Posture Correction for Motion Palpation Doctors

Mark R. Payne DC

             Over the years we’ve highlighted any number of articles in both Science In Brief and Postural Rehab,  looking at the detrimental impact of  cervical hypolordosis.  I realize many of you are already working hard to make meaningful structural corrections in you practices. But I also know that many more of you simply aren’t getting the corrective care outcomes that are possible. It’s far too easy to simply adjust patients and watch them get better, but never take the extra steps needed to rehab the posture and function of the spine. When we fail to take those extra steps we are shortchanging our patients in terms of their long term results and our own practices in terms of potential revenue generated from genuinely needed rehab services.

If your practice incorporates Motion Palpation methods (which I think many of us do), it’s important to understand the relationship between poor spinal motion and poor posture.  In this issue I want to refer back to a 2013 study which looked at the effect of a straightened lordosis in creating stress concentrations and decreased motion in the neck. As you’ll see, posture and spinal motion are literally “joined at the hip”, or as is shown in today’s study, at the neck! I hope you find this helpful.

 Stress Concentrations in the Straight Neck

In this paper (1) , the authors modeled a cervical spine, using finite element analysis, in both the normal (lordotic) and straight (military) configurations to measure both internal and external responses of the spine to loading. The authors describe the vertebral column as a "highly versatile mechanism" which "displays all rigidity, strength, and leverage required in the jib of a crane".  They note that the sagittal "curves are important because they are useful to increase strength, and to maintain balance, shock absorption and fracture protection." (emphasis mine.)

They found a subject with a straightened cervical spine then used CT imaging to collect data on that spine.  Using that data they created  "a high quality finite element model of the complete cervical spine with straightened" cervical curve. Once the model was created they then used sophisticated mapping and mesh deformation methods to study the biomechanical differences between the straightened configuration and a more normal (lordotic) curvature.

 

 Here are some of the study’s key points:

 A. They found that straightening of the cervical spine caused a 24-33% loss of motion and a 5-95% increase of mechanical stress.

B. Increased stress was concentrated in "the facet joint cartilage, uncovertebral joint and the disk."

C. Straightening of the cervical spine is thought to lead to vertebral deformity (cervical spondylosis)  due to the increased loading stresses and loss of normal vertebral motion.

D. The authors suggest " that cervical lordosis may have a direct impact on cervical spondylosis treatment."

E.    Finally, they also note the observed stress concentrations might give rise to " abnormal tensions on the hind-brain, cranial nerves, cervical cord, and cervical nerve roots."

  Given that nobody focuses more on restoring normal segmental motion than MP doctors and that it isn’t possible to have normal motion in the absence of a healthy lordosis as shown above, here are three quick reasons that…

Motion Palpation Doctors Should Incorporate Corrective Care Procedures.  

1. We now have multiple studies (2,3,4,5) showing that adjustments alone do very little to restore the cervical lordosis. The occasional miracle case aside, this is true regardless of how we adjust. As good as our adjustments are at relieving pain and symptoms, they tend to not be a very effective tool for restoring the normal spinal curves.  

2. Likewise, we have good evidence that the lordosis can be successfully rehabilitated using a variety of simple, low tech, methods (.5,6,7,8)

3. Postural Rehab doesn’t take away from what you are doing, it adds to it by allowing you to offer needed corrective care above and beyond mere pain relief.

 

A Basic Tool Kit for Restoring the Cervical Lordosis

 

Two of the most fundamental procedures for restoring the cervical lordosis are: 1) Extension Traction  and 2) Spinal Remodeling (see these items under our Products Heading). Both methods have a long history of safety and efficacy. Here are our two most popular and affordable items for your tool kit which should cover about 95% of your hypolordotic patients.

Extension Traction: Our Original Dakota Traction device provides a simple, affordable tool for GENTLE sustained stretching of the anterior soft tissues, permitting a return of the normal lordosis. Prices start at $34.75 (suggested retail $70-75) and we have great volume discounts for our doctors who are serious about implementing corrective care procedures in their clinics.

 

Spinal Remodeling– Occasionally you’ll run into patients who simply don’t tolerate the full extension forces of the Dakota Traction device. When that happens  you’ll need another option.  Our S.M.A.R.T. (Spinal Maintenance And Remodeling Tools) Series fulcrums provide an easy, low tech way to gently reintroduce the normal lordosis, OR just maintain the corrections you’ve already achieved with extension traction.  Although not as effective as extension traction methods, spinal remodeling certainly has a place in your care programs.  Compare our adjustable height S.M.A.R.T. fulcrums to  more expensive, “one size fits some” blocks. There’s nothing mysterious about this process. So don’t overpay for the hype..

  Doc, whenever a patient leaves your office with a hypolordotic/kyphotic neck, the imbalance is virtually guaranteed to affect their future spinal health. Correcting postures isn’t easy and to be honest, there will always be some patients who aren’t interested in anything beyond  relief care. But it’s always the right thing to educate your patients and  make the effort to get them involved in their own recovery.

  Two easy steps forward will get you started toward the best corrections of your career: 1)Begin with a commitment to delivering real corrective care outcomes once your patient is feeling better have achieved some symptomatic relief and 2) Get familiar  with the basic tools needed for corrective care. If you aren’t already incorporating extension methods in your practice, the two methods shown above will fast track your results.  Call us at 334-448-1210 or check us out at Matlinmfg.com.  We’ve been here for 33 years and can help you get started the right way, without changing your technique or investing a fortune.

Best regards,

Mark R. Payne DC/ Pres. Matlin Mfg Inc.   

References:

1. Wei W, Liao S, Shi S, Fei J, Wang Y, Chen C. Straightened cervical lordosis causes stress concentration: a finite element model study. Australian Phys Eng Sci Med. 2013;36:27-33

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

3. A retrospective consecutive case analysis of pretreatment and comparative static radiological parameters following chiropractic adjustments. Plaugher G, Cremata EE, Phillips RB. J Manipulative Physiol Ther. 1990 Nov-Dec;13(9):498-506.

4. 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. J Chiropr Res Clin Invest 1994;9:19-23

5. Harrison DD, Jackson BL, Troyanovich S, Robertson GA, DeGeorge D, Barker WF. The efficacy of cervical extension compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: A pilot study. J Manipulative Physiol Ther 1994;17:454-464.

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

7..  Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial.. Arch Phys Med Rehabil. 2002 Nov;83(11):1585-91

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