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Why Do People visit the Chiropractor?
What Are the Assessments, Goals, and Treatments
at a Typical Chiropractic Office Visit?
The most recent authoritative review of Chiropractic appeared in the December issue of the prestigious orthopaedic medical journal Spine, titled (1):
The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults:Results From the 2012 National Health Interview Survey
The data for this study was from the National Health Interview Survey (NHIS), which is the principle and reliable source of comprehensive health care information in the United States. The NHIS dataset provides a large-scale nationally representative sample regarding chiropractic use.
The study noted that 63% of patients go to Chiropractors for low back pain and 30% for neck pain.
They found that only 3% of patients reported that Chiropractic care did not help them.
The authors also made the following points:
“The most common complaints encountered by the Chiropractor are back pain and neck pain and this is in line with the recent systematic reviews identifying the substantial evidence on the efficacy of Chiropractic for neck pain and back pain.”
“Chiropractic services are an important component of the healthcare provision for patients affected by musculoskeletal disorders (especially for back pain and neck pain) and/or for maintaining their overall well-being.”
What Are the Chiropractic Clinical Assessments?
Some spinal pain can be serious. These usually involve compressive neuropathology. Examples of compressive neuropathology include disc herniations, lateral recess stenosis, and central canal stenosis. Although each of these conditions can be successfully managed by Chiropractors, they often need advanced diagnostics (MRIs, etc.), and sometimes require surgical intervention. Chiropractors are well trained to examine and recognise cases of compressive neuropathology and to make appropriate referrals when necessary. Statistically, compressive neuropathology is quite rare, constituting only 1-2% of Chiropractic clinical practice.
As well as the standard orthopaedic and neurological tests used to determine if a patient has compressive neuropathology, chiropractic clinical assessments can include X-rays, posture analysis and joint range of motion. These assessments show a patient’s proprioceptive integrity. A large majority of Chiropractic pain patients have lack of proprioception, causing joint pain and immobility in the area.
An important study was published by the Institute of Occupational Health, Helsinki, Finland, in 1987, by physician T. Viderman, MD. in the journal Clinical Biomechanics, and titled Experimental Models of Osteoarthritis: The Role of Immobilization (2)
Dr. Viderman noted that when there is a lack of joint motion for any reason, the tissues surrounding the joint adapt to the shortest distance between its origin and insertion. This significantantly alters musculoskeletal function. Viderman makes the following points:
“Whenever the periarticular shrinkage stems from immobilisation, the process does not affect articular cartilage only; instead the whole joint is involved.”
“Immobilisation, for whatever reason, is one of the pathogenic factors in musculoskeletal degeneration.”
“With respect to patients, it can be postulated that immobilisation, for whatever cause, will initiate a pathogenic chain of musculoskeletal degenerative changes.”
Dr. Viderman also discusses the value of mobilisation to prevent and reverse the pathological consequences of immobilisation. He notes:
“If immobilisation, irrespective of its cause, cannot be avoided, it would be therapeutically logical to take every possible step to limit its extent and duration.”
“When the adverse effects of immobilisation have already become apparent, the earlier they are treated the better.”
“The evidence reviewed shows very clearly that early mobilisation is essential.”
Chiropractors focus on the treatment and management of spinal pain syndromes.
Chiropractors first rule out or confirm the presence of compressive neuropathology. A series of orthopaedic and neurological tests are carried out, usually with imaging, such as x-rays or possibly an MRI. If a compressive neuropathology is present, the Chiropractor may decide to treat the condition, refer the patient to another provider, or co-treat the patient with another provider.
Once compressive neuropathology is ruled out, the Chiropractor will assess the status of the patient’s proprioceptive signals. This classically involves three interrelated mechanical assessments:
1. Postural alignment
2. Regional spinal range of motion (cervical, thoracic, and lumbar)
3. Segmental range of motion (joint motion integrity)
Discovered mechanical problems are dealt with mechanically, including ergonomically, exercise, traction, tissue work, and spinal adjusting.
When spinal joints do not have optimum movement, the pain gate at that level is open. Chiropractic adjusting (specific manipulation) increases the firing of the proprioceptors, creating a neurological sequence of events that closes the pain gate. The reduction in pain is often immediate, depending on levels of concomitant inflammation.
The quality of proprioception is a significant factor in the state of the pain gate. Improved proprioception closes the pain gate. Chiropractic adjusting improves proprioception. Consequently, chiropractors are noted for their treatment and management of pain syndromes, especially for spinal pain syndromes.
1. Adams J, Peng W, Cramer H, Sundberg T, Moore C; The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults; Results From the 2012 National Health Interview Survey; Spine; December 1, 2017; Vol. 42; No. 23; pp. 1810–1816.
2. Viderman T; Experimental Models of Osteoarthritis: The Role of Immobilization; Clinical Biomechanics; November 1987; Vol. 2; No. 4; pp. 223-229.
While it is common for most people to look in the mirror once a day, few of us look at ourselves from different angles, such as from the side. However, the view from the side help explain why you may be suffering from neck pain.
Firstly, you need to take note of the position of your head in relation to your shoulders. Is your ear right above your shoulders or does it lean forwards over your chest? This is known as forward head posture and it can lead to pain developing in your neck. Problems originating in your lower back can also lead to forward head posture. It’s common to gain weight around the waistline as you age. When this occurs, the body must counter-balance the added weight by forcing the lumbar spine to “sway back.”
While this “sway back” posture can lead to pain developing in the lower back, it can also have a knock-on effect on the neck’s posture. Usually, Patient's with a protruding waistline and "sway back" will have rounded shoulders and a noticeable forward head posture. If treatment is only focused at the neck pain without considering how other areas of the spine may affect the stability of the neck, then the results may be slower than expected.
Doctors of Chiropractic are trained to look at the whole patient, not just their primary complaint. They know that dysfunction in other parts of the spine can result in neck pain by referral or they can slow complete recovery as the body is compensating elsewhere for abnormal posture or movement.
X-ray analysis of the full spine can show this abnormal posture.
So, do you like what you see when you view your posture from the side? If you’re wondering whether your neck pain could be improved by addressing poor posture in another part of your spine, then it's important to be thoroughly checked by a Chiropractor in Belfast as soon as possible.
Call us now on 028 9600 9075
Pran Manga Ph.D. et al. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Ontario Ministry of Health 1993
This government funded report found:
"On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by Chiropractors is shown to be more effective than alternative treatments for low back pain." "There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management."
"There should be a shift in policy to encourage and prefer Chiropractic services for most patients with low-back pain." "A very good case can be made for making Chiropractors the gatekeepers for management of low-back pain."
Key Study Concepts:
The Manga Report represents the biggest and most extensive government initiated and funded review of the literature regarding the treatment of Low Back Pain in history.
The reason for the report was rising costs of healthcare. The main focus was on back pain and back pain related disability, and the lack of evidence for many commonly used treatments.
The study concluded:
"In our view, the constellation of the evidence of:
(1) the effectiveness and cost-effectiveness of Chiropractic management of low-back pain.
(2) the untested, questionable or harmful nature of many current Medical therapies.
(3) the economic efficiency of Chiropractic care for low-back pain compared with medical care.
(4) the safety of Chiropractic care.
(5) the higher satisfaction levels expressed by patients of Chiropractors, together offers an overwhelming case in favour of much greater use of Chiropractic services in the management of low-back pain.
Key Study Points:
Chiropractic has been found, by the most comprehensive independent, government initiated, government funded report in history, to be the most evidence-based, most effective, most cost-effective, safest option for patients with back pain that also produces the highest level of patient satisfaction.
If you are in the Belfast area and want to be helped with back pain - please contact our office on
028 9600 9075
Research Shows Spinal Issues Don't Recover Without Proper Care.
Itz, C.J. et al. (2013) Clinical course of non-specific low back pain: A systematic review of prospective cohort studies set in primary care. European Journal of Pain (17): 5-15
"The findings of this review indicate that the assumption that spontaneous recovery occurs in a large majority of low back pain patients is not justified. There should be more focus on intensive follow-up of patients who have not recovered within the first 3 months."
"The findings in this review are in stark contrast with current recommendations and guidelines for the treatment of patients with non-specific LBP, which are based on the assumption that in a large majority of patients spontaneous recovery occurs."
It is illogical to wait for back pain to just go away or to use medication to numb it. Similar to waiting for tooth pain to go away or to use pills to numb tooth pain.
If you are serious about recovering your health and function you need to address the cause of your back pain. You need to "fix the spinal cavities"; not simply try to numb the pain that its causing.
Ignoring the issue does not resolve it. Even if the pain temporarily goes away, the unresolved problem is still lurking in the tooth or spine. Unresolved issues get worse over time not better.
Important Take Home Points:
Evidence-based Chiropractors have always emphasized the fact that it is important to identify and address the cause of spinal pain.it is both illogical and unscientific to cover up the symptoms rather than fix problems and restore the patient's health and function.
The Chiropractic Research:
An important study illustrating the value of Chiropractic care for chronic low back pain patients was carried out at the University of Saskatchewan's Hospital Orthopedics Department by Dr. Kirkaldy-Willis, a world-renowned Orthopedic Surgeon. 300 subjects in the study were “totally disabled” by lower back pain, with pain present for an average of 7 years. All had gone through intensive, unsuccessful Medical treatment before participating in the study.
After 2 to 3 weeks of Chiropractic treatment, more than 80% of the patients had good to excellent results, reporting substantially increased mobility and decreased pain. After Chiropractic treatment, more than 70% were improved so much that they no longer suffered from work restrictions. Follow-up's a year later demonstrated that the changes after Chiropractic treatment were long-lasting. Even those with a narrowed spinal canal, generally considered the most challenging cases, showed a notable improvement.
Senna, M.K. and Machaly, S.A. (2011) "Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?" Spine. Aug 15;36(18):1427-37.
"This study confirms previous reports showing that spinal manipulation is an effective modality in chronic non-specific LBP especially for short-term effects as the disability and pain scores in our study are significantly reduced in the short-term evaluation - but not in long-term - when compared with the sham manipulation."
Oswestry Disability Score: "At the 4-month and 7-month evaluation the mean disability scores gradually elevated back toward the pretreatment level in the non-maintained SMT group. However disability score in the maintained SMT group continue improving."
"SMT is effective for the treatment of chronic non-specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy."
This was a prospective single blinded placebo controlled study. That means this is a VERY high quality study.
Subjects were randomly assigned to their groups (no bias), there was a control to remove, as much as possible, the chance that improvements were from placebo, and assessments of improvement were performed by a blinded examiner (meaning the examiner did not know which group the patient was from - ie whether the patient had or had not been treated).
"Sixty patients, with chronic, non-specific LBP lasting at least 6 months, were randomized to receive either (1) 12 treatments of sham SMT over a 1-month period, (2) 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or (3) 12 treatments over a 1-month period, along with "maintenance spinal manipulation" every 2 weeks for the following 9 months."
"To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1, 4, 7, and 10 month intervals."
The outcome measures were Oswestry, Visual Analog Scale (VAS) for pain, SF-36 to measure quality of life, Patient Self Evaluation of Improvement, and Mobility tests.
"Patients in the second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029, respectively)."
"However, only the third group that was given spinal manipulations (SM) during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation."
"In the non-maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level."
"At the 4 and 7-month evaluation the mean pain score gradually elevated back toward the pretreatment level in the non-maintained spinal manipulation therapy group. However, pain score in the maintained spinal manipulation therapy group continued improving."
"Spinal Manipulation Therapy is effective for the treatment of chronic low back pain. To obtain long-term benefit, this study suggests maintenance spinal manipulation after the initial intensive manipulative therapy."
Spinal mobility, spinal comfort, and spine-related functional ability and quality of life all showed the exact same trend; the group that received maintenance care not only maintained but increased mobility, comfort, function, and quality of life as time under maintenance care progressed over the 10 months.
The group that did not receive maintenance care not only failed to improve, they actually lost the improvements they had made during the first month.
MAIN CLINICAL GEM
For the first time we have peer-reviewed evidence from a well designed study that shows a maintenance chiropractic care program consisting of care every 2 weeks for up to 10 months not only prevents relapse and a waste of initial investment, it pays dividends in continued improvements!
Lower back pain can be localised to only the low back area or the pain can travel down the leg also. Localised lower back pain is often less complicated and usually has a more favourable prognosis for complete recovery. During your Chiropractic consultation, a large portion of the history and examination is focused on this differentiation between back pain and leg pain. This week's article aims to explain the different types of leg pain that can occur with different lower back conditions.
We’ve all heard the word “sciatica”. It is loosely used to describe everything from lower back pain coming from the facet joints in the back, from the sacroiliac joints, from the muscles of the low back, and even from compressed nerves caused by a ruptured disc in the lumbar spine.
For the sake of accurcy, the term “sciatica” should really only be used when the sciatic nerve is being compressed. The sciatic nerve is comprised of five nerves (L4, L5, S1, S2, S3) that come from the spine and sacrum and join to form one large nerve called the sciatic nerve. True sciatica occurs when any one of the five small nerves or the larger sciatic nerve itself becomes irritated or compressed. There are many causes for this irritation, such as a lumbar disc herniation, a mal-positioned vertebra aka "a spondylolisthesis", pressure from an arthritic bone spur growing off the vertebrae where the nerve exits aka “spinal stenosis”.
"Pseudosciatica" is caused by compression of the sciatic nerve by the piriformis muscle where the nerve passes under the buttocks. Other “pseudosciatica” causes include pain referred from the facet joints of the lower back which the patient often describes as a deep ache felt inside the leg.
Some direct trauma, like a bruise to the buttocks from a fall or pinching the nerve during an injection into the buttock area, can also trigger “sciatica.”
The most common symptoms of sciatica include: leg pain, buttocks pain, low back pain and foot or leg numbness and tingling. If the nerve compression is there for a long enough time, muscle weakness and wasting can occur. This weakness is noted during the Chiropractic examination by the Patient struggling to stand up on their tip toes leading to a limp when walking.
In the examination, your Doctor may raise your straightened leg and if the sciatic nerve is compressed, then a sharp pain can occur. If the pain occurs between 30 and 70° of elevation, this indicates a positive test for sciatica.
Testing the lower limb reflexes and skin sensation with a sharp object can give your Chiropractor clues where the is nerve damage is occuring.
The good news for patients in Belfast is that Chiropractic techniques can resolve this problem, thus helping you to avoid unnecessary surgery or the nasty side effects of prescription medication! So, check with your Doctor of Chiropractic first, before consulting the surgeon.
When low back pain strikes, we often think it’s a brand new problem. But why did coughing, twisting, or doing the hoovering cause injury this time? These are activities we normally do every day.
What is the problem this time?
The problem is caused by joint dysfunction. This is often a ligament or muscle problem that occurs by tiny micro-traumas repeated over many years, or sometimes a traumatic event such as car accidents or falls.
The ligaments can stretch or the muscles tighten, causing the joints and vertebrae in your spine to become displaced or stuck. This can irritate the delicate nerve fibers in the area. The body will usually find a way to compensate to take the pressure off that area over the next few days or weeks. The pain that accompanies this injury eventually lessens and sometimes goes away all on its own.
But has the problem really gone away?
Usually its still there in the background, because when ligaments or muscles are damaged, the repair mechanism involves the laying down of of scar tissue in the damaged area. Scar tissue is less elastic than the original tissue and this makes the joint vulnerable to re-injury. Oftentimes it impairs the normal motion of the spinal bones.
The Doctor of Chiropractic examines for this type of joint strain/sprain using a technique called motion palpation. They are looking for tenderness and swelling in the area. Sometimes x-rays are needed to see the directions the vertebrae have moved or whether they are moving at all. These specific analyses tell them the vulnerable joint directions and how the bones in the spine need to be repositioned to promote normal movement and good alignment.
When joint movements are faulty in the spine, it can lead to premature degeneration of the bones and discs and early arthritis in the area.
This may be why an everyday task such as hoovering the floor can flare up your back so easily. You may be performing the task with good posture but with faulty mechanics in the spine, a painful episode of back pain is a possible result.
Sometimes, the discs in the spine are so damaged that a simple cough or sneeze can lead to cause severe pain.
When these simple tasks seem to trip you up, there is likely an underlying problem that needs to be addressed and treated.
If you have been suffering with symptoms similar to this, please call our Belfast clinic to book an appointment with the Chiropractor.
There is a commonly held clinical belief that 90% of all low back pain episodes spontaneously self-resolve within a 60 day period.
It would appear that this commonly held “fact” may not be “factual” at all.
Possibly the most authoritative textbook of the 1970’s “Clinical Biomechanics of the Spine” was the main contributor to the 60 day self healing belief. An important comment was made on page 424 of the book.
“There are few diseases [low back pain] in which one is assured improvement of 70% of the patients 3 weeks and 90% of the patients in two months, regardless of the type of treatment employed.”
Firstly we need to ask where is this statement derived?
Reference J Dixon; Progress and Problems in Back Pain Research; Rheumatology and Rehabilitation; Volume 12, Number 4; November 1973; Pages 165-175.
Surprisingly the reference is not a scientific study at all. The reference is actually from a paper read at the Annual Meeting of the British Association for Rheumatology and Rehabilitation, London, March 1973.” (p. 165)
The first two sentences of the article are as follows:
“It is a great honor to be invited to talk to my own Medical School, but I am not noted for my contribution to back pain research nor for my startling observations into the biochemistry of the human intervertebral disc. My only contribution has been to show that patients with non-specific back pain more often do better in a rabbit-wool body belt than in a rigid spinal corset which they are more frequently prescribed.” (p. 165)
It is quite obvious, from Dixon’s own opening statement, he is not an expert on back pain, nor is he a back pain researcher of any kind.
Even though Dr. Dixon is the most often end reference of the natural history of back pain, a review of Dixon’s article finds that he actually quotes another article as well J Fry; Advisory Services Colloquia; “Back Pain and Soft Tissue Rheumatism”; Advisory Services (Clinical & General) Ltd., London; Number 1; 1972; Page 8
Dr. Fry’s contribution to the colloquium includes the following:
In an average GP practice each year 125 patients could be expected for soft tissue rheumatism or acute back pain.
“Of these 125 patients, 50 would be likely to be suffering from acute back pain and 25 from acute neck pain.”
“44% of the patients with acute low back pain lost their symptoms in less than one week and 82% in less than 4 weeks.”
Dr. Fry makes it abundantly clear that these numbers are from a retrospective review of his general practitioner practice of acute low back pain patients.
Dr. Fry provides no information regarding how he evaluated his patients and their progress or lack there of. Equally he fails to discuss how many patients he used to establish these statistics.
A more recent group of researchers, led by professor Peter Croft published in the British Medical Journal, actually took the time to evaluate the statistics on the natural history of low back pain that are frequently attributed to Dixon, and they unequivocally show Dixon’s statistics to be false.
Here is the review of the Croft Group article, the results speaks for themselves:
“Outcome of low back pain in general practice: a prospective study; British Medical Journal; May 2, 1998; Vol. 316, pp. 1356-1359; Peter R Croft, Gary J Macfarlane, Ann C Papageorgiou, Elaine Thomas, Alan J Silman”
KEY MESSAGES FROM AUTHORS:
1) It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month.
2) While 90% of subjects consulting the GP pactice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability.
3) Only 25% of the patients who consulted about low back pain had fully recovered 12 months later.
KEY POINTS FROM THIS ARTICLE INCLUDE:
1)This prospective study of 463 patients with an acute episode of low back pain agrees with numerous other studies that indicate that approximately 90% of such patients will stop consulting their doctor about their back within three months. In this study the number was actually 92%.
2)However, this study is adamant that NOT seeing a doctor for a back problem does NOT mean that the back problem has resolved. This study showed that 75% of the patients with a new episode of low back pain have continued pain and disability a year later, even though most are not continuing to go to the doctor.
3)The belief that “90% of episodes of low back pain seen in general practice resolve within one month” is false, and based primarily upon one flawed study published in 1973 by Dixon. [As noted above, Dixon is NOT a study, and should not be referred to as such.]
4)It is generally believed that most low back pain episodes will be “short lived and that ’80-90% of attacks of low back pain recover in about six weeks, irrespective of the administration or type of treatment.'” This belief is untrue, false.
5)Many patients seeing their general practitioner for the first time with an episode of back pain will still have pain or disability 12 months later but not be consulting their doctor about it. [Very Important]
6)Low back pain should be viewed as a chronic problem with an untidy pattern of grumbling symptoms and periods of relative freedom from pain and disability interspersed with acute episodes, exacerbations, and recurrences.
7)90% of episodes of low back pain DO NOT end in complete recovery within a few months.
If you are part of the 92% with back pain that hasn't got better by itself, please contact our Belfast clinic to see if Chiropractic can help you.
Around 80% of people will suffer from back pain at some point in their lives. If it lasts for more than 3 months it is considered chronic back pain and can have a devastating effect on their overall quality of life.
Since back pain is usually multifactoral, there are some tips that can be used to ease the pain alongside Chiropractic treatment.
A 2017 study showed that simply taking adequate vitamin D supplementation produced significant benefits to those patients suffering with chronic lower back pain.
In the study, 68 patients with chronic lower back pain and low vitamin D levels were given an oral dose of 60,000 iu of vitamin D3 every week for 8 weeks.
The data showed that not only did the patient's vitamin D levels improve, but the participants also had a significant improvement in pain and disability throughout the course of the treament.
The authors concluded that Vitamin D supplementation can have a significant effect on the pain and disabilty of those suffering with chronic back pain.
Up to 75% of teens and adults have suboptimal levels of Vitamin D. Recent research has shown that vitamin D deficiency may be a risk factor for diseases such as cancer, depression, heart disase and diabetes.
Chiropractors frequently use supplementation and diet advice to help reduce the pain levels of our patients 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).
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.
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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.
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