Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy

A Randomized Controlled Trial


Lumbosacral radiculopathy is a condition caused by compression of nerve roots in the lower back, often due to disk herniation. It can lead to pain, weakness, and sensory changes in the legs. Clinicians struggle to integrate the knowledge of a patient’s specific spinal issues (such as disk herniation) causing lower back pain with the role of overall spinal alignment and mechanics in the individual’s condition. Studies in recent years show that neck alignment affects overall pain and disability, including lower back pain, but it’s unclear if it’s solely a mechanical issue. Reflexes related to upright posture are located in the head and neck area. Current conservative treatment for lumbosacral radiculopathy and lower back pain lacks consideration of the impact of cervical spine alignment on pain, disability, and treatment outcomes and therefore satisfactory treatment is still in need.

Denneroll™ is a brand of chiropractic equipment that is designed to help improve spinal alignment and relieve pressure on the nerves. While there is limited research on the use of Denneroll for the treatment of lumbosacral radiculopathy, some chiropractors (those using Chiropractic BioPhysics® or CBP® Technique systems) may use this equipment as part of a larger treatment plan. The goal of using Denneroll is to help restore normal spinal alignment and mobility, which may help to relieve pressure on the affected nerve. To this account, Dr. Deed Harrison from CBP® NonProfit, Inc. in collaboration with Professors Ibrahim Moustafa and Alia Diab from the University of Sharjah conducted a clinical study where they used a cervical traction device called the Denneroll™ to restore normal spinal alignment. The Denneroll™ applies sustained extension loading to the cervical spine in a supine position to create visco-elastic creep-deformation in the spinal connective tissues. This leads to a more consistent and effective correction of cervical sagittal alignment, based on principles of 3-point bending traction methods. The clinical research work is now published in the peer-reviewed Journal of Clinical Medicine.

The research team wanted to compare the effects of TENS and hot packs to those of a combination of TENS and hot packs with the use of Denneroll  as an extension cervical traction device, which is known to improve sagittal cervical spine alignment. The participants were allocated into one of two groups: the control group receiving only TENS and hot packs, and the study group receiving the TENS and hot packs along with the Denneroll. The authors found that the  traction group demonstrated improvements in cervical lordosis and anterior head translation after 10 weeks of therapy, but the control group showed no change. Both groups were found to have similar improvements in back pain, leg pain, and disability at the 10-week post-treatment evaluation. The improvement in forward head posture and cervical lordotic curve observed in the traction group using the Denneroll was predicted, as previous research has indicated that the Denneroll does improve cervical lordosis and reduce anterior head translation. The study group using the Denneroll experienced significant changes in posture parameters in the sagittal, transverse, and coronal planes. The use of the Denneroll may have altered the sagittal contour of the whole spine, which may have helped to enhance posture metrics in the transverse and coronal planes. Moreover, according to the authors, the improvement in pain for the study group at the 6-month follow-up can be reasonably attributed to the restoration of normal posture. At the 10-week assessment, the researchers also observed better H-reflex latency and amplitude in the study group compared to the control group; this improvement persisted at the 6-month follow-up. The study group’s better posture and cervical spine alignment likely reduced longitudinal stress and strain on the central nervous system and the lumbosacral nerve roots, which is the plausible explanation for these results.

In conclusion, the study revealed that after 10 weeks of treatments, both groups had improved lower back pain, leg pain, and disability; however, the improvement in the control group had returned to pre-study levels at the 6-month follow-up, while the Denneroll traction study group showed continued improvement in all variables including lower back pain, leg pain, disability, posture, neurophysiology, and cervical alignment, suggesting that improving cervical alignment has benefits for those with chronic lower back pain and lumbosacral radiculopathy.

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial - Medicine Innovates
Figure 1. The Denneroll cervical traction orthotic. The participant must lie on a firm surface, such as the floor, and place the peak of the denneroll just distal to the apex of their cervical lordotic abnormality as shown on the lateral cervical x-ray. Shown is a mid-cervical spine placement. ©Copyright CBP Seminars. Reprinted with permission.

About the author

Dr. Ibrahim Moustafa is a Professor of Physiotherapy at University of Sharjah (UOS), United Arab Emirates (UAE).He received the doctoral degree in physical therapy  form Cairo University in 2009 , and he was promoted to associate professor in 2014, and  full professor in 2022. He served as the chairperson of physiotherapy department, University of Sharjah  since 2018. His recent publications include many international journals and conference papers in the area of spinal rehabilitation and neurophysiological basis of posture correction. He founded and led a rehabilitation research group in 2021 to advance the evaluation and therapeutic intervention in musculoskeletal and neurological disorders for different target populations. He obtained several national and international scientific and research awards. He is acting as associate editor, guest associate editor, and editorial board member in many international journals.

Email : [email protected]

About the author

Dr. Aliaa is a physiotherapy professor at Cairo University in Egypt. She works as a manual physiotherapist with a focus on spinal structural rehabilitation and neurophysiological testing. She obtained her PhD from Cairo University’s Faculty of Physical Therapy in 2012. She is now working as a main investigator on many funded projects, amongst others, investigating the neurophysiological consequences of spinal structural rehabilitation for different populations of the Egypt. She has worked as a physician and/or academic in various roles. She has received a number of national and international scientific and research prizes. In numerous international journals, she serves as associate editor, guest associate editor, and editorial board member.

Email : [email protected]

About the author

Deed E. Harrison, D.C., graduated from Life-West Chiropractic College in 1996. Dr. Harrison has developed and researched original spinal rehabilitation procedures and has lectured to thousands of Chiropractors at nearly 1000 educational conferences around the world. He has authored / co-authored approximately 200 peer-reviewed spine related publications, 7 spine textbooks, 39 Letters to the Editors in peer-reviewed journals, and numerous conference proceedings. Dr. Harrison is a manuscript reviewer for several Q1 and Q2 peer-reviewed Spine journals. Additionally, Dr. Harrison is a past member to the International Society for the Study of the Lumbar Spine (ISSLS), is a former International Chiropractors Association’s (ICA) Nevada State Assembly Representative member, and is the acting Chair of the PCCRP Chiropractic Radiography Guidelines. He formerly held a position on the Chiropractic Physicians Board of Nevada. Currently, Dr. Harrison is the President / CEO of Chiropractic BioPhysics® (CBP®) Technique and Seminars and is the President of CBP NonProfit, Inc. – a spinal research foundation based in Eagle, ID, USA.

Email : [email protected]


Moustafa IM, Diab AA, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of lumbosacral radiculopathy: a randomized controlled trial. Journal of Clinical Medicine. 2022 Sep 29;11(19):5768.

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