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Health Articles

Why We Need Curves In Our Spine

Brian Bartholomew - Thursday, January 05, 2012


INTRODUCTION
The neck of the human body is a bio-mechanical marvel.
It possesses a wide range of mobility in nearly every direction. The neck serves as a conduit for the major blood vessels to the brain and is the primary pathway of the central nervous system. The cervical (neck) region of the body is one of the most important areas of the body and a growing body of research clearly shows that its structural integrity and function are absolutely critical to overall health and healing.
The brain and the spinal cord make up the central nervous system. The spinal cord is often thought of as just a cable that transmits nerve messages, but it is actually a direct part of the brain. The spinal cord plays a crucial role in the health and homeostasis of the human body by sending and receiving billions of nerve messages every single second.
The Central Nervous System is so vital to overall health and functioning of the human body that it is protected by the hardest substance in the body — a series of vertebral bones that make up the spinal column.
The human vertebral column, or spinal column, is a highly versatile mechanism and displays all the rigidity, strength, and leverage required in the job of a crane. In contrast, it is extremely elastic and flexible. The vertebral column exhibits more varied functions than any other unit of the human body.
The small bones of the spine are called vertebrae and are designed to fit together in an S-shape. This column of curves is balanced so that the weight of the human body is evenly distributed throughout the spine. If these curves are out of balance, the vertebrae are pushed out of line, placing abnormal stress on the nerve pathways, muscles, and soft tissues of the spine.
The curves of the spine are important because they allow the spine to support more weight and to withstand more stress than if it were straight. This is because the curves increase resistance to axial compression — that is, head-to-toe squishing of the spine.
That means 10 times more weight can be supported by a curved spine than if it was straight.
When viewed from the side, the vertebral column shows four normal curves. The curves of the vertebral column are important because they increase its strength, help maintain balance in the upright position, absorb shock during walking and running, and help protect the spinal column from fracture.1

PRINCIPLES OF ANATOMY AND PHYSIOLOGY
Humans are born with a C-shaped spine and the spinal curves develop in resistance to different gravitational stresses that affect the body.
The first spinal curve to develop is the cervical curve and it develops as the baby learns to lift its head.
The cervical spine consist of 7 vertebrae the same in all mammals — from the tiny mouse to the long- necked giraffe. The cervical bones - the vertebrae - are smaller in size when compared to other spinal vertebrae.
The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement (e.g., rotate side to side, bend forward and backward).
Between each vertebra (with the exception of the space between C1 &C2) are springy disks of tough cartilage with a jellylike core that compress when under pressure to absorb shock. These disks are subjected to tremendous forces.
Strong ligaments and muscles surround the spine to stabilize the vertebrae and to control movement. The cervical spine has a unique structure that is related to its important biomechanical functions.
Head Support: The cervical spine supports the weight of the head, which weighs between 10-14 pounds — about the same as a bowling ball. With proper posture, the weight of the head is held directly above the center of gravity. In a forward head position, the head is held ahead of the center of gravity and results in a stress load on the cervical spine that is equivalent to the weight of the head multiplied by the number of inches the head is forward from the center.
Mobility: The spine is a dynamic structure; designed for movement in a wide variety of positions, including flexion, extension, lateral flexion, and rotation of the head. Specialized articulation between the occiput and the atlas (C1) allows for 50% of the flexion and extension of the neck. Specialized articulation between the atlas (C1) and axis (C2) allows for 50% of the rotation of the neck.
Protection and Transmission: The spinal cord and nerve roots are encased within the protective structure of the spinal column. Pairs of nerves exit in the intervertebral foramina (IVF). When the spine is in its optimal structure, the spinal cord and nerve roots are protected. Loss of this optimal spinal structure results in the interference of normal nerve transmission.
The human body contains millions of sensory receptors that supply input into the Central Nervous System (CNS) to allow it to control and coordinate all bodily functions.
Each receptor is sensitive to a form of physical energy — mechanical, thermal, chemical, and electromagnetic.
The receptors transform stimuli into electrochemical energy that the nerves use to supply sensory information into the CNS.
Encased within the joints of the body are different types of mechanoreceptors that enable our bodies to unconsciously monitor the exact position of our muscles, joints, and bones — a process called "proprioception." Proprioception is our "body sense": If you have ever tried to walk after one of your legs "falls asleep," you will have some idea of the difficulty in coordinating muscular activity without proprioception. Mechanoreceptor input into the CNS occurs at an optimum state when the biomechanical integrity of the spine is intact. Loss of spinal structure diminishes important sensory input into the CNS.

OPTIMAL STRUCTURE OF THE CERVICAL SPINE
When discussing the human body, it is important to understand that the word “normal” applies to a condition that is optimum or ideal, rather than a condition which might be considered “average” for a large group of people.
The point is not to try and determine an exact ideal of what everyone’s body conforms to, but rather to use the laws and principles of physics, math, and neuroanatomy to determine a range of optimal normal values to which everyone can strive to achieve.
Health care is slowly changing from a symptom/disease-based system to a function/performance-based system in which the structure of the human body is restored and maintained. Correction and maintenance of the structure of the spine, in particular the cervical spine, is of paramount importance in the pursuit of optimal health.
Gray’s Anatomy clearly shows how spinal muscles leave the greatest pivotal stress at C1 and C4-C5 to allow for the greatest strength and potential energy. This demonstrates that there must be lateral curves for peak performance.3
It is widely recognized that proprioceptive input from muscles, joints and other receptors is necessary for the accurate control of movement and posture. Loss of proprioception results in large systematic errors in multi-joint movements attributed, at least in part, to impaired motor programming.2
JOURNAL OF NEUROPHYSIOLOGY
There is a mechanical basis for these normal
anatomic curves; they give the spinal
column increased flexibility and augmented,
shock-absorbing capacity, while at the same
time maintaining adequate stiffness and
stability at the intervertebral joint level. 4

CLINICAL BIOMECHANICS OF THE SPINE
“The normal curvatures of the spinal column lie in the plane of the sagittal suture. The curves absorb
vertical forces in a spring-like fashion and this has shock-absorbing qualities. The ideal shape of the
spine was elucidated by Killus(1976) with the help of computer analysis. Killus superimposed 150
measurements and with the help of further conversions, found the ideal spinal column.”5
NORMAL BIOMECHANICAL STRESS ON SPINAL FUNCTION
SIDE VIEW OF THE KILLIAN IDEAL SPINE MODEL
“A study in the research journal Neurosurgery, of patients who required surgery for cervical
spondylotic myleopathy, revealed that those patients who had a normal cervical lordosis prior
to the surgery showed significant post-operative neurological improvement over those
surgical patients who did not have a pre-operative cervical curve.”6
NEUROSURGERY
Because of its mobility, relatively small structure, and weightbearing
role, the cervical spine is a frequent site of spinal
nerve trauma, subluxations, and fixations.
When you have sensitive nerve pathways passing through such a
mobile structure, the potential for breakdown is high.
The cervical spine has the greatest amount of potential for
malfunctions and for creating health problems that affect the
entire health and function of the body.

THE CERVICAL SPINE AND TRAUMA
The cervical spine is susceptible to various forces that cause the vertebrae to lose their proper structural position. These types of traumas include macro trauma, such as auto accident/whiplash, sports injuries, and falls; repetitive or micro-trauma, such as work tasks and poor postural habits; and early development trauma, which includes childhood falls and even the birth process.
Whiplash injury is caused by a sudden exaggerated thrust of the head backwards, forwards, and sometimes sideways.
Abnormal forces are applied to muscles, ligaments, bones, nerves, blood vessels, and intervertebral disks, as the weighty head moves beyond normal physiological limits.
There are often no visible bruises or abrasions from this type of injury, yet victims report classic symptoms following the accident — even years after its occurrence.
The symptoms are due to abnormal structural stress of the vertebral bones and soft tissue of the head and neck. Whiplash injury is most often associated with automobile accidents, but can also occur due to impact sports, domestic violence, playfully tossing a small child into the air and even amusement park rides.
WHIPLASH FACTS
• Over one million Americans each year suffer a whiplash
injury
• 25% of whiplash victims suffer from chronic pain
disabilities;
• 1/7th of whiplash victims report pain 3 years after initial
injury.
U.S. Automobile Accident Statistics
"In speaking of the forces generated in the head and neck as a result of whiplash, the convention is to use the term G. One G is equivalent to the acceleration resulting from the earth's gravity, 32.2 feet/sec. Ewing measured the maximum peak acceleration of the head of human volunteers exposed to nominal 10-G, 250-G/sec runs and found the surprising high\ force of 47.8 G. Thus, in some cases, the head may accelerate up to 5 times the input acceleration."
CROFT & FOREMAN
The birth process, even under normal conditions, is frequently the first cause of spinal stress. After the head of the child appears, the physician grabs the baby's head and twists it around in a figure eight motion, lifting it up to receive the lower shoulder and then down to receive the upper shoulder. This creates significant stress on the spine of the baby.
"Spinal cord and brain stem injuries occur often during the process of birth but frequently escape diagnosis. Infants who survive often experience survive often experience lasting neurological defects. Spinal trauma at birth is essentially attributed to excessive longitudinal traction, especially when this force is combined with flexion and torsion of the spinal axia during delivery."9
Dr. Abraham Towbin
The proper structure of a baby's spine must be maintained, as the primary ossification (rigid bone development) is not complete until approximately 3-6 years of age. Deviation from proper spinal structure resulting from the birth process can result in abnormal spinal development.

LOSS OF OPTIMAL CERVICAL STRUCTURE AND FUNCTION
Loss of the optimal cervical spinal structure and its resulting pathologies are known in medical literature by numerous names including spondylosis, spinal stenosis, cervical compression myleopathy, spondylocondrosis, cervical disc herniation, subaxial disc space narrowing, cervical fixation, cervical radiculitis, vertebral subluxation, and many more.
Vertebral subluxation is perhaps the most accurate description of loss of normal vertebral position.
Vertebral subluxations alter the protective structure of the spine, which causes abnormal nerve transmission, resulting in a state of disharmony and lowered resistance in the body.
Vertebral subluxation also causes abnormal joint physiology, resulting in a degeneration of the bones and soft tissues of the spine.
Vertebral subluxation and loss of cervical curve is devastating to a person’s health and are well documented by leading health authorities.
“Encroachment or narrowing of the intervertebral canals may be
the result of some involvement of the proximate soft tissue
structures and/or the bony structures. Irritation of the cervical
nerve roots may give rise to pain, sensory changes, muscle
atrophy, muscle spasm, and alteration of the tendon reflexes
anywhere along their segmental distribution. Any condition
causing narrowing of the intervertebral canals may cause
compression of the nerve roots”.11
Ruth Jackson, M.D.
THE CERVICAL SYNDROME
“An injured joint is likely to cause persistent, disturbed, sensory feedback to the central nervous
system and therefore existing motor programs have to be modified. Sensory receptors in the joint can
influence muscle tone. This produces interdependence between biomechanical and neurological
mechanisms.”
NEURO-ORTHOPEDICS
Alfred Brieg, leading neurosurgeon, has shown
that the loss of the normal cervical curve
stretches the spinal cord anywhere from 5 to 7
cm and results in abnormal tensions on the hindbrain,
cranial nerves, cervical cord, and cervical
nerve roots.

BIOMECHANICAL EFFECTS OF POSTURAL CHANGE
Abnormal rotations and translations on the soft tissue
in the cervical canal are depicted in the figure at right.
In A, the neck is in the normal lordotic position.
The cord is relaxed and folded in the posterior. The
nerve roots are relaxed. Loss of curve B, the cord is
stretched, the nerve roots are stretched, and the
nerve roots are pressed upward against the pedicles
of the vertebra.
“Neural dysfunction associated with acute or chronic subluxation syndromes basically
manifest as abnormalities in sensory interpretation and/or motor activities. These
disturbances may be through one of two primary mechanisms, either direct nerve or nerve
root disorders of a reflex nature.”10

CERVICAL SPINE TRAUMA
SPINAL DEGENERATION

Spinal degeneration is the gradual and progressive breakdown of vertebral joints and related structures due to long-standing misalignments or vertebral subluxations, caused by deterioration of the intervertebral disc, bad posture, or a variety of traumatic injuries. When left uncorrected, these spinal misalignments cause abnormal biomechanics which erode joint surfaces. This degenerative process is similar to the abnormal wear on automobile tires when left unbalanced.
To stabilize the degenerating joints, the body deposits calcium at the edge of bone, resulting in irregular joint surfaces and arthritic spur ring. Although it has been suggested that aging is responsible for degenerative changes in the spine, recent research indicates otherwise. According to Anatomico-Roentgenographic Studies of the Spine, the incidence of degenerative changes varies from one segmental level to another. The C5/C6 level is most frequently involved, with C6/C7 being the level most frequently affected. The C2/C 3 level is the one least likely to exhibit degenerative changes. Clearly, the primary cause of spinal degeneration is abnormal stress loads on the biomechanics of the spine.14
“The aim of this study was to determine whether F-16 pilots are at an increased level of cervical spine degeneration versus pilots who do not fly F-16s and therefore are not exposed to the G-force stress on the cervical spine. In total, 316 pilots were evaluated, 188 F-16 pilots and 128 pilots in the control group. Two radiologists, who were blinded as to whether the x-ray films wer e of F-16 pilots or the control group, examined these x-rays separately. In both groups, the time between the pre- and post-x-rays was an average of six years. Results: Both radiologists found comparable statistically significant differences between the groups. In the F-16 group, an increased osteophytic spurring was found at levels of C4-C5 and C6-C7 and increased arthritis deforms were found in the cervical spine. These findings demonstrated that the increased biomechanical stress on the cervical spine was responsible for the degeneration.”15
AVIATION SPACE ENVIRONMENTAL MEDICINE
Spinal degeneration often goes undetected because of the lack of pain and symptoms during the early phases. During the later phases, pain, loss of mobility, stiffness, and a host of neurological conditions become more common.

VERTEBRAL SUBLUXATIONS AND HEALTH CONDITIONS
Vertebral subluxations cause nerve interference which diminishes the inherent healing potential of the human body. Subluxations have been documented to cause a variety of health problems, including headaches, migraines, carpal tunnel syndrome, neck pain, TMJ, sinus infections, ear infections, vertigo, allergies, asthma, thyroid conditions, sinusitis, arm pain, shoulder pain, hormonal imbalance, insomnia, fibromyalgia, and many others
“I have seen pain and illness of the human body caused by subluxations.”16
Dr. Louis Casamajor
Professor of Neurology
We have been conditioned to believe that health problems begin or are indicated by some type of a symptom, but nothing could be further from the truth.
In any health condition, the symptoms are always the last thing to show up and the first thing to go away.
Vertebral subluxations are often referred to as the “silent killer” because they destroy the health and healing potential of the human body long before the presence of any symptoms.
Cervical spine surgery is often necessary in cases involving major accidents, trauma or other obvious pathologies, but in many cases, the surgery could have been prevented by using a mechanical or corrective approach. Most cervical spine surgeries involve the removal of part of or all of the disk or bone, and then fusing the vertebrae together with a bone graft, either in front of or behind the spine. The bone graft may be one of two types: an autograft (bone taken from another part of the person’s body) or an allograft (bone supplied by a bone bank donor). Often, metal plate screws or wires are also used to further stabilize the spine. Cervical spine surgeries always result in loss of function and mobility in the cervical spine.

CERVICAL SPINE SURGERY STATISTICS
From 1979 through 2009, spinal surgeries increased 137%, while the population on whom almost all of the surgeries are performed rose only 23%.
The rate of cervical spine surgery increased 53% from 1979 to 2009, and the rate of cervical fusion surgery increased more than 70%.
The rate of spinal surgery in the United States is 40% higher than any other country.
Complications of cervical spine surgery include nervous system complications (15 per 1,000) and death (6 per 1,000).17
National Center for Vital Statistics

CHIROPRACTIC HEALTH CARE
The science of Chiropractic is founded on the premise that a properly functioning nervous system is the foundation of health, and that the structural integrity of the spinal column must be maintained in order to facilitate optimal nervous system transmission and communication.
Virtually all spinal problems are caused by some type of mechanical or structural stress; therefore, it stands to reason that they require a mechanical correction. Drugs can do little more than suppress the symptoms that may be associated with spinal conditions and surgery, even when required, can eliminate some of the more obvious structural effects of subluxations, but neither can correct and restore the optimal structure of the spine.
Doctors of Chiropractic detect and correct vertebral subluxations by physically adjusting the spine to restore normal spinal function and balance which allows the nervous system to send and receive information. This allows the inherent healing potential of the body to best express itself.
Chiropractic adjustments restore the normal structure of the spine and maximize the posture of the human frame — a process that is unique to the Chiropractic profession
The Chiropractic correction of the spine is not something that happens overnight. The time frame for correction varies with individuals. The corrective process requires time, and usually corrective exercises and changing of ergonomic and postural habits, but the results are worth it.
The pre-care x-ray (fig. 1) shows a lateral view of the cervical spine in which the normal cervical lordosis (curve) has been lost.
This has resulted in vertebral subluxation and abnormal stress on the spinal muscles, tendons, and ligaments. If left uncorrected, spinal degeneration will occur.
The post-care x-ray (fig. 2) shows a lateral view of the cervical spine that has undergone Chiropractic care. The cervical curve (lordosis) has been restored, resulting in the removal of nerve vertebral subluxations and restoration of normal balance, mobility, and stress loads on the spine.
Doctors of Chiropractic have been correcting vertebral subluxations in patients for over one hundred years, which has resulted in the recovery of virtually every known health problem and condition. It is important to remember that all healing is ultimately self-healing and that a Chiropractor simply removes the interference (subluxation) from the body’s master control system.
The effectiveness of Chiropractic care (referred to in scientific literature as “adjustments” or “manipulation”)\has been demonstrated by thousands of scientific research and case studies.
“Even infants can be affected by life- and health-damaging effects of vertebral subluxation, according to a study by Dr. V. Fryman, M.D. The study, published in the Journal of the American Orthopedic Association, says that out of 1,250 infants chosen at random, 211 of them suffered from nervousness, vomiting, muscular abnormalities, tremors, and insomnia. Two hundred (95%) of those children had abnormal cervical (neck) muscle strain, indicating vertebral subluxation. When the subluxation was adjusted and the muscle strain removed, an immediate calming effect resulted: the children’s crying stopped, the muscles relaxed, and the children fell asleep.”20
“Interference to the nervous system results in damage within a short period of time and, therefore, Chiropractic care should begin at birth on a preventive basis”.21
Dr. Arpad DeNagy
“Factual evidence strongly suggests that the atlas adjustment has an effect on the entire nervous system, primarily through its effect on joint mechanoreceptors. The most important proprioceptive information needed for maintenance of equilibrium is derived from the joint receptors of the upper cervical spine, appraising the orientation of the head with respect to the body. Upper cervical misalignments can adversely affect reticular formation activity by abnormal afferentation to the thalamus.”
.UPPER CERVICAL MONOGRAPH
“Subluxation alone is a rational reason for Chiropractic care throughout a lifetime from birth.” 23
Dr. Lee Hadley,
Syracuse Memorial Hospital
“Chiropractors have suspected involvement of the somatoautonomic reflex, and current experimental findings suggest this is a valid assumption. It appears from clinical research that abnormal spinal reflexes can set into motion a wide variety of abnormal pathological and functional processes. The somatoautonomic reflex hypothesis may be the most logical justification for the use of chiropractic adjustments for conditions other than pain.”24
Robert A. Leach,
THE CHIROPRACTIC THEORIES
“Spinal manipulation applied to a restricted atlanto-occipital joint results in an immediate disappearance of spontaneous activity in the oblique capitus superior muscle. With spinal manipulation, this is more rapid than either anesthetic applied to the joint capsule or to the muscle directly.25
MANUAL MEDICINE
“If people truly understood the value and importance of Chiropractic, they would hold their Chiropractor at gunpoint, if necessary, in order to ensure their family was adjusted.”26
Dick Gregory,
Comedian, Author, and Political Activist
“Capsular or ligament injury results in loss and deactivation of mechanoreceptors — the proprioceptive role of the affected segment is adversely affected. Spinal manipulation may help activate receptors and restoring proprioceptive control reduces the chance of re-injury. Hence, it is an important consideration in preventive care.” 27
Basmajan & Ryberg,
RATIONAL MANUAL THERAPY

REFERENCES
1. Tortora, Gerard T. (1996). Principles of Anatomy and Physiology. Benjamin Cummings Publishing, p. 181.
2. Journal of Neurophysiology, 70(5).
3. Gray, Henry MD. Gray’s Anatomy.
4. White, A., & Panjabi, M. Clinical Biomechanics of the Spine. Philadelphia: J. B. Lippincott, p. 2.
5. Junghanns, Herbert MD. (1990). Normal Biomechanical Stress on Spinal Function. Aspen Publishing, p. 32.
6. Naderi, S. MD, & Ozgen, S. MD. (1998, July). Cervical spondylotic myleopathy surgical results: Factors affecting
results. Neurosurgery, 43(1).
7. National Safety Council. (1998). U.S. Automobile Accident Statistics. Itasca, Illinois.
8. Croft, A., & Foreman, S. (1995). Whiplash Injuries: The Cervical Acceleration/Deceleration
Syndrome. 2nd edition. Baltimore, MD: Williams and Williams Publishing.
9. Towbin, Abraham MD. (1998). Brain Damage in the Newborn and Its Neurological Sequels:
Pathological and Clinical Correlation. Danvers, MA: P.R.M. Publishing, p. 137.
10. Schafer, R. DC, Monograph — 22 www.chiro.org/places/mon-22.html
11. Jackson, R. MD. (1978). The Cervical Syndrome. Springfield, Illinois: Thomas Publishing, p. 61.
12. Johannsen. (1990). Neuro-Orthopedics, 1(23).
13. Greive, G. (1986). Modern Manual Therapy of the Vertebral Column. New York: Churchill-Livingston, p. 186.
14. Hadley, L. MD. (1981). Anatomico-Roentgenographic Studies of the Spine. Springfield, Illinois:Thomas
Publishing.
15. Hendrickson, Ingrid J. PhD, & Holewijn MSc. (1999). Degenerative changes of the spines of
fighter pilots of the Royal Netherlands Air Force. Aviation Space Environmental Medicine, 70,
pp. 1057-1063.
16. Dr. Louis Casamajor, Professor of Neurology.
17. National Center for Vital Statistics.
18. Seyle, Hans. Nobel Laureate.
19. Lennon, J. (1994, January). American Journal of Pain Management.
20. Fryman, V. Journal of the American Orthopedic Association.
21. DeNagy, Dr. Arpad. The Rockefeller Institute.
22. Crowe, T., & Kleinman, H. (1991). Upper cervical influence on the reticular system. Upper Cervical Monograph, 5(1), pp. 12-14.
23. Hadley, Dr. Lee. Syracuse Memorial Hospital.
24. Leach, R. DC. (1986). The Chiropractic Theories: A Synopsis of Scientific Research. Williams &vWilkins, p. 150
25. Thabe, MD. (1986). Manual Medicine, 2: pp. 53-58.
26. Gregory, Dick. Comedian, author, and political activist.
27. Basmajian MD, & Ryberg MSc. (1993). Rational Manual Therapy. Williams and Williams Publishing, pp. 451-467.

How Your Cervical Curve Effects Your Health

Brian Bartholomew - Wednesday, July 13, 2011

Forward Head Posture and

Loss of Cervical Lordosis

In a normal spine, the head should be suspended directly over the spine.  This keeps the weight of the head over the body's center of gravity.  The head is suspended not by an inflexible rod, but rather by a 43 degree arc formed by the vertebral bones in the neck.  This arc acts as a shock absorber for our head with every step and jump we make.  Sometimes, because of bad posture while reading or doing computer work (or texting!), or because of an accident, or for any number of reasons, a person's posture will change such that their head is shifted forward in a neutral position.  This condition is called Forward Head Posture (FHP). 

FHP4.jpgThis change in the body's posture has two effects:  one, it reduces the 43 degree arc of the cervical curve, and two, it places the head forward of the body's center of gravity.  Forward head posture causes several problems.

First, for every one inch of forward head posture, the head effectively weights ten more pounds.  Try this yourself:  hold a bowling ball right next to your shoulders, in front; then, shift it forward.  It got heavier, right?  This shift in head position means that the muscles of your neck and your upper back will need to work harder to hold your head up (red star on diagram).  This can cause neck and back pain, and muscle fatigue.  Research has shown that blood flow through a muscle decreases as contraction increases, and is virtually cut off at 50-60% of continuous maximal contraction (click here to read abstract).  Lack of blood flow results in buildup of lactic acid and other metabolites that cause muscle pain and soreness.  Do you always find your upper back muscles fatigued and sore, with massage providing only temporary relief?  Forward head posture could be to blame.

Second, when the head shifts forward of the body's center of gravity, the spinal column in the neck elongates and straightens.  Harrison et al (click here) have clearly shown that loss of the cervical curve alters the mechanical properties of the spinal cord and nerve roots, which may change the firing patterns of the neurons that comprise these structures .  Since the neck contains every neuron that connects your brain with the rest of your body, the spinal cord in the neck is especially important to the function of every organ, cell, and, tissue in your body.  A recent paper by Morningstar and Jockers supports this contention, demonstrating that correction of forward head posture and restoration of cervical lordosis is correlated with increase in pulmonary function (click here).  Furthermore, loss of the cervical curve has been correlated with a myriad of health problems; in fact, one study (click here) found that this condition is predictive of mortality in geriatric populations

Third, loss of the cervical lordosis causes unnatural stresses on the vertebral bones in the cervical spine.  Wolff's Law of Bone Adaptation states that the body will lay down new bone in an area of stress or strain in order to strengthen it; research has shown that this process results in arthritic bone spur growth in the cervical spine (click here).  Forward head posture and loss of the cervical lordosis clearly predispose the spine to arthritis.

Fourth, a study by Stemper et al (click here) has shown that spines lacking the proper 43 degree arc in the cervical spine "enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications."  Given the number of rear-end collisions every day, having your spine more prone to injury due to lack of cervical curve is a big risk to carrry.

Fortunately, chiropractic care can help you to correct forward head posture and loss of cervical curve if you suffer from these conditions.  Forward head posture and loss of cervical lordosis are problems with multiple components, including both vertebral subluxation and soft tissue issues (shortened or tightened or inhibited muscles, trigger points, and potentially fasical adhesions).  At Bartholomew Family Chiropractic we have created a specific program that will address each of these problems and help you to reduce or correct both forward head posture and loss of cervical curve. 

What sorts of benefits might you see from correcting forward head posture and restoring your cervical curve?  For one, less stress on your body from not fighting to hold your head upright will certainly be good for your health; but more importantly, reducing mechanical deformation of the tissues of your spinal cord and nerve roots will allow your nervous system function at its best.  Furthermore, restoration of the cervical curve can reduce your risk of whiplash injury in the event of an accident.  Lastly, correction of FHP and cervical curve problems can increase your body's oxygen supply.  

Would you like to see health benefits like these?  Call or email us to get your spine assessed for forward head posture and for the integrity of your cervical curve today, so you can start your progress towards a healthier life tomorrow.

How Do Head Weights Help Correct The Spine?

Brian Bartholomew - Wednesday, July 13, 2011
Improvement of Cervical Lordosis and Reduction of
Forward Head Posture with Anterior Head Weighting
and Proprioceptive Balancing Protocols


E. Stephen Saunders, D.C.1 Dennis Woggon B.S, D.C.2
Christian Cohen B.S. D.C.3 David H. Robinson, PhD.4

ABSTRACT
Background and Objectives: Evidence of the kinesiopathological
component of the vertebral subluxation complex
is frequently apparent in observation and assessment of posture.
Postural distortion from loss of the normal cervical lordosis
has been referred to as forward head posture (FHP) and
may precipitate pain, decreased ranges of motion and other
health problems. FHP can be quantified by measurement of
neutral lateral cervical radiographs. The objective of this study
was to determine if the use of head weighting and balancing
protocols could improve the cervical curvature and head carriage.
Methods: One hundred and thirty one patients from six Chiropractic
clinics in the United States, two in Canada and one
in the Russian Federation participated in the study. Study participants
were randomly selected and assessed with neutral
lateral cervical radiographs. These patients performed motion
activities while wearing three or five pounds of weight
on the front of their heads for five minutes then a weighted
stress lateral cervical film was taken.
Results: A comparison of the measured results from the two
films was made considering the cervical lordosis and FHP.
Average improvements in the cervical lordosis of 34% (p <
.0001) and in FHP 14mm (p < .0001) were noted after the
head weighting protocol was preformed with five pounds. Improvement
of cervical lordosis of 31% (p < .001) and in FHP
18mm (p < .0001) was recorded in a group using three pounds
of weight.
Conclusion: Head weighting may prove to be a useful therapeutic
tool in addressing FHP and the concurrent loss of the
normal cervical lordosis.

Key words: cervical lordosis, forward head posture, anterior
head weighting, proprioceptive retraining, wobble chair,
vertebral subluxation.
Introduction
The biomechanical ideal configuration for the human cervical
spine is a posterior concave arc or lordosis.1,2,3 This positions
the center of gravity of the skull over the mid cervical
vertebrae.4 The loss or reversal of the normal cervical lordosis
and attendant forward head posture has long been identified
with numerous consequential health problems5 including decreased
vital lung capacity,6 cervical, interscapular and headache
pain,7,8 and temporomandibular disorders.9 Many symptoms
may be moderated or eliminated by improving posture.10
Chiropractors and other health care professionals have attempted
to measure and correct these postural problems through spinal
adjustments and rehabilitative protocols. Successes in changing
forward posture through spinal adjusting and other therapeutic
activities have been reported but routine predictable
changes have not. Published opinion and unpublished clinical
research has suggested that purposefully attached external
weights can cause the body’s righting reflexes to react and correct
posture to a more ideal state.10,11 Proprioceptive balance
activities have been used therapeutically in recent times and
studies show that stimulation of sensory receptors in spinal ligaments
elicits reflex activity in the paraspinal muscles and contributes
to maintaining spinal stability.11,12,13 There are five righting
reflexes14 that relate to proprioception (orientation in time
and space). See Table 1, page 2.
To our knowledge, no literature exists that combines proprioceptive
activities with corrective external weighting protocols
to produce postural improvements that are measurable on
radiographs.
Methods and Materials
One hundred and thirty one patients from six Chiropractic
clinics in the United States, two in Canada and one in the Russian
Federation participated in the study. Eighty female and
1. Locum tenens, Seattle Washington
2. Private Practice St. Cloud, Minnesota
3. Private Practice Kankakee, Illinois
4. Professor and Chair, Department of Statistics, St. Cloud State University,
St. Cloud, Minnesota
Improvement of Cervical Lordosis J. Vertebral Subluxation Res., April 27, 2003 2
fifty-one male patients were tested. There ages ranged from 11
to 92 years. Patients were consecutively selected for the study
from the pool of incoming new patients in each field practice.
They were evaluated before any therapeutic intervention. Neutral
lateral cervical views were taken. Films were analyzed and
loss of the cervical curve measured, using Jackson’s Angles.2
George’s lines were extended down from the posterior margin
of the second cervical vertebral body and up from the posterior
margin of the seventh cervical vertebral body.15 The angle of
intersection of these two lines was measured. The loss of curve
was calculated by converting the angle to a percentage of loss
by ascribing 2.25 percent loss per degree less than the fortyfive
degree normal lordosis.2,16 Kyphotic curves were recorded
in percentages greater than 100% and double or triple buckled
curves had the separate percentage losses added together.14 Forward
head posture was calculated by measuring the distance
between the anterior quarter of the C4 - C5 inter-space and a
gravity line that was constructed perpendicular to the superior
border of the film that bisected the anterior margin of the sella
tursica.4
Patients were then fitted with a five- pound anterior head
weight made up of chilled lead shot in a cloth headband. Participants
in the Russian federation used 1500 grams or approximately
three pounds of weight. The headband was velcroed
securely around the head with the weight over the frontal and
temporal bones. The patient wore this weight while seated on a
proprioceptive training chair, The Wobble Chair.™ The chair
seat is freely movable on a pivotal axis and allows 20 degrees
of pivot off its vertical center, to each point of the compass.
The chair allows 360 degrees of rotation. Each patient was
instructed to rock backward and forward, from side to side and
rotate in circular motions while on the chair. They were instructed
to look straight ahead and keep their head and shoulders
relatively still while performing these maneuvers. After
the subject was timed, continuing these activities for five minutes,
a neutral lateral stress radiograph was taken while the patient
continued wearing the head weight. This weighted view
was analyzed in the same manner as the neutral view and the
results were compared. Thirty of the study participants x-rays
were consecutively sampled and lines were drawn parallel with
the hard palate and the bite line. These were then compared to
the edge of the film in the initial and subsequent radiographs to
determine if the patient’s head and cervical spine were in the
neutral position.18
Table 1: The Five Righting Reflexes
Labyrinthine (inner ear) maintains the head’s orientation in
space (medulla)
Optic (ocular) keeps the head in proper
orientation to its gravitational
environment (occipital cortex)
Neck righting (joints of keeps the body orientated to the
reflex the neck) head (medulla).
Body righting (body surface orientates the body in space
reflex receptors) (medulla).
Body righting keeps the head, oriented to the
reflex #2 body (midbrain).
Patient performs proprioceptive exercises on Pettibon Wobble
Chair™ with five pounds of anterior head weight for five minutes.
Results
The average loss of the cervical curve was 94% in the North
American cohort. 35 of the 97 subjects had kyphotic or kyphotic
S curves of the cervical spine. Forward head posture
averaged 1.2 inches or 31mm for the 97 subjects. Average loss
of curve was 76% in the smaller sample from the Russian Federation.
FHP averaged 30mm or 1.1 inches in this smaller
sample. Films taken after the proprioceptive training activity,
with the subjects weighted, demonstrated average loss of curve
improved from 94% to 58% loss, a 34% improvement, in the
North American study group.
A paired t-test showed this improvement to be highly significant
in a statistical sense (t = 7.20, p < .0001). Data from
the Clinic in Vladivostok identified average improvements from
76% loss of curve to 45% loss of the cervical lordosis, a 31%
improvement. A paired t-test showed this improvement to also
be highly significant in a statistical sense (t = 3.92, p < .001).
Forward head posture improved from an average of 31 to 17
mm, for a total of 14 mm improvement of anterior head translaImprovement
of Cervical Lordosis J. Vertebral Subluxation Res., April 27, 2003 3
Discussion
Case reports in the chiropractic literature have demonstrated
positive changes in the cervical lordosis as a result of specific
chiropractic care. Wallace et al have reported a close association
between changes in the cervical curve and decreased subjective
symptoms.17
A comparison of the data from the North American sites and
the Russian Federation revealed a surprising consistency and
has suggested that there is a range of weight that produces beneficial
changes. Prior to the trial, clinical observations had suggested
that three pounds was insufficient to produce the desired
changes in individuals with significant degenerative joint
disease in the cervical spine. Due to the fact that the Russian
participants were younger and with less pathology, this may
suggest utilizing a 3-pound head weight on a non-pathological
cervical spine and a 5-pound head weight where osteoarthritic
degenerative changes are present. The amount of the weight
may also be varied based on patient strength, stature and comfort.
One subject demonstrated a significant worsening of the
lordosis and the magnitude of forward head posture. It is speculated
that this individual was of slight stature and with her relatively
small muscle mass, the cervical spine buckled with the
five-pound weight.
An important and pertinent finding from this study was that
the changes in the cervical curve and forward head posture were
produced within five minutes without any other therapeutic intervention
other than the proprioceptive activity while wearing
the head weight. The study did not evaluate whether the changes
were apparent after the subject removed the head weight or
whether the protocol produced lasting changes. Further study
is necessary to evaluate these questions.
It was also noted that the kyphotic and kyphotic S-curved
necks responded better than a lordotic S-curve or a hypolordotic
curve. It is unknown why individuals with kyphotic or kyphotic-
S curves showed such large improvements during the
head weighting protocol. This may simply be a product of the
magnitude of the percentage loss of curve calculated in the kyphotic-
S configurations. It may represent rapid adaptation to
the imposed demands of the weight with an unstable spine and
demonstrate the spines ability to alter structure to a more efficient
configuration.
It is proposed that external head weighting is based on adaptive
principals, forcing the body to react in ways that produce a
more optimum posture. The frontal head weight imbalances
the skull, which in turn activates the extensor muscles that then
cause the front of the skull to rotate upward. The upward rotated
skull causes the optic and labyrinthine righting reflexes as
well as the mechanoreceptors and body surface receptors to
bring the optic righting reflex in line with the horizon by activating
the cervical flexor muscles.
Conclusions
Anterior head weighting combined with proprioceptive retraining
activities produced significant and immediate improvements
in forward head posture in a sample group. The encouraging
initial results demonstrate large improvements in static
posture. This suggests that these simple therapeutic protocols
tion in the American cohort. A paired t-test showed this improvement
to be highly significant (t = 13.11, p < .0001). The
Russian sample showed an average of 18 mm improvement,
again highly significant (t = 8.50, p < .0001). The sample of
thirty patients in the American cohort showed an average change
of 2.70 degrees of the hard palate angles from the non-weighted
to the weighted x-rays. This verifies that there was good consistency
with patient positioning.
Further investigation of the relationship of the percentage
loss before and after the training activity continued by examining
the scatterplot of the two % loss variables in the American
cohort. The graph of the 97 subjects is shown in Figure 1.
The patients plotted in the lower right-hand corner of the
graph experienced the greatest improvement (reduction) in %
loss. These are some of the 35 patients exhibiting kyphotic or
kyphotic S curves of the cervical spine. The North American
cohort was then separated into two subgroups. Group 1 was
the 35 subjects with kyphotic or kyphotic S curves (% loss
greater than 100), while Group 2 were the 62 subjects not exhibiting
this condition. (In Figure 1, Group 1 is all points on
the right side and Group 2 is all points on the left side.) Table 2
summarizes the statistical information from the two groups.
Table 2: North American Cohort (training with 5 lb)
Group 1 Group 2 Overall
N = 35 N = 62 N = 97
Before training, Mean % Loss 166% 54% 94%
(Std Error of Mean) (6%) (3%) (6%)
After training, Mean % Loss 93% 39% 58%
(Std Error of Mean) (8%) (4%) (5%)
Separate t-tests were run on the two groups to see if each
group exhibited significant improvement. For Group 1, the
average loss of curve improved from 166% to 93%, a 73% improvement.
The paired t-test showed this to be a highly significant
improvement (t = 7.53, p < .0001). For Group 2, the average
loss of curve improved from 54% to 39%, a 15% improvement.
The paired t-test showed this to also be a highly significant
improvement (t = 4.50, p < .0001). There was no significant
difference in age or gender composition between the two
groups.
Improvement of Cervical Lordosis J. Vertebral Subluxation Res., April 27, 2003 4
31 mm. to 15 mm. 1.2" to .6" 196% to 52%
61mm. to 31mm. 2.4" to 1.2" 134% to 89%
32 mm. to 15 mm. 1.3" to .6" 41% to 7%
20 mm. to 0 mm. .8" to 0" 74% to 32%
(Note Harrington Rod)
69 mm. to 23 mm. 2.7" to .9" 211% to 70%
may be recommended to patients with health problems related
to forward head posture and combined with traditional adjusting
approaches to produce significant postural improvements.
These inexpensive, low-tech activities can be administered as
active care protocols that, after coaching, can be performed by
patients without provider supervision at home. Additional studies
are needed to determine the long-term effects of this adjunctive
rehabilitation to ascertain if this protocol makes lasting
changes to the posture and function of the spine.
Improvement of Cervical Lordosis J. Vertebral Subluxation Res., April 27, 2003 5
Acknowledgments
This study utilized data submitted by Gary C. Lawrence D.C.,
Stillwater Minnesota; David W. Butler B.E.S., D.C., Alexandria
Minnesota; Ian J. Horseman D.C., Toronto Canada; Martin
K. Kuwamoto D.C., Fresno California; William A Watt D.C.,
Sundre Canada; Michael L. Milasich.D.C., Tacoma Washington,
Jeffrey A. Cronk D.C., Seattle Washington and St. Cloud
Chiropractic Clinic, St. Cloud MN. Alexey Ushkov M.D. and
his colleagues made a substantial contribution from "Spine" the
Regional Center for Chiropractic in Vladivostok, Russia. The
Chiropractic Leadership Educational Advancement and Research
Institute in St. Cloud Minnesota funded consulting fees
for David H. Robinson PhD for statistical analysis.
References:
1. Harrison DD, Janik T, Troyanavich S, Holland B, Comparisons of Cervical
Spine Curvatures to a Theoretical Model of the Static Sagittal Cervical
Spine, Spine 1996 21: 667-675
2. Jackson R, The Cervical Syndrome 3rd Edition: 35-42, Charles C Thomas
Publisher 1971
3. Pettibon BR, Harrison DD, Pettibon Spinal Biomechanics Theory and
Implications, 2nd Edition, Pettibon Biomechanics Institute1984
4. Kapandji I A, Physiology of the Joints Volume 3, Churchill Livingston
1974
5. Wallace HL, Jahner S, Buckle K, Desai N: The Relationship of Changes
in Cervical Curvature to Visual Analog Scale, Neck Disability Index Scores
and Pressure Algometry In Patients with Neck Pain. Journal of Chiropractic
Research and Clinical Investigation, Volume 9 (1) 19-23 1994
6. Cailliet R, Rejuvenation Strategy, 52-58 Doubleday and Co 1987 52-58
7. Greigal-Morris P, Larson K, Mueller-Klaus K, Oatis C A Physical Therapy
1992 June: 72 (6): 425-31
8. Watson DH, Trott PH, Cephalgia 1993 Aug; 13 (4): 272-84
9. Lee WY, Okeson JP, Lindroth J. Journal of Orofacial Pain 1995 Spring:
9(2): 161-7
10. Lennon J, Sealy CN, Cady RK, Matta W, Cox R, Simpson F, Postural and
Respiratory Modulation of Autonomic Function, Pain and Health AJPM
Jan 94 4(1) 36-39
11. Solomonow M. PhD Spine 1998; 23(23): 2552-2562
12. Cailliet R, Neck and Arm Pain, 2nd Edition 134 FA Davis Company 1981
13. Hongxing J, MB PhD Spine 1997; 22(1): 17-25
14. Chusid, Correlative Neuroanatomy & Functional Neurology, 19th Edition,
1985, 56, Lange Medical Publications
15. Pettibon BR, Woggon D, Pettibon Spinal X-ray System, 1989, Pettibon
Spinal Biomechanics Institute
16. Pettibon et al, Introduction to Spinal Biomechanics, 1-19, Pettibon Spinal
Biomechanics Institute, 1989
17. Wallace HL, Jahner S, Buckle K, Desai N: The Relationship of Changes
in Cervical Curvature to Visual Analog Scale, Neck Disability Index Scores
and Pressure Algometry In Patients with Neck Pain. Journal of Chiropractic
Research and Clinical Investigation, Volume 9 (1) 19-23 1994
18. Harrison DE, Harrison DD et al. Slight Head Extension: Does it Change
the Sagittal Cervical Curve? European Spine Journal 2001; 10 149-153

Curve in The Neck, Headaches and Neck Pain

Brian Bartholomew - Wednesday, July 13, 2011

In this blog post we review many studies showing that loss of the spinal cervical curve or the curve in the neck can cause neck degeneration, headaches and neck pain.

Journal of Manipulative and Physiological Therapeutics
J Manipulative Physiol Ther. 1994 Sep;17(7):454-64.  

The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study.

Harrison DD, Jackson BL, Troyanovich S, Robertson G, de George D, Barker WF.
Chiropractic BioPhysics, Non-Profit, Inc., Harvest, AL 35749.

OBJECTIVE: To experimentally investigate the effect of cervical extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting in establishing or increasing cervical lordosis. DESIGN: Blinded, before and after trial with pre- and postlateral cervical radiographic measurement. SETTING: Primary care private chiropractic clinic in Saugus, MA. SUBJECTS: A) Control group--convenience sample who had no health care for 10-14 wk, 30 persons. B) Treatment group 1, nonrandomized control trial, 35 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7. C) Treatment group 2, nonrandomized control trial, 30 persons, whose pre- and postlateral cervical radiographs were taken 10-14 wk apart and whose radiographs clearly depicted C1 through C7.

INTERVENTIONS: Treatment group 1: diversified spinal manipulation, drop table adjustments and cervical extension-compression traction five times per week for 10-14 wk (12 wk +/- 2). Treatment group 2: diversified spinal manipulation and drop table adjustments five times per week for 10-14 wk (12 wk +/- 2). MAIN

OUTCOME MEASURES: Anterior head translation millimeters, C2 to C7 absolute rotation angle, angle of C1 to horizontal (atlas plane angle), five relative rotation angles (C2-3, C3-4, C4-5, C5-6, C6-7) and qualitative classification of lordotic configuration. RESULTS: No statistically significant changes existed between the pre- and posttests for the control group except in the C6-7 relative rotation angle. In the treatment group 1, statistically significant differences were found in all X-ray markings. Twenty-nine of 35 members have a lordosis after treatment compared to 11 of 35 before treatment. The C2 to C7 angle changed an average 13.2 degrees, C1 to horizontal changed an average 9.8 degrees, the anterior head translation reduced an average of 6.8 mm, the average relative rotation angle changed: C2-3: 3.1, C3-4: 5.5, C4-5: 4.80, C5-6: 2.7 and C6-7: 1.1. In the treatment group 2, no statistically significant changes existed between the pre- and posttests except atlas angulation to horizontal which increased an average of 3.0 degrees.

CONCLUSIONS: A transformation to a lordotic configuration or increase in lordotic configuration occurred and was measured in the majority of treatment group 1 subjects, while no change in the control group and essentially no change in treatment group 2 was measured. Extension-compression traction combined with diversified chiropractic manipulation and drop table adjusting procedures may improve or partially reestablish the cervical lordosis in 10-14 wk of daily care.

Publication Types:
· Clinical Trial
· Randomized Controlled Trial

PMID: 7989879 [PubMed - indexed for MEDLINE]

CBP Structural Rehabilitaion of the Cervical Spine, Deed E. Harrision, DC, Donald D. Harrison, PhD, DC, MSE, Jason W. Haas, DC, 2002 Harrison CBP Seminars, Inc.  pg. 56, “Cervical Lordosis and Headaches”

     We believe it relevant that several studies have investigated and linked the relationship of altered cervical curve configuration to the presence of chronic headache pain.  In a survey of over 6,000 cases of chronic headache sufferes, Braaf and Rosner found that “complete or segmental loss or reversal of the normal lordotic curve of the cervical spine is the most consistent tension and migraine headaches, Vernon et al. found a high incidence of hypolordosis, straightened and reversed cervical curve configurations.  Also, Nagasawa et al. compared 372 patients with tension headaches to 225 controls matched for age and sex.  They found patients with tension headaches to 225 controls matched for age and sex.  They found statistically significant differences between the two groups, with patients having straightened curve was straight more frequently.  This information contrasts nicely with the findings of Gore et al., where in asymptomatic subjects, the cervical curve increased with age.  Gore et al. found that the average C2-C7 lordosis was 27 degrees in their older asymptomatic patients compared to an average 23 degree for all asymptomatic patients.

CBP Structural Rehabilitaion of the Cervical Spine, Deed E. Harrision, DC, Donald D. Harrison, PhD, DC, MSE, Jason W. Haas, DC, 2002 Harrison CBP Seminars, Inc. Studies Referenced in “Cervical Lordosis and Headaches”

1.  Headache. 1993 Feb;33(2):90-5.  

Roentgenographic findings of the cervical spine in tension-type headache.
Nagasawa A, Sakakibara T, Takahashi A.

Department of Neurology, Nagoya University School of Medicine, Japan.

Roentgenographic studies were carried out on 372 patients with tension-type headache and 225 normal control subjects to determine relationships between straightened cervical spines, low-set shoulders, and cervical spine instability. A great majority of the patients with tension-type headache were found also to have straightened cervical spine. Patients with tension-type headache may have a restricted progression of the cervical spinal lordosis, which results in a straightened cervical spine. The flexor muscles of the head and neck prevent physiological lordosis of the cervical spine, and their sustained chronic contraction may be a principal cause of a straightened neck. The low-set shoulder was frequently seen in patients with tension-type headache, and it may result in traction of the brachial plexus, which gives rise to pain in the neck and shoulders. Cervical spine instability, on the other hand, was rather infrequent in patients with tension-type headache. Its relationship to tension-type headache is unclear and warrants further study. Our results suggest that both a straightened cervical spine and low-set shoulders may play an important role in the pathogenesis of tension-type headache and its accessory symptoms.

PMID: 8458729 [PubMed - indexed for MEDLINE]

2.  J Manipulative Physiol Ther. 1992 Sep;15(7):418-29.  

Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.

Vernon H, Steiman I, Hagino C.
Center for the Study of Spinal Health, Canadian Memorial Chiropractic College, Toronto, Ontario.

OBJECTIVE: The prevalence and nature of findings of cervicogenic dysfunction is explored in subjects with muscle contraction/tension-type (MCH) headache and common migraine without aura (CM). DESIGN: Descriptive survey. SETTING: Chiropractic outpatient research clinic. PATIENTS: Forty-seven (47) subjects, aged 18-55 with two categories of benign headache, were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an intervention trial and, thus, form a consecutive sample of patients. The present findings were elicited as part of the initial assessment. INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURES: Standardized headache history; plain film and dynamic spinal X rays; motion palpation; and pressure algometry. RESULTS: For CM, the most prevalent headache locations were frontal (81%) and occipital (78%). Neck pain and upper back pain accompanied headache in 90% and 41% of subjects, respectively. For MCH, the most prevalent headache locations were occipital (87%) and frontal (81%). Neck and upper back pain accompanied headache in 100% and 27%, respectively, of all subjects. For the total group, 77% of all subjects and 89% of females exhibited a marked reduction, absence or reversal of the normal cervical lordosis. Ninety-seven percent of all subjects exhibited, on dynamic X-ray studies, at least one significant abnormality of segmental mobility from C1 to C7, while 43% exhibited abnormalities at four or more segments. Segmental motion at C0-C1 was reduced in 90% of subjects in flexion and 70% of subjects in extension. On motion palpation, 84% of CM and MCH subjects were found to have at least two major fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had at least one verifiable tender point (TP) in the upper cervical region. The most common locations for TPs were mid-cervical (C2-C3), lateral occipital and suboccipital. CONCLUSIONS: Both MCH and CM subjects demonstrate high occurrences of: a) occipital and neck pain during headaches; b) tender points in the upper cervical region; c) greatly reduced or absent cervical curve; and d) X-ray evidence of joint dysfunction in the upper and lower cervical spine. These findings support the premise that the neck plays an important, but largely ignored role in the manifestation of adult benign headaches. A case-control study should be conducted to confirm the greater prevalence of cervicogenic dysfunction in headache as compared to nonheadache subjects.

PMID: 1342581 [PubMed - indexed for MEDLINE]

3.  Spine. 2001 Nov 15;26(22):2463-6.  

Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up.

Gore DR.
Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

STUDY DESIGN: The lateral roentgenographic findings in 159 initially asymptomatic persons were reviewed at a 10-year interval. A questionnaire was used at the time of the last roentgenogram to determine the incidence of pain. OBJECTIVES: To identify the number of persons who experienced pain during that 10-year period, describe the roentgenographic changes, and determine the association between the development of symptoms and roentgenographic findings. SUMMARY OF BACKGROUND DATA: It is well established that degenerative changes of the cervical spine increase with age and may occur in asymptomatic persons. However, it is unknown whether pain is more likely to develop in persons with degenerative changes than in those with normal roentgenograms. METHODS: Lateral cervical roentgenograms were obtained in 200 asymptomatic persons, 100 women and 100 men, to obtain normal values of cervical lordosis and degenerative changes in persons aged 20-65 years. Ten years later, 159 participants had repeat roentgenograms and were administered a questionnaire regarding the presence or absence of pain. RESULTS: There was an increase in the number of subluxations and an increase in degenerative changes. Pain developed in 15% of participants in the 10-year interval. The presence of degenerative changes at C6-C7 on the initial roentgenogram was a statistically significant predictor of pain. CONCLUSION: With age, there is an increase in the number of subluxations and the incidence and severity of degenerative changes. Pain is more likely to develop in persons with degenerative changes at C6-C7.

PMID: 11707711 [PubMed - indexed for MEDLINE]

Other Studies:
There are several studies indicating cervical kyphosis as a factor predicting por results after whiplash injury.  In a 5-year long-term follow-up of 146 patients’ with whiplash injury.  Hohl identified cervical kyphosis as a factor predicting a poor outcome.  Norris and Watt followed 61 patients involved in motor vehicle accidents for a minimum of six months.  They found that abnormal neck curves “…are more common in patients with a poor outcome.”  In a prospective study, Ettlin et al. found that loss of lordosis was very common (68%) in patients with cerebral symptoms due to whiplash injury.

  •  Recently in a prospective study of 110 patients, Kai et al. studied the relationship of neurogenic thoracic outlet syndrome (NTOS) to whiplash injury.  They found an incidence of cervical kyphosis of 44%-46% in the patients with NTOS compared to 11-24% in the subjects without NTOS.  Kai et al. concluded that reversal of the cervical lordosis was abnormal and cervical lordosis is a significant finding after whiplash injury.  Lastly, several studies have demonstrated that whiplash injuries do indeed cause reversals and other changes in the configuration of the cervical lordosis. 

CBP Structural Rehabilitaion of the Cervical Spine, Deed E. Harrision, DC, Donald D. Harrison, PhD, DC, MSE, Jason W. Haas, DC, 2002 Harrison CBP Seminars, Inc.  “Studies indicating Cervical Lordosis is related to pain after Whiplash”

1.  J Bone Joint Surg Br. 1983 Nov;65(5):608-11.  

The prognosis of neck injuries resulting from rear-end vehicle collisions.

Norris SH, Watt I.

Injury of the neck may result when a motor vehicle is run into from behind; such injury is frequently the cause of prolonged disability and litigation. We report a series of 61 patients with these injuries. A classification, based upon the presenting symptoms and physical signs has been evolved. This classification is shown to be a reliable basis for formulating a prognosis. Factors which adversely affect prognosis include the presence of objective neurological signs, stiffness of the neck, muscle spasm, and pre-existing degenerative spondylosis.

PMID: 6643566 [PubMed - indexed for MEDLINE]
2. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):943-8.  

Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury.

Ettlin TM, Kischka U, Reichmann S, Radii EW, Heim S, Wengen D, Benson DF.

University Clinics, Basel, Switzerland.

Twenty one unselected patients with an acute whiplash injury of the neck had neurological and neuropsychological assessment, cervical x rays, EEG, BAEP, MRI, and an otoneurological examination within two weeks of the injury. Subjectively, 13 patients reported concentration deficits, 18 reported sleep disturbances, 9 had symptoms of depression, and 7 female patients told of menstrual irregularities. Neuropsychological examination revealed significantly lower performance in tests related to attention and concentration compared to sex, age and educational matched control subjects. Otoneurological examination showed abnormalities in 9 of 17 whiplash subjects. EEG showed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in all patients. Repeat neuropsychological testing in 15 patients at three months showed that attention deficits had improved but were still shown in 12 of 14 and the concentration deficits in 8 of 13 patients. At one year all patients had returned to work, 16 to full and 5 to part time employment. In 4, cognitive dysfunction remained the only significant problem. These findings are discussed as being compatible with possible damage to basal frontal and upper brain stem structures after whiplash injury of the neck.

PMID: 1431958 [PubMed - indexed for MEDLINE]

3. J Spinal Disord. 2001 Dec;14(6):487-93.  

Neurogenic thoracic outlet syndrome in whiplash injury.

Kai Y, Oyama M, Kurose S, Inadome T, Oketani Y, Masuda Y.

Orthopaedic Surgery, Fukuoka City Hospital, Fukuoka, Japan.

A prospective study of 110 patients was carried out to determine the pathogenic significance of trauma to the upper body in the development of neural compressive irritation at the thoracic outlet. Twenty-nine patients were reviewed as cervical strain injuries (N group), 25 patients as probable neurogenic thoracic outlet syndrome (NTOS) (PT group), 39 patients as definite NTOS (T group), and 17 patients as NTOS associated with cervical disc disease (CD-T group). The time lapse between accident and diagnosis and the duration of treatment were significantly longer in T patients or CD-T patients than those in the N group. Radiography of NTOS patients also showed a higher percentage of cervical spine-length/height ratio. Traumatic NTOS would suggest two types related to direct damage of scalene muscles that included some physical aspects of cervical disc disease. Pathogenesis provided a key to the resolution of more complex posttraumatic problems of whiplash injury.

PMID: 11723397 [PubMed - indexed for MEDLINE]

4. Am J Med. 2001 Jun 1;110(8):651-6.  
Whiplash: a review of a commonly misunderstood injury.

Eck JC, Hodges SD, Humphreys SC.

University of Health Sciences, College of Osteopathic Medicine, Kansas City, Missouri, USA.

Whiplash injury is a relatively common occurrence, but its mechanism and optimal treatment remain poorly understood. It is estimated that the incidence of whiplash injury is approximately 4 per 1,000 persons. The most common radiographic findings include either preexisting degenerative changes or a slight flattening of the normal lordotic curvature of the cervical spine. Computed tomography and magnetic resonance imaging are generally reserved for cases of neurologic deficit, suspected disc or spinal cord damage, fracture, or ligamentous damage. Biomechanics studies have determined that after rear impact C6 is rotated back into extension before movement of the upper cervical vertebrae. Thus, the lower cervical vertebrae were in extension while the upper vertebrae were in a position of relative flexion, producing an S shape in the cervical spine. It is believed that this abnormal motion pattern might play a role in the development of whiplash injuries. Historically, a soft cervical collar has been used early after the injury in an attempt to restrict cervical range of motion and limit the chances of further injury. More recent studies report rest and restriction of motion to be detrimental and to slow the healing process.
PMID: 11382374 [PubMed - indexed for MEDLINE]


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