When it comes to adjusting the spine, I think it’s easy to argue that the top of the neck is the most important and delicate part; there is a ton of sensitive anatomy, coupled with the tremendous range of motion that the joints of the upper neck are capable of compared to the rest of the spine – about 70% of cervical rotation comes from the Atlanto-axial joint!
The upper neck is also more challenging to adjust than the rest of the spine; with 2 joints at C1 instead of three you have at every other spinal joint you have a more mobile but less stable joint. This is why I use xray to guide my adjustment of this area, there are more possible ways for this joint to misalign than further down the spine.
If a patient has an accident or injury to this joint, they may feel scared of having the area treated, and rightfully so, it is a very sensitive area. The NUCCA procedure is an image guided adjustment of this joint, and with any process that you are trying to do carefully and precisely, you do it more slowly. In the NUCCA procedure the joint is moved over 30-60 seconds, so there is no twisting or cracking that is typically associated with Chiropractic adjustments.
What conditions can be related to the upper neck? The obvious one would be neck pain, but headaches are also a very common symptom which responds extremely well (this is how I got into doing NUCCA – it made my migraines go away!). Because the joints of the upper neck are also significant contributors to our proprioceptive sense, posture will typically break down with an injury to this area. With a patient laying, posture breakdown will typically present as a long or short leg, or significant imbalance in paraspinal muscle tone that either won’t release fully, or that doesn’t stay released (reoccurs once they return to a standing posture).
Have a tough case that you think might have an upper cervical spinal issue? My door is always open (even if it’s closed, I’m always happy chat if not with patients). If you are sure there is an upper cervical issue present you can also suggest the patient book a 1 hour assessment. This will allow me to understand if they have the signs of an upper neck issue and if I might be able to help move the case forward with you!