There is a lot of talk in chiropractic about how important the cervical curve is. Many chiropractors feel this is so important that their practice is devoted to re-introducing a normal cervical curve back into their patients via spinal rehabilitation. One professor at Parker is even known by students and alumni for his intense passion on this subject simply by the words “anterior head carriage.”
But what is normal, as it pertains to the cervical curve?
Chiropractic Biophysics states that a normal cervical curve is 42.5°. This is based on the path of the posterior longitudinal ligament through the posterior vertebral body margins.
But let’s take two separate people, Person A and Person B for example.
What if Person A has a decreased cervical curve of, let’s say 29 degrees, but has no sign whatsoever of nerological interference i.e. a vertebral subluxation? They have a straight line on a thermography/NCM scan, normal juxtaposition of C1 and C2 on x-ray, no muscle tightness, no pain, and they are basically healthy. Are they abnormal because their curve is decreased?
What about Person B who has the textbook perfect 42.5° cervical curve, but they have clear evidence of neurological interference i.e. a break in their thermography/NCM scan, tightness, leg length inequality, evidence of C1 and/or C2 misalignment on x-ray, muscle tightness, and they are showing signs of dis-ease? Are they normal?
Don’t get me wrong, I know the cervical curve is important. It just seems to me that a decreased cervical curve and no vertebral subluxation is much better than a good cervical curve with the presence of vertebral subluxation.
What are your thoughts on this topic?
{ 15 comments… read them below or add one }
I would imagine that the probability of someone having an abnormal curve and no indicators of an upper cervical subluxation would be low, but still possible, same as the person with the normal curve having indicators of an upper cervical subluxation would also be low, but again possible. Anything is possible the question lies in what is the most probable. “Absolute certainty is a privilege of uneducated minds an fanatics.” C.J. Keyser. I have often wondered with NUCCA’s focus on postural assessment if anyone has ever done a test/study to see if there is a high degree of correlation between when this assessment says to adjust and when pattern analysis says to adjust.
I have to agree to some extent, Brandon.
While a “normal” cervical curve is usually a good thing and is evidence of a cervical spine that is not under undue stress, the problem with “normal” curve is that it is just like “normal” blood pressure. It’s an *AVERAGE*!!! This means that by DEFINITION, 50% of people who are completely healthy are going to be BELOW the “normal”. Just as 50% of completely healthy people have “high” blood pressure.
I am an absolute believer in the core chiropractic principle that the body is smarter than we are, so I base my primary clinical decisions on PHYSIOLOGICAL indicators rather than absolutes. The absolutes give you something to aim at with your care, but when the physiology tells you that things are good, don’t keep pushing for the target you initially set “just because”.
What if someone has no pain, no muscle tightness, a 1/16th of an inch leg length discrepancy, no disease, is perfectly healthy but shows a 3/4 degree atlas laterality on x ray. Do you adjust them? I know of some upper cervical docs who belong to certain consulting groups like AMC who might sign them up for a 24 visit advanced payment treatment plan. Thoughts?
Trying to restore the cervical curve is one of the most common ways chiropractor’s use to keep the patients comimg back. I see cases where the chiropractor recommends 100 or 200 visits and promises a return of the cervical curve. I agree that having a cervical curve is the best case scenario for a person without any degeneration, but let’s look at it this way. When we take an x-ray of a patient and they have degenerative changes, we ususally see a compromise in the size of the intervertebral foramen. With an increase in lordosis we get an decrease in the size of the foramen, with a hypolordosis or a reversal of the cervical curve we get an increase in size of the intervertebral foramen. There is more room for the nerves. This is Innates way of adapting to the stresses and the degenerative changes over time. If a chiropractor tries to put a curve in the neck that will be working against Innate. I have had many curves restored by correcting the upper cervical subluxation, but I don’t try to force a curve in a spine that should not have one, that is an outside in medical approach.
There is a segmental subluxation and there is a global subluxation. They both require correction. It’s myopic to dismiss the significance of one just because it doesn’t jive with your own practice philosophy or some kind of rigid technique ideology. My loyalty is to my patient’s health, not to obediently adhering to the rules of any one technique. – And I’m a recovering CBP addict. LOL
Eric,
Personally, I would go by the pattern analysis via thermography/NCM. If that showed a straight line, or no consistent pattern, I would just send them on their way and just have them stop by once a month, at most, just to check if they’re holding.
24 visits paid in advance for someone who is basically healthy is obviously not right. That person would probably only need 1-3 office visits in the beginning.
Something you might consider Brandon – what if the pattern of nerve internference is not present in the cervical spine, but rather in the reading from S2-VP? It happens!
Interesting, Thanks for all your thoughts. Here is mine based on what I have seen in practice. I have had practice members show up at the start of care with a “perfect cervical curve” ones defined by a range of arbitrary numbers assigned, yet presenting with a short leg and related muscle spasms. Other times, I have seen reversed curves with no apparent “symptomtology” and have to agree that the bodies innate wisdom has self corrected and adapted to the stress. You can have a “crooked tree” that bares really great fruit. Are we trying to straighten the “tree’ or get the best fruit from it?
Structure dictates function. The vertebral column is the conduit which contains the electric wiring. When the conduit is crimped, it has an adverse effect on the nerve impulse.
Are we supposed to be nervous system doctors? And if so, does it make sense that our job description should be to correct subluxations when and where we find them? A global subluxation (such as forward head posture) can be extremely deleterious to a person’s health – even if it’s not causing symptoms right away. There is so much evidence to support this (both in terms of published research as well as what’s alreay been published in biomechanical textbooks).
The lack of a good documentation on biomechanical normal has been a wedge that subluxation skeptics, and the cottage industry of chiropractic critics (both DC and non-DC) has used against subluxation based chiropractic care. I think the Harrison’s should continue to be commended for pursuing the math behind a biomechanical normal, as it may be the very thing that keeps our rights to x-ray our patients in our hands. Both Dr. Doble and Dr. Kuhn make excellent points on whether these definitions of ideal are important, or should be corrected, in all cases. I certainly understand as an orthogonal UC practitioners that there are cases where I’m quite happy just getting the patient to stay on a vertical axis, and peck away at atlas laterality. But that doesn’t mean I throw out the orthogonal ideal as a framework with which to objectively judge the progress of a case. The golden mean continues to be a standard on which dentists, plastic surgeons, and artists are judged in their work. It makes sense that the internal structure would have as rigid of measure, and we should respect it, by actually measuring it.
Sometimes the body adapts to it’s environment in an unhealthy way (such as the case of laying down calcium in areas of greatest stress – as per Wolff’s Law of hard tissues). The result is bone spur formation.
Adaption is necessary for survival, not necessarily ideal health.
Just because the body does it naturally does not necessary mean it’s a desirable outcome. Remember, cancer is “normal” too. It’s a natural occurrence, yet it’s hardly an ideal outcome.
It is my own deep personal belief that everything is life has a wisdom, a meaning, a purpose. The foods we eat, the water we drink, all have an intelligence. While my OPINION/belief might not be popular from the “physical” perspective of how we judge normal, I do believe that bone spurring, calcium formations, and even cancer is an ideal outcome for some. I have seen peoples lives transformed and others die both acquiring a greater state of consciousness accepting that their state is what was needed. Some people need to move through dis-ease in order to evolve from a spiritual perspective. Dr. Smith you said “Sometimes the body adapts to it’s environment in an unhealthy way (such as the case of laying down calcium in areas of greatest stress” If you re-read it the body had not a chance to adapt in an ideal way because there was still stress in an area. If there was no stress, according to Wolff’s law, there would be no bone formation. If the stress had been identified and corrected the body would not have a reason to lay down new bone formations.
The gravitational stress placed on the body isn’t going to go away. It pulls us to the Earth 24/7. So long as that’s a reality, it makes sense to optimize the correct loading on our joints, discs, and other structures. It’s like having a house with a bad foundation. You’re going to get cracks in the walls. And no matter how well your intentions are, no matter how good your drywall skills are, you’re always going to have this problem until you fix the structure.
One of the traps many chiropractors fall into is when they feel like they have to pick a side – vitalism or mechanism. But the thing is – they’re not mutually exclusive. They BOTH exist simultaneously, and in harmony with each other. It’s our own limiting belief systems (the “subluxation” we often have in the 6 inches between our own two ears) which prevents us from realizing that we affect patients from BOTH the vitalistic and mechanistic paradigms.
The expression of Innate is always paramount to health. However, turning a blind eye to osseous pathology (such as bone spurs and degenerative joint disease) – simply because it doesn’t fit neatly within our own philosophy, does not serve the best interests of our patients.
Well if we are all chiropracTORs here, then we need to look at some definitions to determine our answer. I think we’ll all agree that Subluxation = misalignment + nerve interference. Notice the “+” is not an “or”. Meaning we cant allude misalignment always results in nerve interference just as we cannot allude nerve interference is always caused by misalignment. It is the sum of the two that defines our craft.
The problem with a CBP style approach is it measures (for many, not all doctors) misalignment ONLY. The problem with diversified doctors that may use some kind of diagnostic instrumentation is that they measure nerve interference ONLY. If you can show me a misalignment correlating to some kind of nerve interference, and the absence of that misalignment showing an absence of nerve interference, you are demonstrating the principle. Anything less is missing the point.
On the concept of the ‘ideal curve’ itself: a mentor of mine once showed me that angle which the facets developed with respect to the vertebral bodies will ultimately decide what a person’s ideal curve is. If you look at a lateral cervical film, you will find a wide variety of facet angles, and it’s hard for me to believe they will all have the same ideal curve. Just as it is hard for me to believe everyone’s subluxation free status is perfectly orthogonal (blasphemy, I know!)
Great responses from all! I try not to talk about curves to much in practice. I do not want to make an adjustment a physical act, or mechanical event. Patients and even some Chiros get into “My back went out” and they want us to “put it back in” (with 1 visit) type of mentality?