Wednesday, July 6, 2011
Cervical Curve and Its Importance
A New Cervical Lordotic Home Traction Device: The Denneroll—An Initial Case Series
Sunday, February 14, 2010 at 6:34AM
CBP Seminars
CBP Seminars
Deed E. Harrison, DC
President CBP Seminars, Inc.
Vice President CBP Non-Profit, Inc.
ICA Nevada State Assembly Rep
Chair PCCRP Guidelines
Editor—AJCC
In a previous issue of the AJCC (2008), I presented the evidence for in office CBP® Technique structural rehabilitative procedures. According to the CBP publications, mirror image® exercises and traction procedures should be performed in-office at least 3-4 times per week for 9-12 weeks in order to obtain significant improvement in abnormal alignment of the spine and improvements in a patient’s chronic disorder(s).1-5
However, the evidence based practice guideline/protocol of care for CBP technique, recommends home exercise and home traction for patients as a supplementary procedure to the in-office intervention program.4,5Also, home traction and exercise may be the only viable means of rehabilitation for patient’s whom live many miles away from a given practice or for schedules that are simply not conducive to regular care.
Problematically, to my knowledge, there exist no formal publications documenting the potential benefit/effect of different types of home traction procedures aimed at rehabilitation of the sagittal plane curvatures of the spine. Thus, the purpose of the present article is to present preliminary information on the immediate effect of one traction session using a new cervical orthotic device termed the Denneroll.
Materials and Methods
The Denneroll (Designed by Adrian Dennewald, D. C. of Australia) is a new cervical sagittal plane orthotic device designed to passively stretch the cervical lordosis into a more lordotic position. See Figure 1. Its unique design allows it to support the upper thoracic
curvature while simultaneously create a 3-point bending extension load on the cervical spine.
Most commonly, the Denneroll has 3 primary positions that are used for aiding in the rehabilitation of the cervical lordosis:
1) The apex of the Denneroll orthotic is placed in the upper cervical region (C2-C4) region. This position allows extension bending of the upper cervical segments while causing slight anterior head translation. An upper neck setup and example x-ray subluxation is shown in Figure 1. The red line represents the ideal curvature after Harrison et al.6 while the black line shows the patient’s subluxated alignment.
2) The apex of the Denneroll orthotic is placed in the mid-cervical region (C4-C6) region. This position allows extension bending of the mid-upper cervical segments while creating a slight posterior head translation. SeeFigure 1.
3) The apex of the Denneroll orthotic is placed in the upper thoracic or lower-cervical region (C6-T1) region. This position allows extension bending of the majority of cervical segments while creating a significant posterior head translation. See Figure 1.
Figure 1. On the top row from left to right, 3 uniquely different subluxated lateral cervical curvatures are shown; the red line represents the ideal curvature of the neck after Harrison et al.1 On the bottom row, three primary placements of the Denneroll cervical orthotic are shown. The Denneroll placement should match both the shape of the cervical curve and the amount of sagittal head translation correction that is desired.
For a preliminary investigation, 11 Chiropractors volunteered for an initial neutral lateral cervical radiograph and completed a neck disability index. One out of the 11 lateral cervical came out with digital artifacts that could not be corrected and was discarded; while another had a normal cervical lordosis on the initial lateral x-ray. This left 9 subjects.
The 9 subjects were asked to lie supine on the floor over the Denneroll orthotic device for 10-13 minutes. Only 1 traction-session was used. The Denneroll location was selected by a trained practitioner.
Following the 10-13 minute traction session, the subjects were asked to relax comfortably for 3-5 minutes without stretching or bending the neck. Once the 3-5 minute interval elapsed, a second neutral lateral cervical radiograph was obtained.
Results
The initial and follow-up lateral cervical radiographs were analyzed with the PostureRay x-ray digitization system. Only 2 of the many reported variables are shown in Table 1. The cervical lordosis using the posterior body margins of C2-C7 and the sagittal plane translation of C2-C7 were recorded. From Table 1 it can be seen that a significant improvement in the cervical lordosis (9.8°) and reduction in sagittal plane head translation (7.4mm) were obtained.
Figure 2 shows subject #9’s initial and after lateral cervical alignment. Here the green semi-circular line represents the ideal cervical lordosis after Harrison et al.6; while the red line represents his lateral cervical alignment.
Figure 2. Before and After Denneroll x-rays. With the subject supine, the Denneroll was placed in the lower neck as in Figure 1 for 11 minutes. The following up x-ray was taken after 5 minutes of recovery (no Denneroll). Good improvement in cervical lordosis was found after 1 session indicating likely benefit.
Discussion
It is significant that following only one 10-13 minute session on the Denneroll orthotic device, a significant improvement in both the cervical lordosis and anterior head translation. Obviously the results presented herein are preliminary and follow-up should be and will be performed on this device.
From Table 1, the astute reader will see that a couple of the subjects showed remarkable change in lordosis while a couple of subjects showed little only slight change. This type of situation is typical of any/all treatment devices and is due to many variables:
· The elasticity of the individual subject’s tissues,
· The age of the subject,
· The state of degenerative joint disease-stiffness of the tissues,
· The shape of the thoracic curvature,
· Improper application during traction,
· Perhaps the device just won’t work for some individuals, etc.
Most of the above variables can be overcome with continued effort on the patient’s and the doctor’s part. However, as with all interventions, there is no such thing as a one size fits all.
To me, the information presented herein, is preliminary data indicating the Denneroll orthotic may be a viable home traction device to supplement a CBP Chiropractors in office rehabilitative treatments. When the shape of the cervical curve indicates, the Denneroll could be used on off days from office treatments; and in difficult cases, it could be used daily once tolerance is developed.
Hopefully, the information presented will stimulate further research into the effects of home traction units. After all the majority of us (including me) recommend home products to our patients and believe in their effects; but wouldn’t it be nice to know?
Note: If you would like more information on the Denneroll Cervical Orthotic device contact:drdeed@idealspine.com or see www.idealspine.biz.
References
1. Harrison DD, et al. J Manipulative Physiol Ther 1994;17(7):454-464.
2. Harrison DE, et al. Arch Phys Med Rehab 2002; 83(4): 447-453.
3. Harrison DE, et al. J Manipulative Physiol Ther 2003; 26(3): 139-151.
4. Oakley PA, et al. J Canadian Chiro Assoc 2005; 49(4):270-296.
5. Harrison DE, Harrison DD, Haas JW. CBP® Structural Rehabilitation of the Cervical Spine. CBP Seminars, 2002; pgs:147-151. ISBN 0-9721314-0-X.
6. Harrison DD, et al. Spine 2004; 29:2485-2492.
President CBP Seminars, Inc.
Vice President CBP Non-Profit, Inc.
ICA Nevada State Assembly Rep
Chair PCCRP Guidelines
Editor—AJCC
In a previous issue of the AJCC (2008), I presented the evidence for in office CBP® Technique structural rehabilitative procedures. According to the CBP publications, mirror image® exercises and traction procedures should be performed in-office at least 3-4 times per week for 9-12 weeks in order to obtain significant improvement in abnormal alignment of the spine and improvements in a patient’s chronic disorder(s).1-5
However, the evidence based practice guideline/protocol of care for CBP technique, recommends home exercise and home traction for patients as a supplementary procedure to the in-office intervention program.4,5Also, home traction and exercise may be the only viable means of rehabilitation for patient’s whom live many miles away from a given practice or for schedules that are simply not conducive to regular care.
Problematically, to my knowledge, there exist no formal publications documenting the potential benefit/effect of different types of home traction procedures aimed at rehabilitation of the sagittal plane curvatures of the spine. Thus, the purpose of the present article is to present preliminary information on the immediate effect of one traction session using a new cervical orthotic device termed the Denneroll.
Materials and Methods
The Denneroll (Designed by Adrian Dennewald, D. C. of Australia) is a new cervical sagittal plane orthotic device designed to passively stretch the cervical lordosis into a more lordotic position. See Figure 1. Its unique design allows it to support the upper thoracic
curvature while simultaneously create a 3-point bending extension load on the cervical spine.
Most commonly, the Denneroll has 3 primary positions that are used for aiding in the rehabilitation of the cervical lordosis:
1) The apex of the Denneroll orthotic is placed in the upper cervical region (C2-C4) region. This position allows extension bending of the upper cervical segments while causing slight anterior head translation. An upper neck setup and example x-ray subluxation is shown in Figure 1. The red line represents the ideal curvature after Harrison et al.6 while the black line shows the patient’s subluxated alignment.
2) The apex of the Denneroll orthotic is placed in the mid-cervical region (C4-C6) region. This position allows extension bending of the mid-upper cervical segments while creating a slight posterior head translation. SeeFigure 1.
3) The apex of the Denneroll orthotic is placed in the upper thoracic or lower-cervical region (C6-T1) region. This position allows extension bending of the majority of cervical segments while creating a significant posterior head translation. See Figure 1.
Figure 1. On the top row from left to right, 3 uniquely different subluxated lateral cervical curvatures are shown; the red line represents the ideal curvature of the neck after Harrison et al.1 On the bottom row, three primary placements of the Denneroll cervical orthotic are shown. The Denneroll placement should match both the shape of the cervical curve and the amount of sagittal head translation correction that is desired.
For a preliminary investigation, 11 Chiropractors volunteered for an initial neutral lateral cervical radiograph and completed a neck disability index. One out of the 11 lateral cervical came out with digital artifacts that could not be corrected and was discarded; while another had a normal cervical lordosis on the initial lateral x-ray. This left 9 subjects.
The 9 subjects were asked to lie supine on the floor over the Denneroll orthotic device for 10-13 minutes. Only 1 traction-session was used. The Denneroll location was selected by a trained practitioner.
Following the 10-13 minute traction session, the subjects were asked to relax comfortably for 3-5 minutes without stretching or bending the neck. Once the 3-5 minute interval elapsed, a second neutral lateral cervical radiograph was obtained.
Results
The initial and follow-up lateral cervical radiographs were analyzed with the PostureRay x-ray digitization system. Only 2 of the many reported variables are shown in Table 1. The cervical lordosis using the posterior body margins of C2-C7 and the sagittal plane translation of C2-C7 were recorded. From Table 1 it can be seen that a significant improvement in the cervical lordosis (9.8°) and reduction in sagittal plane head translation (7.4mm) were obtained.
Figure 2 shows subject #9’s initial and after lateral cervical alignment. Here the green semi-circular line represents the ideal cervical lordosis after Harrison et al.6; while the red line represents his lateral cervical alignment.
Figure 2. Before and After Denneroll x-rays. With the subject supine, the Denneroll was placed in the lower neck as in Figure 1 for 11 minutes. The following up x-ray was taken after 5 minutes of recovery (no Denneroll). Good improvement in cervical lordosis was found after 1 session indicating likely benefit.
Discussion
It is significant that following only one 10-13 minute session on the Denneroll orthotic device, a significant improvement in both the cervical lordosis and anterior head translation. Obviously the results presented herein are preliminary and follow-up should be and will be performed on this device.
From Table 1, the astute reader will see that a couple of the subjects showed remarkable change in lordosis while a couple of subjects showed little only slight change. This type of situation is typical of any/all treatment devices and is due to many variables:
· The elasticity of the individual subject’s tissues,
· The age of the subject,
· The state of degenerative joint disease-stiffness of the tissues,
· The shape of the thoracic curvature,
· Improper application during traction,
· Perhaps the device just won’t work for some individuals, etc.
Most of the above variables can be overcome with continued effort on the patient’s and the doctor’s part. However, as with all interventions, there is no such thing as a one size fits all.
To me, the information presented herein, is preliminary data indicating the Denneroll orthotic may be a viable home traction device to supplement a CBP Chiropractors in office rehabilitative treatments. When the shape of the cervical curve indicates, the Denneroll could be used on off days from office treatments; and in difficult cases, it could be used daily once tolerance is developed.
Hopefully, the information presented will stimulate further research into the effects of home traction units. After all the majority of us (including me) recommend home products to our patients and believe in their effects; but wouldn’t it be nice to know?
Note: If you would like more information on the Denneroll Cervical Orthotic device contact:drdeed@idealspine.com or see www.idealspine.biz.
References
1. Harrison DD, et al. J Manipulative Physiol Ther 1994;17(7):454-464.
2. Harrison DE, et al. Arch Phys Med Rehab 2002; 83(4): 447-453.
3. Harrison DE, et al. J Manipulative Physiol Ther 2003; 26(3): 139-151.
4. Oakley PA, et al. J Canadian Chiro Assoc 2005; 49(4):270-296.
5. Harrison DE, Harrison DD, Haas JW. CBP® Structural Rehabilitation of the Cervical Spine. CBP Seminars, 2002; pgs:147-151. ISBN 0-9721314-0-X.
6. Harrison DD, et al. Spine 2004; 29:2485-2492.
Article originally appeared on Chiropractic BioPhysics, American Journal of Clinical Chiropractic (http://www.chiropractic-biophysics.com/).
See website for complete article licensing information.
Subscribe to:
Posts (Atom)