Expert: Scott F. Gillman, DC, DACBSP - 12/3/2010

Question
  I went to the chiropractor for the first time on Wednesday 12/01/10. I have been having some lower back pain
and wanted to get it checked out. While he was examining me
he noticed that my head and neck protrudes out more than
normal. He did some x-rays and asked me to come back on
12/03/10 (today) to go over the x-rays and talk about
treatment. when he showed me the x-rays, he started with my
lower back and said that my spine was slightly curved and
that 2 of my vertebra were twisting slightly in opposite
directions and that was what was causing my lower back pain.
Then he put up the x-rays of my neck. He said that a normal
curve should be around 45 degrees and that mine is curved at
-22 degrees and is about 67 degrees off of where it should
be. my insurance will cover 8 visits and the x-rays and he
said that he could not put a dent in the curve in 8 visits
but could help some of the headaches and tightness that i
have for now and that i can decide how i want to continue
treatment. I was a lot for me to think about when i was
there and i plan on talking to him more on Monday for my
next appointment. I was just wondering what your opinion on
the -22 degree curve of my neck is and how serious you would
classify it as. also, what kind of things am i at risk of in
the future if i cannot get it fixed. thank you, Bri

Answer
Bri,

The neck curve thing is a bunch of bunk.  Forget about your neck curve measurements.  It's not a valid treatment parameter. It's not fixable because nobody knows if it's something that needs fixing.  It's a shame you were x-rayed over this.   I've written on this topic several times.   You can check out previous posts on this.  Here's a basic version, below.  'Hope it helps you understand what's going on.

Dr. G

As an adult, the bony alignment to your neck and back is likely not going to change.  Right hander’s usually have low right shoulders and left hander’s usually have low left shoulders, for example.   With minor curve alterations, the literature and clinical experience points in the direction that there is no correlation between curve alteration and pain.   There are minor compensations to global posture that, in theory, are affected by exercises and manual therapies in general.  "Upper and Lower Crossed Syndrome" (google this), for example, has always been discussed in regards to how tight or weak muscles are associated with alterations in pelvic tilt or shoulder girdle posture, or forward head carry.    
In this regard, a commonly encountered issue in chiropractic regards the loss of ideal cervical curvature (the sagittal curvature, called “lordosis”), and whether it should it be corrected.   First, there is very little clinical research that demonstrates that we are better off for having cervical curves (lordosis) “corrected.”   While some experts believe that a loss of lordosis is a variation of normal, the general observation by practitioners is that the loss of curve has no great bearing on health or the prevalence of pain.   A recent, large cohort study demonstrated that a loss of lordosis does not correlate with pain or worsened prognosis.   We really need to answer the question:  does loss of the perceived normal curve of the cervical spine matter?   That being said, chiropractic adjustments alone have never been proven to restore the normal "lordotic" curve of the neck.  There are many reports of improvement, and lots of media hyped devices that tout efficacy of improvement, but little in the way of solid evidence.  There is a chiropractic system that touts curve restoration, and it involves a head harness that forcefully tractions and extends the neck over a wedge or fulcrum.  While the research on the outcomes appears impressive, it is highly criticized by the clinical science community.   In particular, one such study showed improved neck curves and reduced pain, but the treatment group was compared to a group that had no treatment at all.  That’s not a fair comparison.   People with neck pain get resolve all the time without ever knowing what their neck curves are.   Therefore, restoring a neck curve is may not be essential to good health.  We assume it might be, but is it worth months and months of treatment and significant costs to improve the neck curve when it may not change your health, or your future neck pain history?  With neck or back pain, it is not essential to take x-rays in most cases.  Only if a patient's history or physical exam findings warrant concern for diseases that would exclude them from treatment (or some forms of treatment) or make treatment dangerous would x-ray be necessary.  More important than neck curves on x-ray is a patient's symptomatic and functional outcome in their treatment program.  In other words, is your neck pain gone?  Are your ranges of motion improved?  Can you perform daily activities such as bending, reading, sleeping, etc, without problems?   These activities can be tracked with a Neck Disability Index questionnaire or an Oswestry Low Back Pain questionnaire, for example.   Pain relief and improved functional ability is a worthy goal of treatment.   Not if your neck curve improves.     There is a growing trend of practitioners scaring the people into believing that their neck curvature will lead to ill health later in life, and compelling this unknowing lay public to submit themselves to lengthy and costly care.    
1.   Christensen, S.T. and J. Hartvigsen, Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther, 2008. 31(9): p. 690-714.
2.   Gore, D.R., Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine, 2001. 26(22): p. 2463-6.
3.   Leach, R.A., An evaluation of the effect of chiropractic manipulative therapy on hypolordosis of the cervical spine. J Manipulative Physiol Ther, 1983. 6(1): p. 17-23.


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