Chiropractic and Head Forward Posture

(borrowed from scienceinbrief.com)

Hyperkyphotic Posture 

 (Dowagers hump, extreme head forward posture, those people who walk around like they are looking on the ground for something. 

Stuff in red is from me) 

Predicts Mortality in Older

Community-Dwelling Men and Women: a prospective study ¹

Some of this is technical, but all very informative. 

The Facts:

a. The authors studied the association between thoracic hyperkyphosis and mortality in over 1300 individuals with a mean age of 73.

b. If the individual laid on their back and was unable to rest the head on the table without putting the neck into hyperextension they were considered to have thoracic hyperkyphosis.

c.   Patients were followed for an average of 4.2 years.

d.   Those "with hyperkyphotic posture had greater mortality rates. Increased severity of "kyphotic posture" appeared to be associated with a higher risk of mortality.

Discussion: Obviously, the inability to bring the head back to neutral resting position COULD be also caused by factors other than thoracic hyperkyphosis, but what's important here is that POSTURE appears to be associated with early mortality. Interestingly, thoracic kyphosis was found to be twice as common in men (44%) as women(22%) in this study, which seems to be at odds with conventional thought that thoracic hyperkyphosis is commonly caused by osteoporosis, a condition much more common in women.

The "NORMAL" Thoracic Kyphosis (curve)...

              Obviously, a radiographic evaluation of the T spine gives us a much more accurate idea of the sagittal curvature.

              Harrison defined the thoracic kyphosis as ELLIPTICAL in shape, having a Jackson's (Cobb) angle of 44.2 degrees from T1-T-12. Realizing the difficulty of visualizing both T1 and T12 on the radiograph, Harrison recalculated the model to reflect a thoracic kyphosis of 33.3 degrees between T 3 and T10. ²

Vaz et al, define the average thoracic kyphosis as 47 degrees in healthy young adults. ³

Boseker et al, defined a range of "normalcy" between 20-50 degrees in healthy children. ⁴

So you can see that opinions vary as to what is actually normal. I encourage interested readers to come to do some reading and establish in their mind what they consider to be the appropriate upper limits of thoracic kyphosis. Personally, I generally tend to view curves in excess of 40 degrees (as measured from T3-T10) as suspect. That's just my opinion based on my reading of the literature, but 40 degrees is an upper limit you will find frequently cited. Regardless of which value you consider appropriate, it is important to have some sort of firm upper limit, above which you will start considering clinical intervention.

Clinical Management:

A number of tools have been looked at for treating thoracic hyperkyphosis but definitive research is still sorely lacking. Some options you may want to consider are exercise, bracing, and spinal remodeling (chiropractic). Here are two simple, inexpensive tools I have found to be helpful.

Thoracic Rolls

One method of actively addressing the thoracic kyphosis is to simply place the patient over a large foam roll (in the 10-13" diameter range work well for this), have them cross their arms on their chest and raise their hips up, and then "roll" themselves up and down over the roll by alternately flexing and extending the knees. This does two things. First, it introduces a fulcrum effect into the mid T spine to help reduce the kyphosis. Secondly the rolling motion helps mobilize the spine and costovertebral articulations to promote a reduction of kyphosis.

  

Thoracic Arch

                      Another method is to simply allow the patient to passively rest over a foam roll or fulcrum, working up from 1 minute to 20-30 minutes. This time frame allows for stretching of the paraspinal tissues to occur and for the spine to "remodel" into a reduced kyphosis.  

I generally start with the patient over the arch with the fulcrum at the apex of the kyphosis as shown above. Once they can comfortably relax for the full 20-30 minutes without any problems or soreness, I place a 1" spacer beneath the arch to raise it up and increase the leverage effect into the mid thoracics. Occasionally, I may end up placing an additional spacer or two as needed to effectively introduce extension into the thoracics.

References:

1.Kado DM, Huang MH, Karlamangla AS, Barett-Connor E, Greeendale GA. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. JAGS 2004;52:1662-7

2. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon SF. Can the thoracic kyphosis be modeled with a simple geometric shape? The results of circular and elliptical modeling in 80 asymptomatic patients. J. Spiinal Disord Tech. 2002 Jun;15(3):213-20.

3. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine.Eur Spine J. 2002 Feb;11(1):80-7.

4. Boseker EH, Moe JH, Winter RB, Koop SE. Determination of "normal" thoracic kyphosis: a roentgenographic study of 121 "normal" children. J Pediatr Orthop.2000 Nov-Dec;20(6):796-8.