SIB# 430- Fat Infiltration- Cervical Lordosis and Neck Pain

The Study:  Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study                

The Facts: 

a. “Weakness of cervical extensor muscles causes loss of cervical lordosis, which could also cause neck pain.” 

b. The authors wished to see if fatty infiltration of the musculature used in cervical extension had any impact on the cervical curve or neck pain. 

c. The study looked at 56 subjects. 

d. They used an MRI to determine the amount of fat infiltration into the extensor muscles from C2 to C6. 

e. They used three methods for clinical evaluation: The visual analog scale, 12 item short form health survey and the Neck Disability Index. 

f. “Fat infiltration seems to be a late stage symptom of muscular degeneration.” 

g. The authors concluded that fatty infiltration of the upper cervical extensor muscles was related to loss of the cervical lordosis. 

h. They also concluded that fat infiltration into the lower neck extensors was related to cervical functional disability. 

i. “Therefore, we recommend muscle strengthening exercises to prevent fat infiltration of cervical extensor muscles, which could also be effective for relief of neck pain as well as maintenance of cervical lordosis.”

Take Home:

Fatty infiltration of the cervical extensors is a late stage indicator of muscular weakness and is associated with loss of the cervical lordosis and functional disability.  

Reviewer's Comments:

Once again we see a relationship between structure, function and symptoms.

Reviewer:  Roger Coleman DC

Editor’s Comments: Doctors who confine themselves to a binary approach to patient care (i.e. a focus on EITHER rehabilitation of function OR a restoration of normal sagittal alignment) are likely compromising long term outcomes. While we have long been advocates of the structure based approach to spinal care, we encourage our readers to embrace effective rehab methods to restore muscular function; likewise, doctors who are singularly focused on motion based adjusting to restore intersegmental mobility would better serve their patients by also including rehab strategies to correct global spinal alignment.

Editor: Mark R. Payne DC

 Reference: Choong-Young Kim, Sang-Min Lee, Seong-An Lim et.al. Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study. Clin Ortho Surg. 2018 Jun;10(2):197-203.doi: 10.4055/cios. 2018.10.2.197. Epub 2018 May 18. 

Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/29854343/  

Link to Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964268/pdf/cios-10-197.pdf