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      Structural rehabilitation of the cervical lordosis and forward head posture: a selective review of Chiropractic BioPhysics ® case reports

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          Abstract

          [Purpose] To characterize the case report evidence of Chiropractic BioPhysics ® (CBP ®) technique methods applied to increase cervical lordosis and improve forward head posture. [Methods] The CBP Non-profit website as well as PubMed and Index to Chiropractic literature were searched for case reports/series documenting the increase of cervical lordosis and improvement of forward head posture in the treatment of various craniocervical spinal disorders by CBP technique methods. [Results] Sixty patients were reported in 41 unique manuscripts detailing the improvement in cervical spine alignment by CBP technique methods. On average, there was a 14° improvement in cervical lordosis and a 12 mm reduction in forward head position after 40 treatments over 16 weeks with a 5-point reduction in pain rating scores. Thirty-eight percent of cases included follow-up showing only slight loss of lordosis, but maintenance of pain and disability improvements after an average of 1.5 treatments per month for 1.8 years. [Conclusion] An abundance of reports document improvement in craniocervical and other ailments by CBP methods that increase cervical lordosis. Routine radiographic imaging of the spine is recommended as it is safe and the only current practical method of screening for critical biomechanical biomarkers of sagittal spine alignment.

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          Cervical spine alignment, sagittal deformity, and clinical implications: a review.

          This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T-1 incidence and cervical sagittal balance can further our understanding of cervical deformities. Other important parameters that account for the cervical-pelvic relationship are surveyed in detail, and it is recognized that all such parameters need to be validated in studies that correlate HRQOL outcomes following cervical deformity correction.
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            Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy.

            Narrative review.
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              Determining the relationship between cervical lordosis and neck complaints.

              To investigate the presence of a "functionally normal" cervical lordosis and identify if this and the amount of forward head posture are related to neck complaints. Using the posterior tangent method, an angle of cervical lordosis was measured from C2 through C7 vertebrae on 277 lateral cervical x-rays. Anterior weight bearing was measured as the horizontal distance of the posterior superior body of the C2 vertebra compared to a vertical line drawn superiorly from the posterior inferior body of the C7 vertebra. The measurements were sorted into 2 groups, cervical complaint and noncervical complaint groups. The data were then partitioned into age by decades, sex, and angle categories. Patients with lordosis of 20 degrees or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0 degrees or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0 degrees 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. Males had larger median cervical lordosis than females (20 degrees vs 14 degrees) (2-sided Mann-Whitney U test, P = .016). When partitioned by age grouping, this trend is significant only in the 40- to 49-year-old range (2-sided Mann-Whitney U test, P < .01). We found a statistically significant association between cervical pain and lordosis < 20 degrees and a "clinically normal" range for cervical lordosis of 31 degrees to 40 degrees. Maintenance of a lordosis in the range of 31 degrees to 40 degrees could be a clinical goal for chiropractic treatment.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                1 November 2022
                November 2022
                : 34
                : 11
                : 759-771
                Affiliations
                [1) ] Private Practice: Newmarket, ON, L3Y 8Y8, Canada
                [2) ] CBP NonProfit, Inc., USA
                Author notes
                [* ]Corresponding author. Paul A. Oakley (E-mail: docoakley.icc@ 123456gmail.com )
                Article
                2022-075
                10.1589/jpts.34.759
                9622351
                36337218
                a1c19eb9-1954-4825-91ee-f914e88de778
                2022©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/ )

                History
                : 13 July 2022
                : 16 August 2022
                Categories
                Review Article

                cervical lordosis,forward head posture,cervical spine

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