Expert: Dr. J. Shawn Leatherman - 2/22/2007

Question
I visited a chiropractor for the first time yesterday in regards to some neck and lumbar pain. The Dr. took x-rays of both areas and called me back saying that I had a -17 degree reverse curvature of my neck. He said a normal person has a 35-45 degree curvature therefore putting me in a 60 degree curve in the wrong direction.  I'm supposed to meet w/ him on Monday to go over the results in detail but I'm a little concerned about the results.  I have neck pain but I'm able to workout regularly and sleep w/ out too much pain.  I never would have visited him if I thought this was something that could be put off but the results are a little alarming.  I'm only 26yrs old and he said this could be permantly damaging if not treated immediately.  Any insight you may provide would be greatly appreciated.

Answer
Dear Andrea,  

I am familiar with the measurements you have mentioned and the effects on the spine.  Yes a reversal of the normal curve in the neck is a bad thing, and the published clinical literature that the doctor is speaking of, I have read and am aware of.  It states: the optimal curve of the neck called "lordosis" is 43 degrees.  The neck curve can be reduced and considered normal in the population without effects at about 34 degrees. Anything less than a curve of 34 degrees should be considered abnormal, thereby increasing stress on the spinal cord and associated structures.  If the neck is actually starting to curve in the opposite direction this is called "Kyphosis" and is worse.  

This being said,  I assume the doctor will be outlining how he can change the structure of the spine to regain some of the loss you have experienced.  This is completely possible and I do this type of structural rehabilitation in my office as well.  It does take some time, and a commitment on your part to follow the exercise protocols and submit to traction of the neck to affect the ligamentous component of the spine which is the limiting factor in structural rehab.

The loss of the neck curve stretches the spinal cord and the associated spinal nerve roots placing tension on the neurological system as well as stress on the associated muscles, ligaments, and disks.   Additionally, it has been found that loss of the curve reduces oxygenation levels to the brain because the brainstem is placed in a tensed position.  Over the course of time this will deteriorate the condition of the spine as well as other areas of the body that receive information from the nerve roots in that area and the brain stem.  This is not an overnight process, but it will not improve without active treatment.

That being said, spinal adjustments alone will not restructure the curve of your neck, so if the doctor states that you need to be adjusted for a year without any type of specific rehab, or wants you to sign a contract don't buy it and don't sign it.  There are a few unscrupulous doctors who use this types of scare tactics...unfortunate but true.  On the other hand there are great doctors who practice structural rehab, get great results and do it ethically.  Make sure your doctor is certified or has plenty of advanced training on the subject and ask him to prove it.  Check out these sites for more information:  

www.idealspine.com
www.pettibonsystem.com

The first thing you need to do is realize that you are young and you are a great candidate for care, but this problem is not likely to become significantly worse for a few years...so take a deep breath you have time to make an informed decision on care, as well as learn things that you can apply at home to help alleviate the problem, such as ergonomic and postural factors that are contributory to the problem.  I can understand the doctor's want to start treatment immediately due to the measure of curve change, but do not let him push you into care without fully understanding what is going on.  You as the patient have a right to informed consent which means the doctor has an obligation to fully explain the problem, the treatment, the risk of care and not obtaining care.

This problem of loss of the curve only happens for two reasons...significant trauma or chronic abnormal postural stress over time...post-grad college students who study all the time are an example.I am going to present you with a few quotes of information for you to consider:

“For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.” Kapandji, Physiology of Joints, Vol 3.

“Loss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.”  Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

“Forward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.”  The Mayo Clinic, Nov. 3rd, 2000

“90% of the stimulation and nutrition to the brain is generated by the movement of the spine” Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

Andrea, the bottom line is that you need to closely look at the x-rays and the markings to fully understand what has been relayed to you on the phone.  Listen to what the doctor says, and ask intelligent questions about progression, prognosis, and the information I have provided to you.  If the doctor cannot provide you with intelligent answers and some research to back up his assertions, then do go forward with treatment.  The doctor should welcome your questions and concerns, and be able to answer them fully to your expectations.

If you have any further comment, questions, or concerns feel free to write back.  In addition make sure to check the websites listed above to see if your doctor has the appropriate training to actually perform what he is presenting for your treatment...if you need some help, I will find out for you.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net