Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP) publications

Abstract

Background: Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures.

Objective: (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP((R))) methods, and (2) to compare the evidence for Diversified, SMT, and CBP((R)).

Methods: Clinical control trials utilizing CBP(R) methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP((R)) were rated and compared.

Results: From the evidence from Clinical Control Trials on SMT and CBP((R)), there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP((R)) (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support.

Conclusions: While CBP((R)) Technique has approximately as much evidence-based support as SMT for neck pain, CBP((R)) has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP((R)) publications.

Figure 1

Algorithm for Structural Rehabilitation

Figure 2

The CBP^® Full-spine Normal Model is the path of the posterior longitudinal ligament through the posterior body margins. It is composed of separate ellipses in the different spinal regions (cervicals, thoracics, & lumbars). It has near perfect sagittal balance of vertical alignment of C1-T1-T12-S1. This model provides normal sagittal plane curves and normal values for all segmental angles and global angles. The sagittal curves have points of inflection (mathematic term for change in direction from concavity to convexity) at inferior of T1 and inferior of T12. Reprinted with permission from Harrison DE et al. Spinal Biomechanics for Clinicians. Vol. I. Evanston, WY: Harrison CBP^® Seminars, Inc., 2003.

Figure 3

In A, normal AP postural alignment is depicted. In B and C, ideal sagittal and average sagittal alignment are illustrated, respectively. Since the average human sagittal alignment (C) has forward head posture and poor C1, T1, T12, and S1 sagittal balance, it is not considered normal. Adapted with permission from Harrison DE et al. Spinal Biomechanics for Clinicians. Vol. I. Evanston, WY: Harrison CBP^® Seminars, Inc., 2003.

Figure 4

Abnormal Postural Rotations. Rotations of the head relative to the thorax; thorax relative to the pelvis; and pelvis relative to the feet are depicted from the top to bottom rows, respectively. Regional rotations about the x, y, and z-axes are depicted from the left to right columns, respectively. Reprinted with permission from Harrison DE et al. Spinal Biomechanics for Clinicians. Vol. I. Evanston, WY: Harrison CBP^® Seminars, Inc., 2003.

Figure 5

Abnormal Postural Translations. Translations of the head relative to the thorax; thorax relative to the pelvis; and pelvis relative to the feet are depicted from the top to bottom rows, respectively. Regional translations along the x, y, and z-axes are depicted from the left to right columns, respectively. Reprinted with permission from Harrison DE et al. Spinal Biomechanics for Clinicians. Vol. I. Evanston, WY: Harrison CBP^® Seminars, Inc., 2003.