Hyper-kyphosis & Scheuermann's Disease

According to the Scoliosis Research Society, the normal range of a thoracic kyphosis is considered to be 20° to 45°. Once kyphosis exceeds 45° it is considered to be abnormal; hyper-kyphosis, is typically referred to as “round back” posture.

In the case of Scheuermann's Disease, a juvenile (adolescent) thoracic kyphosis, which occurs at birth, the cause is unknown, but it may be hereditary. Common symptoms include muscle cramps and spasms, pain or stiffness in the back after sitting for long periods, reduced flexibility, or pain when doing activities that require twisting.

Developmental Kyphosis

Fig. 1 Male age 12 with
Thoracic hyper-kyphosis

Thoracic hyper-kyphosis in adolescents, “developmental kyphosis”, results in a larger than normal forward curvature which develops before puberty, a period of increased bone growth occurring in juvenile years and between age 10 to 15. While Individuals may experience pain, they and their parents are more likely to seek medical advice due to concern about the round back posture, and the likelihood of the disorder continuing in adulthood.

The abnormality can take the form of a postural kyphosis - a milder and more flexible condition, or become a rigid, structural disorder.

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Clinical Charactersistcs of Scheuerman's disease

In Scheuermann’s hyper-kyphosis the back becomes stiff due to the wedge shaped development of vertebrae. While scoliosis can also be present with the abnormality, the condition is usually minor.

Definitions of Scheuemann’s disease vary, one being definitive in its diagnosis in that 3 adjacent vertebra must be wedge shaped by 5°; another defines Sheuermann’s disease as a kyphosis of greater than 45° with two or more wedged vertebra.

Clinical characteristics present in cases of Sheuermann’s disease in the thoracic spine include: a posterior shift in the thoracic region; the pelvis moving anteriorly; weight-bearing onto the forefoot; leg axes adjusted anteriorly; a compensatory hyper-extension of the lumbar region; and the head and neck displaced in an anterior position. Tightness in the hamstrings is also a common.

Conservative treatment for Thoracic Hyper-Kyphosis

The default treatment for managing thoracic hyper-kyphosis in adolescence is observation. However, once a skeletally immature patient's curvature becomes more advanced, a brace is usually prescribed to stop or even reverse the abnormality.

According to Lowe, brace treatment is almost always successful in patients with kyphosis between 55° degrees and 80°, if the diagnosis is made before skeletal maturity.

In 2009, the authors of the study concluded that conservative treatment of Scheuremann’s hyper-kyphosis is regarded as an effective treatment approach: physiotherapy (exercise therapy) and bracing being “first-line” treatments for this disorder.

The kyphologic TM brace, which is customized for individual patients, is available and supported in Australia.

Lumbar Spine Scheuerman's Disease

Sheuermann’s disease mainly presents as a thoracic spine disorder, however it does to a lesser extent, manifest itself in the lumbar spine. While not as obvious, the lumbar spine disorder is usually more painful, limits movement, and is more likely to continue into adulthood.

Schroth method 3 day intensive hyper-kyphosis programs

Schroth 3 day intensive exercise therapy programs for postural kyphosis and Sheuermann’s kyphosis are conducted by the Scoliosis Therapy Centre, Sanctuary Cove, Qld. for Program format and costs,