Dr. Leach:  Okay this podcast is a bit heady. It’s about ligaments of the upper cervical spine. How they’re important, if they’re injured what structures they protect, and all of that nerdy geeky stuff. Super important but not the most exciting thing in the world. So if you’re interested I hope you enjoy it, if not wait for the next podcast to come out. Thanks.Hi there. I’m Dr. Kevin Leach here with The Chiropractic Deep Dive Podcast bringing you the most important research and information on conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic care. These research reviews interviews and episodes are made for you whether you’re a medical doctor, patient, or concerned family member or friend. The goal of these shows is to bring awareness of the importance of taking care of our spine and the impact it has on our health and the hundreds of different health conditions it could cause without us realizing it. I’m really trying to bring value with these so I’d appreciate commenting on the videos, hitting the like button, and sharing them with as many people as you can. You never know who might need to see it and consider subscribing to the channel so you can see all the other episodes and videos coming out. Thank you so so much. I truly appreciate your support. Now on to the show. Okay. Welcome back everyone to The Upper Cervical Chiropractic Research Show. This is episode #15. I am Dr. Kevin Leach. I’m your host and by now my good friend and colleague Dr .Tyler Evans is probably the co-host. We haven’t really made anything official but you’ve pretty much done almost every single one here with me and he is also here today so welcome, Tyler. 

Dr. Evans:  Thank you. I look forward to this one.

Dr. Leach:  Yeah me too. Tyler this is a paper that you really wanted to do. You recommended it for one of the next ones that we do here. The title of the paper is “Ligaments of the Craniocervical Junction: A Review” and this is by Tubbs et al. and it was published in The Journal of Neurosurgery. So this is a neurosurgeon who published this and what the paper pretty much does is it brings together a lot of other research to really go into what’s going on with the ligaments and other structures that are going on with the craniocervical junction. So where the head meets the top bones in the neck. And he goes over the importance of it, the biomechanics, the anatomy and really goes over that. and you sir wanted to go over this. Why don’t you just tell the audience why you feel this paper was important and really really important for not only patients but doctors and upper cervical chiropractic but just for everybody to understand the importance of this. 

Dr. Evans:  Sure. So I think it’s really important to understand that the craniocervical junction – so cranium skull, cervical spine, the upper cervical spine, the junction between the two is where they connect. That’s where Dr. Leach and I work every day that’s what we do. We correct that upper cervical spine to release tension and allow for the messages and signals from the brain down to the body, body back up to the brain to be as clear and and open as possible as well as the blood flow the cerebral spinal fluid flow. And in this paper we’re going to talk about the ligaments and how they play a role in all that and this paper actually came to me back in 2014 or 2015 from the upper cervical diplomate program that I did. And it was a really foundational piece in that program actually it was on our final exam and so today when I was reviewing the paper I was like, “Oh man this takes me back.” So it was a lot of fun to go back and review this stuff but it’s funny how now going back looking at it again after another five years of or six years of experience there’s some new things that I got out of it and just good reminders. And so this podcast is for someone anyone who is just one, interested in what upper cervical chiropractors do and how they help. Two, people who have been in car accidents or kind of intense head and neck trauma or just have had repetitive head and neck trauma and they’re suffering from post-concussion syndrome what we call cranial cervical syndrome and they’re not getting a lot of answers. This is where we really shine in the upper cervical profession within chiropractic because when we talk about the upper cervical spine it’s the most complex joint in the spine, this paper actually outlines it says, “the atlanto occipital and atlantoaxial joints house the spinal cord, multiple cranial nerves, and many important blood and lymphatic vessels that supply the head and neck. The CCJ must protect its contents while simultaneously allowing significant mobility.” So it’s got to be mobile and it’s got to protect the spinal cord, the brain stem. And so that needs a specific correction and that’s what we do and we want to stabilize that joint because this joint is made of muscles, ligaments, and tendons. It is not held together by bony locks like the rest of the joints lower down below C2 and so that’s where this paper comes in. They talk about two main ligaments. The one being the transverse ligament and the second one being the alar ligaments that limit a lot of motion there. I believe it’s collagenous. There’s a lot of collagen in them so it makes them very dense and very stiff. The other nine ligaments that are discussed in this paper are what we call accessory ligaments and just kind of help those other two ligaments limit motion. And really one of them, the apical ligament, may even just be left over from remnants of evolution and they didn’t even really have a reason why it’s there. And one of the ligaments, the posterior atlanto-occipital membrane, actually attaches and is what we call a myodural bridge from a muscle, the rectus capitis posterior minor, at the base of the skull from that outside muscle all the way through – goes through the ligaments and attaches into the dura of the spinal cord. Which that’s a big deal because if the bone is off and that ligament attaches to the bone it attaches to the muscle and there’s tension in that muscle that’s where upper cervical chiropractors, that’s where craniosacral therapists, and massage therapists come in huge when you are working to relax those muscles-balance the joints to take pressure off the brain stem and the spinal cord so that the brain can heal and the nervous system can heal. And so that’s where upper cervical really comes in and it was interesting because they talk about the p-a-o membrane and they say well it doesn’t really have much value. and I’m like, “That’s what we do.” Right. That’s where we fit in. So anyways real quick that was kind of my summary. I just want to run through some of this stuff kind of pick apart some of the ligaments. The two main ones – the alar and the transverse off the top and then I’ll talk about the other nine ones in brief. So the kind of biomechanics of the ccj. The ccj is composed of the two major joints we talked about that. Prominent movement at the a-o joint, so the atlanto-occipital joint, between the skull and C1 is a flexion and extension. So this movement. Flexion and extension. That’s the primary movement there. The primary movement at the atlanto-axial joint is rotation. And so the numbers that we get from this for the flexion and extension, let’s see. It’s the various movements at the joint occur because the condyles glide in the sockets of the atlas and that’s flexion and extension occiput to atlas. Adele found the atlanto-occipital joint to be responsible for 27 degrees of flexion and 24.9 degrees of extension and then a little bit of 8 degrees of axial rotation there at C1 under the occiput, under the skull. And then down further we talk about the atlanto axial joint we actually have mostly rotation there and that joint we found between atlantoaxial rotation was 23 to 38.9 degrees. And then if you take those two those two make up, so between the occiput and C1 – C1 and C2, we have roughly 50% of the range of motion in the cervical spine comes from how that head moves on that top neck joint. And so that’s really really really important when we’re talking about function of the body and just alignment in general. If that upper neck is out of place it’s going to translate all the way down the spine and cause issues even down into the lower spine, hips, and legs. The first ligament we want to discuss here is the transverse ligament which holds the dens, which is this top – this vertical bone here, it’s C2. It’s the pike that the ring of C1, this back piece here and the front piece here, sit around/sit on top of and there’s a little synovial disc between the two bones right there and this transverse ligament is right here, this this kind of thicker blue area right here. And what it does is it limits the motion of C1 forward away from the den. So that’s flexion away from that bone. And that’s really important because one of the things that we actually work with all the time in chiropractic is we’re trying to reduce the anterior motion or rotation of that bone away from C2. And so if you understand where it sits and the problems that can arise with it, which they actually talk about later on the paper and I’ll just kind of add this in here so we don’t have to hit it later, but rheumatoid arthritis is where a lot of people will run into issues with that ligament. Where it will get inflamed and degenerated I actually see it a lot on what we do is called cone beam CT in our office where we take a 3D dental x-ray and you can actually see that ligament as you can slice through and see when that ligament has ossified and hardened on the back of the dens. And so it’s something that we’re taking into account in terms of how we care for people. It’s really really important that that ligament maintains its structure because it’s one of the strongest ligaments in the spine. It’s actually the strongest ligament in the craniocervical junction. Which is important to know and second to that are the alar ligaments which actually attach.. So what they do is they’re called the check ligaments. So alars here. So what they limit is lateral flexion and rotation, where the head is bending side to side or turning. They’re actually limiting the movement of the skull away from C2 and the cervical spine. because they attach down from the base of up inside of the skull here, in this what we call the the foramen magnum, they actually attach right up here at the base of it this hole and attach down at that dens that top of that bone here that I was telling you about a minute ago and they limit movement. So if you tip your head one way the one on the other side so the one on the other way from away from where you’re moving actually gets tight and holds that dense to the skull. Now if there’s a problem with that in a lot of accidents and injuries where someone might have their head turned in a car accident or a fall where they hit their head that ligament can be damaged. And so it’s really important that if there has been a head or neck injury we do something called T2 weighted MRI where, and I always remember this from my diplomate days, we would talk about T2 MRIs or the terminator T2 the one that mostly looks like water and that’s how we know a T2 weighted MRI is where we’re looking at water in the image and so you’ll see ligaments light up more and if they’re dark or if they’re black they’re separated and that’s bad. That’s really bad. And you’ll see that sometimes in alar ligaments in and a lot of people they have these big car accidents and injuries where they don’t have a lot of evidence to support what they’re feeling and what they’re going through. But then if you do one of these two T2 weighted MRIs and look at their alar ligaments and their alar ligaments might actually be completely separated or blown as Dr. Rosa said a lot in our program and that is a court case winner right there. I mean if those ligaments are gone that’s a really important thing to document. So just in terms of car accidents that’s a big deal that limits that rotation lateral bending of the head and the neck and that’s something that we’re not looking at it on a regular basis in our chiropractic offices but if there’s a problem we know to look for that. So one way that we can in our chiropractic offices is we can do lateral bending, APOMs, AP open mouth. Where actually the person opens their mouth and then you have them tilt their head and you can see C1 would slip off of C2 quite a bit on one side and that would open that up for quite a bit of movement. And so that’s just something that we look at and we’re keeping an eye on in terms of craniocervical junction instability. And so one of the main points here of the paper is that there are other ligaments, there are nine other ligaments, but those two are the main stays of the upper cervical spine. There are nine others and they go from the transverse occipital ligament. Which is a tiny little guy that actually sits right behind the dens and that is actually attaching from the base of the occiput on one side over to the other side. And that limits some more of that extension and flexion. Holding things in place there. And then it’s, “TOL is a small accessory ligament of the CCJ located posterior superior to the alar ligaments and the odontoid process..  it limits.. sought to have similar functions to alar ligaments actually limits lateral flexion and possible rotation as well.” So good to know there. Then the accessory atlanto axial ligament. This one was kind of an interesting one to me because I forgot about it but what it does is it actually attaches down lower on the base of C2 and goes all the way up into the skull and attaches on C1. So it literally holds everything together and stabilizes it all together in flexion and extension and so that’s important to know. They even said that this structure may be important for conveying blood supply to the base of C2 or the top of C2 area. And then let’s see the lateral atlanto occipital ligament. This one was another kind of funny one and what was interesting about this guy, this is out on the transverse process of C1. So this is looking all the way out on the edge and it attaches from C1 up to the base of the skull. I completely forgot that guy existed but it sits right behind this muscle here, which is called the medial rectus capitis lateralis. And I didn’t even know that muscle existed because I looked it up, it said it in the paper and what’s fascinating is this is another one of the little upper cervical muscles, the suboccipital muscles. These four muscles here and then this guy right here. They don’t do movement so much as they are sensory in nature and limit motion. So they’re all there to basically tell your brain where your head is sitting on C1 and C2. And so that little ligament the lateral ligament there, the LAO, it’s sending a lot of information into your brain about how C1 is sitting under your skull and that ligament limits lateral bending of your head too they kind of found that. So just fascinating stuff that I didn’t even know that existed. 

Dr. Leach:  Before you continue doctor, when I was looking at this as well and just reviewing that exact ligament that you just talked about. I can’t help but to think of one of the key concepts we look at in upper cervical chiropractic is laterality. Meaning for everyone listening meaning which way the atlas has displaced left or right compared to the head, compared to the occiput. So it makes me wonder if those ligaments would actually be able to be red with a T2 weighted MRI as injured as part of the mechanism of the misalignment that we’re actually correcting. For example if there’s a right laterality is there damage to the left ligament or is there damage to the right it makes you kind of think. And obviously there’s different levels of sprains to a ligament. There’s three different levels so it makes you wonder you know when there’s a misalignment maybe it’s only a grade one. Maybe when there’s a significant grade two or even a grade three that’s when really really bad things will happen. It just makes me kind of wonder. I wonder what that T2 MRI would say. 

Dr. Evans:  Yeah and that’s actually a good point and I think what would probably be the outcome is just that the accessory ligaments are quite a bit less dense. So this is one of the accessory ligaments, it may be quite hard to see and that might be why we don’t talk about it too much. But again it limits movement and you may be able to pick it up on an MRI. I just haven’t seen anyone talk about it or study it so that might be something to look at. That’s a good point though because that is an important piece to what we do. Moving on to the barkow’s ligament, which is the sixth ligament in the in the eleven that we’re studying here today. This ligament is located just anterior to the superior aspect of the den. There’s actually a picture just for the barkow’s ligament. It’s real small and this is in the paper but this little picture right here so this little band that runs across from one side to the other. Now this is in front of the dens where the.. Oh gosh, what was the name of the other one? I believe it’s the posterior. What was it the..

Dr. Leach:  Transverse occipital. 

Dr. Evans:  Yeah transverse occipital. That’s actually posterior to the dens. Nice catch Dr. Leach. So you can see that there’s a lot of emphasis placed on this craniocervical junction to maintain the relationship of the dens, to C1, to the base of the skull. There’s all these tiny little ligaments that hold all of this together.

Dr. Leach:  One of the things that I saw while reviewing this that was super interesting is they talk about the barkow ligament. So I’m going to use my coffee cup for the dance. So you’ve got your barkow ligament that’s on the front and then what they say is that in order for that to actually do its job for holding things in place as we bend our head back the transverse ligament behind it actually has to be intact. So not only are these ligaments supporting structures and making sure we have mobility and stability but they’re actually working together.

Dr. Evans:  Yes

Dr. LEach:  Which is just.. It’s crazy. It’s incredible how amazing that is. That they’re actually working together to prevent that lack of motion and just how intricately they all work together to give us the mobility we have while protecting all the structures in there and it’s just incredible. Dr. Evans: That’s a great point that actually was in there. I remember that. So good catch. 

Dr. Leach:  Yeah. 

Dr. Evans:  And that one mostly limits flexion and extension right? 

Dr. Leach:  So yeah. I think it’s the barkows for the extension but for it to not go too far that transverse ligament has to be behind it.. 

Dr. Evans:  Right 

Dr. Leach:  ..intact in order for it to. Because if it wasn’t there then there wouldn’t be anything for that pressure to anchor on and it would  just keep pushing back. Yeah. 

Dr. Evans:  Yeah. Yeah. Which would not be good right because that dens is sitting right there and it’s right by your base of your brain stem. So if that then slips back that’s right in the brain stem. So your body is.. 

Dr. Leach:  Nothing good will come from that. 

Dr. Evans:  Yeah. Your body is protecting yourself there. So then we have number seven is the apical ligament. The apical ligament is this tiny little ligament right here. Which is actually probably not the best picture to use. So I can see it. Right there. That little guy right there, just behind the transverse occipital ligament. And what that guy does.. So if we look at it from this picture. This is a better picture. You can see right here from the dens up to the base of the skull that guy again limits motion; however, they actually said in the paper that it’s not taught in most of the cadavers that they studied. Well maybe in real life it is but you know in the cadavers that they studied I believe that most of the time it wasn’t even really holding tension. So they kind of said well it probably doesn’t have much reason to be there these days but I’m a believer that the body has everything for a purpose. And again that motion it would limit, it’s there to stop motion going forward. 

Dr. Leach:  Yeah even if it’s a backup. 

Dr. Evans:  Yeah. Right. 

Dr. Leach:  It’s gonna prevent excessive excess motion. 

Dr. Evans:  Right. Exactly and so that’s kind of how you and I look at stuff. Well it’s there at least to prevent big injury.

Dr. Leach:  Right. 

Dr. Evans:  There might be a problem because you and I look at millimeters in a misalignment, millimeters of problems. Where if there’s a few millimeters of play it may not be a medical problem but to you and I that’s millimeters of brain stem pressure right. That’s a problem. 

Dr. Leach:  Yeah. 

Dr. Evans:  So all right. So that’s the apical ligament and then number eight is the tectorial membrane.  It’s like a big flowing cover that goes on the back of the anterior portion of the cervical spine. And what it does is it lays. So it’s like this. It lays. It’s the orange one or kind of red colored one here and that lays across all of these other ligaments to kind of glue them onto the bone and hold them on there together so that they play together. And it’s made up of a little different structure. “A description of the tectorial membrane are insufficient and inconsistent with regard to anatomy and function; some authors have reported this. This membrane is an accessory ligament that restricts flexion others describe it as a primary stabilizer of the CCJ resisting extension.” So basically they just couldn’t come to an agreement based on all the papers that they reviewed what it actually does.  But it’s there again. It’s kind of holding everything together. It’s the glue on the back of the front of the canal. So you’ve got the hole and so here you’ve got all those ligaments we were talking about on the front of the cord in the canal and then it lays on that and then you have the spinal cord in the center and then we have the back of the canal and the bones on the back of the canal. So then we talk about number nine is that..

Dr. Leach:   Can I say one more thing about that? I think this is super important to understand we’re getting a little bit outside of the upper cervical spine. But the tectorial membrane it says, “Worny has also described the tectorial membrane as the well-developed superior continuation of the deep layer of the posterior longitudinal ligament.” Now this is super important especially in whiplash injuries. When we see an anterolisthesis or posterolisthesis of the lower cervical spine during whiplash that posterior longitudinal ligament can be torn and then you’ll get a shifting and that’s another, again whether it’s from radiographs or from MRI, to show injury in a med legal case to support the patient’s injury. I just wanted to kind mention how those are kind of one and the same. It’s just a continuation of that but it’s a super super important structure of what gets damaged and what protects the lower cervical spine in head/neck injuries and whiplash injuries.

Dr. Evans: Yeah. That’s a good point. That was something that I noticed and I’m glad you picked that up. I forgot about that. Good job. 

Dr. Leach:  Yeah. 

Dr. Evans:  One of the last ones here is the POA membrane. So the posterior atlanto occipital membrane. So this is that one that it’s the myodural bridge and it actually attaches from the base, so the the top of the atlas to the base of the skull, and then it actually goes into the dura of the canal and out to the rectus capitis posterior minor, which is this muscle out on the back of the bones. And so we talked about that earlier but if that muscle is tight or if that bone is misaligned that ligament actually attaches all the way into the dura and that can affect the spinal cord. And so that’s how we know. Dr. Leach and I are always checking people’s low backs and their hips to see if their neck is misaligned. Well that goes along with our dentate ligament theory that we talked about a long time ago in one of our other podcasts and that all kind of goes together with how someone might get symptoms that go up into their head or go down into the lower part of their body. If that ligament is attaching into the cord itself then you could have an issue in any one of the tracks of the spine that go up and down at that area so by correcting that upper neck you can literally change the entire neurology above or below. Were you going to say something, Dr. Leach?

Dr. Leach:  Yeah. I was curious why wouldn’t they have on the picture here the myodural bridge going into the duras? Are they just focusing on ligaments? Is that kind of why? 

Dr. Evans:  Yeah well, there’s papers on that. We can do a paper on that in the future. They just didn’t show it. Yeah. They actually talk about it so there’s a part here where they say, it’s in the kind of breakdown later on of the importance of.. 

Dr. Leach:  Now is that myodural bridge? Is that just another function of stability and control to make sure things aren’t compressed and to anchor? 

Dr. Evans:  Yeah. 

Dr. Leach:  It seems like it would be important on flexion to make sure that the spinal cord and brainstem don’t get bent. It’s almost like anchoring it from a superior aspect, like a tent kind of thing. Yeah? 

Dr. Evans:  Yeah and I think there’s a lot of place put on this that is more signaling to the brain about where the bones are at in place and so it can tell. It gives input into the brain. Unfortunately in these big head and neck injuries it gives bad information and that’s what we want to fix. That’s what upper cervical chiropractors want to fix and reduce that tension at the bone and the spine. But their comment here was, “a study conducted by Hack et al reported the presence of a connective tissue bridge joining the rectus capitis posterior minor muscle to the spinal dura in all catavaric specimens.” Yeah and then this other guy found, “connective tissue bridge to be present in 67% of cadavers indicating that this represents normal anatomy rather than a rare anatomical anomaly.” Which is really cool to hear because that’s what we do. That’s where we live. That’s what we do and we see changes in hips and low back all the time we see changes in the mid spine we see changes in brain function and so if there is a ligament that’s attaching all the way into the dura well that could be a big reason as to one of the big reasons why we’re seeing changes elsewhere in the body when we correct the upper neck. Okay. So that said the anterior atlanto occipital membrane. This guy right here. So this big guy right up here. So it attaches from the front of C1 so what’s called the anterior arch up to the base of the front of the skull. That ligament or membrane as it’s called, “..is a thin structure that attaches the anterior aspect of the atlas to the anterior rim of the foramen magnum.” It says Tubbs et al noted that, “aao membrane may function synergistically with the barkow ligament to limit atlanto occipital extension of the head.” So again not an extension of the head. It’s holding things down kind of locking them down in the front. So there’s a lot of strength and weight put on holding that C1 down to the dens into the skull on that front end because things go backwards. That’s not good. And that happens a lot in accidents, whiplash accidents. That’s where people get really severe injuries and trauma and that’s why that ligament’s there. So the nuchal ligament is the 11th ligament. The nuchal ligament is on the back of the cervical spine here and actually lower down when it goes into the thoracic spine we call it the spinous ligament. And so this nuclear ligament is actually full of what they said, “Intuitively the nuchal ligament restricts hyperflexion of the cervical spine. Interestingly, some have identified a greater concentration of proprioceptive fibers in this structure and that it may play a role in maintaining proper alignment of the cervical spine.” So again. We’re talking about information heading up into the skull up into the brain. If the vertebrae are off it’s going to send bad information up into the brain and that’s what this ligament is doing it’s actually kind of a GPS unit for where things are out in space. So that’s an important thing to remember. Then it goes into histology of the craniocervical ligament. Where they come from. How they’re made. One of the important things they said in this little piece is just that, “The histology of these ligaments are that they are mainly composed of collagen fibers with minimal elastic fibers in their periphery. The degree of elastic tissue present varies from ligament to ligament. For example the transverse and alar ligaments contain very few elastic fibers.” Which is why they’re so dense and strong. They’ve got to be strong to prevent that movement. Okay so with that said then it goes into what are some of the problems that could happen. They discussed rheumatoid arthritis, down syndrome, calcium pyrophosphate, dihydrate crystal deposition. Which I actually had a patient that had that. We identified it through our radiologist, Matthew Richardson, who’s an amazing guy down at Palmer, Florida Chiropractic College. He identified it and we got that patient a medication and I’m you know not a guy that tells people to go get on medication but what’s pretty cool is that was a life changer for that guy. Because some of these problems, some of these more like autoimmune diseases, are really tough and just a good review of the spine can give a lot of great information and so we were able to help that gentleman in that situation. And then the last thing is whiplash and they talk about whiplash for a big chunk of the paper here. And just says that,  “Prevalence of whiplash associated disorders has drastically increased over the last 20 years.” So basically that the CCJ is the most commonly injured joint in the spine during whiplash injuries. “Alar transverse ligaments are the most likely to be injured from a whiplash associated disorder. Trauma resulting in whiplash associated disorders often involves the transfer of large amounts of forces across the atlanto axial joint resulting in rupture of these two key ligaments.” So just really important stuff there to know if you’ve been in a car accident or know someone that hasn’t they’re suffering from all kinds of symptoms and problems very well likely could be that they’ve either had injury to these ligaments or they are stretched and there’s a big misalignment in that craniocervical junction and that’s what we do. That’s where we live. We want to balance that craniocervical junction to bring order and restore function back to the joint so that the brain can communicate with the body again. And that’s where we live. In this paper they actually talk about how rheumatoid arthritis is one of them but a lot of times they’ll talk about stabilizing C1 and C2 and the cervical spine to the skull and it’s like they say here an anterior subluxation of the atlas is a big deal and it may require surgical fixation. It’s like hey! What about trying to conservatively correct that misalignment? Trying to conservatively reduce that. So that’s what we do. With all that said.

Dr. Leach:  Yeah I think a good thing that.. a couple things. And again when they talk about subluxation in this paper they’re referring to a medical subluxation not a chiropractic subluxation., meaning ligament laxity. Meaning a displacement of the bone. When chiropractors talk about subluxation if it’s a full spine chiropractor they’re talking about more fixation and more of a stuck/immobile joint and then upper cervical we’re talking about that also that stuckness out of place but not from a medical standpoint of ligament laxity. Maybe kind of to bring things full circle, maybe a slight ligament laxity. Just commenting about what we talked about before as far as maybe there’s a grade 1 or even smaller tear to the ligament that allows a slight displacement of that vertebra but not to the degree where it would be diagnosed as a medical subluxation. That’s number one. And the second thing just to kind of review here is you talked about craniosacral therapy earlier and massage therapy and then chiropractic and it’s important to understand the difference between all these. 

Dr. Evans:  Yeah 

Dr. Leach:  For the layperson for medical doctors. What we’re doing is not something physical therapists, massage therapists, or soft tissue therapists of any kind do. Which is addressing maybe the fascia or maybe the muscles or just to get things functioning properly that way, whether there’s adhesions and they’re doing massage or trying to restore function that way. Especially as upper cervical chiropractors we’re dealing with the bones in the joints. And then the nerve function, whether it’s coming from the joint or around the joint in the brain stem or the spinal nerves or what have you. So it’s important to know that all of these providers working together to figure out what the exact problem is is the most important part. Because again if we have these tiny injuries to these ligaments that are causing a misalignment the upper cervical spine which are causing problems with the patient and that patient is only getting care to treat the muscles that are in spasm because they’re trying to brace and protect the spine you’re just relaxing a muscle that the body is telling to spasm as a protective mechanism. Right. So if we can get the alignment and the joints back into alignment and back to functioning properly, that in and of itself will allow a lot of the muscle and soft tissue to self-correct. But then there’s always that well how long has it been there is more soft tissue therapy needed. So these cases they can be pretty complex and Dr. Evans I’m sure you’ve had patients that have just literally gotten 100% better just by correcting their atlas. Tons of things get better. They’re feeling phenomenal but then you have other patients where you correct them and then there’s other things going on. Okay let’s get some massage in there. Let’s get some soft tissue work, some physical therapy whatever those may be. So I just kind of wanted to point out that there’s a really important understanding of where the value of upper cervical chiropractic really comes in as a missing piece for most people most providers to really know about the value of what it is that we’re doing and the intricacy. And obviously with these 11 ligaments just of the upper cervical spine the importance obviously that we know that the body knows that we have in that area with all these ligaments and stability and the brain stem being right there and just being an important area. Yeah, anything on that Dr. Evans? 

Dr. Evans:  No I think that’s really important and you’ve covered it well.

Dr. Leach:  Fantastic. Any closing comments about anything with this paper about what people would like to know? I’ll link the paper or link a link to the paper in the description below for people to go find it so they can read it on their own. Any last last input? 

Dr. Evans:  Maybe one thing. I was calling back I was talking about the APOM and open mouth and just thinking back that it’s the relationship between the dens and the atlas, you can see how the dens is moving inside of C1 not how C2 is slipping off of C3 or C1 slipping off of C2. But there are ligaments that you can look at ligament damage there and see if there’s instability and then you can then make maybe imaging protocols from that. 

Dr. Leach:  Yeah. Got it. Perfect. Fantastic. Okay. Well thanks everybody for listening. Comment. Like the video. Share the video. We’re trying to bring value as always and let us know if there’s any other papers or questions or anything that we can review in the future. Until then thanks so much and thank you Dr. Evans and we’ll talk to you soon. Okay that’s it for this episode so what did you learn that fascinated you or surprised you about the research today? Join or start the conversation in the comments below. Hey thanks so much for watching. To watch more of our research shows click or tap the screen right there. To subscribe to the channel click or tap the screen right there. Until next time, I’m Dr. Kevin Leach with The Upper Cervical Chiropractic Research Show bringing awareness to conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic. Until next time, take care and take care of your spine. It’s the only one you’ll ever have.