325- Cervical Spine Alignment, Function, and Sensorimotor Control

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with the research. This is a study that came out in 2021 and it is interesting. It is titled Demonstration of Autonomic Nervous Function and Cervical Sensory Motor Control after Cervical Lordosis Rehab. And it is a randomized controlled trial. This is a study that I'm going to say opens up Fandor's box. A lot of questions, some answers mixed in and certainly some things to think about with your clinical practice. Before we get started, I'll say a few words about the smart chiropractor. The Smart Chiropractor.com the Smart Chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better retention, and more consistent reactivations without spending any money on advertising. This is about content marketing, staying consistent, teaching and inviting your audience, your health tribe, and really availing yourself by proactively answering the questions that they already have. You can do that across all of the most popular channels. You can do it without spending any money on advertising and you can do it with the help of the smart chiropractor. But as I said today on this podcast, we're talking research. And this is a study that came out in the Journal of Athletic Training and it is a good one anytime. We're talking about autonomic nervous function, we're talking about cervical sensory motor control. As Allen Iverson once said. We talking about practice? No, we're talking about cervical lordosis rehab and how that impacts really the ability for individuals with chronic non specific cervical spine pain, neck pain, to improve not only in terms of pain but also in terms of functional ability. And this is a randomized control trial, as we said at the top. So I always love to hear that. Gives it a little bit of extra umph. Now, why does this matter? Well, neck pain is one of the most common musculoskeletal disorders requiring physician intervention, with an annual prevalence they estimate could range 30 to 50%. So up to half of people out there at any given time could have neck pain. And specifically in this study, there's a focus on chronic non specific neck pain. And I love that they lead in with this in this study because it gets to the heart of it and they. I'll just read it as a quote, quote. Conflicting views exist about the clinical importance of variations in the sagittal plane cervical spine alignment. In chronic nonspecific neck pain. It is often asserted that abnormalities of the cervical curvature may represent a normal variant. And this gets to the heart of a lot of conversations happening in and around chiropractic. I mean, this practically ties into X ray, this ties into your pain versus function. And they kind of throw it out there right at the beginning of this study saying there's some conflicting views in terms of what happens when there are alignment issues. Is it normal variation? Can it cause problems? Does the problems always equate to pain? These are all questions I think as chiropractors we've, I wouldn't say struggled with, but, you know, sought to refine, maybe instead of arguing about, I'll say sought to refine our answers for over the last 100 years plus. But there are a few things that throughout that journey that we have learned that I think all of us can hold true today based upon the science. And one of them is that cervical spine proprioceptive afferentation system is a major, major component of sensory motor control. And there is a deep, deep connection between afferent input from proprioceptive visual and vestibular systems and a stable upright posture of the head and neck. In the cervical spine and the muscles, the ligaments, the discs, there's a lot of mechanoreception going on and that provides a lot of the neurophysiological feedback and input that we need to in, in order to have great control of, of our head and neck. You know, it's. We have the bowling ball on top of the toothpick here with our head and neck and how those things line up, so to speak. It does matter to a certain degree now how much. I think that's what we're trying to dig to the bottom of. And what is a normal variant and what's problem territory? It's difficult. And I'll say, in my opinion, that it's different for just about everybody. Of course there's gross challenges, right? Something is misaligned, 5 millimeter, you know, something wild. But on these more subtle findings, they might not always be causing pain, they might not always be causing abject dysfunction. But is it optimal? Probably not. And this is a balance I think all of us work towards and sort of play with throughout our careers in terms of how much are we really leaning into that, how much are we leaning away from it when we go through our movement assessments, when we create our care Plans, et cetera. So the assumption coming into this study was that restoring normal posture and cervical alignment is necessary for better affrontation process. And there's a little bit of preliminary evidence around that. Now this was a randomized single blind trial. A little bit over 100 patients, 110 patients in both groups received a 10 week multimodal program. Remember, these people had chronic nonspecific neck pain. That multimodal program consisted of things like tens, thoracic spine mobilization and manipulation, soft tissue mobilization. And in addition to that, both groups received all that. The intervention group, so the control group, that's what they got. The intervention group received all of that and a cervical traction device, in this case a dental orthotic to improve the sagittal plane cervical alignment. So control group received again, tension mobilization, manipulation, soft tissue work, and the, the intervention group received all of that and then the dental treatment as well, so that cervical traction. So, so how did things fare? Well, the differences between the intervention and control groups for sensory motor control measures indicated that restoration of the sagittal plane cervical alignment did in fact alter pain disability or autonomic nervous function and sensory motor control. So they did a variety of tests with these individuals, you know, starting in a neutral, moving verbally, you know, to a 30 degree, getting back to where you started. And they went through a variety of different tests to see how, you know, how does the intervention of a cervical traction unit change things. And the thought is that cervical extension traction devices can cause longitudinal tension on that anterior longitudinal ligament and an unloading of the disc due to the shift in the axis of rotation. And that the application of that traction can cause, they say, viscoelastic deformation of the cervical spine, soft tissue, resulting in a more normal load sharing. So they're thinking about this in terms of when there's that traction, it maybe, maybe reset is a little bit of a strong word to say here, but that it impacts and influences the load across the cervical spine, creates, you know, less, you know, less ups and downs, so to speak, and more consistently shares that load across the vertebral segments. So again, let's dig one level deeper. So a lot of this gets down to the interplay between proprioception and postural control. That's really what it comes down to. And their assumption was that restoring normal posture and cervical spine alignment is, is important for better afferentation. And it's been proposed that as your head migrates forward, as you get that forward head posture, it provides increased strain on muscles, ligaments of head, neck and shoulders. And that Creates altered joint positions and dysfunction that can lead to dysaffrontation. So I can follow that from the matter of. Yeah, that makes sense to me, especially when I think about these other studies and that showcase 1 inch, 2 inch, 3 inch. As that chin and head go into forward head posture, the load can change pretty dramatically on the cervical spine. So again, not everybody's gonna be perfect. Not everybody needs to have quote, unquote, perfect alignment. But I think there is something to be said for individuals that are spending a ton of time on the computer. They have, you know, rounded shoulders, they have a hyperkyphotic thoracic spine, they have significant forward head posture, and then they're having chronic neck pain. Number one, a multimodal program sounds like a really good idea. And again, one thing that was interesting in this study, I didn't see too much about adjusting the cervical spine. In this case, a lot of it was thoracic spine adjusting. This gets back to always. Please check those next door regions. If somebody has a wrist issue, be sure you're checking the elbow. If they have a shoulder issue, check up and down that kinematic chain. And I think there's a lot of docs out there, a lot of docs that might be that consider themselves to be evidence based docs that can become at times so myopic, they have pain right here. I want to take care of this issue. I don't want to do anymore. I'm focused, you know, and there's a, there's a balance here. So I would encourage everybody listening to, you know, be mindful of that balance and you know, take into account that there's a lot of literature out there supporting for cervical spine issues, the care and treatment of the thoracic spine, which makes a lot of sense because there's so much interplay between the two. But keep that in mind. I think that's a good clinical tip to utilize. So altered. If we get back to the cervical spine, altered cervical lordosis and forward head translation can cause two things. It can cause a reduced range of motion and altered segmental motion. So when there's altered segmental motion, there can be altered load and thus disaffrontation. When there's a reduced range of motion, it's just not ideal. Right. Our bodies are built to have a balance of strength and flexibility. And if we're not able to move throughout an entire range of motion comfortably, chances are, you know, just you pick this up on your movement assessment, right? And you'd say, gosh, this is going to. Has an increased likelihood to have challenges down the road. If somebody's not able to move through a range of motion comfortably, there's going to be compensation patterns that go on over time. As I like to say, you can get away with it for maybe a week, maybe a month, maybe a year, maybe 10 years. But eventually gravity catches up to you. So ensuring that you have the balance of strength and flexibility that you have as, let's say, neutral as opposed to a forward head posture is a good thing. And multimodal care continues to show itself, whether it's cervical spine or lumbar spine, to be a really good idea. So in this study, the researchers found, quote, as we observed, pain cannot be considered the only determinant for sympathetic system dysfunction in patients with chronic non specific neck pain. They also came to the conclusion, quote, a reduction in adverse mechanical tension acting on the brainstem cranial nerves the 5th of the 12th of, and specifically cranial nerve 10 may be one of the underlying mechanisms that explains the improved autonomic function in our intervention group, because improved head posture and increased lordosis would result in, in reduced longitudinal stress and strain on the neural elements. So a couple things to keep in mind that I take away from this. Number one, cervical traction units. I know that they focused on the dental role in this case. However, they're pretty darn cheap. I mean, I did a quick search before I hopped on. I mean, 25 bucks, 50 bucks, 75 bucks. So this is something that has a low barrier to entry to get your patients involved with. And I'm going to say at least try out and give it a whirl. I know that historically in my practice I recommended a lot of over the door traction units. As I would say to my patients, those medieval looking things, you close it over the door, I found those to be just super cheap, super easy to use and really be able to in an upright posture, unload. And people just seem to get really good results with the over the door traction. However, if you're using a traction device that they might use while lying down, that can work as well. I think as clinicians, as chiropractors, part of our job is to kind of figure this out, right? And to identify, hey, what patients. Maybe if they have really, really aggressive neural compression, maybe those over the door traction units are better if they don't have neural compression, but it's more chronic non specific neck pain. Excuse me, maybe those lying down type traction units like adenerol are better. So just things to play with, things to think about. They call it practice because it's a constant evolution of learning. It's a constant evolution of the application of what we do with our hands and with our minds and with our patients each and every day. So hopefully this opened your eyes to the fact of hey, there's some interesting things going on related to biomechanics and posture. The jury's still out in terms of research is never a closed book. Every research study basically enables 10 more to be done by asking a lot more questions. But I think there is something to be said for sure about the understanding that traction and potentially taking a peek at those curves is not a bad idea. Now, how you want to implement that in your practice is totally up to you. And this did not get into the specifics of displacement, the specifics of alter translation, let's say, in terms of how much that impacts. So all of that still to be learned, but a lot of nice information to be able to take out of this study. So before we wrap up, I want to say a few words about powerstep Orthotics are frequently used to address foot pain and alignment issues, but not all patients need or can afford custom orthotics. I know we see this in our practice all the time. In these situations it is a wise move to trust the clinically proven pain relief and prevention of Power Step Pro Tech Orthotics. These were designed by a podiatrist over 30 years ago and they are coming into our space as chiropractors. You can get a pair for free a sample pair by visiting pro.powerstep.com sample again that is pro.powerstep.com sample I will drop that link in the show notes, Pick up a sample pair, see if you like it. This is a product that actually my father uses. He has been thrilled with so I highly recommend checking it out. Otherwise I hope you have a fantastic week in practice. Leave us a rating or review if you have not done so for this podcast and I will talk to you soon.

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