Does Forward Head Posture Influence Somatosensory Evoked Potentials and Somatosensory Processing in Asymptomatic Young Adults?

The current investigation used somatosensory evoked potentials (SEPs) to assess differences in sensorimotor integration and somatosensory processing variables between asymptomatic individuals with and without forward head posture (FHP). We assessed different neural regions of the somatosensory pathway, including the amplitudes of the peripheral N9, spinal N13, brainstem P14, peak-to-peak amplitudes of parietal N20 and P27, and frontal N30 potentials. Central conduction time (N13-N20) was measured as the difference in peak latencies of N13 and N20. We measured these variables in 60 participants with FHP defined as a craniovertebral angle (CVA) < 50° and 60 control participants matched for age, gender, and body mass index (BMI) with normal FHP defined as CVA > 55°. Differences in variable measures were examined using the parametric t-test. Pearson's correlation was used to evaluate the relationship between the CVA and sensorimotor integration and SEP measurements. A generalized linear model (GLM) was used to compare the SEP measures between groups, with adjustment for educational level, marital status, BMI, and working hours per week. There were statistically significant differences between the FHP group and control group for all sensorimotor integration and SEP processing variables, including the amplitudes of spinal N13 (p < 0.005), brainstem P14 (p < 0.005), peak-to-peak amplitudes of parietal N20 and P27 (p < 0.005), frontal N30 potentials (p < 0.005), and the conduction time N13-N20 (p = 0.004). The CVA significantly correlated with all measured neurophysiological variables indicating that as FHP increased, sensorimotor integration and SEP processing became less efficient. FHP group correlations were: N9 (r = -0.44, p < 0.001); N13 (r = -0.67, p < 0.001); P14 (r = -0.58, p < 0.001); N20 (r = -0.49, p = 0.001); P27 (r = -0.58, p < 0.001); N30 potentials (r = -0.64, p < 0.001); and N13-N20 (r = -0.61, p < 0.001). GLM identified that increased working hours adversely affected the SEP measures (p < 0.005), while each 1° increase in the CVA was associated with improved SEP amplitudes and more efficient central conduction time (N13-N20; p < 0.005). Less efficient sensorimotor integration and SEP processing may be related to previous scientific reports of altered sensorimotor control and athletic skill measures in populations with FHP. Future investigations should seek to replicate our findings in different spine disorders and symptomatic populations in an effort to understand how improving forward head posture might benefit functional outcomes of patient care.

The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial with 2-Year Follow-Up.

Sagittal cervical alignment is a clinically related feature in patients suffering from chronic cervical spondylotic radiculopathy (CSR). We designed this randomized trial to explore the effects of cervical lordosis (CL) correction in thirty chronic lower CSR patients with CL < 20°. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received neck stretching and exercises and infrared radiation; additionally, the SG received cervical extension traction. Treatments were applied 3× per week for 10 weeks after which groups were followed for 3 months and 2 years. The amplitude of dermatomal somatosensory evoked potentials (DSSEPS), CL C2−C7, and pain scales (NRS) were measured. The SG had an increase in CL post-treatment (p < 0.0001), this was maintained at 3 months and 2 years. No statistical improvement in CL was found for the CG. A significant reduction in NRS for SG after 10 weeks of treatment with non-significant loss of change at 3 months and continued improvement at 2 years was found. CG had less significant improvement in post-treatment NRS; the 3-month and 2-year measures revealed significant worsening in NRS. An inverse linear correlation between increased CL and NRS was found (r = −0.49; p = 0.005) for both groups initially and maintained in SG at the final 2-year follow-up (r = −0.6; p = 0.01). At 10 weeks, we found significant improvements in DSSEPS for both groups (p < 0.0001). We identified a linear correlation between initial DSSEPs and CL for both groups (p < 0.0001), maintained only in the SG at the final follow-up for all levels (p < 0.0001). Improved CL in the SG correlated with significant improvements in nerve root function and pain rating in patients with CSR at short and long-term follow-up. These observed effects indicate that clinicians involved in the treatment of patients with symptoms of cervical degenerative disorders should add sagittal curve correction to their armamentarium of rehabilitation procedures for relevant patient populations.

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial.

A randomized controlled study with a six-month follow-up was conducted to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy (CDLR). Participants included 80 (35 female) patients between 40 and 55 years experiencing CDLR with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group. Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic. Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months. Radiographic measures included cervical lordosis (CL) from C2-C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination. Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured. Statistically significant differences between the groups at 10 weeks were found: for all postural measures, CL (p = 0.001), AHT (p = 0.002), H-reflex amplitude (p = 0.007) and latency (p = 0.001). No significant difference for back pain (p = 0.2), leg pain (p = 0.1) and ODI (p = 0.6) at 10 weeks were identified. Only the study group's improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline. At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.

Sensorimotor integration, cervical sensorimotor control, and cost of cognitive-motor dual tasking: Are there differences in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain compared to healthy controls?

PURPOSE: The current investigation aimed to compare the sensorimotor integration, sensorimotor control, and cost of cognitive-motor dual task during walking, in persons with chronic WAD as compared to matched chronic idiopathic neck pain and normal healthy controls. METHODS: A cross-sectional, case control design comparing 30 participants in each of two study groups (chronic WAD and chronic idiopathic neck pain) to a matched control group was conducted. Measurements included: (1) the cranio-vertebral angle (CVA), (2) left and right rotation head repositioning accuracy (HRA), (3) frontal N30 amplitudes to assess sensorimotor integration, (4) dual cognitive gait cost (DCGC). RESULTS: A statistically significant difference for the CVA was found between groups: WAD 36.8° ± 3.4, chronic pain 44.5° ± 1.5, and controls 47.1° ± 4; p < 0.05. MANOVA revealed significant group differences for the N30 amplitude (p < 0.05), where the WAD group had the greatest amplitude. Statistically significant differences among the three groups were found for HRA left and right where the WAD group had the greatest error, (p < 0.05). Post hoc tests revealed that the WAD group had the highest dual-task cost during walking, (p < 0.05). Significant linear correlations between the CVA and N30 amplitude, HRA, and DCGC were identified in all 3 groups, (p < 0.05). CONCLUSIONS: Compared to both a matched control group and chronic neck pain group, whiplash-injured persons have greater forward head posture, greater error in sensorimotor control, and an altered ability to perform a motor task with a simultaneous cognitive task.

Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: a randomized, placebo-controlled trial.

A randomized controlled study was conducted to evaluate the effect of rehabilitation of the cervical sagittal configuration on sensorimotor integration and central conduction time in an asymptomatic population. Eighty (32 female) participants with radiographic cervical hypolordosis and anterior head translation posture were randomly assigned to either a control or an experimental group. The experimental group received the Denneroll cervical traction while the control group received a placebo treatment. Interventions were applied 3 × per week for 10 weeks. Outcome measures included radiographic measured anterior head translation distance, cervical lordosis (posterior bodies of C2-C7), central somatosensory conduction time (latency) (N13-N20), and amplitudes of potentials for spinal N13, brainstem P14, parietal N20 and P27, and frontal N30. Outcomes were obtained at: baseline, after 10 weeks of intervention, and at 3 months follow up. After 10 weeks and 3-months, between-group analyses revealed statistically significant differences between the groups for the following measured variables: lordosis C2-C7, anterior head translation, amplitudes of spinal N13, brainstem P14, parietal N20 and P27, frontal N30 potentials (P < 0.001), and conduction time N13-N20 (P = 0.004). Significant correlation between the sagittal alignment and measured variables were found (P < 0.005). These findings indicate restoration of cervical sagittal alignment has a direct influence on the central conduction time in an asymptomatic population.

Does restoration of sagittal cervical alignment improve cervicogenic headache pain and disability: A 2-year pilot randomized controlled trial.

BACKGROUND: To investigate the feasibility and effect of a multimodal program for improving chronic cervicogenic headache (CGH) via the addition of sagittal cervical spine alignment correction. DESIGN: Pilot, parallel-group, randomized controlled trial. PARTICIPANTS: 60 patients with CGH, straightening of the cervical lordosis, and forward head posture (FHP) were randomly assigned using permuted-block randomization either to a control (n = 30) or an experimental group (n = 30). INTERVENTIONS: Subjects in both groups received a multimodal program where the denneroll cervical spine extension traction orthotic was added to the experimental group only. Feasibility was assessed through recruitment rate, compliance rate, adherence rate, safety, and global satisfaction in addition to clinical outcome measures: FHP distance, cervical lordosis, headache frequency, headache disability inventory (HDI), headache impact test-6 (HIT-6), and daily defined dose (DDD). Evaluations were performed at: baseline, 10 weeks, 1 year follow up, and 2-year follow up. The assessor was blind to group allocation for all measured outcomes. RESULTS: The recruitment rate was 60%, 78 % out of them completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded and greater overall satisfaction with the interventions was reported. Greater improvements were found for the experimental group's cervical lordosis (f = 259.9, P< < .001) and FHP (f = 142.5, P< < .001). At 10 weeks, both groups showed equal improvements in CGH outcomes: headache frequency (P = 0.07), HDI (P = 0.07), HIT-6 (P = .2), and DDD (P = .3). In contrast, at the 1-year and 2-year follow up, between group differences were found for all CGH outcomes, P < .00, indicating greater improvement in the experimental group. CONCLUSION: The results indicated feasibility for recruitment rate, compliance rate, exercise session adherence, safety, and global satisfaction. At 1-year and 2-year follow-up, the addition of the denneroll orthotic device revealed positive influence on CGH management outcomes. TRIAL REGISTRATION: The trial was retrospectively registered with the Pan African Clinical Trial Registry (PACTR201605001650300).

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial.

BACKGROUND: There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. METHODS: A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. RESULTS: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001). CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. TRIAL REGISTRATION: Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects?

OBJECTIVE: To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR. METHODS: Thirty chronic lower CSR patients with cervical lordosis < 25° were included. IRB approval and informed consent were obtained. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received stretching exercises and infrared; the SG received 3-point bending cervical extension traction. Treatments were applied 3 × per week for 10 weeks, care was terminated and subjects were evaluated at 3 intervals: baseline, 30 visits, and 3-month follow-up. Radiographic neutral lateral cervical absolute rotation angle (ARA C2-C7) and cervical segmental (C2-C7 segments) rotational and translational flexion-extension kinematics analysis were measured for all patients at the three intervals. The outcome were analyzed using repeated measures one-way ANOVA. Tukey's post-hoc multiple comparisons was implemented when necessary. Pearson correlation between ARA and segmental translational and rotational displacements was determined. RESULTS: Both groups demonstrated statistically significant increases in segmental motion at the 10-week follow up; but only the SG group showed a statistically significant increase in cervical lordosis (p < 0.0001). At 3-month follow up, only the SG improvements in segmental rotation and translation were maintained. CONCLUSION: Improved lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

BACKGROUND: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. AIM: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. DESIGN: A randomized controlled study with a 1 year and 10 weeks' follow-up. SETTING: University research laboratory. POPULATION: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. METHODS: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks. RESULTS: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group. CONCLUSIONS: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up. CLINICAL REHABILITATION IMPACT: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.

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.

The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures. This randomized clinical trial with one-year follow-up was completed at the research laboratory of our university. A total of 120 (52 female) patients with fibromyalgia syndrome (FMS) and definite C1-2 joint dysfunction were randomly assigned to the control or an experimental group. Both groups received a multimodal program; additionally, the experimental group received upper cervical manipulative therapy. Primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ), whereas secondary outcomes included Pain Catastrophizing Scale (PCS), algometric score, Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 3D postural measures. Measures were assessed at three time intervals: baseline, 12 weeks, and 1 year after the 12-week follow-up. The general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of 3D postural parameters (P < .0005), FIQ (P < .0005), PCS (P < .0005), algometric score (F = P < .0005), PSQI (P < .0005), BAI (P < .0005), and BDI (P < .0005). The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with FMS.

The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study.

OBJECTIVE: The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy. METHODS: This randomized clinical study included 154 adult patients (54 females) who experienced chronic discogenic lumbosacral radiculopathy and had forward head posture. One group received a functional restoration program, and the experimental group received forward head posture corrective exercises. Primary outcomes were the Oswestry Disability Index (ODI). Secondary outcomes included the anterior head translation, lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, pelvic inclination, leg and back pain scores, and H-reflex latency and amplitude. Patients were assessed at 3 intervals (pretreatment, 10-week posttreatment, and 2-year follow-up). RESULTS: A general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of ODI (F = 89.7; P < .0005), anterior head translation (F = 23.6; P < .0005), H-reflex amplitude (F = 151.4; P < .0005), H-reflex latency (F = 99.2; P < .0005), back pain (F = 140.8; P < .0005), and leg pain (F = 72; P < .0005). After 10 weeks, the results revealed an insignificant difference between the groups for ODI (P = .08), back pain (P = .29), leg pain (P = .019), H-reflex amplitude (P = .09), and H-reflex latency (P = .098). At the 2-year follow-up, there were significant differences between the groups for all variables adopted for this study (P < .05). CONCLUSIONS: The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

Multimodal treatment program comparing 2 different traction approaches for patients with discogenic cervical radiculopathy: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. METHODS: This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). RESULTS: The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P < .0005), neck pain (F = 108.9, P < .0005), arm pain (F = 91.3, P < .0005), H- reflex amplitude (F = 207.7, P < .0005), and H-reflex latency (F = 58.9 P < .0005). We found that the extension position of cervical spine (5° extension) was the position that achieved the maximum improvement in the novel cervical traction method. CONCLUSIONS: This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the amplitude and latency of FCR H-reflex for a group of patients with chronic discogenic CR.

The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial.

BACKGROUND: There is growing interest in the role of abnormal asymmetrical posture, which is considered one of the most important etiological factors reported to be associated with mechanical low back pain. OBJECTIVE: This study was conducted to investigate the effect of lumbar extension traction on the pain, function and whole spine sagittal balance as represented in lumbar curvature, thoracic curvature, C7 plumb line, and sacral slope. METHODS: Eighty patients with chronic mechanical low back pain (CMLBP) and definite hypolordosis were randomly assigned to traction or a control group. The control group (n=40) received stretching exercises and infrared radiation, whereas the traction group (n=40) received lumbar extension traction in addition to stretching exercises and infrared radiation three times a week for 10 weeks. Back pain rating scale, Oswestry Disability Index, and radiological spine sagittal balance parameters in terms of lumbar lordosis, thoracic kyphosis, sacral slope, and positioning of C7 plumb line were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at six months follow-up). RESULTS: There was a significant difference between the traction and control groups adjusted to baseline value of outcome at 10 weeks post treatment with respect to lumbar lordotic curve (P=0.000), thoracic kyphosis (P=0.013), sacral slope (P=0.001), C7 plump line distance (p=0.001), while there was no significant difference with respect to pain (p=0.29) and Oswestry Disability Index (ODI) (p=0.1). At 6-months follow-up, there were significant differences between both groups for all the previous variables (p< 0.05). CONCLUSIONS: Lumbar extension traction in addition to stretching exercises and infrared radiation improved the spine sagittal balance parameters and decreased the pain and disability in CMLBP.

Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial.

OBJECTIVE: To investigate the effects of lumbar extension traction in patients with unilateral lumbosacral radiculopathy due to L5-S1 disc herniation. DESIGN: A randomized controlled study with six-month follow-up. SETTING: University research laboratory. SUBJECTS: Sixty-four patients with confirmed unilateral lumbosacral radiculopathy due to L5-S1 disc herniation and a lumbar lordotic angle less than 39°, randomly assigned to traction or control group. INTERVENTIONS: The control group (n = 32) received hot packs and interferential therapy, whereas the traction group (n = 32) received lumbar extension traction in addition to hot packs and interferential therapy. MAIN OUTCOME MEASURES: Absolute rotatory angle, back and leg pain rating scale, Oswestry Disability Index, Modified Schober test, H-reflex (latency and amplitude) and intervertebral movements were measured for all patients three times (before treatment, after 10 weeks of treatment and at six-month follow-up). RESULTS: There was a significant difference between the traction group and the control group adjusted to baseline values at 10 weeks post treatment with respect to: absolute rotatory angle (P < 0.001), Oswestry Disability Index (P = 0.002), back and leg pain (P = 0.009, P = 0.005), Modified Schober test (P = 0.002), latency and amplitude of H-reflex (P = 0.01, P < 0.001), intervertebral movements (P < 0.05). At six-month follow-up there were statistically significant differences between the study and control groups for all the previous variables (P < 0.05). CONCLUSION: The traction group receiving lumbar extension traction in addition to hot packs and interferential therapy had better effects than the control group with regard to pain, disability, H-reflex parameters and segmental intervertebral movements.

The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of forward head correction on three-dimensional posture parameters and functional level in adolescent idiopathic scoliotic patients. DESIGN: A randomized controlled study with three-month follow-up. SETTING: University research laboratory. SUBJECTS: Seventy-six adolescent idiopathic scoliotic patients with Cobb angle ranged from 10° to 30° and craniovertebral angle less than 50° were randomly assigned to a study or a control group. INTERVENTIONS: All the patients (n = 76) received traditional treatment in the form of stretching and strengthening exercises. In addition, patients in the study group (n = 38) received a forward head posture corrective exercise programme. OUTCOME MEASURES: Craniovertebral angle, Functional Rating Index and posture parameters, including: lumbar lordosis, thoracic kyphosis, trunk inclination, trunk imbalance, lateral deviation, surface rotation and pelvis torsion were measured before treatment, after 10 weeks, and at three-month follow-up. RESULTS: There was a significant difference between the study and control groups adjusted to baseline values at 10 weeks post treatment with respect to the following parameters: craniovertebral angle (P = 0.006), trunk inclination (P = 0.005), lordosis (P = 0.01), kyphosis (P = 0.001), trunk imbalance (P = 0.001), lateral deviation (P = 0.001), pelvic torsion (P = 0.004) and surface rotation (P = 0.013). At three-month follow-up, there were still significant differences in all the previous variables (P < 0.005). In contrast, while there was no significant difference with respect to Functional Rating Index at 10 weeks (P = 0.8), the three-month follow-up showed a significant difference (P = 0.001). CONCLUSION: A forward head corrective exercise programme combined with conventional rehabilitation improved three-dimensional scoliotic posture and functional status in patients with adolescent idiopathic scoliosis.

Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial.

OBJECTIVE: The purpose of this study was to investigate the effects of lumbar extension traction with stretching and infrared radiation compared with stretching and infrared radiation alone on the lumbar curve, pain, and intervertebral movements of patients with chronic mechanical low back pain (CMLBP). METHODS: This randomized clinical study with 3-month follow-up was completed at the Cairo University research laboratory. Eighty patients (age ranged from 40 to 50 years) with CMLBP and a hypolordotic lumbar spine were randomly assigned to traction or a comparison group. The comparison group (n = 40) received stretching exercises and infrared radiation, whereas the traction group (n = 40) received lumbar extension traction in addition to stretching exercises and infrared radiation. The absolute rotatory angle, intervertebral movements, and visual analog scale were measured for all patients at 3 intervals. RESULTS: The results revealed a statistically significant difference between the groups at 2 follow-up time points compared with the baseline values for the translational and sagittal rotational movements of L3-L4, L4-L5, L5-S1, and L2-L3 (posttreatment) and absolute rotatory angle (P < .01). There were no statistically significant changes in pain (P = .1 and .3) and L1-L2 (P = .072 and .076) or L2-L3 (at follow-up; P = .3), and there was no significant difference between all the previous variables adjusted to the groups' baseline outcome interaction (P > .01). CONCLUSION: Lumbar extension traction with stretching exercises and infrared radiation was superior to stretching exercises and infrared radiation alone for improving the sagittal lumbar curve, pain, and intervertebral movement in CMLBP.

The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial.

OBJECTIVE: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy. DESIGN: A randomized controlled study with six months follow-up. SETTING: University research laboratory. SUBJECTS: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5-C6 and C6-C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group. INTERVENTIONS: The control group (n = 48) received ultrasound and infrared radiation, whereas the exercise group (n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation. MAIN OUTCOME MEASURES: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months). RESULTS: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P = 0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables (P = 0.000). CONCLUSION: Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.