REDUCING THORACIC HYPERKYPHOSIS SUBLUXATION DEFORMITY: A SYSTEMATIC REVIEW OF CHIROPRACTIC BIOPHYSICS® METHODS EMPLOYED IN ITS STRUCTURAL IMPROVEMENT
Main Article Content
Keywords
Thoracic Spine; Hyperkyphosis; Spinal Deformity; Posture; Chiropractic; Spine Rehabilitation
Abstract
Objective: Thoracic hyperkyphosis is a serious postural health disorder that is associated with many health conditions including morbidity and mortality.
Methods: We reviewed all clinical evidence for the treatment of hyperkyphosis by Chiropractic BioPhysics® technique methods. Seven peer-reviewed papers were located that included 4 case reports, 2 case series, and 1 randomized clinical trial treating the cervical spine reporting reduction of the thoracic curve.
Results: Although the amount clinical evidence is small, these studies document successful reduction in thoracic curve by an average of 12° concomitant with the improvement in pain, disability, quality of life measures and in some cases improvement in vital capacity. There was large variation in number of treatments, duration of treatment and age of patients. Although there are some clinical trials demonstrating improvement in thoracic kyphosis primarily by exercise programs, the changes are small and most report on suboptimal mensuration methods that do not directly relate to the gold standard x-ray measurement. Only 2 previous exercise intervention trials have reported pre-post x-ray improvements in thoracic alignment, and this was 3°.
Conclusion: If future CBP intervention trials are consistent with the initial CBP patient outcomes for this disorder, the CBP treatment approach may prove to be an effective treatment that may logically lead to reduced mortality rates and improvements in quality of life measures in these patients.
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References
1. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther 2010;40:352-360
2. Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive Spinal Kyphosis in the Aging Population. Neurosurgery 2015;77 Suppl 4:S164-172
3. Petcharaporn M, Pawelek J, Bastrom T, et al. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine 2007;32: 2226–2231
4. Ensrud KE, Black DM, Harris F, et al. The fracture intervention trial research group: correlates of kyphosis in older women. J Am Geriatr Soc 1997;45:682–687
5. Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010;19:1824-1836
6. Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. J Bone Miner Res 2012;27:2144-2151
7. Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141:68–71
8. Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine 1994;19:1250–1255
9. Lee SJ, Chang JY, Ryu YJ, Lee JH, Chang JH, Shim SS, Hwang JY. Clinical Features and Outcomes of Respiratory Complications in Patients with Thoracic Hyperkyphosis. Lung 2015;193:1009-1015
10. Miyakoshi N, Itoi E, Kobayashi M, et al. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 2003;14: 1007–1012
11. Mattox TF, Lucente V, McIntyre P, et al. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000;183:1381–1384
12. Lind LR, Lucente V, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol 1996;87:605–609
13. Winans HM. Anemia in the aged. Syndrome of kyphosis, gastric hernia, and anemia. Tex J Med 1938;34:422–423
14. McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay SP, Schousboe JT, Nichols JF, Kado DM. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int 2018;29:163-169
15. Patwardhan AG, Khayatzadeh S, Havey RM, Voronov LI, Smith ZA, Kalmanson O, Ghanayem AJ, Sears W. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J 2018;27(Suppl 1):25-38
16. Lewis CL, Sahrmann SA. Effect of posture on hip angles and moments during gait. Man Ther 2015;20:176-182
17. Kado DM, Browner WS, Palermo L, et al. Study of Osteoporotic Fractures Research Group: Vertebral fractures and mortality in older women: a prospective
study. Arch Intern Med 1999;159:1215–1220
18. Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 2003;14:589–594
19. Kado DM, Huang MH, Karlamangla AS, et al. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. J Am Geriatr Soc 2004;52:1662–1667
20. Milne JS, Williamson J. A longitudinal study of kyphosis in older people. Age Ageing 1983;12:225–233.
21. Anderson F, Cowan NR. Survival of healthy older people. Br J Prev Soc Med 1976; 30:231–232.
22. Cutler WB, Friedmann E, Genovese-Stone E. Prevalence of kyphosis in a healthy sample of pre- and postmenopausal women. Am J Phys Med Rehabil 1993;72:219–225.
23. Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, Fink HA, Ensrud KE. Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 2014;29(10):2210-2216
24. Zipnick RI, Gorek J, Kostiuk JP, et al. The aging spine. Spine: State of the art reviews 1996;10(3):467-489
25. Kado DM, Huang MH, Barrett-Connor E, et al. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study. J Gerontol A Biol Sci Med Sci 2005;60:633–637
26. Chow RK, Harrison JE. Relationship of kyphosis to physical fitness and bone mass on post-menopausal women. Am J Phys Med 1987;66:219–227
27. Ryan SD, Fried LP. The impact of kyphosis on daily functioning. J Am Geriatr Soc 1997;45:1479–1486
28. Takahashi T, Ishida K, Hirose D, et al. Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people. Osteoporos Int 2005;16:273–279
29. Keller TS, Harrison DE, Colloca CJ, et al. Prediction of osteoporotic spinal deformity. Spine 2003;28:455–462
30. Huang MH, Barrett-Connor E, Greendale GA, et al. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res 2006;21: 419–423
31. Itoi E, Sinaki M. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc 1994;69:1054–1059
32. Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017;28(10):2831-2841
33. Jang HJ, Hughes LC, Oh DW, Kim SY. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design. J Geriatr Phys Ther 2017;Sep 13. doi: 10.1519/JPT.0000000000000146. [Epub ahead of print]
34. Kamali F, Shirazi SA, Ebrahimi S, et al. Comparison of manual therapy and exercise therapy for postural hyperkyphosis: A randomized clinical trial. Physiother Theory Pract 2016;32:92-97
35. Pawlowsky SB, Hamel KA, Katzman WB. Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women. Arch Phys Med Rehabil 2009;90:358-361
36. Ball JM, Cagle P, Johnson BE, et al. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int 2009;20:481-489
37. Katzman WB, Sellmeyer DE, Stewart AL, et al. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil 2007;88:192-199.
38. Fortner MO, Oakley PA, Harrison DE. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: a CBP® case report. J Phys Ther Sci 2018;30:1117-1123
39. Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP® mirror image® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018;30:1039-1045
40. Moustafa IM, Diab AA, Taha S, et al. Addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves shortand
long-term outcomes in patients with discogenic cervical radiculopathy. Arch Phys Med Rehabil 2016;97:2034–2044
41. 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
42. Moustafa IM, Diab AA, Hegazy FA, et al. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical
spondylotic radiculopathy subjects? J Back Musculoskeletal Rehabil 2017;30: 937–941
43. Harrison DE, Cailliet R, Harrison DD, et al. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: a nonrandomized
clinical controlled trial. Arch Phys Med Rehabil 2002;83:447–453
44. Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse
load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther 2003;26:139–151
45. Moustafa IM, Diab AM, Ahmed A, et al. The efficacy of cervical lordosis rehabilitation for nerve root function, pain, and segmental motion in cervical spondylotic
radiculopathy. Physiotherapy 2011;97:846–847
46. 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 No. 184 Mediterranean Region Award Winning Paper.
p.71
47. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J
Manipulative Physiol Ther 2012;35:246–253
48. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil
2013;27:51–62
49. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial. J Back Musculoskeletal
Rehabil 2013;26:213–220
50. Harrison DE, Cailliet R, Harrison DD, et al. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled
trial. Arch Phys Med Rehabil 2002;83:1585–1591
51. Miller JE, Oakley PA, Levin SB, et al. Reversing thoracic hyperkyphosis: a case report featuring mirror image® thoracic extension rehabilitation. J Phys Ther Sci 2017; 29:1264–1267
52. Fortner MO, Oakley PA, Harrison DE. Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics®: a case report utilizing a multimodal mirror image® rehabilitation program. J Phys Ther Sci 2017;29:1475–1480
53. Jaeger JO, Oakley PA, Colloca CJ, et al. Non-surgical reduction of thoracic hyper-kyphosis in a 24-year old music teacher utilizing chiropractic biophysics® Technique. Br J Med Med Res 2016;11:1–9
54. Fedorchuk C, Snow, E. Reduction in thoracic hyperkyphosis with increased peak expiratory flow (PEF), forced expiratory volume (FEV) and SF-36 scores following CBP protocols in asymptomatic patients: a case series. Ann Vert Sublux Res 2017;Oct 12: 189–200
55. Moustafa I, Diab AM, Harrison D. 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, Athens, Greece, May 13-16, 2015:p.157
56. Harrison DD, Janik TJ, Harrison GR, et al. Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic. J Manipulative Physiol
Ther 1996;19:525–535
57. Oakley PA, Harrison DD, Harrison DE, et al. 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
58. 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(11):E227-234
59. 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(3):213-220
60. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas J. Do alterations in vertebral and disc dimensions affect an elliptical model of thoracic kyphosis? Spine 2003;28(5):463-469
61. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech 1995; 10:363–368
62. Panjabi MM, White AA, III. Biomechanics in the musculoskeletal system. New York: Churchill Livingstone, 2001.
63. Bogduk N. Management of chronic low back pain. Med J Aust, 2004;180: 79–83.
64. Perriman DM, Scarvell JM, Hughes AR, Lueck CJ, Dear KB, Smith PN. Thoracic hyperkyphosis: a survey of Australian physiotherapists. Physiother Res Int 2012;17(3):167-178
65. Schneider DL, von Mühlen D, Barrett-Connor E, et al. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol 2004;31:747–752
66. Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response 2018; Jun 19;16(2):1559325818781437
67. Oakley PA, Harrison DE. Radiogenic Cancer Risks from Chiropractic X-rays are Zero: 10 Reasons to Take Routine Radiographs in Clinical Practice. Ann Vert Sublux Res 2018;March 10:48-56
68. Oakley PA, Harrison DE. Radiophobia: 7 Reasons Why Radiography used in Spine and Posture Rehabilitation Should Not be Feared or Avoided. Dose Response 2018; Jun 27;16(2):1559325818781445
2. Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive Spinal Kyphosis in the Aging Population. Neurosurgery 2015;77 Suppl 4:S164-172
3. Petcharaporn M, Pawelek J, Bastrom T, et al. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine 2007;32: 2226–2231
4. Ensrud KE, Black DM, Harris F, et al. The fracture intervention trial research group: correlates of kyphosis in older women. J Am Geriatr Soc 1997;45:682–687
5. Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010;19:1824-1836
6. Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. J Bone Miner Res 2012;27:2144-2151
7. Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141:68–71
8. Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine 1994;19:1250–1255
9. Lee SJ, Chang JY, Ryu YJ, Lee JH, Chang JH, Shim SS, Hwang JY. Clinical Features and Outcomes of Respiratory Complications in Patients with Thoracic Hyperkyphosis. Lung 2015;193:1009-1015
10. Miyakoshi N, Itoi E, Kobayashi M, et al. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 2003;14: 1007–1012
11. Mattox TF, Lucente V, McIntyre P, et al. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000;183:1381–1384
12. Lind LR, Lucente V, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol 1996;87:605–609
13. Winans HM. Anemia in the aged. Syndrome of kyphosis, gastric hernia, and anemia. Tex J Med 1938;34:422–423
14. McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay SP, Schousboe JT, Nichols JF, Kado DM. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int 2018;29:163-169
15. Patwardhan AG, Khayatzadeh S, Havey RM, Voronov LI, Smith ZA, Kalmanson O, Ghanayem AJ, Sears W. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J 2018;27(Suppl 1):25-38
16. Lewis CL, Sahrmann SA. Effect of posture on hip angles and moments during gait. Man Ther 2015;20:176-182
17. Kado DM, Browner WS, Palermo L, et al. Study of Osteoporotic Fractures Research Group: Vertebral fractures and mortality in older women: a prospective
study. Arch Intern Med 1999;159:1215–1220
18. Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 2003;14:589–594
19. Kado DM, Huang MH, Karlamangla AS, et al. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. J Am Geriatr Soc 2004;52:1662–1667
20. Milne JS, Williamson J. A longitudinal study of kyphosis in older people. Age Ageing 1983;12:225–233.
21. Anderson F, Cowan NR. Survival of healthy older people. Br J Prev Soc Med 1976; 30:231–232.
22. Cutler WB, Friedmann E, Genovese-Stone E. Prevalence of kyphosis in a healthy sample of pre- and postmenopausal women. Am J Phys Med Rehabil 1993;72:219–225.
23. Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, Fink HA, Ensrud KE. Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 2014;29(10):2210-2216
24. Zipnick RI, Gorek J, Kostiuk JP, et al. The aging spine. Spine: State of the art reviews 1996;10(3):467-489
25. Kado DM, Huang MH, Barrett-Connor E, et al. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study. J Gerontol A Biol Sci Med Sci 2005;60:633–637
26. Chow RK, Harrison JE. Relationship of kyphosis to physical fitness and bone mass on post-menopausal women. Am J Phys Med 1987;66:219–227
27. Ryan SD, Fried LP. The impact of kyphosis on daily functioning. J Am Geriatr Soc 1997;45:1479–1486
28. Takahashi T, Ishida K, Hirose D, et al. Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people. Osteoporos Int 2005;16:273–279
29. Keller TS, Harrison DE, Colloca CJ, et al. Prediction of osteoporotic spinal deformity. Spine 2003;28:455–462
30. Huang MH, Barrett-Connor E, Greendale GA, et al. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res 2006;21: 419–423
31. Itoi E, Sinaki M. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc 1994;69:1054–1059
32. Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017;28(10):2831-2841
33. Jang HJ, Hughes LC, Oh DW, Kim SY. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design. J Geriatr Phys Ther 2017;Sep 13. doi: 10.1519/JPT.0000000000000146. [Epub ahead of print]
34. Kamali F, Shirazi SA, Ebrahimi S, et al. Comparison of manual therapy and exercise therapy for postural hyperkyphosis: A randomized clinical trial. Physiother Theory Pract 2016;32:92-97
35. Pawlowsky SB, Hamel KA, Katzman WB. Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women. Arch Phys Med Rehabil 2009;90:358-361
36. Ball JM, Cagle P, Johnson BE, et al. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int 2009;20:481-489
37. Katzman WB, Sellmeyer DE, Stewart AL, et al. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil 2007;88:192-199.
38. Fortner MO, Oakley PA, Harrison DE. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: a CBP® case report. J Phys Ther Sci 2018;30:1117-1123
39. Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP® mirror image® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018;30:1039-1045
40. Moustafa IM, Diab AA, Taha S, et al. Addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves shortand
long-term outcomes in patients with discogenic cervical radiculopathy. Arch Phys Med Rehabil 2016;97:2034–2044
41. 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
42. Moustafa IM, Diab AA, Hegazy FA, et al. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical
spondylotic radiculopathy subjects? J Back Musculoskeletal Rehabil 2017;30: 937–941
43. Harrison DE, Cailliet R, Harrison DD, et al. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: a nonrandomized
clinical controlled trial. Arch Phys Med Rehabil 2002;83:447–453
44. Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse
load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther 2003;26:139–151
45. Moustafa IM, Diab AM, Ahmed A, et al. The efficacy of cervical lordosis rehabilitation for nerve root function, pain, and segmental motion in cervical spondylotic
radiculopathy. Physiotherapy 2011;97:846–847
46. 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 No. 184 Mediterranean Region Award Winning Paper.
p.71
47. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J
Manipulative Physiol Ther 2012;35:246–253
48. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil
2013;27:51–62
49. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial. J Back Musculoskeletal
Rehabil 2013;26:213–220
50. Harrison DE, Cailliet R, Harrison DD, et al. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled
trial. Arch Phys Med Rehabil 2002;83:1585–1591
51. Miller JE, Oakley PA, Levin SB, et al. Reversing thoracic hyperkyphosis: a case report featuring mirror image® thoracic extension rehabilitation. J Phys Ther Sci 2017; 29:1264–1267
52. Fortner MO, Oakley PA, Harrison DE. Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics®: a case report utilizing a multimodal mirror image® rehabilitation program. J Phys Ther Sci 2017;29:1475–1480
53. Jaeger JO, Oakley PA, Colloca CJ, et al. Non-surgical reduction of thoracic hyper-kyphosis in a 24-year old music teacher utilizing chiropractic biophysics® Technique. Br J Med Med Res 2016;11:1–9
54. Fedorchuk C, Snow, E. Reduction in thoracic hyperkyphosis with increased peak expiratory flow (PEF), forced expiratory volume (FEV) and SF-36 scores following CBP protocols in asymptomatic patients: a case series. Ann Vert Sublux Res 2017;Oct 12: 189–200
55. Moustafa I, Diab AM, Harrison D. 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, Athens, Greece, May 13-16, 2015:p.157
56. Harrison DD, Janik TJ, Harrison GR, et al. Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic. J Manipulative Physiol
Ther 1996;19:525–535
57. Oakley PA, Harrison DD, Harrison DE, et al. 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
58. 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(11):E227-234
59. 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(3):213-220
60. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas J. Do alterations in vertebral and disc dimensions affect an elliptical model of thoracic kyphosis? Spine 2003;28(5):463-469
61. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech 1995; 10:363–368
62. Panjabi MM, White AA, III. Biomechanics in the musculoskeletal system. New York: Churchill Livingstone, 2001.
63. Bogduk N. Management of chronic low back pain. Med J Aust, 2004;180: 79–83.
64. Perriman DM, Scarvell JM, Hughes AR, Lueck CJ, Dear KB, Smith PN. Thoracic hyperkyphosis: a survey of Australian physiotherapists. Physiother Res Int 2012;17(3):167-178
65. Schneider DL, von Mühlen D, Barrett-Connor E, et al. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol 2004;31:747–752
66. Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response 2018; Jun 19;16(2):1559325818781437
67. Oakley PA, Harrison DE. Radiogenic Cancer Risks from Chiropractic X-rays are Zero: 10 Reasons to Take Routine Radiographs in Clinical Practice. Ann Vert Sublux Res 2018;March 10:48-56
68. Oakley PA, Harrison DE. Radiophobia: 7 Reasons Why Radiography used in Spine and Posture Rehabilitation Should Not be Feared or Avoided. Dose Response 2018; Jun 27;16(2):1559325818781445
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Jun 18, 2018
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Oakley, P. A., & Harrison, D. E. (2018). REDUCING THORACIC HYPERKYPHOSIS SUBLUXATION DEFORMITY: A SYSTEMATIC REVIEW OF CHIROPRACTIC BIOPHYSICS® METHODS EMPLOYED IN ITS STRUCTURAL IMPROVEMENT. Journal of Contemporary Chiropractic, 1(1), 59–66. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/32
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