Reducing Chronic Spine Pain in an Adult Male by Decreasing Lumbar Scoliosis and Increasing Cervical Lordosis Using Chiropractic BioPhysics® Protocols: A 26-Month Follow-Up Case Report

Abstract

We present a case report of a patient suffering from chronic low back pain (CLBP) and chronic non-specific neck pain (CNSNP), both of which were caused and complicated by a physically demanding occupation, a history of mixed martial arts, and lumbar scoliosis. Improvements in patient-reported outcomes (PROs) and radiographic findings were observed following conservative spine rehabilitation. The patient, a 34-year-old male, had experienced chronic spine pain, particularly CLBP and CNSNP, for several years. He reported severe pain and increasing disability after a recent neck injury sustained while practicing jiu-jitsu. Radicular pain, along with numbness and tingling, was noted in the right upper extremity, extending to the first three digits, and there were also altered sensations and temperature changes in both feet. He described sharp, pinching mid-back pain and worsening disability due to the persistent pain, which led him to seek manual manipulative chiropractic spine therapy, though he reported little benefit from it. The patient had relied on over-the-counter pain medications for many years without achieving long-term pain and disability relief, and these medications were no longer used following treatment. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to improve coronal and sagittal balance, as well as paraspinal muscular strength, addressing posture, mobility, and related aspects. These protocols include postural exercises, postural Mirror Image® traction, and postural spinal manipulative therapy. All PROs improved, with a near resolution of all initial symptoms of chronic spine pain. Outcomes measured included disability indices and health-related quality of life (HRQoL) indicators. Radiographic parameter improvements were significant, demonstrating improved coronal and sagittal balance as a result of the treatment. Following 30 in-office treatments, administered three times per week for 10 weeks, initial outcomes were reassessed. The patient then received 13 in-office treatments periodically over one year, and all initial outcomes were repeated. The improvements remained stable over time. A 26-month follow-up found that the improvements were sustained over a very long period without additional treatment after the 13-month examination. Chronic spine pain, specifically CLBP and CNSNP, is a significant source of suffering and contributes substantially to the global burden of disease. Improvement in HRQoLs, PROs, and objective spine parameters are desirable clinical outcomes. Our case report documents objective improvement in lumbar scoliosis and spine pain, which is rare in conservative studies. This successful treatment of chronic pain with long-term follow-up contributes to the growing evidence supporting conservative, non-surgical treatments for CNSNP and CLBP. Successful management of chronic spine pain was observed in a patient undergoing CBP® treatment. The treatment was designed to address abnormal sagittal and coronal postural balance and radiographic abnormalities indicating spinal misalignment and reassess progress in PROs, as well as objective and subjective HRQoL measures, both following treatment and 13 months later. However, larger studies are needed to draw firm conclusions regarding the efficacy of this treatment for chronic pain.

Keywords: cbp® rehabilitation; cervical lordosis; coronal balance; low back pain; lumbar lordosis; neck pain; sagittal balance; scoliosis; spine rehabilitation; standard radiography.

Figure 1. Lateral cervical radiographs. Panel A is the pre-treatment initial radiograph. Panel B is the post-treatment radiograph. Panel C is the 13-month long-term follow-up. The dotted red lines represent the HPTM analysis of the posterior body margin of the individual cervical spine segments. The green line is an ideal model of cervical lordosis for comparison of the patient’s parameters and a normal model. The spine parameters were digitized using PostureRay® software.

HPTM: Harrison posterior tangent method

Figure 2. Anterior-posterior full spine radiographs. Panel A is the pre-treatment. Panel B is the post-treatment. Panel C is the 13-month long-term follow-up. The red line represents the Riser-Ferguson center-of-mass analysis of the coronal contour of the patient’s spine. The yellow lines represent the four-line Cobb analysis of scoliosis. The green line represents an ideal equilibrium model of the ideal spine. The results show improvements in the scoliotic curve and improvements in spine coronal balance and stability over the long term. All measurements were performed with PostureRay® software.

Figure 3. MI® cervical spine two-directional traction. The patient is seated, and the thorax is gently restrained with a Velcro strap to prevent movement. Two loads are applied to the patient: (1) a superior-posterior load to increase some spine unloading in an extended and posteriorly translated position and (2) a posterior-to-anterior load in a slight caudal orientation. The traction aims to cause sustained loading while the cervical lordosis is increased. The duration and intensity increase throughout the treatment program.

MI®: Mirror Image®

Figure 4. Robo-TracTM coronal MI® traction designed to address the abnormal left coronal balance seen on the anterior-posterior radiograph with a significant right lateral translation of the torso compared to the pelvis and lower extremity. A firm strap is placed at the apex of the scoliosis, and the table is able to slightly distract the lumbar spine to unload the joints and increase the focus in the MI® position of the abnormalities found with the PostureRay® digitization software.

MI®: Mirror Image®

Figure 5. The FLIPTM protocol to increase lordosis. Panel A shows the patient anteriorly translating the head forward to increase lower cervical flexion. Panel B shows the patient extending the head against the ProLordoticTM resistance. Panel C shows the patient posteriorly translating the head. D shows the patient posteriorly and caudally translating the head to increase lordosis. The patient is performing the exercise under the influence of whole-body vibration on the Power Plate®.

FLIPTM: Fedorchuk lordosis-inducing protocol

Figure 6. DCTO. A model representation of the Denneroll® device being applied to the region that matches the placement in this case; low placement due to the reduction in the lordosis in the lower cervical spine worsening superiorly. The traction was utilized approximately two times per week by the patient for the 13 months following the treatment re-assessment and long-term follow-up. The duration is initially mild with two to three minutes on the orthotic and increases with tolerance to 15-20 minutes.

DCTO: Denneroll® cervical traction orthotic

Figure 7. Panel A shows the patient’s two-year long-term anterior-posterior full spine radiograph, showing the patient's coronal balance is well preserved in the long term. Panel B shows the patient’s full spine lateral radiograph also shows well-maintained sagittal balance, cervical and lumbar lordosis, and thoracic kyphosis. The green line is the ideal spine model, and the red dashed line traces the patient's posterior vertebral body tangents.