NUCCA: The National Upper Cervical Chiropractic Association Presented by the Palmer NUCCA Club.

NUCCA: The National Upper NUCCA: The National Upper Cervical Chiropractic Cervical Chiropractic

AssociationAssociation

Presented by the Palmer Presented by the Palmer NUCCA ClubNUCCA Club

What is upper cervical?What is upper cervical?

• Many who go through Chiropractic Many who go through Chiropractic College hear of upper cervical but do not College hear of upper cervical but do not understand completely the reasoning understand completely the reasoning behind an upper cervical technique.behind an upper cervical technique.

• So, how does adjusting the atlas help my So, how does adjusting the atlas help my lumbar or my thoracic problem? lumbar or my thoracic problem?

• Do you know the answer to this Do you know the answer to this question?question?

NUCCA…NUCCA…

• An orthogonal upper cervical technique An orthogonal upper cervical technique can truly be called a full spine technique.can truly be called a full spine technique.

• The premise of NUCCA: An unbalanced The premise of NUCCA: An unbalanced position between the head and the rest position between the head and the rest of the cervical spine can cause of the cervical spine can cause debilitating problems in the rest of the debilitating problems in the rest of the body, neurologically and body, neurologically and biomechanically.biomechanically.

The rationaleThe rationale

• Look at it from the top down.Look at it from the top down.• Take a weight and raise it Take a weight and raise it

above your head, so that it above your head, so that it feels centered and balanced. feels centered and balanced. Now move that weight to the Now move that weight to the side or an imbalanced side or an imbalanced position, do you feel strain in position, do you feel strain in your back musculature?your back musculature?

• When the delicate When the delicate articulations between articulations between occiput, atlas and axis occiput, atlas and axis become subluxated our head become subluxated our head is placed in an unbalanced is placed in an unbalanced position.position.

• The rest of the body has to The rest of the body has to compensate due to the compensate due to the righting reflex and other righting reflex and other proprioceptive input. This proprioceptive input. This can cause fixations and pain can cause fixations and pain down through the rest of the down through the rest of the spine.spine.

Why Postural Changes Why Postural Changes OccurOccur

• Accidents and injuries tear connective tissue.Accidents and injuries tear connective tissue.• Creates weakness and the spine breaks down.Creates weakness and the spine breaks down.• For stability it locks into positionFor stability it locks into position• If the skull and atlas complex lock into a position where the If the skull and atlas complex lock into a position where the

eyes and ears aren’t level with the horizon, the righting eyes and ears aren’t level with the horizon, the righting reflex takes over coupled with other proprioceptive input.reflex takes over coupled with other proprioceptive input.

• Other portions of the spine must adapt to bring the eyes Other portions of the spine must adapt to bring the eyes and ears back to leveland ears back to level

• This causes twisting and bending of the spine, all of which This causes twisting and bending of the spine, all of which is mediated by the musculature.is mediated by the musculature.

• Correcting this Correcting this misalignment misalignment can objectively can objectively predict predict restoration of the restoration of the entire spine to a entire spine to a more normal and more normal and balanced balanced position. position.

MeasurementMeasurement• NUCCA, like Gonstead and other techniques, uses a NUCCA, like Gonstead and other techniques, uses a

listing system.listing system.

• 50 + years clinical research, (90+ if you include BJ) 50 + years clinical research, (90+ if you include BJ) indicate that the subluxation exists and can be indicate that the subluxation exists and can be captured on X-ray.captured on X-ray.

• If it came out in one specific direction, there is one If it came out in one specific direction, there is one specific vector or line of correction that will “put it specific vector or line of correction that will “put it back” to where it belongs. In NUCCA we take back” to where it belongs. In NUCCA we take measurements to find a precise vector that will measurements to find a precise vector that will reposition the head with cervical spine using the least reposition the head with cervical spine using the least amount of force necessary.amount of force necessary.

Measurement Cont.Measurement Cont.• To illustrate this point…imagine that you want to open a To illustrate this point…imagine that you want to open a

door. door. You start pushing on the side closest to the door. door. You start pushing on the side closest to the hinges. Finding this difficult and effortful, you step back hinges. Finding this difficult and effortful, you step back and think where would be the spot on the door where, if I and think where would be the spot on the door where, if I push, the door will open with the least amount of effort. So push, the door will open with the least amount of effort. So it is with NUCCA and other orthogonally based techniques. it is with NUCCA and other orthogonally based techniques. We measure to see where is the easiest place “ to push”.We measure to see where is the easiest place “ to push”.

Measuring SubluxationMeasuring Subluxation• Subluxation listings are Subluxation listings are

taken off of Pre-taken off of Pre-adjustment X-rays. The adjustment X-rays. The subluxation and x-ray subluxation and x-ray listing should not change listing should not change except with trauma.except with trauma.

• Some people would say Some people would say that you cannot find a that you cannot find a subluxation on an x-ray; subluxation on an x-ray; however, when the atlas however, when the atlas is out of alignment the is out of alignment the body will respond in a body will respond in a manner which we can manner which we can measure. You can say measure. You can say that the x-ray is showing that the x-ray is showing how the body looks in a how the body looks in a subluxated state.subluxated state.

Chiropractic Evaluations of Chiropractic Evaluations of SubluxationSubluxation

• You must find a system that works for you You must find a system that works for you and your understanding of the human and your understanding of the human body.body.

• Dual probe? Static palpation? Motion Dual probe? Static palpation? Motion Palpation? X-ray? Titron/Myovision? Leg Palpation? X-ray? Titron/Myovision? Leg Checks?Checks?

• Whatever you choose in chiropractic, your Whatever you choose in chiropractic, your post adjustment findings should be better post adjustment findings should be better than your pre adjustment findings. than your pre adjustment findings.

NUCCA Evaluation of NUCCA Evaluation of SubluxationSubluxation

• Deals mainly with postural changesDeals mainly with postural changes

- Supine leg check- Supine leg check

- Anatometer- Anatometer

The AdjustmentThe Adjustment

• Atlas is used as an anatomical leverAtlas is used as an anatomical lever• Adjustment takes into account what Adjustment takes into account what

will happen to C2 and occiput during will happen to C2 and occiput during the adjustmentthe adjustment

• Gentle and vectored controlled force is Gentle and vectored controlled force is applied down the ideal line of applied down the ideal line of correction that will align the head and correction that will align the head and neck together at the same timeneck together at the same time

• No twisting or popping – patients love No twisting or popping – patients love it!it!

• Some patients feel nothing, others feel Some patients feel nothing, others feel the atlas move back into alignment.the atlas move back into alignment.

• Regardless of what is perceived to be Regardless of what is perceived to be happening from the patient’s happening from the patient’s perspective, restoring alignment to perspective, restoring alignment to the head and neck will balance the the head and neck will balance the body.body.

How does it happen?How does it happen?

NUCCA believes that occiput, C1 and C2 are all going to move. Their anticipated movement is calculated before the adjustment. With the model of Wernsing and Grostic, which states “atlas moves as if on the rim of a circle” we can see how using atlas as a lever will influence the Occiput and C2.

Outcome of the adjustmentOutcome of the adjustment

• Clinical research has shown that the Clinical research has shown that the closer you are able to get someone’s closer you are able to get someone’s head sitting upright on their atlas with head sitting upright on their atlas with the lower neck underneath that head, the lower neck underneath that head, the more likely the chance you will the more likely the chance you will remain unsubluxated.remain unsubluxated.

• Unsubluxated correlates with being both Unsubluxated correlates with being both objectively and subjectively in a healthy objectively and subjectively in a healthy state. state.

Post AdjustmentPost Adjustment

• Supine leg check – return to normalSupine leg check – return to normal• Anatometer – more balanced postureAnatometer – more balanced posture• This makes NUCCA a full spine This makes NUCCA a full spine

technique. If I change the position of technique. If I change the position of your pelvis by putting your head and your pelvis by putting your head and neck back in alignment, is this not a neck back in alignment, is this not a full spine technique?full spine technique?

Post FilmsPost Films

• Post x-rays are taken to make sure the body Post x-rays are taken to make sure the body responded the way in which the doctor intended.responded the way in which the doctor intended.

• NUCCA measures the reduced amount of NUCCA measures the reduced amount of misalignment after the adjustment on this post filmmisalignment after the adjustment on this post film

• If the subluxation has been reduced, the doctor If the subluxation has been reduced, the doctor knows the listing is correct and no other films are knows the listing is correct and no other films are needed.needed.

• Patients are not x-rayed every office visit, usually Patients are not x-rayed every office visit, usually only the first visit.only the first visit.

• It is essential to shoot a post film to ensure you are It is essential to shoot a post film to ensure you are giving the correction the patient deserves.giving the correction the patient deserves.

Leg Check pre-post Leg Check pre-post Eriksen pg 468 F Eriksen pg 468 F

Thoracic and Lumbar Thoracic and Lumbar Eriksen pg 454DEriksen pg 454D

LumbarLumbarEriksen pg 455DEriksen pg 455D

Lateral CervicalLateral CervicalEriksen 447CEriksen 447C

Nasium AnalysisNasium AnalysisWhat the lines representWhat the lines represent

Ericksen pg 442-BEricksen pg 442-B

NasiumNasiumEriksen pg 442-BEriksen pg 442-B

Pre Chiropractic Adjustment Pre Chiropractic Adjustment Eriksen pg 183Eriksen pg 183

Post Nucca AdjustmentPost Nucca AdjustmentSame PatientSame Patient

Eriksen pg 183 Eriksen pg 183

Post Diversified Adjustment Same Post Diversified Adjustment Same PatientPatient

Eriksen pg 183 Eriksen pg 183

Post Nucca Adjustment after Post Nucca Adjustment after Diversified AdjustmentDiversified Adjustment

Eriksen pg 183 Eriksen pg 183

Sources:Sources:

• Images graciously donated/”borrowed” Images graciously donated/”borrowed” from Kirk Eriksen and the NUCCA Textbook from Kirk Eriksen and the NUCCA Textbook

• Eriksen, Kirk. Upper Cervical Subluxation Eriksen, Kirk. Upper Cervical Subluxation Complex – A Review of the Chiropractic Complex – A Review of the Chiropractic and Medical Literature. 2004. Lippincott and Medical Literature. 2004. Lippincott Williams & WilliamsWilliams & Williams

• Thomas, Michael. NUCCA Protocols and Thomas, Michael. NUCCA Protocols and Perspectives – A Textbook for the National Perspectives – A Textbook for the National Upper Cervical Chiropractic Association, 1Upper Cervical Chiropractic Association, 1stst Edition. 2002. Edwards BrothersEdition. 2002. Edwards Brothers