Chiropractic Health & Wellness Blog

Lyn Lake Chiropractic

Scheuermann’s and thoracic disc herniations

November 25, 2009
Due to the increase of patients with mid back pain we are seeing at Lyn Lake Chiropractic, we decided to write a little info blog to help educate people on a couple of topics.

Scheuermann’s and thoracic disc herniations. Please use this for information only and not for diagnosis or a treatment plan. Consult a Chiropractor or Medical Doctor. I wrote this to help one of my friends that recently had an MRI and had questions on what to do next.

Scheuermann’s kyphosis

This condition (also called Scheuermann’s disease) occurs when the front of the upper spine does not grow as fast as the back of the spine, so that the vertebrae become wedge-shaped, with the narrow part of the wedge in front. The wedge-shape of the vertebra creates an increase in the amount of normal kyphosis (front angulation of the thoracic spine)

The wedging of vertebrae in Scheuermann’s kyphosis is most Quick read more or view full article common in the thoracic spine (upper back), with the apex of the curve typically between the T7 and T9 levels of the spine. Although less common, Scheuermann’s kyphosis may also occur in the junction between the thoracic and lumbar spine (thoracolumbar spine) or in the lumbar spine (lower back).

The cause of Scheuermann's disease is unknown, but is thought to be due to a growth abnormality of the vertebral body. The growth plate anteriorly (in the front) stops growing but the posterior part of the growth plate continues to grow. This is due to a condition known as osteochondrosis.
Scheuermann’s disease does not spread and is not really a “disease” but a condition that can arise during growth. It is more common in males and appears in adolescents usually towards the end of their growth spurt. If the roundback deformity is severe, patients are more likely to have discomfort or pain along with the deformity as they age.

Treatment options for Scheuermann's disease:

Treatment will vary depending on the size of the curve, the flexibility of the curve, the patient’s age and the patient’s preferences.

Chiropractic is extremely important for anyone with Scheuermann, Sheuermanns does not make the discs brittle. What chiropractic will do is ensure that the joints in the back have motion in them because as the joints lose their motion they begin to degenerate (you don't use it, you lose it). So it is particularly important for people with Sheuermanns to have their spine adjusted by a chiropractor because there’s already some degree of spinal degeneration involved with the disease. Chiropractic will not cure this disease however many people have found it to help decrease the curve and keep it from getting worse.


Some other thoughts on treating these symptoms:

Chiropractic adjustments of the spine are beneficial, increasing the movement and nutrition of the joints

Exercise has been proved to help with the treatment of Scheuermanns disease, but contact sport like rugby and karate are forbidden. The vertebral endplates are fragile leading to fragmentation of the bone and cartilage. Obviously trauma should be avoided.

Specific exercises to strengthen the muscles between the shoulder blades are advised. Either by your chiropractor or P.T.
Using a foam roller, over which the back is gently extended is recommended and flexion distraction.
Swimming, particularly breaststroke and backstroke, is excellent.


Thoracic Herniated Discs

Any injury that causes a high degree of sudden force on the discs in the upper spine could lead to a thoracic herniated disc. Examples of a traumatic event that may lead to a thoracic herniated disc include a fall, car accident or sports injury that places sudden force on the upper back.
Thoracic herniated discs tend to occur in younger patients prior to significant degenerative disc changes. While in most cases some history of mild trauma has led to an exacerbation of the patient’s symptoms, a mild trauma (such as reaching up while twisting) will usually just worsen symptoms from a degenerated disc. Regardless of the cause of the thoracic back pain, getting a correct diagnosis is critical because it will guide treatment of the thoracic herniated disc. Thoracic disc disease is conceptually similar to disc disorders in the cervical, thoracic and lumbar spine, but symptomatic lesions (anatomical problems related to the symptoms) are far less common.

The most common location for thoracic disc disorders is at the thoracolumbar, mid back pain (the thoracic and lumbar parts of the spinal column) junction (T8-T12) in the mid back. The true incidence is unknown because many thoracic disc disorders do not cause thoracic back pain or other symptoms, and they comprise only a very small percent of all herniated disc surgeries.

In one study, 90 asymptomatic patients (with no pain or other symptoms) were evaluated with thoracic MRI scans. These were the findings:

1. 73% of patients were found to have disc abnormalities in the upper back, such as a thoracic herniated disc.
2. 37% specifically had a thoracic herniated disc.
3. 29% had radiographic evidence of spinal cord impingement identified on the MRI.

These patients were followed for 26 months and none of them developed thoracic back pain from their thoracic disc disorders. The fact that so many people had thoracic herniated discs but no pain or symptoms is important to mention, as it shows that people may have both upper back pain and a thoracic herniated disc, but that the disc disorder may not be the cause of the thoracic back pain – it may just be an incidental finding. In fact, there are many causes of upper back pain that are much more common than a herniated disc.

Thoracic Disc Herniation Treatment

The vast majority of thoracic disc herniation can be treated without thoracic surgery. There are a variety of non-surgical treatment options that can be tried, and often patients will need to try several, or a combination of different treatments, to find what works best for them.

1. A short period of rest (e.g. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). After a short period or rest, the patient should return to activity as tolerated. Gentle exercise, such as walking, is a good way to return to activity.
2. Narcotic and non-narcotic analgesic medications to help reduce the thoracic back pain. Narcotic pain medication is usually only prescribed to treat severe upper back pain for a short period of time. For mild or moderate thoracic back pain, an over-the-counter pain reliever such as acetaminophen (e.g. Tylenol) is commonly recommended for thoracic herniated discs.
3. Anti-inflammatory agents, to help reduce inflammation around the herniated disc in the upper back, including:

  • Medications NSAIDS – Advils, oral steroids.
  • Anti-inflammatory injections – epidural steroid injections.
  • Ice packs - applied to the painful area for 15–20 minutes at a time, as often as necessary.
  • Strengthening exercises - stabilization exercises do not directly affect the herniated disc, but they
    can stabilize the thoracic spine muscles. This has an effect of decreasing the load experienced by
    the disc and vertebrae. Stronger, well balanced muscles help control the thoracic spine and
    minimize the risk or injury to the nerves and the disc.
  • Manual manipulation - usually performed by chiropractor.

    The patient’s activity levels should be progressed gradually over a 6 to 12 week period as symptoms improve. In the vast majority of cases, the natural history of thoracic disc herniation is one of improvement with one or a combination of the above conservative (non-operative) treatments.

    Thoracic Surgery

    Most often surgery is recommended if more conservative measures do not relieve your symptoms. Thoracic herniated disc surgery is reserved for cases of myelopathy (Defined: Disorder in which the tissue of the spinal cord is diseased or damaged.), progressive extremity weakness, and intolerable radicular pain that does not get better with non-surgical treatments.

    In cases where thoracic surgery was indicated, two researchers evaluated 19 patients treated with either costotransversectomy or trans-thoracic decompression of a thoracic disc herniation.

    The following was reported:

  • 16 patients with good or excellent outcomes
  • 3 patients with fair or poor results
  • 2 of the poor outcomes were in the costotransversectomy group.

    With these results in mind, the researchers opined that the trans-thoracic approach should be the preferred.

    Another approach you can try - supplements:

    Glucosamine and chondroitin sulfate are components of normal cartilage. In the body, they are the building blocks for cartilage and appear to stimulate the body to make more cartilage.

    Many people with back pain especially osteoarthritis use supplements in their diet to ease the pain of. Glucosamine and chondroitin are the most well-known and best tested.

    Glucosamine works to improve the condition of the cartilage of the body. The cartilage is a fibrous substance most often found in our joints. One of its main functions is to attach bones to other surfaces of the body such as tendons Glucosamine works by making the cartilage stronger and more pliable.

    Chondroitin is another substance that is normally found in the cartilage in joints and disc of the body. It is responsible for improving the ability of cartilage to defend itself against stress. It also helps to inhibit action on the part of certain enzymes that have the ability to break down the cartilage of the joints. Several clinical trials have shown that when chondroitin was taken regularly long term, people had reduced pain and inflammation.

    MSM or methyl sulfonylmethane is a herbal supplement that is sulfur based. This substance is a naturally found sulfur and is normally found in the foods that humans and animals eat on a daily basis. The way that this substance works is that it reduces inflammation. It also has been shown to reduce painful sensation by stopping or reducing the pain impulses that are relayed on the nerve fibers from the body part through the nervous system to the brain.

    The combination of the three supplements gives the consumer the best combination possible. Glucosamine and chondroitin help to improve the structure of the cartilage as well as reducing inflammation while MSM quickly reduces inflammation and pain that comes along with these illnesses. The addition of MSM can give people much quicker results as well as an added boost in a well rounded combination of herbs for issues such as we have discussed here.

    Lyn Lake Chiropractic likes to use a product by Metagenics.

    Chondro-Relief Intensive Care: Ingredients -

    Glucosamine Hydrochloride, Chondroitin Sulfate, MSM (Methylsulfonylmethane), Vitamin C (Manganese ascorbate),
    Manganese (Manganese ascorbate), Hyaluronic Acid.

    What Lyn Lake Chiropractic would do to treat these issues.

    We would provide chiropractic adjustments, Ultrasound, Cold Laser treatment, EMS, Hot or Cold Packs, Massage, Therapeutic Exercises, Traction and more! If you want us to help set you up on some core exercise, you can meet one of our Certified Personal Trainers at no cost.

    If you have any questions please feel free to contact us at Lyn Lake Chiropractic and we would be glad to help point you in the right direction. If needed, we will refer you to either a Neurologist and/or Neurosurgeon for a second opinion on what you should do next. I hope this helps! Read Less
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