Question
Hello, I have some issues with my back and neck, and no insurance (at the moment, although I might by next year). I'd appreciate any answers you are able to provide.

A few years ago, I fractured one of the vertebrae in my back most likely while practicing judo, somewhere in the mid-back, I think. I didn't even know about it until I had an x-ray for kidney stones. I was told then it was healing. I felt no pain except for some back pain when lifting weights with my back.

In the last year, I developed a "buffalo hump" and I can see I have marked forward head posture. I'm a writer so I spend a lot of time at a computer. I am also a cyclist, so I'm bent over a lot, often with a backpack on so I'm carrying a fair amount of weight on my back.

I went into the chiropractor today. He said I had "cervical kyphosis," or a reverse curve of the neck vertebrae in my spine. I could see it on the x-ray. He also said I had a fracture right around the bottom of the cervical curve, where head meets shoulders (that's where the hump is). He said I probably got it as a kid, and now that vertebra is pushing forward. I'll know more when he sends me his report.

I've had a bit of back pain and a tendency to pull back muscles recently, which is no good considering I cycle for transportation and must write for my profession. However, he told me my posture is surprisingly good; I think that's because I've been aware of it ever since I developed the hump and am trying to correct it (including sitting straight at the computer, and bending forward from the lower back when I'm biking, not from the upper back).

My question is whether I can correct this through exercises alone, and a cervical wedge and orthopedic pillow of some sort. If so, what exercises/brands are best? And if not, what sort of treatment will I need?

Sorry if this is too open-ended a question--I wish I could afford more chiropractic visits, but I can't, and would like to take care of this situation on my own if possible.

I forgot to mention that I also have scoliosis. However, the curvature appears very mild and much less severe than even three years ago, which is odd; however three years ago the doctor did not mention any sign of cervical kyphosis (I am going to call and have those x-rays emailed to me).

Oh, and I am 29 years old. Thank you. :)

Answer
Carmen,

Thanks for your question.

In the medical literature, much is written about the cervical kyphosis, generally from a surgical point of view when it produces neurological symptoms. In the chiropractic profession, cervical kyphosis is generally considered to be a structural abnormality that may (but not always) contribute to mechanical spinal pain and progressive degenerative changes of the neck. In both professions, there is concern about the rarer complication of neurological problems resulting from spinal cord compression (myelopathy) as a result of progressive kyphosis (that is, a kyphosis that continues to increase and cause degenerative changes of the spine).

Cervical kyphosis has been reported to be caused by advanced degenerative disease, trauma, tumors, or after surgery (1, 2). Some researchers have suggested that because the alternating curves of the spine enable the head to be positioned over the trunk and pelvis, allowing humans to function in the upright position, imbalance involving any of the constituent parts of the spinal column can affect form and function, causing postural problems as well as the possibility of pain and neurological impairment (3).

Pain caused by postural abnormalities resulting from cervical kyphosis is explained by the increased energy expenditure of the muscles of the back of the neck, which work harder to maintain the desired head-over-shoulder posture. This can also lead to accelerated degenerative changes of the adjacent segments of the spine (3, 4). These degenerative changes are usually responsible for myelopathy when the degenerative changes are severe in nature.

Some manual therapy treatment approaches to cervical kyphosis, where surgery is not required, generally focus on neck and upper trunk muscle training, traction with an extension (backwards bending) component of the neck, muscle/myofascial trigger point therapy, and spinal manipulation. As far as I am aware, no one method has been shown to be more effective than the other.

A home neck traction unit that incorporates a mostly extension component may be of benefit in restoring a more normal curvature to the neck, especially when the person with cervical kyphosis makes a concerted effort to address postural faults and use proper ergonomics and biomechanics, so as not to perpetuate cycles of poor posture and mechanical over-use. An example of such a device is:

http://tinyurl.com/bzowj7s

Prior to using any such device in an unsupervised capacity, you need to speak to your chiropractor, physician, or physical therapist. Of concern in your background information is the fracture you mentioned; traction with the extension component may be harmful if the fracture is unstable.

I hope that this helps to answer your question.

References:

1. Steinmetz, M et al. Cervical deformity correction. Neurosurgery. 2007 Jan 60(1):S1-90-97.
2. Cervical kyphosis: predictive factors for progression of kyphosis and myelopathy. Iwasaki, M et el. Spine. 2002 Jul 1;27(13):1419-25.
3. Ganju, A.;l Cervical kyphosis. Techniques in Orthopedics. 2002 17(3);345-354.
4. Griegel-Morris, P. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their associations with pain in two age groups of healthy subjects. Physical Therapy Journal. 1992 Jun;72(6):425-31.