Chiropractic Management of Spinal Curves

Do Spinal Curves Matter?

Scientific knowledge changes with newly published research. What we know today may not be entirely true in the years to come. Chiropractors today are asked the same questions they encountered 50 years ago.  However, have the answers changed?

In today's blog, let's look at three commonly asked questions, and see how the answers have changed (or not changed) over the past 50 years.

The answers may directly impact your future clinical decision-making process and patient education as it relates to spinal curves...

1. Is there a correlation between spinal curves and acute clinical presentation?

2. Can treatment affect spinal curvature?

3. Do spinal curves even matter?

Patients learn from multiple sources of information with varying degrees of truth.  The idea of spinal structure as the etiology behind painful conditions is not a new topic. In today's blog, let's review the literature around the issue of spinal lordosis as it relates to function and pain.  Here is what I think.

The history of spinal curvature as it relates to pain in the cervical spine.

Research from the 1970s found nearly 20% of asymptomatic populations present with alterations of "normal" cervical lordosis. (1) Again, in the 1980s, a 10-year longitudinal study by Gore et al. found the presence of narrowed spinal canal diameter, degeneration, and changes in spinal lordosis correlated to clinical symptoms. (2) These early studies found that curvature appears to not correlate with function or clinical symptoms.  Interestingly, hypolordotic cervical spines are found less frequently in acute post-injury patients compared to healthy groups.  (3) The vast majority of research of the '70s, '80s, and '90s concludes that the straightening of the cervical spine may be a natural age-related process independent of pain. Normal cervical lordosis occurs only in about 40% of asymptomatic populations. (4)

Nearly every observational and longitudinal study in the last 40 years does not correlate with a clinical condition, pain, or long-term prognosis with a loss of cervical lordosis. (5)

Every point has a counterpoint. There has been one group of researchers purporting the importance of spinal curvature for pain relief. These studies promote the restoration of spinal curves to achieve pain relief.  One such study found a statistically significant association between cervical pain and lordosis <20°. (6) Another paper in the '90s by Moustafa et al. found that treatment of cervicogenic dizziness should include restoring the normal cervical lordosis and correction of head posture correction. These patients received longer-lasting improved function when compared to standard physical therapy rehabilitation. (7)

In full transparency: The authors of the two previous papers have devised proprietary methods to restore spinal curves and "appear to be the only group that continues to devise methods for the restoration of cervical lordosis as a means to improve neck pain and related disability." (5) View an exhaustive review of these claims HERE.

Realistically, pain is a bio-psychosocial phenomenon.  Rarely is chronic pain alleviated with only one intervention.  Current trends in research point to active approaches to care by implementing a recipe of successful interventions dependent on the diagnosis and complicating factors.  Often, psychological, musculoskeletal, and metabolic dysfunctions are present, requiring a multimodal approach.  While we all may see a connection between painful conditions and posture, spinal curves are not the cause or perpetrator of pain or dysfunction. I hope future non-biased research will help elucidate the roadmap to patient care.  However, as for now:

Treat the patient—not their images.

So, is there a correlation between loss of spinal lordosis and acute clinical presentation? The overwhelming amount of research over the last 50 years says NO. There are treatments directly aimed at affecting cervical curvature. Studies (albeit highly biased) have demonstrated the effectiveness of specific treatment approaches to restore spinal alignment with varying degrees of success. However, if spinal lordosis does not affect symptoms or progression of the disease, then does it matter?

Patients may often use their prior diagnoses as a crutch to limit future activity. Don't allow your patients to fall prey to historical beliefs of spinal curvature and arthritis as a disability.  Remain an educator to your patients, looking out for their best interests.  Transparency in your practice plants the seeds for the long-term growth of your practice.  

Research guides our decision-making process, but research changes.  Do you think that restoring spinal curves assists in the resolution of pain or the long-term prognosis of spinal conditions? Comment your thoughts below, and let’s start a conversation.

Regardless of your opinion, we can all agree that staying on top of the latest research is imperative to delivering clinical excellence. However, as practicing clinicians, we don’t all have the time to stay up-to-date. And that’s OK.

Because ChiroUp does it for you.

With ChiroUp, you can educate yourself with protocols that contain the most pertinent tests, treatments, & exercises for 100+ conditions and counting. It’s clinical confidence at your fingertips...

• References

  1. Weir DC. Roentgenographic signs of cervical injury. Clin Orthop Relat Res. 1975;109:9–17. Link

  2. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976) 1986;11:521–4. Link

  3. Helliwell PS, Evans PF, Wright V. The straight cervical spine: Does it indicate muscle spasm? J Bone Joint Surg Br. 1994;76:103–6.  Link

  4. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine (Phila Pa 1976) 1997;22:1472–80. Link

  5. Lippa L, Lippa L, Cacciola F. Loss of cervical lordosis: What is the prognosis?. Journal of craniovertebral junction & spine. 2017 Jan;8(1):9. Link

  6. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005;28:187–93. Link

  7. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: A 1-year randomized controlled study. Eur J Phys Rehabil Med. 2016. Link