Does manipulation for neck pain change the cervical lordosis?

Neck pain is one of the most common musculoskeletal complaints among patients.

It will affect about one in four people at some point in their lives, and is one of the biggest problems that bring them in to see their regular doctor. In fact, the 12-month prevalence rate ranges anywhere from 30 percent to 50 percent.^1,2 Despite all of this, the actual causes of most neck pain remains elusive.³

Several studies have proposed that reduced cervical lordosis may be a result of cervical trauma or disc degeneration. Furthermore, the amount of cervical lordosis may be a good indicator for treatment prognosis.⁴ Unfortunately, some of these studies may suffer from deficiencies, including lack of comparison to a healthy control group.

However, a recent study published in the journal Chiropractic & Manual Therapies attempted to approach the issue of cervical lordosis before and after manipulation by comparing patients with neck pain to healthy controls.⁴

Methods

The angle of cervical lordosis was measured for 29 patients with subacute, chronic, nonspecific neck pain.⁴ These measurements were compared to those of 30 healthy subjects to determine if there was a change over the course of four weeks of cervical manipulative therapy, with two visits per week.

Measurements were taken at baseline for both groups of subjects and at the end of the four week treatment period for those with neck pain.⁴ The researchers determined that the neck pain patients would have to show a minimum of a 13.5° positive shift in the angle of lordosis to be able to attribute it to the treatment.

Results

As expected, neck pain patients showed greater lordotic curves at baseline than did the healthy subjects.⁴ Furthermore, they did show positive changes in the angles of their lordotic curves, ranging from 9.5° to 11.6°. However, none of the positive changes in angle met the requirement of 13.5°.⁴

What are the clinical implications?

Professor Johnathan Branney, Lecturer at Bournemouth University in the UK, and corresponding author for the article explained the clinical upshot of this research, “The angle of the cervical spine is generally not a good basis for treating mechanical neck pain with spinal manipulation. In other words, there is little justification for taking cervical x-rays if the only reason is to measure the angle of the cervical spine prior to, or after, spinal manipulation.”

The researchers noted that although the changes in lordotic curve did not mean the minimum required level to attribute the changes to therapy, there was nevertheless improvement.

“It should also be acknowledged that, while the measurement method used in the study was reliable and highly standardized, the observer interpretation of x-rays may have been an important source of measurement variability (error) and the sample size was small,” Branny said.

Despite these results being inconclusive, this study’s main strength is in the comparison to healthy subjects. They hope that further studies will strengthen their initial findings by using a larger sample of participants.

Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal 2006 Jun, 15(6), 834-848.

Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008 Feb 15, 33(4 Suppl), S39-S51.

Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Journal of Manipulative Physiological Therapeutics 2009 Feb, 32(2 Suppl), S117-S140.

Shilton M, Branney J, de Vries BP, Breen AC. Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropractic & Manual Therapies 2015, 23, 33. doi:10.1186/s12998-015-0078-3.