Who should I refer to for reversal of cervical lordosis?

Referral for Reversal of Cervical Lordosis

For reversal of cervical lordosis, you should refer to a physical medicine and rehabilitation specialist (physiatrist) who can coordinate comprehensive neuromusculoskeletal management and appropriate therapeutic interventions.

Understanding Cervical Lordosis Reversal

Cervical lordosis reversal (straightening or kyphosis of the normal cervical curve) can result from various causes:

• Muscle spasms and cervical dystonia
• Post-traumatic changes (whiplash)
• Degenerative changes
• Postural issues
• Neurological conditions

Appropriate Referral Pathway

1. First-line referral: Physical Medicine & Rehabilitation (PM&R) specialist/Physiatrist

   • Physiatrists are specifically trained in neuromusculoskeletal disorders and can coordinate comprehensive management 1
   • They can assess for cervical dystonia, which is characterized by painful dystonic spasms of the cervical muscles 1
   • They can develop a personalized rehabilitation program

2. Secondary referrals (as determined by the physiatrist):

   • Physical therapist for specialized exercises and manual therapy
   • Chiropractor with expertise in structural correction techniques
   • Pain management specialist if pain control is inadequate
   • Neurologist if neurological symptoms are present

Diagnostic Evaluation

The PM&R specialist will likely order:

• Cervical spine radiographs (lateral, anteroposterior, and possibly oblique views) 1
• Possibly high-resolution CT of the cervical spine with sagittal reconstructions for detailed assessment 1
• MRI may be indicated if there are neurological symptoms or concerns about soft tissue involvement

Treatment Approaches

The PM&R specialist will coordinate treatment that may include:

1. Physical therapy interventions:

   • Cervical extension exercises and protocols 2, 3
   • Manual therapy techniques
   • Postural retraining

2. Pain management:

   • Nerve-stabilizing agents (pregabalin, gabapentin, duloxetine) for pain and muscle spasms 1
   • Possibly botulinum toxin injections for cervical dystonia or persistent muscle spasms 1

3. Specialized traction techniques:

   • Extension-compression cervical traction has shown effectiveness in improving cervical lordosis 4
   • Mirror image exercises and positioning 2

Expected Outcomes

Research suggests that with appropriate intervention:

• Cervical lordosis can be improved in as little as 8-10 weeks with specialized care 2, 5
• Improvements in cervical alignment correlate with reduction in symptoms 5, 6
• Long-term follow-up shows maintenance of improvements with proper management 3, 6

Important Considerations

• Cervical lordosis reversal may be associated with neck pain, headaches, and radiculopathy 5, 6
• Early intervention may prevent future injury and degenerative changes 2
• Structural correction approaches have shown better long-term outcomes than symptom management alone 6, 4

Remember that the PM&R specialist will be best positioned to coordinate the multidisciplinary care needed for effective treatment of cervical lordosis reversal, ensuring proper assessment, appropriate interventions, and monitoring of progress.