CERVICAL PSEUDO-SCOLIOSIS REDUCTION AND ALLEVIATION OF DYSTONIA SYMPTOMS USING CHIROPRACTIC BIOPHYSICS® (CBP®) TECHNIQUE: A CASE REPORT WITH A 1.5-YEAR FOLLOW-UP
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Abstract
Objective: To discuss the reduction of lateral head translation pseudo-scoliosis in a patient with chronic craniocervical symptoms including cervical dystonia.
Clinical Features: A 59-year-old female had cervical dystonia and cervical scoliosis. Examination showed symptoms consistent with dystonia including involuntary neck contractions, neck pain, headaches, and a right-handed tremor. Radiographic assessment showed a primary right-sided head translation posture (pseudo-scoliosis) with secondary left lateral head flexion, and tertiary left head rotation.
Intervention and Outcome: The patient was treated by Chiropractic BioPhysics® mirror image® left-sided head and neck traction, exercises, and spinal adjustments. After 24 treatment sessions over 8 weeks, she reported a 90% reduction in cervical dystonia symptoms, improvement in neck pain and improved disability. Repeat radiography demonstrated A 75% reduction in the cervical subluxation. A 1.5-year follow-up showed maintenance of symptoms and posture.
Conclusion: Although the mechanisms are not yet known, the correction of posture in those suffering from cervical dystonia and related neurological disorders may benefit from the correction of posture. The distinction between true scoliosis and ‘pseudo-scoliosis’ postures by routine radiographic assessment is essential prior to initiating spine rehabilitation as their treatment approaches will differ.
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References
1. Harrison DE, Harrison DD, Cailliet R, et al. Cervical coupling during lateral head translations creates an S-configuration. Clin Biomech 2000:15:436–440
2. Harrison DE, Betz JW, Cailliet R et al. Radiographic pseudoscoliosis in healthy male subjects following voluntary lateral translation (side glide) of the thoracic spine. Arch Phys Med Rehabil 2006;87:117-122
3. 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;16:1559325818781437.
4. van den Dool J, Tijssen MA, Koelman JH, et al. Determinants of disability in cervical dystonia. Parkinsonism Relat Disord 2016;32:48-53
5. Hu W, Rundle-Gonzalez V, Kulkarni SJ, et al. A randomized study of botulinum toxin versus botulinum toxin plus physical therapy for treatment of cervical dystonia. Parkinsonism Relat Disord 2019;Feb 25. pii: S1353-8020(19)30081-1. doi: 10.1016/j.parkreldis.2019.02.035. [Epub ahead of print]
6. Marques RE, Duarte GS, Rodrigues FB et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2016;May 13;(5):CD004315
7. Brashear A, Lew MF, Dykstra DD et al. Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia. Neurol 1999;53:1439-1446
8. De Pauw J, Van der Velden K, Meirte J, et al. The effectiveness of physiotherapy for cervical dystonia: a systematic literature review. J Neurol 2014;261:1857-1865
9. 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
10. 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
11. Troyanovich SJ, Harrison D, Harrison DD, et al. Chiropractic biophysics digitized radiographic mensuration analysis of the anteroposterior cervicothoracic view: a reliability study. J Manipulative Physiol Ther 2000;23:476-482
12. 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
13. 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
14. 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
15. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–415
16. Ware JE. SF-36 health survey update. (www.sf-36.org/tools/SF36.shtml) 2004
17. 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
18. Harrison DE, Harrison DD, Haas JW. Structural rehabilitation of the cervical spine. Evanston, WY: Harrison CBP® Seminars, Inc., 2002
19. 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
20. Harrison DE, Cailliet R, Betz J, et al. Conservative methods for reducing lateral translation postures of the head: a nonrandomized clinical control trial. J Rehabil Res Dev 2004;41:631–639
21. Oakley PA, Harrison DE. The prevalence of lateral head shift postures in a patient population: a correlation of posture magnitude, pain, and demographic variables. J Chiro Ed 2004;18:73–74
22. 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
23. 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
24. Moustafa IM, Diab AAM, Hegazy FA, et al. 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
25. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clinical Rehab, 2012, 27: 51-62
26. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain. J Manipulative Physiol Ther, 2012;35:246-253
27. Diab AAM, 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
28. Woo S, Livesay GA, Runco TJ, et al. Structure and function of tendons and ligaments. In: Mow VC, Hayes WC. Eds. Basic orthopedic biomechanics. 2nd ed. Philadelphia: Lippencott-Raven; 1997. p.209-252
29. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech, 1995;10:363–368
30. Harrison DE, Cailliet R, Betz JW, et al. A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain. Eur Spine J 2005;14:155-162
2. Harrison DE, Betz JW, Cailliet R et al. Radiographic pseudoscoliosis in healthy male subjects following voluntary lateral translation (side glide) of the thoracic spine. Arch Phys Med Rehabil 2006;87:117-122
3. 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;16:1559325818781437.
4. van den Dool J, Tijssen MA, Koelman JH, et al. Determinants of disability in cervical dystonia. Parkinsonism Relat Disord 2016;32:48-53
5. Hu W, Rundle-Gonzalez V, Kulkarni SJ, et al. A randomized study of botulinum toxin versus botulinum toxin plus physical therapy for treatment of cervical dystonia. Parkinsonism Relat Disord 2019;Feb 25. pii: S1353-8020(19)30081-1. doi: 10.1016/j.parkreldis.2019.02.035. [Epub ahead of print]
6. Marques RE, Duarte GS, Rodrigues FB et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2016;May 13;(5):CD004315
7. Brashear A, Lew MF, Dykstra DD et al. Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia. Neurol 1999;53:1439-1446
8. De Pauw J, Van der Velden K, Meirte J, et al. The effectiveness of physiotherapy for cervical dystonia: a systematic literature review. J Neurol 2014;261:1857-1865
9. 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
10. 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
11. Troyanovich SJ, Harrison D, Harrison DD, et al. Chiropractic biophysics digitized radiographic mensuration analysis of the anteroposterior cervicothoracic view: a reliability study. J Manipulative Physiol Ther 2000;23:476-482
12. 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
13. 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
14. 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
15. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–415
16. Ware JE. SF-36 health survey update. (www.sf-36.org/tools/SF36.shtml) 2004
17. 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
18. Harrison DE, Harrison DD, Haas JW. Structural rehabilitation of the cervical spine. Evanston, WY: Harrison CBP® Seminars, Inc., 2002
19. 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
20. Harrison DE, Cailliet R, Betz J, et al. Conservative methods for reducing lateral translation postures of the head: a nonrandomized clinical control trial. J Rehabil Res Dev 2004;41:631–639
21. Oakley PA, Harrison DE. The prevalence of lateral head shift postures in a patient population: a correlation of posture magnitude, pain, and demographic variables. J Chiro Ed 2004;18:73–74
22. 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
23. 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
24. Moustafa IM, Diab AAM, Hegazy FA, et al. 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
25. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clinical Rehab, 2012, 27: 51-62
26. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain. J Manipulative Physiol Ther, 2012;35:246-253
27. Diab AAM, 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
28. Woo S, Livesay GA, Runco TJ, et al. Structure and function of tendons and ligaments. In: Mow VC, Hayes WC. Eds. Basic orthopedic biomechanics. 2nd ed. Philadelphia: Lippencott-Raven; 1997. p.209-252
29. Oliver MJ, Twomey LT. Extension creep in the lumbar spine. Clin Biomech, 1995;10:363–368
30. Harrison DE, Cailliet R, Betz JW, et al. A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain. Eur Spine J 2005;14:155-162
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Published
Sep 16, 2019
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Haas, J., Oakley, P., & Harrison, D. (2019). CERVICAL PSEUDO-SCOLIOSIS REDUCTION AND ALLEVIATION OF DYSTONIA SYMPTOMS USING CHIROPRACTIC BIOPHYSICS® (CBP®) TECHNIQUE: A CASE REPORT WITH A 1.5-YEAR FOLLOW-UP. Journal of Contemporary Chiropractic, 2(1), 131–137. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/83
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