The Forward Head Posture Page
Persistent forward head posture (a.k.a “hyperkyphotic posture”) puts compressive loads upon the upper thoracic vertebra, and is also associated with the development of Upper Thoracic Hump, which can devolve into Dowager Hump when the vertebra develop compression fractures (anterior wedging). A recent study found this hyperkyphotic posture was associated with a 1.44 greater rate of mortality.
Does Cervical Kyphosis Relate to Symptoms Following Whiplash Injury?
Manual Therapy 2011 (Aug); 16 (4): 378–383
Editorial Comment: This is an intersting study. I have issue with the fact that these studies were taken in the supine position (based on the limitations of MRI technology.) Chiropractors have noted since the 1920s that sitting vs. standing films of the same subject made significant changes in the architecture of the cervical spine. Sitting films made the neck *look* like it had more lordosis than it had in standing position. Further, the presence of Forward Head Posture is impossible to determine in supine films. How can you address a problem you can't observe in your special studies?
Accurate Prognosis in Personal-Injury Cases Using George's Line
Dynamic Chiropractic ~ March 26, 2010
The AMA's Guides to the Evaluation of Permanent Impairments uses George's Line to rate neck impairments. A moderate (3.5 mm) break in George's Line on the flexion and extension lateral X-ray films is a permanent impairment, equivalent to a post-surgical fusion of two cervical vertebra. Most chiropractors see small anterolisthesis and/or retrolisthesis on the films and ignore it or fail to appreciate its significance. Since 35 percent to 45 percent of trauma patients have this injury, it is very likely you have failed to diagnose it many, many times. By failing to diagnose this injury, you have failed to accurately, thoroughly and honestly describe your patient's injuries to the claim adjusters and attorneys, who will use the facts in your patient chart as the basis for the personal-injury settlement. These people need you, the doctor, to give them all the facts so a fair settlement can be reached. The jury also needs to understand whether your patient had this injury in order to decide how much to award your patient in a trial verdict.
Alteration of Motion Segment Integrity
Dynamic Chiropractic ~ November 18, 2010
Alteration of motion segment integrity is determined by exact mensuration procedure published in the AMA Guides to the Evaluation of Permanent Impairment. It is a spinal subluxation that can be objectively identified with a high degree of accuracy, especially when one acknowledges the advancements that have occurred in assessment of stress imaging (X-ray, DMX).
Effects of Abnormal Posture on Capsular Ligament Elongations
in a Computational Model Subjected to Whiplash Loading
J Biomech 2005 (Jun); 38 (6): 1313—1323
Although considerable biomechanical investigations have been conducted to understand the response of the cervical spine under whiplash (rear impact-induced postero-anterior loading to the thorax), studies delineating the effects of initial spinal curvature are limited. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.
Determining the Relationship Between Cervical Lordosis and Neck Complaints
J Manipulative Physiol Ther 2005 (Mar); 28 (3): 187-193
In a study of 277 lateral cervical x-rays, patients with lordosis of 20° or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0° or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0° or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges.
Cervical Kyphosis is a Possible Link to Attention-deficit/hyperactivity Disorder
J Manipulative Physiol Ther 2004 (Oct); 27 (8): e14 ~ FULL TEXT
A 5-year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12 degrees C2-7 kyphosis to a 32 degrees C2-7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behavior vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis.
Cervical Spine Curvature During Simulated Whiplash
Clin Biomech 2004 (Jan); 19 (1): 1-9
Average peak lower cervical spine extension first exceeded the physiological limits (P<0.05) at a horizontal T1 acceleration of 5 g. Average peak upper cervical spine extension exceeded the physiological limit at 8 g, while peak upper cervical spine flexion never exceeded the physiological limit. In the S-shape phase, lower cervical spine extension reached 84% of peak extension during whiplash. Both the upper and lower cervical spine are at risk for extension injury during rear-impact. Flexion injury is unlikely.
Cervical Spine Geometry Correlated to Cervical Degenerative Disease
in a Symptomatic Group
J Manipulative Physiol Ther 2003 (Jul); 26 (6): 341-346
Chiropractors have long maintained that loss of spinal curvature was a sign of loss of function that leads to degenerative joint disease. This paper discusses "5 geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease."
Is the Sagittal Configuration of the Cervical Spine Changed in Women with Chronic Whiplash Syndrome? A Comparative Computer-assisted Radiographic Assessment
J Manipulative Physiol Ther 2002 (Nov); 25 (9): 550-555
The whiplash group showed a decreased ratio between the lower versus upper cervical spine but comparisons between groups were not statistically significant. The whiplash group was in a significantly more flexed position at the C4-C5 level compared with the asymptomatic group (P =.007). The reliability measures have to be strengthened to render these results definitely conclusive.
Sagittal Alignment of Cervical Flexion and Extension:
Lateral Radiographic Analysis
Spine Journal 2002 (Aug 1); 27 (15): E348–E355
The results suggest that alterations in the static alignment
of the cervical curvature cause alterations in the dynamic kinematics of the cervical spine during cervical flexion-extension. This information should aid in the interpretation of kinematic studies of the cervical spine.
The Use of Flexion and Extension MR in the Evaluation of Cervical Spine Trauma: Initial Experience in 100 Trauma Patients Compared with 100 Normal Subjects
Emerg Radiol 2002 (Nov); 9 (5): 249—253
The cervical spines of 100 consecutive uninjured normal asymptomatic adults and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI. Injured subjects were evaluated during the subacute period, at 12 to 14 weeks after injury. The "normal subjects" showed: Loss of normal cervical lordosis (hypolordosis) in 4% (4 of 100) patients: Range of motion of 50° flexion, and 60° extension; and asymptomatic disk herniations were observed in 2% (2 of 100) patients.
In the subacute post-traumatic subjects, there was a loss of the normal segmental motion pattern, with hypolordosis in 98% (98 of 100) patients. Range of motion was restricted, quantified as 25° flexion and 35°; and disk herniations were observed in 28% of the patients. The authors conclude that flexion and extension MR can be a valuable adjunct examination in the evaluation of patients in the clinical setting of subacute cervical spine trauma.
Characteristics of Sagittal Vertebral Alignment in Flexion
Determined by Dynamic Radiographs of the Cervical Spine
SPINE (Phila Pa 1976) 2001 (Feb 1); 26 (3): 256–261
This study was conducted to depict the change patterns of intervertebral motion of the cervical spine during flexion, upright, and extension positions using dynamic radiographs. Special interest was focused on the flexion position.
Abnormal Spinal Curvature and its Relationship to Pelvic Organ Prolapse
Am J Obstet Gynecol 2000 (Dec); 183 (6): 1381–1384
This Study found that an abnormal change in spinal curvature, specifically, a loss of lumbar lordosis, appears to be a significant risk factor in the development of pelvic organ prolapse.