NON-SURGICAL REDUCTION IN ANTERIOR SAGITTAL BALANCE SUBLUXATION AND IMPROVEMENT IN OVERALL POSTURE IN A GERIATRIC SUFFERING FROM LOW BACK PAIN AND SCIATICA: A CBP® CASE REPORT
Main Article Content
Keywords
Adult Spinal Deformity, Thorac-Lumbar deformity, Low Back Pain
Abstract
Objective: To discuss dramatic reduction of severe anterior sagittal balance and overall posture in an elderly woman with chronic low back pain and sciatica
Clinical Features: An 87-year old female had low back pain and sciatica for 30 years. She had poor posture, limited flexibility and many positive orthopedic tests. Radiography quantified the gross anterior sagittal balance and spinal subluxation
Intervention and Outcome: Chiropractic BioPhysics® methods included spinal extension traction, extension exercises, and paraspinal muscle stimulation to improve posture. After 24 treatment sessions over 8 weeks, she achieved a dramatic reduction of symptoms, improvements in flexibility and orthopedic testing. There was also an approximate 110mm reduction in anterior sagittal balance as well as improvements in other spinal parameters
Conclusions: This case suggests that gross spinal deformities can be reduced by non-surgical methods, and that the improvement in gross deformity correlates with reduction in chronic symptom burden. Although there is a substantial evidence base for the use of Chiropractic BioPhysics methods, research is needed for its use on patients having severe spinal deformities.
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References
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25. Mundis GM Jr, Turner JD, Kabirian N et al. Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity. World Neurosurg 2017;105:249-256
26. Pellisé F, Serra-Burriel M, Smith JS, et al. Development and validation of risk stratification models for adult spinal deformity surgery. J Neurosurg Spine 2019;Jun 28:1-13. doi: 10.3171/2019.3.SPINE181452. [Epub ahead of print]
27. Moustafa IM, Diab AM, Ahmed A, Harrison DE. The efficacy of cervical lordosis rehabilitation for nerve root function, pain, and segmental motion in cervical spondylotic radiculopathy. PhysioTher 2011;97 Supplement:846-847
28. Diab AA, Moustafa IM. Rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J Manipulative Physiol Ther 2012;35:246-253
29. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil 2012;27:51-62
30. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain. a randomized trial. J Back Musculoskelet Rehabil 2013;26:213-222
31. Moustafa IM. Does improvement towards a normal cervical configuration aid in the management of fibromyalgia. A randomized controlled trial. Bull Fac Phys Ther Cairo Univ 2013;18:29-41
32. Moustafa IM, Diab AA, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of lumbosacral radiculopathy: A randomized controlled trial Proceedings of the 13th World Federation of Chiropractic Biennial Congress / ECU Convention, Athens, Greece, May 13-16, 2015. Paper #184 Mediterranean Region Award Winning Paper
33. Moustafa IM, Diab AA, Taha S, Harrison DE. 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. Arch Phys Med Rehabil 2016;97:2034-2044
34. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. Eur J Phys Rehabil Med 2017;53:57-71
35. Moustafa IM, Diab AAM, Hegazy FA, Harrison DE. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects? J Back Musculoskelet Rehabil 2017;30:937-941
36. Moustafa IM, Diab AAM, Taha S, Harrison DE. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial. Proceedings of the 14th biennial congress of the World Federation of Chiropractic, March 15-18, 2017
37. Moustafa IM, Diab AA, Hegazy F, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskelet Disord 2018;19(1):396
38. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration for the management of cervicogenic headaches: a 2-year pilot randomized controlled trial. 15th World Federation of Chiropractic Biennial Congress/78th European Chiropractor’s Union Convention, March 20-23, 2019, p.142
39. Harrison DE, Cailliet R, Betz JW et al. A non-randomized clinical controlled trial of Harrison mirror image methods for correcting trunk list: a non-randomized clinical control trial. Eur Spine J 2005;14:155-162
40. Harrison DE, Harrison DD, Haas JW et al. Conservative methods to correct lateral translations of the head: a non-randomized clinical control trial. J Rehab Res Devel 2004;41:631-640
41. Harrison DE, Harrison DD, Betz J et al. Increasing the cervical lordosis with seated combined extension-compression and transverse load cervical traction with cervical manipulation: non-randomized clinical control trial. J Manipulative Physiol Ther 2003;26:139-151
42. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-point bending traction method of restoring cervical lordosis combined with cervical manipulation: non-randomized clinical control trial. Arch Phys Med Rehab 2002;83:447-453
43. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: non-randomized clinical control trial. Arch Phys Med Rehab 2002;83:1585-1591
44. Harrison DD, Jackson BL, Troyanovich S, Robertson G, de George D, Barker WF. The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study. J Manipulative Physiol Ther 1994;17:454-464
45. McCarthy IM, Hostin RA, Ames CP, et al. Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study. Spine J 2014;14:2326-2333
46. Oakley PA, Berry RH, Harrison DE. A structural approach to post-surgical laminectomy: a case study. J Vertebral Sublux Res 2007;Mar 19:1-7
47. Ferrantelli JR, Harrison DE, Harrison DD, Stewart D. Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods. J Manipulative Physiol Ther 2005;28:e1-8
48. Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two. J Phys Ther Sci 2018;30:1131-1137
2. Harrison DE, Harrison DD, Troyanovich SJ, Harmon S. A normal spinal position: It's time to accept the evidence. J Manipulative Physiol Ther 2000;23:623-644
3. Pellisé F, Vila-Casademunt A, Ferrer M, et al. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 2015;24:3-11
4. Harrison DE, Colloca CJ, Harrison DD, Janik TJ, Haas JW, Keller TS. Anterior thoracic posture increases thoracolumbar disc loading. Eur Spine J 2005;14:234-242
5. Ware JE. SF-36 health survey update. (www.sf-36.org/tools/SF36.shtml) 2004
6. Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 2000;25:2072-2078
7. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine 2001;26:E227-234
8. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine 2001;26:E235-242
9. Harrison DE, Holland B, Harrison DD, Janik TJ. Further reliability analysis of the Harrison radiographic line-drawing methods: crossed ICCs for lateral posterior tangents and modified Risser-Ferguson method on AP views. J Manipulative Physiol Ther 2002;25:93–98
10. Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE. Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Res 1998;16:766–770
11. Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. J Spinal Disord 1998;11:430–439
12. 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 Spinal Disord Tech 2002;15:213–220
13. Harrison DD, Janik TJ, Troyanovich SJ, Holland B. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 1996;21:667–675
14. Harrison DD, Harrison DE, Janik TJ et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 2004;29:2485–2492
15. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187–193
16. Harrison DD, Janik TJ, Harrison GR, Troyanovich S, Harrison DE, Harrison SO. Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic. J Manipulative Physiol Ther 1996;19:525-535
17. Oakley PA, Harrison DD, Harrison DE, Haas JW. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP) publications. J Can Chiropr Assoc 2005;49:270–296
18. Harrison DE, Harrison DD, Haas JW. Structural rehabilitation of the cervical spine. Evanston, WY: Harrison CBP® Seminars, Inc., 2002
19. Harrison DE, Betz JW, Harrison DD, Haas JW, Oakley PA, Meyer DW. CBP® Structural Rehabilitation of the Lumbar Spine: Harrison Chiropractic Biophysics Seminars, Inc., 2007
20. Harrison D, Moustafa I, Oakley P. Systematic review of Chiropractic Biophysics® (CBP®) methods employed in the rehabilitation of cervical lordosis. Proceedings from the 14th International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) meeting, San Francisco, April 25-27, 2019. p.156
21. Harrison D, Moustafa I, Oakley P. Systematic review of Chiropractic Biophysics® (CBP®) methods employed in the rehabilitation of lumbar lordosis. Proceedings from the 14th International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) meeting, San Francisco, April 25-27, 2019. p.157
22. Colloca CJ, Keller TS. Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain. J Manipulative Physiol Ther 2001;24:489-500
23. Bae J, Theologis AA, Strom R et al. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2018;28:40-49
24. Manwaring JC, Bach K, Ahmadian AA, et al. Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study. J Neurosurg Spine 2014;20:515-22
25. Mundis GM Jr, Turner JD, Kabirian N et al. Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity. World Neurosurg 2017;105:249-256
26. Pellisé F, Serra-Burriel M, Smith JS, et al. Development and validation of risk stratification models for adult spinal deformity surgery. J Neurosurg Spine 2019;Jun 28:1-13. doi: 10.3171/2019.3.SPINE181452. [Epub ahead of print]
27. Moustafa IM, Diab AM, Ahmed A, Harrison DE. The efficacy of cervical lordosis rehabilitation for nerve root function, pain, and segmental motion in cervical spondylotic radiculopathy. PhysioTher 2011;97 Supplement:846-847
28. Diab AA, Moustafa IM. Rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J Manipulative Physiol Ther 2012;35:246-253
29. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil 2012;27:51-62
30. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain. a randomized trial. J Back Musculoskelet Rehabil 2013;26:213-222
31. Moustafa IM. Does improvement towards a normal cervical configuration aid in the management of fibromyalgia. A randomized controlled trial. Bull Fac Phys Ther Cairo Univ 2013;18:29-41
32. Moustafa IM, Diab AA, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of lumbosacral radiculopathy: A randomized controlled trial Proceedings of the 13th World Federation of Chiropractic Biennial Congress / ECU Convention, Athens, Greece, May 13-16, 2015. Paper #184 Mediterranean Region Award Winning Paper
33. Moustafa IM, Diab AA, Taha S, Harrison DE. 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. Arch Phys Med Rehabil 2016;97:2034-2044
34. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. Eur J Phys Rehabil Med 2017;53:57-71
35. Moustafa IM, Diab AAM, Hegazy FA, Harrison DE. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects? J Back Musculoskelet Rehabil 2017;30:937-941
36. Moustafa IM, Diab AAM, Taha S, Harrison DE. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial. Proceedings of the 14th biennial congress of the World Federation of Chiropractic, March 15-18, 2017
37. Moustafa IM, Diab AA, Hegazy F, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskelet Disord 2018;19(1):396
38. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration for the management of cervicogenic headaches: a 2-year pilot randomized controlled trial. 15th World Federation of Chiropractic Biennial Congress/78th European Chiropractor’s Union Convention, March 20-23, 2019, p.142
39. Harrison DE, Cailliet R, Betz JW et al. A non-randomized clinical controlled trial of Harrison mirror image methods for correcting trunk list: a non-randomized clinical control trial. Eur Spine J 2005;14:155-162
40. Harrison DE, Harrison DD, Haas JW et al. Conservative methods to correct lateral translations of the head: a non-randomized clinical control trial. J Rehab Res Devel 2004;41:631-640
41. Harrison DE, Harrison DD, Betz J et al. Increasing the cervical lordosis with seated combined extension-compression and transverse load cervical traction with cervical manipulation: non-randomized clinical control trial. J Manipulative Physiol Ther 2003;26:139-151
42. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-point bending traction method of restoring cervical lordosis combined with cervical manipulation: non-randomized clinical control trial. Arch Phys Med Rehab 2002;83:447-453
43. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: non-randomized clinical control trial. Arch Phys Med Rehab 2002;83:1585-1591
44. Harrison DD, Jackson BL, Troyanovich S, Robertson G, de George D, Barker WF. The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study. J Manipulative Physiol Ther 1994;17:454-464
45. McCarthy IM, Hostin RA, Ames CP, et al. Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study. Spine J 2014;14:2326-2333
46. Oakley PA, Berry RH, Harrison DE. A structural approach to post-surgical laminectomy: a case study. J Vertebral Sublux Res 2007;Mar 19:1-7
47. Ferrantelli JR, Harrison DE, Harrison DD, Stewart D. Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods. J Manipulative Physiol Ther 2005;28:e1-8
48. Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two. J Phys Ther Sci 2018;30:1131-1137