Giving Thanks To Upper Cervical Care Past, Present and Future

Today's post is a brief history of vector based Upper Cervical Care and the progression toward the future and the development of the QSM3 Procedure in Upper Cervical Care.  A great big thank you to all the people past, present and future that brought, bring and will bring advancements to this work for the people of the world so that we all may live a life closer to our potential.  Thanks again!

History

Vector based Upper Cervical Chiropractic systems (Wernsing, Grostic, Orthospinology, and NUCCA), all have a long history of high quality specific spinal corrections.  This pinnacle of chiropractic principles attracts some of the brightest and most detail-oriented doctors.  Wernsing introduced the concept of atlas laterality and rotatory (angular) measurement in the 1930’s. Grostic, in the 40’s, introduced a new cervical x-ray series and rotatory system of analysis (along with the supine leg check) in conjunction with Gregory.  Later, with NUCCA, Gregory organized specific misalignment types and greatly clarified the biomechanical principles involved, essentially bringing the correction to its present level of specificity by the late 1970’s.  Since the era of these pioneers, little has progressed in upper cervical chiropractic (UCC). The advent of multiple adjusting machines, although hailed by their inventors for specificity and ease, also have specific limitations in their ability to correct the misaligned spine.

The Progression of QSM³ Procedure

QSM³ is a logical progression and reasoned evolution of these great 20th century systems. It consolidates the brilliant discoveries of vector-based Upper Cervical Chiropractic (UCC) with innovative examination and re-thinking of the various protocols by Dr. Friedman. The attention to x-ray detail, the specific analysis, the correction table, and the lightest touch at the C1 vertebra (< .5lb) are the foundations that QSM3 integrates. The QSM³ procedure measures the 3D misalignment of the human frame to improve the correction potential. QSM³ uses a posture measurement device in a unique way to evaluate pelvis to skull misalignment.  In conjunction with the upper cervical analysis, QSM³ now enables measurement of the complete misalignment pathway. This means more detail, better data, and higher resulting potential to hold the correction.

QSM³ looks at a 3 dimensional full spine correction. This means the weight scales are only a small piece to the necessary information that demonstrates at a diagnostic level that any patient’s spine has been corrected. We see many patients that check clear in the weight scales (frontal plane) but have a head tilt and pelvic distortion. A correction is not one plane or piece but a 3D balance of all parts. The Anatometer, although it lays claim to measure pelvic twist/ distortion, definitely at an engineering level is completely inaccurate. We have retro fit our digital device with a system that measures rotation coupling in the pelvis.

The reason the pelvic distortion/correction is key to a balanced spine is:

1. It is the largest mass in the human frame and must be corrected to restore true balance.

2. It indicates as it rotates that the spine is breaking down against gravity.

3. Is the key aspect for symptomatic relief and must be corrected first before the weight is even an issue. This concept is like talking about the paint on the walls on a house when the foundation has not been set and balanced.

The QSM³ procedure is a comprehensive approach that restores body balance pelvis to skull using multiple headpiece placements when necessary to correct, by component, the breakdown of the human frame. Not everyone is a perfect linear misalignment but a culmination of years of multiple traumas.

This approach after being board certified in more than one UC procedure has begun to answer the complications that are a regular occurrence with stability and better results.

Upper Cervical Care and Scoliosis Correction: A Case Study

Correction of juvenile idiopathic scoliosis after primary upper cervical chiropractic care: a case study. Abstracts from the 13th annual upper cervical spine conference, Nov 16-17, 1996 Life College, Marietta, Georgia. Pub in Chiropractic Research Journal, Vol. 1V, No.1, Spring 1997 p.29

From the abstract:

A nine-year-old male presented in our office with a chief complaint of juvenile idiopathic scoliosis and intermittent back pain. The patient had fractured his clavicle one month before his initial visit and complained of intermittent "growing pains" in his right foot. The case history also revealed that he had been involved in a motor vehicle accident two years previously.

The patient was managed with upper cervical care, utilizing the Grostic Procedure of adjusting by hand. Over the five months and ten days of care, the patient was checked on 13 visits and required an upper cervical adjustment on five of those visits. The leg length inequality, posture, and palpatory findings balanced immediately after the first upper cervical adjustment. Post-adjustment paraspinal surface EMG showed that the paraspinal muscular activity was more balanced. Post-treatment x-ray taken on the 13th visit revealed the thoracic and lumbar curves had an 88% overall reduction in the scoliosis after the five months of care.

(Editor's note: 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 any condition, disease or symptom.)

The Medullary Lock: The Basis Of Upper Cervical Care

Editor's note: This is a little on the technical side so some readers may get lost with some of the terminology. For some people who are more skeptical and analytical minded this will serve to explain upper cervical care in a more detailed way.

Medullary Lock

by KCUCS.com

The Brain Stem, from a Neuro-Physiological standpoint is the center of life in the body. It is one of the first organized structures formed in embryo (1) and the last place life is evident before a person passes. The lower portion of the Brain Stem lies in the cradle where the head sits on the spine. Therefore, a Head/Neck Misalignment can potentially manifest in a wide variety of symptoms and diseases.

The Medullary Lock is an elaborate network of hard and soft tissue that acts as a stabilizing support for the medulla and upper spinal cord. It secures the medulla and upper spinal cord in the center of the spinal canal and foramen magnum in cases of trauma. Otherwise, even minor slips and falls could be devastating to the body.

With atlas and/or axis misalignment, the very safeguards the medulla and upper spinal cord are afforded through the Medullary Lock become the very mechanism creating cord distortion.

The development of the Medullary Lock was built upon the foundation of Dr. John D Grostic's Dentate Ligament theory (2).

To introduce the Medullary Lock we need to consider 4 basic components.

1. Upper Cervical muscles and their roles
2. Supportive ligaments and membranes and their roles
3. 4 known structures with external attachments to the Dura Mater
4. One structure internally attached to the Dura Mater and intimately connected with the cord.

Each of these components not only work together but are synergistic one with another. There are 4 pairs of muscles called suboccipital muscles (3-5) that act to extend, rotate and laterally bend the Upper Cervical Spine and head. They as well are called proprioceptive muscles because they are chalked full of proprioceptive nerve fibers and carry the responsibility of relaying info to the brain stem as to head position at any given time.

There is an elaborate ligament system that secures the Upper Cervical spine (6-10). The Alar ligament attaches to the lateral margin of the dens about half way up from its base and connects to the medial aspect of the ipsilateral condyle. In the neutral head position these ligaments are in their most relaxed position. The purpose of the Alar ligaments is to check lateral bending and head rotation on the contralateral side. The Alar ligaments do afford some protection for the medulla in checking extreme head rotation. When Alar ligaments are compromised the atlas slides lateral ipsilateral upon lateral bending.

The tectorial membrane works together with the alar ligaments providing stability for the upper cervical region in flexion. The atlanto occipital membrane provides stability in extension. The anterior longitudinal ligament and posterior longitudinal ligament as well provide craniovertebral stability.

The muscles, ligaments, capsules and membranes all provide support for the cranio vertebral region working synergistically. They provide stability and positional awareness for the upper cervical region.

Some of these structures; ligaments, muscles and membranes have direct connection with the dura mater at the cranio vertebral junction. There are four known structures external to the cord that attach to the dura mater.

1. Attachment of the dura mater to the foramen magnum (11)
2. Attachment of the dura mater to the posterior arch of C1 & C2 (11)
3. Connective tissue bridge between the rectus capitus posterior minor muscle and the dura mater (12)
4. Connective tissue attachments between the ligamentum nuchae and flavum to the dura (13,14)

There is one internal structure to the dura mater, the dentate ligament, which stabilizes the medulla and upper spinal cord within the spinal canal space in the upper cervical spine. Dr. Grostic outlined its detrimental effects (2).

The Medullary Lock is a stabilizing factor for the medulla and upper spinal cord (15). The 4 known structures described above external to the dura and the one internal, the dentate ligament, all work together as a network of support. Regardless in what position the head moves, whether rotation right or left, flexion or extension, lateral bending left or right, or any combination, it is important for the medulla and upper spinal cord to remain fixed within their position relative to the spinal canal and foramen magnum. This becomes even more crucial in the cases of trauma. Movement beyond a small amount in the vertical superior or inferior, anterior upon flexion, posterior upon extension or any combination can prove to be fatal. In fact, it is reported that most fatal car crashes are the result of a fractured atlas. In these cases, it is easy to see how the Medullary Lock could lose its integrity.

The Medullary Lock is a mechanism that provides security and stability for the medulla and upper spinal cord. However, because of its mechanism of support, when the upper cervical vertebrae are in a 3 directional torque misalignment, stretch and tension are exerted through the dentate ligaments exerting forces on the cord as described by Dr. Grostic.

Dr. Grostic's dentate ligament cord distortion hypothesis was consistent with what BJ Palmer described (16) in Volume XVIII, regarding cord pressure.

BJ Palmer expounded upon the original 4 elements of a subluxation:

1. Misalignment
2. Occlusion of a foramen
3. Pressure upon nerves
4. Interference to the mental impulse.

BJ explained the necessity of a 5th element (17) describing the subluxation as a 3 directional torque, misaligning on three planes simultaneous. In this manner, the misalignment becomes permanent more or less. It is the permanency of the upper cervical subluxation that leads to the weakened ability of the body to adapt to the environment and grow in dis-ease.

The longer a person is able to stay balanced in the upper cervical area, remaining relatively clear from nerve interference, the stronger the Medullary Lock becomes. The stronger the Medullary Lock becomes the more difficult it is for a person to subluxate and the higher the potential is for that person to recover from long term illness or simply achieve their highest potential health. The reverse is true, the more unstable the Medullary Lock, the more easily it will be for that person to subluxate and the more susceptible the person will be in 'growing dis-ease'.

It is our opinion that over adjusting or adjusting too often, especially with upper cervical procedures, can weaken the Medullary Lock.

KCUCS practitioners view their purpose as Upper Cervical doctors to be guardians of the Medullary Lock, to facilitate more stability of the Medullary Lock over a long period of time. Putting particular emphasis on substantial long-term growth in health and life. This is consistent with what BJ Palmer referred to Accumulative Constructive Survival Value (ACSV) (18). The greater the ACSV, the greater the ability to grow in health, adapt to the environment and overcome disease.

REFERENCES:

1. Sanes DH, Reh TA, Harris WA: Development of the nervous system, 2nd edit. 2006, Elsevier Inc. Burlington, MA ISBN: 978-0-12-618621-5.
2. Grostic JD: Dentate ligament - cord distortion hypothesis. CRJ Vol 1(1): Spring, pp 47-55
3. Gray H, Pick TP, Houdin R: Gray's Anatomy: The unabridged running press edition of the American classic. ISBN: 0-914294-08-3.
4. Hallgren RC, Fernandez C: Suboccipital muscle contribution to tension-type headache chapter 7 in diagnosis and management of tension-type and cervico-genic headache. Jones and Bartlett, Sudbury, Massachusetts, 2008.
5. Hallegren RC, Andary, MT, 2008. Under-shooting of a neutral reference position following cervical motion in the sagittal plane. J Manipulative and Physiol Ther, 31(7):547-552.
6. Bogduk N, Mercer S: Biomechanics of the cervical spine, I: normal kinematics. Clin Biomech (Bristol, Avon). 2000; 15:633-648.
7. Dvorak J, Panjabi M, Gerber M, Wichmann W: CT-functional diagnostics of the rotatory instability of upper cervical spine, 1: an experimental study of cadavers. Spine, 1987; 12:197-205
8. Penning L: Kinematics of cervical spine injury: a functional radiological hypothesis. Eur Spine J. 1995; 4:126-132.
9. Swartz EE, Floyd RT, Cendoma M: Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J Athl Train. 2005 Jul-Sep; 40(3): 155-161.
10. Singh AP: Biomechanics of upper cervical spine. Bone & Joint. Feb 10, 2010, http://boneandspine.corn/spine/cervical-spine/biomechanics-of-upper-cervical-spine/
11. Hinson R, Zeng ZB: Epidural attachments in the Upper Cervical Spine. Abstracts from the 15th Annual Upper Cervical Spine Conference, November 20-21, 1998, CRJ, 1999;6(1):31-32.
12. Hack G: Anatomical relation between the rectus capitus posterior minor and the dura mater. Spine, 20(23): 2484-2486
13. Shinomiya K, Dawson, J, Spengler DM, Konrad P, Blumenkopf B: An analysis of the posterior epidural ligament role on the cervical spinal cord. Spine, 1996; 21(18):2081-2088
14. Dean N, Mitchell B: Anatomic Relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. 2002 Clin. Anat. 15:182-185.
15. Kessinger, R: KCUCS instrumentation module notes. 2009, Cape Girardeau, MO, pp 20-23.
16. Palmer BJ: The subluxation specific the adjustment specific, Vol. XVIII. 1934, Palmer School of Chiropractic, Davenport, IA. pp 322-323.
17. Palmer BJ: The subluxation specific the adjustment specific, Vol. XVIII. 1934, Palmer School of Chiropractic, Davenport, IA. pp 248-251
18. Palmer BJ: History repeats, Vol. XXVII. 1951, Palmer School of Chiropractic, Davenport, IA. pp 707-708.

Upper Cervical Care and Kids

Upper Cervical Care and the Pediatric Patient
by Dr. Claudia Anrig
from: Dynamic Chiropractic - April 10, 2006, Volume 24, Issue 08

Upper cervical technique is not new to the chiropractic profession. It started with the toggle (HIO) technique, developed by Dr. B.J. Palmer, followed by other upper cervical techniques, such as Grostic, NUCCA, orthospinology and atlas orthongal. In preparing this article, I interviewed Dr. Julie Mayer Hunt, a second-generation upper cervical chiropractor who is board certified in orthospinology and has earned diplomate status in chiropractic pediatrics. She is currently a board member of the Society of Chiropractic Orthospinology and the Academy of Upper Cervical Chiropractic Organizations (AUCCO).

According to Dr. Mayer Hunt, "The upper cervical spine is one of the most vulnerable areas of the spine and is a critical area to keep free from nerve interference." She cites a study published in the Journal of Clinical Chiropractic Pediatrics that identified approximately 58 articles regarding chiropractic care of the pediatric patient.1 All of the literature reviewed involved upper cervical adjustments (UCA) and reported the overall level of improvement as a result of rendering specific chiropractic care. Many of the studies involved cases in which any of a myriad of conditions frequently affecting children was resolved completely. Moreover, the response time of a UCA often was seen within one to three treatments. The conditions cited included infantile colic, glaucoma, irritability, head trauma, hemiparesis, projectile vomiting, tonsillitis, sinusitis, bronchitis, nocturnal enuresis, allergies, sleep disorders curvature of the spine, fever, otitis media, asthma, ADHD, headaches, torticollis and seizures. The JCCP study summarized studies involving more than 1,000 children under chiropractic care; the findings suggested the focal area of care involved the upper cervical spine.

Dr. Kirk Eriksen best describes the upper cervical biomechanics as not moving in only one plane of motion. During normal cervical movement, coupled motion occurs. Coupling is defined as motion in which rotation or translation of a rigid body about or along one axis is consistently associated with simultaneous rotation or translation about or along another axis. During normal range of movement, coupled motion helps reduce tension on the nervous system. This is accomplished by offsetting pure lateral flexion or rotation, with small amounts of movements in the X, Y or Z axes.2

One feature of an upper cervical subluxation is that the occipito-atlanto-axial articulations have misaligned in an uncoupled fashion. This condition is measured radiographically in a neutral posture, with the spine at rest. The body must continually adapt, from a biomechanical and neurological standpoint, to this type of subluxation.2

The birth process alone can contribute to upper cervical trauma and instability. Abraham Towbin, MD, reported the results of a study on newborn spinal cord/brainstem injuries that he conducted at the Harvard Department of Neuropathology.3 He performed autopsies on more than 2,000 newborns that died shortly after birth. In his report, Latent Spinal Cord and Brain Stem Injuries in Newborn Infants, Dr. Towbin stated: "Spinal cord and brain stem injuries often occur during the process of birth, but frequently escape diagnosis. Respiratory distress is a cardinal sign of such injury."3

A study by H. Biedermann, published in the Journal of Manual Medicine, high lights the importance of checking the newborn following delivery. In his evaluation of 1,000 newborns, he discovered that 119 cases revealed kinematic imbalances of the suboccipital spine. The finding of suboccipital strain equated to approximately 12 percent of the population group.4

Upper cervical techniques traditionally use the supine leg-length evaluation to determine necessity for adjusting the atlas. When evaluating the pediatric patient with the supine leg check, a leg-length difference is often readily apparent, usually half an inch or greater. Dr. K. Eriksen notes the following hypothesis regarding the short leg findings:

"The spinocerebellar tracts are located along the lateral edge of the spinal cord and are located at the most probable site of maximal mechanical irritation via the dentate ligaments. These proprioceptive tracts are primary pathways for regulating muscle tone and joint position sense. The spinocerebellar tracts are arranged in a laminar fashion (although somewhat angulated) with the most lateral fibers innervating the most caudal structures (i.e., legssacrallumbarthoracic cervical [very limited]). Irritation of these tracts could lead to muscle tone imbalance of the pelvic girdle resulting in a functional short leg."5

Upper cervical chiropractors also note postural corrections as a byproduct of specific upper cervical adjustments. These doctors advocate that one of the benefits of chiropractic care for the pediatric population is eliminating spinal stress (weight of the head centered and structurally/neurologically balanced) on the child's developing spine.

A resource regarding upper cervical techniques for both pediatric and general practice is Dr. Erikson's book, Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. The book reviews the anatomy and kinematics of the upper cervical spine, and explains how impaired biomechanics causes neurological dysfunction and physiological concomitants.5 This textbook is not intended to be about chiropractic technique; rather, the text provides the "why" as opposed to the "how" of upper cervical chiropractic care. A follow-up book providing specifics on upper cervical techniques including pediatric care is scheduled to be released in spring 2007.

Claudia Anrig, DC, practices in Fresno, Calif. She is on the board of directors of the International Chiropractic Pediatric Association. For more information, including a brief biography, a printable version of this article and a link to previous articles, please visit Dr. Anrig's columnist page online: www.chiroweb.com/columnist/anrig.

To learn more regarding specific upper cervical techniques for pediatrics, access the following resources:

orthospinology: www.orthospinology.org
atlas orthogonal: www.atlasorthogonality.com
NUCCA: www.nucca.org
It should be noted that Dr. Mayer Hunt has published several pediatric case studies on irregular bowel function, cystic hygroma and asthma,6-8 which illustrate functional improvement of these nonmuscular disorders when the subluxation was corrected by specific upper cervical adjustments.

References

1. Prax C. Upper cervical care of the pediatric patient: a review of the literature. Journal of Clinical Chiropractic Pediatrics 1999;4(1):257-263.
2. Eriksen K. The upper cervical subluxation complex. Today's Chiropractic, March/April 2004.
3. Towbin A. Latent spinal cord and brain stem injuries in newborn infants. Develop Med Child Neurol 1969;(11):54-68.
4. Biedermann H. Sub-occipital strain in newborn infants. Journal of Manual Medicine 1992;(6):151-156.
5. Eriksen K. Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. Baltimore, MD: Lippincott Williams & Wilkins, 2003.
6. Hunt JM. Upper cervical chiropractic care of an infant with irregular bowel function: a case report. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.
7. Upper cervical chiropractic care and resolution of cystic hygroma in a twelve-year-old female: a case study. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.
8. Upper cervical care of a pediatric patient with asthma: a case study. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.

Upper Cervical Care Reviewed

This is one person's overview of NUCCA care. I thought it was very well done and worth sharing as it covers many of the basics of Upper Cervical Care.

By Lennard Zinn

The top, or Cl vertebra (C is for "cervical," i.e., "neck") is also called the "atlas" vertebra. Cl is concave on top to accept the convex base of the skull, and it is convex on the bottom to fit into the concave top of the next vertebra. Central to the vertebrae runs the spinal cord, carrying body control messages from the brain. Between each pair of vertebrae are 31 pairs of nerves extending out to organs and muscles.

Misaligned (or "subluxated") vertebrae can impinge on the nerves and hamper body function. Chiropractors apply force to parts of the spine with the intent of returning vertebrae to their normal positions. Cracking sounds usually accompany the adjustment. Upper Cervical Technique is distinct in that the adjustment is only performed on the Cl vertebra and the adjustment normally makes no sound. Furthermore, the direction of the application of force to perform the adjustment is not based simply on palpation (the chiropractors "feel") but rather on detailed analysis of X-rays. From the X-rays, a three-dimensional force vector is calculated and then applied to Cl to correct its position.

A misaligned atlas throws off leg length and distorts the entire body. The skull and the other vertebrae rotate and tip to compensate for rotation and tip in C1. The head weighs between 8 and 14 pounds. If it is not sitting straight on top of the spine, the muscles of the body must do something to counteract this bowling ball hanging off to the side. If the muscles on one side of the spine are tighter than those on the other, then the pelvis is pulled up on that side, thus "shortening" that leg.

I went to Farmington, New Mexico, a town of 40,000 near the four comers area, to view this procedure, as there are no practitioners of it within hundreds of miles of my Boulder, Colorado, home. Lloyd Pond, D.C., who practices with his son, Lonnie, is recognized among those who follow the subject as one of the leading practitioners of upper cervical technique.

Diagnostic Methods

The Ponds use a complex diagnostic machine with a digital printout called an "Anatometer" to quantify body distortion. It measures the degree of vertical pelvic tilt, pelvic rotation in a horizontal plane, the lean of the spinal column at the shoulder level, and the amount of weight the patient carries on each foot.

Patients first lie flat on a table to have leg length differences measured.

Patients said that they only feel a very slight pressure and the warmth of the hand on their neck. There was no deflection of the patient's head or neck during the procedure, nor was there an audible sound.

A heat-sensing probe is passed up the spine on the back of the neck. The probe has a temperature sensor on either side, of the spine hooked up to a machine that graphs the temperature readings as a function of position. The graph shows large surface-temperature variations on either side of the spine, indicating interrupted nerve supply.

The adjustment direction is based on X-rays, which one of the Ponds takes to ensure accuracy. Patient position and distance to the lens is precisely set in each of three different X-ray angles.

On a light board, lines are drawn on the X-rays through a series of bone points. The precise relative angles of Cl, the head, and the spine are measured in three planes. Once the exact misalignment of the atlas is determined, a vector direction in three dimensions is determined, precisely opposing the misalignment.

Adjustment procedure

The chiropractor applies a force directly along the determined vector direction to return the atlas to its proper position. The force must be applied with enough pressure to overcome the body's internal resistance to the adjustment without going too far.

The patient lies on his or her side on a low inclined bed with a head support. The adjustment is performed with the side of the heel of one hand on a comer of the Cl vertebra located just behind the patients ear lobe. Lloyd or Lonnie Pond takes a number of measurements with the tape measure to determine where to stand and how to orient his sternum relative to the patient, a different position is used with every patient.

He clasps one hand about the wrist of the other hand, sets the heel of the lower hand on the bone and aligns his arms and the top of his sternum directly down the force vector determined from the X-ray. He does not push by straightening the arms, nor does he push by rocking his back or body forward. With either of those motions, the heel of the hand does not move along a line connecting the top of the sternum and the heel of the hand. Instead, the chiropractor locks his body in place, and the force comes from the shoulders by contracting the head of the triceps muscle. To call it subtle would be an understatement.

I observed the procedure being performed on a number of patients, and interviewed them before and after. They were long-term patients of the Ponds (some on the order of 15-20 years; Lloyd Pond has been doing this work in Farmington for 40 years). Several of the leg-length discrepancies were originally around an inch. Most Patients were coming in for a semi-annual or annual checkup, although one had been involved in an automobile accident dent three days earlier.

Patients said that they only feel a very slight pressure and the warmth of the hand on their neck. There was no deflection of the patient's head or neck during the procedure, nor was there an audible sound.

Afterward, the leg lengths were even, and the thermographs showed consistent temperatures on both sides of the spine.

Patients' comments

The patients reported feeling immediate relief. The reduced strain in the face of the auto accident victim was obvious.

Patients commented that while many joke about "having magic words said over them... half the people in town come to the Ponds." One woman, noted that Pond's rates have gone up from $11 a visit when she first started seeing him 20 years ago to the current $30 per visit but quickly added that she "would pay any amount for it" Patients told me of not only a reduction in the symptoms of body aches, but generally improved overall health.

Lloyd Pond claims only to correct the position of Cl, and he acknowledges that it can improve overall health by improving delivery of nerve impulses and instructions from the brain, helping the body combat disease processes. Due to Cl's close proximity to the brain stem, it simultaneously affects the brain and the entire spinal cord, and thus the entire body.

Lloyd Pond comments that his method is simply the application of physics to the human body. The adjustments can hold for years, unlike most chiropractic adjustments. After the initial series of treatments, visits are separated by many months, and Pond says if alignment is not off, "we don't touch 'em".

When asked why less than 1 percent of chiropractors specialize in this technique, Lonnie Pond says that chiropractors are pulled in many different directions toward various chiropractic specialties, and, he added, "it is easier to crack backs."

John Dunn, D.C., a cyclist, and upper cervical chiropractor from Tallahassee, Florida, says that it takes a certain type of person to practice the technique. It is an exacting method and a real-life application of vector analysis, and therefore, attracts "the pocket-protractor types who drive used cars."

Dunn notes that the work-up is time consuming, the adjustment is sublime, and the follow-up visits are less frequent so there isn't much motivation for a chiropractor to pursue the approach.

"It also takes balls to tickle someone behind the ear and tell them they are going to be just fine," joked Dunn.

Disc Problems in Neck and Upper Cervical Care

MANAGEMENT OF CERVICAL DISC HERNIATION WITH UPPER CERVICAL CHIROPRACTIC CARE
Kirk Eriksen, D.C.

Objective: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI).

Clinical Features: A 34 yr old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathetic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5.

Intervention and Outcome: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of greater than 1 yr has shown that surgery was not necessary.

Conclusion: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments and this condition should be pursued (J Manipulative Physiol Ther 1998: 21:51-6).

Torticollis / Wryneck Significantly Reduced

UPPER CERVICAL CARE FOR SPASMODIC TORTICOLLIS CASES
by Kevin A. James, D.C.

BACKGROUND AND OBJECTIVES: This study involved two torticollis cases. On both instances patients presented at our office complaining of severe neck pain. Severely distorted posture of the head and neck area was present in both cases. Both patients were less than 20 years old. One patient was male. The other patient was female. With this severe pain and grossly distorted postural changes, we would use the Grostic/Orthospinology Procedure to attempt to make a spinal correction that would improve the patient's health and well-being.

METHODS: The patient would be examined and a set of cervical x-rays were to be taken using the Grostic Procedure Model. After the x-rays were analyzed, the patient would be adjusted using the hand or instrument as described by the Grostic Procedure/Orthospinology.

However, due to the severe pain involved in these cases, the method of spinal correction was modified based on the doctor's knowledge and understanding of the cervical biomechanics. Along with these modifications, the hand and instrument form of spinal correction was used.

After the spinal correction was made, post Grostic x-rays were taken to note any changes.

RESULTS: In one case, a stroking pull type maneuver (Laney's Finger Tip Pull), as described by Dr. Cecil Laney at a previous Life University Annual Upper Cervical Conference, was used with great success. This maneuver was used because the patient, due to his head weight and pain, could not lay on his side. This successful correction was noted on post cervical x-rays as used in the Grostic Procedure. The second case was adjusted with the stroking pull maneuver and with the hands and instrument as described Orthospinology. This patient was in such pain that the Laney maneuver did not make any notable differences and the customary correction methods were used. Following post cervical x-rays, on this second patient, a notable correction was observed also.

CONCLUSION: In cases, presenting with severe spasmodic torticollis, the symptoms of severe pain are normally expected. The correction of the Vertebral Subluxation Complex in the Upper Cervical area is a must. Due to the severe pain and muscle spasm involved with spasmodic torticollis, the light forced gentle non-manipulative Grostic Procedure provides an excellent method of correcting the VSC causing this spinal imbalance. If this patient is unable to lay down in the proper position due to severe spasm and pain, the doctor's knowledge of the cervical biomechanics as described by Dr. John F. Grostic can be applied using the Laney Finger Tip Pull obtaining favorable results. Once the subluxation has been reduced enough to allow for decreased muscle spasm, the patient can now lay in the desired position for care. The customary hand or instrument adjustment can be used to complete the correction of the VSC.

Upper Cervical Corrections by Hand or Instrument?

I think this is a fair assessment of the question above.

HOW GREAT IS THY ART?
Cecil D. Laney, D.C.

Chiropractic is a philosophy, science and art. The philosophy is our core beliefs which maintain that optimum nerve function is vital to good health and that the nerve function can have interference and this interference can be removed.

The science is the mathematical determination of the structural integrity of the human body. It also addresses the postural standards as to what is normal and optimum to achieve normal nerve function.

The art is the skill with which we render service to the patient in restoring nerve function in the pursuit of better health.

Without data, everything is just an opinion. Therefore, I will offer opinions after over 50 years of observation. I am saying that our greatest failure has been our poor achievement in the art of chiropractic.

Someone estimated that there are over 150 different techniques in the country. I think that there are really two major procedures, the manipulators and the specific adjusters. There is a difference. To manipulate, you move structure randomly. To adjust, you move structure from a given place to a different given place. Unfortunately, the vast majority of chiropractic practices consists of manipulation.

The time is here when the powers that be, the government, insurance companies, etc. are asking: "What do you chiropractors do?" Our answer is: "We correct spinal distortions." But do we? Can you prove it? Do you take pre and post x-rays? If not, what is your method of evaluation?

Dr. B.J. Palmer said the subluxation can only exist in the cervical area. My experience leads me to agree with him. In this area, palpation and postural observation are helpful, but the only reliable performance monitoring method is precision pre and post x-rays. This is the only method I accept.

I have heard claims of everything up to 100% on nearly all cases. I have yet to see proof of this kind of performance. Dr. John D. Grostic told me his father had about 87% overall average correction. This was a surprise to me in view of the fact that adjusting me, he hit 100% almost every time.

It doesn't tell us much if you show a case of 100% correction, but it will give a picture of your performance if you show a dozen consecutive cases with close proximity dates on the film.

In discussions with some of our best hand adjusters, I have come to the conclusion that their overall average is in the nature of 50%. This is good, a far better performance than the manipulators. It is about twice as good as I was ever able to do. I applaud anyone who is training themselves to hand adjust. Maybe someone will come up with a modification of the procedure that will make it more doable.

My observation is that an average 50% correction will eventually build a referral practice even if the doctor has a sour disposition. A 70% average correction will build you an overflow practice.

We are entering a new era in the art of chiropractic. I have designed, built and delivered to Life University a new table mounted cervical adjusting instrument, giving them all rights to it. It has functions that to my knowledge, has never been utilized before. It is being evaluated in the Research Department. We expect to achieve 80 to 90 percent average corrections. This kind of performance will make miracle cases commonplace. The instrument uses the Grostic analysis and adjusting vectors. We urgently need for it to be placed in a few Grostic proficient doctors' offices to accumulate data.

If my opinion is wrong and you can document a correction performance of 70% or above, I want to be a student of yours. If you are averaging much less than 50% with hand adjusting, I would recommend you move to the use of adjusting instruments. It is not fair to your patients to do otherwise.

Trigeminal Neuralgia and Upper Cervical

Yet another example of Upper Cervical Care and the results possible.

Chiropractic management of trigeminal neuralgia: A preliminary study

Roger Hinson, DC and Susan Brown, PhD, DC.

Trigeminal Neuralgia (TN), the most common pain disorder of the face and one of the most painful afflictions known,1 affects one or more branches of the fifth cranial nerve and has a reported annual incidence of 4.3 per 100,000.2 Once known as the suicide disease, TN effects women more often than men and the annual incidence rate increases significantly with age. The pain, abrupt in onset and typically lasting no more than a few seconds, can be triggered by both mechanical and thermal stimuli from inside or outside the area of pain. TN may undergo spontaneous remissions and recurrences, but the frequency of pain commonly increases with chronicity. 3

Medical management starts with a course of anticonvulsants (carbamazepine, gabapentin, phenytoin) gradually increasing in dosage as symptoms warrant. Surgery is performed if symptoms are initially, or become, refractory to medication. Percutaneous ablation of the Gasserian ganglion is the most commonly practiced approach but carries a relatively high risk of numbness and dysesthesia. Microvascular decompression (MVD) of the trigeminal root, involving open surgery through the posterior fossa, has the best results with long term pain relief and the lowest chance of numbness and dysesthesia but greater incidence of serious complications. All currently practiced neurosurgical procedures are associated with significant morbidity and recurrence rates.

There is no reference in the indexed literature to the efficacy of chiropractic procedures for TN. We report outcomes of an 8 week trial of chiropractic care on 8 subjects suffering from TN.

Patient Background

Eight subjects were recruited for this study through a support organization for facial pain sufferers. All reported with a previous diagnosis made by a neurologist of trigeminal neuralgia. Seven subjects met diagnostic criteria for trigeminal neuralgia set forth by the International Headache Society (IHS), while one subject (5) described pain more characteristic of atypical trigeminal neuralgia (ATN) as there were no pain free periods and Aslow@ pain, i.e. aching, burning sensations, was more bothersome than brief, lancinating pain. One subject (7) suffered from trigeminal neuralgia and contralateral anesthesia dolorosa (AD), an iatrogenic disorder caused by surgical deafferentation and characterized by a constant sensation of numbness and burning pain. She had suffered from bilateral TN prior to unilateral radio frequency ablation two years previous.

All subjects were under medical therapy at the time of enrollment and five had undergone unsuccessful surgical treatment, four subjects had undergone two procedures and one had undergone a single procedure. All were female and the ages ranged from 47 to 79 (mean, 62; SD 11.6) years. Chronicity of TN symptoms ranged from 1 15 (mean, 7.4; SD 5.3) years.

Methods

Informed consent was obtained from all subjects prior to enrollment. (Upper Cervical)Chiropractic management was per Grostic technique protocol, which utilizes three mutually orthogonal x ray views for measuring upper cervical displacement from a theoretical norm. Adjustments were administered by one clinician as indicated by supine leg length estimation and dual probe thermocouple analysis. The adjustments consisted of a low force, precisely vectored impulse delivered to the transverse process of C1 with an instrument. Patients were seen three times per week for the first 2 weeks of care, then twice a week for weeks 3 and 4. Visits were scheduled for weeks 5 through 8 as needed, typically once a week.

Pain was assessed via short form McGill Pain Questionnaire (SF MPQ), VAS and pain drawing. Depression was evaluated with the Modified Zung Depression Index. The Rand SF 36 was used to evaluate quality of life. Questionnaires were administered at two weeks prior to (Upper Cervical) chiropractic care, on the first day of care, and after 4 and 8 weeks of care. Subjects maintained a diary in which number, intensity and duration of paroxysms and analgesic usage were recorded.

Results

Reduction in pain was reported by all subjects during the experimental phase. Mean values after eight weeks of intervention were reduced by 69% for MPQ and 78% for VAS. Depression as measured by Zung was reduced by 43%. Pain drawings demonstrated reductions in distribution of pain for all patients. Antiseizure medication usage was discontinued by two, decreased by 33% by one and by 66% by one, and unchanged by four subjects during the eight week period of intervention. Two subjects reported complete absence of paroxysmal pain within four days of first adjustment and no return of paroxysms during eight weeks of intervention. One subject suffering from otalgia had no recurrence of such pain subsequent to first adjustment.

Discussion

The spinal tract and nucleus of the trigeminus descend from the caudal brainstem down to the level of the second cervical vertebra. That area of the nucleus located in the cervical spine, the subnucleus caudalis (Vc), contains second order neurons receiving pain and temperature stimuli not only of trigeminal origin, but also from the facial (n intermedius), glossopharyngeal and vagus nerves, and converges with neurons in the upper cervical dorsal horn which convey equivalent stimuli from upper cervical dorsal rami.

Trigeminal, geniculate, glossopharyngeal, vagal and occipital neuralgias have been described as hyperactive dysfunction syndromes. The efficacy of antiseizure compounds in the treatment of these primary neuralgias results from the depression of exitatory mechanisms of Vc neurons.4 The venules which drain the lateral columns proximal to the dorsal horn where Vc is located operate at low pressure and have little redundancy 5. If adverse mechanical tension were transmitted to the cord via upper cervical dentate ligaments, this area would be among those earliest effected. Such tension could lead to direct mechanical compression of the descending tract of the trigeminus, which lies on the periphery of the cord adjacent to the dorsal spinocerebellar tract, or of Vc. Compression might also lead to venous stasis with resulting hypoxia and hyperexcitability of Vc. We speculate that such tension may result from displacement of the atlanto occipital and atlanto axial joints, and that correction of such displacements may result in attenuation of Vc hyperactivity.

Conclusions

Results from this study suggest that upper cervical chiropractic procedures may be of benefit to TN sufferers. Further study is needed to better qualify the efficacy of chiropractic procedures for TN and other primary neuralgias. A controlled trial is planed to improve the evidence base on which clinicians and patients can make decisions.

References

1. Goodman J. chap 14. In: Biller J, Ed. Practical Neurology. Lippencott Raven, 1997: 142 3

2. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945 1984. Neuroepidemiology 1991;10(5 6):276 81

3. Adams R, Victor M, Ropper A. Principles of Neurology, Sixth Ed. McGraw Hill 1997

4. Kondo T, Fromm GH, Sxhmidt B. Comparison of gabapentin with other antiepileptic and GABAergic drugs. Epilepsy Res 1991 Apr;8(3):226 31

5.Gillilan LA. Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 1970 Sep;20(9):860 8