Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit.

OBJECTIVE: This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis. METHODS: Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T12, L3, S2, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T12 and L3, and the line joining L3 to S2. RESULTS: Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20). CONCLUSION: Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Evaluation of Anterior-Posterior Spine Curvatures and Incidence of Sagittal Defects in Children and Adolescents Practicing Traditional Karate.

BACKGROUND AND STUDY AIM: To evaluate anterior-posterior spine curvatures and incidence of sagittal defects in children and adolescents practicing traditional Karate. MATERIAL AND METHODS: 152 people aged 6-16 yrs, mean age 10.5±3.03. The study group (SG), subjects attending traditional Karate classes for min one year, 60 minutes twice a week (76 people). The control group (CG) randomly selected on 1:1 basis to match SG. The anterior-posterior curvatures were measured with a gravitational inclinometer. Sauder's norms were used to assess postural defects. Body mass, height, and BMI were measured. Mann-Whitney U-test/Student's t-test for independent variables, χ 2 test, and Cramer V test were used in statistical analysis. RESULTS: Significant differences were observed between the groups in lumbosacral inclination ALPHA1 p<0.001; karateka had significantly lower ALPHA 1 and greater thoracic inclination (GAMMA TH/L) p=0.23. In study group, lumbosacral angle flattening (ALPHA 2) (81.6%) was greater than in CG (56.6%). ALPHA 2 (43.4%) was more frequently within the norm in CG. Increased ALPHA 2 was reported only among SG (2.6%). Differences were statistically significant (χ 2 (2) = 15.23 p<0.001) and of moderate power (Cramer V=0.31). Regarding thoracic kyphosis and lumbar lordosis, there were no statistically significant differences between the groups. CONCLUSIONS: Traditional Karate affects pelvic tilt leading to posterior tilt; it correlates with somatic parameters: height, mass, and BMI in terms of spine curvatures. The size of the lumbar lordosis and thoracic kyphosis in karatekas is comparable to that of those not practicing sport. Frequent incidence of reduced pelvic tilt in karatekas requires implementing exercises activating anterior tilt during training session.

The Validity and Reproducibility of the Flexicurve in the Evaluation of Cervical Spine Lordosis.

OBJECTIVE: The purpose of this study was to measure the validity and reliability of flexicurve measurements of cervical curvature in the sagittal plane in adults. METHODS: One hundred thirteen adults were assessed in the seated position with flexicurve radiographs. Two groups were measured: (1) the validity group (n = 55), and (2) the reliability group (n = 58). Both groups were subdivided into 3 subgroups according to body mass index: underweight, normal weight, and overweight. Radiographs were simultaneously taken with flexicurve molded on the cervical spine. Pearson's correlation and the root mean square error were used for the concurrent validity. The reliability of the flexicurve was assessed by 3 raters using the intraclass correlation coefficient (ICC), the standard error of the measurement (SEM), and minimal detectable change (MDC). RESULTS: For the concurrent validity, a high correlation (r = 0.570, P < .001, root mean square error = 9.8°), and excellent results were obtained for intra-rater (ICC = 0.771, P < .001, SEM = 4.4°, MDC = 8.6°) and inter-rater (ICC = 0.775, P < .001, SEM = 4.3°, MDC = 8.5°) reliability. The subgroups had different results, whereas the underweight subgroup consistently had the best results. CONCLUSION: These findings suggest that the flexicurve can be a valid instrument for evaluating the curvature of the cervical spine in the sagittal plane in adults classified according to the body mass index as underweight and normal weight. Reliable measurements were provided for its use whether by the same or different raters. The flexicurve can be recommended for use both in clinical practice and in research settings as long as the suggested protocol is followed.

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.

OBJECTIVE: To investigate the immediate and 1-year effects of a multimodal program, with cervical lordosis and anterior head translation (AHT) rehabilitation, on the intensity of pain, disability, and peripheral and central nervous system function in patients with discogenic cervical radiculopathy (CR). DESIGN: A randomized controlled trial with 1-year and 10-week follow-up. SETTING: University research laboratory. PARTICIPANTS: Patients (N=60; 27 men) with chronic discogenic CR, a defined hypolordotic cervical spine, and AHT posture were randomly assigned to a control group (n=30; mean age, 43.9±6.2y) or an intervention group (n=30; mean age, 41.5±3.7y). INTERVENTIONS: Both groups received the multimodal program; in addition, the intervention group received the Denneroll cervical traction device. MAIN OUTCOME MEASURES: AHT distance, cervical lordosis, arm pain intensity, neck pain intensity, and disability (Neck Disability Index [NDI]), dermatomal somatosensory evoked potentials (DSSEPs), and central somatosensory conduction time (N13-N20). Measures were assessed at 3 time intervals: baseline, 10 weeks, and 1-year follow-up. RESULTS: After 10 weeks of treatment, between-group analysis showed equal improvement in arm pain intensity (P=.40), neck pain intensity (P=.60), and latency of DSSEPs (P=.60) in both intervention and control groups. However, also at 10 weeks, there were significant differences between groups, favoring the intervention group for cervical lordosis (P<.0005), AHT distance (P<.0005), amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), and NDI (P<.0005). Although at 1-year follow-up, between-group analysis identified a regression back to baseline values for the control group. Thus, all variables were significantly different, favoring the intervention group at 1-year follow-up: cervical lordosis (P<.0005), AHT distance (P<.0005), latency and amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), intensity of neck and arm pain, and NDI (P<.0005). CONCLUSIONS: The addition of the Denneroll cervical orthotic device to a multimodal program positively affected discogenic CR outcomes at long-term follow-up. We speculate that improved cervical lordosis and reduced AHT contributed to our findings.

Immediate Effect of Hold-Relax Stretching of Iliopsoas Muscle on Transversus Abdominis Muscle Activation in Chronic Non-Specific Low Back Pain with Lumbar Hyperlordosis.

OBJECTIVE: To determine the immediate effect of hold-relax (HR) stretching of the iliopsoas muscle on pain, transversus abdominis (TrA) activation capacity, lumbar stability level, lumbar lordosis angle and iliopsoas muscle length in chronic non-specific low back pain (CNSLBP) with lumbar hyperlordosis. MATERIAL AND METHOD: Participants aged from 30-55 years with CNSLBP with lumbar hyperlordosis were divided in two groups: (Group 1) Intervention group received 10-second isometric contraction ofthe iliopsoas muscle (HR), 10-second rest, 20-second static stretch, 5 repetitions. (Group 2) control group received 15 minutes resting in supine lying. The visual analog scale, prone test with the pressure biofeedback unit, modified isometric stability test, aflexible ruler and modified Thomas test were usedforpre- and post-test. Two-way ANOVA was used for within and between-group comparisons. RESULTS: The present study consisted of 20 participants. Significant differences were found in pain, TrA activation capacity, lumbar lordosis angle and iliopsoas muscle length between intervention and control groups and between pre- and post-test for intervention group (p<0.05). Lumbar stability level showed no significant difference in within and between-group comparisons. CONCLUSION: The HR of the iliopsoas muscle reduced pain and lumbar lordosis angle, enhanced TrA activation, and increased length of hip flexor in CNSLBP with lumbar hyperlordosis.

Different critical perinatal periods and hypothalamic sites of oestradiol action in the defeminisation of luteinising hormone surge and lordosis capacity in the rat.

Female rats show a gonadotrophin-releasing hormone (GnRH)/luteinising hormone (LH) surge in the presence of a preovulatory level of oestrogen, whereas males do not because of brain defeminisation during the developmental period by perinatal oestrogen converted from androgen. The present study aimed to identify the site(s) of oestrogen action and the critical period for defeminising the mechanism regulating the GnRH/LH surge. Animals given perinatal treatments, such as steroidal manipulations, brain local implantation of oestradiol (E(2) ) or administration of an NMDA antagonist, were examined for their ability to show an E(2) -induced LH surge at adulthood. Lordosis behaviour was examined to compare the mechanisms defeminising the GnRH/LH surge and sexual behaviour. A single s.c. oestradiol-benzoate administration on either the day before birth (E21), the day of birth (D0) or day 5 (D5) postpartum completely abolished the E(2) -induced LH surge at adulthood in female rats, although the same treatment did not inhibit lordosis. Perinatal castration on E21 or D0 partially rescued the E2-induced LH surge in genetically male rats, whereas castration from E21 to D5 totally rescued lordosis. Neonatal E(2) implantation in the anterior hypothalamus including the anteroventral periventricular nucleus (AVPV)/preoptic area (POA) abolished the E(2) -induced LH surge in female rats, whereas E(2) implantation in the mid and posterior hypothalamic regions had no inhibitory effect on the LH surge. Lordosis was not affected by neonatal E(2) implantation in any hypothalamic regions. In male rats, neonatal NMDA antagonist treatment rescued lordosis but not the LH surge. Taken together, these results suggest that an anterior hypothalamic region such as the AVPV/POA region is a perinatal site of oestrogen action where the GnRH/LH regulating system is defeminised to abolish the oestrogen-induced surge. The mechanism for defeminisation of the GnRH/LH surge system might be different from that of sexual behaviour, in terms of the site(s) of oestrogen action and critical period, as well as the neurotransmitter system involved.

A comparison of the torsional stiffness of the lumbar spine in flexion and extension.

OBJECTIVE: The main mechanism of injury to the spine is torsion especially when coupled with compression. In this study, the in vitro torsional stiffness of the lumbar spine segments is compared in flexion and extension positions by cyclic and failure testing. METHODS: Fifteen lumbar spines were sectioned from fresh cadavers into 15 L2/3 and 15 L45 motion segments. Each vertebral segment was then potted superiorly and inferiorly in polymethylmethacrylate, effectively creating a bone-disk-bone construct. The potted spinal segments were mounted in a mechanical testing system, preloaded in compression to 300 N, and axially rotated to 3 degrees in both directions at a load rate of 1 degrees /s. This was done over 3 cycles for each motion segment in the flexion and extension positions. Each specimen was then tested to torsional failure in either flexion or extension. Stiffness, torque, and energy were determined from cyclic and failure testing. RESULTS: The results showed that in all cases of cyclic testing, the higher segment extension resulted in higher torsional stiffness. In relative extension, the lumbar specimens were stiffer, generated higher torque values, and generally absorbed more energy than the relative flexion condition. There were no differences found in loading direction or failure testing. CONCLUSIONS: Increasing the effective torsional stiffness of the lumbar spine in extension could provide a protective mechanism against interverbral disk injury. Restoration of segmental extension through increasing the lumbar lordosis may decrease the strain and reinjury of the joints, which can help reduce the extent of pain in the lumbar spine.

Lateral cervical curve changes in patients receiving chiropractic care after a motor vehicle collision: a retrospective case series.

OBJECTIVE: To examine radiological changes of the lateral cervical curve in patients who received chiropractic care after motor vehicle collisions. DESIGN: A retrospective case series. Thirteen patients who had received chiropractic care after motor vehicle collisions were selected from a northeastern Washington chiropractic office. Patients had a lateral cervical radiograph taken prior to the initiation of chiropractic treatment and a comparative lateral cervical radiograph subsequent to a period of care. Cases were included if they met the previously stated criteria and if the radiographs were of sufficient quality to determine the lateral cervical curve from C2-C7. RESULTS: Adjustments rendered using an Activator Adjusting Instrument. Eleven of the subjects were also instructed to perform stretching exercises. Compared to the initial lateral cervical radiograph, the comparative radiographs demonstrated a mean increase in cervical lordosis between C2 and C7 of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. CONCLUSION: There was a mean increase in the cervical lordosis of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. We were not able to determine the individual effects of adjustment, stretching, and natural progression of the condition. The results suggest that further study of this phenomenon should be undertaken.

Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial.

BACKGROUND: Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported. OBJECTIVE: To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients with loss of the cervical lordosis. STUDY DESIGN: Nonrandomized, prospective, clinical control trial. METHODS: Thirty preselected patients, after diagnostic screening for tolerance to cervical extension with compression, were treated for the first 3 weeks of care using cervical manipulation and a new type of cervical extension-compression traction (vertical weight applied to the subject's forehead in the sitting position with a transverse load at the area of kyphosis). Pretreatment and posttreatment Visual Analogue Scale (VAS) pain ratings were compared along with pretreatment and posttreatment lateral cervical radiographs analyzed with the posterior tangent method for changes in alignment. Results are compared to a control group of 33 subjects receiving no treatment and matched for age, sex, weight, height, and pain. RESULTS: Control subjects reported no change in VAS pain ratings and had no statistical significant change in segmental or global cervical alignment on comparative lateral cervical radiographs (difference in all angle mean values < 1.3 degrees ) repeated an average of 8.5 months later. For the traction group, VAS ratings were 4.1 pretreatment and 1.1 posttreatment. On comparative lateral cervical radiographs repeated after an average of 38 visits over 14.6 weeks, 10 angles and 2 distances showed statistically significant improvements, including anterior head weight bearing (mean improvement of 11 mm), Cobb angle at C2-C7 (mean improvement of -13.6 degrees ), and the angle of intersection of the posterior tangents at C2-C7 (mean improvement of 17.9 degrees ). Twenty-one (70%) of the treatment group subjects were followed for an additional 14 months; improvements in cervical lordosis and anterior weight bearing were maintained. CONCLUSIONS: Chiropractic biophysics (CBP) technique's extension-compression 2-way cervical traction combined with spinal manipulation decreased chronic neck pain intensity and improved cervical lordosis in 38 visits over 14.6 weeks, as indicated by increases in segmental and global cervical alignment. Anterior head weight-bearing was reduced by 11 mm; Cobb angles averaged an increase of 13 degrees to 14 degrees; and the angle of intersection of posterior tangents on C2 and C7 averaged 17.9 degrees of improvement.

Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model.

BACKGROUND: Osteoarthritis and spinal degeneration are factors in neck and back pain. Calculations of stress in clinically occurring configurations of the sagittal cervical spine are rare. OBJECTIVE: To calculate and compare combined axial and flexural stresses in lordosis versus cervical configurations in anterior and vertical sagittal head translated positions. DESIGN: Digitized measurements from lateral cervical radiographs of 3 different shapes were used to calculate axial loads and bending moments on the vertebral bodies of C2-C7. METHODS: An elliptical shell model was used to model horizontal cross-sections of the vertebral bodies of C2 through T1. Axial and flexural stresses were calculated with short compression block equations. Elliptical shell modeling permitted separation of stresses into cortical and inner medullary regions. Digitized radiographic points were used to create polynomials representing the shape of the sagittal cervical curvatures from C1 to T1. To calculate bending moments at each vertebral segment, moment arms from a vertical line through C1 were determined from digitizing. RESULTS: Compared with the normal lordosis, stresses on the anterior vertebral body cortical margins of C5-T1 in the sagittal translated postures are compression rather than tension. At the posterior vertebral bodies in the anteriorly translated position and vertically translated postures, the stresses change from compression to tension at C5 through T1. In absolute value (ABS) compared with values at the same segments in a normal lordosis, the magnitude of the combined anterior stresses in the sagittal postures are higher at C5-C7 (eg, ABS[sigma(straight)/sigma(normal)] approximately 1.25 to 4.25). CONCLUSIONS: Vertebral body stresses are reversed in direction at C5-T1 in sagittal translated postures compared to a normal lordosis. Stress analysis, with implications for bone remodeling, indicates that both sagittal head translation postures, anterior head carriage, and vertical head translation, are undesirable configurations in the cervical spine.

The minimum energy hypothesis: a unified model of fixation resolution.

OBJECTIVE: To present a new theoretical construct, the Minimum Energy Hypothesis, which explains structural changes observed in the spine concomitant to spinal joint fixation resolution in initial investigations. DESIGN: Theoretical analysis. HYPOTHESIS: A unified theory of manipulative effectiveness is proposed that integrates the fixation and sensory tonus models of manipulation. The theory is based on the fact that the spine will assume a position of minimum internal energy when mechanical equilibrium is achieved. By using a simple mathematical model, it is shown that the fixation model and the sensory tonus models are 2 different aspects of the same theoretical construct. The Minimum Energy Hypothesis predicts that the spine will seek an optimal minimum energy configuration if the constraints preventing it from doing so are removed. Constraints are hypothesized to be joint fixations caused by inflammation in and about the spine and its sequella, muscle spasm, fibroadipose and scar tissue, and ultimately, degeneration. It is further hypothesized that the use of a computerized mechanical manipulative device may resolve such fixations, an example of which is radiographically demonstrable cervical hypolordosis. CONCLUSION: A unified theory of manipulative effectiveness based on the concept of minimum energy to attain mechanical equilibrium is brought forward to explain the results of initial investigations.

Effect of anterior wedging of L1 on the measurement of lumbar lordosis: comparison of two roentgenological methods.

OBJECTIVE: To determine whether the choice of either the superior or inferior endplate of the L1 vertebra as the proximal landmark for the measurement of lumbar lordosis could significantly affect the categorization (i.e., hypo- or hyperlordotic or normal) of that lordosis in subjects where the L1 vertebra is wedged anteriorly. DESIGN: Concurrent validity. SETTING: The Anglo-European College of Chiropractic teaching clinic. SELECTION: A total of 260 files were screened from new patient files at the clinic dating from the year 1980 onward. A total of 96 films fulfilled the inclusion criteria, which were: the patient was 20-50 yr old at the time of presentation, and had no evidence of severe degeneration, scoliosis or bony deformity, and the quality of the radiograph was not poor. Wedging of the L1 vertebra in excess of 2 mm was measured in 70 radiographs; these films were used for the two measurements of lumbar lordosis. OUTCOME MEASURES: The lumbar lordosis was roentgenometrically measured on lateral lumbar radiographs. RESULTS: Seventy-three per cent of the X-rays meeting the inclusion criteria showed wedging of the L1 vertebra in excess of 2 mm. Using the Student's t test, the mean lumbar lordosis, measured using the superior endplate of L1 as the proximal boundary for measurement of the lordotic angle, was 52.0 +/- 11.82 degrees and was significantly lower (p < .0001) than the mean lumbar lordosis measured using the inferior endplate of L1, which was 59.06 +/- 12.01 degrees. The Kappa analysis performed to determine the level of agreement in the categorization of the lumbar lordosis using these two methods indicated that, statistically (K = .394), there was poor agreement in the categorization of the lumbar lordosis between the two methods. An intraexaminer reliability study indicated significant intraexaminer agreement using both methods. CONCLUSION: The choice of landmark (i.e., superior or inferior endplate of L1) can significantly affect the value of the lumbar lordosis angle and its subsequent categorization as hypo-/hyperlordotic or normal in patients where this vertebra is wedged anteriorly. In view of the high incidence of this anatomical variant, L1 might not necessarily represent the best choice of landmark for the measurement of the lumbar lordosis. However, further work is necessary to determine which method is the most accurate and to investigate the validity of the suggestion that L2 may be a reasonable alternative.

The curve of the cervical spine: variations and significance.

OBJECTIVE: To review the literature regarding the curve of the cervical spine in normal and injured persons, emphasizing common variations in cervical curvature and their possible clinical significance. DATA SOURCE: A MEDLINE literature search of the English-language, human literature was performed using multiple search strategies relevant to radiography, posture, lordosis, injury, diagnosis and prognosis of the cervical spine (MESH: cervical vertebrae). Additionally, article bibliographies were searched for further relevant articles. No publication time limit was imposed. STUDY SELECTION: Articles were identified by the author as being directly relevant to the objective and scope of this review. DATA EXTRACTION: Data was extracted as presented in each original article. DATA SYNTHESIS: The articles reviewed indicate that a wide range of normal exists in the posture and configuration of the cervical spine. Although kyphotic angulation and straightening or reversal of cervical lordosis are commonly seen following trauma, they may be normal variants. Muscle spasm is a widely used explanation for these variations when seen in patients with pain or trauma. Kyphotic angulation is often associated with posterior ligamentous injury of a motion segment. Prognostic significance of these variations is claimed by some authors. CONCLUSION: There is little evidence to support the contention that altered cervical curvatures are of prognostic significance. Although kyphotic angulation is associated with anterior subluxation (hyperflexion sprain), it is not a reliable diagnostic criterion for that condition. It is reasonable to assume that straightening or reversal of a previously lordotic cervical curve is the result of muscular spasm, but more specific interpretation is not supported by the literature. More study is needed to characterize the specific dynamics and etiologies involved in the determination of cervical spine configuration.

Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.

OBJECTIVE: The prevalence and nature of findings of cervicogenic dysfunction is explored in subjects with muscle contraction/tension-type (MCH) headache and common migraine without aura (CM). DESIGN: Descriptive survey. SETTING: Chiropractic outpatient research clinic. PATIENTS: Forty-seven (47) subjects, aged 18-55 with two categories of benign headache, were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an intervention trial and, thus, form a consecutive sample of patients. The present findings were elicited as part of the initial assessment. INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURES: Standardized headache history; plain film and dynamic spinal X rays; motion palpation; and pressure algometry. RESULTS: For CM, the most prevalent headache locations were frontal (81%) and occipital (78%). Neck pain and upper back pain accompanied headache in 90% and 41% of subjects, respectively. For MCH, the most prevalent headache locations were occipital (87%) and frontal (81%). Neck and upper back pain accompanied headache in 100% and 27%, respectively, of all subjects. For the total group, 77% of all subjects and 89% of females exhibited a marked reduction, absence or reversal of the normal cervical lordosis. Ninety-seven percent of all subjects exhibited, on dynamic X-ray studies, at least one significant abnormality of segmental mobility from C1 to C7, while 43% exhibited abnormalities at four or more segments. Segmental motion at C0-C1 was reduced in 90% of subjects in flexion and 70% of subjects in extension. On motion palpation, 84% of CM and MCH subjects were found to have at least two major fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had at least one verifiable tender point (TP) in the upper cervical region. The most common locations for TPs were mid-cervical (C2-C3), lateral occipital and suboccipital. CONCLUSIONS: Both MCH and CM subjects demonstrate high occurrences of: a) occipital and neck pain during headaches; b) tender points in the upper cervical region; c) greatly reduced or absent cervical curve; and d) X-ray evidence of joint dysfunction in the upper and lower cervical spine. These findings support the premise that the neck plays an important, but largely ignored role in the manifestation of adult benign headaches. A case-control study should be conducted to confirm the greater prevalence of cervicogenic dysfunction in headache as compared to nonheadache subjects.

[Chiropractic diagnosis of the atlanto-occipital joint with reference to the Palmer-Sandberg-Gutman functional aspects from the traditional medic-radiologic viewpoint]. / Die chiropraktische Kopfgelenksdiagnostik "unter funktionellen Gesichtspunkten" nach Palmer-Sandberg-Gutmann aus schulmedizinisch-radiologischer Sicht.

Owing to joint mechanics, movement of the atlas alone, as envisioned in HIO diagnosis for producing a superior or inferior position, is not possible when the tranverse ligament is intact, since an atlas movement of this kind would necessitate a change in the statics of the dens amounting to kyphosis or lordosis. Only in the superior or inferior position, as defined by Decking and ter Steege, is there a true malposition of the atlas as a result of atlas movement, and this is only possible if the dens assumes a lordotic or kyphotic position. In such cases all the segments of the cervical spine are used to modify dens statics. Aside from this, superior and inferior positions in HIO diagnosis do not represent any pathology requiring treatment, but normal positions of the atlas within a relatively broad physiologic range. In the vast majority of cases, providing the angle of view is horizontal, there are no findings reflecting the current position of the atlas, but rather a finding due to the development of a condyle movement.