger or smaller movement restrictions. At this point it is important to visit orthopedist or physiotherapist and find out whether it is deformity - Scheuermann’s disease of just incorrect body posture. In a more advanced stage of the illness, a small hump forms in the lower third of the spine, which is a clear symptom of this disease.

THERAPY

When we treat the problem in a critical stage - in time of the biggest advance/worsening of the curve - we need to radically lower the pressure on the spine, which also applies for performance athletes. In case the worst stage doesn’t set in, we don’t need to limit the pressure on the spine. For correct examination of further worsening it is possible to evaluate the bone growth and estimate the height of the person. If there is less than 5% of growth remaining, we don’t have to fear further development of the curve.

With active training we try to affect the current muscle imbalance and reach muscle balance. The key principle in therapy is that the client trains segmental mobility in the thoracic spine. For therapy we use apart from manual techniques especially techniques with neurophysiological basis, and the client should be able to exercise them regularly at home.

By more serious forms which can not be taken under control just by exercises, a corset is recommended to be worn.

Video tutorial about how to exercises the chest muscles

Stretching the chest 



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience in private practice and physiotherapeutic field, FYZIOklinika

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