Science In Brief

Chiropractic Litterature Review

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The Study: The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study.

The Facts:

  1. The authors performed a study lasting 2 years on patients who suffered from "chronic discogenic lumbosacral radiculopathy".
  2. The treatment was multimodal and a part of the treatment in one group was to give them exercises designed to correct forward head translation.
  3. They had two groups, one of which got the "functional restoration program".
  4. The other group also received the functional program and in addition "the experimental group received the forward head posture corrective exercise".
  5. The primary outcome measurement was the Oswestry Disability Index.
  6. There were a lot of secondary outcome measurements which dealt with mechanical factors such as translation, lordosis and kyphosis. In addition to the mechanical measurements they also included "leg and back pain scores, and H-reflex latency and amplitude."
  7. Patients were evaluated prior to treatment, 10 weeks post treatment plus a follow up evaluation at 2 years.
  8. At 10 weeks there was really no difference between the two groups in terms of disability. But at 2 years they found significant differences between the two groups. The group that received the forward head posture corrective exercises added to their program was significantly improved in all the variables studied.
  9. The authors concluded that adding the corrective head posture exercises to the treatment conferred a positive effect on disability, spinal posture, back pain, leg pain and the function of the S1 nerve in these patients.
  10. In the introduction they referenced Brumagne writing in the European Spine Journal and Wong writing in the journal BMC Musculoskeletal Disorders and stated, "Abnormal posture is one of the most important etiological factors associated with low back pain." (emphasis ours.)
  11. They also note there is a lack of study on the affect of the cervical spine on "spinal posture closely linked to low back pain."
  12. In the discussion section the authors also suggest the possibility tha "the cervical spine has an important role in global spinal posture".
  13. Abnormal posture may lead to joint dysfunction and abnormal afferent information.

Take Home:

Functional restoration was just as good as functional restoration coupled with forward head posture corrective exercises as far as disability in the short term but at 2 years the patients who received the corrective exercises (note: the alignment of this group was significantly improved) were significantly better in all the variables used to study these patients.

Reviewer's Comments:

I'm sorry you can't see the pre, 10 week post, and and 2 year follow up lateral cervical x-rays of the group receiving the corrective exercise in addition to the functional restoration program. The pre x-rays show spines with very little cervical lordosis and pronounced forward head posture. The post treatment film shows a very nice lordosiswith the head balanced over the thorax and the 2 year follow up shows that the great majority of what was accomplished by the treatment has been maintained.

I have always found it unreasonable not to acknowledge that the structural alignment of the spine can have a significant effect on the health and well being of patients. Skyscrapers do not rise toward the heavens at 45 degree angles. No architect would say that the alignment of the supporting structures in their new 40 story building don't matter. But I've heard chiropractors say the equivalent when it comes to patients. Spinal alignment is important.

But here is the other side of the argument. Am I saying the only thing important to health is spinal alignment or that we get to treat patients endlessly in an effort to achieve our own model of perfection. Absolutely not! We need to recognize that structural alignment is important to all things on this earth. In addition we should consider its importance as we undertake the reasonable and appropriate care of our patients. I'd like to thank the physical therapist who wrote this article for doing the type of research which is so important to the health of patients.

Reviewer: Roger Coleman DC

Editor's Comments: Once again, we see competing professions doing good research into the most basic tenets of chiropractic. The physical therapy profession realizes full well the importance of healthy spinal alignment and they will be more than willing to steal our professional birthright if we are stupid enough to abandon this concept. Chiropractic academia at large, no doubt still influenced by the same old intra professional politics of the past hundred years, is letting our profession and the people we serve down terribly in this area.

Editor: Mark R. Payne DC

Reference: Moustafa IM, Diab AA. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. J Manipulative Physiol Ther 2015;38:167-78

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/25704221

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