The Study:  Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. 

The Facts:

a. The authors note that the association between cervical lordosis and pain is controversial.

b. The study looked at 30 patients with neck pain and 30 healthy volunteers. 

c. This was a part of a study in which fluoroscopic imaging of the cervical spine in flexion/extension was performed in both subjects with neck pain and the healthy volunteers.

d. The neck pain subjects received a four week course of spinal manipulation and the healthy volunteers received no manipulations. The imaging was performed in both groups before and after the pain subjects received the four weeks of manipulation.

e. The neutral posture images of all the participants were measured to assess the cervical lordosis.

f. The subjects were placed in a seated position for the imaging.

g. The stabilization frame had chest stabilization bars. The subjects performed flexion and extension. At the neutral position a face rest was positioned.

h. The spinal manipulation treatment consisted of diversified technique at a rate of 2 times per week for 4 weeks to the cervical area. 

i. Although the subjects receiving the spinal manipulation did show an increase of 2.1 degrees on the images performed following the course of manipulation that was less than the natural variation of the images of the healthy volunteers.

j. The study was limited due to the small sample size and the authors noted that in order “to detect a mean difference of 2.1 degrees in lordosis” 437 subjects would have been needed in the study.

k. Diversified technique manipulation did not significantly change the lordosis in neck pain patients.

l. They also stated that they had a large minimal detectable change amount. They stated that, “Only changes greater than 13.5° can, at least in part, be confidently associated with a factor (such as treatment) to which the healthy volunteers have not been exposed.”

Take Home:

Diversified technique manipulation did not significantly change the lordosis in neck pain patients. But the large minimal detectable change amount is a problem which stems from the study design.

Reviewer's Comments:

Note: I am going to leave out the concerns regarding the large minimal detectable change amount and as that is somewhat complex the reader should refer to the article. But I will note that this factor gives me great concerns.

However, I am happy to see this type of article being done. Maybe it is because the results were what I would have thought. If you are trying to change the position of spinal vertebrae it would be logical that you would use a method that is likely to cause that change. I think most of us will agree that the vectors of force used in the diversified technique are not designed to significantly move the vertebrae anterior in the cervical spine nor was the spine prepositioned in any way so as to increase the lordotic curve. Additionally, spinal vertebrae may not move for a variety of reasons or they move and return to their previous position or near to their previous position because of the elastic properties found in the spine. For those doctors interested in correcting the cervical lordosis, this study would indicate that a diversified adjustment is probably not the way to do it. Although we should note that the size of the study was not large enough to firmly come to that conclusion.

Reviewer:  Roger Coleman DC

Editor: Mark R. Payne DC

Reference: Michael Shilton, Jonathan Branney, Bas Penning de Vries and Alan C. Breen. Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropractic & Manual Therapies (2015) 23:33 DOI 10.1186/s12998-015-0078-3

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26644909

Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671213/pdf/12998_2015_Article_78.pdf