Cervical

Correct cervical lordosis (figure 5 below), as defined by numerous research studies, has been shown to prevent nerve, ligament, and muscle damage, relieve pain, and improve overall health. Car accidents, falls, and poor posture all contribute to abnormal Cervical Lordosis (Figures 1-4 below), putting a patient at greater risk of adverse nerve, ligament, and muscle function. Ultimately, abnormal Cervical Lordosis may lead to a number of health-related disorders.

Denneroll, as proven in numerous clinical cases and a randomized clinical trial, has been shown to correct abnormal lordosis of the cervical spine. The Cervical Denneroll products are used worldwide by over 2500 Chiropractors from North America and Australia to the UK, Europe, Asia, and several other international locations.

So, for any chiropractic professional, it’s an easy connection to make. And, thanks to Denneroll, it’s an easy correction to make.

The Cervical Denneroll Orthotic Device is a simple, yet complex, pillow-like device engineered with curves, angles, and ridges extrapolated from the CBP evidence based cervical spinal model. With simple training and education, you can instruct your patients to properly position the Cervical Denneroll device for low-stress, comfortable mirror-image® traction (spinal remodeling) treatments at home.

Three Sizes for Unmatched Versatility

Currently, the Denneroll is available in three sizes—for tall or flexible adults (gray Denneroll), average or stiffer adults (white Denneroll), and small adults or pediatric patients (gold Denneroll)—the Denneroll Cervical Orthotic Device is an important addition to your patient-care inventory. Its suggested retail price is affordable for patients too. Note: The blue device depicted in some of the photos below was a sample production used for the purposes of demonstration of setups only!

Three General Regions of Denneroll Placement

Lower Neck / Upper Thoracic (C7-T2)
The apex of the Denneroll orthotic is placed in the upper thoracic or lower-cervical region (C7-T2) region. This position allows extension bending of the majority of cervical segments while creating a significant posterior head translation. It will increase the upper thoracic curve, and increase the overall cervical lordosis. Specifically, this placement should be used for straightened or kyphotic lower cervical segments with loss of upper thoracic kyphosis and anterior head translation of ≤ 40mm. See below.

Figure Lower Neck Denneroll.
Abnormal cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the lower cervical region. These spines must have:
• Normal or a mild loss of the upper thoracic kyphosis;
• Loss of the lower cervical curve (with or without kyphosis);
• Anterior head translation of approximately ≤ 40mm.

Mid Neck (C4-C6)
The apex of the Denneroll orthotic is placed in the mid-cervical region (C4-C6) region. This position allows extension bending of the mid-upper cervical segments while causing slight posterior head translation; however if the larger Denneroll device is used on a small statured individual then it will create some anterior head translation. The cervical spine should have straightened or kyphotic mid cervical regions (apex of the curve). See Figure below. In cases with significant posterior head translation, as in Figure below, the large Denneroll orthotic should be used and a towel can be placed under the Denneroll to increase the height if needed.

Figure Mid Cervical Placement
Abnormal cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the middle cervical region. These spines must have:
• Normal or a loss of the upper thoracic kyphosis;
• Straightening or apex at the mid-cervical curve;
• Slight anterior head translation of approximately ≤ 15mm;
• In B with Posterior head translation the LARGE Denneroll should be used with a small towel under it to increase height.

Upper Neck Region (C2-C4)
The apex of the Denneroll orthotic is placed in the upper cervical region (C2-C4) region. This placement of the Denneroll is used for posterior head translation with straightened or kyphotic mid-upper cervical curves. This position allows extension bending of the upper cervical segments while causing slight anterior head translation. See Figure below. In cases like Figure below with significant posterior head translation, where the posterior vertebral bodies are behind the ideal red curved line,7 the large Denneroll orthotic should be used. While in Figure below, the small Denneroll should be used.

Figure Upper Neck Denneroll Placement
Cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the upper cervical region. These spines must have:
• Close to normal lower cervical curvature;
• Straightening or apex at the C2-C4-cervical segments;
• In B, normal head translation of approximately ≤ 15mm. Here the SMALL Denneroll is used to not create anterior head posture;
• In A with Posterior head translation the LARGE Denneroll should be used to create anterior head translation.

Denneroll Stress X-rays

Oftentimes, it is helpful to the clinician to have the patient lie on the denneroll while obtaining an x-ray of the patient’s cervical spine. This is termed the ‘denneroll stress x-ray’. The spine segments (3 vertebra usually) immediately above the denneroll peak will show localized end range of extension motion. The stress x-rays help in determining if the denneroll has been placed in the proper location of the cervical spine. Also the stress x-ray helps to understand if the dennerol will be an effective tool at improving the cervical lordosis by itself or if more advanced types of extension traction are needed in conjunction with the Denneroll.

Choosing the size of the Denneroll for the specific patient – Small, Medium or Large

The size of the Denneroll should be based on a combination several variables:

Patient Height

• Large Cervical Denneroll – Patient Height: ≈ 5’9” & up= Large Cervical Denneroll;
• Medium Cervical Denneroll – is generally indicated for people that are ≤ 5’8”.
• Small Cervical Denneroll – is generally reserved for pediatric patients, or beginners to the denneroll that have a difficult time with cervical extension.

Patient Flexibility

Patient flexibility plays a role in selecting the height of the cervical denneroll. As a general rule, the more flexible the patient, the taller the denneroll should be. Conversely, the more rigid or stiff a patient’s neck is, the smaller (shorter) should be utilized.

Also, the first time a patient uses the denneroll, they should be provided with the small denneroll to ensure that they are ‘tolerance tested’ for extension of the neck over the device.

Patient Posture

Based on the patient’s sagittal plane posture, different denneroll sizes may be used to create more or less anterior or posterior head translation and displacement of the cervical spine itself.

• A. Neutral Head Posture AND The Patient Has Neck Pain, Headache, or Upper Back Pain
  We will assume here that the reason the patient has pain is because they have a Hypo-Lordosis, Loss, or Reversed Cervical Curvature. Placement of the Denneroll should be in the Mid-Lower Cervical Region (C5-C7).

• B. If the patient has Anterior Head Translation
  Start with the smaller size denneroll, if the patient’s head firmly touches the floor, then try the medium cervical denneroll. If the patient’s head still firmly touches the floor, then the large size can be used.

Conversely, if the patient’s head firmly touches the floor on the small Denneroll size but the patient has an increase in pain, the patient should be kept on the small size until the pain response improves over several sessions (5-10 Denneroll sessions is often required before pain subsides).

• C. General Anterior Head Translation
  Placement of the Denneroll should be in the Upper Thoracic to Lower Cervical Region (C7-T2). Caution should be used to instruct the patient not to extend the head too much. Once in position, the patient should only slightly tuck the chin into slight flexion in order to limit the amount of upper neck extension on the device.
   
• D. Anterior Head Translation with Flexion
  Placement of the Denneroll should be in the Upper Thoracic to Lower Cervical Region (C7-T2). The patient should have significant head extension once placed on the device.
   
• E. Anterior Head Translation with Extension
  Placement of the Denneroll should be in the Upper Thoracic to Lower Cervical Region (C7-T2). The patient should be instructed to actively flex the chin once in position so that the patient has slight flexion while on the device as well as posterior head translation.
   
• F. If the patient has Posterior Head Translation
  Start with the smaller size placed in the mid-to upper (C3-C5) cervical spine. If the patient’s head rests on the floor, then the larger size should be used in order to translate the head anterior to the shoulder. If the patient’s head still rests on the floor, then the Denneroll device should be moved towards the upper cervical spine such that the head is translated off the floor at least 1 inch (≈25 mm).
   
• G. Posterior Head Translation and Head Flexion
  Placement of the Denneroll should be in the Mid-Upper Cervical Region (C3-C5). Caution should be used to instruct the patient to extend the head also. Once in position, the patient should have visible anterior head posture and head extension compared to the upper shoulders. If more anterior translation is needed, the use the Large-Grey Denneroll Device or move the Denneroll higher in the cervical spine.
   
• H. Head Flexed Posture
  Placement of the Denneroll should be in the Mid-Lower Cervical Region (C5-C7). The patient should have significant head extension once placed on the device and can be asked to extend the head further into the proper position.