On August 28, 2020, a 15-year-old female presented to the clinic with the chief complaint of constant low back pain for 2 months, occurring daily and relieved with rest; but aggravated with prolonged activities like being standing or seated for more than 1 h. She initially felt low back pain 2 months prior to her coming to the clinic. She was treated prior by another spinal practitioner for two consecutive sessions using spinal manipulation, which relieved her pain for 2 weeks. However, her current low back pain episode started 4 days earlier. The patient also reported suffering from "bad posture," which she described as, "a hunched back and rigid." The patient rated her LBP at 5/10 on average (0 = no pain; 10 = worst pain ever) and an 8/10 at worst. The patient scored 25% on the Revised Oswestry Chronic Low Back Pain Disability Questionnaire (ODI).
During the initial physical examination the patient reported pain and tenderness on palpation of the mid-cervical spine and lumbar region, paraspinal musculature felt taut and tender. Lumbar range of motion (ROM) was limited in forward flexion of about 60% (visually estimated) due to her hypertonic hamstrings. Cervical ROM was limited in both the right and left lateral flexion by 30% (visually estimated). All other orthopedic tests were unremarkable. Several spinal segmental fixations were identified in the cervical and lumbar region via segmental spinal motion palpation.
The patient brought with her a full spine standing radiographic assessment that included anterior-posterior (AP) and lateral cervical, thoracic, and lumbar images. The images were assessed and digitized using novel ASPINE Systems (Shanghai, China). The ASPINE System refers to a standard protocol for spinal diagnostic procedures and non-invasive multidisciplinary rehabilitation treatments. ASPINE Systems developed a novel digitizing image data collection and X-ray interpretation software. The lateral images were calculated via the Harrison Posterior Tangent (HPT) method, which measures the rotation between adjacent vertebrae using lines contiguous with the posterior margins of each vertebral body. The AP views are assessed via the Risser-Ferguson method, best fit lines from the assessed center of mass of each vertebra, and the Cobb Method, the gold standard for scoliosis measurement.
Several positive postural abnormal factors were identified including forward head shift as measured as the horizontal distance from the posterior superior C2 body to a line drawn from the posterior inferior C7 vertebral body; showed a large forward head. The lateral lumbar view showed an L1-L5 hyper lordosis of [-48.5  vs. -40 normal ]. A negative numeric value indicates the direction of the curvature; a negative value refers to a lordosis, a positive value indicates a kyphosis. Cervical lordosis from C2-C7 showed a reversal curve [+1  vs. -42  normal ]. The AP images showed a Risser Ferguson (RF) of 22  and a Cobb of 23  in her lumbar spine.
This case study occurred during the outbreak of COVID-19. By August 2020 China had already implemented quarantine and preventative measures all over the country, meaning COVID-19 did not delay or alter the course of the treatments.