Failed back surgery syndrome successfully ameliorated with Chiropractic Biophysics® structural rehabilitation improving pain, disability as well as sagittal and coronal balance: a Chiropractic Biophysics® case report with a 6†year follow-up.

[Purpose] To present the case of the amelioration of chronic pain and disability in a patient suffering from failed back surgery syndrome. [Participant and Methods] A 27-year-old male with chronic low back pain was treated with a Coflex® intra-spinous instrument, however, it was removed shortly after due to poor outcome including worsening pain and disability. Radiographic assessment revealed significant posterior translation of the thorax complicated by significant loss of the normal lumbar lordosis and a left lateral translated thoracic cage posture. Chiropractic Biophysics® technique was applied over a 5.5-month period leading to structural spine improvements as well as improved pain, Oswestry disability index (ODI) and quality of life (QOL). [Results] There was a 21 mm reduction in posterior thoracic translation, a 6.2° improvement in lumbar lordosis and a 16 mm reduction in lateral thoracic translation corresponding with improved ODI and QOL scores. A 6 year follow-up showed successful outcome despite some degenerative changes in the spine at the prior surgical level. [Conclusion] This case adds to the growing literature showing the efficacy of non-surgical spinal rehabilitative methods in improving outcomes in patients with spinal deformity and associated disabilities. This case also demonstrates necessity of the continued criterion standard of spinal radiography for biomechanical assessment.

Chronic Widespread Spinal Pain (CWSP) Alleviated With Chiropractic Biophysics®: A Case Report With Three-Year Follow-Up.

The aim of this case report is to provide clinicians with an option for the treatment of spine pain, spine disorders caused or complicated by abnormal spine alignment, and failed prior interventions for pain and suffering with a conservative protocol. Multi-decade chronic widespread pain (CWSP), low back pain (LBP) headache (HA), and neck pain (NP) cause significant disability and reduced quality of life across all socio-economic and societal categories. Treatment options for decades-old long-term pain with good outcomes are uncommon with non-surgical and surgical interventions. Herein is a single case of positive outcomes with Chiropractic BioPhysics® (CBP®)protocol and long-term follow-up. A 60-year-old male with a lifting injury working on a farm at age 12 suffered for decades with LBP, mid-back pain (MBP), NP, HAs, radiculopathy, and poor health-related quality of life (HRQoL). Prior over-the-counter (OTC) medications with diminishing results over 48 years were reported. The patient had multiple abnormal patient-reported outcomes (PROs) as well as measured postural and spine structural abnormalities at the initial assessment. Following 12 treatments, PROs and other measures improved dramatically. Continued brief treatment showed continued progress followed by no treatment beyond continued home exercises and home postural orthoses. All subjective and objective outcome measures improved at one-year follow-up and remained long-term. Improvements in sagittal and coronal postural balance with improved spine alignment, better PROs, and measurably improved HRQoLs were found at one- and three-year follow-ups from the initial evaluation. Chronic NP, LBP, MBP, and extremity pain with altered sensation, loss of function, and failed drug therapy are common across the globe and combined represent the greatest contributors to disability and the global burden of disease (GBD). Economic, efficacious, repeatable, and reliable methods for treating pain will reduce GBD and improve PROs. Larger studies of CBP® methods for multi-decade chronic pain are challenging; however, continued case reports and RCTs for similar conditions are warranted.

Alleviation of shoulder injury related to vaccine administration (SIRVA) pain and disability following COVID-19 vaccine with chiropractic biophysics® (CBP®) methods: a case report and long-term follow-up with global implications.

[Purpose] To present the dramatic improvement in posture, radiographic parameters and the alleviation of neck and severe shoulder pain related to shoulder injury associated with vaccine administration (SIRVA) after a COVID-19 injection with a shoulder mobility and posture rehabilitation program. [Participant and Methods] A middle-aged male presented complaining of severe left shoulder pain evolving since receiving a COVID-19 vaccination. The pain was severe and throbbed into the neck. Posture analysis showed a chronic stooped posture with forward head posture and thoracic hyperkyphosis. Treatment included 42 sessions of Chiropractic Biophysics® technique and a shoulder rehabilitation program using three-dimensional vibration. [Results] At 4-months, the patient reported no neck or shoulder pain. There was a 60% decrease in neck disability. The forward head decreased 34 mm, thoracic hyperkyphosis decreased 13°, and T1-T12 forward lean decreased 73 mm, among other radiographic parameters. Re-assessment after 26-months showed maintenance of the treatment induced posture/x-ray corrections and shoulder pain relief. [Conclusion] This case demonstrates immediate and long-term improvement in a patient suffering from COVID-19 vaccine SIRVA, concomitant with neck pain and disability as well as significant radiographic postural/spinal deformity. These conditions all improved and were maintained at a 2 year follow-up without further treatment.

Reduction of thoraco-lumbar kyphosis results in the alleviation of low back pain in an adolescent basketball player: a Chiropractic Biophysics® (CBP®) case report.

[Purpose] To present the case of a significant reduction in thoraco-lumbar deformity and alleviation of chronic low back pain in an otherwise healthy and active adolescent male basketball player. [Participant and Methods] A 17 year old was assessed with chronic low back pain persisting for 4 years. Radiographic assessment revealed a prominent thoraco-lumbar kyphosis. Chiropractic Biophysics® structural rehabilitation including mirror image® exercise and traction methods as well as spinal manipulative therapy was performed 2-3 times per week. [Results] There was a 12° improvement in the thoraco-lumbar deformity corresponding with the alleviation of chronic low back pains and near complete reduction in disability after 36 treatments over a 4-month period. [Conclusion] This case adds to the growing literature showing the efficacy of the non-surgical spinal rehabilitative methods of Chiropractic Biophysics in improving spine alignment and relieving spinal pain syndromes. This case also demonstrates the importance of the routine screening for spine alignment via radiography in leading to proper biomechanical diagnosis and treatment.

Subjective and Objective Improvement in a 39-Year-Old Male Suffering From Severe Chronic Pain and Disability Using Chiropractic BioPhysics® Protocols Following Rear-Impact Motor Vehicle Crash With a 10-Month Long-Term Follow-Up.

We present the case of a patient receiving structural rehabilitation following a rear-impact motor vehicle collision (MVC). Medications did not alleviate the symptoms of the crash injuries. Resolution of injury-caused pain and disability was found following postural and structural rehabilitation treatment. A 39-year-old male was injured in a rear-impact collision between two very large vehicles. Severe migraine headaches, neck pain, and radiculopathy, as well as lower back pain, were the result of the crash. Patient-reported outcomes (PROs) demonstrated that the symptoms were causing severe disability and poor health-related quality of life (HRQoL) measures. Radiographs found spine alignment abnormalities consistent with rear impact MVC. Chiropractic Biophysics® (CBP®) structural rehabilitation was performed. Following a treatment regimen involving strengthening weakened and damaged muscles, postural and spinal traction, postural spinal manipulative therapy (SMT), and home therapies resulted in the resolution of the symptoms. All outcome measures demonstrated improvement, including Short-Form 36 question health questionnaire (SF-36), quadruple visual analog scale (QVAS), headache disability index (HDI), neck disability index (NDI), revised Oswestry disability index (RODI), as well as significant measured improvements found on radiographs. Spine pain and altered alignment are frequent results of MVCs. If left uncorrected, these abnormalities increase the likelihood of chronic pain and disability. Combined low back pain (LBP), neck pain (NP), headache (HA), and radiculopathy, as found in our subject, significantly pre-dispose the individual to poor HRQoL, years lived with disability (YLDs) and increased the global burden of disease (GBD). Physicians who treat injured patients should have a repeatable, reliable, valid, and efficacious method to reduce pain, increase range of motion (ROM), improve spine alignment, and improve the performance of activities of daily living (ADLs). Further, larger studies of injured patients are necessary to determine if the CBP® protocol reduces GBD caused by MVC injuries.

The Subjective and Objective Improvement Using Chiropractic Biophysics® Protocols.

The aim of this study is to describe the Chiropractic BioPhysics® (CBP®) (Chiropractic BioPhysics, Eagle, USA) technique in alleviating the persistent spine pain syndrome (PSPS) and dysfunction in a 50-year-old female who suffered for many years. The purpose of this study is to provide clinicians with a potential treatment option for failed back surgery syndrome (FBSS) and PSPS that doesn't respond to other treatments. The patient did not receive benefits from pharmaceutical and conservative therapies following a low back lifting injury in 2004. After several years of suffering from widespread spinal pain and dysfunction, she received a lumbosacral pedicle screw surgical fixation. The initial surgery was unsuccessful and a follow-up revision and expansion of the fusion failed to alleviate the pain and dysfunction as well. After treatment using CBP, the patient received subjective, objective, and radiographic improvements with long-term stability measured at follow-up. Given that spine pain and low back pain are the number one cause of disability in the world, having economical, repeatable, and measurable techniques to improve even difficult cases is important for astute clinicians treating spine pain.

Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics® Methods: A Pre-Auto Injury and Post-Auto Injury Case Series.

This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine's alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 females, 28-42 years) treated for cervical hypolordosis. These subjects received Chiropractic BioPhysics® (CBP®) rehabilitation and then were involved in a rear-end MVC. All cases had radiographic assessment that quantified the buckling of the cervical spine, presumably resulting directly from the CAD trauma. After an average of 3 years and 9 months (range: 1-7.6 years) following their initial program of care, the 7 patients sought care for a second time after the MVC. At this time, compared with their previously recorded post-treatment spine radiographs, there was an average 18.7° (range: 7.6-35.4°) reduction in cervical lordosis, a 9.2 mm (range: 3.6-19.8 mm) increase in anterior head translation (AHT), an 11.3° (range: 0.2-19.9°) decrease in the atlas plane line (APL), as well as a 35.7% (range: 22-52%) average neck disability index score (NDI) measured after the MVC. After the crash, a second round of CBP rehabilitation was administered, resulting in an average 15.1° improvement in cervical lordosis, 10.9 mm reduction in AHT, 10.4° increase in APL, and a 23.7% drop in NDI after an average of 35 treatments over 9 weeks. Treatment was universally successful, as an average 80% re-establishment of the lordosis toward its pre-injury state was found. There were no adverse events reported. This case series demonstrates that motor vehicle collisions may alter the alignment of the cervical spine. Rehabilitation of the cervical curve using extension traction improved the patients' initial pre-crash alignments toward their pre-injury alignments and was likely responsible for improvement in the patients' conditions. Clinical trials are needed to confirm these findings.

Concurrent validity of flexicurve instrument measurements: sagittal skin contour of the cervical spine compared with lateral cervical radiographic measurements.

OBJECTIVES: The aim of this study was to compare flexicurve surface contour measurements of the cervical spine with radiographic measurements of cervical lordosis. METHODS: One examiner evaluated 96 patients with chronic neck pain in neutral posture using a flexible ruler, flexicurve, to measure sagittal contour of the skin over the cervical spine from the external occipital protuberance to the vertebra prominens. The flexicurve skin contour and neutral lateral radiographs were digitized and compared. The flexicurve and radiographs were categorized into height-length ratio, curve angle, curve depth, sum of depths, modified Ishihara's index, and inverse of radius. Mean values, SDs, mean differences, and limits of agreement were calculated. The differences between flexicurve measurement mean values and x-ray mean values were deemed significant if the lower limit of agreement exceeded 15% of the mean values for the x-ray measurements. RESULTS: For all variables, except the height-length ratio, the mean values of the flexicurve variables differed significantly from the corresponding mean values of the radiographic measurements. All Pearson correlation coefficients were in the very poor range (r < 0.15). CONCLUSION: The flexicurve sagittal skin contour measurement has poor concurrent validity compared with established radiographic measurements of the cervical lordosis. The flexicurve tracings always predicted lordosis, overestimated the lordosis compared with x-ray values, and cannot discriminate between radiographic lordosis, straightened, S curves, and kyphotic alignments of the cervical curve.

Sagittal skin contour of the cervical spine: interexaminer and intraexaminer reliability of the flexicurve instrument.

OBJECTIVES: To evaluate reliability of a simple instrument, the flexicurve, in determining cervical sagittal skin contour. METHODS: This study obtained repeated random measurements involving 3 investigators and 30 subjects once per day over a 2-day trial period. Thirty normal subjects were examined for cervical spine skin contour twice by 3 separate investigators with a 1-day delay. With subjects in a neutral standing position, investigators placed the flexicurve on the posterior portion of the subject's neck from the external occipital protuberance to the vertebral prominens and traced the flexicurve shape onto paper. The tracings were divided into 6 equal arcs and digitized. Statistical computation was performed on the depth at 5 points, arc angle, and arc radius of curvature. Interexaminer and intraexaminer correlation coefficients (ICCs) were calculated to determine reliability. RESULTS: All interexaminer correlation coefficients were in the poor range (<0.40). For the arc radius, arc angle, depth at top one third, and depth at bottom two thirds, the intraexaminer correlation coefficients were in the poor range. For the 3 deepest depths, the intraexaminer correlation coefficients were in the fair range (0.4-0.50). CONCLUSION: The flexicurve showed marginal reliability with most (12/16) ICCs in the poor range (ICC <0.40) and 4 values in the fair range (0.4 < ICC < 0.5).

Conservative treatment of a patient with syringomyelia using chiropractic biophysics protocols.

OBJECTIVE: To present a case of a 41-year-old man with syringomyelia and intractable pain and the subsequent reduction of symptoms. CLINICAL FEATURES: This patient acquired a traumatically induced syrinx in his upper cervical spinal cord after he fell approximately 9 feet and landed on his head, upper back, and neck 9 years before presenting for care. He was diagnosed with a spinal cord cyst (syrinx), located at approximately C2 through C4 after magnetic resonance imaging. In 1995, the patient underwent occipitoatlantal decompression surgery, which improved his symptoms for a short time. INTERVENTION AND OUTCOMES: The patient was treated using Clinical Biomechanics of Posture protocol. The patient was seen 26 times over the course of 3 weeks. His scale for pain severity decreased 50% and other subjective complaints decreased. His posture improved based upon pretreatment and posttreatment lateral cervical radiographs, showing a change from a 10 degrees lordosis with midcervical kyphosis to a 30 degrees lordosis. One-year follow-up examination showed stable improvement in the cervical lordosis and pain intensity. CONCLUSION: This case represents a change in subjective and objective measurements after conservative chiropractic care. This case provides an example that structural rehabilitation may have a positive effect on symptoms of a patient with syringomyelia.

Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP) publications.

BACKGROUND: Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE: (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP((R))) methods, and (2) to compare the evidence for Diversified, SMT, and CBP((R)). METHODS: Clinical control trials utilizing CBP(R) methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP((R)) were rated and compared. RESULTS: From the evidence from Clinical Control Trials on SMT and CBP((R)), there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP((R)) (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS: While CBP((R)) Technique has approximately as much evidence-based support as SMT for neck pain, CBP((R)) has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP((R)) publications.

Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder.

OBJECTIVE: To discuss the case of a patient who was diagnosed with attention-deficit/hyperactivity disorder (ADHD) by a general practitioner and was treated with chiropractic care. CLINICAL FEATURES: A 5-year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12 degrees C2-7 kyphosis to a 32 degrees C2-7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behavior vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis. CONCLUSION: The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication. There may be a possible connection that correction of cervical kyphosis in patients with ADHD may produce a desirable clinical outcome.

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.