Question
QUESTION: I went to a "Maximized Living" chiropractor and he took an x-ray and showed me the my cervical curve is 0 degrees. He wants me to sign up for a year of treatment for $2500 to get my curve to 43 degrees. He also e-rayed my wife's neck and her's was at 19 degrees, he said he would treat her for half price and wants a comittment for $3700 up front.  We have no real pain or problems but he says it needs to be at 43 degrees for optimum health and if we don't fix it we will have problems such as bone spurs and fusions. I can find no evidence to his claim that everyone should be at 43 degrees or studies that show even if he does get it to 43 degrees that it will both benifit me and stay there.
I told him my problens were lower back. DJD, bulging disc and narrowing of spinal column. I am considered a disabled Vet by VA because of these problems but he wants to work on my neck.
I would like to hear your thoughts on this practice if you are familliar with this franchise.
I would also like your advise on what kind of doctor to see about my lower back.
Do you think we should be concerned about the curvature of our necks?



ANSWER: Kurt,

Thank you for your question.

It is true that the average angle of the spinal curvature (called a lordosis) of the cervical spine (neck)is about 45  to 50 degrees. A loss of the cervical curvature is called hypolordosis, and it most likely predisposes an individual to degenerative disc and joint disease (which would include the formation of bone spurs, called osteophytes, and possibly the fusion of adjacent segments after a long period of time). Hypolordotic curvatures are common, but in many instances don't produce any symptoms, while in others, they appear to be present in people with chronic neck pain.

However, if you don't have any neck symptoms, I would not recommend treatment of that area. The chiropractor you described is emphasizing a marketing tactic rather than an evidence-based practice approach, particularly as regards the financial arrangements you described.

As regards your degenerative joint disease in the lumbar spine, lumbar spinal stenosis (narrowing of the spinal column), and disc problems, you could benefit from seeing the right kind of chiropractor, specifically one who practices a technique called Flexion-Distraction. This technique involves the use of a mechanical treatment table that gently stretches and opens the spine into a forward-bending position (called flexion), thereby opening up the spinal joints and helping to alleviate the symptoms of spinal stenosis, facet arthrosis (or "arthritis"), and disc protrusion. This technique does not involve any thrust manipulation

However, do be aware that lumbar spinal stenosis is a chronic problem that may be progressive and may  not be healed with a short-term treatment program of any kind. Most cases of lumbar spinal stenosis that don't require surgery do require a long-term or on-going treatment program, which should include self-care exercises that you perform on your own each day. A chiropractor who is versed in this condition can advise you on the best maneuvers to perform, as could a good a physical therapist.

As a disabled veteran, you should be aware that chiropractors are present in the VA health care system (depending on your state and region), as are physical therapists, so you could avail yourself of treatment in a VA hospital, as well as seeing a private practitioner.

I hope that this answers your question.

---------- FOLLOW-UP ----------

QUESTION: Dr Anzalone,
Thank you so much for taking the time respond to my concerns.
This is all new to me. It's not so much the money but also the time commitment of 80 visits and home excersize 2 times a day. Even that would be OK if we received a great benifit.  What I have been trying to figure out is "is it worth it? Yes indeed it was a very slick marketing presentation that's why I wanted your thoughts on this organization. He is a new DR. starting a new practice and may be more interested in building a business.
Back to the cervical lordosis issue, I have been trying to find out what normal curvature is.  I've found where the medical doctors say it should be around 20 to 40 degrees and chiropracters that say it should be 34 to 42 degrees and you say 45 to 50.  Whatever it is suppose to be, I'm still way off. Here are my questions:
1. Is the straightening out of the curve the bodys way to balance itself because of lower spinal problems or bad posture?
2. If I get my lordosis angle to 40 degrees will it stay there?
3. Are you familliar with Maximized Living?  They used to be Body by God. Any opinion on them?

Thanks again for your time.  
I will check into getting help through the VA. Should I seek a DC or a PT? Do they both use flexion?

Answer
Kurt,

To answer your questions, "Maximizing Living" and "Body by God" are proprietary marketing strategies that are not taught in accredited chiropractic colleges, nor are they considered to be consistent with the best available evidence to substantiate evidence-based chiropractic care.

Regarding cervical curvatures, depending upon the source, the average measurements for a normal cervical lordosis will vary somewhat.

A 2005 study in the Journal of Manipulative and Physiological Therapeutics ("Determining the Relationship Between Cervical Lordosis and Neck Complaints") found that patients with lordosis of 20?or less were more likely to have cervicogenic symptoms (that is, pain arising from dysfunction of the joints of the neck).

The study also found that people who had a 0?or less (meaning a reversal of the normal curvature of the neck) had significantly increased incidences of pain. The odds that a patient with cervical pain had a lordosis of 0?or less was 18 times greater over all age ranges. Males were found to have greater incidences of cervical lordosis loss than females, especially in the 40- to 49-year-old age range.

The researches also found a statistically significant association between cervical pain and lordosis less than 20?and a 揷linically normal?range for cervical lordosis of 31?to 40? They concluded that maintenance of a lordosis in the range of 31?to 40?could be a clinical goal for chiropractic treatment.

Some reports in the literature assert that restoration of the cervical lordosis is possible through various proprietary chiropractic techniques. As far as I am aware, however, these techniques are not part of standard chiropractic education and training, and the clinical utility of these techniques has not been clearly established in the research.

To answer the other questions you raised, there is nothing in the research to suggest that the loss of the normal cervical lordosis is the body's way to balance itself because of lower spinal problems or bad posture. The causes for loss of the cervical lordosis have not been clearly identified.

I am also not familiar with anything in the literature to suggest that once your cervical curvature is restored to a certain range that it will remain there. I support the concept of patient self-care (meaning rehabilitative exercise or ergonomic and postural modifications, which the research substantiates), but I am skeptical about any technique that requires an initial 80 visit commitment. This is a marketing strategy rather than a clinical strategy based on the best available evidence. I am also skeptical of any technique that brings a spiritual element into the clinical treatment realm, for the same reasons. In my opinion, based upon the research consensus to date, treatment of a spinal region that is not causing symptoms is unnecessary.

Finally, doctors of chiropractic perform flexion-distraction , which might be an effective treatment approach for your lumbar stenosis and disc problems. I would try seeking a chiropractor who uses this technique first; if after 12 visits you fail to notice any significant improvement in your lower back symptoms, then you might consult a physical therapist.

I hope that this answers your questions.