Educational Articles Designed to help CA's Understand the Underlying Anatomy and Physiology of Conditions Presenting to the Chiropractic Office Posture and Terminology Ideal postural alignment of the back includes an S-shaped spine with natural curves. The cervical spine should curve to the anterior (front), the thoracic spine to the posterior (back), and the lumbar spine to the anterior. If the curves are increased or decreased, it can cause altered biomechanics/motion, create undue pressure on the joints involved, cause stress to the surrounding musculature, cause subluxations, and even lead to degeneration of the involved joints. Anterior/Lordotic = Toward the front. Examples are the cervical and lumbar curves. Posterior/Kyphotic = Toward the back. Example is the horacic curve. Hypo = Decreased. In "hypothyroidism," you see a decreased production of thyroid hormones. In the spine, if the DC notes a hypolordotic or hypokyphotic curve, it means the curve has decreased, or flattened out. Hyper = Increased. In "hyperthyroidism," you see an increased production of thyroid hormones. In the spine, if the DC notes a hyperlordotic or hyperkyphotic curve, it means the curve has increased, or become more pronounced or angulated. What is Anterior Weight Bearing? Anterior means "forward," or "toward the front" of the body. In this article, we are looking at anterior weight bearing of the cervical spine. As already stated, the cervical spine should have a natural anterior curve, called a "lordosis," or lordotic curve. But what happens if the natural curve is altered and allows the head to hang forward? Envision the head as a bowling ball sitting atop the spine. We want it to be centered and stabilized, as shown in the first picture on the diagram. If our cervical spine posture is altered to the anterior, the stress to the structures in our neck, like joints and muscles, is greatly increased. The patient will likely be complaining of neck pain, muscle spasms, or other associated symptoms, such as headaches. A normal posture exudes approximately 12 lbs. of pres sure into the spine. Notice what happens when head carriage is slightly forward. The amount of pressure to our anatomy increases almost threefold. Someone with extreme anterior head carriage increases the pressure even more. This creates significant stress and strain to the involved joints and muscles, and if not corrected, it can lead to long-term effects of joint disease, bone spurs, and disc degeneration. Also, note that as the anterior carriage increases, it also creates imbalance in the thoracic spine, increasing the posterior/kyphotic curve in that region as well. What Causes Anterior Weight Bearing? We see this type of postural change all the time. It could stem from something as simple as bad postural habits. Sometimes tall adolescents, for example, will try to hunch down to appear shorter. We often see this with tall lanky girls who are self-conscious about their height. But we also see this type of alteration after an injury. Sprain/Strain to the neck can occur from things like sports injuries, car accidents, injury on a playground, or a slip and fall. We commonly use the term 'whiplash' to refer to the sprain/strain of the neck seen after a car accident. Our entire bodies are interconnected through our anatomy. If a patient has a shoulder, thoracic, or even a low back issue, we can see a translation of altered biomechanics into the cervical spine. Have you ever experienced a sprained ankle/limp that then translated into hip or low pain? Whenever we alter our biomechanics in the body, it can affect other areas. Management of Anterior Weight Bearing of the Cervical Spine When a DC creates a care plan for a patient, he or she will address all of these issues. In the chiropractic office, many patients need more than adjusting the misaligned joints; they also need help to create a more ideal posture to stabilize those joints. You should certainly expect the DC to find and adjust the areas of subluxation, but also expect that the DC will be looking to correct posture in order to help prevent future issues. The DC may begin with passive-care techniques, such as ice, heat, electric muscle stimulation, ultrasound, cold laser, etc., in order to help heal injured tissue or relax the area being addressed. As the tissue is stabilized, the DC will move the patient into active-care protocols, which will include stretching the area, strengthening the soft tissues, and creating proper alignment. One exercise that a patient can do at home to help strengthen the posterior muscles of the neck and promote a more natural postural is what I call the "stoplight exercise." Being stopped at a red light helps the patient remember to do it, so the stoplight is a trigger of sorts. The exercise involves gliding the head posteriorly into resistance, such as a wall, chair back, the patient's own hands, or in this case, the headrest of the car seat. It is important that the motion is a posterior glide, and not simply tilting the head backward. Ask your DC to show you this important difference in the office. If the patient is not performing the exercise correctly, then he or she will not achieve the desired correction. Education Fosters Understanding An understanding of anatomy helps all health-office employees better communicate with patients and provide care more safely. Online training programs in particular make high-quality training affordable and convenient, and can be taken any time of day. At www.CCCAonline.com, learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfill the training requirement needed for the national examination. DCs will often pay for their employees to train. Full price for this training is an affordable $339 for the entire 24-hour program. However, www.CCCAonline. com also has special discount programs available for COCSA state association members. Ask your state association for your specific discount code. Not a member? If you are receiving this article through The American Chiropractor magazine, you can still enjoy a discount. Use AMCHIRO as your discount code. When you enter this code during the registration process, it will automatically provide a $15 discount off the regular price of the program. This is the program that gives back to the profession. Learners can expect text, images/schematics, dynamic video lectures, and robust, customized, experiential interactivities in a thorough 19-module program. In addition, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an e-mail at [email protected] Imirie Mueller, B.I, DC, served in private practice in San Diego, California. She was the postgraduate director at Palmer ("ollegefrom 2000 through 2010; served as the AC X "postgraduate subcommittee chair for six years; peer reviewed'for the Research Agenda Conference; and wrote the informal mle determination study that aided in the development ofFCLB's guidelines for chiropractic assistants. Dr. Mueller cunvntly works as a private el.earning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, and subsidiary www. CCCAonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
