Special Feature Abstracts of presentations made at the Upper Cervical Experience Conference February 26th-28th, 2015 in New Orleans LA.

Topics in Integrative Health Care 2015, Vol. 6(1)   ID: 6.1006

Published on
March 31, 2015
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The following abstract is the winner of the poster competition:
Case report: Resolution of sciatic nerve pain following upper cervical chiropractic care
Jean-Paul Bohemier, DC, Calgary, Alberta, Canada
Introduction: This case report describes the outcomes of chiropractic care using an upper cervical technique with a patient with sciatic nerve pain.
Case Presentation: 53 year old female presented with chronic sciatic nerve pain. The pain originated in the lumbar spine and radiated to the right foot. The patient was taking morphine every 12 hours for mild lower back pain. She had had 3 discectomies with little pain relief. Upon physical examination the patient was measured using the Postural Stress Analyzer (PSA) machine. She presented 16 degrees of postural distortion (0-5 degrees being normal) and an increase in symptomatology while lying flat or with a straight leg raise test above 45 degrees. 
Interventions and outcomes: The patient had 9 office visits over 8 weeks. She was given chiropractic adjustments (spinal manipulation) using the NUCCA technique. After her first adjustment her posture reduced from 16 degrees to 6 degrees of postural distortion. The patient’s subjective and objective measures improved significantly. After her fourth visit the patient was able to sleep lying on her back for the first time in 8 years.
Discussion: The patient experienced significant improvement subjectively and objectively following chiropractic care using upper cervical technique.

Upper cervical chiropractic management of a patient with headaches and neck pain and a history of traumatic internal carotid artery dissection: a case report
Mychal Beebe, DC
Private practice, Seattle WA, USA
Introduction: This case details upper cervical chiropractic spinal manipulative therapy utilizing the Blair protocol of a patient with neck pain and headaches with a history of cervical artery compromise following a motor vehicle accident. 
Case Presentation: A 54 year old male was seen in a chiropractic office with neck pain and headaches. 8 months prior to his initial visit, the patient was involved in a motor vehicle accident which resulted in partial dissection of his left internal carotid artery. Upon exam the patient reported pain and demonstrated decreased cervical and lumbar range of motion as well as leg length inequality, positive cervical syndrome test and postural distortion. Blair upper cervical specific radiographs indicated an anterior superior left atlas listing.
Intervention and Outcomes: The patient was evaluated 26 times over a 6 month period, and received 5 Blair upper cervical adjustments.  Physical exam findings, the Numerical Rating Scale, the Neck Pain Disability Index and the RAND-36 outcomes were used to track progress at baseline, 6 weeks, 12 weeks and 6 months.  All outcome measures demonstrated statistically significant positive changes. 
Discussion: Further investigation is needed to understand the relationship between a history of traumatic cervical artery compromise and the use of upper cervical chiropractic Blair protocol to manage symptoms. 

Improvement in post-concussion syndrome in a 16-year-old female under upper cervical chiropractic care: a case report
Jonathan Chung, DC, private practice, Wellington, FL, USA

Introduction: A 16-year-old female presented to a chiropractic clinic with post-concussion syndrome. Her improvement under upper cervical care is described.
Case Presentation: The patient was a 16-year-old female with dizziness, headache, neck pain, and brain fog. Symptoms persisted for 3 months following a concussion. Acupuncture, vestibular therapy, and management under a neurologist had shown no improvement. Patient was missing 2 school days per week, was unable to participate in competitive equestrian riding, and could not study for periods longer than 10 minutes since the injury.
Intervention and Outcomes: The patient was evaluated through the NUCCA protocol and was found to have an Atlas Subluxation Complex. Post adjustment x-ray showed reduction in atlas laterality (50%) and atlas rotation (60%). The patient was seen 14 times in 6 weeks and required 6 adjustments. She showed 60% improvement in Visual Analog Scale (VAS) scores for dizziness and concentration since beginning care. She also reported a 100% VAS improvement in headaches and cervical pain. Her mother reported the patient missing just 3 school days during the 6 weeks. The patient also resumed equestrian riding 3 weeks into care.
Discussion: Traumatic head injury has also been associated with altered venous outflow and decreased intracranial compliance. Head injury may lead to a disruption in the mechanics of the craniocervical junction causing altered venous drainage which may result in chronic neural degeneration. Correction of the atlas subluxation complex may play a role in restoring normal cranial hemodynamics. More research is needed to determine causative role.

Upper Cervical chiropractic management of a patient with chronic low back pain with unilateral lower extremity radiation: a case report
Trevor Hillard, BSc., chiropractic student
Palmer College of Chiropractic, Davenport, IA, USA

Introduction: This case report describes chiropractic management of a patient with low back pain using only Upper Cervical chiropractic technique.

Case Presentation: A 51 year-old female presented to Palmer College of Chiropractic’s outpatient clinic, with a chief complaint of radiating low back pain of nine years’ duration. The patient reported she had tried multiple forms of chiropractic manipulative therapy (CMT), and obtained temporary relief. The patient reported that her third lumbar vertebra was “exquisitely painful” upon palpation, with radiation down the antero-lateral thigh to the head of the fibula. Pain was rated 6/10 on a Visual Analog Scale (VAS). The physical exam demonstrated an area of decreased sensation over the L5 dermatome, but was otherwise unremarkable.
Intervention and Outcomes: An Upper Cervical chiropractic technique (NUCCA) was recommended to the patient, and was implemented on 8/21/14. After beginning this treatment plan, no other interventions were used with the exception of the patient using Aleve, Cryoderm and ice for pain management. Prior to care the patient reported having nearly stopped running. Under care, the patient ran a half marathon, and reported no pain at 7 of the 17 appointments.
Discussion: This case report demonstrates that an area of misalignment/joint dysfunction in the neck may affect other parts of the body, and that a subsequent reduction in this misalignment possibly restores function to parts of the body that are not directly impacted by the adjustment.

Resolution of strabismus, diplopia and headaches following reduction of upper cervical subluxation: A case report
Johanna Hoeller, DC, private practice, Seattle, WA, USA
Jonathan Chung, DC, private practice, Wellington, FL, USA

Introduction: This case report describes the outcomes of upper cervical chiropractic care in a woman with strabismus, diplopia, and headaches .
Case Presentation: A 42-year-old female presented to a chiropractic office with headaches. The patient had a history of diplopia related to strabismus as diagnosed by her optometrist. She had a history of multiple neck injuries and head trauma linked back to childhood. The NUCCA chiropractic procedure uses a standardized protocol consisting of a supine leg check and postural assessment (caliper measurers of shoulder and hip orientation) in determining need for a three-view orthogonal radiographic series. These views allow for evaluation of an atlas misalignment in three dimensions while concurrently developing a correction strategy. An eye exam was utilized to properly assess the presenting complaint.
Intervention and Outcomes: Using a correction strategy derived from radiographic analysis, a “triceps pull” (low velocity low amplitude adjustment) intervention was delivered to the Atlas transverse process. Follow-up radiographs demonstrated reduction of the upper cervical misalignment. The post assessment findings observed inequality of leg length, reduction of postural distortion, reduction of craniocervical misalignment on radiograph and improved eye tests. The patient was seen 7 times in10 months and was adjusted 3 times. She showed almost complete resolution of her diplopia, and complete resolution of headaches. The patient remains under chiropractic care to manage any exacerbations. 
Discussion: The case presentation describes the resolution of headaches and diplopia of a 42-year-old woman under upper cervical chiropractic care. 

Upper cervical care of a migraine patient: a case report
Melissa Licari, DC, Tampa, FL USA
Introduction:According to the Migraine Research Foundation, migraine is an extraordinarily common disease that affects 36 million people in the United States. This case report describes a 57-year old woman with a 40-year history of migraines who had significant improvement after upper cervical chiropractic care with Orthospinology.
Case Presentation: Prior to care, migraines were occurring 2-4 times a month with daily “low-grade” headaches. Each migraine lasted 1-2 weeks.
Intervention & Outcome: Evidence of an upper cervical subluxation was gathered through a chiropractic examination using static and motion palpation and diagnostic x-rays, using technique guidelines. Upper cervical chiropractic adjustments were administered with a KH-2 Laney Instrument to correct the atlas misalignment. All migraines were reported as absent after starting upper cervical chiropractic treatment and remained absent in the ensuing 8 months. The patient stated that it is “very rare” that she experiences a headache. The Headache Disability Index given 3 times over a 10 week period reflected scores of 32, 14, and 0, respectively.
Discussion: This case presents an example of the resolution of longstanding migraines after a course of upper cervical chiropractic care. More research is necessary to determine if results are replicable.

Force-time thrust profiles of six chiropractic Upper Cervical procedures
Roderic P. Rochester, DC, private practice, Clarksville, GA USA
Vice-President – International Chiropractors Association Council on Upper Cervical Care and Co-Director, Society of Chiropractic Orthospinology Research Board
Introduction: Over the last decade, researchers have investigated the risks and benefits associated with certain types of manual manipulation to the neck. Because several different upper cervical chiropractic methods are used, it is imperative to describe in detail the patient positioning, method of delivery, and force-time profile of the thrust for these procedures. The purpose of this study is to describe the force-time thrust profiles of six chiropractic procedures used at the craniocervical junction.
Methods: Nineteen doctors performed 24 thrust trials on a modified version of the Titronics Research and Development Company’s adjustment simulator utilizing 6 different upper cervical chiropractic procedures, which included Orthospinology handheld/table-mounted instruments, Grostic, NUCCA, Knee Chest, Blair, and Toggle. The resultant force-time graphs were examined and descriptive statistics were computed.
Results: The procedures’ mean Peak Force varied from 4.4 lbs (SD=0.5) to 22.8 lbs (SD=6.7) with the instruments producing the lowest mean Peak Force and the Toggle producing the highest mean Peak Force.
Discussion and Conclusion: Force-time profiles were described for six chiropractic procedures used at the craniocervical junction. Significant differences in peak force exist among procedures.

Upper cervical chiropractic management of dystonia: Case report
Philip R. Schalow, DC
Private practice, Rockford IL, USA
Introduction: Dystonia is a condition that involves involuntary sustained and painful muscle contractions, twisting, and shaking. There is evidence that genetics, atlanto-axial misalignment and medication can be associated with dystonia. This case report describes the chiropractic management of dystonia.
Case Presentation: This 47 year old farm-raised, construction-working female with a history of trauma presented with pain from muscle spasms throughout the body, difficulty breathing and uncontrollable shaking of the hands and head. She was unable to work, write, fasten buttons, or pick up dishes securely. Breathing was impaired due to muscle contractions
Intervention and Outcomes: A National Upper Cervical Chiropractic Association (NUCCA) protocol for patient assessment was used. It consists of the supine leg check screening test, posture evaluation with hip calipers, both positive, indicating need for a NUCCA orthogonal radiographic series. From these images, an adjusting vector was determined as part of developing a spinal correction strategy specific for this patient. Correction was attained using a low velocity, low force manipulative procedure. Radiographic images demonstrated a complete reduction of the misalignment. Pain and shaking reduced without adverse reaction.
Discussion: For this patient, reduction of the misalignment of the upper cervical segments was associated with improvement in dystonia symptoms. Further research is important to clarify the role that different cervical structures plays in the etiology of dystonia.

Relationship between cranio-cervical orientation and center of force of occlusion in adults. Jeff Scholten, DC, private practice, Calgary, Alberta,
Curtis Westersund, DDS, private practice, Calgary, Alberta, Canada Raymond J. Turner, PhD, Professor, Dept. of Biological Sciences, University of Calgary, Alberta, Canada. 


Introduction: The integration of care between chiropractors focused on treating disorders of the cranial cervical junction (CCJ) and dentists treating dysfunction of the temporomandibular joint (TMJ/TMD) has developed as clinicians seek effective, integrative, patient management strategies. Clinical observation suggests changes to the dental occlusion following an adjustment to the CCJ using the procedure developed by the National Upper Cervical Chiropractic Association (NUCCA).  Our purpose is to investigate whether there is there is a change in occlusion that can be measured using a dental force plate, following a NUCCA adjustment to the CCJ.
Methods: In this case series, the patients served as their own control. Eleven volunteer active patients were assessed four times within ninety minutes.  The initial baseline NUCCA and occlusion assessment were performed twice prior to and following the NUCCA intervention. Data were collected on leg length, postural position, paraspinal thermography and occlusion (T-Scan) twice prior to the NUCCA intervention and twice following the intervention.  Data were observed for consistency between pre-pre and post-post measurements as compared to pre-post measurements.  Standard deviations of the mean and t-test of the data were used to compare the measures.
Results: Findings obtained in this first study of its kind, demonstrate that changes in both posture and occlusion can be observed after the NUCCA procedure. However, patients tend to have unique responses with some showing a shift in initial occlusal contact and others lending to a more balanced contact pattern. 
Conclusion: Our findings demonstrate further the interconnectivity of the CCJ and the TMJ. 

Instantaneous remission of tonic-clonic seizures and unconsciousness after atlas misalignment reduction: a case report
Craig York, DC, private practice, Morrilton, AR, USA
Introduction:  This report discusses the relationships between atlas misalignment, cerebellar tonsillar ectopia (CTE), and cervical hypolordosis with instantaneous remission of tonic-clonic seizures and unconsciousness after high velocity, low amplitude, vectored, atlas chiropractic adjustments.
Case Presentation: A 27-year-old male presented to a private chiropractic office with a history of back pain and spontaneous unconsciousness of brief duration after mild trauma which progressed to include prolonged periods of unconsciousness with intermittent tonic-clonic seizures. A brain MRI, taken post-trauma, revealed cerebellar tonsillar ectopia (CTE), a right dominant vertebrobasilar system, and a right ponticulus posticus. Cervical radiographs demonstrated a cervical hypolordosis. A neurologist’s examination revealed no positive physical, neurological, or EEG findings and the prescribed Depakote was poorly tolerated.
Intervention and Outcomes: On 9 occasions during a 5-year treatment period, the patient was carried into the office while unconscious, experiencing intermittent tonic-clonic seizures. Each episode, the patient received an atlas adjustment using the Orthospinology Procedure. On every occasion, the patient had instantaneous cessation of his seizures and immediate return to consciousness. On other visits, the patient was successfully treated for back pain flare-ups or as scheduled maintenance using the same procedure.
Discussion:  The positive immediate changes elicited by vectored atlas adjustments suggest that CTE, cervical hypolordosis, prolonged episodic unconsciousness, and tonic-clonic seizures may be directly linked to an upper cervical misalignment. Further study is warranted.
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