Monday, January 25, 2010

Cervical Kyphosis - Loss or Reversal of Neck Curvature

Most commonly known as a “military neck” a straight or forward curve of the neck is abnormal and may cause an unkind progression of symptoms leading ultimately to cervical disk degeneration.

A healthy neck manifests a normal lordotic curvature as portrayed in the picture to the right. The pathology leading to a neck curve reversal (cervical kyphosis shown below right) may be inspired by a multitude of conditions as follows:
  • Post whiplash
  • Post head injury
  • Stomach sleeping
  • Poor sitting/working postures
  • Congenital spinal curvatures
  • Osteoporosis
  • Degenerative cervical discs (a form of osteoarthritis that can either be the cause of or the result of a cervical kyphosis)
  • Compression fracture of vertebral body
  • Infection of the cervical spine


“I’ve always heard that it was good to stand up straight.”

“Stand upright, stick your chest out and hold your shoulders back! Otherwise you’re going get widows hump.”

Are these expressions as familiar to you as they are to me? One might think that having a curved neck goes against what we heard from parents and teachers as we were growing up, but the reality is that there is a little bit a truth in both. Maintaining good posture throughout our lives is crucial to both the health of our spine and vital organs. On the contrary, a special type of curve called a “lordosis” is a good thing, both in the neck and lower back.

When we look at a person from the back their spine should be truly straight, so that the left and right sides of one’s body is symmetrical. However, when we view a person from the side, the front and back of their body is different and this is reflected in a coinciding curvature of the spine. Both the lower back and neck are hollowed out (concave) and the mid or “thoracic” spine is protrudes (convex). Thus there is an alternation of curves functioning to provide stability, shock absorption and aid in propulsion. A straight spine would be very stiff and not flexible. Imagine the plight of a pole vaulter with an inflexible pole.

Nature’s design of our spine and rib cage facilitates breathing and offers protective and supportive framework for vital organs. Spinal disks are shock absorbers and because they are in the front of the spine, lordotic curvatures keep them from having to bear weight. Kyphosis or loss of such curvatures bears weight upon the disks, leading to their ultimate degeneration. This process of deterioration is a form of osteoarthritis and in the spine is known as degenerative spondylosis.

Although most chiropractors or conservative orthopedists can recognize a cervical curve reversal upon viewing the patient’s posture, a definitive diagnosis may be obtained via a standing lateral (side view) X-ray of the neck. Cause can often be determined by corroborating a comprehensive history, a thorough examination, X-rays and questions about sleep, work and lifestyle.

In my professional career as a chiropractic physician, I found that the majority of young adults presenting with cervical kyphosis either had a whiplash or were stomach sleepers from an early age. For desk jockeys 40-60 years of age, many hours of sitting with their head flexed forward almost dictates the fate of developing kyphosis. In prior years I considered cervical kyphosis a job hazard for the careers of accountants, attorneys and often teachers because of years spent with their head in a book or paperwork. However, the digital age offers some relief in that respect. A well-planned, ergonomically-friendly office can do wonders for protecting the spine in the sedentary worker.

During my chiropractic practice I had the opportunity to note a good percentage of correction toward a more normal lordosis (noted on X-ray) for 70% of patients under my care. This was almost always consistent with those patients that followed all recommendations and were model participants in their own care. Here is the recommended treat plan:

  1. Spinal manipulation of stiff and fixated spinal segments by a qualified physician
  2. Flexibility exercises for flexion and extension of cervical spine
  3. Resistance exercises for flexors and extensors of the neck
  4. Learn the Alexander Technique for maintaining good posture (HINT: the basic philosophy is to sit and stand like you were hanging by a string from the vertex of your skull. Liken it to a puppet on a string).
  5. Elimination of stomach sleeping
  6. Avoid standing on your head, although some yoga postures may be beneficial
  7. Use of orthopedic neck pillow while sleeping
  8. Establish and ergonomic friendly work environment while working at your desk
    • top of computer monitor should be at eyebrow level
    • ergonomic chair should remain in a slightly forward tilted position to facilitate an upright posture. If you do not have such a chair, try a wedge cushion with a built in forward tilt.
    • prudent use of an ergonomic footrest to balance the forward tilt of an ergonomic chair
    • elbows must be at your side during mousing, track pad or keyboard entry. DO NOT reach for these items

Friday, January 15, 2010

DR. OZ – The Wellness Messiah

As a retired chiropractic physician and quasi wellness expert I have long espoused the true philosophy of wellness. I’m what Doctor Oz would call a “wellness warrior”. I can really relate to the philosophy administered by Dr. Oz and the Dr. Oz show team. It pleases me to note that a well-respected medical doctor like Mehmet Oz is reaching a vast audience with a common sense approach for care of the human frame. As a nation we have lived in an environment whereby doctors have hastily recommended surgery or loaded patients up with powerful medicines. We must turn our focus to health and away from simply treating diseases as they arise. I’ll take this moment to commend Dr. Oz for his valiant efforts and designate him the “Wellness Messiah”.

Personally, I have lived true to the wellness warrior lifestyle and strongly advocated such to my friends and family members. During my journey as a health care provider I often experienced the need to overcome negative rhetoric surrounding the chiropractic profession from both patients and allopathic (conventional medicine) colleagues. I found it interesting that patients dosed with multiple medications from their medical doctor(s) were often those that suffered from the greatest ill-health. I have jousted with patient apprehension for alternative therapies, yet have been joyful when the acceptance of such produced a welcomed result.

I believe chiropractors were the first modern day wellness professionals although ancient medicine had its origins in what we now consider alternative therapies. The foundation of the wellness warrior is a strong belief in the innate recuperative powers of the human body. An active, harmonious lifestyle combined with a balanced, colorful, and sustainable diet is the way of the warrior. Key components exclude processed grains and sugars, but require proper breathing, movement (exercise), dependence on vital plants/herbs and judicious use of all Mother Earth’s bounties.

“Let me take this opportunity to join Dr. Oz in welcoming new Wellness Warriors to a vital and long life.”