Individuals that sit at a desk/workstation for hours for work or school, or drive for a living, could be fostering a long-term condition known as forward head posture. Can understanding the signs and symptoms help to prevent the condition?
Forward Head Posture
Neck pain often causes or is caused by misalignment in the area between the shoulders and head. Forward head posture is a common problem that can strain the neck muscles, leading to pain and worsening neck, shoulder, and back posture. (Jung-Ho Kang, et al., 2012) For individuals who are at risk of developing or are already showing signs/symptoms, it’s important to get medical attention to prevent complications, such as chronic neck pain or compressing a nerve. Individuals can continue to do the work that they need to do but may need some postural adjustments and re-training so as not to continue straining the neck while working.
Postural Deviation
The head is in a healthy alignment with the neck when the ears line up with the gravity line.
The gravity line is an imaginary straight line that represents gravity’s downward pull.
It is used in posture assessments as a reference for noting the positions of the body and determining the presence of any postural misalignment or deviation.
A forward head posture occurs when the head begins to position forward of the gravity line when looking at the body from the side.
Forward head posture is a postural deviation because the head varies from the reference line. (Jung-Ho Kang, et al., 2012)
Muscle Imbalances
Forward head posture often results in a strength imbalance between muscles that support and move your neck, shoulders, and head. (Dae-Hyun Kim, et al., 2018)
The muscles in the back of the neck become shortened and overactive as they flex forward, while the muscles in the front become lengthened, weaker, and strained when they relax.
Kyphosis
Kyphosis also known as hunchback is when the shoulders round forward, and the head is also brought forward. (Jung-Ho Kang, et al., 2012) After many hours sitting at a desk, computer, or driving, kyphosis can also cause and/or worsen forward head posture.
This occurs because the upper back area supports the neck and head.
When the upper back moves or changes position, the head and neck follow.
The majority of the head’s weight is in the front, and this contributes to the forward movement.
An individual with kyphosis has to lift their head to see.
Treatment
A chiropractic injury specialist team can develop a personalized treatment plan to relieve pain symptoms, provide postural retraining, realign the spine, and restore mobility and function.
Standing and sitting using a healthy posture, along with exercises to strengthen the neck muscles, can help get the spine in alignment. (Elżbieta Szczygieł, et al., 2019)
Targeted stretching can help if the neck muscles are tight.
At-home stretches may also relieve pain
Risk Factors
Pretty much everyone is at risk of developing a forward head posture. Common risk factors include:
Constantly looking down at a phone and staying in this position for a long time aka text neck.
Desk jobs and computer use can significantly round the shoulders and upper back, leading to a forward head posture. (Jung-Ho Kang, et al., 2012)
Driving for a living causes prolonged back, neck, and shoulder positioning.
Sleeping or reading with a large pillow under the head can contribute to forward head posture.
Doing work that requires dexterity and close-up positions, like a seamstress or technician can cause over-positioning of the neck.
Individuals who regularly carry a significant amount of weight in front of their body may begin to develop kyphosis.
An example is carrying a child or another load in front of the body.
Large breasts can also increase the risk of kyphosis and forward head posture.
Neck Injuries
References
Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98–104. doi.org/10.5535/arm.2012.36.1.98
Kim, D. H., Kim, C. J., & Son, S. M. (2018). Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong public health and research perspectives, 9(6), 309–313. doi.org/10.24171/j.phrp.2018.9.6.04
Szczygieł, E., Sieradzki, B., Masłoń, A., Golec, J., Czechowska, D., Węglarz, K., Szczygieł, R., & Golec, E. (2019). Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health, 32(1), 43–51. doi.org/10.13075/ijomeh.1896.01293
Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.
As humans, there are a variety of stressors experienced daily. Stress collects in various body areas, most commonly the upper back, jaw, and neck muscles. Stress leads to tension in the muscles. The built-up tension can cause the spinal bones to shift out of alignment, irritating the nerves between the spinal bones. A cycle begins as increased nerve tension causes the muscles to continue to contract/tighten. The extra muscle tension continues to pull the spinal bones out of alignment, making the spine stiff and less flexible affecting posture, balance, coordination, and mobility, causing the spine to become further unstable. Chiropractic treatment at regular intervals is recommended to help realign and maintain proper position.
Why The Spine Goes Out of Alignment
The nerves in the body are intricately linked to the spinal cord, and small distortions in the alignment can cause nerves to misfire and malfunction. When the spine goes out of alignment, the nervous system/brain and nerves get stuck in a stressed or tense state. Even a minor misalignment can cause a series of discomfort symptoms to travel throughout the body.
Causes
Causes of misalignment that creates tension in the nerves and muscles include:
A chiropractor will feel/palpate the spine to see if the bones are in alignment, move well, or are out of alignment and not moving correctly or moving at all.
Posture Exam
If the head, shoulders, and hips are uneven or the shoulders and head are pulling forward, the spinal bones are out of alignment/subluxations.
Balance and Coordination
Unhealthy balance and coordination can indicate the brain, nerves, and muscles are malfunctioning by spinal misalignment.
Range of Motion
A loss of spinal movement flexibility can show tension in the nerves, muscles, and misalignments.
Muscle Test
Loss of strength in a muscle can indicate the nerve signals are weak.
Orthopedic Tests
Tests that put the body in stressful positions focus on what tissue/s may be injured and the causes.
X-rays
X-rays look for abnormalities, dislocations, bone density, fractures, hidden/invisible injuries, and infections.
Injury Medical Chiropractic and Functional Medicine Clinic provide personalized treatment plans. These specific therapies are made to generate long-term spine benefits. Spinal manipulation, deep tissue massage, MET, and other manual therapy techniques, combined with exercise, help get the bones moving properly, the muscles functioning correctly, and the spine back into proper form. Treatment relieves muscle spasms, tension, and joint dysfunction, increases circulation, and retrains the muscles to remain relaxed.
The Natural Way to Heal
References
Ando, Kei et al. “Poor spinal alignment in females with obesity: The Yakumo study.” Journal of Orthopaedics vol. 21 512-516. 16 Sep. 2020, doi:10.1016/j.jor.2020.09.006
Le Huec, J C et al. “Sagittal balance of the spine.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 28,9 (2019): 1889-1905. doi:10.1007/s00586-019-06083-1
Meeker, William C, and Scott Haldeman. “Chiropractic: a profession at the crossroads of mainstream and alternative medicine.” Annals of internal medicine vol. 136,3 (2002): 216-27. doi:10.7326/0003-4819-136-3-200202050-00010
Oakley, Paul A et al. “X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks.” Dose-response: a publication of International Hormesis Society vol. 16,2 1559325818781437. 19 Jun. 2018, doi:10.1177/1559325818781437
Shah, Anoli A, et al. “Spinal Balance/Alignment – Clinical Relevance and Biomechanics.” Journal of biomechanical engineering, 10.1115/1.4043650. 2 May. 2019, doi:10.1115/1.4043650
Postural dysfunction happens when unhealthy postures are practiced and maintained for prolonged periods. This can occur in any sitting, standing, or lying down position and is a major factor in musculoskeletal injuries. Injuries related to poor posture are normally caused by overuse that builds up over time. When the body starts to go out of alignment, the muscles must work harder to compensate, which further strains the body. This stress can lead to soft tissue injury and excess joint wear and tear. These injuries start as minor aches and pains in the short term. However, if left untreated, they can lead to chronic conditions. Injury Medical Chiropractic and Functional Medicine Clinic can rehabilitate the body to optimal function and provide postural training.
Postural Dysfunction
Posture is how the skeleton and muscles hold the body in a healthy position while standing or sitting, affecting breathing, muscle growth, and mobility. Practicing healthy posture means:
The bones are properly aligned.
The muscles, joints, and ligaments function correctly.
The organs, like the stomach, kidneys, and GI tract, are in the right position and can work efficiently.
The nervous system can operate at its full potential.
This allows the body to have:
More energy.
More room for the lungs to expand.
Experience less stress.
Alleviate muscle fatigue.
Achieve physical fitness.
Imbalance Causes
Unhealthy body positioning causes imbalances in muscle strength that pull the body out of alignment. This leads to muscles becoming tight/shortened and others becoming weak/lengthened, and it can also cause internal organ problems. For example, individuals that slump excessively cause the abdomen to compress, crowding the stomach and intestines, which leads to digestive issues. Postural dysfunction can be caused by the following:
Stress and strain from day-to-day activities.
Job responsibilities that involve sitting/standing for long periods and/or repetitive tasks like bending, lifting, reaching, twisting, etc.
Unhealthy driving position.
Non-supportive footwear.
Joint stiffness usually of the neck, upper and lower back, and hips.
Sedentary habits.
Lack of physical activity and exercise.
Muscle tightness.
Muscle weakness.
Weakened core stability.
Inadequate or failed post-surgical recovery.
Effects
Decreased blood circulation resulting in fatigue.
Overuse Injuries.
Breathing difficulties.
Balance issues.
Knee pain.
Joint misalignment.
Increased strain on the spine.
Compression of discs and joints.
Neck pain.
Lower back pain.
Less space for nerves to move due to compression.
Nerve problems.
Piriformis syndrome.
Shoulder impingement.
Chiropractic Rehabilitation
Chiropractic treatment for postural dysfunction provides adjustments, massage and decompression therapy, targeted stretching and exercises, retraining movement patterns, and nutritional and health coaching. Personalized treatment plans can include the following:
Targeted stretches and exercises to maintain posture correction.
Fix Posture
References
Korakakis, Vasileios, et al. “Physiotherapist perceptions of optimal sitting and standing posture.” Musculoskeletal science & practice vol. 39 (2019): 24-31. doi:10.1016/j.msksp.2018.11.004
Lee, Yongwoo, and Ki Bum Jung. “Effect of Physiotherapy to Correct Rounded Shoulder Posture in 30 Patients During the COVID-19 Pandemic in South Korea Using a Telerehabilitation Exercise Program to Improve Posture, Physical Function, and Reduced Pain, with Evaluation of Patient Satisfaction.” Medical science monitor: international medical journal of experimental and clinical research vol. 28 e938926. 27 Dec. 2022, doi:10.12659/MSM.938926
Shih, Hsu-Sheng, et al. “Effects of Kinesio taping and exercise on forward head posture.” Journal of back and musculoskeletal rehabilitation vol. 30,4 (2017): 725-733. doi:10.3233/BMR-150346
Snodgrass, Suzanne J et al. “Relationship between Posture and Non-Contact Lower Limb Injury in Young Male Amateur Football Players: A Prospective Cohort Study.” International journal of environmental research and public health vol. 18,12 6424. 14 Jun. 2021, doi:10.3390/ijerph18126424
Zhao, Mingming, et al. “Driver posture monitoring in highly automated vehicles using pressure measurement.” Traffic injury prevention vol. 22,4 (2021): 278-283. doi:10.1080/15389588.2021.1892087
Subluxation is when a joint shifts out of alignment, which can happen to any joint in the body. Spinal subluxation indicates a misalignment of one or more portions of the spinal vertebrae. It is common in the spine from all the reaching, bending, twisting, and flexing the body goes through. Spinal subluxations, if left untreated, can cause disc degeneration, permanent nerve damage, neurological conditions, and chronic pain symptoms. A subluxation chiropractor will realign and decompress the spine combined with massage therapy to relax the muscles and restore mobility and function.
Subluxation Chiropractor
Some subluxations don’t cause any problems or pain, but that doesn’t mean they aren’t affecting the back and body. A spinal subluxation can cause long-term problems by:
Research shows that spinal subluxations can affect many facets of the body. Long-term effects may include:
Sleep problems
Low energy
Brain fog
Mood swings
Anxiety and depression
Digestive issues
Respiratory problems
Bone spurs
Spinal arthritis
Chiropractic Care
When the spine is out of alignment, it can cause issues throughout the body. Changes in one area affect the rest of the body. A subluxation chiropractor looks at the spine’s neurological and mechanical components and aims to reset everything back into its proper position. Similar to the way a massage helps the mind and body relax and de-stress, a spinal adjustment helps by:
Increasing circulation
Relieving discomfort and pain
Releasing tension
Improving mood
Reducing stress levels
Improving sleep function
Increasing energy levels
When the spine is properly aligned, the body can operate at its full potential.
Green, J D et al. “Anterior subluxation of the cervical spine: hyperflexion sprain.” AJNR. American journal of neuroradiology vol. 2,3 (1981): 243-50.
Meyer, S. “Thoracic spine trauma.” Seminars in roentgenology vol. 27,4 (1992): 254-61. doi:10.1016/0037-198x(92)90004-l
Neva MH, Häkkinen A, Mäkinen H, et al. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopedic surgeryAnnals of the Rheumatic Diseases 2006;65:884-888.
Nourollahi, Maryam, et al. “Awkward trunk postures and their relationship with low back pain in hospital nurses.” Work (Reading, Mass.) vol. 59,3 (2018): 317-323. doi:10.3233/WOR-182683
Vernon, Howard. “Historical overview and update on subluxation theories().” Journal of chiropractic humanities vol. 17,1 (2010): 22-32. doi:10.1016/j.echu.2010.07.001
Uneven hips can throw the back out of natural alignment and cause back stiffness, tightness, discomfort, and pain. Hips that are off-balance unhealthily affect standing, sitting, sleeping posture, walking gait, and overall movements. Biomechanics issues cause the core and spine stabilizing muscles to become weakened and fatigued from overcompensating to keep the body up and moving. Over time this can lead to chronic pain in the back, hips, knees, and feet. Chiropractic care can restore proper hip and spinal alignment and wellness.
Uneven Hips
Misaligned hips can be caused by work or sports injury, exercise, vehicle collision, and/or general wear and tear. When hips are out of alignment, they have shifted from their centered position. They could be rotated forward or backward, forcing the spine and the lower limbs to compensate, resulting in the spine tilting that can make the legs appear uneven. Discomfort may be one-sided low back pain near the sacroiliac joint, causing a stiff/tight back, limited motion, and/or pain symptoms. Because the spine and lower limbs have to compensate for the unevenness, the shoulders and upper back, connected to the pelvis through the spine, are also affected and result in:
Back pain.
Hip and gluteal muscle pain.
Uneven leg length.
Knee, ankle, and foot issues and pain.
Uneven shoulders.
The shoulder blades can stick out on the side of the lower hip.
Rib discomfort and pain.
The rib cage could protrude out on one side. However, this could be due to advanced scoliosis.
Therapy
Staying active is recommended and includes stretching and core strengthening. General stretches recommended to optimize hip equity include:
Hamstring stretch
For this stretch, lie on a flat surface with your legs extended straight out.
Bend the right leg at the knee, placing the right foot on the ground.
Use a towel, belt, or band to grab and wrap around the left foot.
Keep the hip/buttock on the left side planted on the floor.
Slowly raise the left leg upward as far as possible until you feel the stretch.
Once you feel a stretch or restriction in the hamstring, hold the position for 30 seconds.
Repeat on the other side.
Perform 2 to3 times.
Hip flexor stretch
Kneel on the affected leg and bend the healthy leg out in front with the foot flat on the floor.
Back straight.
Slowly push the hips forward until you feel the stretch in the upper thigh and hip.
Hold the stretch for around 15 to 30 seconds.
Chiropractic Care
Chiropractic treatment is a highly recommended non-surgical option for uneven hips and pelvic tilt. Depending on the severity of the misalignment, underlying issues, and body scanning images, hip alignment treatment could include:
Soft tissue therapeutic massage
Chiropractic muscle release for tight hip flexors, quadriceps, hamstrings, and glutes.
Kiapour, Ali et al. “Biomechanics of the Sacroiliac Joint: Anatomy, Function, Biomechanics, Sexual Dimorphism, and Causes of Pain.” International journal of spine surgery vol. 14, Suppl 1 3-13. 10 Feb. 2020, doi:10.14444/6077
Lee, Jeong-Hoon, et al. “The effect of Graston technique on the pain and range of motion in patients with chronic low back pain.” Journal of physical therapy science vol. 28,6 (2016): 1852-5. doi:10.1589/jpts.28.1852
Patel, Rikin V et al. “Pelvic Tilt and Range of Motion in Hips With Femoroacetabular Impingement Syndrome.” The Journal of the American Academy of Orthopaedic Surgeons vol. 28,10 (2020): e427-e432. doi:10.5435/JAAOS-D-19-00155
Rivière, C et al. “Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review.” Orthopaedics & traumatology, surgery & research : OTSR vol. 103,4 (2017): 549-557. doi:10.1016/j.otsr.2017.03.010
Suits, William H. “Clinical Measures of Pelvic Tilt in Physical Therapy.” International journal of sports physical therapy vol. 16,5 1366-1375. 1 Oct. 2021, doi:10.26603/001c.27978
The ribs are designed to protect the lungs and heart and assist breathing. Twenty-four ribs start at the shoulders in the thoracic spine region and run down the mid-back covering the front, back, and side of the chest. Almost all ribs are attached in two places, including the spine in the back and the sternum in the front of the chest, by cartilage joints. Trauma, poor posture, intense coughing, sneezing, and heaving are a few factors that can cause mechanical rib dysfunction or rib misalignment.
Rib dysfunction and misalignment are typically caused by unhealthy postures like slumped back and rounded shoulders, weakened posterior muscles, and repetitive stress from work, sports, and intense physical activity. Any ribs can become misaligned, causing dysfunction and stress on the body. A chiropractor can adjust and reset the rib as they do for misaligned and compressed spinal joints.
Rib Cage Design
The ribcage is flexible and expands when inhaling. Each rib is attached to the spine by three joints in the back and the breastbone in the front. Breathing is an involuntary reflex that is impossible to avoid movement in these joints. The joints are small but allow flexing, so the ribs rise and fall with each breath. These rib joints can become inflamed from rib misalignment causing movement problems that can restrict breathing.
Rib Misalignment
Rib misalignment symptoms can include:
Difficulty breathing.
Difficulty when trying to sit up.
Dull, achy, deep pain next to the spine or under the shoulder blade.
Unexplained back pain.
Pain when moving or walking.
Painful sneezing and/or coughing.
Tenderness and pain in the front of the chest.
The formation of a lump over the affected rib.
Swelling and/or bruising in the region.
Numbness in nearby or surrounding ribs.
Radiating pain from the back to the front and vice versa.
Improvement when pressure is applied to the affected rib.
Rib Dysfunction
Up to 50% of emergency room visits for chest pain symptoms result from non-cardiac factors, with the majority being rib misalignment and the muscles and joints around the rib cage becoming irritated/inflamed.
Causes
There can be several reasons for a misaligned rib. The more common causes include:
Unhealthy Postures
Unhealthy postures stress the body that can place pressure on the posterior portion of the ribcage.
With time, the ribs can start to shift out of alignment.
Physical Activity, Exercise, and Sports
Working out intensely can cause the ribs to shift out of position.
Weight lifting improperly can cause the body to shift along with the muscles involved not being strong enough to handle the added weight and movement, causing rib misalignment.
Pregnancy
As a woman’s body changes, the weight shifts to the front.
This can create a downward pull on the rib cage, increasing misalignment risk.
Intense Coughing or Sneezing
Excessive or severe coughing, associated with asthma, bronchitis, or pneumonia, can significantly strain the ribcage.
Coughing from a common cold can generate stress to cause a rib to dislocate.
Sneezing hard can also cause a rib to shift out of place.
Illnesses associated with constant coughing and sneezing can increase an individual’s susceptibility to rib misalignment because of the weakened state of the muscles.
Intense Vomiting
Vomiting intensely or heaving can cause the condition.
Vomiting does not necessarily involve the lungs, but the convulsive action can cause a rib shift/pop out.
Chiropractic Treatment
Chiropractic can diagnose and treat rib misalignment/dysfunction by using various stretching or massage techniques to loosen the area, making the muscles more flexible, then applying firm pressure to realign the rib back. The treatment plan will include specific stretches, postural exercises, diet, and other recommendations to prevent rib problems.
Spinal Decompression In 90 Seconds
References
Flodine TE, Thomas M. Osteopathic Manipulative Treatment: Inhaled Rib Dysfunction. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK560751/
Jawed, Muzamil. and Bruno Bordoni. “Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs.” StatPearls, StatPearls Publishing, 19 February 2022.
It is one thing to wake up with back pain, but another when the pain is combined with a fever, body aches, and chills. It could be the flu or another infection. However, after checking the body’s temperature and fever is present with no other symptoms than back pain unless it is the flu; the fever could be another issue that may or may not be related as there are a variety of causes for back pain like:
Muscle or ligament strain – If in poor physical condition, repeated and constant tension on the back can cause muscle spasms. Repeated heavy lifting or a sudden awkward movement can strain the back muscles and spinal ligaments.
Bulging or ruptured discs – Discs act as cushions between the bones/vertebrae in the spine. The soft material inside a disc can bulge or rupture and press on a nerve. However, a bulging or ruptured disc can present without back pain. Disc disease is often found by accident when spine X-rays are performed for another reason.
Arthritis – Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can narrow the space around the spinal cord, a condition called spinal stenosis.
Osteoporosis – The spine’s vertebrae can develop painful fractures if the bones become porous and brittle.
Back pain without a fever is usually an indication of a misaligned spine.
Fever A Sign of Something Else
A fever is the body’s way of trying to raise its core temperature in an attempt to kill off a virus or a bacterial infection. Possible causes of back pain with fever include:
Kidney Infection
This type of infection often presents with low back pain and fever.
Spinal Epidural Abscess
This is an infection of the lower region of the spine, causing fever and lower back pain.
Vertebral Osteomyelitis
This is an infection of the lower spine that causes pain in the arms, lower back, and legs, along with a fever.
Meningitis
This causes swelling and inflammation of the brain and spine and needs to be addressed immediately.
Spinal Cord Abscess
This is an infection of the internal part of the spine. It is rare but can happen, causing low back pain and fever.
Symptoms
This is when seeing a chiropractor can help. A few signs that should not be ignored include:
Recently involved in an automobile accident.
Suffered a serious fall.
Feeling a tingling in the legs.
Having balance issues.
Having abdominal pain.
Pain is not going away, or it goes away for a while, then comes back.
Have weakness in the arms or legs.
Having bowel or urinary problems that were not present previously.
The pain is worse when sitting or standing up after sitting.
Have upper back pain after alcohol consumption.
A chiropractor will take a complete medical history, X-rays, an MRI if necessary, and a thorough physical examination will be performed to determine the cause. After a diagnosis is reached, the chiropractor will perform adjustments to relieve the pain and open the nerve pathways to increase circulation to the area. A chiropractic massage will help reduce stress, relieve back pain, and reduce depression, which can also help reduce the fever unless it is from another issue.
Body Composition
Influenza
Influenza or the flu is a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. It can cause mild to severe illness and, in extreme cases, can lead to death. Like a common cold, the flu is spread primarily through tiny droplets that get expelled from an infected person when they sneeze, cough, or talk. Approximately 8% of the population gets the flu each season. Flu symptoms are sudden, causing the following:
Fever
Chills
Muscle or body aches
Headaches
Sore throat
Runny or stuffy nose
Cough
Fatigue
Vomiting and diarrhea which is more common in children.
Most individuals with healthy immune systems will recover around seven days. However, the elderly, pregnant women, individuals of any age with certain chronic medical conditions like asthma, diabetes, or heart disease, and children under the age of five have an increased risk of developing complications. Flu vaccination is currently recommended for anyone older than six months in the U.S. and effectively prevents infection in 50 – 80% of the population. The primary treatment method for the flu is to support the immune system with plenty of rest, proper nutrition, and hydration.
References
Ameer MA, Knorr TL, Mesfin FB. Spinal Epidural Abscess. [Updated 2021 Feb 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441890/
Kehrer, Michala et al. “Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population.” The spine journal: official journal of the North American Spine Society vol. 15,6 (2015): 1233-40. doi:10.1016/j.spinee.2015.02.021
Rubin, Devon I. “Epidemiology and risk factors for spine pain.” Neurologic clinics vol. 25,2 (2007): 353-71. doi:10.1016/j.ncl.2007.01.004
Tsantes, Andreas G et al. “Spinal Infections: An Update.” Microorganisms vol. 8,4 476. 27 Mar. 2020, doi:10.3390/microorganisms8040476
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