Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

Ibrahim Moustafa Moustafa, Tamer Mohamed Shousha, Lori M Walton, Veena Raigangar, Deed E Harrison, Ibrahim Moustafa Moustafa, Tamer Mohamed Shousha, Lori M Walton, Veena Raigangar, Deed E Harrison

Abstract

This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT—ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.

Keywords: neck pain; postural kyphosis; randomized trial; sensorimotor control; thoracic kyphosis.

Conflict of interest statement

D.E.H. teaches rehabilitation methods and sells the Denneroll™ products to physicians for patient care as used in this manuscript. D.E.H. is not a patent holder for the Denneroll™ products. All the other authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Flow chart of participants in the study over time.
Figure 2
Figure 2
The 4D Formetric device measurement of Thoracic Kyphosis and Trunk Inclination where kyphotic angle ICT-ITL (max) is measured between tangents of cervicothoracic junction (ICT) and of thoracolumbar junction (ITL). ICT: Inflectional points from cervical to thoracic spine. ITL: Inflectional points from thoracic to lumbar spine. KA: kyphosis angle. LA: lordosis angle. VP: Vertebra prominence. DM: Dimple.
Figure 3
Figure 3
Denneroll™ Thoracic Traction Orthosis (DTTO). The DTTO can be placed in the upper (T3–T4), mid thoracic spine (T5–T8)-shown in B; or lower thoracic region (T9–T12) pending the apex of a participant’s thoracic kyphosis and sagittal balance alignment. Each participant began lying supine over the apex of the DTTO for 1–3 min and progress 1–3 min per session until the target of 15–20 min per session was reached. Images copyright CBP Seminars, Inc. Reprinted with permission. Note: The individual used in the figures in this manuscript was a paid model and provided consent for commercial use.
Figure 4
Figure 4
Kyphosis formetric posture alignment outcomes for a sample intervention group participant receiving the DTTO. (A) Initial baseline; (B) after 10-weeks and 30-sessions of intervention; and (C) the 1-year follow-up assessment where no further treatment was provided over the course of one year.

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