Cervical lordosis is the forward curve of the neck seen on a side-view X-ray. There is no single normal number, because the value depends on how it is measured and on who was studied. Published averages for people without neck pain fall roughly in the 27 to 35 degree range depending on the method, and people with neck pain tend to measure lower on average. Whether a lower curve causes pain in a given person is a separate and contested question. I explain both parts to patients in Charlotte before showing them their own films.
Two Ways to Measure the Curve
The Cobb method draws lines along the endplates of C2 and C7 and measures the angle between them. The posterior tangent method draws lines along the back of each vertebral body and sums or compares them. The same neck gives different numbers by each method. In one study, normal subjects averaged 34.5 degrees between the C2 and C7 posterior tangents but 26.8 degrees by the C2-C7 Cobb method (Harrison, Spine 2004). A report that gives a number without naming the method cannot be compared with another report.
What the Comparison Studies Report
That 2004 study compared 72 people without neck pain, 52 with acute neck pain, and 70 with chronic neck pain, all without kyphotic segments. Average posterior tangent angles were 34.5, 28.6, and 22.0 degrees respectively, and Cobb angles were 26.8, 16.5, and 12.7 degrees (Harrison, Spine 2004). In a separate analysis of 277 radiographs, patients with a lordosis of 20 degrees or less were more likely to have neck symptoms, and the authors proposed 31 to 40 degrees as a clinically normal range (McAviney, J Manipulative Physiol Ther 2005). Both groups of authors are affiliated with Chiropractic Biophysics, a technique that treats curve restoration as a goal.
A Swiss study of 107 adults over age 45 found no significant difference in total curvature, segmental angles, or the frequency of a straight or kyphotic neck between people with and without neck pain in the past year (Grob, Eur Spine J 2007). The authors concluded those findings should be considered coincidental in a patient with neck pain.
How to Read the Disagreement
The studies differ in age, selection, and method. The Harrison and McAviney data come from mixed-age clinical populations; the Grob study enrolled only older adults. Both lines of evidence are cross-sectional, so neither shows that a curve causes or does not cause pain. The fair statement is that groups with neck pain often measure lower on average, and that an individual's curve on one film does not by itself explain their symptoms.
Motion Matters Too
A resting curve is one measurement. How the segments move is another. In 75 normal subjects, nearly all angular differences between levels in flexion were under 7 degrees (Lin, Spine 2001). A neck can have an average curve and an abnormal segment, or a flat curve and normal motion.
How I Report It
I name the method, report the C2-C7 value, note any segmental kyphosis, and compare with prior films when they exist. I do not call a curve abnormal on its number alone, and I do not tell a patient their pain comes from it without matching findings on exam.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read the published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient by Dr. Justin Dick, DC.
Frequently Asked Questions
What is a normal cervical lordosis?
There is no single normal value. Averages for people without neck pain were 34.5 degrees by posterior tangents and 26.8 degrees by the Cobb method in one study (Harrison, Spine 2004).
How is cervical lordosis measured?
By the Cobb method, using the endplates of C2 and C7, or by the posterior tangent method, using the back of each vertebral body. The two give different numbers for the same neck.
Is a low neck curve linked to neck pain?
Some studies found people with neck pain measured lower on average (Harrison, Spine 2004; McAviney, J Manipulative Physiol Ther 2005). A study of adults over 45 found no difference (Grob, Eur Spine J 2007).
What cervical lordosis is considered clinically normal?
One study proposed 31 to 40 degrees by the posterior tangent method (McAviney, J Manipulative Physiol Ther 2005). Its authors are affiliated with Chiropractic Biophysics.
How does Dr. Justin Dick, DC report the neck curve?
Dr. Justin Dick, DC in Charlotte, NC names the measurement method, reports the C2-C7 value and any segmental kyphosis, and compares with prior films.
Where can I get a cervical alignment evaluation in Charlotte, NC?
Dr. Justin Dick, DC, CLEAR Institute Senior Fellow and CNMT, ARRT(N)(CT), sees patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Wy, Ste 103, Charlotte, NC 28278, phone 980-368-0766.
Sources and Evidence Tiers
- Harrison DD, Harrison DE, Janik TJ, et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine. 2004;29(22):2485-2492. PMID 15543059. LinkEvidence tier: Cross-sectional comparison (194 subjects); CBP-affiliated authors
- McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005;28(3):187-193. PMID 15855907. LinkEvidence tier: Cross-sectional radiographic study (277 radiographs); authors include CBP NonProfit affiliation
- Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16(5):669-678. PMID 17115202. LinkEvidence tier: Cross-sectional comparison (107 adults over 45)
- Lin RM, Tsai KH, Chu LP, Chang PQ. Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine. 2001;26(3):256-261. PMID 11224861. LinkEvidence tier: Cross-sectional normative study (75 subjects)
About the author. Dr. Justin Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as a field doctor for Life, Sherman, and Palmer chiropractic colleges. ORCID: 0009-0001-2794-2159.
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Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
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- Personal injury and car accident spinal care in Charlotte
- Research by Dr. Justin Dick, DC
- Case report: refractory lumbar pain after a motor vehicle accident
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8814 Rachel Freeman Wy, Ste 103
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Phone: 980-368-0766
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