- Do a posterior (P) to anterior (A) rotation procedure, contacting from the posterior aspect of the neck, i.e., rotating left to right, and right to left.
- Do coupled rotation and lateral bending testing, contacting from the posterior aspect of the neck.
- Do A-to-P motion testing, contacting the anterior transverse processes or pedicle regions. The specific technique for doing this involves gently pushing A-to-P over the sternocleidomastoid and underlying segment or joint, while the other hand rolls the head in the direction of the hand testing A-to-P motion. Restrictions are found almost without exception on the right side. Such restriction at C-1 in A-to-P motion can signify a fixation between occiput and C-1. To test the integrity of C-1 on C-2, perform step number four.
- Push your left hand under the patient's neck from left to right. Take a tissue pull with your second or third finger posterior to C-1 on the right side, and pull to the left side until slack is removed. You can position the first phalanx of the index finger on the posterior aspect of C-1 on the left side. Having a left and right-sided C-1 contact, rotate the head and neck to the right with your left hand, exactly following and assisting with the right (indifferent) hand. Look and feel for the amount of gross rotation and feel for endplay, especially at the distal contact on the right side. Loss of overall motion and abrupt endplay point to an anterior C-1/C-2 fixation. This fixation is made worse by adjusting the right side of C-1 from right to left as a posterior right fixation, which can create neurological deficits. The left-sided two-point correction can include some lateral bending in the thrust, if lateral bending is also present. It may be that lateral bending is the primary restriction, requiring only moderate rotation. This is determined while testing.
What you can commonly expect to see with a right anterior C-1/C-2 fixation:
- restricted motion, often causing compensation motion and soreness elsewhere, such as the lower cervicals and upper thoracics;
- right-sided headaches, and eye and ear problems;
- mood swings;
- right SCM hypertonicity and possible swelling;
- right-sided posterior neck pain/stiffness;
- levator scapula soreness, stiffness;
- upper trapezius soreness, stiffness;
- throat complaints;
- TMJ complaints; and
- shoulder complaints.
If correction of C-1 is made, and the A-to-P right C-1 still tests with restricted motion and endplay using procedure number three, then there is a probable restriction on the right between the occiput and C-1. This can be corrected two ways:
- The occiput will test with a coupled rotation and extension restriction on the right. Adjusting the right occiput for rotation and extension together will correct the occiput/C-1 fixation.
- In the supine position, place your left thumb over the SCM at the right C-1 level and pull tissue slack medial to lateral. With an Activator-type or multiple-thrust instrument such as the Arthrostim, perform a few thrusts upon your thumb, forcing A-to-P pressure upon C-1. If the patient is relaxed, the head should lightly shake during the instrument thrust. Retesting should be done to test the success of the procedure.
Use of the testing described can reveal significant problems of dysfunction and subluxation at C-1. The same testing procedures, however, can be used in the same way at all levels of the cervical spine. Correction of such problems must be as specific as the testing, and is merely an extension of the examination. Such corrections can be accomplished with manual adjusting, instrument adjusting, or a combination of both. The choice of correction methods depends upon the skill of the adjustor and the age, condition (health) and mental status of the patient. Discrimination regarding methods of correction should be utilized, rather than using one for all approaches.
It's difficult to adequately communicate understanding of these touch and motion procedures, nor do still photos help much. Observe this methodology and try to distill the meaning behind this written communication, and practice assessing motion and joint endplay from posterior and anterior contacts.
All adjusting procedures can be accomplished with manual adjusting procedures or instrument adjusting, using single-thrust devices (Activator-type) or multi-thrust devices (Arthrostim, VP-II, etc.). The techniques for instrument correction of such problems presented here have not been discussed in detail and require a separate presentation.
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.