Thursday, March 22, 2012

NUCCA Upper Cervical And Supporting Research

The National Upper Cervical Chiropractic Association NUCCA is a unique form of (Upper Cervical) Chiropractic spinal health care that uses a specific procedure focused on correcting a small misalignment of the upper neck know as the Atlas Subluxation Complex. This subtle correction ultimately restores optimal balance to the entire spinal column. Because the spinal column protects the central nervous system that controls and coordinates all body functions, good spinal balance is critical to good health.

Extensive research and clinical studies show that improved body balance effectively reduces stress throughout the body and helps to relieve pain and stress. Although the NUCCA correction is performed on the neck, it affects the balance of the entire body.

In 1941, two chiropractors from Michigan, Dr. Ralph Gregory and Dr. John Grostic Sr., joined together in developing a more accurate method of rebalancing the body. This procedure has effectively helped to reduced pain and discomfort and worked to enhance the overall well being of many thousands of people. Their work proved to be very successful and eventually other doctors and professions have joined in their pursuit of studying the benefits of this care.

The NUCCA organization was formed in 1966 to conduct educational seminars. The National Upper Cervical Chiropractic Research Association, now called the Upper Cervical Research Foundation or UCRF, was formed in 1971 to do extensive research related to understanding the small misalignment in the upper neck called the Atlas Subluxation Complex.

National Upper Cervical Chiropractic Association

Published on April 20, 2010

Historically, Chiropractic moved from palpation of ‘hotboxes’ to the Meric system.  The idea of major and minor subluxations then became popular as Chiropractors realized that manipulating every segment was impractical and time consuming.  By the 1930’s some in the profession were beginning to see the upper cervical area as the major subluxation all the time.  The techniques of the day were not always able to adequately objectify nor consistently correct the upper cervical misalignments, nor were they able to be taught to the majority of students.  Political and financial controversy surrounding the neurocalograph had split the profession by the mid 1920’s and many in the profession turned away from many of BJ Palmer’s concepts, the upper cervical approach, and the idea of misalignment in general.

Working in relative obscurity since the late 1930’s, Dr. John Grostic -who later joined in partnership with Dr. Ralph Gregory in 1941, and others as time went on, began to do the clinical work necessary to understand how to take accurate films, how to accurately place (and replace on the post films) patients so that the misalignment was accurately imaged.  They developed templates enabling more accurate analysis of the films using a rotatory measurement system instead of the linear measurements which were more prone to geometric distortion factors.  The adjustment itself has undergone significant evolution.  The toggle of the HIO days has been long replaced by the triceps pull which utilizes the ‘kinetic chain effect’ allowing accurate, consistent, and precise, vectored adjustments.  Biomechanical analysis has also undergone great evolution as the misalignment factors became understood and reduction and correction of the upper cervical spine and skull improved, allowing increasingly better instruction for students and doctors. This clinical investigation continues to the present day.

Today, the NUCCA doctor can objectively measure the spinal misalignment and its effect on posture.  They can accurately adjust the upper cervical subluxation complex and objectively measure whether they reduced the misalignment factors in the cervical spine as well as the effect on postural tone as referenced by gravity in the neutral standing position. 

The NUCCA work is orthogonally-based upper cervical chiropractic.  It is based from the empirical realization, derived from decades of clinical experience, that postural distortion (first seen as simply a ‘short leg’ in the supine position) and now also defined in the neutral standing position, including high and low pelvis in the frontal plane, transverse rotation of the pelvis, and movement of T1 away from the vertical axis in the frontal plane, accompanied by bilateral weight inequality.  This postural disturbance correlates with misalignment of the upper cervical spine and skull when measured using aligned radiographs, and accurate patient positioning technique, in three planes.  Maximal and proportional correction of the upper cervical spine and skull (as measured by post films as outcome assessment) correlate with return of posture to the vertical axis, untorqueing of the pelvis and is accompanied by symmetrization of weight balance.  These constitute the measurable (objective) aspects of the work but certainly do not constitute the only outcomes for the patient.

NUCCA doctors have used the Anatometer, a stand up, posture measuring device that can indicate pelvic unleveling and twist, as well as positional change of T1 in the frontal plane in terms of degrees.  Many versions also have a bilateral weight scale that can calculate percent difference left to right.  Correlating supine leg check with Anatometer measurements has revolutionized the doctor’s ability to know when the patient is in proper adjustment.  The Anatometer was designed by Dr. Gregory, Peter Benesch and Daniel Seemann, Ph.D.  Dr. Seemann, a Professor at University of Toledo became the Director of Research for NUCCRA in the early 1970’s.  He was succeeded by James Palmer,  a Professor of Physics at the University of Toledo.

Use of pre and post radiographs, while immeasurably enhancing the practice of upper cervical chiropractic, had another more difficult side.  When Chiropractic split in the mid 1920’s, the contention between those who looked at misalignment and those who found the segments to approximate and fixate, became essentially divorced.  There was little interest from the NCA or later the ACA in validation of a political ‘enemy’ and their contrary ideas.  Upper cervical work continued to evolve but harsh memories divided the work.  A ‘catch 22’ evolved in that use of pre and post films was ‘a priori’ considered unnecessary use of radiation, therefore “dangerous and without benefit”.  NUCCA was denied publication in the Chiropractic peer reviewed literature without being allowed to prove its case.  Unable to find a Chiropractic IRB [Institutional Review Board] willing to allow this decades long work a chance to prove itself, NUCCA eventually had to move outside the profession to publish a recent paper, one that once published, was noticed by everyone in Chiropractic and far beyond, “Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a preliminary study.” Bakris, Dickholtz, et al.  Published in the Journal of Human Hypertension [(2007),1-6]. It was the first time that Chiropractic was able to show a significant normalizing effect on hypertension. A larger study is now being conducted at Palmer Chiropractic College (Davenport) to see if the findings can be replicated.  Our hope is to continue to work to obtain the funding necessary to validate orthogonally based upper cervical work and regain the respect of the Chiropractic profession while getting our results to the world. 

The Atlas Research Foundation (ARF) was established by grateful philanthropic NUCCA patients from Barrington, IL.  They understand how the benefit of  NUCCA care provides answers to some of medicine’s quandaries in addressing indistinct conditions such as Chronic Fatigue Syndrome.  Their vision in demonstrating the benefit that NUCCA care could decrease overall healthcare costs, guided their funding of the NUCCA Hypertension study.  Knowing it takes research to provide needed evidence and research takes money, they raised the required funds to conduct the landmark investigation.  ARF continues to investigate ways to provide funding for further Upper Cervical Research that supports their vision.

Several other studies are currently underway, including the most sophisticated finite element model of the head and spine (and spinal attachments) that has ever been produced, at the University of Toledo under the direction of Vijay Goel, PhD. The model is already giving insight into the biomechanics of the upper cervical spine.  Several papers are in progress.

Charles Woodfield, DC, RPh, a researcher from Life West Chiropractic College (full-time research faculty), is being partially funded by NUCCA and UCRF.  He has several projects underway, including procedural reliability studies, the development of a practice based research model for NUCCA practitioners, and a study using phase-contrast MRI to image changes in blood flow secondary to adjustment, among others.  

Published Papers, Lectures and Poster Presentations (Not including the decades of papers published in The Upper Cervical Monograph:

Abstract & Poster Board Presentations: Development of a Head-Neck Finite Element Model for the Investigation of Subluxation-Based Upper Cervical Chiropractic Manipulation by Liu, Potluri , Chinthakunta ,Goel ,Denton , and J. Palmer. ASME June 2009 California.

Improvement in Radiographic Measurements, Posture, Pain & Quality of Life in Non-migraine Headache Patients Undergoing Upper Cervical Chiropractic Care: A Retrospective Practice Based Study by J. Palmer& M. Dickholtz, J. Vertebral Subluxation Research [JVSR] June 4, 2009.

 Improvement in Radiographic Measurements, Posture, Pain & Quality of Life in Non-migraine Headache Patients Undergoing Upper Cervical Chiropractic Care: A Retrospective Practice Based Study by J. Palmer& M. Dickholtz, J. Vertebral Subluxation Research [JVSR] June 4, 2009.

Scholten J, Plotsky J. “Our energetic relationship with gravity- success of the NUCCA intervention measured by postural balance.” Canadian Chiropractor Feb 2007 :22-23.

Bakris G, Dickholtz M, Meyer PM, Kavitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. “Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.” Journal of Human Hypertension (2007) 1-6.

Thomas M. Editor. NUCCA Protocols and Perspectives. A Textbook for the National Upper Cervical Chiropractic Association. 1st ed. National Upper Cervical Chiropractic Research Association (NUCCRA) Monroe, MI 2002.

Palmer J, Creswell K. “A brief history of the modus operandi of measuring and correcting the atlas Subluxation complex syndrome and the role of posture in the National Upper Cervical Chiropractic Association (NUCCA) standard of care.” 13th International ICCMO Congress, Kona, Hawaii, Nov4-6, 2005.

Woodfield, C. International Conference on Spinal Manipulation, Minneapolis, MN. “Outcomes of Chronic Fatigue Syndrome Subjects Adjusted by a Specific Chiropractic Technique.” Platform Presentation Sep 22, 2000.

Woodfield C. “The hypothalamic-pituitary-adrenal (HPA) axis and the atlas misalignment in chronic fatigue syndrome- an hypothesis.” 16th Annual Upper Cervical Conference Life University of Chiropractic, Marietta, GA Nov. 1999.

Dickholtz M, Woodfield C. Atlas correction of patients with neck and back pain using the NUCCA technique. (Abstracts from the 16th Annual Upper Cervical Spine Conference, November 20-21, 1999) Chiropr Res J, 1999; 6(2):86-87.

Seemann DC. Anatometer measurements: a field study intra- and inter-examiner reliability and pre to post changes following an atlas adjustment. Chiropr Res J, 1999; 6(1)7-9.

Woodfield C, Dickholtz M. Measuring the effects of upper cervical chiropractic corrections on patients with Chronic Fatigue Syndrome. Abstract from the 15th Annual Upper Cervical Conference, November 21-22, 1998.

Woodfield C. “Outcome of 25 headache patients presenting for upper cervical chiropractic care, preliminary SF-36 results of chronic fatigue patients receiving NUCCA chiropractic adjustments.” 14th Annual Upper Cervical Conference, Life University of Chiropractic, Marietta, GA. Platform Presentation Oct 1997.

Woodfield C. “A comparison of outcome and process measures to determine the effectiveness of an upper cervical chiropractic correction.” World Federation of Chiropractic, Tokyo Japan. Posster Session. Jun 1997.

Woodfield C. “A comparison of outcome and process measures to determine the effectiveness of an upper cervical chiropractic correction.” American Health Services Research Symposium, Chicago IL. Posater session. January 1997.

Dickholtz, M. Woodfield C. “Analysis of a NUCCA practice using a practice-based research model.” 13th Annual Upper Cervical Conference, Life University of Chiropractic, Marietta, GA. Nov 1996.

Seemann DC, Dickholtz M. Range of motion at the atlanto-occipital joint: lateral flexion and side slip. 11th Annual Upper Cervical Spine Conference, Life College Marietta, Georgia, 1995.

Weidemann RL. “Case studies of surface emg tested at C1 and C3 pre and post adjustment along with correlated pre and post x-rays. 11th Annual Upper Cervical Spine Conference, Life College 1994.

Seemann DC. Bilateral weight differential and functional short leg: an analysis of pre and post data after reduction of an atlas subluxation. Chiropr Res J, 1993; 2(3):33-38.

Goodman R. Hypertension and the atlas subluxation complex.  J Chiropr Res Clin Investigation, 1992; 8(2):30-32.

Thomas M, Wood J. Upper cervical adjustments may improve mental function. J Man Med, 1992: 6:215-216.

Standards of Care Manual. Submitted to Conference for the Establishment of Guidelines for Chiropractic Quality Assurance and Standards of Practice. Chaired by Scott Haldemann, DC, MD,PhD. October 1991.

Goodman RJ, Mosby JS. Cessation of a seizure disorder: correction of the atlas subluxation complex. J Chiropr Res Clin Investigation, 1990; 6(2):43-46.

Sherwood KR, Brickner DS, Jennings DJ, Mattern JC. Postural changes after reduction of the atlanto-axial subluxation. J Chiropr Res, Summer, 1989; 5(4):96-100.

Gregory RR, Seamann DC. “A critique of a critique of vectored adjusting.” The Digest of Chiropractic Economics. July/August 1981:14-18.

Seemann DC. “C1 subluxations, short leg and pelvic distortions.” Journal of the Australian Chiropractors Association. 1980 11(6):96-100.

Gregory RR, Seamann DC. “An analysis of some hypotheses about the atlas subluxation complex.” Digest of Chiropractic Economics. January-February 1976.

(Editors Note:  For more research supporting Upper Cervical Care click here.  Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for tinnitus or any other condition, disease or symptom.)

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