What is it?

Scheuermann disease is a fixed deformity of the thoracic spine (the mid-spine at the levels the ribs attach to). The fixed deformity is called a hyperkyphosis, which means the upper/mid-back is rounded (bent too far forward), and it cannot be improved by having the individual sit up or stand straight with correct posture. This disease is seen in adolescents, with the disease being more prevalent in males than in females, and is the most common cause of thoracic back pain in adolescents.

The exact cause is unknown, but some think that repetitive microtrauma from sport or other physical stress to the area over time may lead to the deformity.

Symptoms

The main symptom is thoracic spine pain located between the shoulder blades. The pain is usually worse with physical activity, prolonged sitting, standing, or bending forward. Individuals may also present with poor posture (with the upper/midback rounded too far forward), but the disease can start with just pain prior to the change in posture. Progressive postural changes may be seen as time goes on. It is important to differentiate Scheuermann disease from adolescent postural kyphosis (also known as postural round back) with the latter being correctable with asking the individual to sit up straight.

Sports Medicine Evaluation & Treatment

A sports medicine evaluation will include taking a history, performing a physical exam, assessing for the presence of a fixed hyperkyphosis that worsens when bending forward, and spine radiographs (x-rays). Radiograph findings may include irregularities of the vertebral end plates (the top and bottom aspects of an individual vertebral body), disc space narrowing, and anterior wedging of at least three successive vertebrae that results in the observed curve.

Treatment includes flexibility exercises of the hamstrings and low-back muscles. Strengthening exercises of the core are also recommended. Pain should be controlled with over-the-counter pain medications as needed. Bracing may be considered if the kyphosis is greater than 50 degrees and the individual is still growing. Curves greater than 70 degrees, that are progressing, and are associated with severe pain, may require surgery (correction of the curve with spinal fusion).

Return to Play

Athletes with curves less than 50 degrees that have undergone appropriate rehabilitation and are pain free can return to sport without restrictions. Individuals that require bracing are allowed to partake in sports, with removal of brace during practice and competition, as long as they too are rehabbing without pain.

Long-term problems that can continue with Scheuermann disease can be mild pain with activity and some limitation of back extension/straightening in nonsurgical cases, however, outcomes overall are reported to be very good. For individuals that require surgical fusion, participation in contact/collision sports is not recommended.

AMSSM Member Authors
Michael Stiller, MD

References
Janicki, Joseph A., et al. “Section 9/Pediatric Orthopaedics.” Essentials of Musculoskeletal Care 5, by April D. Armstrong and Mark C. Hubbard, American Academy of Orthopaedic Surgeons, 2016, pp. 1146–1149.
Patel, Dilip R., and Elizabeth Kinsella. “Evaluation and Management of Lower Back Pain in Young Athletes.” Translational Pediatrics, vol. 6, no. 3, 2017, pp.225–235., doi:10.21037/tp.2017.06.01.