Normal spinal side alignment
Normal spine when observed from the side is not straight. It has two inward (neck and the low back) and two outward curves (upper back and sacral spine). The inward curve is called lordosis and the outward kyphosis. It is usually accepted that normal values of these natural physiological curves are 20° to 40° (upper limit 45°) for the upper back kyphosis and 40° to 60° for the lower back lordosis. When the curve exceeds these values, we are talking about hyperkyphosis and hyperlordosis.
A special type of hyperkyphosis in which the thoracic spine becomes very rigid due to the vertebral bodies (spine bones) being wedged is called Scheuermann’s disease or Scheuermann’s kyphosis. It was first described by H. W. Scheuermann in 1920 where the name is coming from. Sorenson later further developed the diagnosis based on the presence of three or more adjacent vertebrae that are wedged beyond 5° and there is no evidence of congenital, infectious or traumatic disorders of the spine.
Prevalence of Scheuermann's Kyphosis
It is believed that the prevalence in the general population ranges from 4% to 10% with approximately even numbers between females and males. Similar to idiopathic scoliosis, the cause is not known. Most common complain is feeling of stiffness or rigidity and back pain that be present in the mid back, low back or neck.
Scheuermann's kyphosis presents usually around puberty and is frequently attributed to poor posture, which leads to numerous late diagnosis. This type of round back is very distinctive from a typical bad posture because it presents with a "peak" in the flexed spine and does not follow a smooth harmonic line.
People with Scheuermann's kyphosis also have various degrees of hyperlordosis in the neck and the low back areas. Typically these curves are flexible and correctable.
Treatment for Scheuermann's kyphosis
Scheuermann's kyphosis and the Schroth treatment
Scheuermann's kyphosis can be treated using the Schroth method, braces or, in most severe cases, surgically. The Schroth method can improve flexibility, pain, posture, esthetic appearance and curve magnitude.
Specific individualized treatment with the Schroth exercise for the Scheuermann's kyphosis consists of lengthening and repositioning of the spine, rebalancing of the centre of gravity, as well as reshaping of the torso though guided expansion of the rib cage using the Schroth breathing.
The picture shows the effect of combined 2-year treatment with Sanomed kyphosis brace and daily Schroth exercises.