One of the things that we have been discussing in past issues is the cervical lordosis. There are probably few clinicians who have not drawn an association between the loss of cervical lordosis and headache. This clinical observation is also supported in the scientific literature.1,2 But, of course, we’d like a quick, easy, accurate and inexpensive method to measure the cervical lordosis. Fortunately, we have something that just fits the bill.
That brings us to Ruth Jackson, BA, MD, FACS, and her book, The Cervical Syndrome, the first edition of which was published in 1956. Dr. Jackson had many impressive positions during her career, including that of Associate Clinical Professor of Orthopedic Surgery at the Southwestern Medical School of The University of Texas in Dallas. But, for our purposes, Ruth was able to draw two straight lines.
Dr. Jackson drew these lines down the back of the second cervical vertebra (axis) and up the back of the seventh cervical vertebra. She taught that the level at which they crossed was the area of the greatest stress and strain in the neck.
Now, both of us, as were thousands of other doctors of chiropractic, were introduced to these lines by B. R. Pettibon, DC. Dr. Pettibon was using these lines to determine the magnitude of the cervical lordosis on the neutral lateral cervical X-ray.
Doctors like Pettibon, and the much earlier Dr. Solon Langworthy, the father of corrective spinal traction,3 were both innovators in the field of restoring the cervical lordosis and, unfortunately, their contributions have often been pushed aside for a new crop of gurus. A mature profession recognizes its history for, without them, there would be no us. So we think it only right that we note that whatever is done in this field is built upon the shoulders of chiropractors such as these two distinguished gentlemen.
To measure the magnitude of the cervical lordosis, Ruth Jackson’s stress lines are drawn down the posterior body margin of C2 and up the posterior body margin of C7 on the neutral lateral cervical X-ray. Then, using a protractor, the angle at which they cross can be measured. This simple method allows you to measure the magnitude of your patient’s lordotic curve and also allows you (with the addition of comparative post-treatment film) to know if your efforts to improve the lordosis are working.
The following illustration demonstrates a pre-treatment radiograph (figure 1) and a post-treatment radiograph (figure 2). Note how the lines are drawn along the posterior body margins of C2 and C7 and the angle at which they cross.
Now we have a simple way to measure lordosis. But, the next question that arises is, “What is the magnitude of a normal lordosis?” The answer could certainly be debated, but it appears that, if we look to the literature,4,5 we can come up with a reasonable range of 21 to 34 degrees for healthy individuals.
Loss of cervical lordosis is a common finding in cases involving headaches and/or following auto accidents. For those of you who have been following our little column, you now have been exposed to simple, inexpensive methods to work with cases of hypolordosis and an easy method to determine if your care has been successful.
References
1.Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: A descriptive study. J Manipulative Physiol Ther 1992;15:418-29.
2.Nagasawa A, Sakakibara T., Takahashi A. Roentgenographic findings of the cervical spine in tension-type headache. Headache 1993;33:90-95.
3. Troyanovich SJ, Coleman RR. Origins of the use of mechanical traction for reduction of the chiropractic subluxation. Chiropractic History. 2004;24(2):1-10.
4. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986;6:521-4
5. 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;21:667-75.
Dr. Roger R. Coleman is a 1974 graduate of Palmer College of Chiropractic, practicing in Othello, WA. He is a member of the Adjunct Research Faculty at Life Chiropractic College West, and on the postgraduate faculty of National University of Health Sciences
Dr. Stephan J. Troyanovich is a 1987 graduate of Palmer College of Chiropractic, practicing in Normal, IL, and a member of the Adjunct Research Faculty, Dept. of Research, at Life Chiropractic College West. He may be reached at 309-454-5556.
Note: This information in not intended as healthcare advice. The determination of the risk and usability of information rests entirely with the attending doctor of chiropractic.