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Orthogonal Upper Cervical Correction

The orthogonal chiropractic methods of upper cervical correction evolved from the orignal method developed by BJ Palmer in 1939. The upper cervical spine includes the base of the skull, the first cervical vertebral (C1) called atlas, and the second cervical vertebral called axis.
The primary difference between the two methods is that the orignial method of specific upper cervical chiropractic correction used general anatomical notations, called listings, to describe the strain position or misalignment (subluxation). For example the listing ASR means that the atlas (C1), the first cervical vertebra has misaligned anterior (forward), superior (upward)and laterally to the right side.
The picture above was taken from Palmer's original textbook. It shows an example of a PRI listing for the second cervical vertebra called axis. In this particular example it has misaligned posterior (toward the rear) and to the right and sliding inferior (downward).
The adjustment was performed with the patient kneeling down and bent over with their upper body supported on a special table. It was thus called the knee chest position. The patient's head was turned toward the side of the listing for the misalignment which was determined by x-ray analysis. The doctor stood bent over arms hanging straight down directly over the contact point on the atlas or axis vertebra. Typically the posterior arch of atlas was contacted.
Palmer called his method of correction HIO, which stood for a "hole-in-one", meaning adjusting this vertebra was the only necessary correction to eliminate the subluxation. His goal was to align the foramen magnum in the base of the skull with the spinal canal of the upper cervical spine. There are several methods of specific upper cervical in use today that continue to use and refine anatomical notations such as the Kale Brainstem method, the Blair method, and others.

In contrast to anatomical notation, several methods based on the work of Dr. Francis Grostic evolved from Palmer's HIO method. Rather than general anatomical notation these systems use orthogonal notation.
Orthogonal notation uses specific degrees of misalignment in three anatomical planes called the x, y and z axes. The word orthogonal comes from the Greek word orthogonios meaning right-angled. The picture on the right, as well as the one below show the different axes of motion. The sketches are from an article written by Dr. Marc Heller called "The Upper Cervical Spine - The Occiput," and published in Dynamic Chiropractic on December 14 2001.
In terms of motion, the x axis passes through the body from left to right. The movement that occurs around the x axis is forward and backward similar to nodding your head in agreement, the yes motion. Technically it's called flexion and extension.
The y axis is like a pole that passes through the top of the head down through the body to the feet. Action around the Y axis consists of twisting the spine to the left and right. It can involve the whole spine or it can involve particular segments as in shaking the head in disagreement, saying no.
The z axis passes through the body from front to back. The movement around the axis that runs through the belly button results in side bending the whole body. Another example is touching the ears to the shoulders on either side.
Looking at a person from the side the atlas can rock back and forth and misalign toward the front or back. Looking at a person from front to back, the atlas can misalign to the left or the right side. Looking at a person from the top down or bottom up the upper cervical spine can misalign in a twist to the left or to the right.
To make the determination orthogonal upper cervical chiropractors use different types of special x-rays enhanced by added filtration and precise alignment using head clamps. All of the systems use frontal views, side views and a top to bottom or bottom up view of the upper cervical spine.
In contrast to the HIO method based doctors, who continue to use the open mouth odontoid view which focuses more on the second cervical vertebra for the front view, the orthogonal methods prefer a nasium view. Nasium views are taken through the nose area. The nasium is used to determine the shift of the atlas to the left or the right side.
A side view called a sagittal or lateral view shows whether the atlas is misaligned upwards (superior) or downwards (inferior).
Vertex or base posterior views are taken from the top of the skull down or the bottom up respectively. These views provide information about rotation, as well as laterality (side shift to the left or right). Some upper cervical doctors also use stereo views to gain a three dimensional perspective.

The different orthogonally based upper cervical methods also use different approaches to correcting the upper cervical spine. Atlas Orthogonal, Grostic and others have switched to instruments mounted on special stands that allow precise alignment of the corrective vector forces and a consistant corrective force.
In contrast to instruments, NUCCA doctors prefer to use their hands. To take the correct vector or line of correction they use a special stance and then align their arms and hands along precise predetermined lines of correction. The adjustment is made by the doctor subtly extending the upper arms ever so slightly using the triceps muscles to gently push and nudge the atlas back into place.
All orthogonal methods use precision x-rays taken with head clamps to determine the misalignment and line of correction for treatment. The different orthogonal methods use slightly different approachs to monitoring a patient's response and progress during care, as well as the need for further corrective intervention (adjustments).

Most methods continue to use thermogram tests to determine when to adjust. Thermograms measure skin temperature differentials along the left and right side of the spine. The picture on the right shows the original type of heat measuring instrument. Most methods now use more modern electronic digital thermograms to record temperature differentials in the spine.
In addition to thermograms, most orthogonal methods also use leg length checks to monitor progress and determine when to adjust. Some NUCCA chiropractors also use a highly sophisticated piece of equipment called an anatometer to monitor misalignments, as well to measure weight shifts and curvatures in the lower spine. Still others use range of motion and palpation of trigger points.
In contrast to the original knee chest table, orthogonal methods also use a special side posture table in which the patient lies on their side. The table also has a special headpiece which is specifically set to accommodate the patient's misalignment and position for the corrective adjustment.

When it comes to the upper cervical spine the knuckle joints on the base of the skull that connect to C1 are called condyles. The picture above shows the outside of the skull looking from the bottom up. The condyles are on other side of the foramen magnum (hole in the middle) and appear as wide commas. The surface of the condyles have slope, convexity and convergence, which determine and limit the type of motion that occurs between the skull and C1.
The condyles are sloped because the base of the skull inclines upward. They have convexity because they buldge outward. Conversely, the joint the condyles sit in on the top side of C1 are concave. Lastly, in contrast to being parallel, the condyles of the skull converge around the foramen magnum toward the midline so that they are closer together toward the front of the foramen and futher apart toward the rear.

The motion of the first cervical vertebra in regards to its occiput connection is mostly flexion and extension with some side bending and a slight degree of rotation at extremes of neck rotation. In addition to determining its particular range of motion, the characteristics of the condyles of the occiput and the facets of C1 also affect the way the upper cervical spine misaligns. The misalignments can be described in terms of degrees of deviation from its correct center location on a circle. The design of the base of the skull and condyles is often assymmetrical. According to Dr. Blair who developed the Blair technique, there is more assymmetry than symmetry.
Regardless of the method used, all upper cervical methods are based on sound scientific principles and theories that have been around for over seventy years and continue to evolve while following specifically set protocols that make it perfect for further research and working with other medical disciplines.
Which upper cervical method is the best remains to be seen. Brains scans including MR angiograms (MRA) and (MR) venograms (MRV) of brain blood flow, as well as Cine MRI of CSF flow and, most importantly, upright MRI will provide many more clues.
As this website grows, I will be including more on the different upper cervical methods, as well as other methods used by chiropractors, such as craniopathy and special spinal decompression tables. These methods may be helpful and should be given serious consideration in the care, cure, prevention and co-management of neurodegenerative diseases.