Dr. med. Rainer M. M. Seibel
Mülheimer Radiologie Institut [Mülheimer Institute of Radiology]
45470 Mülheim an der Ruhr
Date: 08 December 2009
Expert Report on René-C. Schümperli’s Atlas Prophylaxis
In April 2006, we launched a research study about René-C. Schümperli’s Atlas Prophylaxis at our university institute. We examined a total of 114 subjects in this study. The initial evaluation of the data has been completed. The academic publication of these findings is anticipated for the near future. We conducted an MRI (nuclear magnetic resonance) examination of the cervical spine with special attention to the atlas. Afterwards, an atlas prophylaxis was performed. Subsequently, we conducted a follow-up MRI examination of the cervical spine.
The atlas is the first cervical vertebra and together with the joint surfaces of the occiput, it forms the craniocervical joint. Together with the second cervical vertebra, the axis, the occiput and the atlas constitute a major functional unit of the locomotor apparatus and the spine.
In contrast to its importance, the atlas has generally occupied a lowly position in radiological diagnostics, since there are no intervertebral discs in the first or the second craniocervical joints, and thus no disc prolapse can occur at this level. Instead, there is only cartilage between these joints and ligamentous connections. A number of short and long neck muscles allow great mobility for the head. Fractures of the first cervical spine are relatively rare and are generally seen only with specific types of injuries, such as swimming pool trauma, and even in these cases, fractures of the second cervical vertebra (the axis) are significantly more common. In this type of injury, the head is compressed upon the spine. The type of fracture known as Jefferson’s fracture (1) is a "burst" type fracture, where parts of the atlas joint are displaced laterally. Neurological symptoms do not typically occur, since the spinal canal is very broad at this level and broken fragments of the atlas do not penetrate into the spinal cord of the spinal canal. (Figure 1).
Fig. 1 Jefferson fracture of the atlas with displacement of the lateral portions. The vertebral arteries are also displaced as a result of this type of fracture. As a result of the arch of the atlas, which enables some injury-free mobility
of the arteries during normal rotation of the head, there is sufficient compensatory capacity available to prevent tears of the vertebral arteries at this level.
It is only since the introduction of MRI that we have been able to obtain detailed images of the craniocervical junction. High-resolution computer tomography of the cervical spine is likewise capable of precisely demonstrating malpositioning of the vertebral bodies. However, it is much more difficult to differentiate the soft tissues. X-ray images of the upper cervical spine are typically overlain by the surrounding bony structures and are not sufficiently reliable for estimating the position of the atlas. In addition, similar to computer tomography, they involve some radiation exposure.
MRI examination of the cervical spine is usually performed by radiologists in two views (sagittal and axial). Most often, this procedure allows scarcely any estimation of malpositioning of the atlas, especially as the atlas is almost never examined in an axial view. This is related to the fact that most intervertebral disc problems are located in the middle and lower third of the cervical spine. It is specifically the coronal view that allows for a precise diagnosis of malpositioning of the first and second cervical vertebrae.
At our institute, we have always performed examinations of the cervical spine in three views. We have been engaged in research about diseases of the spine for over 23 years and we diagnose and treat diseases of the spine (2). Our special study on the atlas was begun about 4 years ago. Our objective was to be able to determine the precise position of the atlas in relation to the occiput and the axis. In a prospective study, we performed MRI examinations in three views using standardized examination sequences. Subsequently, René-C. Schümperli’s atlas prophylaxis was performed on each of the subjects examined, after which they underwent a second MRI examination. The images were evaluated at medical workstations to determine the position of the craniocervical joints, the position of the vertebrae in relation to each other, and the rotation of the atlas. The examinations were evaluated by two independent physicians. The results showed in almost all cases a rotational malpositioning of the atlas with respect to the occipital joint surfaces prior to atlas prophylaxis therapy. After the massage, the joint surfaces were shown to be in the proper position.
In a second phase of the study, I endeavored to learn about the procedure personally and had the practitioners give me a precise description of the technique in order to be able to judge what changes might occur, what the physiological and physical mechanism of action might be, and especially to be able to assess the possible damage that might result from the treatment. To facilitate this process, Mr. Schümperli traveled personally to visit our university institute in Mülheim.
Atlas from above
Anatomically correct position of the atlas. A trained examiner can palpate the transverse processes of the atlas in normal-weight individuals. (Sobotta, Atlas of Anatomy)
The procedures developed by René-C. Schümperli constitute a massage technique for ameliorating symptoms arising from problems in the craniocervical junction. The technique most often leads to success by relieving the muscular tension that has been caused by malpositioning of the upper cervical spine. Other massage techniques have also achieved positive results for other regions of the body. These include massage for spinal conditions as well as Ayurvedic massage in Indian medicine and in traditional Chinese medicine (TCM). These methods are sometimes employed in the wellness area, and sometimes for medical treatment. It has taken a long time for such methods that have been employed for centuries in Ayurveda and TCM to establish themselves in Western medicine and for them to achieve general acceptance. It has not been unusual for certain individual methods to be practiced both in medicine and in the wellness area.
Fig. 3 © MRI – Rainer M. M. Seibel - AtlasPROfilax®
Atlas from above in a rotational malposition
Blue Line: Malrotation of the atlas
Red Line: Correct position of the Atlas
Red arrow: force effect of the "impulses" as they are applied by Dr. Lohse-Busch.
Curved red arrow: incorrect direction of rotation
Curved yellow arrow: correct direction of rotation of the Atlas
Yellow circle: center of rotation
The massage developed by Schümperli does not work directly on the vertebra, but rather, it has an indirect effect through muscle relaxation and movement in the nuchal ligament. In contrast, it is possible that the Arlen technique (3,4), as described by Dr. Lohse-Busch, which uses "impulses" over a site in front of the sternocleidomastoid muscle may have a harmful effect on the craniocervical joint. This method generates a direct effect on the transverse process of the atlas, which could lead to an aggravation of the malposition of the atlas. The reason for this is that the force exerted works in the wrong direction, and can result in further malrotation of the atlas, which was already rotated toward the left before the treatment (Fig. 3). Overall, the Arlen treatment that is performed by Dr. Lohse-Busch is not without controversy in academic medicine (6). Its use in KISS ("Craniocervical joint induced symmetry disorder") in babies, as described in Dr. Lohse-Busch’s publication, is open to question. Prior to each of these treatments, an X-ray image of the cervical spine is supposed to be taken. These are of minimal value for assessing the position of the cervical spine, since the spinal structures are to some degree overlain by other bony structures and are difficult to visualize in a standardized manner. In addition, parts of the atlas are not calcified yet in babies and are thus invisible on X-ray examination.
The KiSS syndrome itself is declared to be only an unproven hypothesis in a position statement by the Society for Neuropediatrics:
The existence of "the ‘craniocervical-induced-symmetry-disorder’ (KiSS) as a defined disease leading to specific clinical disturbances in head posture in infants and babies, or responsible for a host of behavioral disorders remains an unsubstantiated hypothesis." (7)
Arlen’s treatment method, as promoted by Dr. Lohse-Busch (5), has been evaluated in the following terms according to the summary report of the Working Committee on "medical treatment" of the National Committee of Doctors and FHI Funds regarding their consultation in accordance with § 135 Paragraph 1 SGB V of 24 September 2002:
Considering the current scientific literature, the uses, necessity and effectiveness of Arlen’s Atlas Therapy have not been sufficiently proven. Therefore, the method cannot be recognized as a statutory medical service.
According to our study, all cases of malrotation have been shown to occur in one direction (toward the anterior left). This corresponds to the thesis proposed by René-C. Schümperli in 1993, according to which the first cervical vertebra is found in a rotational malposition tilted forward, upward and toward the left. There was a significant rotational disturbance that could be demonstrated on MRI in coronal sections. This condition is unrelated to any prior injury to the cervical spine. The findings of our study help to elucidate the anatomic relationships in the area of the craniocervical joints. Additional studies and analyses will have to be undertaken to evaluate any claims for distant effects on the autonomic nervous system of atlas prophylaxis or other measures applied to the craniocervical junction.
Our subjects consistently achieved an improvement in head rotation after the atlas prophylaxis. This result is primarily attributable to relaxation of the short neck muscles at the craniocervical junction. What is surprising is that this improvement in head rotation is sustained. We documented this in the follow-up studies on our subjects. We witnessed no negative effects after atlas prophylaxis. According to our findings, and in keeping with the physical and anatomical conditions, we would rate Schümperli’s method, when properly applied, to be without risk. The breadth of the spinal canal at the craniocervical junction and the associated distance of the bony mass of the atlas from nerves and the spinal cord (significantly greater than for other vertebrae) would lend support to this. Specific training in this massage technique is a prerequisite for performing atlas prophylaxis, and in our opinion, should result in approval for practice.
Dr. med. Rainer M. M. Seibel