Expert: Gerald Anzalone, D.C. - 1/20/2012

Question
I am 38 years old, and did some upper body exercises with fairly light weights followed by lifting my toddler over a crib rail.  Within 24 hours, I experienced terrible neck pain and muscle spasms which was diagnosed as torticollis by both a medical doctor and chiropractor (whom I saw with encouragement from a coworker).  After a month of regular electrical ultrasound and trigger point therapy, my xrays show improved but persistent reverse curve of the neck.  The chiropractor is suggesting traction and rehab exercises to try and correct this.  My primary care doctor suggested I see a "spine specialist", I assume an M.D.  What would a spine specialist with a medical degree do differently to treat this?  Also, is traction likely to help and over what period of time?  Thanks in advance.

Answer
Stephanie,

Thank you for your question.

First, the neck pain and spasms you experienced after exercising and picking up your toddler are most likely not related to the reversal of the cervical curve (the normal curve of the neck is called the cervical lordosis); rather, the cervical kyphosis (reversal of the lordosis) is most likely an acquired condition that was present prior to the onset of your symptoms.

Secondly, having repeat x-rays of your neck while undergoing treatment for acute muscle spasms and contracture is completely unnecessary. Some proprietary chiropractic techniques push the idea of multiple sets of x-rays while undergoing a treatment plan to show "progress"; however, evidence-based chiropractic radiologists emphasize that this unnecessarily exposes the patient to potentially harmful levels of ionizing radiation. An initial set of x-rays prior to treatment is appropriate, depending upon the patient's clinical situation. In most cases, anything beyond that is usually clinically unnecessary.

Regarding the question of surgical intervention versus conservative manual therapy for cervical kyphosis, spine surgeons typically only consider surgical intervention in cases of cervical kyphosis when myelopathy, or damage to the spinal cord, is found or if the patient is at high risk of developing myelopathy.

In a 2002 paper published in the medical journal Spine, the authors found that a ratio below 0.3 between the anteroposterior (front-to-back) diameter of the brainstem and the spinal cord at the apex was a risk factor for cervical myelopathy. One of the most predictable risk factors of progression of the cervical kyphosis was osteophyte formation (bone spurs) at the anterior aspect (the front) of the vertebral body (Iwasaki et al. Cervical Kyphosis: Predictive Factors for Progression of Kyphosis and Myelopathy. Spine 2002 Jul 1;27(13):1419-25).

Typically, non-surgical treatment of cervical kyphosis addresses the symptomatic aspect of the condition. Many, but not all, patients with cervical kyphosis may experience neck pain as well as mid-back pain. A 1997 paper published in Spine fond that changes in cervical lordosis correlated inversely with changes in thoracic (mid-back) alignment (Hardacker et al. Radiographic Standing Cervical Segmental Alignment in Adult Volunteers Without Neck Symptoms.1997 Spine 1997 Volume 22 - Issue 13 - pp 1472-1479). Individuals with a cervical lordosis reversal typically have significantly tense muscles with trigger points (tender nodules found in taught bands of muscle which typically radiate pain in predictable pattersn) in the front and back of the neck and in the shoulder regions.

Forward head carriage and forward rounding of the shoulders is commonly noticed to be associated with a reversed cervical lordosis. The desk worker is notorious for developing this abnormal posture due to computer and telephone use. In this situation, the shoulders move forward and the head does not sit in line with the shoulders.

Spinal manipulation, manual muscle therapy, acupuncture, massage therapy, and physical therapy all provide potentially helpful short-term venues for symptomatic care, and many patients obtain good long-term results by simply improving their poor posture and making their work environments more ergonomically sound. An excellent resource for explaining the effects of poor posture and how to correct it is a book entitled The Alexander Technique Workbook: The Complete Guide to Health, Poise and Fitness by Richard Brennan:

http://tinyurl.com/6wgqm86

For the symptomatic neck sufferer, a resistance traction device such as this may be helpful:

http://tinyurl.com/5olvcu

Care must be taken when using a device of this nature to avoid further injury or discomfort; patients with significant degenerative joint or disc disease of the neck, or those who have had surgery of the neck, should not use this device. You should discuss using a device like the Posture Pro with your chiropractor or medical physician prior to beginning a course of home-based therapy with it.

As for time frames for treatment, symptomatic care for neck pain usually consists of between 1-6 chiropractic treatments. Longer-term postural changes depend on the individual and may vary quite widely.

I hope that this helps to answer your question.