Research 4801-Winter 2015-Sahijwani, Raj-Final

Cervical Curve Restoration and Overall Health Improvement
Using Various Chiropractic Techniques: A Case Report
Wade Port, D.C.
Life Works Chiropractic
2840 Johnson Ferry Rd #100
Marietta, GA 30062
lifeworksatl@gmail.com
(678) 926-9300
Raj Sahijwani, Student Clinician
2003 Lake Park Drive Apt. H
Smyrna GA 30080
rsahijwani@student.life.edu
(610) 348-2490
Life University College of Chiropractic

1
Abstract
Objective:
To illustrate the use of various chiropractic techniques to facilitate the restoration of a cervical
curve in a patient experiencing shoulder pain with radiculopathy, low back pain, and headaches.
Clinical Features:
The patient presented with a chief complaint of shoulder pain, low back pain, and
headaches. Pre-examination X-rays were taken and demonstrated a loss of lordosis in the lower
cervical measuring -13° from C5-C7, indicating a cervical kyphosis.
Intervention and Outcomes:
Initially, the patient inquired about Network Spinal Analysis™ care. After receiving a somato-
respiratory integration™ (SRI) session and several Network Spinal Analysis (NSA)
entrainments, manual adjustments to the spine were initiated using CBP™ protocols. As the
techniques were integrated throughout care, the X-rays demonstrated significant sagittal curve
improvement from -13° to 0° within 2 months, as well as a decrease in intensity of symptoms.
Conclusion:
Progress towards a normal cervical curve measurements demonstrated successful chiropractic
care. Integrating chiropractic techniques specific for the needs of individual patients has shown
to restore abnormal posture and improve health.
Key words:
Chiropractic, Cervical curve, cervical kyphosis, lordosis, Network Spinal Analysis, Mirror Image
Adjustments, Harrison Spine Model, Radiography, Denneroll, Adverse Mechanical Tension,
Subluxation.

2
Introduction
Many techniques in chiropractic have proven effective to help restore optimal posture. Many
Protocols ranging from structural correction techniques such as Chiropractic Biophysics™ and
Pettibon™ to light-touch applications such as Network Spinal Analysis™ (NSA), may be
applied to restore structural curves.1,2 Regardless of the technique utilized, the underlying goal
of every chiropractic technique is to reduce and remove the vertebral subluxation complex,
VSC.3 The VSC, a universal concept adopted by most chiropractors, is a biomechanical spine
derangement thought to produce clinically significant effects by disturbing neurological
function.4 The severity of the VSC may be dependent on the person’s anatomical and
physiological makeup. Alf Brief first introduced the biomechanics of the cervical curve relating
to the function of a person’s central nervous system in 1960. He stated, “Unfavorable
mechanical tensions may occur in the nervous system resulting in various clinical pathological
disturbances.”5 The basic biomechanical functions of the spinal system are; to allow movements
between body parts, to carry loads, and to protect the spinal cord and nerve roots.6 Therefore,
having an understanding of the general biomechanics regarding curvature and posture of the
spine can provide a greater understanding of a patient's symptoms, pain, and overall health. The
human framework is a dynamic structure. We understand there is structure-function relationship
existing in all living organisms, therefore applying such techniques and utilizing protocols to
optimize spinal structures and curvatures is the goal of many chiropractors.
During fetal-life development, the curves of the spine begin to form.7 However, the
majority of cervical spine development naturally occurs after birth. As we start holding our head
up while learning to crawl, the lordotic curve forms.7,8 The loss of normal cervical lordosis or
the development of a kyphosis through trauma or abnormal posture may impact our bodies’

3
ability to function properly.7,8 Radiographically, using the Drexler method, an ideal cervical
lordosis should measure between 35 and 45°.9 A loss of lordosis, or a reversed neck curve
predisposes patients to premature spinal degeneration (due to outstretching of the posterior
musculature and contracture of the anterior musculature), neck pain, and tension-type and
migraine headaches.10
Additionally, constant mechanical traction on the spinal cord from increased kyphotic
curves puts pressure on nerve tissues, which results in a decreased threshold for nerve firing and
increased sympathetic tone.11 Adverse Mechanical Tension in the connective tissues causes
increased tension in the neural tissues.5,12 Moreover, this increased stretch or traction in the
spinal cord through holding abnormal positions such as a cervical kyphosis will cause increases
in intramedullary pressure, increased CSF pressure, and increased pressure within the nerve cell,
and eventually leading to dysafferentation.12 The most typical changes observed as postural
distortions continue include osteoarthritis of the facet joints with reduced joint space and
degenerative intervertebral disc narrowing.10 Additionally, instability of the muscles and
ligaments in the cervical spine will impact optimal curvatures.6
Many chiropractic techniques have proven to restore cervical lordosis using protocols to
focus on the osseous, muscular, and ligamentous structures. The founder of chiropractic D.D.
Palmer stated, “Life is an expression of tone. Tone is the normal degree of nerve tension. Tone is
expressed in function by normal elasticity, strength, and excitability…the cause of disease is any
variation in tone.”14 By optimizing tone and tension in the connective and neural tissues,
reducing dysafferentation, and simultaneously applying correctional-based adjustments, it is
theorized that chiropractic can help improve one’s overall health. Therefore, this case study
illustrated how integrating techniques such as light-touch applications to help ease the patient

4
into receiving osseous adjustments, and concomitantly using spinal correction protocols, helped
restore a patient's cervical lordosis and improved their overall health.

5
Case Report
This paper is a retrospective study on a patient who received both light-touch applications
and structure-correction based protocols. The patient is a 38-year-old female who entered the
practice with complaints of shoulder pain, low back pain, arm pain with numbness, and
headaches. Her past history revealed neck pain, fatigue, and dizziness. The purpose of her
appointment was to receive Network Spinal Analysis, because she previously had incompatible
experiences with past chiropractors. She stated that she has been under chiropractic care for
several years and was exploring different avenues of care. In addition to the health history
intake questionnaire, which revealed the complaints, a physical examination was conducted to
assess for vertebral subluxation. Vertebral subluxations were found in the cervical, thoracic,
lumbar, and pelvic regions. Lateral and anterior-posterior x-rays were also taken of her cervical,
thoracic, and lumbar regions.
Radiology
Radiographic line analysis was performed on both the lateral and A-P cervical x-
rays. Using CBP protocols to measure the lateral cervical curve, tangential lines were drawn on
the posterior bodies of C2-C7 and measured relative each other. This measured angle is referred
to as the Absolute Rotational Angle, ARA and according to the Harrison Spine Model, optimal
angles from C2-C7 should be 42.5°, C4/C5-C7 should optimally be 30°.16 In the patients case
this angle revealed a -13° curve indicating a severe cervical kyphosis.
Chiropractic Care
This case study focuses on a window of 15 visits where the patient received various
chiropractic techniques and protocols. The intent behind chiropractic adjustments and

6
applications is to focus on reducing and removing vertebral subluxations. The ‘Vertebral
Subluxation Complex’ is a theoretical model with many components, ultimately describing a loss
or reduction in neurological integrity due to alterations in the anatomical, physiological, and
biochemical function of a living system.17 Moreover, techniques and protocols were used to
restore appropriate tone and tension in the patients’ active and passive structures to correct those
spinal structures to reduce spinal cord compression.
The first visit focused on having the patient relax and regain awareness of their mind and
body. Included in the visit was a Somato-Respiratory Integration, SRI, session which Donald
Epstein, the founder of Network Spinal Analysis, derived for this specific mind-body
reconnection intention.18 Along with this initial SRI session, NSA care was initiated. NSA uses
a phasing system and as the patient progressed through care, the phases become more complex to
match the progression.18 Around the 9th visit, the patient began using the Denneroll™ orthotic
help restore the sagittal cervical curve. The DennerollTM is a orthotic device adopted by
Chiropractic Biophysics founders to support the optimal cervical curvature.19 Diversified
bilateral cervical manipulations were also implemented around the 11th visit. This window of
care is mainly correlated to pre and post x-rays taken. The techniques and protocols
implemented were derived from patient presentation and also spinal curvatures presented on the
x-rays.
Somato (Body) Respiratory (Breathing) Integration™ (SRI)
SRI is an exercise designed to help the brain reconnect with the body and its experience.
The goal of SRI is to help an individual develop lifetime skills to better understand how they
perceive their reality. With the use of breath, touch, focused movement and attention, SRI

7
allows for a shift of positive conscious perception.16 Included within SRI exercises are the 12
stages of healing, which allow a person to progressively attain growth and healing.
Network Spinal Analysis™ (NSA) care
In the focused period of time, the patient received 9 Network Spinal Analysis
entrainments. NSA is a subluxation-based approach to health and well being using light touch
procedures to create new healing strategies ultimately releasing tension in ones body.19 Network
Spinal Analysis™ care conceptualizes that subluxation is a global phenomenon involving the
entire spine.18,19 The works of Donald Epstein draws upon the concepts of Breig to hypothesize
that tension in neural tissues is shared between active, passive, and neural control subsystems.
Marked facilitation in one or more subsystem indicates a loss of spinal and neural integrity,
accompanied by a hyper-reactive, and physiologically unresponsive state of “defense
physiology.”3,19 During those Initial 9 visits, and in addition to the one SRI session, the patient’s
only form of chiropractic care was receiving Network Spinal Analysis.
Using access points or more appropriately finding ‘Spinal Gateways’, this light touch
application allows the body to reorganize postural patterns and to initiate a shift toward a more
responsive, self-reflective and adaptive state.20 The term “spinal entrainment” is often used in
place of “adjustment” as a more descriptive term that signifies a harmonization or a
synchronization of internal processes throughout the body, to result in a state that promotes
healing and growth.3 Network care focuses on two healing waves; the respiratory and somato-
psychic wave. The respiratory wave intends to release spinal cord and muscular tension and
helps the person relax. The somato-psychic wave intends to allow movement through the spine
for reorganization of healing processes to occur.17

8
Structural Correction and Bilateral Cervical Manipulation
The structural protocols used were based off of CBP protocols. The subluxation-based
adjustments given were determined through mirror imaging and static and motion palpation.
After the patient was adjusted they laid on a DennerollTM, which is a CBP created device. It was
directed for the use by the patient for 8 visits into the start of care. The Denneroll is a device
used to provide extension in the cervical curve to try and remodel the spinal structures to recreate
the cervical lordosis and retrain neurological pathways.17 The time spent on the Denneroll
progressively increased from 6 minutes to 8 minutes during the last 5 visits of the 15-visit care
plan.
Results
During the course of care the patient stated that she experienced an awareness of her
body that she never felt. She claimed that her breathing was deeper and easier. She noticed that
her posture improved and became aware about her posture when driving in her car and sitting
still. In addition, her overall, low back, shoulder pain, and headaches reduced along with the
dizziness she felt. Follow-up questionnaires about the pain or any physical re-examinations were
not conducted throughout the care. Radiograph analysis demonstrated significant sagittal
cervical curve improvement from a 0° initial Absolute Rotational Angle, ARA, from C2-C7 on
the lateral cervical projection to a 13° ARA in just 15 visits.

9
Discussion
Cervical Lordosis
As previously mentioned, an optimal sagittal curvature measuring the posterior tangential
lines or the ARA, from C2-C7 ranges between 35-45°. Maintaining a normal, forward-arching
cervical lordosis is a necessary component for spinal health. We know that deformities such as
kyphosis can develop from childhood injuries, falls, stress, and whiplash. Even activities of
daily living such as; sleeping with the head in a flexed position, sitting at a desk, or looking
down at a cell-phone overtime may cause deformities. These kyphotic postures increase the load
on the vertebral bodies and causing the intervertebral discs to move posterior.10 If no intervention
is initiated the body starts to remodel itself as dictated by Wolff’s Law and Davis’ Law. Simply
stated Wolff’s Law is the notion that bone is deposited and reabsorbed to help achieve an
optimum balance between strength and weight.21 The trabecular bone tends to line up with the
directions of principal stresses that the structures experiences. This phenomenon occurs through
self-regulating mechanisms that respond to mechanical loads acting upon anatomical
structures.21 Davis’s Law is the similar phenomena in soft tissue structures of muscles, tendons,
and ligaments. These soft tissues also remodel compensating for the mechanical forces placed
on the structures. Essentially, these hard and soft tissues changes may become permanent,
altering optimal anatomical and physiological function of that living system.
Adverse Mechanical Cord Tension (AMCT)
AMCT is the result of our bodies less than optimal ability to handle the stresses induced
in our lives. The adverse effects of AMCT may be dysafferentation, aberrant afferent signaling
from peripheral tissues to centers in the brain may lead to the perception of pain.5,12 The nervous
system has two primarily intimately related components: The connective tissue component and

10
the neural tissue component. Adverse tension due to altered biomechanics causing postural
disturbances inherently effects neural tissue signaling. As much as connective tissues such as
meninges, dentate ligament protect the neural component in a manner that allows signaling to be
sent in any desired posture or movement, and protect neural tissues from compressive and
stretching forces, the interface between neural tissue and connective tissue may be disrupted
causing clinical signs and symptoms.13
Spinal Stabilizing System
One of the first to recognize stability within the spinal column was Punjabi. He
conceptualized that the spinal stabilizing system consisted of three subsystems. [The passive
musculoskeletal subsystem includes vertebrae, intervertebral discs, facet joints, and spinal
ligaments. While, the active musculoskeletal subsystem consists of the muscles and tendons
surrounding the spinal column. The neural control subsystem consists of the various signals and
forces located in the active and passive subsystems that control their movements.]6 These
subsystems work interdependently with each other and injury, degeneration, and/or disease to
any one of the 3 subsystems will affect the overall stability of the entire spinal system.6 There are
three main possible outcomes from dysfunction of the subsystems: (1) an immediate response
from other subsystems to successfully compensate, (2) a long-term adaptation response of one or
more subsystems, and (3) an injury to one or more components of any subsystem.6 It is
conceptualized that the first response results in normal function, the second results in normal
function but with an altered spinal stabilizing system, and the third leads to overall system
dysfunction, producing, pain. Lardner proposed that the myofascial subsystem was responsible
for human resting muscle tone (HRMT). HRMT is the vital low-level, passive tension, and
resistance to stretch that contributes importantly to maintain postural stability in balanced

11
equilibrium positions.23 HRMT is integrated with other passive fascial and ligamentous tensional
networks of the body to form a biotensegrity system.20, 21 Certain neurological events such as
vertebral subluxation can create hypertonic (increased muscle tone) or hypotonic (decreased
muscle tone) muscles causing an imbalance in our biomechanics leading to postural distortions
and altering spinal curvatures.24
Tension, Tone, and Biotensegrity
The term biotensegrity stems from the idea that all biological systems have an
independent pre-stressed tension providing it’s mechanical shape or mechanical integrity.14 From
the simplest entity such as individual cells to organs and bodies, these tensegritous structures are
pre-stressed due to natural forces exerted on that system. It is now realized that mechanical
forces in individual cells, organs and bodies impact biochemical and physiological process such
as cell development, cellular function, and pathological processes.15 All cells have cytoskeletal
networks of microfilaments, that generate internally-integrated tension.11
There is an inherent interdependent structure-function relationship in nature. Evidence-
based research has shown that when spinal structures shift away from optimal values that
symptomology may be experienced. The shifting of spinal structures out of normal alignment
impacting neurological input to the brain affects biochemical and physiological processes in the
brain, which may affect output messages from the brain altering spinal biomechanical function.
Optimizing this structure-function relationship may be the secret to overall health.

12
Conclusion
Cervical curve restoration leading to health improvements has been illustrated in many
areas of chiropractic. Different techniques have proven to restore function in the central nervous
system and remove vertebral subluxations by directly or indirectly focusing on postural curves.
Understanding principles and components of neurology allows all chiropractic practitioners to
balance the different subsystems that create stability throughout the body’s anatomy and
physiology. While patient care is provided on an individual basis, optimizing tone and tension
within the whole system is the foundation for chiropractic.25
Initiating Network Entrainments and SRI sessions in the beginning of patient care may be
beneficial to allow a persons system to relax. The body’s ability to reconnect, self-recognize,
and self-correct patterns reduces global tension patterns in the body system. before progressing
into more manual manipulation and using devices to administer the chiropractic adjustment,
reducing the tension, allowed this individual to receive structural correction adjustments to
restore their cervical curve, reduce their neurological impairment, and improve their overall
health. Improving one’s health and expression of life by removing the vertebral subluxation
complex, so eloquently described by Simon Senzon as [A misalignment of one or more
articulations of the spinal column or its immediate weight-bearing articulations, to a degree less
than a luxation, which by inference causes alteration of nerve function and interference to the
transmission of mental impulses, resulting in a lessening of the body's innate ability to express its
maximum health potential],26 is the essence of chiropractic.

13
References:
1. Morningstar M. Cervical curve restoration and forward head posture reduction for the
treatment of mechanical thoracic pain using the Pettibon Corrective and Rehabilitative
procedures. J Chiropr Med. 2002 Summer; 3(1):113-115.
2. Ray K. Knowles D. Knowles R. Reduction of a Lumbar Scoliosis & Improved Cervical Curve
in a Geriatric Patient Following Network Spinal Analysis™ Care: A Case Study. A Vert Sublux
Res. 2010 Jun.
3.Pauli Y. Quality of Life Improvements and Spontaneous Lifestyle Changes in a Patient
Undergoing Subluxation-Centered Chiropractic Care: A Case Study. J Vert Sublux Res. 2006
Oct.
4. Henderson C. The basis for spinal manipulation: Chiropractic perspective of indications and
theory. J Electromyogr Kinesiol. 2012;22(5):632-642.
5. Brieg A. Adverse Mechanical Tension in the Central Nervous System, Almqvist and Wiksell.
Stockholm 1978.
6. Panjabi M. The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation,
and Enhancement. J Spinal Disord Tech. 1992;5(4):383-389. doi:10.1097/00002517-199212000-
00001.
7. Kaplan KM, Jeffrey M, Spivak K, Bendo J. Embryology Of The Spine And Associated
Congenital Abnormalities'. Spine J. 2005: 564-576.
8. University of Maryland Medical Center. Cervical Kyphosis [Internet]. 2015 [cited 13 January
2015]. Available from: http://umm.edu/programs/spine/health/guides/cervical-kyphosis
9. Yochum T, Rowe L. Yochum and Rowe's essentials of skeletal radiology. Philadelphia:
Lippincott/Williams & Wilkins; 2005.

14
10. Harrison DD, Harrison DLJ. Pathological stress formations on the anterior vertebral body in
the cervicals. Mechanical Engineering Dept., Univ. of Colorado, 1983:31-50.
11. Swanson R. Biotensegrity: A Unifying Theory of Biological Architecture With Applications
to Osteopathic Practice, Education, and Research—A Review and Analysis. J Am Osteopath
Assoc. 2013 Jan; 1 (113): 34-52.
12. Saracino M. Vertebral Hypomobility More Common than Subluxation. Chiropractic
Neurology Research Brief. 2012 7(2).
13. Butler D, Gifford L. The concept of adverse mechanical tension in the nervous system. Part
1: Testing for ‘dural tension’. Physiotherapy 1989;75, 622–629.
14. Brown S. Subluxation and Chaos Theory [D.C., L.C.P.]. The International Chiropractic
Association Philosophy Conference; 2004.
15. Brown S. A Philosophical Model of Subluxation. The Legion of Chiropractic Philosophers
[D.C.]. Palmer College of Chiropractic; 2000.
16. Harrison DE, Harrison DD, Troyanovich SJ, Harmon S. A normal spinal position: It’s time
to accept the evidence. J Manipulative Physiol Ther. 2000; 23(9):623-644.
17. Kent C. Models of Vertebral Subluxation: A Review. J Vert Sublux. 1996; Aug 1(1).
18. Wiseworldseminars.com. What is SRI? - Wise World Seminars [Internet]. 2015; [cited 13
January 2015]. Available from:
http://www.wiseworldseminars.com/wws/SomatoRespiratoryIntegration/WhatisSRI/index.cfm
19. Chiropractic-biophysics.com. 'The Cervical Lordosis In Health And Disease: Literature
Review & The Denneroll 'Home Based' Orthotic - American Journal Of Clinical Chiropractic -
Chiropractic Biophysics. Am J Clin Chiro. 2015 Feb.

15
20. Epstein D. Network Spinal Analysis: A system of health care delivery with the subluxation-
based chiropractic model. J. Vert Sublux Res. 1996 Aug: 1(1): 1-9.
21. Rohrbach T, Knowles D, Knowles R. Restoration of the Cervical Curve and Improvement in
Neurolgical Function in a Patient Following Network Spinal Analysis. J Vert Sublux Res. 2011
Sep.
22. Pearson O, Lieberman D. The Aging of Wolff’s “Law”: Ontogeny and Responses to
Mechanical Loading in Cortical Bone. Am J Phys Anthropol. 2004; 47:63–99.
23. Lardner R. Stretching and flexibility: its importance in rehabilitation. J Bodyw Mov Ther
2001; 5(4):254-263.
24. Masi A, Nair K, Evans T, Ghandour P. Clinical, Biomechanical, and Physiological
Translational Interpretations of Human Resting Myofascial Tone or Tension. Int J Ther Massage
Bodywork. 2010; 3(4).
25. Palmer DD, Palmer BJ. The Science, Art and Philosophy of Chiropractic. Portland, Oregon:
Portland Printing House Company, 1910.
26. Senzon S. A History of the Mental Impulse: Theoretical Construct or Scientific Reality?
Chiro Hist 2001; 21(2): 63.

16
Radiographs
Initial lateral cervical x-ray
demonstrating a severe
kyphotic cervical curve
Final lateral cervical x-ray
demonstrating a reduced
kyphotic cervical curve

17
Cover Letter
Raj Sahijwani
Life University
March 9th, 2015
Dear Dr. McCoy,
I wish to submit a new manuscript entitled “Cervical Curve Restoration and Overall Health
Improvement Using Various Chiropractic Techniques” for your consideration.
I confirm that this work is original and has not been published elsewhere nor is it currently under
consideration for publication elsewhere.
Please address all correspondence concerning this manuscript to me at
rsahijwani@student.life.edu.
Thank you for your consideration of this manuscript.
Sincerely,
Raj Sahijwani

Research 4801-Winter 2015-Sahijwani, Raj-Final

More Related Content

What's hot

Similar to Research 4801-Winter 2015-Sahijwani, Raj-Final

Research 4801-Winter 2015-Sahijwani, Raj-Final