NUCCA: The National Upper Cervical Chiropractic Association

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NUCCA The National Upper Cervical Chiropractic
Association

• Presented by the Palmer NUCCA Club

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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?

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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.

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

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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 arent 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.

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

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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.

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Measurement Cont.

• To illustrate this pointimagine 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.

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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.

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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.

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NUCCA Evaluation of Subluxation

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

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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 patients perspective, restoring
  alignment to the head and neck will balance the
  body.

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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.
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Outcome of the adjustment

• Clinical research has shown that the closer you
  are able to get someones 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.

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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?

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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.

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Leg Check pre-post Eriksen pg 468 F
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Thoracic and Lumbar Eriksen pg 454D
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LumbarEriksen pg 455D
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Lateral CervicalEriksen 447C
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Nasium AnalysisWhat the lines representEricksen
pg 442-B
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NasiumEriksen pg 442-B
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Pre Chiropractic Adjustment Eriksen pg 183
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Post Nucca AdjustmentSame Patient Eriksen pg
183
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Post Diversified Adjustment Same Patient Eriksen
pg 183
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Post Nucca Adjustment after Diversified
Adjustment Eriksen pg 183
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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, 1st Edition.
  2002. Edwards Brothers