NUCCA: The National Upper Cervical Chiropractic Association

Presented by the Palmer NUCCA Club

What is upper cervical?

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

So, how does adjusting the atlas help my lumbar or my thoracic problem? Do you know the answer to this question?

NUCCA…

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

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

The rationale

• • • • Look at it from the top down.

Take a weight and raise it above your head, so that it feels centered and balanced.

feel strain in your Now move that weight to the side or an imbalanced position, do you back musculature?

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

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

• • • • • •

Why Postural Changes Occur

Accidents and injuries tear connective tissue.

Creates weakness and the spine breaks down.

For stability it locks into position If the skull and atlas complex lock into a position where the eyes and ears aren’t level with the horizon, the righting reflex takes over coupled with other proprioceptive input.

Other portions of the spine must adapt to bring the eyes and ears back to level This causes twisting and bending of the spine, all of which is mediated by the musculature.

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

•

Measurement

NUCCA, like Gonstead and other techniques, uses a listing system.

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

• If it came out in one specific direction, there is one specific vector or line of correction that will “put it back” to where it belongs.

In NUCCA we take measurements to find a precise vector that will reposition the head with cervical spine using the least amount of force necessary.

Measurement Cont.

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

door. You start pushing on the side closest to the hinges.

Finding this difficult and effortful, you step back 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 it is with NUCCA and other orthogonally based techniques. We measure to see where is the easiest place “ to push”.

Measuring Subluxation

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

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

•

Chiropractic Evaluations of Subluxation

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

• Dual probe? Static palpation? Motion Palpation?

X-ray? Titron/Myovision? Leg Checks?

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

NUCCA Evaluation of Subluxation

• Deals mainly with postural changes - Supine leg check - Anatometer

The Adjustment

• • • • • • Atlas is used as an anatomical lever Adjustment takes into account what will happen to C2 and occiput during the adjustment Gentle and vectored controlled force is applied down the ideal line of correction that will align the head and neck together at the same time No twisting or popping – patients love it!

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

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

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 adjustment

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

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

Post Adjustment

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

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

Post Films

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

NUCCA measures the reduced amount of misalignment after the adjustment on this post film If the subluxation has been reduced, the doctor knows the listing is correct and no other films are needed.

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

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

Leg Check pre-post Eriksen pg 468 F

Thoracic and Lumbar Eriksen pg 454D

Lumbar Eriksen pg 455D

Lateral Cervical Eriksen 447C

Nasium Analysis What the lines represent Ericksen pg 442-B

Nasium Eriksen pg 442-B

Pre Chiropractic Adjustment Eriksen pg 183

Post Nucca Adjustment Same Patient Eriksen pg 183

Post Diversified Adjustment Same Patient Eriksen pg 183

Post Nucca Adjustment after Diversified Adjustment Eriksen pg 183

Sources:

• • • Images graciously donated/”borrowed” from Kirk Eriksen and the NUCCA Textbook Eriksen, Kirk. Upper Cervical Subluxation Complex – A Review of the Chiropractic and Medical Literature. 2004. Lippincott Williams & Williams Thomas, Michael. NUCCA Protocols and Perspectives – A Textbook for the National Upper Cervical Chiropractic Association, 1 st Edition. 2002. Edwards Brothers