Anatomy: The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles.

Cause: Scheuermann’s disease occurring in approximately 4% of the population (article). A curvature of the back occurs (bending over forwards) due to the vertebrae becoming wedge shaped. There are also characteristic x-ray finds. The cause of the condition is unknown, but evidence tends to suggest that the condition is hereditary (article).

Symptoms: Back curvature localised high in the back (thoracal Scheuermann) gives often only few, if any, symptoms. Back curvature localised in the lower back (thoracolumbal or lumbal Scheuermann) does entail back pain for the majority (article).

Examination: The diagnosis is usually made following a medical examination supplemented with an x-ray (at least 3 adjacent vertebrae with at least 5 degrees wedge form, Schmorlske impressions, flattening of discs, irregular end plates) (article). The crooked back is often mistaken in the beginning for “bad posture”. In some cases, CT or MRI scanning is recommended.

Treatment: The vast majority of cases can be treated with training, attempting to maintain the mobility of the back, counteract the curvature tendency and strengthen the stomach and back muscles. A corset can in some cases be used until the young person is fully grown. An operation can be performed only in very rare cases. The condition has a good prognosis (article), and even after an operation it is still possible to take part in many different forms of sport (article).

Complications: In some cases a crooked back can have other causes (infection, nerve disease, inborn bone change, rheumatic illness, bone disease, metabolic disorder).

Anatomy: The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles.

Cause: The cause of scoliosis in children and adolescents is unknown in the majority of cases (idiopathic). Scoliosis is most commonly seen during the growing years, and is more often seen in girls than boys (Photo).

Symptoms: Scoliosis does not necessarily cause pain or other symptoms.

Examination: It is important that the diagnosis is made as soon as possible as better results are achieved if the treatment is commenced as soon as it is necessary. One should therefore always be aware of the early signs of scoliosis (uneven shoulder or hip level, one or both shoulder blades being prominent, slanting waist). A normal medical examination will usually be sufficient to make the diagnosis. X-rays will reveal the degree of severity of the scoliosis. In some cases, CT or MRI scanning is recommended (article).

Treatment: Treatment is dependant upon the degree of severity. The majority of cases will normally be able to be controlled without treatment (article). It will normally be possible to take part in sports activities without any problems (article). Strength training and stretching of the stomach and back muscles is recommended. Supportive bandaging can be used if the scoliosis becomes worse (> 25-30 degrees) and the young person is still growing. It is normally possible to take part in sport at the usual level despite the bandaging (article). An operation may become necessary if the scoliosis becomes pronounced (> 40-50 degrees), and even earlier in some special cases. Certain forms of sport can be resumed 6-9 months after the operation (article).

Complications: In some cases the presence of scoliosis can have other causes (infection, nerve disease, inborn bone change, rheumatic illness, bone disease, metabolic disorder).

Anatomy: The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles. (Sketch)

Symptoms: Pain and stiffness in the lower back (lumbago) and buttocks, occasionally radiating to the leg (“sciatica”).

Examination: Slight back discomfort does not necessarily require medical examination, however, all cases with strong or repeated back pain should be examined. The doctor will be able to evaluate whether further examination is required, i.e. x-ray (including lateral projection) (X-Ray) ,(Scintigraphy), CT or MRI scanning (article).

Treatment: Treatment is dependant upon the degree of severity. The majority of cases will normally be able to be treated with relief (article-1) (article-2) (which in sever cases must last for several months). In approximately 10% of cases where a vertebra has slid significantly forwards (spondylolisthesis), it will be necessary to operate (article).

Complications: If the pain does not decline under the treatment, medical (re)examination by a doctor should be performed. Special consideration should be given to:

• slipped disc
• secondary muscle infiltrations (myalgia)
• piriformis syndrome
• Scheuermanns disease

however, many other causes of lumbago are found (infection, tumour), of which some will require further examination.

Special: Training should be performed on a “lifelong” basis to reduce the risk of relapse after a successful rehabilitation.

Anatomy: The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles. Cartilage discs (disci) are located between the vertebrae which act as shock absorbers. The discs lie close to the spinal canal from where nerves depart to the legs.

Symptoms: Pain and stiffness in the lower back (lumbago), radiating to one of the legs. There can be sensory interference and reduction in strength of the leg. Symptoms are often aggravated by coughing. In rare cases the nerves can be so severely compressed that problems can arise in control of bladder and bowels, requiring acute surgical treatment.

Examination: If a slipped disc is suspected medical attention should be sought at once to establish the diagnosis and which treatment should be initiated.

Treatment: If examination reveals signs of a slipped disc without alarming symptoms (problems in control of bladder and bowels or substantial deterioration of muscle/paralysis), treatment will primarily be directed at altering the imbalance between the load the back is subjected to, opposed to the level the back is trained to manage. It is therefore recommended that you are instructed (possibly by a physiotherapist) in the appropriate way to put a strain on the back, and which loads and movements should be avoided (“ergonomic guidance”). A few days’ rest and relief may be needed to subdue the pain, after which steadily increasing training should be started with back and stomach stabilising and strengthening exercises. If painkillers are required, paracetamol can be recommended, possibly combined with rheumatic medicine (NSAID). Chronic back pain may suggest stronger painkillers, however, stronger medicine should be used with extreme caution as it can quickly lose its effect and there is a risk of increased dependence on the medicine. By far the majority of slipped discs can be managed through correct training (article 1). In cases where the above treatment does not produce progress in the condition, a CT or MRI scan will be considered with a view to possible operation. CT and MRI scan and operation is therefore first considered if the rehabilitation programme does not succeed (article 2). In cases with alarming symptoms (problems in control of bladder and bowels or substantial deterioration of muscle/paralysis) acute hospitalisation is recommended for evaluation of the need for acute surgery.

Special: Training should be performed on a “lifelong” basis to reduce the risk of relapse after a successful rehabilitation. Smoking causes increased risk of lumbago by reducing the flow of blood to the cartilage discs (disci), implying that daily small injuries do not heal so well. Stopping smoking is therefore an important part of the treatment. Shock absorbing shoes or insoles will reduce the load on the back.

Anatomy: The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles.

Symptoms: Pain and stiffness in the lower back (lumbago), occasionally radiating to the leg (“sciatica”).

Examination: Slight back discomfort does not necessarily require medical examination, however, all cases with strong or repeated back pain should be examined. The doctor will be able to evaluate whether further examination is required, i.e. x-ray, CT or MRI scan.

Treatment: Treatment will primarily be directed at altering the imbalance between the load the back is subjected to, opposed to the level the back is trained to manage. It is therefore recommended that you are instructed (possibly by a physiotherapist) in the appropriate way to put a strain on the back, and which loads and movements should be avoided (“ergonomic guidance”). A few days’ rest and relief may be needed to subdue the pain, after which steadily increasing training should be started with back and stomach stabilising and strengthening exercises. If painkillers are required, paracetamol can be recommended, possibly combined with rheumatic medicine (NSAID). Chronic back pain may suggest stronger painkillers, however, stronger medicine should be used with extreme caution as it can quickly lose its effect and there is a risk of increased dependence on the medicine. With acute lumbago without signs of a slipped disc, assistance can be sought from manipulative treatment by a doctor, physiotherapist or chiropractor.

Complications: If the pain does not decline under the treatment, clinical (re)examination by a doctor should be performed. Special consideration should be given to:

• Slipped disc
• piriformis syndrome
• Secondary muscle infiltrations (myalgia)

However, many other causes of lumbago are found, of which some will require further examination. In the majority of cases, the treatment will be identical. It will not be possible for some to be completely free of discomfort (i.e. with heavy degenerative arthritis in the lumbar region), and the aim of the treatment will often be to reduce the frequency and degree of pain.

Special: Training should be performed on a “lifelong” basis to reduce the risk of relapse after a successful rehabilitation. Smoking causes increased risk of lumbago by reducing the flow of blood to the cartilage discs (disci), implying that daily small injuries do not heal so well. Stopping smoking is therefore an important part of the treatment. Shock absorbing shoes or insoles will reduce the load on the back.