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Scheuermann’s disease is a condition that affects the growth of the vertebrae in the spine, most commonly during adolescence. It causes the vertebrae, particularly in the thoracic spine (upper back), to grow unevenly—specifically, the front part of the vertebrae grows more slowly than the back. This leads to a wedge-shaped deformity, resulting in an exaggerated forward curvature known as kyphosis.

This structural kyphosis is different from postural kyphosis, which is more flexible and often correctable with effort. Scheuermann disease, by contrast, involves rigid, structural changes in the bones of the spine. It is one of the most common causes of thoracic kyphosis in teenagers.

Signs & Symptoms

The symptoms of Scheuermann disease can vary in severity and may include:

  • Kyphotic curvature: A visibly rounded or hunched back, particularly when bending forward.
  • Back pain: Often described as a dull, aching pain in the mid-back, especially after prolonged sitting or physical activity.
  • Muscle fatigue: Pain and fatigue in the back muscles due to the abnormal spinal alignment.
  • Reduced flexibility: Particularly in the thoracic spine and hamstrings.
  • Tenderness: Around the apex (peak) of the kyphotic curve.
  • Neurological symptoms (less common): In severe cases, nerve compression may cause radiating pain, numbness or weakness.

In some cases, individuals may not experience significant pain, and the condition is identified incidentally during imaging for other reasons.

Differentiating from Postural Kyphosis

While both Scheuermann’s disease and postural kyphosis involve rounding of the upper back, several features help distinguish them:

  • Structural rigidity: The kyphosis in Scheuermann’s disease is caused by wedge-shaped vertebrae and does not improve with conscious effort or changes in position. In contrast, postural kyphosis is flexible and typically resolves when the person adopts a correct posture.
  • Age of onset: Scheuermann’s often appears during adolescence and progresses during growth spurts. Postural kyphosis can occur at any age but is especially common in adolescents with poor posture habits.
  • Pain: Pain is more frequent and localised in Scheuermann’s, whereas postural kyphosis may not always cause discomfort unless poor posture is prolonged.
  • Spinal stiffness: People with Scheuermann’s frequently report spinal stiffness and tightness that limits movement. In postural kyphosis, movement is usually unimpaired.
  • Radiographic findings: X-rays of someone with Scheuermann’s will show at least three adjacent vertebrae wedged more than 5 degrees each, whereas postural kyphosis typically shows normal vertebral shape.

Causes & Contributing Factors

The exact cause of Scheuermann disease is unknown, but several contributing factors are recognised:

  • Genetics: There is often a family history, suggesting a hereditary component.
  • Growth abnormalities: It is thought to result from a growth abnormality where the front of the vertebral bodies grow slower than the back during a growth spurt.
  • Biomechanical stress: Repetitive loading of the spine during adolescence, especially in sports involving bending or axial loading (e.g., gymnastics, weightlifting), may contribute.
  • Poor posture: While not a cause, poor postural habits can exacerbate symptoms and the appearance of the curve.
  • Vertebral endplate changes: Irregularities, such as Schmorl’s nodes (disc material pushing into the vertebra), are often seen in imaging and may be involved in the disease process.

Grading

Scheuermann disease is generally diagnosed when the following radiographic criteria are met:

  • At least three adjacent vertebrae are wedged by 5 degrees or more.
  • The kyphotic angle (Cobb angle) of the thoracic spine exceeds 45 degrees.
  • Irregular vertebral endplates and/or Schmorl’s nodes may also be present.

There is no universally accepted grading system, but the severity is often described based on:

  • Mild: Cobb angle < 60°, minimal pain or functional impact.
  • Moderate: Cobb angle between 60°–75°, noticeable deformity and discomfort.
  • Severe: Cobb angle > 75°, significant cosmetic and/or functional impact, possibly including neurological symptoms.

Prognosis

Scheuermann disease typically stabilises after skeletal maturity. The pain and structural changes do not usually worsen significantly in adulthood. However:

  • Adolescents may experience pain and fatigue during rapid growth periods.
  • Adults with untreated or severe curves may be at risk for chronic back pain, early degenerative disc disease, and reduced lung function in extreme cases.

With early detection and appropriate management, most individuals lead active, pain-free lives.

Treatment

Treatment depends on the severity of the curvature, symptoms, and the patient’s age and skeletal maturity.

Physiotherapy Management

Physiotherapy is a key component in managing Scheuermann’s disease, helping to reduce pain, slow postural progression, and support spinal health through targeted exercises and education.

Postural education
Teaching awareness and correction of poor posture is a cornerstone of physiotherapy. Young people are encouraged to develop awareness of spinal alignment during everyday tasks such as sitting, standing, and carrying school bags.

Strengthening exercises
Physiotherapists design personalised strengthening programs to support the spine. These often include:

  • Back extensors: Crucial for counteracting kyphotic posture.
  • Core stabilisers: Such as the deep abdominal muscles to provide trunk support.
  • Gluteal muscles: To assist pelvic stability and spinal alignment.

Stretching
Tightness in certain muscles contributes to postural changes:

  • Hamstrings: Can pull the pelvis into a posterior tilt.
  • Hip flexors: Can tilt the pelvis anteriorly, exaggerating spinal curvature.
  • Pectoral muscles: Tightness can round the shoulders further.

Thoracic mobility work
Improving thoracic spine mobility is essential. Interventions may include:

  • Foam rolling: To increase thoracic extension and relieve stiffness.
  • Manual therapy: Gentle joint mobilisation or soft tissue techniques provided by a physiotherapist.

Breathing techniques
In cases where the kyphosis is severe enough to affect lung function, physiotherapists may address:

  • Chest expansion: Through targeted breathing exercises.
  • Breathing efficiency: By retraining diaphragmatic breathing patterns.

A structured and progressive physiotherapy program—usually over several months—is often required, with regular reassessment and modification based on goals and clinical response.

Energy conservation techniques
Physiotherapists provide guidance on pacing strategies that help manage daily activities without overexertion. This includes:

  • Breaking up tasks into manageable segments.
  • Alternating periods of activity and rest.
  • Prioritising essential activities.
  • Modifying the environment (e.g., ergonomic seating, supportive backpacks).

These strategies can significantly reduce fatigue and enable ongoing participation in valued activities such as school, work, and recreation.

Other Management Options

Bracing
A spinal brace may be prescribed in moderate cases, particularly if the curve is progressing in a skeletally immature individual. Bracing is most effective when worn consistently and combined with physiotherapy.

Pain management
Occasional use of analgesics or anti-inflammatories may be advised, but long-term reliance is discouraged. Physiotherapists can also use modalities like heat, massage, or TENS if appropriate.

Surgical intervention
Surgery is considered only in select cases:

  • Severe curves >75–80 degrees with pain or functional limitations.
  • Progressive deformity despite conservative management.
  • Presence of neurological symptoms or significant cosmetic concerns.

The standard procedure is spinal fusion, which corrects the curvature and stabilises the spine using rods and bone grafts. Surgery carries risks and requires a lengthy rehabilitation period, so is reserved for carefully selected individuals.

References

Lowe, T. G., & Line, B. G. (2007). Evidence-based medicine: Analysis of Scheuermann kyphosis. Spine, 32(19 Suppl), S115–S119. https://doi.org/10.1097/BRS.0b013e318134ea89

Murray, P. M., Weinstein, S. L., Spratt, K. F., & Huizenga, B. A. (1993). The natural history and long-term follow-up of Scheuermann kyphosis. The Journal of Bone and Joint Surgery. American Volume, 75(2), 236–248. https://doi.org/10.2106/00004623-199302000-00008

Ristolainen, L., Kettunen, J. A., Kujala, U. M., & Heinonen, A. (2012). Sport injuries as the main cause of sport career termination among Finnish top-level athletes. European Journal of Sport Science, 12(3), 274–282. https://doi.org/10.1080/17461391.2011.566373

Roussouly, P., Berthonnaud, E., & Dimnet, J. (2005). Geometrical and clinical classification of the sagittal spinal alignment. European Spine Journal, 14(9), 743–750. https://doi.org/10.1007/s00586-005-0927-6

Wenger, D. R., Frick, S. L., & Winter, R. B. (2004). Scheuermann kyphosis. Spine, 29(2), 207–217. https://doi.org/10.1097/01.BRS.0000105522.88918.B6