Neck and arm pain arising from a cervical disc herniation is referred to as discogenic cervical radiculopathy (DCR) in the spine care literature. DCR is relatively common in today’s patient populations and it is typically associated with patient limitations in their activities of daily living and persistent disability.1 The sixth and the seventh cervical nerve roots are the most frequently involved. Despite the high annual incidence of this condition,2 the identification of appropriate conservative management strategies appears to remain a clinical enigma for many patients.3-5
Causes of Altered Lordotic Curve and Disc Herniation
Abnormal alignment of the cervical lordotic curve from the side view (straightening and kyphosis) has been found to result in degenerative changes in the muscles, ligaments, intervertebral discs and bony structures of the cervical spine. These degenerative changes, in turn generates increased force on the spinal cord and neural elements leading to arm pain and altered nerve conduction / action potentials times and amplitudes.6-9 Recently, there has been a growing interest in the understanding of and rehabilitation of the cervical lordotic curvature as a clinical outcome or goal of patient care.10-13 Problematically, however, the available literature on conservative treatments for DCR patients has not addressed proper rehabilitation of the cervical lordotic alignment in specific patient populations.14,15 The development of effective intervention strategies and trials testing this concept in DCR patients is thus sorely needed.
New Breakthrough Randomized Trial
Recently a breakthrough randomized trial was conducted at Cairo University in Egypt and co-authored by CBP NonProfit President Dr. Deed Harrison, DC. The Cairo University team was led by Professor Ibrahim Moustafa, PT, PhD and included collaborating authors Professor Aliaa Diab PT, PhD and Shimaa Taha PT, MSc.16
Clinical features: The study investigated 40 patients with chronic pain and disability due to DCR. The short (10-weeks) and long term (1-year) outcomes of neck disability, neck pain, arm pain, and measures of neuro-physiology were assessed in this project.
Interventions: The investigation used a standard intervention frequency and duration of 3x per week for 10 weeks or 30 total treatment sessions. Patient participants were assigned equally to one of two groups: Denneroll group and Non-Denneroll Group. Of interest both groups received a standardized multiple treatment procedure protocol including:
- Spinal manipulative therapy for the thoracic spine,
- Myofascial stretching and release techniques to the cervical spine and anterior brachial plexus area,
- Tens and hotpacks to the cervical and upper thoracic regions,
- Functional and strengthening exercise protocol designed to improve strength, flexibility, posture, and reduce pain,
- A series of home care instructions.
Only the Denneroll group received the cervical denneroll in addition to the standardized multiple treatment techniques. Figure 1. shows the Cervical Denneroll device.
All treatments were applied 3x per week for 10 weeks. At the end of the 30 treatments, following a minimum of 1-day with no treatment, all subjects were re-evaluated. Lastly, treatment was then stopped and all subjects were followed for an additional 1-year to see if the 10-week outcomes were maintained at this long term follow up.
Important Findings and Conclusion
The addition of the cervical denneroll orthotic device to a multi-modal physical therapy intervention program was found to improve the cervical lordotic curvature by an average of 13° and improve anterior head translation by 12mm. This improvement in cervical curvature and posture in the Denneroll group was found to be associated with improvement in chronic neck pain, arm pain, and neck disability and a reduction in medication usage over the 1 year time period. Furthermore, in the group receiving the denneroll and curve correction, their peripheral nervous system speed was found to increase by 24% and the spinal cord–central conduction time–was found to increase by 23%!16
Figure 2. shows an example of a patient’s lateral cervical spine x-ray with a cervical kyphosis and then the 10-week and the long term follow up x-rays indicating correction.
How Can You Get Help for Your Altered Posture and Spinal Arthritis and Disc Disease and Health Disorders?
Chiropractic BioPhysics® corrective care trained Chiropractors are located throughout the United States and in several international locations. CBP providers have helped thousands of people throughout the world realign their cervical spines back to health, and eliminate a potential source of progressive SADD, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. The exam and consultation are often FREE. See www.CBPpatient.com for providers in your area.
- Yoon S.H. Cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011;22:439–446.
- Kuijper B., Tans J.T., Schimsheimer R.J. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review. Eur J Neurol. 2009;16:15–20.
- Miller J., Gross A.R., D’Sylva J. Manual therapy and exercise for neck pain: A systematic review. Man Ther. 2010;15:334–354.
- Cleland J.A., Whitman J.M., Fritz J.M., Heath R. Predictors of short-term outcome in people with a clinical diagnosis of cervical radiculopathy. Phys Ther. 2007;87:9–23.
- Murphy D.R., Hurwitz E.L., Gregory A., Clary R. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther.2006;29:279–287.
- Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Morphological and Biomechanical Modeling of the Thoracoc-lumbar Spine: Implications for the Ideal Spine. Spine Journal 2005; 5:297-305.
- Harrison DE, Harrison DD, Janik TJ. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clinical biomechanics 2001; 16(4):276-84.
- Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART II: Strains in the Spinal Cord from Postural Loads. J Manipulative Physiol Ther 1999; 22(5):322-332.
- Breig A. Adverse mechanical tension in the central nervous system: An analysis of cause and effect: relief by functional neurosurgery. Stockholm, Almqvist and Wiksell International; 1978: 130.
- Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland BA. New 3-point bending traction method for restoring cervical lordosis and cervical manipulation: A non-randomized clinical controlled trial. Arch Phys Med Rehabil 2002;83(4):447-453.
- Harrison DE, Harrison DD, Betz J, Janik TJ, Holland B, Colloca C. Increasing the Cervical Lordosis with CBP Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Non-randomized Clinical Control Trial. J Manipulative Physiol Ther 2003; 26(3): 139-151.
- McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the Relationship between Cervical Lordosis and Neck Complaints. J Manipulative Physiol Ther 2005; 28 (3): 187-193.
- Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.
- Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. J Can Chiropr Assoc. 2012 Mar;56(1):18-28.
- Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013 Dec;29(12):1073-86. doi: 10.1097/AJP.0b013e31828441fb.
- Moustafa IM, Diab AA, Taha, S, Harrison DE. The addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves short and long term outcomes in patients with discogenic cervical radiculopathy. Archives of Physical Medicine and Rehabilitation 2016; In Press. DOI: http://dx.doi.org/10.1016/j.apmr.2016.07.022 http://www.archives-pmr.org/article/S0003-9993(16)30898-X/fulltext