Scheuermann’s Disease: Case study by Dr Andrew Richards

Scheuermann’s disease is less of a disease as such and more of a disorder. One feature is that the vertebra of the thoracic spine are misshaped in the form of a wedge creating an excessive rounding in the upper back. As with any disorder cases range from mild to moderate to severe and it is the more mild to moderate cases that often go undiagnosed and mismanaged. Ironically it is these milder cases that are most responsive to conservative chiropractic intervention.

People with Scheuermann’s disease classically present with poor posture, the result of an excessive rounding of the mid-back and shoulders causing the head to poke forwards and the lower back to hyper-extend. As a result of this postural distortion a whole range of other injuries, stresses and strains can occur. Most commonly people complain of neck, shoulder and lower back pain. Shoulder and low back injuries are very common amongst the more athletic sufferers.

The mistakes I have encountered in managing Scheuermann’s disease are 2 fold:

1) Not being diagnosed with Scheuermann’s disease in the first place. This is as simple as having a spinal x-ray taken.

2) Being under-treated. Chiropractic intervention is a bit like taking a medicine. The effect is dose dependant, meaning that if you don’t take enough, the treatment doesn’t work – even if you are doing the right things. This I have seen time and time again and  is a direct consequence of not having a clear understanding of the root cause and the frequency of care required to bring about change.

Case of Scheuermann’s disease

Mr X presented to our clinic with a long history of poor posture which had become of increasing concern over his teenage years. He had previously worked with both osteopaths and physiotherapists with no success. To the left you can see a digitised image of his lateral posture. This of its own immediately raised concerns about the possibility of Scheuermann’s disease being at the heart of his postural presentation.

Of particular note are:

1) The obvious excessive rounding of the upper back and curvature of the lower back to compensate

2) The degree of forward head posturing relative to the shoulders measured at 5.48cm

3) The degree of forward hip shift measured at 4.96cm

X-rays performed in the clinic on that day confirmed our suspicions. With a diagnosis in hand, further assessment to better ascertain his functional capabilities and impact of this condition on his body as a whole was performed.

A chiropractic adjustment schedule was set at 2 sessions per week for 6 weeks. This was supported with corrective postural exercises to be performed at home. A review at the end of the 6th week was performed which confirmed good progress had been made. Treatment was continued at twice weekly for a further 6 weeks then gradually reduced in frequency to weekly, fortnightly and finally monthly maintenance as changes began to hold and progress continued.

Here you can see a photo taken approximately 1 year later. Comparatively –

1) There is a decreased severity of the curvatures in the mid and lower back

2) An obvious reduction in forward head posture which now measured 3.34 cm. A reduction of more than 2 cm

3) Hip shift back towards the plumb line which was now measured at 0.93 cm. A reduction of more than 4 cm.

While there is still room for improvement most notably in forward head posturing it is clear to see how much change had occurred. The key here is that these results came off the back end of 3 months of consistent treatment. Treatment and expectation depend largely on the severity of the case. Sometimes it becomes a case of halting further deterioration and managing the secondary issues that arise. Mr X was a milder case, young, fit and healthy and most importantly motivated which played key roles in a successful outcome.

A clinicians role is only half done when they find out what is wrong, the magic is always then in the execution and timing of successive treatments for the best results.

If you have any questions regarding Scheuermann’s disease or would like to book a time to have your case evaluated please call me at Better Health on 02 9518 0722