CHIROPRACTIC BIOPHYSICS MANAGEMENT OF STRAIGHT BACK SYNDROME AND EXERTIONAL DYSPNEA: A CASE REPORT WITH FOLLOW-UP

Main Article Content

Miles Fortner
Paul Oakley
Deed Harrison

Keywords

Posture, Spinal Manipulation, Straight Back Syndrome

Abstract

Objective: To discuss a patient with increased thoracic spine kyphosis and improved exertional dyspnea who received Chiropractic BioPhysics® corrective treatments.


Clinical Features: An 18-year old male had back pain and exertional dyspnea. Radiographic assessment revealed a significant reduction in thoracic spine curve. Straight back syndrome is the loss of the physiologic thoracic kyphosis and is associated with back pain as well as the more serious compression of the heart and lungs. There is a paucity of data on non-surgical treatment options.


Intervention and Outcome: Treatment was aimed at increasing the thoracic curve using Chiropractic BioPhysics technique methods, including thoracic hyper-flexion traction and exercises as well as spinal manipulation. An assessment after 24 treatments over a 9-week period showed a 15° increase in thoracic kyphosis as well as a substantial decrease in pain and exertional dyspnea symptoms and improvements in disability and quality of life questionnaires. A 4-month follow-up indicated the patient had stability of the structural correction and remained well.  


Conclusion: This case demonstrates the improvement in both straight back syndrome and cervical hypolordosis corresponding to improvements in back pain and classic exertional dyspnea commonly associated with this disorder. Straight back syndrome is a serious health disorder that may be improved by the non-surgical multimodal spinal rehabilitation methods employed in CBP technique. Routine radiography is necessary to quantify the subluxation and monitor treatment progress.

Downloads

Download data is not yet available.
Abstract 149 | STRAIGHT BACK SYNDROME Downloads 24

References

1. Rawlings MS. The ‘straight back’ syndrome. A new cause of pseudoheart disease. Am J Cardiol 1960;5:333-338
2. Rawlings MS. Straight back syndrome: a new heart disease. Chest 1961;39:435-443
3. De Leon AC, Perloff JK, Twigg H, et al. The straight back syndrome. Clinical cardiovascular manifestations. Circulation 1965;32:193-203
4. Serratto M, Kezdi P. Absence of the physiologic dorsal kyphosis. Cardiac signs and hemodynamic manifestations. Ann Int Med 1963;58:938-945
5. Spapen HDM, Reynaert H, Debeuckelaere S et al. The straight back syndrome. Netherlands Journal of Medicine 1990;36:29-31
6. Datey KK, Deshmukh MM, Engineer SD et al. Straight back syndrome. Brit Heart J 1964;26:614-619
7. Esser SM, Monroe MH, Littmann L. Straight back syndrome. Eur Heart J 2009; 0:1752
8. Raggi P, Callister TQ, Lippolis NJ, et al. Is mitral valve prolapse due to cardiac entrapment in the chest Cavity? A CT view. Chest 2000;117:636-642
9. Tokushima T, Utsunomiya T, Ogawa T, et al. Contrast-enhanced radiographic computed tomographic findings in patients with straight back syndrome. Am J Card Imaging 1996;10:228-234
10. Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients 200 with idiopathic scoliosis. J Bone and Joint Surg 1975;57A:972-976
11. Bradford DS, Blatt JM, Rasp FL. Surgical management of severe thoracic lordosis. A new technique to 196 restore normal kyphosis. Spine 1983;8:420-428
12. Winter RB, Lonstein JE. The surgical correction of thoracic and lumbar hyperlordosis deformities. Iowa Orthop J 1998;18:91-100
13. Brooks WJ, Krupinski EA, Hawes MC. Reversal of childhood idiopathic scoliosis in an adult, without 202 surgery: a case report and literature review. Scoliosis 2009;15:27
14. Mitchell JR, Oakley PA, Harrison DE. Nonsurgical correction of straight back syndrome (thoracic hypokyphosis), increased lung capacity and resolution of exertional dyspnea by thoracic hyperkyphosis mirror image® traction: a CBP® case report. J Phys Ther Sci 2017;29: 2058-2061
15. Betz JW, Oakley PA, Harrison DE. Relief of exertional dyspnea and spinal pains by increasing the thoracic kyphosis in straight back syndrome (thoracic hypo-kyphosis) using CBP® methods: a case report with long-term follow-up. J Phys Ther Sci 2018;30:185-189
16. Hudson-Cook N, Tomes-Nicholson K, Breen A. A revised Oswestry disability questionnaire. In: Roland M, Jenner JR, eds. Back pain: new approaches to rehabilitation and education. Manchester: Manchester University Press, 1989:187–204
17. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247-63

18. Harrison DE, Harrison DD, Cailliet R, et al. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 2000;25:2072–2078

19. Harrison DE, Cailliet R, Harrison DD, et al. Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine 2001;26: E227–E234

20. Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine 2001;26:E235–E242

21. Harrison DE, Holland B, Harrison DD, et al. 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

22. Harrison DE, Harrison DD, Colloca CJ, et al. Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups. J Manipulative Physiol Ther 2003;26:87–98

23. Harrison DE, Janik TJ, Harrison DD, et al. 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
24. Davies MK, Mackintosh P, Cayton RM, Page AJ, Shiu MF, Littler WA. The straight back syndrome. Q J Med 1980;49:443-460
25. 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

26. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187–193

27. Harrison DD, Janik TJ, Troyanovich SJ, et al. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 1996;21:667–675

28. Harrison DD, Cailliet R, Janik TJ, et al. 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
29. 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

30. 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

31. Lee DY. Analysis of muscle activation in each body segment in response to the stimulation intensity of whole-body vibration. J Phys Ther Sci 2017;29:270-273
32. Harrison DD, Cailliet R, Janik TJ, et al. 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
33. 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

34. 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

35. 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

36. 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: 264–1267

37. 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

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. 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;28:2831-2841
40. Bezalel T, Carmeli E, Levi D, Kalichman L. the effect of Schroth therapy on thoracic kyphotic curve and quality of life in Scheuermann's patients: a randomized controlled trial. Asian Spine J 2019;13:490-499
41. 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

42. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech 1995;10:363–368

43. Panjabi MM, White AA III. Biomechanics in the musculoskeletal system. New York: Churchill Livingstone, 2001.

44. 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

45. Moustafa IM, Diab AA, Taha S, et al. 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

46. 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

47. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil 2013;27:51–62

48. 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

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. Gold PM, Albright B, Anani S, Toner H. Straight Back Syndrome: positive response to spinal manipulation and adjunctive therapy - A case report. J Can Chiropr Assoc 2013;57:143-149