My unhappy experience: a lack of cervical lordosis

In the world of chiropractic practice, people come and people go. Although I envision lifetime care, some people leave because they feel better, or because they don’t, because they prioritise their finances differently or whatever other reason.  I am fine with that.  What I am not so good with, is if they perceive I haven’t done my job properly and leave cranky, disappointed or sad.

Some years ago, I had a very unhappy experience involving a wellness family who I had cared for over a period of several years.  The daughter of the family, Amanda, was brought in to see me when she was eight years old as she struggled with attention resulting in school learning delays and self-confidence issues.  She was also quite uncoordinated and chose more ‘sedentary’ pastimes such as craft and colouring in rather than moving.  Thankfully Amanda responded very well to chiropractic care and soon the whole family was under care.

Time flies and suddenly it was time for high school for Amanda. Mum brought her in for a thorough check up a few weeks before school started and insisted on having this assessment include X-rays.  I generally do not X-ray children unless absolutely necessary, but Mum was adamant, so I gave in.

The X-rays came back as expected: unremarkable, except for a lack of cervical lordosis.  Mum knew of the importance of having proper spinal curves from her own images and wanted to know why Amanda didn’t have one. My understanding at the time was that a lack of cervical lordosis in children who are developing and healthy is not typically normal.

I had learnt that cervical lordosis is the first spinal curve to develop in young babies as they learn to lift their head up and hold it there while on their stomachs.  I had learnt that the cervical curve functions to ‘neutralise’ the thoracic kyphosis we are born with, enabling us to keep our head upright with the eyes forward and horizontal. Normal was to have a cervical lordosis.

The only cause I could think of for Amanda’s lack of cervical lordosis was too much time sitting with the neck and spine in a flexed position and mentioned the dreaded tech neck (or book neck) as a possible cause.  Mum exclaimed that Amanda had very limited screen time!  Therefore, she could only conclude that my chiropractic care had been inadequate in providing the appropriate bone and soft tissue development and curvature.

I was very sad and upset as Amanda and her family marched out of the practice with Mum swearing she would never return. And I have to admit that, although I have never thought, intended or claimed that the care I provide creates or restores curves, I was very disappointed in my ability to ensure Amanda developed at her best.

The Shocking Fact: The Lack of Cervical Lordosis in Children is Normal!

Fast forward many years, and here I am in 2019 doing the second year of my Masters in Paediatrics enjoying the company of the legendary Dr. Lindsay Rowe on a video going through ‘Normal and variant radiological anatomy of the paediatric patient’. I almost fell off my chair when he stated that a lack of cervical lordosis in children is normal (WHAT!!).  That the cervical curve commonly doesn’t form till the end of adolescence at 14-16 years old.

As chiropractors, we could argue what ‘normal’ is. However, if the curve does develop at 14-16 years old maybe it is a sign of structural maturity, increasing core and postural strength, better coordination of the spinal muscles and/or developing neural integrity….  The point is: it is not just a sign of subluxation or poor posture.

It is obviously too late for Amanda.  However, for the rest of the families in our practices and communities, it is wonderful to know that we chiropractors have all this extra time to facilitate the development of the proper cervical curve through our adjustments, advise on movement, exercise and proper posture as well as encouraging limiting sitting and screen time.  And encourage chiropractic care for a lifetime!

References:

• Rowe LR. (2005) Normal and Variant Radiological Anatomy of the Paediatric Patient. Kiro Kids p/l, Adelaide South Australia
• https://www.ncbi.nlm.nih.gov/pubmed/24395005
• https://pubs.rsna.org/doi/10.1148/rg.233025121#REF3