Scheuermann’s Disease: Symptoms and Exercises

Scheuermann’s disease

Scheuermann’s disease is a juvenile vertebral osteochondrosis that affects the cartilaginous endplates of the dorsal (and sometimes lumbar) vertebrae during the growth phase, causing a structural dorsal kyphosis (round back) greater than normal. It is the most common cause of rigid kyphosis in adolescents, with a prevalence of 1-8% in the youth population. Unlike postural kyphosis (which corrects actively), Scheuermann’s kyphosis is structural: the vertebrae assume an anterior wedge shape that does not fully correct with voluntary extension.

Table of Contents

• Pathophysiology
• Classification
• Symptoms
• Diagnosis
• Conservative Treatment
• Surgical Treatment
• Prognosis
• Frequently Asked Questions (FAQ)
• Frequently Asked Questions
• Sources and Scientific References

Pathophysiology

Pathophysiology refers to the abnormal changes in spinal vertebrae where growth disturbances cause wedge-shaped deformities, resulting in progressive thoracic kyphosis. During growth, the vertebral cartilaginous endplates (epiphyseal plates) undergo an alteration of normal endochondral ossification. The exact mechanism is not completely clear, but hypotheses include:

• Mechanical overload on the growing epiphyseal plates
• Genetic predisposition (familial history present in 30-70% of cases)
• Avascular necrosis of the epiphyseal plates
• Alteration of collagen metabolism

The result is asymmetrical growth of the vertebrae: the anterior part of the vertebral body grows less than the posterior part, giving the vertebra a wedge shape (wedging). When at least 3 consecutive vertebrae show wedging ≥ 5° each, a diagnosis of Scheuermann’s is made.

Classification

Dorsal form (classic)

• Location: T7-T10 (mid-dorsal vertebrae)
• Accentuated dorsal kyphosis (> 45°, often 50-75°)
• The most common form

Lumbar form (atypical)

• Location: T10-L2 (thoracolumbar junction)
• Less obvious kyphosis, but more pain
• Associated with intense sports activities in adolescence

Symptoms

In adolescence

• Accentuated dorsal kyphosis (“hump”): aesthetic concern is often the reason for the first visit
• Dorsal pain: present in 20-50% of cases, localized at the apex of the kyphosis
• Pain that worsens with prolonged standing, sitting, and sports activity
• Stiffness of the dorsal spine: inability to straighten completely
• Compensatory posture: cervical and lumbar hyperlordosis to compensate for kyphosis
• Hamstring tightness: marked retraction, often the first clinical sign

In adulthood

• Chronic dorsal pain (especially in the lumbar form)
• Spinal stiffness
• Persistent kyphotic appearance
• Possible degenerative acceleration with development of osteoarthritis
• Rarely: spinal cord compression in severe kyphosis (> 80°)

Diagnosis

Clinical examination

• Adams test (forward trunk flexion): Scheuermann’s kyphosis does not correct, unlike postural kyphosis
• Kyphosis measurement: with inclinometer or plumb line
• Flexibility assessment: hamstring retraction (very frequent), pectorals, and psoas
• Neurological examination: generally normal (to rule out spinal cord compression in severe kyphosis)

Full spine X-ray (weight-bearing)

Radiographic diagnostic criteria (Sorensen’s criteria):

• Wedging ≥ 5° of at least 3 consecutive vertebrae
• Irregularity of the vertebral endplates (Schmorl’s nodes)
• Narrowing of disc spaces
• Dorsal kyphosis > 45° (measured by Cobb’s method)

Magnetic resonance imaging

• Not routinely necessary
• Indicated in cases of neurological symptoms, atypical pain, or surgical planning
• Shows Schmorl’s hernias, disc status, and spinal cord

Conservative Treatment

Conservative treatment is indicated for the vast majority of patients and includes physiotherapy, orthopedic bracing (in growing adolescents), and monitoring.

Orthopedic brace (in growing adolescents)

• Indication: kyphosis > 55-60° in a patient with significant residual growth (Risser 0-3)
• Type: anti-kyphosis brace such as Milwaukee or Gschwend
• Duration: 18-23 hours a day until skeletal maturity
• Effectiveness: can reduce kyphosis by 10-15° if worn consistently
• Not indicated after growth plate closure

Physiotherapy and exercises

Phase 1 — Pain reduction and flexibility improvement (weeks 1-6):

Stretching (fundamental):

• Pectoral stretch: in a wall corner, arms at 90° and 120°. 30 seconds, 3 repetitions
• Hamstring stretch: seated, legs straight, bend forward. 30 seconds, 3 repetitions
• Psoas stretch: kneeling lunge position. 30 seconds per side
• Thoracic self-extension on foam roller: lying with the foam roller transversely under the shoulder blades, arms overhead. 2 minutes

Thoracic mobilization:

• Thoracic rotations in quadruped position: 10 per side
• Cat-cow: 15 slow repetitions
• Seated thoracic extension with a stick: 10 repetitions
• Mobilization with foam roller (segmental extension): 2 minutes

Phase 2 — Muscle strengthening (weeks 4-12):

Spinal extensors:

• Prone superman (arms and legs raised): 10 repetitions, hold 5 seconds
• Bird-dog: 10 per side, hold 5 seconds
• Banded rowing (scapular retraction): 3&215;15

Scapular stabilizers:

• Prone Y-T-W: 2&215;10 per position
• Banded face pull: 3&215;15
• Push-up plus for serratus anterior: 3&215;12

Core:

• Front and side plank: 3&215;30-60 seconds
• Dead bug: 3&215;10 per side

Postural re-education:

• Wall postural exercises: heels, glutes, shoulder blades, and occiput against the wall. 3&215;30 seconds
• Chin tuck (cervical retraction): 3&215;10 repetitions

Phase 3 — Maintenance (long-term):

• Exercise program 3-4 times a week
• Recommended sports: swimming (backstroke), Pilates, yoga
• Avoid sports with significant axial loads during growth if kyphosis is severe
• Maintain daily hamstring and pectoral stretching

Surgical Treatment

Indicated in selected cases:

• Kyphosis > 75-80° with progression despite bracing
• Intractable pain
• Neurological deficits
• Aesthetically unacceptable deformity for the patient

Technique: posterior vertebral fusion with instrumentation (pedicle screws and rods). The aesthetic and functional result is generally good, with significant correction of kyphosis.

Prognosis

• Most patients with Scheuermann’s have a good functional prognosis
• Kyphosis stabilizes at the end of growth
• Pain tends to improve in adulthood, especially in the dorsal form
• The lumbar form is more often associated with chronic pain in adulthood
• Long-term quality of life is generally good with conservative treatment

Frequently Asked Questions (FAQ)

Frequently Asked Questions

Does Scheuermann’s disease heal completely?

Scheuermann’s disease involves structural changes to the vertebrae during adolescence, leading to a fixed kyphosis. While the progression typically ceases once skeletal maturity is reached, the structural changes that have occurred are generally permanent. Management focuses on preventing further progression and alleviating associated symptoms.

Can individuals with Scheuermann’s disease participate in sports?

Participation in sports for individuals with Scheuermann’s disease is often possible and can be beneficial, especially activities that promote spinal extension and core strength. Specific recommendations should be tailored by a healthcare professional, considering the severity of the kyphosis and any associated pain. High-impact or contact sports may require careful evaluation.

What is the role of an orthopedic brace in managing Scheuermann’s disease?

Orthopedic bracing is a conservative treatment option primarily used in growing adolescents to help prevent the progression of kyphosis. The brace applies corrective forces to the spine, aiming to reduce the wedging of vertebrae and improve spinal alignment. Its effectiveness is generally higher when initiated early and worn consistently as prescribed.

How does Scheuermann’s disease differ from postural kyphosis?

Scheuermann’s disease is characterized by a rigid, structural kyphosis resulting from vertebral wedging, which does not correct with voluntary straightening. In contrast, postural kyphosis is a flexible curvature that can be actively corrected by the individual. The structural nature of Scheuermann’s disease is confirmed through X-rays showing specific vertebral changes.

Sources and Scientific References

1. Kaur S et al. (2023). Scheuermann’s Disease. Semin Musculoskelet Radiol. 27:522-528. DOI | PubMed
2. Lowe TG (1990). Scheuermann disease. J Bone Joint Surg Am. 72:940-5. PubMed
3. Diaremes P et al. (2022). [Scheuermann’s disease]. Orthopade. 51:339-348. DOI | PubMed
4. Sardar ZM et al. (2019). Scheuermann’s Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg. 27:e462-e472. DOI | PubMed
5. Bezalel T et al. (2014). Scheuermann’s disease: current diagnosis and treatment approach. J Back Musculoskelet Rehabil. 27:383-90. DOI | PubMed