Question
My husband recently passed out whilst at work (in an office). He came round within a couple of minutes complaining of pins and needles within his left arm and left leg and visited a doctor and radiologist that same day. The results of the X-rays showed that he has almost complete loss of curvature to the neck. However, we are unaware of what this means, what treatment is necessary and what the prognosis is. He is 24 years old.  

Answer
Dear Jemma,

According to published research, the optimal curve of the neck called "lordosis" is 43 degrees.  The neck curve can be reduced and considered normal in the population without effects at about 34 degrees. Anything less than a curve of 34 degrees should be considered abnormal.   From what you have described, your husband has about a 0 degree curve, and I would have to assume that his neck is straight or close to it, and that his head protrudes out forward from his torso. (From the side look to see if his ears are in front of his shoulders? If the neck is actually starting to curve in the opposite direction this is called "Kyphosis" and is worse.  

The loss of the neck curve stretches the spinal cord and the associated spinal nerve roots placing tension on the neurological system as well as stress on the associated muscles, ligaments, and disks.  This is how you can easily get pins and needle sensations (paresthesia) into your arms.  There is also a symptom called a Long Track Sign, pain or pins and needles into the legs occur because of impingement of the cord in the neck.  This can happen due to the way the nerves are arranged in the cord...information from the lower body is more toward the periphery of the spinal cord.  Additionally, it has been found that loss of the curve reduces oxygenation levels to the brain because the brainstem is placed in a tensed position.  Over the course of time this will deteriorate the condition of the spine as well as other areas of the body that receive information from the nerve roots in that area and the brain stem.  This is not an overnight process, but it will not improve without active treatment. Below I have just a few quotes for you to appreciate:

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

Jemma, your husband抯 condition can be helped very easily with structural rehabilitation of the spine, and his prognosis is good due to his young age.  This technique has been criticized by some in my profession (doctors who do not use the technique and have no formal training in it), but I have seen it work miracles in my own clinic when applied correctly.  I have been able to completely eliminate radiating symptoms into the shoulders arms and hands by restructuring the cervical curve, and also eliminated headaches from patients who had suffered chronically over ten years.  Although the research is complex, the principle is simple, just restore the curve and eliminate the altered pressure/structure/tension on the nervous system.  Not everyone is a candidate for this type of care, but most people can qualify and benefit from active treatment.

The technique is called Clinical Biomechanics of Posture or Chiropractic Biophysics (CBP).  There is also another technique that will work called Pettibon, but I am not certified in this yet and use the CBP technique.  Both are worth exploring, and I encourage you to check out their websites for more information.  www.idealspine.com  and  www.pettibonsystem.com  you will be able to research both techniques and find doctors who have been through their respective certification programs in your area.  

In addition, your husband needs to start actively being concerned about the stresses in his everyday life such as work ergonomics, posture, sleeping positions etc卼hese all have effects on the spine and will deform it over time due to increased abnormal stress in relation to gravity.  I am going to include a copy of an article I have written about the proper utilization of posture and ergonomics for your consideration, directly below:

Training for Stability of the Neck and Back匩ot What You Think!

A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments.  Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor!  Shouldn抰 you work to prevent injury and strain?  The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma.  It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury.  Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity.  We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.  

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine.  Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor.  Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.  

Lifting technique is important for optimal health and the reduction of injury.  To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back).  This position will activate the musculature properly for stability while not recruiting the ligaments for support.  Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift.   Stooping should be avoided, especially with repetitive movements.  Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk.  This can easily result in a rupture of the disk.  In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer.  The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core.  You can easily accomplish this by sucking the belly button in toward the spine.  This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair.  These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.  

Many of us spend the majority of our days at a desk, computer or workstation.  We need to consider and modify our workspace carefully.  Adding a support for the lumbar spine reduces disk pressures.  A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure.  Proper desk height is approximately 30 centimeters from the seat of the chair.  Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae.  The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.  

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain.  Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead.  This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex.  This will also help reduce those 搘ork headaches?  Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key.  You must have a balanced and relaxed spinal cord for optimal function.  That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it.  If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.  

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion.  Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion.  The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension.  If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body.  This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration.  Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary.  This is mostly common sense, and your mother has telling you to do this since you were a child.  Exercise your postural muscles while walking.  Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground.  Pull your shoulders back, breathe deeply, and take confident long strides.  This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures.  You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance.  Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability.  If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse.  It is essential to incorporate stability into your spine and your life before starting any exercise program.  You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  If you have any cardiovascular issues, a stress test should be performed.  Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics.  Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications.  To learn more about postural correction check out www.idealspine.com. In addition, a Certified Pilates instructor, www.nypilates.info, www.pilates-trainning.com or Certified Personal Trainer www.nsca-lift.org, www.ncsf.org  can have great benefit.  Remember to check their qualifications as well.

Jemma, hope this helps.  I urge you and your husband to read as much information as you can in the next few days and contact a local chiropractic physican who is certified in either CBP or Pettibon for a consultation.  (some chiropractors make claims that they do structural rehabilitation, but have no additional trainning...make sure you are confident in the doctors credentails).  please be sure that you have the x-rays for themn to view as well as the radiologist's report.  Please feel free to write back if you have any further comments or questions.

Respectfully,

Dr. J. Shawn Leatherman
Director of Clinical Rehabilitation
www.suncoasthealthcare.net