Manual Therapy 2011 (Aug); 16 (4): 378–383
Johansson MP, Baann Liane MS, Bendix T, Kasch H, Kongsted A.
Private Chiropractic Clinic,
Godthaabsvej, Frederiksberg, Denmark
This is an interesting study. I have issue with the fact that these studies were taken in the supine position (based on the limitations of MRI technology.) Chiropractors have noted since the 1920s that sitting vs. standing films of the same subject made significant changes in the architecture of the cervical spine. Sitting films made the neck *look* like it had more lordosis than it had in standing position. Further, the presence of Forward Head Posture is impossible to determine in supine films. How can you address a problem you can't observe in your special study?
The mechanisms for developing long-lasting neck pain after whiplash injuries are still largely unrevealed. In the present study it was investigated whether a kyphotic deformity of the cervical spine, as opposed to a straight or a lordotic spine, was associated with the symptoms at baseline, and with the prognosis one year following a whiplash injury. MRI was performed in 171 subjects about 10 d after the accident, and 104 participated in the pain recording at 1-year follow-up. It was demonstrated that postures as seen on MRI can be reliably categorized and that a straight spine is the most frequent appearance of the cervical spine in supine MRI. In relation to symptoms it was seen that a kyphotic deformity was associated with reporting the highest intensities of headache at baseline, but not with an increased risk of long-lasting neck pain or headache. In conclusion, a kyphotic deformity is not significantly associated with chronic whiplash associated pain. Moreover, it is a clear clinical implication that pain should not be ascribed to a straight spine on MRI. We suggest that future trials on cervical posture focus upon the presence of kyphotic deformity rather than just on the absence of lordosis.