Expanding Ellipsoidal Decompression (EED®) of the Spine
Since humans evolved into bipedal creatures, there has been a growing recognition of the important role that posture plays in the total health of a person. We have recognized that there are a multitude of both internal (anatomical/ physiological) and external factors (environmental) in our daily lives that can act to shape our adult frame and habitus in general. The interrelationship or relative positioning of each spinal vertebra is the primary determinant of the skeletal alignment of an individual. There are many known factors that directly and indirectly affect the vertebral positioning and total posture in a given person including:
- inherent spinal health (disease),
- biomechanical forces acting on the spine (work positions),
- musculo-tendinous forces (muscle balance/synergy),
- ligamentous integrity (laxity/strength),
- disease and injury,
- preferred or “grooved” movement patterns, and
- motor strategies (favorite postures).
Many of these factors converge into the clinical presentation practitioners observe during a posture analysis. Sometimes we fail to clinically recognize these factors and simply classify the problem as stemming from age-related changes since the results or consequences of these factors often manifest as non-specific neck/back pain in later stages of life.
Epidemiology of Spine Pain
An interesting spine-related factoid is that lower spine pain represents the fifth most common reason for physician visits in the United States and is the most frequent cause of activity limitations in persons younger than 45 years of age. The vast majority of spine pain is self-limiting and non-organic (not related to infection, inflammatory arthritis, fracture or cancer) and approximately 2% of our U.S. workforce is compensated (paid claims) for spine pain each year. As a result, we spend many billions of dollars in direct treatment costs and many billions more for associated indirect costs of treating spine pain.1
The global prevalence for neck pain of all causes is estimated to be approximately between 27% and 48%, with non traumatic (insidious) cervical discomfort being the most common classification assigned to this disorder. According to CDC-based investigators, three month prevalence (population-based study) of neck and/or low back pain was 31%, with pain sufferers having more co-morbid conditions—together with greater psychological distress—and a greater tendency to engage in risky behavior.2 The precise mechanisms underlying spine pain have been not well described. What is known is that very few people go through life devoid of a single episode of significant cervical/lumbar spine pain. It is estimated that the mean lifetime prevalence of neck pain is approximately 48.5%.3 The incidence rate of neck pain is recognized to be growing as a result of the rapid growth in the computer and video terminal industries. Monitor use tends to make the person draw or pull the upper body forward including head, neck and thoracic spine—all moving into forward flexion in an attempt to get closer to one’s work.4 The end result is a tightening of the anterior body soft tissues and a stretching out, or lengthening, of the posterior body tissue. Forward head posture and rounding of the shoulders go together and eventually lead to gleno-humeral dysfunction, including impingement syndromes with possible subsequent rotator cuff shredding.
Forward cervical spine translation (neck forward posture) disrupts the ideal cervical spinal alignment that is defined by the external auditory meatus lining up with the acromion bone of the shoulder when a plumb line is dropped from the head downward. It is postulated that for every centimeter that the head protrudes forward beyond or past neutral, the effective weight of the head increases by 10 pounds. That is, the force required to control the head in this forward position is the same as it would be if one added a 10 lb weight to the head. In extreme head forward positions, the cervical spine and surrounding soft tissue are under constant mechanical stress in an effort to control or stabilize the head and prevent injury. Chronic postural strain is but one way in which the cervical curve or lordosis becomes neutralized and oftentimes reversed, or kyphotic.
A loss of lordosis has become an important clinical sign that many musculo-skeletal practitioners look for when performing an examination on a patient who complains of neck pain. In the absence of a congenital manifestation that leads to a spinal abnormality in shape—or likewise, a metabolic disease affecting spinal bone where we expect disease related spinal bone changes—one expects the healthy spine to be relatively straight. In a perfect world, we would all have perfect textbook spinal patterns. Human spines, however, are subjected to many forces that can change their natural alignment. The subsequent loss of these spinal curves has physiologic and biomechanical implications including early disc degeneration, muscle strain and imbalances, early arthritis, and even neuro-compression. With a change in alignment comes a change in segmental weight distribution in an anterior-posterior and side-to-side direction. In extreme cases of forward neck posture or poker neck, there is usually concomitant thoraco-lumbar spinal involvement with possible rotational deformity or roto-scoliosis as well. This causes the spine to take a markedly different appearance and, when severe, can interfere with both swallowing and respiration.
Reviewing the Evidence
There is no doubt that the evidence supporting a causal relationship between loss of cervical spine lordosis and subsequent disability is primarily empirical and based on observational methods. It stands to reason that this type of question is best answered with a population-based, or epidemiological, approach and not necessarily a randomized clinical trial. The existing evidence does, for the most part, support a correlation between the degree of forward head posture with a greater degree of disability.5,6 This relationship is supported from an anatomical and general motor control standpoint as well. We now understand that the positional interrelationships amongst the various anatomical structures of the head, neck and shoulders should be maintained in optimal alignment, and this also means preserving our natural spinal curvatures. The body will ultimately “find” its center of balance by re-positioning the spine in such a manner as to always be in neutral balance—i.e., keeping the head close to the midline. The cranio-vertebral angle (CV) is formed by the intersection of two tangential lines—a line of canthus to the external auditory meatus (EAM) along with a line from EAM to C7—measured anterior to intersect. This angle represents a key outcome measure used by many investigators when assessing the severity of a forward head posture or, conversely, when assessing positive interventional change as an outcome measure of interest.