Chiropractic Upper Cervical Atlas

Atlas Subluxation

The large central nerve that carries vital communication between the brain and every organ and gland of the body is the spinal cord. If interference occurs to the signals that travel along this central conduit from the central processing unit (the brain) the body is in some way unable to function correctly.

The most common (but not the only) level of subluxation that occurs in the spine is in the upper neck. This includes the articulations between the cranium (the occipital bone), the topmost vertebra in the spine (the atlas) and the second vertebra (the axis). The atlas is the most mobile vertebra in the spine. For this reason it is also the most common to subluxate (misalign) and put pressure on the major nerves of the spinal cord.

There are approximately 1 billion nerves traveling through the spinal cord. As you can imagine, the number of possible ways that a subluxation in the upper neck can affect these nerves and the number of possible health problems that can result are too numerous to count.

The atlas is important for several reasons. First, it supports the 10-12 pound head which is about the weight of a bowling ball. The atlas is where most of the motion for turning the head comes from. We've all had 100's of knocks, big and small, to our head throughout our lifetime which have resulted in some degree of atlas misalignment. When the atlas is out of balance and the head is crooked the brain's righting reflex (the reflex to keep the head level) reports this information to the rest of the body which forces the entire body out of balance in order to compensate. Misalignment of the atlas can also press on the brain stem.

Normally the body posture should be supported by passive structures of joints and ligaments. However, when there is structural imbalance the body is forced to recruit continuous muscular effort in order to maintain balance and movement in the body. Normally muscles are engaged for movement, but in this situation they are engaged in full time work to structurally support the body. Massive amounts of energy are called on to continually activate the muscular system in a way it is not indented to perform. Muscular fatigue and soreness is followed by general physical fatigue and ultimately a draining of vital energy and resources away from organ and glandular systems resulting in disorders in the hormonal, immunological, digestive, cardiovascular and other systems of the body.

The top two bones of the spine – atlas and axis – are the main pathway through which messages from the brain pass to the body; important messages that keep our body functioning properly, protecting us from disease, illness and injury.

The “atlas” is names after the Greek mythology figure that is pictured holding up the world holds up your head and your brain. The axis is named for its role in allowing the head and neck to turn. Unlike the joints of the other vertebrae spine which are interlocking, the joints of the atlas and axis are shaped differently. They don't have the same boney locks. Instead they are held in place by muscles and ligaments. As a results, our ability to freely move our head all around comes at a price of greater instability in this region. This makes us more susceptible to injury in this area.

Research has shown that many common health problems are improved or resolved when the bones of the upper neck are properly aligned. Misalignment here can cause pressure on the brain stem where delicate cranial nerves originate that control most of the basic physiology of our body.

The atlas bone is shaped like a doughnut with the spinal cord passing through the hole. The spinal cord exits the cranium through and opening called the foramen magnum, passes first through the atlas, then the axis and so on, down the spinal column. In the early days of chiropractic research it was thought that misalignment of the atlas or axis distorted the canal formed by the spinal cord causing interference to the delicate nerve fibers of the spinal cord. Recently there has been an important discovery of an even more direct anatomical relationship between the atlas and the spinal cord. In 1995 a dental researcher discovered that the rectus capitis posterior minor muscle (which attaches from the atlas to the occiput) also attaches to the dura mater, the outer lining of the spinal cord. This attachment is known as the myodural bridge. What this means is that even minor misalignment of the atlas can put direct pressure on the nerves of the spinal cord.

The main goal of chiropractic is to remove any interference on the nervous system. Even though new patients are often motivated to relieve a particular symptom such as a pain, the doctor and the patient must maintain their focus on restoring proper alignment of the spine and normal function to the nervous system. We're not treating for a particular condition. Our goal is to remove interference so your body can heal itself and get itself back to normal health. We're not chasing symptoms or chasing diseases. All healing resides within you. When we remove interference from the nervous system the body can have the best opportunity of healing the way it is supposed to. In this way chiropractic can aid the powerful innate healing process each of us has which affects everything from the top of you head to the bottom of your feet.

When the spine dislodges and can't pull itself back in it in can cause a vast array of problems. Rather than focusing our adjustments to where the pain is located, we focus on where the epicenter is. We assess the spine to determine the source of the problem rather than only focusing on the point of stress, inflammation or pain. The muscles of the body are controlled by the nervous system. They do not simply contract or spasm on their own. Treating muscles or taking medicine rather than correcting the interference on the nervous system is like using white-out on your computer screen. The real correction must be made at the source.

The following is a short list of problems that have been shown to be relieved or corrected with correction of upper cervical subluxations.

• Allergies
• High blood pressure
• Skin problems
• Stomach and digestive problems like ulcers, acid reflux and irritable bowel syndrome
• Brain disorders like anxiety, learning disorders, insomnia
• Sensory problems affecting vision, hearing
• Immune problems like ear infections and chronic fatigue
• Headaches including migraines
• Neurological problems including seizures, vertigo, fibromyalgia
• Spinal problems like back pain, sciatica, scoliosis and sports injuries
• Reproductive disorders and menstrual problems
• And other body problems like carpal tunnel syndrome, knee pain, foot problems

Categories of Atlas Subluxation

The signs of atlas subluxation are not difficult to see when you know what you're looking for. It's easy to see the major indicators just by looking at the patient from the back as they stand. However, accurately assessing and correcting the problem is a matter that requires considerable clinical insight, experience and technical skill. Many chiropractors have the experience of meeting someone at a social event and when they learn you're a chiropractor, for some inexplicable reason, they start to demonstrate the many ways they can “pop” their own neck and back. Perhaps it's good that I'm not a surgeon or their demonstration might quickly turn gruesome. At any rate, many people can “pop” their own spine by going into any number of physical contortions. This is a far cry from an adjustment. If you have ever played pool you know there are 10 thousand ways to hit the ball and still miss the pocket for every one way that makes it go in. Without the precise direction, amplitude and degree of force the subluxation cannot be effectively corrected. A chiropractic adjustment will often produce a popping sound, however this is merely the sound of the slight gap that occurs between joints when they are slightly stretched.

Research from the National Upper Cervical Chiropractic Association (NUCCA) has found that The Atlas Subluxation Complex produces several clinical indicators including misalignment of the head, atlas and cervical spine, imbalanced and overly contracted spinal muscles, postural distortion and a short leg phenomena. This is known as an “orthogonal” approach to atlas assessment. The term “orthogonal” in geometry refers to “right angles.” The goal of orthogonal techniques is to a align a vertical axis line through the skull in a right angle to a the horizontal line of the atlas vertebra which should be parallel to the ground. There are also non-orthogonal approaches to atlas subluxation. These techniques focus on the alignment of the individual joints that articulate the superior facets (joint surfaces) of the atlas with the cranium (occipital condyles).

It's essential for the doctor to determine both the category of subluxation along with the appropriate clinical indicators in order to make a correct adjustment and to objectively know that the adjustment has been effectively done.

Case Studies

Two of my recent patients are shown below. You can clearly see the postural alignment distortion between the head and neck that results from atlas subluxation. In both of these cases (but not in all cases) the left ear is elevated. Photos were taken immediately before and immediately after and atlas adjustment was peformed. The female patient was in a recent motor vehicle rear-end collision and was suffering from sharp, painful headaches. The male patient was suffering from chronic insomnia, headaches and lower back pain. In the male patient there is also considerable rotational misalignment which you can see by the more visible right jaw. Following adjustment the female patient had 100% correction. In the case of the male patient the unleveling distortion is completely corrected. The rotation distortion is reduced, but will require further adjustment.

Some cases of atlas subluxation will show dramatic and immediate correction like in these cases. If the condition is longer standing then there is often some ligamentous remodeling that requires a series of adjustments to correct.

Chiropractors: Straights and Mixers

One common approach to chiropractic is called "spinal manipulative therapy" (SMT). SMT has a general therapeutic effect on the spine including improving mobility, relieving local pain and reducing periarticular fibrosis (scar tissue buildup around the joints that leads to degeneration). Chiropractors with a purely SMT leaning tend to incorporate other kinds of physiotherapy in their practice like ultrasound, electrotherapy and exercise rehabilitation. They also tend to keep their practice focused solely on musculoskeletal pain. Because of this mixing of approaches these doctors are sometimes called "mixers" within the chiropractic profession.

Another approach is "vector specific adjusting" (VSA). With VSA the doctor specifically and acurately assess and corrects the vertebral subluxation for the purpose of removing interference from the central nervous system and restoring general health to the body. The effects of this approach are far reaching and account for many health benefits that aren't obviously related to the spine. These benefits can extend to the cardiovascular system, immune system, respiratory system, digestion, the endocrine (hormonal) system and more. This approach can also reduce musculoskeletal pain. This approach is often called "straight chiropractic."

In my own practice I lean heavily toward straight chiropractic. However, I also realize the benefit of general spinal hygeine with SMT. Some straight chiropractors tend to be dogmatic in their approach. For example, there are some chiropractors who adjust the atlas and nothing else. They claim that the atlas is the only bone you need to have adjusted and that if you get the atlas straight everything else will take care of itself. The atlas is certainly extremely important and you can achieve some incredible results by properly setting the atlas. However, I don't believe that my patient's health is limited to their atlas. I would never believe that my dental hygienist should just clean my incisors and that the rest of my teeth can take care of themselves.

There are also some chiropractors that only use a mechanical instrument for adjusting (e.g. the "Activator®"). This can achieve certain results, but over time it neglects the healthy spinal hygeine benefits of SMT. These instruments simply don't achieve the amplitude of movement needed to reduce the fibrotic changes in the joints that over time lead to decay. Patients that rely solely on a doctor that does only straight upper cervical adjusting or instrument (Activator®) adjusting are missing a huge part of their much needed spinal care.

In my practice I center on straight chiropractic (VSA). However, for the general health and maintainence of the spine I also use the SMT approach in which I use both Western and Japanese style spinal manipulation along with muscle and soft tissue therapy. In this way my patients get the healthy benefits as well as the pain relief of both approaches.

What Causes Atlas Subluxation?

The combination of the weight of the human head, which is the weight of a bowling ball, combined with the highly mobile atlas and axis vertebrae make the upper cervical spine the most vulnerable place for injury and misalignment in the spine. Children are especially vulnerable because their head is proportionally larger compared to their neck. We are all exposed to many bumps, falls and impacts throughout our life. Most people have some degree of atlas subluxation just like they have some degree of plaque on their teeth. It's nearly universal. It's not desirable. And, like plaque, it causing problems when it goes uncorrected.

Many chiropractors believe that first subluxation often occurs at birth with the rather forceful manner in which babies are often delivered. Dr. G. Gutmann, a German medical researcher, discovered that over 80% of the infants examined shortly after birth were suffering from injury to the cervical spine, the neck, causing a variety of health problems.

Dr. Abraham Towbin, of the Harvard Medical School Department of Neuropathology, presented research at the Eighteenth Annual Meeting of the American Academy For Cerebral Palsy that he found "the birth process, even under optimal conditions, is potentially a traumatic, crippling event for the fetus. Spinal cord and brain stem injuries occur often during the process of birth but frequently escape diagnosis." Dr. Towbin also stated that "death may occur during delivery or, with respiratory function depressed, a short period after birth. Infants who survive the initial effects, may be left with severe nervous system defects." Dr. Towbin also states that, "During the final extraction of the fetus, mechanical stress imposed by obestetrical manipulation - even the application of standard orthodox procedures - may prove intolerable to the fetus."

Traction forces as strong as 67 pounds have been recorded during the delivery of babies. In a study of tensile strength of the newborn spinal column it was found that traction of 90 pounds is enough to cause separation of the cranium from the cervical spine - essentially decapitation. Dr. J.M. Duncan, a vascular surgeon and the principle investigator in this study, commented, "This [amount force] is probably far from being what most obestetricians would regard as a great force."

I find that of those that get through the birth process without obvious injury, most have upper cervical alignment issues. If these are not corrected the babies nervous system, immune system and organ functions will be continually impaired creating health problems that can confound both parents and pediatricians.

It is very important that all children be examined by a qualified chiropractor soon after birth. The Atlas Subluxation Complex Syndrome produces effects that reach far beyond the upper neck. This problem can affect the central nervous system and the peripheral nervous system which can in turn produce adverse and unhealthy changes in any organ, gland or tissue in the body. Even many common childhood problems like colic and earaches will often improve very quickly when underlying spinal nerve problems are corrected.

A simple home check

Here is an easy way for anyone to see one possible effect of atlas subluxation:

• Have the subject lie face down on a bed with their shoes on.
• Hold their feet flat and side by side as you look straight down at the top edge of the shoe heals. Don't compare the bottom of the heals as they may have worn unevenly.
• Note any inequality in the leg lengths with face looking straight toward the floor. An uneven leg length at this point can mean that the spine or pelvis could be out of alignment at any level. It could also mean that the subject simply has one leg that is anatomically shorter than the other (although this is not very common). Uneven leg length at this point is a non-specific finding.
• Have the subject turn their head to the left and note any change in comparative leg length at the top of the heels.
• Now have them turn their head to the right and note any change in length.

The subject should be able to turn their head left and right without their leg lengths changing. If the subject turns their head and you see either..

• The previously even legs become uneven
• The previously uneven legs become even
• A short leg on one side change to a short leg on the other side

...then you are looking at the effects of spinal pressure in the upper neck and there is a high probability that the atlas is subluxated.

Correcting The Atlas Subluxation

Atlas subluxations can include a combination of lateral (sideways) misalignment coupled with rotational misalignment along with superior (upward) or inferior (downward) tipping. Precise assessment of the misalignment is the first step in correcting the atlas.

The doctor must gather information on the patient including postural assessment (either using x-rays or anatometric assessment), paraspinal thermography, paraspinal surface electromyography, motion palpation, leg length differential checks and muscle testing we can determine the specific listing of the atlas. I do not routinely x-ray every patient. There are other chiropractic doctors who are adamant about x-rays for every patient. My preference is to employ only non-invasive assessments unless there is some medical reason to x-ray the patient.

In the chiropractic profession we have several well recognized notational methods to record the level and direction(s) of subluxation. These notations are referred to as “listings.” In applying the correct adjustive force to make an effective correction this three-dimensional combination of laterality, rotation and tipping must be reduced to a single, very specific vector line. Randomly twisting the neck or bending it to the side and popping it will not correct the alignment. In many cases this kind of general manipulation, whether it's done by you or by someone else, can actually make the problem worse.

The correction of an atlas subluxation can be very gentle or it can require a small amount of force to overcome the resistance that the misaligned joints produce. In the case of infants and small children the correction is done with an exquisitely small amount of pressure.

Holding The Correction

There are two factors that must be overcome in order for an adjustment to “hold.” One is the remodeling of ligaments, muscles and other soft tissues that are holding the vertebra out of place. In this sense it is very much like the work of an orthodontist in straightening teeth. If there is a significant amount of ligament remodeling that needs to occur (typically because of the long time the subluxation has been present) then it can take a number of adjustments over several months to restore proper alignment. If you wonder that it might take a little time to correct certain problems realize that it can take 2 years or more with braces to move a tooth a mere fraction of an inch! Corrected the spine is much faster than this.

The other factor in getting an adjustment to hold is the nervous system itself. Your brain contains a map of your entire body along with a neurological “GPS system” that allows it to locate and align all your moving parts. This system is called the proprioceptive system and it's how you're able to touch your own nose with your eyes closed. With a long standing subluxation the GPS system has adapted to the faulty alignment. With each adjustment the nervous system has an opportunity to recalibrate its internal GPS to the correct alignment.

If you are an adult that has been subluxated for a long time (possibly since birth) then you will very likely require a series of adjustments to overcome the combination of acquired ligament imbalance and faulty neurology to restore proper balance and function to the spine and nervous system.

Dr. Philip Greenwood, D.C.
Murrieta, California