Abstract

Increasingly, there is more attention being directed to the role that full spine sagittal alignment plays in causing or exacerbating a variety of musculoskeletal disorders. Similarly, spinal displacements, termed subluxation, are thought to cause dysfunctions in the entire neuromusculoskeletal system that may lead to altered neurophysiological function, abnormal sensorimotor control, and altered autonomic nervous system function. Abnormalities in neutral upright spine alignment (sagittal translation or flexion deformities) are known to increase mechanical loads (stresses and strains) on the central nervous system. These increased mechanical loads may subtly or overtly impair neurophysiological function as measured with evoked potentials in terms of latency and amplitudes of potentials. Proprioceptive afferentation from spine ligaments, muscles and discs are considered a major component of sensorimotor control. The voluminous mechanoreceptors in spinal muscles, ligaments, and discs plays an intimate role, providing the necessary neurophysiological input in a feed forward and feedback system for sensorimotor control via connections to the vestibular, visual and central nervous systems. Of particular interest, a network of neurophysiological connections between spine mechanoreceptors and the sympathetic nervous system has been documented. This chapter explores the hypothesis and evidence that restoring normal posture and spine alignment has important influences on neurophysiology, sensorimotor control and autonomic nervous system functionality. There is limited but high-quality research identifying that sagittal spine alignment restoration plays an important role in improving neurophysiology, sensorimotor control, and autonomic nervous system function. Accordingly, in the current chapter, we review this work in hopes of stimulating further investigations into structural rehabilitation of the spine and posture.

Highlights

  • A normal spine alignment including coronal and sagittal balance is essential for optimal biomechanical function [1–7]

  • Clinical trials [10–16] and case reports [17–25] have demonstrated that corrections in patient posture have resulted in relief of neurological symptoms including for example, cervical spondylotic and discogenic radiculopathy, cervical spondylotic myelopathy (CSM), lumbosacral discogenic radiculopathy, trigeminal neuralgia (TN), dystonia, Parkinson’s disease (PD), carpal tunnel syndrome (CTS), and Tourette’s syndrome (TS)

  • The precise mechanisms underlying improved neurological function in patients having improved postural alignment are not fully understood, they are thought to lie in the biomechanics of the central nervous system (CNS) and in normalization of load sharing across tissues innervated by mechanoreceptors which are integral in sensorimotor control through somatosensory potentials

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Summary

Introduction

A normal spine alignment including coronal and sagittal balance is essential for optimal biomechanical function [1–7]. A second prevailing theory on how normalization of spine/posture alignment can dramatically alter patient pain, disability, function, and neurophysiology is through cervical spine sensory afferent input (so called afferentation) and its influence on the motor system termed sensorimotor control. This chapter reviews the Harrison normal spinal model [40–47] that is used to assess a patient’s spine alignment as compared to the normal/ideal position (i.e. gold standard), how the central nervous system is housed in and biomechanically functions within the skeletal structure under normal and pathologic conditions, including mechanisms for neurologic symptom generation under pathologic biomechanical tensions, and altered sensorimotor control from dysafferentation driven by altered load sharing and spine kinematics. The CBP structural rehabilitation approach to realigning the spine and postural position in order to treat patients who present with spinal subluxation that is suspected to be pathognomonic for their pain, disability, and generalized neurologic sensorimotor disorders will be a main theme

The Harrison normal spinal model
Biomechanics of the central nervous system
Pathophysiologic mechanisms from adverse CNS tension
Cervicocephalic kinesthetic sense measured as head repositioning accuracy
Biodex balance and stability measurement
Smooth pursuit neck torsion test or SPNT
Dysafferentation, altered sensorimotor control and autonomic nervous system
Conclusion
Findings
Conflict of interest
Full Text
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