Craniocervical Chiropractic Procedures – A Precis of Upper Cervical Chiropractic

Craniocervical Chiropractic Procedures – A Precis of Upper Cervical Chiropractic

Craniocervical chiropractic procedures. dive into a paper with us that reviews “what is upper cervical?”

Upper Cervical Chiropractic Research Show #3 – Chiropractic Deep Dive Podcast – Craniocervical Chiropractic Procedures – A Precis of Upper Cervical Chiropractic – H. Charles Woodfield, Craig York, Roderic P. Rochester, Scott Bales, Mychal Beebe, Bryan Salminen, Jeffrey N. Scholten.

When someone here’s Upper Cervical, along with Chiropractic, most of the time they are confused if they’ve never heard of it before. Craniocervical procedures is another way of saying “technique”.  And no, it doesn’t have to do with women’s health. It has to do with the “cervical” spine, a.k.a. the neck.  In this episode we go into all the different approaches doctors use to treat the neck, why it’s a specialty and many more details about what Upper Cervical Chiropractic truly is. We hope you enjoy. Let us know if you have any questions!! 

– To Your Health

Dr. Kevin Leach

Dr. Kevin Leach: Welcome to this week’s episode of The Upper Cervical Chiropractic Research Show.  I wanted to give you a quick rundown of the format of the following video to make sure you can get the most value out of the video as you can. So here’s the format in the breakdown. The first thing Dr. Evans and I are going go over is just an overview of the research. We’re going look at just what the research said what it concluded and some highlights of that. Next we’re going get into the nitty-gritty a deep dive into the research. We’re going to go through every single section all the little details that a lot of people don’t know about. But for those people that want to read research but don’t have the time or don’t want to sit down and just kind of grind through that research they can listen to this or watch this and they can follow that research for the most part to go along and to really understand in depth what the research did. After that Dr. Evans and I are going to go through just some discussion on how the research relates to patients to doctors and what the authors are doing in the future and right now as far as research and just kind of give more value for the research and give more context for that. So fast forward through to wherever you want to go to whatever parts you want to see and please give a comment down below in regards to was this valuable what would you like more of any questions anything at all and support us if you can. We appreciate it. We’re trying to bring you value and we want to do that as much as possible, enjoy. Dr. Tyler Evans once again thank you for joining me on our deep dive podcast where we are reviewing upper cervical research papers. We’ve got a good one today that outlines all the upper cervical techniques. The name of the paper is Cranial Cervical Chiropractic Procedures – A Precis of Upper Cervical Chiropractic. Is that right “Precis”?

Dr. Evans: Precis.

Dr. Leach: Precis. Is it French?

Dr. Evans: It’s French.

Dr. Leach: Alright let’s go through the authors as well because I really want to I want to highlight them because they put some work into here and probably don’t get too much compensation for it. The authors are Charles Woodfield, Craig York, Roderic Rochester, Scott Bales, Mychal Beebe, Bryan Salminen, and Jeff Scholten and it’s published by the Canadian Chiropractic Association. So as usual Dr. Evans will you just go through give us a good summary of the paper. How we can get value out of it. What does it say. Why was it done.

Dr. Evans: Yeah perfect. So this paper was a production of the upper cervical diplomate program put on by the ICA. The group that went from 2013 until 2015. I was a member of that initial upper cervical diplomate program that’s now turned the diplomate and craniocervical junction procedures. So those three years of advanced education after we’re done with chiropractic school, after undergrad. All that stuff. After we’ve gone through all our training this is an extra three years on top of that already base of knowledge. So the diplomate program is a group of some of the people in the upper cervical profession that are trying to basically get a deep dive on all the research that’s out there and just go deeper than what you get in chiropractic school or what you get in just daily clinical experience. So a friend of ours Dr. Jeffery Shelton who you know Kevin as the president of the NUCCA Association as you are a NUCCA chiropractor. Dr. Jeffery Scholten is a well known upper cervical chiropractor up in Canada and he was approached by the Journal of the Canadian Chiropractic Association to do a overview of upper cervical because we didn’t have that in PubMed. So this is the first paper that has an overview of what upper cervical chiropractic is. We have many papers in PubMed most of them are small case studies but this was the first overview of upper cervical chiropractic care. The first guy Charles Woodfield he is a researcher. Craig York is a practicing doctor down in Arkansas. Roderic Rochester another great doctor who is an orthospinology doctor down in the south I believe in Alabama. I think I might be wrong there. Scott Bales is another. He’s a knee chest doctor up in Canada. Mychal Beebe is a doctor that I work with in my daily practice in New Hampshire. She is a Blair Upper Cervical chiropractor. Brian Salminen is a NUCCA doctor and Jeffery Scholten is a NUCCA doctor up in Calgary Canada. So that group was put together to make this overview of the techniques of upper cervical chiropractic care. It’s called a precis because the precis is the French word for basically a review or an overview the cranium cervical chiropractic procedures that title is different than what most upper cervical chiropractors call themselves normally. Cranial cervical meaning cranium and then cervical. So the junction between the two. That’s why our diplomate is called the craniocervical junction procedures and that’s where the name of this title comes from. And that actually has implications that medical doctors can connect with because that’s generally what they call this area between C1 C2 and the base of the skull the craniocervical junction. So that’s kind of where the background of this all came from. That’s how it came together. So we can go into some of the foundational pieces of this paper if were ready for that. Are we ready for that Kevin?

Dr. Leach:   So you said it was the upper cervical diplomate program that did this. Is that correct?

Dr. Evans:   Yeah, it was a side project.

Dr. Leach:   Got it.

Dr. Evans:   It was just we were in the diplomate program and these people came together and were drawn together by being in the diplomate program and were chosen out because we were all friends. We were working together.

Dr. Leach:   Got it. What was the motivating factor to get this done? What was the goal of doing this?

Dr. Evans:   Yeah so like I said the author, the lead editor, or the guy that runs The Canadian Chiropractic Association they approached Dr. Scholten and wanted an overview of upper cervical chiropractic care. And so that was the impetus for it and really the goal is to get the word out about upper cervical chiropractic care because there’s never been a paper like this done before. We have many different techniques that have been created over the years and this is the first place that you can go to one paper and find vast majority of the techniques in one paper. What some of the great benefits are. How it’s different from regular chiropractic care. And some of the things that you might look for to find an upper cervical chiropractor and what might differentiate them. And some of the results that we get in upper cervical chiropractic and how we do it differently.

Dr. Leach:   Great. I’m going to get into the introduction, the origins, and I’m just going to get through and go through all of the main points. All of the parts of the study. We will put the link in the description. We’ll try to get this available to most people so they can read it on their own but I’ll go through the highlights right now. Okay, introduction background. The following research is a narrative review of upper cervical procedures serving to facilitate understanding and awareness of upper cervical chiropractic care. It’s designed to discuss safety, efficacy, misconceptions, and research so that providers, students, and the general public can make informed decisions regarding utilization and referrals for upper cervical chiropractic care. Upper cervical meaning, upper neck techniques, have the same goal in mind with different approaches to achieving the same end. They adhere to the same theory in that primary chiropractic subluxation exists in the upper cervical spine. All of these techniques have methods to check before and after intervention to assess whether it was successful or not. While there’s plenty of research on upper cervical care much more is needed. This narrative reviews much of what exists regardless of the quality of the research which includes non-indexed and or non peer-reviewed sources. The paper presents most of the upper cervical techniques similarities and differences of them. Only 1.7% of chiropractors practice upper cervical techniques which makes it understandable that it’s so little-known. The origins of upper cervical chiropractic techniques have been around since B.J. Palmer the developer of chiropractic introduced the HIO method in 1931 at the PSC Lyceum. The 1934 text The Subluxation Specific The Adjustment Specific established the foundation for the articular model of radiographic analysis. While Dr. A. A. Wernsing contributed to the upper cervical work with the orthogonal base radiographic analysis in his book The Atlas Specific. Now the difference between the articular model and the orthogonal model have to do with whether they’re looking at the joint alignment in the upper neck or if they’re looking at how the head sits on top of the top bone in the neck which is atlas which sits on the neck. And the major techniques can be categorized into either an orthogonal technique or an articular technique. The upper cervical techniques that fall under the articular model include Knee Chest, Toggle Recoil, and Blair. The upper cervical techniques that fall under the orthogonal techniques include Grostic, NUCCA, Orthospinology, Atlas Orthogonal and Advanced Orthogonal. Upper cervical anatomy. The theory that the primary misalignment or chiropractic subluxation exists in the upper cervical spine has been around for over seventy years. The upper cervical spine or upper neck consists of top two bones in the neck and where the top bone articulates with the skull the occiput. This is called the craniocervical junction in newer medical and chiropractic literature. This area of the spine is unique compared to the rest of the spine for several reasons. Ranging from anatomical shape, neurological structures, and complex ligamentous systems. Neurovascular structures and cerebral spinal fluid also play a part in this area of the spine. The chiropractic vertebral subluxation has been defined by many organizations and also by those who founded and developed the profession. The World Health Organization defines it as a lesion or dysfunction in the joint or motion segment in which alignment, movement integrity, and or physiological function are altered. Joint surfaces remaining in contact which may influence biomechanical and neural integrity, neural meaning nerves. This definition is for a chiropractic subluxation. Not a subluxation defined by the medical profession which is very different. Medical subluxation is where there is ligament or joint laxity due to a severe injury making the joint unstable but not completely dislocated. The upper cervical procedures paradigm is such that it looks at the occipital atlanto joint complex, meaning where the head articulates with the neck and it looks at the function and all of its sub structures and is analyzed as such making it different than traditional chiropractic techniques. Upper cervical techniques differ slightly in their analysis and application but all focus on an exam to determine the presence of chiropractic subluxation. Then a detailed radiographic analysis to confirm presence of subluxation and also to determine how their unique subluxation and alignment need to be achieved. Most techniques limit their intervention to the craniocervical junction except for the Blair technique, which goes down to C4. Theoretical physiologic mechanism. Leg length inequality or abnormal load-bearing joint mechanoreceptors. So now what happens in the upper cervical spine because of what’s going on with the load-bearing joints and the reflexes that happened with muscles and posture – a misalignment at the top of the neck in the craniocervical junction can distort the hips creating what appears to be a leg length inequality. Now joint dysfunction creates symptoms through this dysafferentation process. Dysafferentation just means abnormal nerve flow or input into the brain and then that feedback loop back to the muscles controlling posture. Now correcting this modulates the nervous system. Which is important. Dentate Ligament Cord Distortion Hypothesis by Dr. Grostic in 1986 is a research article that shows an MRI with cord distortion from an upper cervical subluxation complex. Which I’m very interested in and would love to do review in the future as well. Recent research shows altered cerebral spinal fluid flow and blood flow dynamics in the craniocervical junction. Assessments for care. Determining the presence and absence of the chiropractic subluxation or manipulable lesion has been a point of controversy. While some evidence exists of exams to indicate the presence of subluxations some are stronger than others and some research say there needs to be more research done. Some exams indicate when to perform the adjustment. Some exams indicate where to make an adjustment or correction and in which direction. Some of these examples include leg length inequality, thermography palpation, posture, x-ray line marking. Symptoms are not used to dictate patient care but are used as outcome measures. Table 1 shows which techniques use which. Many upper cervical techniques have certifications and postgraduate work or seminars in order to become qualified to perform the techniques. A misconception of upper cervical practitioners is that they focus only on the upper neck. While this is where the intervention is given many providers analyze the entire spine and the intervention itself given in the upper cervical spine affects alignment of the entire spine. Upper cervical practitioners are also focused on determining if an intervention is necessary on a given visit and whether the intervention was successful with an examination after the intervention. Patients are not adjusted on every visit only after being examined on that specific visit and the patient is found to need an intervention is that intervention given. If the patient does not need an adjustment or intervention on that visit it is commonly known as holding their adjustment or holding their alignment. Now different kinds of assessments. One being palpation and includes assessing the joint and movement of the upper cervical spine and muscle spasms and tenderness of the upper cervical spine. Another assessment being functional leg length and equality. This is analyzed by laying the patient down on the stomach or on the back to analyze what appears to be a short leg. Which is not structural but functional in nature it can be called a contracted leg and this is due to pelvic obliquity resulting from reflexive balancing due to neurological insult in the upper neck. Anatomical inequality may interfere with this measurement. There are several ways to measure an anatomically short leg to rule this variable out. Research shows high interexaminer reliability in leg length testing. Another assessment being thermography. This type of measurement is used in pattern analysis developed by B.J. Palmer in the 1930s. Paraspinal thermographic readings are used as an indirect function of the nervous system used before and after the upper cervical procedure. It has excellent inter and intraexaminer reliability in the research. One study shows improvement in bilateral thermographic readings correlated with an improvement in heart rate variability. Another assessment being posture asymmetry used mainly by Orthospinology and NUCCA to visualize structural changes in posture pre and post correction. NUCCA developed the anatometer to measure posture in the coronal and transverse planes. So meaning twisting of the body you can think of and misalignments from side to side you can think of. Some models have weight scales under each foot to measure different weight differentials. The GSA is another tool that measures standing posture. Another assessment tool being radiography. All upper cervical techniques use radiographic analysis to guide them in correcting misalignments. The analysis allows for each individual patient to receive the most precise correction possible. Radiographs are taken in all three planes to get a three-dimensional measurement or direction and degree of misalignment for all orthogonal models and some particular models. Blair however takes a protracto view which comes in at a diagonal almost through the eye to look at the opposite articulation between occiput and atlas between the head and the neck. Blair also uses a stereo lateral to look at facet alignments below the atlas. X-rays are not performed on every visit. Research shows that misalignments are predictable in the direction that they re-misalign so you don’t need to take an x-ray to look at how the bones have misaligned on every visit because we know how they’re going to misalign. Several factors are used to decrease x-ray exposure. Aligning x-ray equipment, decreasing x-ray port size, meaning where the x-rays come out of the tube, specialized grids and filters and shielding all decrease x-ray radiation. The safety and ethical dilemma of radiation exposures is an entirely different subject that we won’t get into here. Suffice it to say that some believe x-rays should only be taken when trauma is suspected not for just subluxation evaluation. Each technique have standards for taking radiographs. NUCCA has gone as far as developing standards of care and practice and guidelines that are continually updated regarding radiographic guidelines. And once again all techniques, upper cervical technique, that take radiographs have guidelines on how to take proper films so that the analysis of the misalignment can be done correctly. There’s a lot of information in this section that I’ll let you read yourself. Now contrasts of upper cervical techniques. The biggest difference in upper cervical techniques are the difference again between orthogonal and articular model. Articular model typically does not obtain post films as orthogonal does. Differences in radiographic technique and adjusting protocols are unique to each technique, all with the same goal in mind in the end to bring proper function and alignment to the upper cervical spine. Adjustments are done by instrument or by hand. Orthospinology uses a handheld instrument that adjusts the atlas bone and the upper cervical spine the craniocervical junction. Atlas orthogonal and advanced orthogonal uses a table mounted instrument. Blair, Knee Chest, Toggle Recoil, NUCCA, and Grostic are all done by hand. Many providers have patients rest 20 minutes or more after adjustments in hopes that they hold their alignments longer. A symptomatic reaction paper is referenced here were 83 upper cervical doctors following 1,090 patients were studied on safety and efficacy with very very positive outcomes, which we have done a review on that so you can find that video where we go very much in depth to that. Upper cervical chiropractic research. A study with 50 patients, pilot study, in a hypertension medical journal where 25 patients were adjusted 25 received a fake adjustment. The results here were that the patients receiving care had their blood pressure decrease as if they took two antihypertensive medications. The changes in blood flow hypothesized in this previous study was investigated more using phase contrast MRI. Resolution of migraine symptoms with changes in blood flow was found in a study by NUCCA, the National Upper Cervical Chiropractic Association. More hemodynamic and hydrodynamic studies are currently in process. Research correlating degree of improvement on x-ray alignment correlating to patient outcomes has been performed but we do need more studies showing this. Upper cervical technique case reports. Several case studies by Gleberzon describes significant clinical benefits and improvements in quality of life. Case studies are necessary to justify use of limited research resources required for conducting larger clinical studies. Case studies in the literature include the following; parkinson’s disease, multiple sclerosis, seizure disorders, headaches and migraine, seizure and migraine, fibromyalgia, chronic fatigue syndrome, scoliosis, blood pressure and several others. Limitations of this paper. This paper is a narrative review describing upper cervical techniques not an exacting review of all the available literature. There’s little high quality research siteable from PubMed indexed journals. Some research articles are non-indexed and non-peer reviewed. Again, this being a review of techniques more research definitely is needed but we need that financial backing in order to be able to do so, which hopefully will be soon in the future. Alright so Dr. Evans let’s get into the discussion. Okay. Let’s get into some discussion about just some highlights of the paper dr. Evans if you would. If an average, even a chiropractor, a regular person that has heard of upper cervical or upper neck chiropractic – a medical doctor, a healthcare provider – they’ve heard of this they might not want to read the whole thing. What can we explain to them about the paper and just what this is going over in short as a discussion that could really bring some value to them to explain to them what you know what upper cervical chiropractic is? 

Dr. Evans: Yeah. So I think a great place to start is just that upper cervical chiropractic care has been around since the 1930’s. For those in the medical profession it’s kind of a black hole for the medical literature and for the medical healthcare practitioner. There are very few medical doctors who really focus on that area and study it and work just in the craniocervical junction. They usually work either above it or below it. So in the skull in the brain or in the neck below. So we talked about orthopedic surgeons, brain surgeons and neurologists. These sorts of doctors they work either both above or below. So that the upper cervical spine is a very unique area, it requires a very specific correction and so that need was seen very early on in chiropractic. Chiropractic, it was developed in the United States in 1895 so you’d say 35 years later we’ve got this specialty that comes out where they’re trying to understand how best to correct the upper neck to help the brain work better, to help the neck work better, to help the whole body work better. Really the goal back then was to do the least amount of adjusting with the greatest benefit and so that’s where upper cervical really shined. They found that they had more impact on other parts of the body if they really corrected C1 well, specifically left it alone and watched and waited and saw what happened. So there developed the science this specificity, this art of objectively testing with measures of x-ray analysis, with measures of posture, with measures of thermographic scans, with palpation, with all of these tools that objectively could be seen before and after changes that stayed constant if the correction was done properly and what is called held the correction in the upper cervical profession where the misalignment of that upper neck didn’t go away. So if we talk about misalignment, that’s a really important piece is that the upper cervical spine is very special in that there is no disc above or below C1. That vertebra C1 over C2 gives you 50% of rotation. The skull on C1 gives you 50% of flexion extension for the spine or the cervical spine. So when you talk about movement that area of the spine is the most mobile part of at least the cervical spine if not the entire spine and houses the brainstem. So there was an early need for a specific good correction. Through this paper we really outlined some of the unique pieces of the upper cervical profession. One being like I was saying those specific objective measurements being palpation, leg length changes, thermography, posture, and x-rays. So we did a study during our diplomate program, actually I believe it was done by Philip Schalow, he’s a NUCCA doctor and he asked the people in the group what with the different techniques what the procedures they used and almost everybody used a little bit of each one. So across the board through all the different techniques – Knee Chest, Blair, Grostic, NUCCA, Orthospinology, Atlas Orthogonal, and Advanced Orthogonal. So across the board if you go to an upper cervical chiropractor you’re going to be going somewhere where you’re going to have a very thorough analysis of your craniocervical junction, your upper neck, where they won’t be doing any adjusting on the first day. They’re going to be taking specific x-rays, they’re going to analyze those x-rays, then they’re going to have you come back after they’ve analyzed those x-rays. After they’ve analyzed all of your testing your your palpation of the muscles, the postural imbalances, so shoulder imbalances, head tilt, hip imbalances in terms of rotation when have one higher than the other, and one leg that’s functionally a different length than the other but not bone short we’re talking muscles tight and rotating hips. So we take all that information and we create a specific correction, a detailed correction just for each patient, and then we deliver that correction on the follow-up visit, on the second day, or the third day. Then we wait and we see how the body holds that. We might post x-ray to see how the changes in the neck have occurred. Have we done what we set out to do. Now you’re not going to get that in a general chiropractic office. When you go into a general chiropractic office and nothing against that when we go into a general chiropractic office they’re probably thinking they might hopefully take some x-rays if they do then they will do an adjustment or correction off of that maybe on the second day but then when you come back most of the time they will continue to just kind of adjust every day the similar things. In the upper cervical offices we only adjust if enough of your tests are telling us that you are out of alignment. So that’s kind of what this paper is talking about. I think that’s a good run through on what upper cervical care is so if you have anything else you want to share? In your office you take those post x-rays and I think it’s important that people understand that we do take x-rays and they’re very very important if you’re going to be putting a – even if it’s a low gentle force on the back of the neck here it’s important that someone looks into the spine. Do you want to talk about that a little bit, Kevin? Just how you do your x-ray procedures. 

Dr. Leach: Well it’s just like you said we take the pre meaning before and a post meaning after x-ray to see what the alignment is before and what the alignment is after. Then when we have those x-rays after it gives us more information on possibly changing the formula that we’ve created for that patient to get them even better of a correction. We talked about it when we went through each of the major upper cervical techniques with which are Knee Chest, Blair, Grostic, NUCCA, Orthospinology, and then Atlas Orthogonal or Advanced Orthogonal. I think the key to understand what makes upper cervical chiropractic different is that these techniques have been developed in protocols and procedures and are very specific to aligning the upper neck and to correcting the chiropractic subluxation and one of the most difficult things I’ve found in my practice to explain to the patients that have been to other chiropractors and they say, “Well they adjusted my neck too when they adjusted my upper neck.” One of the things that I’ve found helpful to explain what the difference is is the explanation can be found simply on how joints work and what makes a healthy joint in the sense that for a joint to be healthy two major things are needed. One is to be in alignment and then another is to have complete range of motion. Now traditional chiropractic is phenomenal at removing chiropractic subluxation throughout the spine to restore proper range of motion and to restore normal function in the spine. The part that differentiates us is we’re looking for more alignment per se than just putting the force in and getting range of motion. There’s a slight nuance there but again when you get back to just looking at what a joint is supposed to be if the joints are typically mirror imaged and in the anatomical position those joints should be precisely aligned and when moving they should go through complete range of motion and then back to alignment. There are mechanisms inside the joint that when they’re not aligned there will be certain messages to the brain and it may cause inflammation and it may cause dysafferentation which is just abnormal nerve flow back into the brain. Then also when you don’t have complete range of motion and there’s a lot of consequences when that happens. These upper cervical procedures have been developed in such a way that these doctors that know the importance of it, just like B.J. Palmer back when it did all the research, they’ve developed a way that they’re just really looking really hard at that upper cervical spine and really precisely to try to get it as corrected as absolutely possible and that’s what really differentiates these upper cervical techniques from your traditional chiropractic techniques. Which again just like you said they’re very beneficial it’s just we’re looking for something different here. Many people do fantastic under traditional chiropractic but some people like me I needed my upper neck precisely aligned before I could really see those health benefits. On that point I will actually have some of my patients adjusted with traditional chiropractic when indicated. If the upper cervical adjustment and the aligning of the spine isn’t getting to that hip or low back the way that I think that it should then a lot of times I’ll send them to a traditional chiropractor has been doing it for a while and is really good at that low back adjusting to see if we can get some progress there. I think the main point for this is that the patient, the chiropractor, the medical doctor, or whoever is listening is to understand how can I tell if this if I’m going to an upper cervical chiropractic office and these techniques are a really good starting point and know that that office is actually doing an upper cervical technique. 

Dr. Evans: Yeah 

Dr. Leach: Anything to add to that? 

Dr. Evans: I think that it’s really important just that we approach the safety part of upper neck corrections. You covered a lot of stuff there Kevin and you brought up a couple things in my mind I just wanted to hit back and review real fast. So you brought up subluxations or misalignments in the upper neck and the reason why we do what we do is because the brain is the master control for the body and the spine is what houses the nervous system that communicates all the messages out from the brain to the body. So if there is a problem with the body every single organ tissue and cell needs to have a direct nerve connection to the brain. We’ve seen this in many many studies over the years that if the brain is not fully connected we start to have a loss of function and so what we found is that over time the better the correction is the greater the neurological benefit. Now it’s not saying that upper cervical chiropractic or chiropractic in general is a magic wand or magic pill. There is no magic wand or magic pill in health care but why upper cervical is important is because for those who are brain injured and for those who have extreme neurological disabilities the brain stem, which it sits inside of C1 and C2 and that craniocervical junction, it needs special attention and that’s what upper cervical chiropractic does really well. In that a subluxation of that upper neck can affect the entire body down to your toes. I’ve had patients, I’m sure you have had too, that had pain in their feet, or pain in their toes, burning, numbness, and tingling in their toes but that gets better with upper cervical chiropractic care. Now I don’t have a specific study to tell you exactly that this is case review and this is how that works but I’m saying subluxations or misalignments of the upper neck can affect the brain stem so severely that it can limit the nerve function through the whole body. 

Dr. Leach: Yeah. 

Dr. Evans: So that where upper cervical care is really powerful. I just wanted to add that piece. 

Dr. Leach: Absolutely. You spoke about the anatomy of the upper neck as far as there’s no discs or cushions between the head, the top bone, and the neck. Then a little bit about the neurology with the brain stem being just right there so that can be affected when we think about the dentate cord(ligament) as far as how that can affect but as you know again with Dr. Scott Rosa’s research and there’s a lot of research. It’s just incredible how many things can be affected by a misalignment in the upper neck. So regardless of if we take away technique, different protocols, and procedures on how to align the upper neck, even if you were doing it in the traditional way that chiropractors do, it still doesn’t take away from the fact that it’s the most important area of the spine in regards to so many things. Like the neurology in the brainstem. Like the proprioception/mechanoreception in the joints and the muscles of the upper cervical spine. Like the cerebral spinal fluid flow that can be affected by a misalignment in the upper cervical spine. Like the secondary venous outflow or the secondary blood flow coming out of the head that can be affected by the misalignment. So it’s just incredible how many things can go wrong when you have an injury to the upper neck in a subsequential chiropractic subluxation and problem in that area and the problems and the plethora of problems that that could cause in the spine. We didn’t come up with these techniques. It’s a big statement to say that that’s why these specific techniques have been developed for the upper neck, it’s because it’s such an important area and it needs to be treated as such. It’s a study in and of itself. 

Dr. Evans: Yeah and for 90 years this has been going. Literally 90 years. Since 1930 and actually a little bit before that, it started in the 1920s. So it’s just important for people to know that upper cervical does exist. It is out there. It’s also very safe. So the paper that we reviewed recently was the Symptomatic Reactions paper and in satisfaction. It’s important for people to know that upper cervical chiropractic is very safe. People often get worried about someone taking and twisting their neck and then a possible adverse outcome. We covered that in our last video or two two videos ago. I’m trying to remember when it was but we covered it in one of the videos. It’s important to know that in over a million adjustments, lifetime career adjustments of the chiropractors that were in a study on safety and efficacy in upper cervical chiropractic care, there were no serious adverse events. Meaning no one died so there were no strokes that led to a very serious hospitalization. Which that often gets thrown around and that’s a sensitive topic but the reality is that’s not a risk for upper cervical chiropractic care or chiropractic in general. So it’s important for people to know that it’s very safe and the satisfaction of the patients, I don’t remember the exact numbers I’m sure it’s in this paper.. 

Dr. Leach: It was pretty high. 

Dr. Evans: Yeah, it was very high. It was around 8 or 9 I believe. 9.1 I believe was for most people. So it’s important for people to know that there are high satisfaction rates with upper cervical chiropractic care. It’s very gentle. There’s no twisting or popping. The upper cervical chiropractic has been studied for around 90 years. 90 years, so this isn’t a new thing. One guy didn’t come up with this. There have been thousands of upper cervical chiropractors over the years, literally thousands. It’s a safe method to correct misalignment and neurological dysfunction of the upper neck. One last thing Kevin if I can, I just want to touch on the radiographs. So x-ray imaging of the spine. How important that is and the safety of that actually is important for you to understand because many people might be worried about an x-ray. It’s a baseline thing that upper cervical chiropractors – that is one of the things that denotes an upper cervical chiropractor is they will do x-rays beforehand to measure rotation, misalignment overlap/underlap, head tilt, all the factors of what is an upper cervical misalignment in the upper neck. We will want to see changes in that over time and if we don’t have that x-ray we can’t do our job. To get the benefit of upper cervical chiropractic care it far far far outweighs any risk of an x-ray ever. The benefit of having a brain-to-body connection far far far outweighs the risk of x-ray and when we talk about risk with x-rays that’s a whole other video we can go into that another day. But a lot of these fear ideas are based around the idea of a linear non-threshold hypothesis which in reality hasn’t been supported by the data that comes out of things like Hiroshima, Nagasaki, and Chernobyl things like that. The radiation risk at very low levels that we’re taking with x-rays at possibly 10 to 20 to 30 microsieverts(mSv) which is basically like two days of background radiation, maybe three days of background radiation with an x-ray. Then if you stack on top of it a couple of them you might be talking up to five to ten days of background radiation. Normal radiation that you’re getting all the time. It’s coming down from the stars, the Sun, coming up from the ground, radon in the ground and you get that all the time. So just to understand that it is very safe. We’re working within a level of dose that it’s very low. Very low. Far under the ever reported risk of any adverse problems such as cancer/leukemia things like that. Very very very low amount of radiation. So I just wanted to cover that because it’s important that people understand when you go to an upper cervical chiropractor they need to take x-rays. That’s part of the deal and it’s safe. It’s very safe. 

Dr. Leach: Yeah. I used the analogy back about – I want to say six or seven years ago, I figured it out with a colleague. We looked at the World Health Organization’s maximum dose radiation recommendations for a year and we took those millisieverts, I can’t remember exactly what those were, and then we looked at the exposure that we’re doing as far as from a NUCCA stand point pre and post x-rays. We said okay well how many of those x-rays could we take before we hit that maximum and we could literally do those x-rays for a patient every single day of the year and not reach the maximum threshold. That’s significantly saying how small the radiation dosage is for the x-rays that we’re doing. So that’s important to understand. I can’t quote what that is. Maybe when we do our other video we can go with that and we can break down the numbers and express that. 

Dr. Evans: Yeah.

Dr. Leach: But again even if there is some quote-unquote danger to those x-rays to have that brain body connection and not having misalignment in your spine and be specifically adjusted far outweighs, of course in my opinion I have lived through the pain and the suffering from that misalignment, I would much rather have an aligned spine with a tiny dose of radiation.

Dr. Evans: Right. 

Dr. Leach: Great. Well anything else to wrap it up with Dr. Evans? 

Dr. Evans: One last thing is if you are looking for an upper cervical chiropractor two great places you can go; one is uppercervicalcare.com and then upcspine.com. Both of those have locators for practitioners as well if you go to each technique, if you want to go see Dr. Leach, you go look on NUCCA’s website. Which I believe is nucca.com. Is that right? 

Dr. Leach: nucca.org actually. 

Dr. Evans: nucca.org. You would go to nucca.org and look up specifically a NUCCA practitioner but these other two websites uppercervicalcare.com and upcspine.com they both have locators so you can go on there all throughout the world. There are upper cervical chiropractors in Greece and Italy. They’re all over so. 

Dr. Leach: You might have to travel quite a bit but they are around the world. You can find them somehow.

Dr. Evans: Unfortunately there aren’t that many of us. Roughly in the world, throughout the entire world at one time, there’s somewhere between 1,300 people. I think.

 Dr. Leach: Yeah. Well in the paper here 1.7% of chiropractors practice upper cervical technique.

Dr. Evans: Why is that do you think Dr. Leach? what do you think? 

Dr. Leach: There’s too much work to do. It’s not easy. 

Dr. Evans: It’s tough to go quick 

Dr. Leach: It’s tough. There’s a lot of background outside of patient hours analyzing x-rays, takes time to do the adjustments, and then you know be completely candid a lot of chiropractors are going to say that “I adjust the upper cervical spine with my technique and I get it done,” and that’s where you’re just going to disagree from a professional standpoint with someone who’s using a traditional chiropractic technique to adjust the upper cervical spine – being equivalent to using an upper cervical procedure. You’re going to find disagreements in that point so that’s just part of it. I’m sure research in the future will be able to answer more of those questions because in the end it’s not about being right or my technique is better than yours, it’s about doing what’s best for the patient. I practiced NUCCA because it’s had the best effect on me. I see it have a tremendous effect on my patients. If somebody comes along and they can show me that I can get better results with something else that’s what I’m gonna do because again it’s not about the name of the technique, or sticking to a protocol, or sticking to my team. It’s all about the patient. I’ve been speaking to one of our good friends Dr. Myron lately and he’s doing the activator technique. We’ve had some great discussions lately about even correlating both of those features. Getting the upper cervical spine, from a combination standpoint, getting the upper cervical spine in alignment and then also doing maybe an activator protocol to get maybe those little tiny spots here and there that might not be getting cleared out from just adjusting the upper neck and letting the body balance out by itself. I think we might as well say that as well as that this paper I would say is one of the landmark actions that’s happened just within the past maybe even 10 years-20 years that have brought upper cervical techniques together. I would say even 20 years ago they were very “My technique is the best,” but this paper and bringing all these techniques together and you can speak from a personal standpoint going through the diplomate program. All these techniques instead of being off in their own little island doing things their own way, they’re starting to look at other techniques and how they can look at things outside the box. One of our mentors, Dr. Brooks, he says you know what do we as upper cervical chiropractors see – we see a box with a bunch of holes in it looking at the same thing but you’re looking through different holes.

 Dr. Evans: Truth is on the inside. 

Dr. Leach: Yeah. We’re trying to get to the same result. We just have different perspectives and different ideas on how to get there. Quite similar but still different. So I love the projection or the trajection of this research and what it’s doing in the upper cervical world. Just for chiropractic in general to really search and get better and better as providers and practitioners again for that for the end result of providing you know best chiropractic care possible for our patients. 

Dr. Evans: Yeah Dr. Leach. It’s important I think for people to know that you go through a rigorous certification process as well as I did just for my technique alone. So we go to undergrad school for however many years to get our pre-qualified courses for chiropractic college. Then we go through three to four years of chiropractic college to get our chiropractic degree. That gets us just a basic foundational understanding of the spine, the nervous system, the anatomy, the physiology, and how to operate in the world and then you branch off. You can you go into practice with an upper cervical chiropractic specialty. It is a specialty. So it’s just like a spine surgeon out of medical school, they go to school again right. We don’t have any grand rounds. We don’t have any rounds of working in a hospital for years learning the ropes. We go out and we start learning and we do rigorous certification processes through our technique groups. So like NUCCA for you, you have your three certification process and in the Blair world we have three certification steps and then if you layer on top of it this diplomate program. Dr. Leach, I’ve spent quite literally ten years of my life just perfecting my upper cervical work. 

Dr. Leach: Absolutely. 

Dr. Evans: That’s where I live and that’s where you live and that’s all we do all day long. So if somebody says to me “Well they adjust the upper cervical spine,” I’m like okay I get that and I only adjust that all day long to get the same result with less corrections. You and I both see that. That we do less corrections. We do 50% less corrections if not less than that to get the same result. Alright. So it’s a specialty. It’s a lifelong work process and we’re chasing a tiny little thing that makes a huge change in the entire body.

Dr. Leach: Absolutely. When you were talking about that, I don’t think a day has gone by in 15 years when I haven’t thought about the chiropractic subluxation or visualized the upper neck. I’ve thought about how to correct it better or different ways to explain. I just got goosebumps. It’s just such a part of our life it’s just it’s really shaped our lives and it’s just incredible the work that we do. Well anything else?

Dr. Evans: I think we’re good. 

Dr. Leach: Awesome. Awesome. Well thank you for your time Dr. Evans once again. For everyone out there look at the description and leave any comments/questions. I’ll put Dr. Evan’s information below as well. Dr. Evans I think you’re going to post it as well so you’ll have it on your YouTube and maybe website and whatnot. Please support us. Give us some feedback if you want, if we’re rambling on too much or you just want the goods or whatever. We’re really trying to bring this information to people so that they can listen to this on their couch or in their car and just to try to get this information out so they don’t have to sit down and grudge through a research paper. We’re really trying to bring that value to people. So if there’s any way you could subscribe, support, like, comment or anything. Give us good feedback. Good feedback. Constructive criticism. Whatever you’re going to do to give you guys better value because we see a tremendous value in doing this, we dedicated our lives to it, and we want to bring value. So if that’s all, any last words Dr. Evans?

Dr. Evans: No, I think that’s it. Great work Dr. Leach also.

Dr. Leach: Thanks. Alright we’ll see you next time!


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