What happens to the spine
Normally, the thoracic region has a physiological posterior curve, and a slight stoop is not a disease. With this disease, the growth of the anterior parts of the vertebral bodies is disrupted: they grow more slowly than the posterior parts and acquire a wedge-shaped shape. Three adjacent vertebrae with wedge shape are enough to make a diagnosis. The endplates of the vertebrae also change, through which the tissue of the intervertebral disc is introduced into the vertebral body, forming the so-called Schmorl's hernia. As a result, the bend becomes rigid, and the compensatory deflection in the lower back increases and the head moves forward.
- Wedge-shaped deformity of three or more vertebrae
- Uneven endplates
- Schmorl's hernia
- Increased thoracic kyphosis
- Compensatory deflection in the lower back
- Sometimes combined with scoliosis
Causes and risk factors
The reason has not been precisely established. The leading factor is considered to be a hereditary predisposition: the disease often occurs in several family members. A period of rapid growth plays a certain role, when bone tissue is rebuilt, and the back muscles cannot keep up with the skeleton. Additional factors include significant axial loads during this period - weightlifting without control of technique, working with large weights, as well as prolonged sitting in a bent position. Boys get sick more often. Poor posture itself does not cause the disease, but it aggravates its manifestations.
- Hereditary predisposition
- Period of rapid growth
- Male gender
- Large axial loads on the spine
- Sitting in a bent position for long periods of time
- Weakness of the back muscles and shortening of the hamstrings
Symptoms
The main manifestation is a pronounced round back, which is especially noticeable from the side and when bending forward: the back forms a sharp hump at the level of the thoracic region, rather than a smooth arc. The teenager cannot straighten up completely even when asked. Often bothered by aching pain between the shoulder blades and in the lower back, which intensifies towards the end of the day, after long periods of sitting or physical activity; at rest it subsides. The muscles of the back of the thighs are usually shortened, and bending forward with straight legs is difficult. Neurological disorders are rare and require separate examination.
- Stable round back, not straightened by force
- Sharp bend when bending forward
- Aching pain between the shoulder blades
- Increased pain in the evening and after exercise
- Back muscle fatigue
- Shortening of the posterior thigh muscles
- Forward head and shoulders
Diagnostics
The doctor examines the teenager from the side and behind, asks him to bend forward and lie on his stomach: with a normal stoop, the back straightens in this position, but with Scheuermann’s disease the deformity remains. The main method of confirmation is an x-ray of the thoracic spine in a standing lateral projection with measurement of the kyphosis angle and assessment of the shape of the vertebrae. MRI is prescribed for severe pain, suspected disc herniation and neurological symptoms, as well as when planning surgery. Additionally, the possible combination with scoliosis and skeletal maturity are assessed.
- Side view and forward bend test
- Checking whether the deformity is corrected while lying down
- X-ray of the chest in lateral projection
- Measuring kyphosis angle and vertebral shape
- MRI for pain and neurological symptoms
- Assessment of skeletal maturity and concomitant scoliosis
Treatment
The basis is physical therapy: strengthening the back extensors and abdominal muscles, stretching the pectoral muscles and the back of the thigh, learning the correct posture at the table. Classes should be regular and selected by a specialist, and not a random set of exercises from the Internet. If the deformity is severe in a teenager with incomplete growth, a corset is prescribed, which is worn for many hours a day until growth is complete; it is able to reduce the angle of curvature. Painkillers are used briefly and as needed. Surgery is rarely considered: for very large angles, persistent pain and neurological impairment.
- Regular physical therapy under the supervision of a specialist
- Strengthening the back and abdominal muscles
- Stretching the pectoral muscles and hamstrings
- Swimming and activity without axial overload
- Corset for severe deformation during growth
- Workplace organization and posture control
- Limiting heavy lifting
- Surgery in rare severe cases