CF 222: Forward Head Posture And Spinal Manipuative Therapy Effectiveness
Today we’re going to talk about spinal manipulative therapy and forward head posture.
But first, here’s that sweet sweet bumper music
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
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You have found yourself smack dab in the middle of Episode #222
Now if you missed last week’s episode , we talked about The Importance of Movement & Steps. Make sure you don’t miss that info. Keep up with the class. On the personal end of things…..
Business is back. Time is getting more limited. Especially for someone like me that tends to bite off as much as I can possibly chew. It’s a bad habit of mine but I always seem to be in hyperdrive. I get everytihng done and I have to say a whole bunch of ‘no’s’ in order to get it all done…..but I do indeed typically get most of it done.
It would not be possible without a To Do list. I keep it open in a document on my computer. It’s a life saver. The problem right now is that I have abotu 15-20 items on it that need to be done. So how do you address that? Prioritize them.
Put them in order from most important to least. I also list them keeping in mind the time and energy each will take to complete. Not to mention the fact that I do what I can to identify which can be delegated and how they’ll be delegated.
Meaning, my office manager is typically overwhelmed. I want to limit what gets delegated to her and try to utilize the other 4 girls that work for us on our chiropractic and medical side of the office.
So, which tasks are the most important or the most time sensitive. Then, which tasks can be easy and fast ‘wins’ so I can pop them out and knock them off with ease. Like an important phone call or email I’m supposed to send. Then delegate what can be delegated to the people most capable. Up to and including virtual assisstants.
I have a VA in South Africa, one in Nigeria, and one in India. Those are for the chiro side of things. I also have one for voice over marketing and he’s in Pakistan. When you’re busy busy, a VA can be the difference in being heavily buried vs. being slightly buried.
So, when you have an integrated office like I do, a voice over side gig that is demanding more and more time, and real estate investments…..VAs are lifesavers. If you are interested in exploring the world of VAs, look into upwork.com
is an excellent site as well. There are virtual networks here in America as well. There is one that I’ve heard great things about based in the Phillipines called virtualstaff.ph.
Alright, just a tip from your ol’ Uncle Jeffro. Now, let’s get to the research, shall we? Item #1
This one is called “Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain”
by Gevers-Montoro, et. al. (Gevers-Montoro C 2021) and published in Frontiers In Pain on October 25 of 2021. Aye chi wa wa… Why They Did It
For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable.
One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists.
The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness and efficacy of SMT for the management of neck pain and low back pain. Wrap It Up
SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy.
Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain.
Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain.
Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.
They say that the main gap identified in clinical research on SMT for spine pain lies in the low quantity and quality of studies addressing its efficacy against inactive controls. Hence, the effects of SMT against placebo or sham SM remain uncertain. This parallels the state of research on most interventions for spine pain, as no treatment has been demonstrated to be superior to any other or to placebo Item #2
Our last one this week is called “The association between forward head posture and non-specific neck pain: A cross-sectional study”
by Bahat et. al. (Sarig Bahat H 2022) and published in Physiotherapy Theory & Practice.
And this one should get the CBP people riled up.
Mostly because it’s more and more apparent that you don’t need to charge your patients $5,000 for 80 visits this year to correct a curve issue or forward head posture that honestly likely doesn’t cause much of an issue long term. Why They Did It
Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive.
To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP. How They Did It
What They Found
- The study was conducted with 43 volunteers
- 20 asymptomatic individuals, 23 individuals with neck pain
- Aged 19 to 62.
- FHP was assessed by measuring craniovertebral angle on profile photographs.
- Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized virtual reality software.
Wrap It Up
- There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP
- The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05).
- We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures.
Our findings cannot support a clinically applicable association between FHP and neck pain. I know there is research to the contrary but those projects are typically low quality and performed by one of the biggest stakeholders who owns a company that promotes treating patients based on forward head posture and decreased cervical curvature. So that stakeholder has a specific and direct bias. The research likely reflects that. At the end of the day, my recommendation is to not treat patients like a sales target. They don’t usually need $5,000 of treatment over 80 visits in a year to fix a lack of curve that longitudinal research suggests is of little to no consequence. Treat them like you’d treat your mom or your child. Period.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.
Let’s get to the message. Same as it is every week. Store
Remember the evidence-informed brochures and posters at chiropracticforward.com
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
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Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
Gevers-Montoro C, P. B., Descarreaux M, (2021). “Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain.” Front Pain Res.
Sarig Bahat H, L. A., Yona T, (2022). “The association between forward head posture and non-specific neck pain: A cross-sectional study.” Physiother Theory Pract: 1-10.