Background/Objectives: We describe a case series of two patients with non-specific chronic low back pain (CLBP) and measurable decreased quality of life, who showed improvements after a specific multi-modal conservative spine and postural therapy regimen. CLBP is the leading cause of years lived with disability and disability-adjusted life years. This case series adds observational data to the medical literature on conservative treatment of CLBP and potentially improves diagnostic and treatment understanding of how conservative therapies can benefit patients suffering with CLBP. Methods: Two patients (Patient A: 58-year-old female; Patient B: 43-year-old male) presented with severe CLBP who did not find relief with prior traditional chiropractic manipulation. The patients sought treatment at a spine rehabilitation facility closest to their remote locations in Wyoming, USA. The conservative rehabilitation treatment program consisted of multi-modal therapies to strengthen postural muscles, postural spinal manipulation, and specific Mirror Image® traction. After 36 treatments over 12 weeks in office and home rehabilitation exercises, baseline tests and outcome measures were repeated. Results: Patient-reported objective outcomes, disability indices, and radiographic analysis demonstrated changes at the conclusion of treatment that were maintained at long-term follow-up re-examination. Lumbar lordosis initially changed from -21.8° L1-L5 lordosis to post-treatment -33.6° for patient A and from -22.6° to -42.4° for patient B. Long-term follow-up demonstrated continued resolution of initial symptoms and maintained spine alignment. Conclusions: In these two patients, the described multimodal conservative program was associated with sustained improvements in symptoms, function, and radiographic parameters. This case series adds to prior biomedical literature regarding potential conservative interventions for treating CLBP and abnormal posture. Larger randomized controlled studies are required to evaluate generalizability and relative effectiveness.

Objectives: Lumbar vertebral wedge angles reflect vertebral body geometry and may influence lordosis. Whether the total wedge index (TWI) and segmental wedge angles differ between asymptomatic individuals and chronic low back pain (CLBP) patients, and predict lordosis independently of pelvic morphology, remains unclear. Methods: Standing lateral full-spine radiographs from 72 volunteers (49 male; mean age 28.3 ± 7.7 years) and 72 CLBP patients (28 male; mean age 52.0 ± 17.9 years; NRS 4.5 ± 2.2; pain > 3 months) were digitized using a validated quadrilateral vertebral body model. L1–L5 wedge angles and TWI (L1 + L2 + L3 + L4 + L5; negative = net posterior taper) were calculated. Pearson correlations, hierarchical OLS regression, and centile distributions were assessed, following STROBE guidelines. Results: In CLBP, L1 wedge was lower (3.33 ± 4.32° vs. 4.87 ± 3.55°; p = 0.020; d = −0.39) and L5 wedge differed significantly (−6.50 ± 6.32° vs. −8.65 ± 6.30°; p = 0.043; d = +0.34). TWI correlated most strongly with lordosis in volunteers (r = +0.531) and CLBP (r = +0.478; both p < 0.001), and with sacral tilt in both groups. TWI added ΔR2 = 0.183 over pelvic morphology (PTPIA) in volunteers and ΔR2 = 0.210 in CLBP, where PTPIA alone explained <2% of lordosis variance. L1 wedge was greater in males (5.27 ± 3.64° vs. 2.76 ± 4.03°; p < 0.001; d = 0.67). T4-HA translation did not correlate with wedge variables. In CLBP, L1 and L5 lost lordosis correlations, while L2–L4 remained significant. TWI was the primary structural predictor of lumbar lordosis. Conclusions: In CLBP, the pelvic–lordosis relationship is disrupted, yet TWI remains predictive (ΔR2 = +0.210), indicating that vertebral body geometry remains linked to lordosis when pelvic morphology does not. Normative TWI centiles may support radiographic outcome measurement.

We report improvements in debilitating cervicogenic dizziness (CD), as well as neck pain and upper and lower back pain, using Chiropractic BioPhysics® (CBP®) orthopedic rehabilitation with a one-year follow-up. CD is extremely debilitating and strongly impacts health outcomes. Reports of successful conservative treatments for CD combined with neck and spine pain with improved outcomes and sustained long-term results are rare, and this study adds to the literature. A 29-year-old female suffered from sudden-onset dizziness and frequent syncope elicited by cranio-cervical extension motions. The patient concomitantly reported moderate neck pain, upper mid-back pain, and low back pain, self-reported significant disability, and objectively displayed poor posture and altered spine alignment on radiography. Due to the worsening of her condition, she sought treatment at a facility in Shoreline, WA, USA. Following examination and diagnostic evaluation, she undertook an in-office treatment regimen. The multi-modal orthopedic regimen included postural exercises, postural spinal manipulation, and specific spinal structural traction. This combination Mirror Image (MI®) protocol has been shown to reduce pain and disability in musculoskeletal conditions, with improvement in CD and cervical lordosis. Following 68 in-office treatments over 5.5 months, all initial outcome assessments and physical, orthopedic, and neurological examinations were repeated and recorded. At the post-treatment assessment, the patient reported improvements in CD symptoms and neck, upper back, and lower back pain. Cervical lordosis improved from C2 to C7, measuring +9.4° (kyphotic) to -16.4° (lordotic). At the one-year follow-up, all outcome measures were stable; syncope was fully resolved, and 90% of the previously reported CD symptoms were resolved. Cervical lordosis remained stable at -17.6° (lordotic). This case documents successful treatment in a single patient using conservative spine and posture treatment protocols. This case report followed reporting guidelines. This study may contribute to the evidence aiming to fill the gap in the understanding of CD and potential conservative therapeutic interventions that are directed toward improving spine alignment.

Background. Although the stabilizing role of the lumbar musculature is appreciated, the muscles' ability to recover ligamentous instability is less understood. The purpose of this experimental study was to quantify the effects of ligament injury and muscle activation on the in vivo dynamic dorsoventral (DV) lumbar spine stiffness.Methods. Two pairs of electrical stimulating electrodes were placed in the multifidus at L3–L4 in fifteen anesthetized, prone-lying Merino sheep. Dynamic DV spine stiffness was assessed at L3 using a computer-controlled testing apparatus oscillating from 0.5 to 20 Hz. Five randomized trials were conducted at rest and during four 20 Hz supramaximal stimulation voltages (6, 8, 15, and 20 volts). Five randomized trials were repeated following progressive injury to the interspinous/supraspinous ligament (ISL/SSL), and again following facetectomy. The secant stiffness (ky = DV force/L3 displacement, kN/m) was determined across testing frequencies for normal and injured spine states. Statistical comparisons were made using a two-tailed paired-observations t-test (α = 0.05).Findings. Dynamic stiffness varied nearly 4-fold over the 0.5 to 20 Hz frequency range. Twenty-volt muscle stimulation significantly (P < 0.05) increased ky up to two-fold compared to rest. A significant graded increase in ky was observed for submaximal contractions at most mechanical excitation frequencies. Injury to the ISL/SSL caused a significant (P < 0.05) loss in spinal stiffness that was recovered by submaximal (15 V or 20 V) muscle stimulations at most mechanical excitation frequencies. Facetectomy caused a significant loss (P < 0.05) of dynamic spinal stiffness at all mechanical excitation frequencies, which was recoverable only with 20 V muscle stimulation.​Interpretation. Dynamic lumbar spine stiffness is frequency-dependent and is decreased by ligamentous injury. Certain levels of muscle stimulation can recover stiffness following ISL/SSL injury, but only maximal multifidus stimulation can recover stability following facetectomy. These findings have important implications for developing dynamic spinal stiffness assessment technology and neuromuscular rehabilitation strategies for clinical practice.

Background. Dynamic dorsoventral spinal stiffness testing characterizes lumbar spine mechanical behavior, yet sources of measurement variability including respiratory state and dynamometer contact compliance have not been systematically quantified in a living model. This study determined the independent effects of mechanical ventilation state and dynamometer contact condition on dynamic dorsoventral spine stiffness and bending lumbar spinal stiffness in an in vivo ovine preparation.Methods. Fifteen anesthetized Merino sheep (mean 60.73±4.42 kg) underwent impulse mechanical excitation (20–80 N, 100-ms pulses) at the L3 spinous process under three contact conditions: soft stylus over skin, rigid steel over skin, and rigid steel on exposed bone, with ventilator on and off at end expiration. A single animal additionally underwent 2 Hz sinusoidal repeated-measures excitation across all four test conditions for validation.Findings. Ventilator cessation significantly increased dynamic dorsoventral spine stiffness by 10.68% across the 15-animal cohort (5.74±0.21 to 6.35±0.25 N/mm; p < 0.001) and bending stiffness by 4.85% (31.3±0.76 to 32.8±0.90 N·m; p = 0.017). In the 10 fully apneic animals, the stiffness increase was greater and measurement variance was significantly reduced. Soft-tip contacts produced approximately 14% lower dynamic dorsoventral spine stiffness than rigid contacts (p < 0.001), while rigid contact over intact skin was statistically equivalent to direct bone contact. The 2 Hz sinusoidal protocol replicated these patterns.Interpretation. Respiratory state and dynamometer contact compliance are significant, independent determinants of measured lumbar spinal stiffness. End-expiratory breath-hold and rigid dynamometer contact are essential for accurate and reproducible in vivo spinal stiffness assessment.

[Purpose] To present a case series of five patients who presented with a cervical kyphosis and chronic neck pain who were treated with Chiropractic Biophysics® (CBP®) extension traction as part of a multimodal program. [Participants and Methods] Five patients with cervical kyphosis and chronic neck pain were randomly selected from files from one clinic. All patients refrained from follow-up treatments after the initial trial of corrective care of CBP used to improve the cervical lordosis. Treatment included extension traction to the neck as well as mirror image® extension exercises and spinal manipulative therapy. The patients were treated from 2-4 months and follow-up assessment was performed at least 1 year later. [Results] After treatment the patients demonstrated an average increase in global lordosis of 24° and a decrease in the regional cervical kyphosis of 18°. The patients experienced a 5-point improved pain intensity and 24% improved disability. Follow-up of over a year demonstrated a 10° loss of original lordosis correction but no change in disability. [Conclusion] In this randomly selected series, CBP rehabilitation protocols were successful at reducing gross cervical kyphosis, however, a regression in correction occurred supporting the need for further maintenance treatments required to stabilize the original correction.

Background/Objectives: Forward head posture (FHP) has been associated with alterations in cervical sensorimotor function; however, its relationship with trunk muscle activation during dynamic movement tasks remains incompletely understood. This study examined whether individuals with FHP demonstrate differences in the timing and magnitude of trunk muscle activation during a rapid lower-limb movement task. Methods: One hundred asymptomatic young adults (18-25 years) were classified as having normal head posture (NHP; craniovertebral angle (CVA) > 55°) or forward head posture (FHP; CVA < 50°) using PostureScreen® Mobile. Surface electromyography (EMG) was recorded bilaterally from the external oblique (EO), lumbar multifidus (MF), and the transversus abdominis/internal oblique region (TrA/IO) during ten externally cued right-leg raises. EMG amplitude and onset latency relative to rectus femoris activation were extracted for each muscle. Two multivariate analyses of variance (MANOVA) assessed overall group differences in EMG amplitudes and onset latencies. Significant multivariate effects were followed by univariate ANOVAs. Group × Side mixed-model ANOVAs evaluated side-to-side activation patterns. Pearson correlation and regression analyses examined correlations between craniovertebral angle (CVA) and EMG variables. Results: MANOVA revealed significant overall differences between the FHP and NHP groups for EMG amplitude (Wilks' λ = 0.20, F(6, 93) = 62.14, p < 0.001, η2p = 0.80) and onset latency (Wilks' λ = 0.10, F(6, 93) = 133.73, p < 0.001, η2p = 0.90). Follow-up ANOVAs showed significant differences for all EMG variables (all p < 0.001), with large effect sizes (Cohen's d = 1.0-3.2). Mixed-model ANOVAs demonstrated significant Group × Side interactions (all p < 0.05). CVA showed significant moderate to strong correlations with EMG amplitude and onset latency measures (r = 0.43-0.79). Conclusions: FHP was associated with later trunk muscle activation and altered EMG activation patterns during the leg-raise task, including reduced activity recorded from the TrA/IO region and increased EO activation. These findings suggest FHP is associated with different trunk neuromuscular activation strategies during dynamic tasks. Despite consistent CVA-EMG associations, extreme multicollinearity limits the interpretation of CVA as an independent predictor.

Background: The biomedical literature assessing the reliability of mensuration of sagittal cervical spine alignment in radiographs has not been systematically evaluated. This review aims to systematically identify and assess reliability studies on biomechanical assessments of the sagittal cervical spine used in clinical practice. Methods: The study design was registered with PROSPERO (CRD42023402990). Funding was obtained from Chiropractic BioPhysics (CBP) Non-Profit (Eagle, ID, USA). Inclusion criteria involved studies in English with: human subjects, radiography of the sagittal cervical spine, and reliability analysis of biomechanical mensuration of the sagittal cervical spine. Exclusion criteria involved studies with: geometric modeling, animals, cadavers, phantom mannequins, and non-radiographic studies. PubMed, CINAHL, AltHealthWatch, and Web of Science databases were searched from inception through to 24 January 2023. The quality appraisal tool for studies of diagnostic reliability (QAREL) assessed bias risk. Results: We followed the synthesis without meta-analysis (SWiM) according to systematic review guidelines. Scrutiny of the inclusion criteria yielded 51 articles. The results were limited due to the heterogeneity of various mensuration methods (Cobb, posterior tangent, translation measures, etc.) and the incorporation of both manual and digital measured assessments. Other sources of heterogeneity included the quality and type of images used, whether digital or plain film radiographs were used, and the differences in statistical analysis and reporting (ICCs or Pearson correlation coefficients, Cohen's kappa agreement, or Bland-Altman plots). Still, the preponderance of evidence found good-to-excellent reliability. Conclusions: This SROL discovered good-to-excellent intra-examiner reliability for the following biomechanical mensuration methods: intersegmental rotation angles, the thoracic inlet angle, the T1 slope, the C2-C7 posterior tangent method for total cervical lordosis, and the Cobb C2-C7 method for total cervical lordosis. Likewise, using these criteria, we identified good-to-excellent inter-examiner reliability for the following biomechanical mensuration methods: intersegmental rotation angles, the thoracic inlet angle, the T1 slope, translation using the sagittal vertical axis of C2-C7, the C2-C7 posterior tangent method for total cervical lordosis, and the Cobb C2-C7 method for total cervical lordosis.

This study reports on patients with lumbar anterolisthesis(es) (LA) to assess the impact of CBP® corrective spinal rehabilitation on anterior translation displacement (+ Tz) of LA and physical and mental quality of life (QOL) measures. A records review of a private practice isolated patients with LAs greater than 4 mm who were compliant with CBP® treatment recommendations and had pre- and post-treatment health measures documented. Primary outcomes included + Tz measurements at T12-S1 intervertebral levels and overall means as well as SF-36 questionnaire QOL measures (physical and mental component summaries, physical functioning, and bodily pain). LAs were classified using the Meyerding classification system. 117 individuals (54 males [46.2

Conservative treatment for chronic non-specific low back pain (CLBP) includes lumbar extension traction (LET) to re-align lumbar lordosis (LL). This study explores the use of machine learning (ML) models to predict post-treatment outcomes in patients with CLBP undergoing LET and how these predictions can support clinical decision-making. We utilized a retrospective database of 431 consecutive patients with uncomplicated CLBP. Post-treatment variables predicted included LL, NRS pain score, and Oswestry Disability Index (ODI). Input model variables included pre-treatment LL, sacral base angle (SBA), ratio of LL/SBA fit type, NRS, ODI, frequency, duration, LET compliance, and demographic variables of age and BMI. Initial variables were analyzed to predict post-treatment outcomes. Three ML models—Random Forest (RF), XGBoost, and Multilayer Perceptron (MLP)—were employed to handle both continuous and categorical variables, and performance was evaluated for predictive accuracy. Factors affecting outcomes were identified using Shapley Additive Explanations. Treatment was a multimodal spine rehabilitation program featuring LET applied 3–6 times per week, varied between 4 and 10 weeks, and follow-up was performed at the end of care. Improvements in LL, NRS, and ODI were − 11.5° to − 23.6°, 7.3/10 to 3.3/10, and 33.2

A multicenter, prospective consecutive case series study was conducted in 5 physiotherapy clinics in the UAE from January 2021 to March 2023 to assess rotations and translations of head posture parameters as potential predictors of conservative therapy outcomes in patients with chronic non-specific neck pain (CNSNP). Eighty-six patients (mean age 35 yrs., 65% male) with CNSNP underwent conservative therapy. All participants received a detailed examination including a computerized cervical spine posture analysis and demographic data was collected. Interventions included specific exercises, diathermy, longitudinal traction, education, a detailed exercise program, ergonomic advice, and medications. Interventions were applied 3 times per week for 8 weeks. Follow-up was 6-months after final treatment. A successful outcome was based on a minimum improvement of the following four outcomes using the patient centered outcome questionnaire (PCOQ): (1) reduction of pain by 17.5 points (0-100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up it was found that success rates for pain, fatigue, distress, and interference were above 60% for the total participants. The logistic regression for predicting overall success in combined outcomes based on age, gender, smoking status, marital status, and sagittal head translation was: (1) Age: the odds ratio (0.69) suggests that as age increases, the likelihood of overall success decreases (p = 0.001); (2) Sex: females have higher odds of overall success compared to males (OR = 2.71, p < 0.001); (3) Smoking status and marital status: neither of these factors were statistically significant predictors of overall success; (4) Sagittal head translation: each unit increase (more anterior) in this abnormal posture reduced the odds of success by 13%, showing a strong and significant effect (OR = 0.13, p < 0.001). Overall, our findings indicate that younger age, female sex, and less sagittal head translation all had a statistically significant impact on the likelihood of success of 6-month outcomes in patients suffering CNSNP.

Background/Objectives: The lumbar lordosis (LL) is influenced by pelvic morphology, the unique dimensional characteristics of the pelvis. We investigated the sensitivity and specificity of lumbar sagittal radiographic alignment variables to discriminate between normal controls and acute low back pain (ALBP) patients. Methods: A total of 50 normal controls (29 men; mean age of 27.7 ± 8.5 years) with no history of low back pain and 50 ALBP patients (29 men; 28.1 ± 8 years of age) were compared. Radiographic variables included three measures of LL, a b/a elliptical modeling ratio, sacral base angle (SBA), S1 posterior tangent to vertical (PTS1), two measures of pelvic morphology, as well as three relationships between morphology and LL. Descriptive statistics, linear correlations, and receiver operating characteristic (ROC) curves were calculated. Results: The SBA and Cobb T12-S1 LL were significantly greater in the ALBP group. The SBA showed a reasonable ability to discriminate between the normal and ALBP groups with ROC curve analysis (AUC = 0.67, optimal cut-off value = 41.2°, sensitivity = 0.70, and specificity = 0.62). Pelvic morphology was similar between sex and pain groups. Conclusions: Our sample of ALBP patients had similar pelvic morphology as compared to normal control participants; however, they also demonstrated an increased T12-S1 lordosis and sacral base angle, shown as a hyperlordosis.

This study leveraged machine learning (ML) models to explore the relationship between three-dimensional (3D) spinal alignment parameters and clinical outcomes in patients suffering from fibromyalgia syndrome (FMS). A cohort of 303 FMS patients, diagnosed according to the 2016 American College of Rheumatology criteria, underwent comprehensive assessments of sagittal imbalance, coronal imbalance, vertebral rotation, pelvic obliquity, pelvic torsion, and pelvic rotation using a validated 3D imaging system. Clinical outcomes, included the fibromyalgia impact questionnaire (FIQ), pain catastrophizing scale (PCS), Pittsburgh sleep quality index (PSQI), and algometric pain scores. Five ML models were employed: Fast Kolmogorov-Arnold Networks with Bee Colony Optimization (FastKAN-BCO), FastKAN with LBFGS, Multilayer Perceptron with LBFGS (MLP-LBFGS), Multilayer Perceptron with ADAM (MLP-ADAM), and linear regression. Among the models tested, FastKAN-BCO demonstrated the highest R-squared value (0.95) for algometric pain, while the MLP-LBFGS model achieved superior performance for PCS (R2 = 0.94), FIQ (R2 = 0.88), and PSQI (R2 = 0.97) predictions. Sagittal imbalance and pelvic obliquity were identified as key predictors of symptom severity. Stratification revealed that individuals with more pronounced pelvic asymmetry and vertebral rotation exceeding 10° experienced increased symptom intensity. The contribution of vertebral rotation was nonlinear, indicating a threshold-dependent impact. This study illustrates the potential of ML techniques to uncover complex associations between 3D spinal alignment and FMS outcomes, offering a foundation for personalized diagnostic and therapeutic approaches. The results emphasize the critical role of postural dysfunction in FMS and highlight the potential of advanced ML models.

We present the findings of a case showing an improvement in severe, chronic mid-back pain (MBP) and disability following sagittal correction of the thoracic spine using Chiropractic BioPhysics® (CBP®) spinal rehabilitation with a nine-month long-term follow-up. A 40-year-old female had suffered for years and was referred for spinal rehabilitation by her physicians and physical therapist to treat her severe, chronic MBP. The symptoms had not improved despite several months of physical therapy, traditional chiropractic spinal manipulation, and pain management trigger point injections. The pain was reported as severe and rated as 8/10 at worst on the numerical rating scale. The pain was severe enough to interfere with her normal activities including martial arts training. Postural analysis revealed increased thoracic flexion and spine hyperkyphosis. Lateral thoracic radiography showed a previously undiagnosed wedged vertebral body at T6. Mensuration of the radiograph found an increase in overall posterior tangent angulation from T3–T10 measuring 66.2°. Negative sagittal balance measured from a vertical of T3 above T10 was −16.3 mm. Treatment included Chiropractic Biophysics® (CBP®) orthopedic rehabilitation protocols including postural and radiographic based Mirror Image® (MI®) exercises, spinal manipulation, and traction. The patient was treated in-office 37 times over the course of 3 months and all initial subjective and objective outcomes were re-assessed. It was reported that the initial average pain of 8/10 for the mid-back had nearly resolved and was rated as 2/10. All ADLs were reported as pain free, including intense exercise and martial arts. Post-treatment radiography was taken following a 24 h “rest-period” and found reduction in the overall hyperkyphosis from T3–T10 now measured 45.2°. Due to the presence of the wedge vertebra, it was recommended that the patient continue home traction and exercises, and long-term follow-up was assessed at 9 months including a repeat of all initial examinations, for subjective and objective outcomes. Thoracic kyphosis was maintained at 47.7° and VAS was 0/10 at 9-month follow-up and symptoms remained nearly resolved.

CONTEXT:This pilot study assessed participants adherence rate and the effect size needed to determine the sample size for a full-scale study evaluating the effectiveness of forward head posture (FHP) correction on temporomandibular disorders (TMDs) and symptoms. Moreover, the potential impact of adding FHP correction to a standard conservative protocol for treatment of TMD severity, pain, and pain-free mouth opening range is explored. OBJECTIVES:The primary objective was to investigate the additional effect of FHP correction by a cervical extension traction (CET) orthotic on myogenic TMD symptoms of pain and function. METHODS:A total of 21 participants (19 females) were enrolled and completed the study. The participants' mean age was 21.99±2.06 years, body mass index (BMI) 22.92±4.27 kg/m2. A randomized clinical trial was conducted with participants who were randomly divided into two groups: 1) an experimental group with 10 participants receiving a FHP CET orthotic and a conservative TMD protocol; and 2) a control group with 11 participants receiving the conservative TMD protocol and a placebo CET device utilizing a standard pillow. Outcome assessments included: TMD severity with Fonseca's questionnaire, numerical rating scale for pain intensity, maximum mouth opening (MMO), and the craniovertebral angle (CVA) to measure FHP. Assessments were performed at three time points (baseline, 3rd week, 6th week), and three treatment sessions per week for six consecutive weeks were administered. RESULTS:Both groups achieved a high adherence rate to the study protocol (≥90 %). Within-group analysis for both groups, across the three time points, identified significant differences utilizing Friedman's test (p<0.001) between measures for orofacial pain, TMD severity, MMO, and CVA. Between-group comparison identified no difference at the follow-up assessments for orofacial pain or MMO measures (p>0.05). The Mann-Whitney U test for between-group comparisons identified a statistically significant difference in CVA at week 3 (p=0.01) and at the 6th week (p<0.001) favoring the experimental group. For the TMD severity score, no difference was found at week 3 (p=0.11) but there was a significant difference between groups at week 6 (p=0.02) favoring the experimental group. CONCLUSIONS:These preliminary findings suggest that adding FHP correction through the application of a CET orthotic might offer short-term selected benefits for chronic TMD symptoms, which would need to be confirmed in a full-scale trial. High adherence rates were found with a moderate effect size that provided data indicating that at least 38 participants would be required for a full-scale study.

A prospective case control investigation was conducted to assess corticomuscular coherence (CMC) under different balance conditions in order to identify alterations that may arise due to forward head posture (FHP). Sixty-four participants (between the ages of 18-25) were recruited for this study. Participants were free from any musculoskeletal symptoms and matched for relevant demographic variables. Participants were assessed for FHP using the craniovertebral angle (CVA) and separated into either the normal head posture (NHP) group by CVA > 50° or the FHP group by CVA < 50°. Participants were evaluated using the Biodex balance system while both EEG and EMG signals which were acquired simultaneously to investigate CMC. Balance was investigated under four conditions increasing in challenge: (1) standing with eyes open, (2) standing with eyes closed, (3) unstable standing with eyes open with the Biodex set on level 8, and (4) unstable standing with eyes closed with the Biodex at level 8. In addition to recording delta, beta, theta, alpha, and gamma waves, we calculated both peak and average coherence values from the CMC analysis. Statistically significant differences were identified for the FHP group vs. the NHP group for both peak (p < .001) and average CMC values (p < .001) and for the interaction of balance difficulty (stage 1 vs. stage 4), p < .01. Similarly, all brain waves (delta, beta, theta, alpha, and gamma) demonstrated statistically significant differences between the NHP and FHP groups (p < .001) and for increasing balance difficulty across the four stages, p < .05. This study demonstrates that FHP is associated with a significant elevation of CMC, a unique compensatory burden on the brain, particularly during physically challenging balance tasks.

Postural alignment is a critical determinant of health status. Its degradation is associated with deformity-caused and compensation-related back pain, neurologic involvement, osteoarthritic development, as well as disability and reduced quality of life. Radiography remains the most efficient method of evaluating standard sagittal and coronal spine and pelvic metrics that are used to plan surgical and nonsurgical treatment strategies. Many current spine guidelines dissuade the use of initial screening X-rays and some chiropractic guidelines condemn repeat imaging to assess progress from treatment regimens; these are anti-scientific viewpoints that ignore alternate viewpoints and evidence. Current understanding of the relationship between different spinopelvic parameters are essential to plan biomechanically appropriate interventions that are patient-specific. There are radiographically measured parameter thresholds critically related to several spinal disorders and positive patient outcomes. Current guidelines must include a caveat for contemporary biomechanical evaluation and its consequent specific treatments and should recommend routine radiographic imaging for spine patients undergoing corrective rehabilitative interventions. The failure to radiographically diagnose spinal deformity is argued to be negligence in many cases. The prime obstacle to routine X-ray imaging lies with the presumed threat of cancer, however, this is dogma; we summarize the main evidence from recent publications why this is so.

Biomedical literature assessing reliability of mensuration of sagittal cervical spine alignment on radiographs is limited. This review aims to systematically identify and assess reliability studies on biomechanical assessments of the sagittal cervical spine used in clinical practice. The study design was registered with PROSPERO (CRD42023402990). Funding was from CBP, Non-Profit (Eagle, ID, USA). Inclusion criteria involved studies in English with: human subjects, radiography of the sagittal cervical spine, and reliability analysis on biomechanical mensuration of sagittal cervical spine. Exclusion criteria involved studies with: geometric modeling, animals, cadavers, phantom mannequins, and non-radiographic studies. Pubmed, CINAHL, AltHealth Watch, and Web of Science databases were searched from inception through January 24, 2023. The quality appraisal tool for studies of diagnostic reliability (QAREL) assessed bias risk. Results are presented following the synthesis without meta-analysis (SWiM) in systematic reviews guidelines. Scrutiny of inclusion criteria yielded 51 articles. Results are limited due to heterogeneity of the various mensuration methods and statistical analyses. The preponderance of evidence found good to excellent reliability. The results of this systematic review show that sagittal radiographic mensuration of cervical spine biomechanics and alignment is a reliable method for the diagnosis and management of spine conditions in clinical settings.

Background/Objectives: We present a case documenting the successful treatment for a patient with chronic low back pain (CLBP), chronic neck pain (CNP), and decreased quality of life improving after conservative therapy. CLBP has been the leading cause of disability globally for the past few decades, resulting in decreased quality of life physically and emotionally. This case is important in the medical literature to add to studies reporting successful conservative treatment of CLBP and CNP. Triage, diagnosis, and understanding of economical and conservative therapeutics can benefit patients; providers as well as institutions and third party payors benefit from improved outcomes. Methods: A 39-year old male presented with severe CLBP who had experienced no long-term success with prior chiropractic spinal manipulative therapy (SMT). After symptoms began to worsen in spite of receiving SMT, the patient sought treatment for his pain, abnormal spine alignment, and poor sagittal alignment at a local spine facility. History and physical examination demonstrated altered spine and postural alignment including significant forward head posture and reduced cervical and lumbar lordosis and coronal plane abnormalities. Treatment consisted of a multi-modal regimen focused on strengthening postural muscles, specific spine manipulation directed toward abnormal full-spine alignment, and specific Mirror Image® traction aiming to improve spine integrity by realigning the spine toward a more normal position. The treatment consisted of 36 treatments over three months. All original tests and outcome measures were repeated following care. Results: Objective and subjective outcome measures, patient-reported outcomes, and radiographic mensuration demonstrated improvement at the conclusion of treatment and maintained at 1-year follow-up re-examination. Conclusions: This case demonstrates that the CBP® orthopedic chiropractic treatment approach may represent an effective method to treat abnormal spinal alignment and posture. This study adds to the literature regarding conservative methods of treating spine pain and spinal disorders.