Neck pain treatment in Belfast

When looking at the spine from the front it should be straight. The function and health of the spine is at its optimum when there is no lateral deviation from the front. This concept is well-reviewed by James Oschman, PhD (1):

In contrast, when the spine is viewed from the side, optimum health and function requires 3 distinct spinal curves (2):

1) Cervical Lordosis

2) Thoracic Kyphosis

3) Lumbar Lordosis

We are going to focus on the importance of cervical lordosis.

The loss of the cervical lordosis can be categorized into 3 groups:

1) Hypolordosis: is a loss of the normal curve in the neck.
2) Military: is a complete loss of the curve resulting in a straight cervical spine.
3) Kyphosis: is a complete reversal of the normal curve in the neck.

Loss of the normal neck curve is associated with a number of nerve and muscle problems. The primary problems fall into five categories:

1) Muscle strain and the consequent Myofascial Pain Syndromes.
2) Acceleration of Osteoarthritis in the neck and upper back.
3) Spinal Cord Tethering.
4) Spinal Cord Demyelination.
5) Vertebral Artery blood flow compromise.

1)Muscle strain and the consequent Myofascial Pain Syndromes.

Loss of the normal curve of the neck leads to the head being displaced forward on the spinal column. To prevent you falling onto your face, the muscles at the back of the neck and rib cage will contract to maintain balance (3). The constant muscle contraction results in pain, chronic inflammation, muscle tissue fibrosis and disability (3). The term given to this sequence of events is - "myofascial pain syndrome" (4, 5, 6).

If the head weighs 10 lbs. and the loss of neck curve pushes the head’s center of gravity forward by 3 inches, the required counter-balancing muscle contraction would be 30 lbs. (10 lbs. X 3 inches):

In these cases, although muscle therapy such as massage is helpful, it is not a long-term solution. The best solution is improvement of the neck curve, reducing lever-arm stress and allowing the counterbalancing muscles to relax.

2) Acceleration of Osteoarthritis in the neck and upper back.

Loss of normal neck curve not only pushes the head forward resulting in counterbalancing muscle contraction, it also significantly increases the load placed on the the discs and facet joints (7, 8). This starts and accelerates degenerative disc and joint disease in the cervical spine, commonly known as osteoarthritis (9, 10).

The acceleration of the osteoarthritis is most pronounced when there is a reversal of the normal neck curve. This is called a kyphosis (11, 12).

3) Spinal Cord Tethering.

With loss of cervical lordosis there is a stretching of the spinal cord (7). Chronic elongation leading to  tethering of the spinal cord can result in both spinal nerve dysfunction and spinal cord vascular compromise (13, 14). These can result in both autonomic and musculoskeletal symptoms.

4) Spinal Cord Demyelination.

An important research study was published in the prestigious  journal "Spine" in 2005 detailing cervical spine kyphosis and demyelination of the spinal cord (15). 

This study showed that cervical spine kyphosis leads to compression of the anterior blood supply to the spinal cord, resulting in spinal cord demyelination. The demyelination was greatest at the apex of the kyphotic deformity in the neck. Blood Angiography studies showed a decrease in the density of the capillary networks at the compressed spinal cord due to the neck kyphosis. 

As the kyphotic angle in the neck increased, these changes in the blood supply to the area became more marked, especially in the ventral side of the spinal cord that was directly exposed to mechanical compression.

The Anterior Spinal Artery is the main blood supply to the neurons of the anterior and lateral spinal cord.

Reversal of the normal neck curve (kyphosis) compresses the front of the  spinal cord against the  discs and spinal bones.

5) Vertebral Artery Blood Flow Compromise.

The vertebral artery carrys blood, nutrients and oxygen to the brainstem. There is evidence that loss of the normal cervical curve (lordosis) results in reduced blood flow from the heart, through the vertebral artery into the brain stem. This can negatively effect the normal functioning of the cranial nerves and other vital functions.

An important article on this topic was published in the journal "Medical Science Monitor" in 2016, titled: Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis (16).

The authors evaluated the blood flow of the vertebral arteries of patients with loss of their normal neck curve and compared it to control subjects without loss of their cervical lordosis.

30 patients with loss of cervical lordosis and 30 carefully matched controls were assessed with Doppler Ultrasonography. Vertebral artery hemodynamics were statistically compared between the patient group and control group. The cervical lordosis was assessed on X-ray using the posterior tangent method.

The authors state: “The normal cervical spine has a lordotic curve. Abnormalities of this natural curvature, such as loss of cervical lordosis or cervical kyphosis, are associated with pain, disability, and poor health-related quality of life.”

“Loss of cervical lordosis causes disrupted biomechanics, triggering a degenerative process in the cervical spine.”

“The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity.”

When the cervical curve is lost, the vertebral arteries “are also in danger of being stretched or compressed.”

“The results of this study indicate that loss of cervical lordosis is associated with decreased vertebral artery values in lumen diameter, flow volume, and peak systolic velocity.”

This article increases the awareness of the negative impact of loss of the normal curve in the neck. It also highlights the importance of correcting cervical lordosis.

Balmoral Spine Clinic Belfast focuses on the assessment and treatment of spinal pain, including pain and associated symptoms resulting from a loss of cervical lordosis. The most accurate assessment of spinal alignment is with X-rays.

We use a number of techniques to improve and/or restore the cervical spine lordosis. There are numerous studies in the PubMed Database indicating that Chiropractic can improve and even reverse cervical kyphosis. Our typical treatment procedures involve combinations of specific Chiropractic adjustments and extension traction exercises (17, 18, 19, 20, 21, 22, 23, 24, 25).

REFERENCES:

1) Oschman J; Energy Medicine, The Scientific Basis; Chruchill Livingstone; 2000.

2) Kapandji IA; The Physiology of the Joints; Volume Three, The Trunk and the Vertebral Column; Churchill Livingstone; 1974.

3) Cailliet R; Soft Tissue Pain and Disability; 3rd Edition; FA Davis Company; 1996.

4) Travell J, Simons D; Myofascial pain and dysfunction, the trigger point manual; New York: Williams & Wilkins, 1983.

5) Travell J, Simons D; Myofascial pain and dysfunction, the trigger point manual: THE LOWER EXTREMITIES; New York: Williams & Wilkins, 1992.

6) Simons D, Travell J; Travell & Simons’, Myofascial pain and dysfunction, the trigger point manual: Volume 1, Upper Half of Body; Baltimore: Williams & Wilkins, 1999.

7) White AA, Panjabi MM; Clinical Biomechanics of the Spine, Second Edition; Lippincott; 1990.

8) Cailliet R; Low Back Pain Syndrome, 4th edition; FA Davis Company; 1981.

9) Garstang SV, Stitik SP; Osteoarthritis; Epidemiology, Risk Factors, and Pathophysiology; American Journal of Physical Medicine and Rehabilitation; November 2006; Vol. 85, No. 11; pp. S2-S11.

10) Ruch W; Atlas of Common Subluxations of the Human Spine and Pelvis, Second Edition; Life West Press; 2014.

11) Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, Baba H; Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression; Journal of Neurosurgery: Spine; November 2009; Vol. 11; pp. 521-528.

12) Grosso M, Hwang R, Mroz T, Benzel, Steinmetz M; Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery; Journal of Neurosurgery: Spine; June 18, 2013; Vol. 18; No. 6; pp. 537-544.

13) Breig A; Adverse Mechanical Tension in the Central Nervous System; Almqvist and Wiksell; 1978.

14) Wing PC, Tsang IK, Susak L, Gagnon F, Gagnon R, Potts JE; Back Pain and Spinal Changes in Microgravity; Orthopedic Clinics of North America; April 1991; Vol. 22; No. 2; pp. 255-262.

15) Shimizu K, Nakamura M, Nishikawa Y, Hijikata S, Chiba K, Toyama Y; Spinal Kyphosis Causes Demyelination and Neuronal Loss in the Spinal Cord: A New Model of Kyphotic Deformity; Spine; November 2005; Vol. 30; No. 21; pp. 2388-2392.

16) Bulut MD, Alpayci M, Şenkoy E, Bora A, Yazmalar L, Yavuz A, Gulşen I; Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis; Medical Science Monitor; February 15, 2016; Vol. 22; pp. 495-500

17) Leach RA. An evaluation of the effect of chiropractic manipulative therapy on hypolordosis of the cervical spine. J Manipulative Physiol Ther. 1983 Mar;6(1):17-23.

18) Harrison DD, Jackson BL, Troyanovich S, Robertson G, de George D, Barker WF. The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study. Journal of Manipulative and Physiological Therapeutics; September 1994; Vol. 17; No. 7; pp. 454-64.

19) Troyanovich SJ, Harrison DE, Harrison DD. Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms. J Manipulative Physiol Ther. 1998 Jan;21(1):37-50.

20) Harrison DE, Harrison, DD, Haas JW. CBP Structural Rehabilitation of the Cervical Spine, 2002.

21) Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: a nonrandomized clinical controlled trial. Arch Phys Med Rehabil. 2002 Apr;83(4):447-53.

22)Morningstar MW, Strauchman MN, Weeks DA. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study. J Chiropr Med. 2003 Spring;2(2):51-4.

23) Harrison DE, Harrison DD, Betz JJ, Janik TJ, Holland B, Colloca CJ, Haas JW. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther. 2003 Mar-Apr;26(3):139-51.

24) Ferrantelli JR, Harrison DE, Harrison DD, Stewart D. Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods. J Manipulative Physiol Ther. 2005 Mar-Apr;28(3):e1-8.

25)Oakley PA, Harrison DD, Harrison DE, Haas JW. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP) publications. J Can Chiropr Assoc. 200