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Treating ‘slouchy’ (Hyperkyphosis) posture with chiropractic biophysics®: A case report utilizing a multimodal mirror image® rehabilitation program

  • Chiropractic Biophysics
  • Chiropractic BioPhysics Technique and CBP NonProfit, Inc. --A Spine Research Foundation in Eagle, ID

Abstract and Figures

[Purpose] To present a case of the non-surgical reduction of ‘slouchy’ hyperkyphosis posture utilizing the multimodal Chiropractic BioPhysics® rehabilitation program emphasizing the mirror image® concept. [Subject and Methods] A 27-year-old female presented suffering from neck and back pains, headaches and gait dysfunction. The patient was treated 30 times over a period of 6-months. Treatment consisted of anterior thoracic translation, thoracic extension, and head retraction exercises as well as spinal traction and spinal manipulation. [Results] After 6-months of treatment the patient displayed a total correction of the posterior thoracic translation with a significant reduction in thoracic hyperkyphosis. The dramatic correction of her overall posture and spine alignment corresponded to the significant relief of neck and back pains, headaches and improvement of various other health issues as demonstrated by self-report and SF-36. [Conclusion] Poor postures corresponding to poor health can be changed for the better with multimodal rehabilitation programs that are now showing consistent postural improvements corresponding with improvements in various health conditions. We suggest that the postural correction of those with various pain symptoms be considered as a first line non-pharmalogical, non-surgical rehabilitation approach for those presenting with poor posture.
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Case Study
Treating ‘slouchy’ (hyperkyphosis) posture with
chiropractic biophysics®: a case report utilizing
a multimodal mirror image® rehabilitation
  1),  2)*,  3)
1) Private Practice, USA
2) Private Practice: Newmarket, ON, L3Y 8Y8, Canada
Abstract. [Pur pose] To present a case of the non-surgical reduction of ‘slouchy’ hyperkyphosis posture utilizing
the multimodal Chiropractic BioPhysics® rehabilitation program emphasizing the mirror image®
    
            -
for the better with multimodal rehabilitation programs that are now showing consistent postural improvements cor-
       
Key words:
Posture alignment is of great importance for the maintenance of human health, where a healthy individual has maintained
inherent equilibrium of the sagittal spinal curvatures1–3)
compensations that take place4, 5)               
translate backwards such that upright sagittal balance is maintained6)
Thoracic hyperkyphosis is associated with many poor health outcomes such as pain7), altered gait8), compression fractures
in the elderly9, 10), impaired mobility9, 10), as well as reduced quality of life11, 12) and life expectancy13–18)
ous hyperkyphosis reduction19, 20)19), reported on the relief of back pains in a 24-year-old female who achieved
20), reported on the dramatic pain
relief and health improvements in a 15-year-old who attained a 17° reduction in thoracic hyperkyphosis after 94 treatments
J. Phys. Ther. Sci. 2 9: 1475–1480, 2017
  -
 
The Journal of Physical Therapy Science The Journal of Physical Therapy Science
J. Phys. Ther. Sci. Vol. 29, No. 8, 2017 1476
Both of these cases featured Chiropractic BioPhysics®®) corrective rehabilitation utilizing mirror image® exercise
and traction procedures21–23)
24) to human posture25)
so, he had discovered that virtually half of all human movement had not yet been studied25); further, in applying the concept
of rotations about, and translations along the coordinate axes for the head, thorax, and pelvis separately, it became evident
  ®’ or opposite of these postures in order to correct them and the
corresponding spinal coupling patterns21–23)
This case presents the successful relief of bodily pains and improvements in overall health in a 27-year-old female after
the dramatic improvement in her ‘slouchy’ posture by the multimodal CBP rehabilitation program featuring the mirror image
numbness and tingling in the arms bilaterally with the left worse than the right, cold hands, vertigo that made her unable to
The patient’s health history indicated they had experienced a previous whiplash episode, a violent physical assault, as well
    
index27)                28)
Table 1
25), the patient had very
    29–31) 
                       -
Treatment goals were to improve the patient’s posture using the CBP multimodal rehabilitation approach21–23) 
21), ultimately
   
image corrective exercises consisted of posterior head retraction repetitions with simultaneous posterior pelvic translations
having a 50 mm block in the mid back to push against while standing on a PowerPlate®  
The PowerPlate is a three-dimensional vibration platform that adds intensity to any exercise34)   
Table 1.
Health Physcial   Social Mental Bodily 
Perce ption Functioning Physical  Functioning Health Pain Fatig ue
 72 84 81 81 83 75 75 61
 77 40 75 100 75 84 48 70
 92 85 100 100 100 88 78 80
Change 15 45 25 025 430 10
 
    
mimic the clinic traction by laying supine on a 10 cm yoga block placed at T9 starting at 3 minutes then working up to 15
under her left ischial tuberosity while she was driving or sitting for long periods of time as this is a permanent structural
Fig. 1. 
       
         
           -
Fig. 2. 
    
 -
 
Fig. 3. 
translates the head and pelvis posteriorly while the mid
            
      
translation poster is corrected as they lay supine on the
bench, while the thoracic kyphosis is being forced into a
much more extended position by use of the anterior pull-
J. Phys. Ther. Sci. Vol. 29, No. 8, 2017 1478
       
improvement in middle and lower back pain, a 70% improvement in the right leg disuse, a 60% improvement in right hip
pain, a 50% improvement in headaches, a 40% improvement in the numbness and tingling in the arms, a 20% improvement
 
Table 1
posterior thoracic translation posture was corrected as measured as the horizontal distance from T12 to a vertical line from
This case is consistent with two other CBP case reports19, 20) showing that the reduction in posterior thoracic translation
natural, ideal kyphotic alignment33)
Since posterior thoracic translation causes simultaneous thoracic hyperkyphosis6), it becomes evident that the ‘mirror
image’ or opposite movement would reverse, or produce thoracic hypokyphosis, which it has been shown to do6)
35–39), the addition of extension trac-
Thoracic hyperkyphosis is a serious postural deformity as it is associated with serious pathology such as vertebral
compression fractures9, 10) and the ultimate health outcome, mortality13–18)      
deformity40, 41)
42–44), lumbar
lordosis45–47) or with scoliosis48, 49)
generalized programs of care42–49)
base, and therefore a need for a case series and then a clinical trial for the CBP mirror image approach for the reduction of
            -
    [Medline]  
         [Medline]
                   
  [Medline]   
        [Medline]  
             
 [Medline]  
        
 [Medline]  
                       
 [Medline]  
        [Medline]  
            
  [Medline] 
                        
[Medline]  
           -
  [Medline]  
              
    [Medline]  
            
 [Medline]  
                     
[Medline]   
              
 [Medline]  
        [Medline] 
      [Medline]
       
[Medline]  
           ®
  
      ®
                    
             
  [Medline]
            
         [Medline]  
             
   
           [Medline]
        [Medline]
          
[Medline]   
                 
 [Medline]  
        
  [Medline] 
                         
   [Medline] 
         
[Medline]   
       
    [Medline]  
                     
[Medline]   
            -
   [Medline]   
              [Medline]
  
             -
 [Medline]   
                
    [Medline]   
   [Medline] [Cros s-
       [Medline] 
           
[Medline]   
                     
    [Medline]
        
   [Medline]  
J. Phys. Ther. Sci. Vol. 29, No. 8, 2017 1480
           -
 [Medline]   
                               
  [Medline]   
         -
[Medline] 
                         
[Medline]  
              
 [Medline]  
                        
    [Medline]  
... The same SOSORT consensus paper (2010) 31) stated that there is "no sound scientific data available" on effective nonsurgical, conservative treatments for thoracic hyperkyphosis. Although this consensus is now dated, there are emerging conservative treatment options that show initial evidence of hyperkyphosis reduction; these include: 32,33) exercise, manual therapy, spinal orthosis, 'practiced normal posture,' taping, and more recently, thoracic extension traction [34][35][36] . ...
... To our knowledge, there have been only three single case reports and one case series (n=3) on the reduction of thoracic hyperkyphosis by extension traction reported in the literature [34][35][36][37] . In these cases, thoracic extension traction was combined with extension exercises and spinal manipulative therapy (SMT). ...
... In these cases, thoracic extension traction was combined with extension exercises and spinal manipulative therapy (SMT). Jaeger et al. 34) reported a 23° reduction of thoracic curve in a 24 year old with 48 treatments with additional home care over a 6.5-month period, Miller et al. 35) reported a 17° reduction in a 17 year old female with 94 treatments over a 13-month period, Fortner et al. 36) reported a 12° reduction in a 27 year old female with 30 treatments as well as home care, over a 6-month period, and in the series by Fedorchuk et al. 37) , an average reduction of 11° was achieved in three patients after 10-weeks of care. ...
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[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis by the Chi-ropractic BioPhysics ® multimodal rehabilitation program. [Participants and Methods] Ten randomly selected files and corresponding radiographs were chosen from recent clinic archives of patients who were treated for thoracic hyperkyphosis. All patients were treated by CBP mirror image ® thoracic extension traction and exercises, as well as spinal manipulative therapy. [Results] Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25 treatments, over an average of 9 weeks. Patients also experienced a reduction in pain levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious progressive deformity that is related to a plethora of symptoms, syndromes, and early death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic extension protocols including mirror image extension traction and exercises, as well as spinal manipulation as part of the CBP multi-modal rehabilitation program.
... The early diagnosis and treatment of THK is essential in the prevention of the otherwise associated typical poor health outcomes. Several clinical trials and case reports have documented the successful non-surgical reduction of THK in patients [17][18][19][20][21][22][23][24][25][26] . These methods primarily involve back extension exercise regimens, and more recently thoracic extension traction methods [23][24][25][26] . ...
... Several clinical trials and case reports have documented the successful non-surgical reduction of THK in patients [17][18][19][20][21][22][23][24][25][26] . These methods primarily involve back extension exercise regimens, and more recently thoracic extension traction methods [23][24][25][26] . ...
Full-text available
[Purpose] This case presents the reduction of both forward head posture and thoracic hyperkyphosis in a young male with chronic back pain and headaches by a comprehensive posture rehabilitation program as a part of Chiropractic BioPhysics® methods. [Participant and Methods] A 32 year old male presented with constant pain and headaches for seven years since he was involved in a work related injury. He had seen five different MDs, undergone multiple imaging tests, and received multiple prescriptions, thirteen steroid injections and was recommended for a spine surgery that he had denied. He was on long-term disability. Upon comprehensive posture and spine assessment, the patient had exaggerated forward head translation and thoracic hyperkyphosis. The patient was treated 36 times over 13-weeks with cervical and thoracic extension exercises, traction, and manipulation. [Results] After treatment the patient reported dramatic improvement in symptoms as indicated on valid disability questionnaires and substantial improvements in posture. [Conclusion] Posture-related pain and disability is not often addressed in allopathic medicine but substantial posture improvements are achievable in short time periods as this case illustrates. Poor postures in young patients should be corrected to avoid long-term consequences. Radiography as used in spinal rehabilitation is safe and reliable.
... It is important to note that the literature also suggests that many of these radiographic parameters such as sagittal cervical spinal alignment and posture can be corrected with conservative care and these corrections can be corelated with improved function and health outcomes [88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]. Other studies indicate that conservative care can result in radiographic changes to sagittal lumbar spinal alignment and posture, which is correlated with improved pain scores and health-related quality of life (HRQOL) [103][104][105][106][107]. Research has demonstrated that abnormal sagittal thoracic spinal alignment can be corrected, which is correlated with improvement in the risk of falls, headaches, forced expiratory volume, and HRQOL [108][109][110][111][112][113][114][115]. Additional studies have demonstrated that conservative correction of cervical lordosis and forward head posture can be associated with increased HRQOL, reduced back pain, and improved nervous system adaptability [100]. ...
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Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.
... Although there is one RCT on CBP methods showing reduction of the deformity, it is yet to be formally published [52]. A systematic review of CBP methods used to reduce thoracic hyperkyphosis was published [73] and summarized the outcomes of several case reports and series [74][75][76][77][78][79]. In Table 2 of the Oakley and Harrison review an average 12° reduction in thoracic kyphosis occurred after 32 treatments over 14.5 weeks from a total of 17 patients [52]. ...
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Chiropractic Biophysics® (CBP®) technique is a full-spine and posture correcting method that incorporates mathematical principles into a unique approach to treat spinal disorders. It considers that the identification of postural rotations and translations of human postures are first evaluated and compared to the radiographic assessment of the spine alignment. Mirror image® postural positions and movements are utilized including spinal extension positions to improve the spine and posture towards a normal/ideal alignment. Specifically, corrective exercises, corrective traction and chiropractic adjustments are performed encompassing a multimodal rehabilitation program with the goal of improving the posture and spine alignment. CBP Rehabilitation programs are typically performed in-office with supportive at-home measures. Repeat assessment including radiographs are used to quantify and monitor structural improvements. CBP technique is an evidence-based approach to treat spine deformities and is supported by all forms of clinical evidence including systematic literature reviews, randomized controlled trials, non-randomized controlled trials, case reports/series as well as is supported by biomechanical posturespine coupling validity, radiographic and posture analysis reliability/repeatability and use of a validated biomechanical spinal model as the outcome goal of care. CBP technique is a proven method to improve pain, disability and quality of life in those with structural deformities.
... Cases were excluded if the treatment involved patients with scoliosis or if the treatment for the reduction of a lateral thoracic posture was treated exclusively by the prescription of a heel lift (i.e. Fortner et al. (9)). ...
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Objective: To characterize the evidence of CBP® technique methods in the reduction of lateral thoracic (pseudo-scoliosis) translation postures and its effect on pain, disability and quality of life. Methods: The CBP NonProfit website as well as Pubmed and Index to Chiropractic literature were searched for clinical studies on the reduction of lateral thoracic translation postures by CBP methods. Results: One clinical trial and 6 case reports were located. The trial showed an 8mm reduction after an average of 36 treatments over 11.5 weeks in 63 chronic low back pain patients with a 2-point drop in pain rating versus no spine or pain rating changes in 23 untreated controls. Six case reports showed an average reduction of 23mm after 33 treatments over 3.7 months with an average 4-point drop in pain rating. The cases also documented improvements in various functional, disability and quality of life measures. Conclusion: There is a limited but evolving evidence-base supporting the unique mirror image® approach to reducing lateral thoracic translation postures by CBP technique methods that has impacts on pain, disability and quality of life. (J Contemporary Chiropr 2022;5:13-18)
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There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute con-traindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
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Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting “Choosing Wisely,” we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.
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Objective: Thoracic hyperkyphosis is a serious postural health disorder that is associated with many health conditions including morbidity and mortality. Methods: We reviewed all clinical evidence for the treatment of hyperkyphosis by Chiropractic BioPhysics® technique methods. Seven peer-reviewed papers were located that included 4 case reports, 2 case series, and 1 randomized clinical trial treating the cervical spine reporting reduction of the thoracic curve. Results: Although the amount clinical evidence is small, these studies document successful reduction in thoracic curve by an average of 12° concomitant with the improvement in pain, disability, quality of life measures and in some cases improvement in vital capacity. There was large variation in number of treatments, duration of treatment and age of patients. Although there are some clinical trials demonstrating improvement in thoracic kyphosis primarily by exercise programs, the changes are small and most report on suboptimal mensuration methods that do not directly relate to the gold standard x-ray measurement. Only 2 previous exercise intervention trials have reported pre-post x-ray improvements in thoracic alignment, and this was 3°. Conclusion: If future CBP intervention trials are consistent with the initial CBP patient outcomes for this disorder, the CBP treatment approach may prove to be an effective treatment that may logically lead to reduced mortality rates and improvements in quality of life measures in these patients.
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Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body’s adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.
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[Purpose] To present the clinically significant improvement of straight back syndrome (SBS) in a patient with spinal pain and exertional dyspnea. [Subject and Methods] A 19 year old presented with excessive thoracic hypokyphosis and other postural deviations. A multimodal CBP® mirror image® protocol of corrective exercises, traction procedures and spine/posture adjusting were given over an initial 12-week course of intensive treatment followed by a 2.75 year follow-up with minimal supportive treatment. [Results] The patient had significant postural improvements in all postural measures and specifically a 14° increase in the thoracic kyphosis that was maintained at long-term follow-up. The postural improvements were consistent with relief of exertional dyspnea and pain, as well as increases in both antero-posterior thoracic diameter and the ratio of antero-posterior to transthoracic diameter, measurements critical to the wellbeing of patients with SBS. [Conclusion] Long-term follow-up confirmed stable improvement in physiologic thoracic kyphosis in this patient. Nonsurgical correction in thoracic hypokyphosis/SBS can be achieved by mirror image traction procedures configured to flex the thoracic spine into hyperkyphosis as well as corrective exercise and manipulation as a part of CBP technique protocols.
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[Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing a multimodal rehabilitation program emphasizing the mirror image® concept. [Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering from back and neck pains and headaches. The patient was treated sporadically over a period of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment the patient displayed a significant reduction in hyperkyphosis and a dramatic correction of her overall posture and spine alignment corresponding to the reduction in back/neck pains, headaches and the simultaneous improvement of various other health issues. [Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation program emphasizing mirror image thoracic extension procedures.
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[Purpose] The purpose of this study was to investigate the effects of a whole-body vibration exercise, as well as to discuss the scientific basis to establish optimal intensity by analyzing differences between muscle activations in each body part, according to the stimulation intensity of the whole-body vibration. [Subjects and Methods] The study subjects included 10 healthy men in their 20s without orthopedic disease. Representative muscles from the subjects’ primary body segments were selected while the subjects were in upright positions on exercise machines; electromyography electrodes were attached to the selected muscles. Following that, the muscle activities of each part were measured at different intensities. No vibration, 50/80 in volume, and 10/25/40 Hz were mixed and applied when the subjects were on the whole-vibration exercise machines in upright positions. After that, electromyographic signals were collected and analyzed with the root mean square of muscular activation. [Results] As a result of the analysis, it was found that the muscle activation effects had statistically meaningful differences according to changes in exercise intensity in all 8 muscles. When the no-vibration status was standardized and analyzed as 1, the muscle effect became lower at higher frequencies, but became higher at larger volumes. [Conclusion] In conclusion, it was shown that the whole-body vibration stimulation promoted muscle activation across the entire body part, and the exercise effects in each muscle varied depending on the exercise intensities.
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Abstract Objective To investigate the immediate and 1-year effects of a multimodal program, with cervical lordosis and anterior head translation (AHT) rehabilitation, on the severity of pain, disability, peripheral and central nervous system function in patients with discogenic cervical radiculopathy (DCR). Design A randomized controlled study with a 1-year and 10-week follow-up. Setting University research laboratory. Participants 40 (27 males) patients with chronic DCR, a defined hypolordotic cervical spine and AHT posture were randomly assigned to the control (43.9 ± 6.2 years of age) or an intervention group (41.5 ± 3.7 years of age). Interventions Both groups received the multimodal program; additionally, the intervention group received the denneroll cervical traction device. Main Outcome Measures AHT, cervical lordosis, arm pain, neck pain and disability (NDI), dermatomal somatosensory evoked potentials (DSSEP’s) and central somatosensory conduction time (N13-N20). Measures were assessed at three time intervals: baseline, 10 weeks, and 1 year follow up. Results After 10 weeks of treatment, between group analysis, showed equal improvements for both the intervention and control groups in arm pain intensity (p=0.4), neck pain intensity (p=0.6), and latency of DSSEP’s (p=0.6). However, also at 10 weeks, there were significant differences between groups favoring the intervention group for cervical lordosis (p˂0.0005), AHT (p˂0.0005), amplitude of DSSEP’s (p˂0.0005), N13-N20 (p˂0.0005), and NDI (p˂0.0005). Whereas, at the 1 year follow-up, between group analysis identified a regression back to baseline values for the control group. Thus, all variables were significantly different favoring the intervention group at 1-year follow up period: cervical lordosis (P˂0.0005), AHT (P˂0.0005), latency and amplitude of DSSEP’s (P˂0.0005), N13-N20 (P˂0.0005), severity of neck and arm pain, and NDI (P˂0.0005) in favor of the denneroll group. Conclusion The addition of the denneroll cervical orthotic to a multimodal program positively affected DCR outcomes at long term follow up. We speculate the improved cervical lordosis and reduced AHT contributed to our findings. Key Words: Randomized controlled trial, cervical lordosis, disc herniation, radiculopathy, traction
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Background: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. Aim: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. Design: A randomized controlled study with a 1-year and 10-week follow-up. Setting: University research laboratory. Population: 72 (25 female) patients between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. Methods: Both groups received the multimodal program; additionally, the experimental group received the dennerollTM cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. Results: Significant group × time effects at both the 10 week post treatment and the 1-year follow up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P= .09), HRA (P= ,1) and neck pain (P=0.3),. At the 1 year follow-up, the between group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3, - 1.8], P<.0005), cervical lordosis (-14.4° [-11.6, -8.3], P<.0005), dizziness handicap inventory (29.9 [-34.4, -29.9], P<.0005), severity of dizziness (5.4 [-5.9, -4.9], P<.0005), dizziness frequency (2.6 [-3.1, -2.5], P<.0005) ,HRA for RT rotation ( 2.8[-3.9 -3.3], P<.005) ,HRA for LT rotation( 3.1 [-3.5 -3.4, P<.0005] , neck pain (4.97 [-5.3, -4.3], P<.0005); indicating greater improvements in the experimental group. Conclusion: The addition of dennerollTM cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long term follow up. Clinical rehabilitation impact: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.
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Background: Thoracic hyper-kyphosis is a postural deviation that is associated with morbidity and mortality. There is limited evidence for the non-surgical reduction treatment for this condition. Objective: To describe the successful case of conservative reduction in thoracic hyper-kyphosis utilizing thoracic extension traction methods as performed in Chiropractic BioPhysics (CBP®) Technique. Clinical Features: On May 8, 2009 a 24-year old female music teacher reported to a spine clinic in Las Vegas seeking treatment while suffering from neck, mid, and low back pain as well as headaches. The major postural condition was determined to be a hyper-kyphotic thoracic spine Case Study Jaeger et al.; BJMMR, 11(7): xxx-xxx, 2016; Article no.BJMMR.20639 2 with concomitant posterior thoracic translation. Intervention and Outcome: This patient was treated with full CBP® protocol with the unique application of thoracic extension traction. Although the treatment was interrupted by her involvement in a motor vehicle collision, a clinically significant reduction in her kyphosis occurred bringing her spine to within normal limits. She had simultaneous improvements in her clinical symptoms, neurologic and orthopedic tests. Discussion: Traditional conservative treatment options for thoracic hyper-kyphosis have included exercise, manual therapy, spinal orthosis, 'practiced normal posture,' and more recently, taping. All of these procedures, however, have been criticized because despite these methods as showing promise for improving health outcomes in patients with hyper-kyphosis, the trials used to evaluate them have been " small in scale, and most short in duration. " Since this deformity is associated with osteoporosis and worsening of kyphosis it is well advised to treat this condition earlier rather than later. Conclusion: Although traditional approaches to non-surgical treatment for thoracic hyper-kyphosis has weak supportive evidence, we propose extension traction for this condition will prove to be an effective treatment option.
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To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°). This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure. There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group. The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.
Objective: To compare the efficacy of a manual therapy and an exercise therapy program in improving postural hyperkyphosis among young adults. Methods: Forty-six women between the ages of 18 to 30 years with thoracic kyphosis diagnosed by flexicurve ruler were randomly assigned to either an exercise therapy or a manual therapy group. The exercise therapy program focused on stretching and strengthening exercises in 15 sessions over 5 weeks. The manual therapy group received 15 sessions of manual techniques including massage, mobilization, muscle energy and myofascial release. Kyphosis angle and back extensor muscle strength were measured with a motion analysis system and a dynamometer at the baseline and after treatment. The data were analyzed with paired and independent t-tests. Results: After treatment, the angle of thoracic kyphosis was smaller and back extensor muscle strength was significantly greater in both the exercise and manual therapy groups (p < 0.001). We found no significant differences between groups in the changes in kyphosis angle or muscle strength after treatment (p > 0.05). Conclusion: Manual therapy was as effective as exercise therapy in reducing kyphosis angle and increasing back extensor muscle strength in young women with postural hyperkyphosis.
Objective: The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy. Methods: This randomized clinical study included 154 adult patients (54 females) who experienced chronic discogenic lumbosacral radiculopathy and had forward head posture. One group received a functional restoration program, and the experimental group received forward head posture corrective exercises. Primary outcomes were the Oswestry Disability Index (ODI). Secondary outcomes included the anterior head translation, lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, pelvic inclination, leg and back pain scores, and H-reflex latency and amplitude. Patients were assessed at 3 intervals (pretreatment, 10-week posttreatment, and 2-year follow-up). Results: A general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of ODI (F = 89.7; P < .0005), anterior head translation (F = 23.6; P < .0005), H-reflex amplitude (F = 151.4; P < .0005), H-reflex latency (F = 99.2; P < .0005), back pain (F = 140.8; P < .0005), and leg pain (F = 72; P < .0005). After 10 weeks, the results revealed an insignificant difference between the groups for ODI (P = .08), back pain (P = .29), leg pain (P = .019), H-reflex amplitude (P = .09), and H-reflex latency (P = .098). At the 2-year follow-up, there were significant differences between the groups for all variables adopted for this study (P < .05). Conclusions: The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.
Anterior hip pain is common in young, active adults. Clinically, we have noted that patients with anterior hip pain often walk in a swayback posture, and that their pain is reduced when the posture is corrected. The purpose of this study was to investigate a potential mechanism for the reduction in pain by testing the effect of posture on movement patterns and internal moments during gait in healthy subjects. Fifteen subjects were instructed to walk while maintaining three postures: 1) natural, 2) swayback, and 3) forward flexed. Kinematic and force data were collected using a motion capture system and a force plate. Walking in the swayback posture resulted in a higher peak hip extension angle, hip flexor moment and hip flexion angular impulse compared to natural posture. In contrast, walking in a forward flexed posture resulted in a decreased hip extension angle and decreased hip flexion angular impulse. Based on these results, walking in a swayback posture may result in increased forces required of the anterior hip structures, potentially contributing to anterior hip pain. This study provides a potential biomechanical mechanism for clinical observations that posture correction in patients with hip pain is beneficial.
To compare the therapeutic effects of a 3-dimensional corrective spinal technique (CST) and a conventional exercise program (CE) on altered spinal curvature and health related quality-of-life in patients with adolescent idiopathic scoliosis (AIS). Adolescents with idiopathic scoliosis (N=32, 6 males and 26 females) between 10 and 19 years of age (14.34 ± 2.60 years) were recruited and underwent the CST or CE for 60 minutes/day, 2-3 times a week, and an average of total 30 sessions. Diagnostic X-ray imaging technique was used to determine intervention-related changes in the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, sacral slope, pelvic tilt, pelvic incidence, and vertebral rotation (Nash-Moe method). The Scoliosis Research Society-22 (SRS-22) health related quality-of-life questionnaire was used. Data were analysed using independent t-test, paired t-test, and non-parametric Mann-Whitney U-test at p < 0.05. CST showed greater improvements in Cobb angle (p=0.003), vertebral rotation (p=0.000), and SRS-22 scores (self-image and treatment satisfaction subscale scores and total score, p=0.026, p=0.039, and p=0.041, respectively) as compared to the controls. There were no significant changes in the other measures between the two groups. This is the first clinical trial to investigate the effects of the 3-dimensional CST on spinal curvatures and health related quality-of-life in AIS, providing the important clinical rationale and compelling evidence for the effective management of AIS.