Upper Cervical Adjusting

Innate Intelligence
 Chiropractors recognize that an inborn
"innate intelligence" drives the human
machine with the utilization of the nervous
system.
 Specific upper cervical care uses a
mechanistic approach in the assessment of
the subluxation and the application of the
adjustment while appreciating the "vitalistic"
philosophy of health and healing. Kirk Eriksen
 How Much Force To Use
Sweat RW. Minimum Force vs. Moderate Force in the Occipital-
Atlanto-Axial Subluxation Complex (OCP-C1-C2). Am
Chiropr, February 1988:22-24.
 Coefficient of Friction: "Definition. The ratio of tangential force
to the normal interbody compressive force required to initiate a
sliding motion between two bodies.
 "The tangential component in the healthy joints is generally very
small, about 1 percent of the normal component. This is due to
very low joint friction.
 "The value of the coefficient of friction in the animal inkle joint is
.005."
 Adjusting the atlas area is not a simple procedure. It is as
delicate as the most complicated surgery and does require an
endless process of study and discipline.

Eriksen K, Upper Cervical Subluxation Complex, a review of the chiropractic and medical literature. 2004 Lippincott, Williams & Wilkins, Baltimore, MD
How Much Force To Use
Sweat RW: Am Chiropr, February 1988:22-24
Editorial Comment
 The normal human synovial joint will not wear out with normal use and
under normal loads.
 The coefficient of friction is roughly equal to that of ice on ice.
 Due to the unique architecture of the upper cervical joints, this area
should be adjusted differently from the rest of the spine. There are no
interlocking facet joints holding these articulations in place.
 Upper cervical biomechanical stability is accomplished primarily from
the weight of the head and the articular surfaces, muscles, and
ligaments.
 … upper cervical correction appears to require little force. The
displacement used in the hand and instrument adjustment may vary
from about a sixteenth of an inch to a quarter of an inch.
 It has been observed clinically that too much depth will usually cause
the joint to lock up, or an asymmetrical correction can result. A deep
adjustment may cause the suboccipital muscles to splint as a protective
mechanism. This is why the axiom "light is right" may appear
appropriate when it comes to the upper cervical adjustment.
Force of the UC Adjustment
 Depending upon the type of cervical manipulative
technique used, preload forces range from 0 to
approximately 50 N, and peak impulse forces range
from approximately 40 N to approximately 120 N.
 The forces delivered during cervical manipulations
develop faster than during manipulation of the thoracic
spine and sacroiliac joint.
 Impulse duration lasts from approximately 30 ms to
approximately 120 ms.

J.G. Pickar / The Spine Journal 2 (2002) 357–371

 Dr. John F. Grostic stated in his seminars in
Ann Arbor, Michigan, "The atlas area has the
most wedges, circles, incline planes,
fulcrums, and levers than any other area of
the spine.“
 Dr. Ruth Jackson in her, book on the cervical
syndrome states, "The Cervical spine is more
subject to injury than any other area of the
spine."

Sweat R. CHIROPRACTIC PRODUCTS OCTOBER 1995

 Time Line
Palmer Upper Cervical
BJ Palmer (early 1930’s)
HIO and Toggle Recoil 1953 WG Blair develops
the Blair Technique

1934 Wernsing develops

Knee Chest
C1 as the primary focus
(Kale, Kessinger)

1941, J.F. Grostic, R.R. 1966 RR Gregory

Gregory study Wernsing founded NUCCA

1981 R Sweat
1965 John F. Grostic’s death founded AO

Grostic Presentation Inc

Then
Soc. of Chiropractic Orthospinology
Grostic/Orthospinology
 NUCCA and AO have modified various aspects of the original
Grostic procedure.
 NUCCA doctors use exclusive manual upper cervical adjusting
by hand,
 AO doctors use only a table-mounted percussion instrument.
 Orthospinology teaches doctors the hand adjustment and the use
of a hand-held, solenoid-driven instrument and a multivector
table-mounted instrument.
 All three orthogonally-based upper cervical procedures use
similar X-ray analyses for the lateral, nasium, and vertex views to
assess patients' subluxations. However, the interpretation of the
types of analysis, although they have much in common, also
have some subtle to significant differences.

Eriksen K, Upper Cervical Subluxation Complex, a review of the chiropractic and

medical literature. 2004 Lippincott, Williams & Wilkins, Baltimore, MD
Grostic/Orthospinology
 A Mastoid support is used to place the patient
in the optimum biomechanical position to
effect the Atlas (and spinal) position.
 It has been said that with proper analysis of
the orthogonal x-rays, sometimes the adjustic
stimulus may not be necessary if the patient
is positioned correctly on the mastoid
support.
Atlas Orthogonal
 Atlas Orthogonal Percussion Adjusting Instrument,
 The…instruments we have made is a percussion instrument with zero
excursion.
 The latest solenoid instrument is 1.8 pounds which produces 3 to 6
pounds of thrust.
 A mechanical impulse is imparted to a metal stylus by means of a
spring loaded plunger. (Dr. Eugene T. Patron is, Jr., Ph.D., School of
Physics, Georgia Institute of Technology)
 The strength of this impulse is determined by the initial degree of
compression given to the plunger spring.
 The impulse imparted to the stylus by the 'plunger excites a
compressional wave in the stylus.
 The velocity of this wave in the stylus material is determined by the
square root of the ratio of the Young's modulus to the density of the
stylus material.
 At the patient-stylus interface, dependent on the impedance match, a
portion of the wave energy is transmitted into the patient and a portion
is reflected back to the plunger."
Sweat R. CHIROPRACTIC PRODUCTS OCTOBER 1995
Atlas Orthogonal
Light Is Right
 Currently most doctors using the
hand held instrument set the
instrument at its lowest possible
depth thrust.
 We have found that post x-rays
validate the lighter forces resulting
in better, reductions.
 We are fortunate that light force
adjusting protocol utilizing minimal
depth provides the moist favorable
results.
 We strongly believe it is not
necessary to be forceful to properly
move the atlas.
 Conclusion
 Minimal depth, low forces and
specific angles of correction are
appropriate in adjusting the atlas.

Sweat R. CHIROPRACTIC PRODUCTS OCTOBER 1995

 National Upper Cervical
Chiropractic Association
 NUCCA
 Hand adjusting
 Mastoid Support
 Triceps Pull
 Very light force, lighter
is better.
 “If you are having a
problem making the
correction, lighten up.”
NUCCA
 NUCCA has subdivided the misalignments of the ASC into Four
Basic Types or patterns.
 Knowledge of the Four Basic Types aids the practitioner in
achieving maximal corrections of the misalignment factors of the
ASC.
 Sufficient evidence supports the hypothesis that all the
misaligned structures that cause the subluxation complex must
be restored by the adjustment to a position of alignment or no
stabilization can exist.
 A stabilized state for a subluxation-free spinal column is one in
which the skull, spinal vertebrae, and pelvis are aligned or
restored to their normal positions on the vertical axis of the body;
a state in which all acting influences are canceled by other
influences resulting in a balanced or unchanging system.
Orthospinology
 The Procedure employs a method
of X-ray analysis that quantifies
the lateral and rotational
misalignments between atlas and
axis as well as atlas and occiput.
 The analytical procedure
examines the spatial orientation of
the atlas, the geometry of the
articulating surfaces, and the
misalignment configuration to
arrive at an effective correction
vector.
 X-ray analysis, the system
contains steps for ensuring the
precision of the X-ray analysis,
specific adjustment, and post-
adjustment reevaluation
procedures.

http://orthospinology.org/pages/orthospinology2.html
Eriksen, K and Rochester, RP. Orthospinology Procedures:
An Evidenced-Based Approach to Spinal Care. 2007.
Lippincott Williams and Wilkins, a Wolters Kluwer business.
Philadelphia, PA. p.159, 160 and 171.

 The vectored force direction during the hand adjustment is determined by

establishing a point in three-dimensional space for its initiation with the
conclusion at the atlas transverse process.
 A coordinate is established using the rotational factor (RF) and height factor
(HF) as measured and calculated from the x-ray analysis relative to which
the doctor will align his/her body and deliver the corrective vectored hand
adjustment.
 The adjustment is accomplished by contraction of the long head of the
triceps that will straighten the arms, resulting in a controlled, directional
force with minimal depth.
 Orthospinology teaches doctors the use of a handheld and table-mounted
adjusting instrument as well.
 In the late 1990s, Laney designed the torque-specific table-mounted
instrument, which uses multi-vector force that aids in reducing the
atlantoaxial rotatory subluxation.
 The force starts slowly and gains speed as it reaches its peak at the end of
the thrust. This differs from the solenoid impulse force of the handheld
instrument.
Toggle Recoil
 According to the Green Books “The Palmer Recoil was just
beginning to be taught at the P. S. C. in 1909-10, and is still the
basic fundamental of the present Palmer Torque-Toggle-Recoil in
use in Hole-in-One.
 The secret of efficient delivery of the Palmer Recoil is to secure,
first, as complete a relaxation on the part of the patient as
possible, immediately before and during the delivery of the
external adjustic force.
 The object is to all the better secure the patient’s recoil reaction.
Second, it is necessary for the Chiropractor himself to acquire, at
the same time, complete relaxation in his arms and shoulders as
a preliminary immediately before delivery.
 Having accomplished this relaxation as far as possible, the
Chiropractor gives his external force with great speed, followed
by a swift withdrawal of the contact point of his adjusting hand,
so as not to resist the natural recoil of the patient.

http://www.upcspine.com/tech.htm
Toggle Recoil
 Modern Toggle Recoil is a modification of the side posture/knee
chest adjusting procedure that BJ Palmer developed during his
commitment to the upper cervical region of the spine.
 The modification consisted in the incorporation of the drop piece
mechanism which Dr. J. Clay Thompson developed in the late
1940s and which was introduced to the profession in the early
1950's.
 The use of a drop mechanism utilized the Laws of Motion to
make the adjustment in the least traumatic manner to the patient
and doctor.
 The toggle recoil adjustment sets the subluxated vertebra in
motion with the proper line of correction. This precise line of
correction is obtained from the upper cervical line drawing
analysis. The vertebra continues in motion and oscillates until it
rests in its appropriate position.

Strazewski, JW. The Essentials of Toggle Recoil (HIO). 1995. p.3, 38 and 42
Blair Upper Cervical Technique
 The toggle adjustment is a variant on toggle-recoil, as taught at
Palmer College in the 1970’s.
 Blair practitioners use the Blair Toggle-Torque (TT) adjustment
approach, which was developed from B.J. Palmer’s toggle-recoil
technique.
 Blair TT uses toggle without recoil but incorporates a 180-degree
torque (helical twist) force.
 Theoretically, "torque" is used to decrease the superior or inferior
aspect of the misalignment.
 Note: this is not torque, per se by definition as a twisting or rotating
motion about a central point, it is changing the vector of the adjustic
thrust.
 The torque may provide extra leverage via a recto-linear force on
the transverse process of the atlas.
 Adjustments are produced by changing the linear vector of the thrust
through the motion to create forces perpendicular and parallel to the
Joint surfaces.
Knee Chest
 The knee-chest table is utilized in making the atlas adjustment
and such adjustments are delivered only when the patient
presents with the subluxation pattern.
 The adjustment mimics the way Palmer had intended it to be
following his original research and refinement of the technique. It
is a torque, toggle adjustment.
 The adjustment relies on "that extra something" - the torque. The
torque is dependant on the superiority or inferiority of atlas or
axis.
 The body drop is also crucial in delivering a proper adjustment.
Doctor position and hand placement is dependant on the side
and anteriority and posteriority of atlas or axis.