SIB#435- Modified Exercises for Better Curve Correction
Mark R. Payne DC
The Study: Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients with Loss of Cervical Lordosis and Neck Pain
Overview: The authors are all medical physicians associated with Seoul National University Hospital and College of Medicine. The study looks at a modified program of simple neck and shoulder exercise to help better restore the normal cervical lordosis and improve neck pain.
Key Points:
A. The authors acknowledge the importance of a healthy cervical lordosis in reducing abnormal mechanical loading forces on the spine and associated problems such as “disc damage, cervical radiculopathy and myelopathy”.
B. They further acknowledge the impact of poor postural habits such as prolonged periods of reading or screen time on the cervical lordosis.
C. Prior studies have demonstrated the value of neck retraction exercise in restoring the lower cervical lordosis, however they may do so at the expense of reducing the upper neck curve and damaging the upper discs.
D. The modified exercises studied in this paper were designed to help improve the lordosis while minimizing any potential for damage to the upper cervical area.
E. Eligible subjects were experiencing neck pain, were diagnosed with a loss of the cervical lordosis as measured on the lateral cervical radiograph and agreed to attend a follow up exam 6-8 weeks after starting the program.
F. Eighty three patients were eligible to participate however, ultimately only 47 patients completed the follow up process.
G. Two newly modified exercises were used:
Head Retraction- Unlike traditional head retraction exercises in which the head is simply pulled straight backward with the eyes level, the modified version of the exercise asked patients to fully retract their head AND to then lift the chin upward and backward within their pain free range of motion in an attempt to relieve flexion stress in the upper neck.
Shoulder Retraction/Neck Extension- In this movement patients were instructed to pull their shoulders backward as if attempting to approximate the scapulae AND to simultaneously extend the neck and head backward through their full, pain free, range of motion.
H. Patients were instructed to hold each contraction for 3 seconds (head retraction) and 10 seconds (shoulder retraction) and to perform each exercise a total of ten repetitions daily.
I. Upon follow up patients were asked to evaluate their own pain using a numerical rating scale and a second lateral cervical radiograph was obtained to provide an objective measurement of any postural changes.
J. Finally, patients were divided into two groups according to age; ≤ 50 yrs and ≥ 50yrs.
Author’s Conclusions: The authors noted significant improvement in cervical lordosis (3.6-3.8 degrees using the Cobb and Posterior Tangent methods of measurement respectively) and forward head translation (3.52 mm). Pain scores also showed significant improvement. Initially the mean rating for the Numerical Rating Scale was 6.04. Following exercise, the mean score was reduced to 2.99. Both age groups appeared to respond equally well in terms of curve correction however, the change in forward head posture was significantly greater in the younger patients.
Reviewer's Comments: The authors themselves note a number of shortcomings in the study’s design including the lack of a control group, variable follow up periods, and the inability to measure the precise amount of exercise performed by each subject still I think the paper has value to any chiropractor interested in actually correcting the spine. And of course, it is one more example of how Rehabilitative Medicine practitioners are catching on to the importance of postural correction.