Scheuermann's disease (Scheuermann's disease)
What is Scheuermann's disease?
The Scheuermann disease was discovered by the Danish radiologist Holger Scheuermann and named after him. It affects more male than female adolescents. It is estimated that about 10-20% of the population is affected by this growth disorder of the vertebral bodies in more or less pronounced form.
It comes to malformations of the base and cover plates of adjacent vertebral bodies, mainly in the thoracic region, which lead to a wedge-shaped formation of the vertebral bodies. As a result, lying between the vertebral bodies intervertebral discs are narrowed, resulting in later years of life to various ailments.
If the thoracic vertebrae are affected by the growth disorder, the typical round back with hollow back and spinal curvature forms. If, on the other hand, the vertebral bodies of the lumbar spine are affected, the result is the formation of a flat back. Scheuermann's disease is also referred to as osteochondritis deformans juvenilis dorsi.
The actual causes for the development of this growth disorder are still unknown. However, one suspects both a genetic predisposition and external influences that promote growth disorders. In addition to the genetic predisposition also metabolic disorders and hormonal influences in the age of puberty seem to play a role.
Various external factors, such as incorrect posture when sitting for hours at the desk in a stooped posture or even a weak musculature due to a lack of exercise, are also considered to be conducive to Scheuermann's disease. The stooped posture creates increased pressure on the leading edges of the thoracic spine. Since the growth zone of the vertebral bodies is in the edge regions, the growth of the vertebral bodies is impaired and slowed by the increased pressure on the leading edge.
As a result, the vertebral bodies grow stronger at the trailing edge than at the leading edge, as a result of which wedge-shaped vertebral bodies develop. This in turn leads to a reduction of the distance between the vertebral bodies to one another, to a flattening of the intervertebral discs and to a greater risk of breakage of the base and cover plate of the vertebral bodies. Another cause of Scheuermann's disease is a mechanical overuse of the spine, for example in competitive athletes.
Symptoms, complaints & signs
Scheuermann's disease is often seen externally by the trained eye in terms of a clear rounding of the thoracic spine and a possibly compensating hollow back in the area of the lumbar spine. The symptoms and symptoms associated with Scheuermann's disease are directly derivable from the external appearance.
The strong curvature forward in the chest has back pain and neck tension especially in the advanced state. Headaches are also possible. More muscle tensions are caused by the spine significantly losing mobility in the affected area. In the thoracic spine this can also lead to pain in the shoulders and arms.
The internal organs also often respond to the non-physiologically constricted conditions. Thus, the lungs can not develop freely to deep inhalation in a strong expression of Scheuermann's disease. Cardiac arrhythmias and stomach problems are also among the late symptoms of Scheuermann's disease.
The lumbar spine often responds to the curvature of the thoracic spine by creating a pronounced hollow back and hypermobility. This too can lead to problems. The typical symptom is low back pain, especially when the abdominal muscles are in a weak state of training.
Other complications include leg pain of a markedly radiating character that may result from a proliferation of disc material into the spinal canal, due to increased voiding.
Diagnosis & HistoryBack pain in Scheuermann's disease.
The diagnosis of Scheuermann's disease is made by X-ray diagnostics. The x-ray shows the typical curvature of the spine and the wedge-shaped deformed vertebral bodies.
At the beginning of the disease, hardly any complaints. In the further course it comes to forward pulled shoulders and a round back. Due to the rounded back, there is an increased stress on the lumbar spine and the formation of a hollow cross. In order to reduce the pain, the sufferer is often taken an already-malpractice, which leads to wear and tear on the vertebral bodies and impairment of the muscles, tendons and ligaments.
In most cases of Scheuermann's disease, however, it does not fully develop the clinical picture, as with the end of the growth phase, the malignant growth is completed.
First and foremost, Scheuermann's disease leads to a curvature of the spine in the patient. This is usually associated with relatively severe pain, so sufferers affected by movement restrictions. The pain can also occur at night and lead to sleep problems or other unpleasant feelings and depression. Not infrequently, the pain from the back spread to other regions of the body.
The back pain itself significantly limits the patient's everyday life and leads to a significantly reduced load capacity of the patient. Furthermore, the growth of children by the Scheuermann's disease is markedly reduced and delayed. This can also lead to secondary damage in adulthood, which is irreversible in most cases.
The treatment of Scheuermann's disease takes place with the help of various therapies. Thus, the pain can be relatively well limited and treated. Special complications do not occur. As a rule, surgery is only performed if it is a serious case. The life expectancy of the affected person is usually not reduced by the Scheuermann disease.
When should you go to the doctor?
Special features of the skeletal system should always be examined by a doctor. If abnormalities occur in the growth process in children or adolescents, a doctor's visit should be made as soon as possible. In the case of an optical change of the spine, there is a special duty of care. If a malposition of the body can be perceived, a visit to the doctor is necessary.
Back pain or discomfort of the neck should be presented to a doctor. The use of pain medications is only recommended in consultation with a doctor, because the risk of side effects or complications is very high. Headaches, musculoskeletal discomfort, heart rhythm disorders, and respiratory problems are to be examined and treated.
If it is not possible for the person concerned to breathe deeply, there is cause for concern. A strong hollow cross formation, restrictions of the movement possibilities or a decrease of the usual physical capacity should be discussed with a doctor. If the day-to-day school or work commitments can not be fulfilled or participation in sports activities is restricted, a doctor is needed. If emotional or emotional problems occur due to the visual blemish as well as the reduced mobility, a doctor should be consulted. In case of depressive moods, an aggressive appearance or withdrawal from social life, it is advisable to consult a doctor.
Treatment & Therapy
In mild cases of Scheuermann's disease targeted physiotherapy is sufficient. In the physiotherapeutic exercises a healthy posture is trained and the back muscles strengthened. Important is a regular exercise that counteracts the curvature of the spine.
Special back exercises, swimming and hiking serve to strengthen the muscles and a healthy posture. It is also helpful to wear a corset during the growth phase, which forces the upper body to maintain a healthy posture and promotes healthy growth of the vertebral bodies.
Only in particularly severe cases, when it has already come to a pronounced malpractice and associated strong back pain, surgery may be required. The defective discs are removed and replaced by previously removed from the ribs or the iliac crest bone pieces. However, only about half of all cases of this method of operation are successful and involve certain risks.
Outlook & Forecast
In general, the prognosis for Scheuermann's disease is favorable if therapy is started early. The deformation of the spine usually develops during puberty and, if left untreated, can lead to more or less severe deformations of the spine (humpback, scoliosis, hyperkyphosis).
Therefore, a timely diagnosis and a regular follow-up is important, in which the so-called "Cobb angle" (measure of the vertebral curvature) is determined. From this, the measures that slow down the progression of the spinal deformity or, ideally, even prevent it, can be derived.
The targeted training of the back muscles by appropriate physiotherapy has a favorable effect on the prognosis. Also sports that strengthen the back muscles (such as swimming), can have a positive effect on the symptoms and development of the spine. Very good results are achieved with the use of a supporting corset. Not to be ignored is the diet. Deficiency symptoms favor Scheuermann's disease.
With the end of the growth, Scheuermann's disease does not progress. However, secondary damage (herniated discs, postural damage, neurological abnormalities) can still occur. Important factors are, above all, too little movement, an unfavorable posture (lots of bent over sitting) and overweight. These generally have a negative effect on the prognosis of Scheuermann's disease.
For the prevention of Scheuermann's disease, the prevention of poor posture in children and adolescents include, for example, a desk height adjusted to the size of the person and an ergonomically shaped chair. Regular exercise strengthens the back and abdominal muscles, supports the spine and promotes a healthy posture. Auspicious sports such as swimming and running are favorable, while competitive sports as well as the lifting and carrying of heavy loads and the associated strong mechanical stress on the spine should be avoided.
Just like the therapy, the after-treatment of Scheuermann's disease depends on the extent of the pain, the circumference of the spine and the age of the patient. As part of the follow-up usually orthopedic surgeons and physiotherapists work together. An important role, however, also plays the part of the patient. So he should regularly perform the physiotherapy exercises he is learning at home to advance recovery.
The physiotherapy exercises provide for a shortened chest muscles and prevent an unhealthy crooked posture. In the upper part of the back, strengthening of the muscles takes place. This in turn has a positive effect on the erection of the spine. Both in rehabilitation and in gyms, a precise implementation for muscle strengthening is possible. Also, the risk of injury can be reduced in this way.
For the affected children as well as for their parents, a sports consultation is helpful in addition to the physiotherapy measures. So it is important to know which sports have a positive effect and which do not. Water sports such as backstroke are considered cheap. In contrast, art gymnastics, cycling, trampolining or rowing are considered negative.
The aim of the aftercare is to stabilize the alignment of the spine in order to counteract a progressive deformation. Obesity can negatively affect the treatment. In most cases, however, no severe forms of Scheuermann's disease are to be feared.
You can do that yourself
The typical symptoms of Scheuermann's disease are closely related to the attitude. In many cases this means that the more crooked the patient is sitting or standing, the more pain is reported. This is where self-help about Scheuermann's disease sets in: the more upright the posture, the greater the well-being and the better the therapeutic success of conventional medicine and physiotherapy. Therefore, the patient can help himself if he consistently practices the prescribed physiotherapy with all his sessions and conscientiously carries out exercises recommended for the home. Even a corset, which can be prescribed in more severe cases, must be worn with high self-discipline.
In everyday life, the patient can also do a lot to relieve or even eliminate the symptoms caused by Mobus Scheuermann. This includes in particular the strengthening of the trunk muscles (abdomen and especially back), which is responsible for the erection of the body and thus the spine. This should always be done in consultation with the attending physician or physiotherapist. Strengthening exercises on the machines especially suitable for these muscle groups are well suited in the gym. Swimming or walking exercises not only the back muscles but also the stamina. When lying down while sleeping or reading it is often helpful to take the prone position over and over again.