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Painful necks about 10 degree straighter in X-rays

PainSci » bibliography » McAviney et al 2005
Tags: neck, biomechanics, chiropractic, exercise, head/neck, spine, etiology, pro, manual therapy, treatment, controversy, debunkery, self-treatment

Two articles on PainSci cite McAviney 2005: 1. Does Posture Matter?2. The Complete Guide to Neck Pain & Cricks

PainSci commentary on McAviney 2005: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Researchers examined 277 neck x-rays and reported a “statistically significant association between cervical pain and lordosis < 20 degrees” — in other words, painful necks tended to be flattened necks (about 10 degrees flatter than the lower end of what they defined as normal). They concluded that “maintenance of a lordosis … could be a clinical goal for chiropractic treatment.” A cynic might point out that the authors were chiropractors, and the odds that they would identify a justification for chiropractic therapy in the data were approximately “very high.” (It is also unclear and implausible that chiropractic treatment is capable of achieving the clinical goal of “maintenance of lordosis.”)

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To investigate the presence of a "functionally normal" cervical lordosis and identify if this and the amount of forward head posture are related to neck complaints.

METHODS: Using the posterior tangent method, an angle of cervical lordosis was measured from C2 through C7 vertebrae on 277 lateral cervical x-rays. Anterior weight bearing was measured as the horizontal distance of the posterior superior body of the C2 vertebra compared to a vertical line drawn superiorly from the posterior inferior body of the C7 vertebra. The measurements were sorted into 2 groups, cervical complaint and noncervical complaint groups. The data were then partitioned into age by decades, sex, and angle categories.

RESULTS: Patients with lordosis of 20 degrees or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0 degrees or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0 degrees or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges. Males had larger median cervical lordosis than females (20 degrees vs 14 degrees) (2-sided Mann-Whitney U test, P = .016). When partitioned by age grouping, this trend is significant only in the 40- to 49-year-old range (2-sided Mann-Whitney U test, P < .01).

CONCLUSION: We found a statistically significant association between cervical pain and lordosis < 20 degrees and a "clinically normal" range for cervical lordosis of 31 degrees to 40 degrees. Maintenance of a lordosis in the range of 31 degrees to 40 degrees could be a clinical goal for chiropractic treatment.

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