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Cervical Kyphosis - Loss or Reversal of Neck Curvature

Posted Jan 25 2010 12:00am
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


ANATOMY: STRAIGHT VS.CURVED

“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.

DIAGNOSIS
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.

TREATMENT FOR CERVICAL CURVE REVERSAL (KYPHOSIS)
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
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