*8.4.5 Thoracic hypokyphosis (straight back syndrome)*

Thoracic spine hypolordosis is termed straight back syndrome (SBS) and is associated with back pains and exertional dyspnea. Fortner et al. [81] reported on an 18-year old male suffering from back pains and exertional dyspnea. Twenty-four treatments over a 9-week period resulted in a 15° increase in thoracic kyphosis, a decrease in pain and improved exertional dyspnea symptoms. A 4-month follow-up showed the patient remained well.

Betz et al. [82] reported the improvement in a 19-year old male who suffered from exertional dyspnea and back pain. Over 12-weeks a 14° increase in thoracic curve was achieved resulting in relief of exertional dyspnea and pain, as well as increases in both the antero-posterior thoracic diameter and the ratio of antero-posterior to transthoracic diameter, both measures critical to the wellbeing of patients with SBS. A 2.75-year follow-up showed the patient remained well.

Fedorchuk et al. [83] reported on a 13° increased thoracic curve in a 26-year old male with back pains and type 1 diabetes. Treatment over 7-weeks included 36 sessions. Back pains reduced and importantly, there was also improvement in blood glucose immediately following the onset of each visit. An improvement in blood glucose averages, percentage of time of blood glucose in a healthy target range, and glycosylated hemoglobin occurred and the patient was able to reduce their basal insulin need by approximately half after the 7-weeks of care.

Mitchel et al. [84] reported a 10° increase in thoracic curve over 16-weeks in a 33-year old male suffering from exertional dyspnea and back pains. The measured lung capacity improved by 2L, the back pain diminished and the exertional dyspnea resolved. A 7-month follow-up indicated the patient remained well.

### *8.4.6 Anterior sagittal balance*

Anterior sagittal balance (ASB) is the forward displacement of the upper body over the pelvis. Haas et al. reported on the dramatic 110 mm reduction in ASB in

an 87-year old female with CLBP and sciatica [85]. Treatment consisted of 24 in office sessions over an 8-week period. The patient achieved a dramatic reduction of symptoms, improvements in flexibility and orthopedic testing.

Anderson et al. [86] reported on a 91 mm reduction in ASB in a 59-year old male patient suffering from a variety of symptoms associated with Parkinson's disease. Initial treatment involved 38 treatments over 5 months. The patient experienced significant improvements in multiple postural parameters, gait, balance, hand tremors, low back and knee pains and SF-36 values. A 21-month follow-up showed the patient remained essentially well and most of the initial postural improvements were maintained.
