Rehabilitation of Thoracic Hyper-Kyphosis: The Thoracic Denneroll

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

&

Adrian Dennewald, DC

President / CEO Denneroll Industries

Private Practice of Chiropractic Sydney, Australia

INTRODUCTION

The thoracic spine as viewed from the side, should have a natural elliptical or ‘oval’-shaped curve; where slightly more curvature per segment occurs in the mid and upper thoracic segments.^1,2 Lifting injuries, falls, poor posture, de-conditioned supporting muscles of the trunk and lower extremity, and poor ergonomics all may contribute to abnormal increased thoracic kyphosis (hyper-kyphosis). Figures 1-4 depict abnormal types of thoracic kyphosis and the proposed elliptical shape that should be present (Figure 5.)

In the past decade, research into the detrimental effects of thoracic hyper-kyphosis on patient populations has become quite prolific.^3-14 In fact, studies have identified that hyper-kyphosis places a person at greater risk of adverse nerve, ligament, and muscle function. Ultimately, abnormal thoracic hyper-kyphosis has been found to contribute to a number of health related disorders including: lower self image, depression, lack of motivation, increased potential for back pain, injuries-falls, vertebral fracture, deformity progression, and even shortened life span.^3-14

While there has been increased awareness of and studies on proposed effective treatments for thoracic hyper-kyphosis, these studies are based on small case series and trials with few reporting long-term results.⁶ Of the proposed interventions for rehabilitation of thoracic hyper-kyphosis, only spinal extension based exercise programs and spinal corrective orthoses have been found to have a corrective effect aimed at reducing curve magnitude. ^6,15

THORACIC DENNEROLL

Due to the paucity of existing methods to effectively improve thoracic hyper-kyphosis and the general lack of a simple but effective home-based corrective orthotic, my colleague (Adrian Dennewald, DC) and I, sought to develop such a spinal orthotic. The idea was to design a unique spinal orthotic to be used with the patient in a supine position where lying over the apex of such device would provide a tolerable but effective stretch that assists in the correction of abnormal thoracic hyper-kyphosis (Figures 6-8 below).

The main features of this Denneroll Thoracic Orthotic as seen in Figure 9 include:

· Contoured thoracic elliptical shape based on the CBP evidence based Elliptical model.^1,2 This shape provides stability and effective passive forces specific to the thoracic spine.

· The denneroll’s fulcrum peak located at the top of the orthotic creates localized 2-4 segment extension specificity at the proximity of the fulcrum peak.

· The width is designed to allow stability whilst not impacting the scapula.

· Tolerable and impactful spinal extension moment-bending- and slightly compressible peak for patient tolerance with a firm base for support so the unit will not collapse or tilt to maximize the effects.

· Note that changing the apex of the thoracic spine segmental contact with the peak of the thoracic denneroll allows customized fit to the individual patient’s needs and their spinal abnormality.

· Ultra light weight, extremely portable, effective, and user friendly.

· Cost effective!

Figure 9. Thoracic denneroll sitting centered on top of the thoracic support block. The taper of the denneroll and design was cut from the CBP evidence based thoracic kyphosis elliptical model.^1,2

The Recommended Types of Patient Cases and Spine Presentation for Denneroll Orthotic Application:

· Hyper-kyphosis with or without posterior thoracic translation relative to the pelvis;

· Allows for specificity in correcting an increased lower, mid, or upper thoracic kyphosis;

· Anterior head posture greater than 25mm (approximately);

· Rounded-protracted shoulder girdle and scapular region. The size of the denneroll allows for support while simultaneously being narrow enough to allow the scapula to retract over the unit;

· The addition of different sizes of the support block under the thoracic denneroll allow correction of internal flexion-extension of the ribcage while simultaneously reducing kyphosis.

DENNEROLL PLACEMENT

There are three primary types of thoracic corrective setups appropriate for thoracic denneroll application:

1. Lower thoracic,

2. Mid-Thoracic, and

3. Upper-Thoracic..

However, in each of these three spinal placement categories there exists the possible need for both a translation component of the whole ribcage as well as a mild flexion-extension component of the top of the curve relative to the bottom of the curve. Review Figures 1-4 for identifying that the thoracic kyphosis can exist with the top of the ribcage 'flexed' relative to the bottom of the ribcage; alternatively, it can exist with the top of the ribcage extended relative to the bottom of the ribcage. See Figures 10-13 below for detailed setup alterations using various sizes of translation support blocks underneath the thoracic denneroll.

Only a radiographic and postural analysis can determine which denneroll placement is right for the individual patient. The denneroll device should only be used on a firm surface such as the floor, or a bench so that an effective stretch can be applied to the thoracic tissues.

Figure 10. Thoracic denneroll turned around so the peak contacts the lower thoracic spine (T10) while the tapered end supports the mid thoracic region. This setup is for hyper-kyphosis in the T9-T12 region with upper thoracic flexion relative to the lower.

Figure 11. Thoracic denneroll placed in the mid thoracic spine (T6-T7). This setup is for mid-thoracic hyper-kyphosis with T1-anterior to T12—or upper thoracic flexion relative to the lowers.

Figure 12. Thoracic denneroll sitting centered on top of the small 20mm block in the Thoracic Support Block System. This setup assist correction of mild posterior thoracic translation postures with upper thoracic kyphosis and anterior head translation.

Figure 13. Thoracic denneroll sitting centered on top of the Thoracic Support Block. This setup assist correction of moderate-severe posterior thoracic translation postures with upper thoracic hyper-kyphosis and anterior head translation. This is for deformities where the T1 vertebra is posterior to T12.

SUMMARY

In future articles, my colleagues and I will report on selective case studies where the effectiveness of the thoracic denneroll is shown in properly selected and managed patient cases. Also, formal clinical trials into the effect of the denneroll on hyper-kyphosis and patient outcomes is planned; these results will be reported as they are completed.

References

1. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. J Spinal Disord Tech 2002; 15(3): 213-220.
2. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW. Do Alterations in Vertebral and Disc Dimensions Affect an Elliptical Model of the Thoracic Kyphosis? Spine 2003;463-469.

3. Katzman WB, et al. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteo Int 2011 Jan;22(1):85-90.

4. Katzman WB, et al. Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study. J Am Geriatr Soc. 2011 Jan;59(1):96-100.

5. Kasukawa Y, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010;28(1):82-7.

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