A visit to the doctor is often prompted not by pain, but by cosmetic concerns about the “hump” appearance of the back with Scheuermann’s disease. A spine screening at school sometimes also alerts the family to the need for medical evaluation.

Symptoms of Scheuermann's Disease:

Scheuermann's disease symptoms worsen with twisting and bending activities.

Symptoms generally develop between the ages of 10 and 15, a time of considerable growth in the spine. These symptoms are typical:

Tiredness and muscle stiffness, especially after a day of sitting in class
Redness on the skin where the curvature is most pronounced and rubs against the back of a chair
Pain made worse by activities involving twisting, bending, or arching backward, such as when participating in gymnastics, figure skating, dancing, or other sports requiring these types of movements
Muscle spasms or muscle cramps
Difficulty exercising
Back pain or backache, which may come and go
Limited flexibility
Tight hamstrings
Feeling off-balance

Serious damage is rare, but it is possible for Scheuermann’s disease to develop in such a way that the spinal cord or internal organs are harmed. For example, if the lungs become compressed by severe forward posture it can lead to breathing problems.

See Spinal Cord and Spinal Nerve Roots

Assessing the Curvature

The curvature in Scheuermann’s disease is measured in degrees. A curvature with no abnormalities of the vertebrae (and one that goes away when the patient lies down) is usually considered postural kyphosis, a milder condition not requiring treatment. However, Scheuermann's disease is usually the diagnosis if the patient has:

A curvature of 45 degrees or more
Three or more adjacent vertebrae wedged together by at least 5 degrees per segment

Diagnosis of Scheuermann’s disease is based on a physical exam—including observation of posture—and analysis of X-rays and any other needed imaging tests.

See Identifying Incorrect Posture

As part of a thorough exam, the doctor typically observes the young person in a variety of positions and assesses the range of motion. Posture is a key factor, and the individual is usually observed from the front, side, and back, and while reclining. Muscle strength may also be checked. In addition, the doctor usually asks the young person to bend forward at the waist and touch the toes. The exam is likely to include a hands-on examination to feel for spinal abnormalities as well.

See Introduction to Diagnostic Studies for Back and Neck Pain

Multiple X-rays Recommended

Scheuermann’s disease is usually marked by a rigid rounding in the upper back, but can appear in the lower back. While the cause may seem obvious, X-rays are helpful in confirming the diagnosis, determining the extent of the curvature, and ruling out other possible causes or related medical issues. One such issue is scoliosis; about 20 to 30 percent of people with Scheuermann’s disease also have some degree of scoliosis.

See Scoliosis: Symptoms, Treatment and Surgery

X-rays are the most useful imaging test for diagnosing Scheuermann’s disease. Full-length X-rays are taken of the spinal column. The patient stands with arms extended forward while keeping the head erect. X-rays may also be taken while the patient is lying down, and bending to the side or backward, to determine flexibility and wedging of the vertebrae.

Once the individual has been examined and the X-rays have been analyzed, the doctor will potential treatments will be recommended and evaluated.

Dr. Paul McAfee is an orthopedic surgeon and Chief of Spine Surgery at the University of Maryland St. Joseph Medical Center and at Towson Orthopaedic Associates in Baltimore, MD. He specializes in cervical spine conditions and has been a practicing spine surgeon for more than 30 years.