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Scheuermann's Disease/Kyphosis

Causes
Definition of Scheuermann's Kyphosis

Scheuermann's Disease is characterized by a deformation caused wedging at the front of the thoracic vertebrae (the vertebrae of the upper back) which causes an increased thoracic curve. The amount of this curvature varies significantly between different people with this condition.

Scheuermann kyphosis is defined as anterior wedging of 5 degrees or greater in at least three adjacent vertebral bodies, as measured on lateral spine radiographs. Degeneration of the vertebral end plates may be seen radiographically as well.

A strong genetic component is suggested by increased concordance in monozygotic over dizygotic twins. A study in New Zealand of 500 17 to 18 year olds found an incidence of 56 percent in males and 30 percent in females, although changes were severe in only 7 percent and 1.8 percent, respectively, closer to other estimates of disease prevalence, ranging from 4 to 8 percent. (1) What this means is that a significant proportion of the population suffers from some degree of wedging and a tendency towards excess curvature of the upper spine.

This predisposes towards a particular use of the body which can create back pain. Firstly people's attempt to hold themselves upright against the curvature of the upper spine is normally too forceful and is initiated by a considerable contraction of the lower back - resulting in lower back pain which can sometimes be acute and in some cases sciatica. The second problem is that when people with this condition bend, they do so constantly from the curve in the upper back, so that over time this curve becomes more and more rigid and inflexible - the structural problem in made more pronounced by a constant manner of misuse.

How the Alexander Technique can help

In teaching the Alexander technique to people with this condition my aim is firstly to help them find a better postural balance, which reduces the lumbar contraction, secondly to introduce a variety of movements and procedures which will help increase thoracic flexibility, within the limitations of the vertebral deformities, and thirdly to help them to develop a different habit of bending which replace thoracic flexion with movement from the hip joints. Pain can normally be reduced considerably after just a few lessons, but they would need to consider a longer course of lessons to develop the awareness and skills to be able to apply the Alexander technique in their daily activities.

More Information on Scheuermann's Disease

A Letter by David Moore discussing the Alexander Technique and Scheuermann's Disease

Abstract

This is a study of the incidence and possible predisposing stress factors of Scheuermann's disease (S.D.). 500, 17 and 18 year old, students from the local larger schools, from one country town school and from the local Teachers' Training College, took part. Each student filled in a questionnaire, underwent a simple spinal examination including a clinical assessment of the available passive hamstring stretch, and had a lateral X-ray of the dorsal and upper lumbar spine. 56.3% of the males and 30.3% of the females had X-ray evidence of previous S.D., in varying degrees of severity. Dynamic stress, such as playing sports involving a lot of potential compression stress, weight lifting, and heavy lifting work in spare time and holidays, seem to play little if any part in the pathogenesis of S.D. Tall males and males who had spent more than 2 weeks in bed, due to sickness or injury, were more prone to S.D. Hamstring tightness showed a significant relationship to X-ray evidence for males. In the absence of possible dynamic stress factors it is suggested that prolonged sitting may be an important factor in the pathogenesis of end plate breakdown and thus S.D.

References

(1) Scheuermann's disease. Clinical and radiological survey of 17 and 18 year olds.
Fisk JW; Baigent ML; Hill PD
Am J Phys Med 1984 Feb;63(1):18-30