“My chiropractor says I have a reverse cervical curve.”
“The MRI says I have a reversed cervical lordosis.”
“There’s no curve in my neck, and now it’s bending the other way. Is this a problem?”
Some people are unlucky enough to have a reverse cervical curve – or a reversed neck. If you have ever been told you have a reverse curve, or suspect that you do, this article is going to teach you:
- What a reverse cervical curve is
- Why it can be a problem
- And how you may be able encourage the neck to move toward a healthier alignment
It includes some actual pictures from actual patients in my chiropractic practice in Auburn Hills, Michigan. So no hype. Just real information. (New video: Correcting the S-Shaped Curve)
What is a reverse cervical curve?
With very few exceptions, most people should have a natural, gentle curve forward in their neck. Some necks will be naturally more curvy than others.
The natural, normal curve is called lordosis, or to be specific, cervical lordosis. Cervical means neck.
Some will have a very straight neck – which some research has linked to trauma, like motor vehicle accidents.
A straight neck is called a kyphosis. It can also be called military neck.
And in some people this straight neck will begin to collapse forward, causing the neck bones to literally move backward – in the opposite direction of a normal neck curve.
Reverse curves in the neck can have more than one shape
Sometimes these backward moving neck bones happen at the bottom of the neck, and sometimes they happen at the top. It just depends on the patient. In some really tough cases, one part of the neck will be reversed, while the other part is actually increased into a normal curve.
There are five major patterns for curve reduction in the neck
Only four of these patterns are true reverse curves. The patterns are
- Mild kyphosis (straight neck)
- Advanced kyphosis (with forward collapse at the top of the spine, usually C2 – C4)
- C-Shape
- S-Shape
- Inverse S-shape
Patterns two through five are true reverse cervical curve patterns. If you want to see examples of these patterns and a discussion of a few cases which show these patterns, see my answer to the question on Quora: Is it possible to restore the curve in your cervical spine?
Multiple trauma patterns can lead to different curve reduction shapes
Personally, I believe this is a result of multiple traumas, often called whiplash injuries. Don’t be confused by the term whiplash, because these injuries don’t necessarily have to take place in a car.
Some of the reverse curves I have seen have been in hockey players from the practice of “checking” players into the boards at fast speeds. I have also seen reverse neck curves in patients who deny ever being in a car accident, but have had concussion injuries, including concussion injuries in childhood.
Is a reverse neck curve a problem?
A reverse neck curve can involve any number of mild to debilitating symptoms. Let’s talk about some of them.
Symptoms (musculoskeletal) associated with a a reversal of cervical lordosis
In my professional experience, reverse cervical curve is often associated with symptoms like:
- head pain, neck pain, shoulder pain, and spine pain
- patients can also experience arm and hand pain, or symptoms similar to thoracic outlet syndrome
- people with reverse neck curves are also prime candidates for headaches
Headaches of all kinds and varieties are common in patients with a reverse cervical curve. Especially tension type headaches and headaches just under the bone at the back of the skull.
Keep in mind: just because someone has a reverse cervical curve doesn’t mean their symptoms will include any or all of the above, just that when we see these symptoms together, it’s common to see a curve reversal.
Reverse neck curve may also impact the body in other ways that lead to more than just musculoskeletal pain.
Most doctors don’t screen patients for loss or reverse of neck curve, which mean it’s not well known
While medicine understands that a lot of head, neck, spine, and arm pain is directly related to joint alignment in the neck – most doctors don’t screen for these kinds of neck problems.
In other words, as long as your neck is not broken or dislocated then a reverse curve may go a long time without being treated or even discovered.
In fact, a reverse curve may not be discovered until you experience symptoms associated with disc swelling or herniation in the neck.
Reverse or loss of neck curves are often not discovered until an MRI is taken with neuropathy symptoms
Your neck may start to get attention if an intervertebral disc (disc for short) starts to get inflamed and painful. Discs can get swollen and even herniate, causing pain in the disc itself, or by causing inflammation or direct pressure on a nerve near the disc.
This can lead to neuropathy symptoms, like pain, numbness, tingling and even muscle weakness in the shoulders, arms, or hands.
Many patients with reverse cervical curves don’t find out that their neck alignment is a problem until it’s bad enough to get an MRI due to these symptoms.
At that point, the swollen disc gets all the attention, and the curve of the neck does not, other than the radiologist may note the loss of curve.
How can a reverse curve be a real problem if it’s so common?
Because a lot of people have this problem and may not yet experience severe symptoms, some people think the problem is therefore not a problem.
It’s a bit of fuzzy logic. With the amount of physical trauma from car accidents many of us endure, as well as the forward head posture we face from sitting down all day – a lot of people have a loss of neck curve. And fewer have a reverse cervical curve.
But just because your neighbor has a loss of neck curve doesn’t mean that yours is not causing an issue.
What happens when the neck moves away from normal alignment?
When the neck moves away from normal alignment it causes the neck joints to break down.
Loss of proper motion and spinal degeneration are consequences of loss of neck curve
Here is one hypothesis on why degeneration in the neck vertebrae is associated with loss/reverse of the neck curve
- A reverse curve changes the way the neck has to support the weight of the heavy head
- It limits normal range of motion in the neck, which often leads to chronic joint inflammation – and a literal breakdown of the joint surfaces over time
- Ligaments are often stretched or torn in the trauma that caused the the neck curve to reverse
- These ligaments can then remain stressed and chronically irritated
- Chronically irritated ligaments often lead to chronic neck pain – as neck ligaments are loaded with pain sensors
- Chronic neck pain then induces periods of muscle spasm – a protective mechanism to help the joints – which then lead to more cycles of inflammation
- The intervertebral disc (a pad of cartilage between the neck bones) has to deal with unnatural pressure, and it will often dry out and begin to herniate, especially at the level of C5
A study on the geometry of the neck seems to support this idea (1). In this study, x-rays of 186 patients with neck symptoms were examined looking at the shape and angles of the neck joints.
“Geometric analysis was focused on vertebral position, alignment, and gravitational loading acquired from the neutral lateral cervical radiograph…We identified 5 geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease. There were discrete age, sex, and symptom groups, which demonstrated an increased incidence of degenerative joint disease.”
Another study (2) looked at the relationship between the neck curve (sagittal alignment), motion, and disc degeneration:
When the alignment shifted from normal to less lordotic [became more straight and lost curve], the translational motion and angular variation tended to decrease at all levels…changes in sagittal alignment of the cervical spine affect the kinematics. Consequently, it may cause changes in the segment subjected to maximum load for overall motion and accelerate its degeneration.
A reverse neck curve also affects the spinal cord and nerve tissue of the neck
MRI images of patients with reverse curves often show stress on the spinal cord
- The cord no longer sits in the middle of the neck, but is often pulled toward either side of the vertebra touching the bone – a term called spinal cord effacement
- If the disc is bulging or joints are overgrown, they could be touching the spinal cord causing something called a thecal sack compression
- Functional MRI images can show changes in flow of cerebrospinal fluid – the fluid that surrounds the cord as a protective barrier
- In some cases ligaments inside the neck can actually tug on the spinal cord creating a downward pull from the inside the neck – a situation that can create all kinds of strange and confusing symptoms we generally associate with a trip to the neurologist or ENT.
Even if there is no stretch to the cord, there can be stretch to the spinal nerves the leave the cord – which can create numbness, tingling, and pain in the upper arms, forearms, hands, or fingers.
Loss of neck curve can be associated with pain
A study investigating a relationship between loss of curve and the neck and pain found that patients with less than 20 degrees of neck curve were 18 times more likely to complain of a neck issue. (Any patients with an S or Inverse S curve were excluded from the study.) (3)
Does a reverse curve make you more vulnerable to injury?
I’m not aware of a study that looks at the health of the neck before a major injury to see if the patient’s neck alignment contributed to their injury.
That means I cannot prove what I’m about to say – but I believe there’s some logic behind it.
I personally believe that patients with a reverse cervical curve are more likely to experience greater side effects of neck injury or even disability when they experience a bodily trauma.
For lack of a better term – all the “available slack” has been taken out of their healthy alignment – to create an unhealthy alignment which has already stressed the bones, joints, ligaments, and muscles to their max, before the trauma.
Just as someone with a depressed immune system is more likely to experience the complications of being sick – someone with a reverse neck curve is more vulnerable to further physical injury.
All things being equal, I would place my bets on more long term symptoms after a car accident for someone with a reverse curve than for someone with a normal curve.
Can you fix a reverse cervical curve?
Yes, it’s possible a reverse cervical curve can move to a more healthy alignment. But it depends on the skills of the chiropractor and the health of the patient. And the correction is not guaranteed.
Your age, health, and levels of injury and joint breakdown all can all play a role. And so can your lifestyle.
If you’re hunched over a smart phone 10 hours per day, all the best care in the world isn’t going to be helpful in correcting your curve long term.
Older patients with larger joint degeneration may not see much change in their reverse curve at all. On the other hand, younger patients with very little joint breakdown may experience a rapid change.
Keep in mind that correcting a reverse curve probably won’t mean a picture-perfect cervical lordosis. Instead it will probably look something like a straight neck. But that’s still better than the stress of a reverse curve.
What kind of spinal care care can fix a reverse cervical curve?
Most chiropractors would probably agree that a series of chiropractic adjustments in the neck with some light neck traction would be helpful in unlocking a reverse cervical curve.
While most chiropractors are very good at moving the neck and unlocking joints, I believe the reverse curve requires a few key ingredients that many practices don’t provide.
Keep in mind what you’re about to read is my opinion only.
For the maximum chance at undoing a reverse curve in the neck, the chiropractor should provide:
- X-rays of the neck taken from the side in a neutral posture. Plus, perhaps flexion-extension views of the neck to see which segments are locked in the mid-and lower neck.
- An upper cervical chiropractic protocol to correct the upper neck (upper cervical protocols are practiced by only about 5% of the profession) – reverse curves can come out without correcting the upper neck first. But I believe but the chance is greater if the upper neck is corrected due to the incredible strain a misalignment in the upper neck places on the spine and nerve system, especially the “tonic muscles” of the neck
- A gentle but dynamic method to adjust the mid and lower neck if the neck is not unlocking or regaining normal range of motion from the upper neck correction.
It’s very possible for the curve to improve maximally, even when its reversed, from a great upper cervical correction
However, some patients will not see a change in their curve until the top of the thoracic spine and the mid-neck is corrected as well. Which patient are you? Nobody knows until we try.
The patient will want to:
- Use a little bit of light traction in the neck, by draping the mid or lower neck over a paper towel roll, rolled towel, or some sort of neck orthotic provided by the chiropractor, and used under the doctor’s direction
- Stretch the minor and major pectoral muscles daily, and even get deep tissue massage of the chest and abdominal muscles to help open up the muscles pulling down on the front posture
- Practice at-home postural corrective exercises that pull the shoulder blades back and strengthen the front of the neck so that the head is easier to carry over the shoulders
Some chiropractors promote aggressive use of traction devices, including weights and equipment that puts the neck into a form of extension compression. I don’t personally advocate this approach in my practice.
Reverse curve? What next?
From a mechanical view of your spine, a reverse cervical curve is challenging condition which can create a number of painful and debilitating symptoms.
Most patients with a reverse cervical curve don’t often know that this problem neck alignment is contributing to their symptoms or is even the cause of them.
Even if they discover that they have a reverse curve, many patients are not informed that a reverse curve may be able to unlock and be partially corrected with quality spinal care.
From my perspective as a chiropractor, you’re most likely to have success coming out of a reverse curve if you
- Have you only have a little bit of joint degeneration
- Are willing to do daily exercises and stretches at home, including some light traction
- And get care from an upper cervical chiropractor who is willing to adjust the mid and lower neck if necessary (or refer out for that care after correcting the upper neck)
Metro-Detroit readers can request a review of their own neck x-rays or MRI via the contact form.
References
(1) Cervical spine geometry correlated to cervical degenerative disease in symptomatic group. https://doi.org/10.1016/S0161-4754(03)00068-X
(2) Kinematic analysis and the relationship between sagittal alignment and disc degeneration in the cervical spine. https://doi.org/10.1097/brs.0b013e3181839733
(3) Determining the relationship between cervical lordosis and neck complaints. https://doi.org/10.1016/j.jmpt.2005.02.015
- Chiropractic isn’t for back pain? Wait, what? - September 15, 2020
- Nature loves your curves: the clues of the patterns in your spine - August 31, 2020
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