I received a comment on recent post basically asking, "When should a general/full-spine Chiropractor refer a patient to an Upper Cervical Doctor?" What indicators should they look for in a patient to know when they should perhaps be evaluated by an Upper Cervical Doctor?
I listed some of these in a post back in December called Signs And Symptoms Of An Upper Cervical Injury.
Here they are again:
1. Is your posture poor? Do you have rounded shoulders &/or forward head posture? Does your head feel heavy to hold?
2. Is your head tilted to one side and/or your head rotated to one side when you look in a mirror? This can be very subtle.
3. Does your nose or nasal septum deviate to one side? If so, you may find that it deviates towards the side to which your atlas has moved forward (e.g. nose deviates to the left; then atlas is forward on the left)
4. Is one of your shoulders lower than the other? Pull your shoulders back and down and look carefully for one lower than the other. Again it can be subtle.
5. Press firmly but gently with your thumb into the impression just below your skull at the top of your neck on both sides of the back of the neck. This is known as the sub-occipital area. Find the base of your skull and press the soft flesh around that area. Is this tender or painful for you?
6. Do you have some shoulder and/or neck pain/aches, which don't seem to go away?
7. Does your jaw click when you open your mouth? Further check on this; Put your pinkies (little fingers) into your ear canals and chew normally. Do you feel a bumpy dislocation like feeling? This should be a smooth action in your joints.
8. Do you have any lower back pain or mid back pain (under the shoulder blades)?
9. Can you move your head from side to side without pain or restriction? Is there a loss of Range of Motion (ROM)?
10. Do you have any sand paper, clicking or crunching sounds when moving your head from side to side in a 'NO' action?
11. Is your hearing a problem or do you have other ear symptoms (e.g. tinnitus, watery sounds, blockages, vertigo, Meniere’s Disease, otalgia, recurrent ear infections)?
12. Do you often get headaches or migraines?
13. Can you remember any trauma (even minor) to the head, neck or shoulders?
14. Was your birth difficult?
15. How’s your vision? – Sensitive to light, especially at dusk, floaters?
16. Do you experience any dizziness, vertigo or movement sensations? Does the ground seem to move away from you?
17. Do you experience any tingling and burning sensations especially in fingers and toes?
18. Do you have confirmed Scoliosis of the spine, from x-rays? Do you have one leg shorter than the other or is your pelvis higher on one side?
19. Have you had any x-rays, CT scans or MRIs taken of your neck? Do these reveal loss of normal neck curve), even a small amount?
Most of these can be and often are indicators of a person's need for general Chiropractic care. The only thing that I would add is that if a general Chiropractor is seeing a patient and noting minimal, short term or no changes in the indicators on this list, that their patient is presenting with, then an Upper Cervical evaluation is probably a good idea. An Upper Cervical evaluation may also be in order if they have wide spread symptoms/pain that just doesn't seem to really go away.
I hope this helps provide some guidance to aid in patients getting the care they need and the results they are looking for.
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