Edited Feb 14 2013
SymptomsPlease be aware that the following list is a list of all possible complications and their anatomical and physiological basis and that few people with this condition will have a full hand of symptoms.
However, a proper understanding of anatomy and physiology of the upper cervical area and brainstem should be enough to make it clear that all of the symptoms listed below are predictable given a large enough subluxation.
The joint between the skull and the neck is designed for nodding movements, and it has been documented that the maximum rotation expected on turning well to the left or right is about 3-4 degrees.
The worst case I have seen was a rotatory subluxation of about 25 degrees demonstrated on a CT upper cervical spine. I was dismayed that the radiologist who reported it failed to note the abnormality. I would observe that this probably happened because such subluxations are not regarded as possible within allopathic medicine- and he was not looking for it. I did get the satisfaction of an amended report after conversation with the radiologist involved.
Most symptoms will be intermittent, and at least partially resolve when the patient is fit and active, so there will be great variability between patients. I have had experience with most of these symptoms being relieved in patients I have seen.
Physical and radiological examination will provide clear cut evidence of the existence of the condition.
- Headaches- often involving the base of the skull, and referring to the sides of the head and around the sinuses.
- Migraines, often with marked agitation and nausea.
- Neck pains and stiffness and difficulty finding a comfortable position on the pillow at night.
- Sometimes crackling or grating noises at the base of the skull when turning the head. Often there are associated shoulder pains, especially between the shoulder blades.
- Jaw joint pains or dysfunction. Clicking jaw.
- Chest wall pain- due to the distortion of the ribcage
- Low back pain and/or disc injuries due to abnormal posture.
- Nerve root irritations at any level.
- Pains or injuries in one hip, knee or ankle, often repeated injuries to one side of the body.
- Patients may be told they have one leg shorter than the other.
Vagus nerve: Nausea, heartburn, irritable bowel, constipation, vasovagal (fainting/near fainting) episodes, probably infantile colic. Cough and voice problems
Internal Jugular Vein and venous drainage of the skull via the foramen magnum: tiredness, mental fogginess (often subtle and this may well contribute to the mental fogginess in ADHD, chronic fatigue syndrome, fibromyalgia and depression). References:
It is of interest that current research into multiple sclerosis has raised the possibility of venous congestion of the brain having a causative role in that condition.
Dizziness- often subtle and hard to describe, and mild incoordination /clumsiness.
Note that these symptoms are likely to be related to disturbed inputs to the Vestibular/proprioceptive (balance) system caused by nerve impingements, and excess tension in some muscles and on some joints. It is likely that the actual atlas subluxation causes some brainstem injury at the time of the injury.
Tingling or burning fingers or toes- usually migratory and intermittent.
Sympathetic Nervous System:
There are multiple reasons to believe that atlas subluxations may cause sympathetic overactivation (stress response): Poor balance itself is a cause of sympathetic overactivation, also the traction on the brain stem caused by the typical head forward posture of most people with the injury activates a stress response, and there may be further impacts on sympathetic ganglia (nerve cell clusters) that lie close to the spine along the whole length of the spine.
Symptoms would include chronic anxiety and impulsiveness, fine tremor, raised heart rate
It is arguable that chronic sympathetic overactivationmay be lead to:
a)gut problems due to chronic diversion of blood flow away from the gut into the muscles which may well be contributory to peptic ulcers, food allergies ( via increased gut permeability)
b) Adrenal gland activation and chronic over production of cortisone as an expected consequence of chronic sympathetic (stress) response. Adrenal fatigue as a downstream consequence of this.
c) unstable attention- as the body is effectively being given a warning to loo for threat in the environment.
It is arguable that chronic sympathetic activation might be contributory to immune suppression, hypertension, diabetes, osteoporosis, disturbed sleep and depression.
This is a common complication in our experience and may be contributed to by neck discomfort at night, by sympathetic over-activation, or by a number of brain stem effects caused by alteration in balance inputs into the nervous system.. In a number of patients the neck discomfort has triggered tooth grinding which has improved after treatment.
The physical signs of atlanto- occipital subluxation are straightforward, and the diagnosis can usually be confirmed without investigations.Posture- the head is carried forwards of the shoulders. ( In healthy posture the centre of the shoulder joint is vertically directly below the ear canals).
The patient may also have a degree of hunch or a sway back.
The patient will have great difficulty straightening up to hold his head in correct position.
The front on view will often clearly indicate the problem. The head may be tilted to one side, and the neck rotated a few degrees or so off straight ahead.
The midline of the trunk may not be vertical.
One shoulder will be higher than the other.
Often the pelvis will visibly be off level as well (Usually high on the side of the low shoulder).
From the back the difference in the level of the shoulders will be more apparent, and one shoulder should be pushed out to the back. The head, shoulders, and hips may be out of alignment (viewed from above).
The neck will almost always be tender just below the ears and behind the jaw. It may be possible to feel that the neck bone is closer to the jaw on one side than the other. Postural issues, muscle spasm, or a “bull neck” can make this sign difficult to identify. However the joint between the atlas and the skull is not one at which rotation naturally occurs (beyond about 3-4 degrees at the extremes of neck rotation) so this sign is always abnormal if found.