Book Review: Practical Shooting: Beyond Fundamentals

(this paper was originally published in The Upper Cervical Monograph, May 2001)

Book Review:

Practical Shooting: Beyond Fundamentals
Written by Brian Enos
[1990, Zediker Publishing, P.O. Box 426, Clifton, CO 81520]

Michael Thomas

Anyone who has been involved with NUCCA for more than five years will remember Dr. Lloyd Pond and his teaching of the adjustment. He often used the metaphor of firing a handgun when he taught the fundamentals of performing the adjustment. He would relate that the buildup of force in the adjustment, leading to the overcoming of resistance and transmission of the adjustic force to the patient, was very similar to the progressive squeeze on the trigger, and, that the two events both come as, almost, a surprise.

A close friend and patient of mine has long listened to me discuss the NUCCA work. He recently gave me Brian Enos’ book to read, saying that there seemed to be important parallels between our talks and his ideas regarding shooting. I am not a great gun advocate, but my friend’s enthusiasm for this text caused me to dip into it. I did indeed, find interesting parallels between the two activities. Brian Enos is a Masters Champion, two-time Bianchi Cup winner, and has placed in the top-5 at every major shooting event. He is also a certified Combat Master. I will ask you to simply substitute the word “adjust” for the word “shoot” as you read the quotes from his book.

Enos begins his text with a discussion of what he noted to usually be considered an advanced topic: the shooter’s “attitude”. He believes however, that attitude, or as he prefers to discuss it, “awareness” and “focus”, are central to everything that follows. As he points out:
“If you can be aware of what’s happening as you are shooting -not analyze it- just be aware of what you’re doing and of what you’re seeing, there is no limit to your potential.” [p.13] Enos defines awareness as: “an opening up of your mind, your vision, and all your senses to accept and observe things that are happening while you’re shooting- at the instant they are happening.” [p.13]
He believes that this is an intuitive process occurring outside the conscious thought process. The conscious mind, in his estimation, operates through the filter of knowledge, which is your past experience. The rational “picture” you have developed from past experience can close you off from awareness of what is unique in the moment. The rational model will allow development up to a certain point, (the limits of the developed model), but that is all. He believes that for continuous growth to occur that an almost “third person perspective” must be achieved. Enos believes that this quality is what separates good shooters from the great shooters.

The other major prerequisite to excellence for Enos is focus. He writes that focus is “a finite occurrence in the infinite realm of awareness. Focus is your filter for all the inputs your observation brings in…” He differentiates this “filter” from the “filter” of past experience by noting: “The difference between a screen of focus and the screen of past experience is that a screen of past experience built only from your own knowledge of the past blocks observations from entering your mind. Focus doesn’t block anything – it only alerts you to the important inputs your observation brings in.” [p.15]

To further clarify his idea of focus, Enos writes: “Focus could be defined as having a flexible preoccupation with anything that will affect your shooting performance. Focus is simply paying attention to things your awareness shows you are happening, as they are happening. Focus brings subjectivity to the objectivity of awareness. Awareness makes focus possible; focus engages awareness.” [p.16]

Enos believes that present time consciousness is critical to optimal performance. He notes: “An awareness of the present tense is a very fleeting delicate thing. The only way to achieve it is to not think about it. We all, if only for an instant, actually fire the gun in the present tense. For maximum performance you have to stay focused entirely in the present tense all the time that you’re shooting. This takes ambition, and especially so since no amount of actual work or thought on the matter can accomplish it for you. Present tense shooting must simply happen.”[pp.17-18]

Enos makes a great contradistinction between concentration and awareness. He points out that concentration is in its classical meaning, “a narrowing down of the mind to one specific, predetermined focal point. Awareness is an opening up of the mind to all available focal points that have some bearing on your shooting performance. Concentration is limiting; awareness is limitless.” [p.19]

Every student of the adjustment has spent much awkward and grueling time learning the multitude of individual phases that comprise the adjustment. Most people can relate to the memory of finally moving their episternal notch over the appropriate coordinate for the listing only to find that every muscle in their body was fully rigid, leaving very little possibility for an effective triceps pull. The sheer effort required to place the body in proper position for the adjustment seems overwhelming at first.

Enos further explains: “There is action and there is the idea of what that action should be. The space that exists between the contradiction of pure action and the idea of action is the thought itself. The larger the contradiction between the action and the idea of action, the larger the space, the more contradictory thought intervenes.”[p.19]

Enos admits that complete understanding regarding why the idea came into being allows the idea to effortlessly disappear. The steps of the adjustment have been formulated to teach a very complex idea. This is similar to the learning of Tai chi. There are many steps that must be carefully learned. The rote explication of these steps however does not produce the results that Tai chi exists for. “Something else” eventually happens once the form has been mastered. I believe this same process occurs in the delivery of the adjustment.

There are no words that can describe these ideas of awareness and focus. The action is felt or visualized in a more global way. Again, Enos: “If you’ll start tuning in to what you see as you are shooting instead of tuning out everything but what you decide to see before you shoot, you’ll be on your way to experiencing the distinction between concentration and awareness and focus for yourself.” [p.21]

More and more, in current society and in the scientific community, a distinction is being made between participation and control. Science has long believed its mandate was to “control” nature”. Western medicine is a natural outgrowth of this idea. Use of control however, divorces us from the participatory process we are actually a part of. Enos writes:
“Anytime you consciously try to do something to achieve something else, there’s no creativity in your actions. Forcing a thought into your mind in the belief that it will control your actions removes you from the experience. If that one thought is the only input you allow into your mind, then there’s no room left for your subconscious to intuit and control your shooting – as it is perfectly able to do. Thinking short circuits your perception…..Concentration is a form of control. But who’s the controller? The whole idea of control is really an abstraction of the thought process. Your words and thoughts may have tricked you into thinking you have control. But control as such – conscious control over the outcome of your shooting – you have no control.” [pp. 22-23]
The NUCCA adjustment is not an attempt to “control” the patient’s physiological processes. We work from the principle of “non-interference”, removing interference and then trusting the innate intelligence to unfold in the life of our patient.

Enos is not saying that the mechanics of the process are meaningless or that technique is not important.

“Your technique as a whole is only a summary of all the separate components of your technique, and the quality of the overall technique depends on the shooter having a complete awareness of all its individual components. All those individual components should be tailored to fit your needs and the needs of your shooting. Think of each mechanic as being a means to realizing a result in your performance. It’s important that you are aware of the effects each of these mechanics should have on your performance, and if you retain that awareness as you begin to experience the results for yourself, your best shooting style will surface.

The mechanics exist only to prepare the shooter to rise above them.

The only function of good form is that it affords maximum shooting efficiency; the mechanics [that] I believe work the best give the shooter physical control in the least compensating manner. Good mechanics give you the physical means to open up and experience the shooting by not restricting the shooting. Good mechanics enhance awareness and focus. But always keep in mind that good mechanics won’t, by themselves, make you a good shooter. What you actually do, technique-wise is not nearly as important as your understanding and being aware of what you’re doing when you’re doing it. ” [p.31]

Enos discusses specific shooting techniques at great length and these are not pertinent to this discussion. To further confirm his point, however, Enos makes a metaphor:

“When you learned to write, you quit thinking about the mechanics of making the letters and moved onto what the letters mean – using them for creative expression. In shooting, you must also quit thinking about the mechanics and move on to using them for creative expression – the desire to hit the targets…” [p.60]

Each NUCCA doctor finds the journey to adjusting excellence to have many twists and turns. There are plateaus and sometimes valleys to cross. Mastery of the basics is only the beginning. Enos finds a similar journey in his own field:

“My improvement now comes from trying to learn how to see more than I thought I could see and intuit past my own experience. There’s not much more in the way of external things to be found. Once you’ve settled into the basic mechanics you feel comfortable with, then it’s all internal. The improvement comes from the mind’s ability to open up, intuit the truth, and perceive what is actually happening, not from any more thoughts.” [p.62]

Enos discusses the need to be relaxed during the procedure. He believes that excessive tension is detrimental to the optimal delivery of the exercise:
“If you are tense, and have always been that way, then you won’t be aware of being tense. In practice, you need to see how relaxed you are. Notice things about tension. Notice tension especially in your biceps, stomach, and face. Check for tension in your jaw and see if your tongue is pressed up against the roof of your mouth. Just see how relaxed you are.

Mostly, if you can keep your stomach relaxed, your whole body will be relaxed…..A recognition that you are too tense and that you move so much more smoothly and accurately when you’re not so tense could be a major discovery for you, and not only in shooting, but in any physical action.” [p.91]

Enos sees the potential for endless improvement. He believes that “learning to shoot” is an impossibility; that instead, one learns with every shot. It is easily possible however, to learn “about” shooting. In his field as in ours, we worry about doing it “right”. He comments:
“See for yourself…If you keep yourself open to your experiences, there’s no right or wrong – there’s only what you’re doing. Right, wrong, good, bad, fast, and slow all exist in comparison, which exists away from the experience. Your perception of your shooting – what you are feeling and what you are seeing – right when it’s happening, is all you need to know to answer that question.” [p.154]

Any complex physical skill requires practice. Beginners require tangible goals. With more experience, the goals become more internally-oriented. Enos has this to say about his practice strategy:

“Shoot every run as if you were on your last magazine before quitting. Shoot every shot as if your life depended on the attention you were giving it. Never get caught in the trap of practicing haphazardly.” [p.158]

In our field, it is not our own life, but rather the life of our patient that is in the balance. Dr. Gregory often used to make a very similar statement. He would say, “Practice does not make perfect. Perfect practice makes perfect.”

I hope the parallels between this text on shooting and the delivery of the adjustment have provided some food for thought.

A Shift in the Prevailing Winds (Thomas and Scholten)

A Shift in the Prevailing Winds

An exploration of current issues in the practice of upper cervical chiropractic

Michael D. Thomas, D.C., Jeffrey N. Scholten, D.C.

(This paper was originally published in The Upper Cervical Monograph, September 2004)

Prologue:

This paper is intended to act as a catalyst for an introspective examination of NUCCA (National Upper Cervical Chiropractic Association) and to a degree, upper cervical chiropractic as a whole. The authors believe it is critical to re-examine the assumptions and assertions that drive NUCCA both scientifically and socially. The percentage of chiropractors working from an upper cervical perspective continues to constitute less than 5% of the profession. The voice of upper cervical chiropractic is essentially silent outside of its own borders. The reasons are many and diverse: historical, technical, political, financial, and social. This isolation has however, resulted in a simplistic perspective that reinforces a sense that we are “right” and that the rest of the profession ought to “wake up” or is “wrong”. This manner of communicating our work to the outside world has not worked for sixty years. We remain basically invisible.

The rest of the profession has not stood still in the intervening decades. Both the chiropractic field and healthcare itself have undergone tremendous changes in the past few decades. The rules are changing and what sufficed in the past is not going to be adequate to guarantee survival into the future. This paper is offered as the beginning of an analysis that can take us into the future. By clarifying our foundation we will improve our delivery of care while building the structure necessary to make our case to the world at large.

Most of you reading this paper owe your livelihoods to upper cervical chiropractic. The right to practice this work is precious and must be protected. You are on the front lines; there is no army in front of you. The need to validate the work we do is paramount and fortunately much work has already been done. Much of this work has however, been published only in upper cervical periodicals and/or passed down by word of mouth. Little has been published where we now need it, in peer reviewed, indexed literature. It is critical that we document what we know as well as what we know we don’t know. Further research can then work to “fill in the gaps” and make our case more objective and complete.

Upper cervical doctors tend to be highly principled, intelligent, thoughtful individuals. In fact, without those qualities, it is unlikely an individual would choose to become an upper cervical doctor. For historical reasons, we have not tended to make much use of this incredible brain trust. We would like to change that and the reader is invited to make one of several choices:

1) You may read this far and decide to toss the paper in the trash.
2) You may read the whole paper and then toss it in the trash.
3) You may wish to respond to one or two items that mean something to you.
4) You may sit down and analyze the paper, making comments (agreeing, disagreeing, perhaps shifting perspective) and adding other meaningful topics that you believe to be of critical importance to the future of this work.

Our plea is that you express your thoughts and opinions. In so doing, you may help to change the face of chiropractic and perhaps even healthcare.

We plan to publish this paper along with the responses we receive in a special issue of the Monograph. The responses will then engender the next step. We believe that a focused group of doctors working together may be more effective than the heroic efforts of a handful of individuals who by sheer force of will have driven this entire segment of our profession. We will always owe them our livelihoods but now the torch is being passed and along with it the responsibility to further this work.

Note: The paper is fairly long and contains a tremendous amount of material. It should probably be chewed slowly. Upper cervical chiropractic cannot be summed up in a “sound-bite”. Just as the work itself is complex, so any meaningful discussion of it will also likely be somewhat complex.

The Real and the Ideal

The Upper Cervical Monograph was launched in 1973 as a vehicle for NUCCA and NUCCRA (National Upper Cervical Chiropractic Research Association) to disseminate the ongoing findings from current investigation and research into the ASC (Atlas Subluxation Complex). It has served NUCCA well for over thirty years. When it was initiated, there was virtually no place in any peer reviewed, indexed journal for investigators in chiropractic to publish their findings. Medicine had simply shut us out. This made The Monograph a critical link in communicating new ideas. As venues have opened up in chiropractic, upper cervical work has still found it difficult to gain access to publication, often because our protocols involve radiating patients and the safety and efficacy of taking pre and post films has not been established in the literature. This has in some ways created a “Catch-22” kind of situation. So the problem has been that the only people who are aware of upper cervical chiropractic research findings are those within our own community. Anyone outside upper cervical work and certainly, any researcher who does a literature search on Medline, will not find any of these papers. As far as the work published in The Monograph is concerned, we are still invisible outside of our subscription population.

Any new research conducted should now be published in a journal, which will be available to the scientific community at large. This leaves The Monograph at a crossroads. The ever-decreasing frequency of Monograph publication is one symptom of this change in professional climate. There are, and will continue to be, still more articles that are of specialized interest only to orthogonally based upper cervical chiropractors which still make sense to publish “in house”. At the same time, it may be time to examine other uses for The Monograph.

The NUCCA landscape has changed in the fourteen years since Dr. Gregory’s death. The major concepts are set and the basic protocols established. Changes are much more incremental now. This is a natural evolutionary consequence of the success of the Grostic and Gregory investigations. At the same time, there has been tremendous change over the past several decades in the scientific community at large in understanding of complex and nonlinear systems. New mathematical models exist that were unknown and unavailable in the past. Biomechanics itself is undergoing rapid change in understanding. The frontiers of biology are approaching models that may accommodate orthogonally based upper cervical chiropractic and may, ultimately, greatly improve its application.

“New ideas in science are not always right because they are new. Nor are the old ideas always wrong just because they are old. A critical attitude is clearly required of every scientist. But what is required is to be equally critical to the old ideas as to the new. Whenever the established ideas are accepted uncritically, but conflicting evidence is brushed aside and not reported because it does not fit, then that particular science is in deep trouble-and it has happened quite often in the historical past.”
Thomas Gold

At this point, excellence has come to be defined by close and long term attention to detail and consistency in all of the various sub-protocols that comprise upper cervical chiropractic. This remains essential and probably always will, but it is no longer enough. As professionals, it is our duty to examine not only the new concepts that arise, but also to periodically re-examine the foundational concepts. When NUCCA was a handful of doctors meeting in Monroe, Michigan with Dr. Gregory, it was appropriate to defer to the decades of close examination of ideas that comprised the life of Dr. Gregory. No one else had the depth of experience, the methodical analytic abilities or frankly, the overriding brilliance that he demonstrated. He was able to explain in considerable detail his process and the rigor by which he arrived at the specifics of all the various components of the work.

We have grown beyond that handful of doctors. We are on the cusp of the next evolutionary step. Dr. Gregory was well aware of the requirements of a scientific endeavor. His work with Dr. Grostic and later individually, was the initial and perhaps most critical step. Individual investigation and experimentation are the genesis of any new scientific process. The issue today is that if we are to be taken seriously in the world at large, we can no longer validate our work by saying that Dr. Gregory (or Dr. Grostic) told us it is true. This is not meant as a refutation of their body of work. In fact, it is the reverse. The years since their deaths have only increased the clinical evidence as hundreds of practitioners have taken on this work and validated its results in the patients who have been adjusted by them. It is precisely for this reason that it is up to this next generation to take the next steps. We owe it to Dr. Gregory, Dr. Grostic and humanity.

The Burden of Proof and Impediments to Truth

Science is often discussed in an idealized form. Returning to Gold for a moment, here is his admittedly “naïve” definition of “what a scientist is”:

“He is a person who will judge a matter purely by its scientific merits. His judgment will be unaffected by the evaluation that he makes of the judgment that others would make. He will be unaffected by the historical evaluation of the subject. His judgment will depend only on the evidence as it stands at the present time. The way in which this came about is irrelevant for the scientific judgment; it is what we know today that should determine his judgment. His judgment is unaffected by the perception of how it will be received by his peers and unaffected by how it will influence his standing, his financial position, his promotion – any of these personal matters. If the evidence appears to him to allow several different interpretations at that time, he will carry each one of those in his mind, and as new evidence comes along, he will submit each new item of evidence to each of the possible interpretations, until a definitive decision can be made.”(p. 245)

Gold asserts that there is probably no one who can actually fulfill this rigorous description. It is acknowledged that people have motivations beyond the abstract ideal of scientific methodology. He sees danger existing in those motivations that are more social in nature. He asks:

“…what are the communal judgment-clouding motivations? What is the effect of the sociological setting? Is our present day organization of scientific work favorable or unfavorable in this respect? Are things getting worse or are they getting better? That is the kind of thing we would like to know.” (p. 246)

Gold then describes two motivations that are deleterious to scientific progress -the unwillingness to learn, and the “herd” instinct.

“Too many people think that what they learned in college or in the few years thereafter is all that there is to be learned, in the subject, and after that they are practitioners not having to learn anymore.”

“When people pursue the same avenue all together, they tend to shut out other avenues, and they are not always on the right one.” (p. 246-7)

He heralds diversity and recognizes the danger of limiting our avenues of investigation.
Gold continues his paper with a devastating critique of the peer review system in science, which seems to him, designed to maintain the status quo actually squelching innovative ideas and dissenting voices. (The reader is encouraged to read the whole paper at: www.suppressedscience.net/inertiaofscientificthought.pdf ) Although we are not looking to overturn the peer review system, we are looking for access to the mainstream scientific community. The flaws of the system are not our greatest concern but they are instructive. We find ourselves entrenched in a process that we are not really examining with a critical eye, hoping to gain access to the “greater herd” which has its own inertia. Keeping our heads down and concentrating on optimizing our x-ray techniques and maintaining parallel forces in our adjustments is critical but not enough to assure the sustainability of this work beyond our generation.

We believe that many of our problems are simply representative of our current level of maturity. We have a very small number of practitioners, many of whom are isolated by geography. We have no real university funding and we have no real corporate sponsorship. Almost all of our investigation and research has been the product of selfless service by individuals, very few of who have any training in research methodology. Each of us is very busy with family and business life. And yet, somehow, upper cervical chiropractic remains a viable career path in chiropractic. Also, considering our scant numbers, we are well represented in the current chiropractic literature. None of this would or could, be true if it wasn’t for the incredible power of the upper cervical adjustment.

It may have been necessary in the past to tightly control access to instruction and information in order to systematize it and create a series of protocols that could produce safe, effective and consistent care. This system is now well in place and has been comprehensively codified in the NUCCA seminars and in the NUCCA textbook. New students as well as long time doctors, all have clear guidelines regarding all of the sub-protocols. Restriction of conversation, ideas or innovations by doctors regarding aspects of the work only serves to disenfranchise the members of our community. Very often, behaviors that are appropriate at one point in time (to protect the work) become the very behaviors that restrict further evolution of it in the future. We believe this to be the case now. While class time at the seminar is not the proper time to delve into a diversity of viewpoints regarding the protocols, we believe there should be some venue for this process.

The Proof is in the Post

In numerous talks to chiropractic colleges, Dr. Gregory often noted that the use of any specific technique was unimportant to him; it was the results that mattered. By “results”, he meant post-films. He often said that he didn’t care if someone adjusted the big toe if it could produce corrections on film. Our gold standard is the radiological measurement of maximal and proportional reduction (correction) of misalignment. Post film analysis ensures that the patient is not left with disproportionate, different or even greater misalignment factors than prior to intervention. Other techniques do not share this goal and therefore the offer to take a set of pre-films prior to some “other” intervention, have the patient “adjusted” in whatever technique is being evaluated, and then posted to analyze whether misalignment factors have been reduced is not necessarily appropriate. The explicit assumption here is that if the misalignment factors are unchanged, reduced disproportionately, or increased, then the intervention has failed to improve the health of the patient. Outcome measurements for most other techniques do not include x-ray analysis of upper cervical spinal alignment. Apples are not oranges and demanding that an apple taste like an orange is unreasonable. There are more than 300 techniques now being utilized in chiropractic and many people have derived health benefits from the whole diversity of procedures.

The growth of chiropractic in recent years can certainly not be credited to the work of a handful of upper cervical chiropractors. All chiropractic procedures exist within their own context and the best ones are internally consistent. Outcome standards vary because our collective understanding of health is at best incomplete. Part of the current challenge upper cervical chiropractic faces as a minority, is in becoming able to enlarge our perspective and not demand that other procedures fit our mold. Instead, we need to work to more completely define and properly document what sort of physiological changes can be consistently expected under our care. When these physiological changes coincide with changes reported by other procedures then the efficacy of different interventions can be compared. The commonality may point to new directions. The upper cervical chiropractor has the burden of proof because of our minority status. Demanding that other techniques conform to the outcome standard of orthogonal upper cervical is not reasonable. There is a plethora of wonderful healing stories that come out of the chiropractic profession in every technique.

Considering the immaturity of our current physiologic understanding, the loss of continued development would be tragic. It is a near certainty that any procedure that does not take the upper cervical misalignment factors into account is not going to produce proportional reduction on post film analysis. Only when the complete reduction of misalignment factors on post film analysis equals a total and completely sustainable return to health in all people all the time will this standard be appropriate as a universal outcome measure for all chiropractic techniques. Health is multi-factorial and each practitioner and procedure brings different pieces of the puzzle to each individual case. Not everyone sees life in the same way however, and honest people take data in different directions. Just as light is both particulate and wave depending on the methods used by the observer there are different truths to each incomplete puzzle depending on the observer’s vantage point.

Integration of our ideas into healthcare will not come from making everyone else “wrong”. We have empirically and repeatedly proved this point over the past sixty years. As mainstream chiropractic continues to move away from the specific structural subluxation concept all together, the very real possibility exists that we could become “righteously” extinct.

Upper cervical chiropractic is simple in initial concept but difficult to truly understand at the level of practical competence. It is also difficult to perform as a consistent and accurate physical act. After six decades of evolution, there are still very few doctors who can be called masters of the work. If the only benefit humanity can derive from upper cervical chiropractic is from this (literal) handful of masters, then the work is of minimal practical significance, perhaps, an asterisk in the history of chiropractic at best. But the truth is that right now many hundreds of upper cervical doctors do their very best everyday and make incredible differences in hundreds of thousands of lives. A twenty percent decrease in misalignment factors can, at times, produce dramatic results. It may take several adjustments to obtain the best possible reduction. Some practitioners find they are unable to produce the results they know are possible with hand adjusting and begin to use an instrument. Any given individual or instrument (mechanical or manual) has greater and lesser qualities that need to be assessed and evaluated but not just discarded out of prejudice. It has been shown time and again that blinded division and unproven prejudice only serves to dilute our pool of talent, frustrate innovation and stall progress. To avoid this righteousness we must be willing to speak from and to share our own experience and allow others to speak from their own experience and observations. The “open forum” is certainly a step in this direction.

The Map and the Terrain

The association between maximal, proportional correction on post film analysis and restoration of health in a multitude of people has astounded upper cervical practitioners and gratified untold numbers of patients for several decades. The correlation between correction on film and return to health is so profound that it has led to the use of post-film analysis as an equal synonym for return to health, among upper cervical doctors. As great as this correlation may be (and we certainly do not dispute this), the post film remains merely a reflection of this potential for the restoration of health in an individual. It is not the transformation itself and it is not inclusive of all the myriad factors that are responsible for optimum health. The map must not be confused with the terrain itself.

This error occurs in the deep-seated conviction among many upper cervical chiropractic practitioners that restoration of health cannot occur without reduction of the upper cervical misalignment factors as measured on film analysis. This may seem to be a trivial point since we are not debating that there is a high correlation. This error in logic has however, in our opinion, created nearly irreparable harm to our standing in the chiropractic community and in healthcare at large.

In the world at large, this has translated into a tiny group of practitioners with the firm conviction that they are “right” and everyone else is “wrong” if they don’t conform to the outcome measure delivered by the post film analysis. This social impediment to widespread acceptance appears unassailable if we maintain our present course. We are not questioning the foundation of using the post film analysis as our main outcome measure; in fact we heartily endorse it. We are questioning the oversimplification that mistakes the map for the terrain and in so doing, dismisses the veracity of all other work.

A map can only take a person into areas that have been explored and charted by others. It is only as accurate as the knowledge and abilities of the maker of the map can allow. Of course, reading the map and orienting the map with the terrain is always a function of the knowledge and abilities of the map-reader, too. There is great comfort (and safety) in following a map that has long proven its worth. When Columbus looked at his map, it told him he could sail west across the Atlantic and find India. What he found, of course, was the Western Hemisphere -a little something that had been left off his map.

Preconceptions necessarily guide even the questions we ask. We can’t know what we don’t know. Samuel Clemons once noted that it wasn’t what people didn’t know that scared him; it was what they “knew” that wasn’t true. What we “know” can also be our current knowledge of what is “possible”. The routine resolution of dis-ease after correction of the upper cervical subluxation complex remains outside the realm of “possibility” for both the medical community and for the general population at large. How often have your patients shook their head as they talked with you about their friends who “know” that it isn’t possible to deal with an issue (sciatica for instance) by touching the afflicted behind the ear?

Paralysis by Analysis

Historically, NUCCA seems to have arisen out of the reaction of Dr. Gregory to the complex biomechanical problems requiring additional understanding and training that had not been available. For Dr. Gregory, the complexity of the issues involved required not just the memorizing of formulas, but a complete biomechanical understanding of the ASC. He believed that a more comprehensive understanding of the various components of upper cervical work would allow a doctor to circumvent or at least correct the problems that arose on post films.

NUCCA’s certification process continues as a successful attempt to develop this biomechanical, kinesthetic and intellectual understanding of our work and is essential to produce a more competent practitioner. This solution has however, created another problem, which is social in context. Our methods of awarding competence to the certified doctors have created a presumptive incompetence among uncertified doctors. The result has been a very small number of doctors charged with tremendous responsibility and a general sense of disconnectedness, even disenfranchisement, among the rest of the membership. The burnout among (and loss of) these few seems to occur faster than the creation of new certified doctors.

The disenfranchisement of the internal membership has a parallel in NUCCA’s relations to chiropractic in general. Essentially in isolation, upper cervical work has, over several decades, consistently and methodically evolved into a sophisticated set of effective protocols. Even so, it continues to remain hidden from public and professional view.

The reasons for this continuing anonymity have long been debated. Perhaps the major reason for this lack of entry into the public domain is that upper cervical chiropractic has demanded a shift in understanding that has no context within the (earlier, as well as) current healthcare paradigm. Only now are some in biology beginning to take on a holistic viewpoint that can accommodate the upper cervical perspective.

There have been no large granting institutions funding upper cervical chiropractic research at the university level across the globe, as there is in medicine. There is no army of PhD’s who have been educated in research methodology critically examining the various aspects of the field. Primarily, any progress that has been made has come from individuals working within their own practices over decades of time. The diversity of protocols in upper cervical work may simply illustrate the level of current maturity of the field. Tremendous gratitude should be rendered to those who have toiled in relative obscurity and who have laboriously developed the current protocols. We simply would not be here without them. This work of decades has been handed over to the current generation. We have much work to do if this work is to be passed on to subsequent generations.

Though the literature now contains ample information to validate the importance of the upper cervical spine to health, communicating this news to a general audience has largely failed. Publication has been difficult until the last decade or so. Aside from JMPT (The Journal of Physiological and Manipulative Therapeutics), we still have no peer reviewed, Medline indexed journal in chiropractic. Any publishing we do in our own journals is seen primarily by upper cervical doctors, and interested students.

This cloistered existence has led to the (decades long) evolution of a shared perspective among a fairly small community that cannot be easily transmitted to others outside of this shared body of knowledge. It has also led to a “self evident” sense of proof that also cannot be shared with others outside of the upper cervical community that have not shared the same experiences. Upper cervical chiropractic has essentially lost its voice in the chiropractic profession, which itself has a very small voice in the overall scheme of healthcare. It took several decades to develop the current protocols, which now provide a method to safely and consistently correct the upper cervical spine. We roughly estimate that upper cervical doctors constitute between 1 and 4 percent of the chiropractic profession and the number of organizations representing this voice presents a challenge to cohesive progress.

The aspirations of the upper cervical chiropractic profession remain essentially the same as they were in the 1940’s. A quote from the Council Bulletin-Official Organ of the Palmer Standardized Chiropractic Council in December of 1944 revealed much of the same frustration still felt today in the field. Dr. Roy Labachotte, in a personal letter to a colleague (and then republished in the Bulletin) wrote:

“We have been going along for years hoping against hope that something would happen which would bring Chiropractic to the front as it deserves. We have during this period watched, only to see that the enemies of Chiropractic have from within been tearing the very foundation out from under our science. We have worried ourselves sick about it but we have been unable to do ANYTHING about it.”

We remain the best-kept secret in healthcare. There are aspects of the work that cannot be changed without loss of the integrity of the work itself. These must be kept clear and inviolate. In our desire to hold onto our legacy, we may lose the flexibility required to move us forward.

The upper cervical approaches are truly a distinct form of chiropractic. As with any specialty, it is neither critical nor appropriate that the entire profession practice the same way we do, but it is critical that they understand how what we are doing is different. As a group, it is essential that we realize that to gain respect, we must give respect. Some of our historical positions have turned out to be self-defeating the most damaging of which has been that we are “right” and until proven to us differently, everyone else is “wrong”.

We have become truly a minority component of the chiropractic profession, and as such the burden of proof is ours. We need more than the post radiograph to convince the rest of the world. It is also critical to our survival that awareness of scientific methodology be propagated amongst the average upper cervical clinician. It is time to create an environment that encourages inquiry and evaluation.

Parallel Systems

A strictly hierarchical model of organization is the traditional form of coordinating a group of people engaged in a process. It is certainly present in the Darwinian natural selection process, and most business and political models. Biology itself has historically been modeled this way assigning ultimate “control” of the organism to some discrete area within the brain. At one point in history the pineal gland was assigned this ultimate role but newer models, unable to find any physical location, began to talk about the “ghost in the machine”. The supposition is that without some ultimate authority (and controller), only chaos can result. Deeper study of biological and other complex systems has clearly shown that stability arises out of “chaos” although it is not the same kind of stability that arises out of equilibrium. Two children on opposite ends of a teeter-totter may “balance” out in a stable equilibrium that leaves the teeter-totter level and unmoving. The balance that occurs at equilibrium is static. The kind of stability that occurs in living systems is however, of a very different kind.

Ilya Prigogine, a Nobel laureate (Chemistry, 1977) for his work with complex systems, wrote in Modern Thermodynamics: from heat engines to dissipative structures (Wiley, 1998, p. 409):

“In nature, far from equilibrium, systems are ubiquitous. The earth as a whole is an open system subject to the constant flow of energy from the sun. This influx of energy provides the driving force for the maintenance of life and is ultimately responsible for maintaining an atmosphere out of thermodynamic equilibrium…every living cell lives through the flow of matter and energy.

“…far-from-equilibrium states can lose their stability and evolve to one of the many states available to the system…these new states can be highly organized states. In this realm of instability and evolution to new organized structures, very small factors, often beyond laboratory control, begin to decide the fate of a system. As for the certainty of Newtonian and Laplacian planetary motion and the uniqueness of equilibrium states, both begin to fade; we see instead a probabilistic Nature that generates new organized structures, a Nature that can create life itself.”

The parallel here with the subluxated state is cogent, but is a subject for another paper. For living systems, stasis (or equilibrium) is death. Life is dynamic and always moving. In a social organization, stasis, or the attempt to concretize process into some “final” rigid form causes a loss of vitality. It results in a lack of innovation and evolution. Socially, a great deal of energy must be expended to “hold” the form in place. The underlying assumption is that the work is in a “final” form and must be formalized in order to prevent loss of the foundation. While it is obviously true that one should not “throw the baby out with the bath water”, it is also true that this “baby” is not yet mature. If it were possible, stopping the growth of our “baby” might ensure preservation of its life, but it also prevents the untold possibilities that maturation into adult form holds. Indeed, the locking up of one area of the spine is defined by chiropractors as a deleterious circumstance that is at least a fixation if not a subluxation.

It is fear of chaos and loss of meaning that is at the heart of the urge to control and limit change. A hierarchical system that maintains control in an elite and centralized way ultimately alienates the majority who find themselves without a voice and unable to be a part of the process. Some form of organization is however, necessary to coordinate activities and assist in the evolution of a process. An interesting possibility for innovative organization leading to enhancement of the goals of the group has surfaced in the design of computer software. We would like to discuss the solution as a possibility for future innovation in our work.

Eric Raymond wrote about this development in a seminal paper entitled “The Cathedral and the Bazaar”, which can be found at http://www.catb.org/~esr/writings/cathedral-bazaar/cathedral-bazaar/. This paper compares two different methods of organizing the development of software. Raymond describes the hierarchical model as a “cathedral”, in which complex undertakings needed to be “built like cathedrals, carefully crafted by individual wizards or small bands of mages working in splendid isolation, with no beta to be released before its time”. (p. 2.) He notes that his prior assumption had been that “there was a certain critical complexity above which a more centralized, a priori approach was required”. (p.2)

Raymond then introduces another model based on a parallel systems approach. He terms it “the bazaar model”. In a bazaar, there are many people interacting together with many different “agendas and approaches”. It would seem that such uncontrolled diversity would lead to little more than chaos. On the contrary, open source software development has now led to several successful outcomes. One of Raymond’s main examples is the Linux kernel (an open source software operating system)

Linus Torvald was the originator of the Linux kernel. Instead of trying to build a proprietary system in the usual “cathedral” style, Torvald put all of his source code on the Internet for everyone to see. By approaching development in this way, “the Linux community seemed to resemble a great babbling bazaar of differing agendas and approaches”. “The fact that this bazaar style seemed to work, and work well, came as a distinct shock”. The development process “seemed to go from strength to strength at a speed barely imaginable to cathedral builders.” (p.3)

We are a community of upper cervical chiropractors. The protocols we use and the science and philosophy behind them are the glue that binds us together. It is in our common interest to develop greater understanding of all phases of our work to make it easier to learn and perform as well as becoming more effective in optimizing our patients’ health. To this end, a closer examination of a parallel systems approach may be helpful. Raymond made a number of points in his paper, many of which seem important to our theme.

Raymond took the lessons he learned with Linux and applied them to a project of his own. He also put his source code onto the Internet so it could be examined by anyone with an interest. He notes: “Given a bit of encouragement, your users will diagnose problems, suggest fixes, and help improve the code far more quickly than you could unaided.

The reason it is so important to have many people involved is Raymond’s next major point: “Given enough eyeballs, all bugs are shallow.” I dub this “Linus’s Law”.

In Linus’s Law, I think lies the core difference underlying the cathedral-builder and bazaar styles. In the cathedral-builder view of programming, bugs and development problems are tricky, insidious, deep phenomena. It takes months of scrutiny by a dedicated few to develop confidence that you’ve winkled them all out. Thus the long release intervals, and the inevitable disappointment when long-awaited releases are not perfect.

In the bazaar view, on the other hand, you assume that bugs are generally shallow phenomena -or, at least, that they turn shallow pretty quickly when exposed to a thousand eager co-developers pounding on every single new release. Accordingly you release often in order to get more corrections, and as a beneficial side effect you have less to lose it an occasional botch gets out the door.

Raymond introduces a phenomenon identified in sociology as the “Delphi Effect” to explain the idea that “Given enough eyeballs, all bugs are shallow”. The concept is that given a population of observers, the averaged opinion of these observers is much more reliable than that of any single (randomly chosen) observer within the population. Raymond’s article contains much more cogent information much of which may relate to our topic but this is enough to make the main point.

So how does this relate to upper cervical chiropractic? We acknowledge that since the 1930’s, several different concepts regarding upper cervical work have come forward. Maintaining the metaphoric parallels, the operating system kernel, (the orthogonal Grostic based approach) was developed in the traditional Cathedral style of inquiry. In the intervening decades, many eyes have looked at it and there are now several variations of practice based on divergent perspectives. The science has always been empirical. Different investigators have taken their empirical data in different directions. But within the orthogonal approaches, the protocols are more similar than different.

This generation of upper cervical doctors finds itself in a dilemma. The clinical results of the work point to possibilities that could profoundly improve delivery of healthcare in the world. At the same time, the publication of the specific components of the work in peer reviewed, indexed journals have not been done so that the scientific community at large continues to be unaware of our existence. In addition, the work is full of unexamined assumptions and unproven assertions. Having made this distressing statement, it seems only reasonable to acknowledge that orthogonally based upper cervical chiropractic has done as much or more to validate itself through investigation as any other work in chiropractic. Dr. Eriksen’s new text (Upper Cervical Subluxation Complex: a review of the chiropractic and medical literature. Lippincott Williams & Wilkins, 2004) makes this point in an extremely thorough fashion.

As valid and important as it is for individuals to improve their accuracy in the various protocols, it is even more important to begin to examine our assumptions and prove our assertions. Even extreme accuracy in the application of (at best) incomplete protocols still results in real limitations for the potential improvement of patient care delivery.

The current NUCCA assertion seems to be that extremely consistent accuracy is required to deliver adequate patient care. Today we find a NUCCA culture that essentially assigns a verdict of incompetence at every level to those who have not become part three certified. The fear is that the incompetence of the uncertified doctors leads to potential changes that are the result of incomplete understanding, wrong thinking, or attempts to make a process easier. All of this is thought to arise because the disciplined rigor necessary to master the particular aspect in question has not been undertaken, leading to poor or incomplete results. This is undoubtedly true at times.

Those doctors who have been in practice for a while have all received films and adjustments from multiple other doctors. Questionable films and poor adjustments are not the territory of the uncertified alone. No one has ever said that certified doctors are perfect but only that the whole certification process is an attempt to minimize this possibility. As noted above, we applaud this process and encourage everyone to participate. At the same time, it should be noted that, “The Emperor wears no clothes”. We are all doing the best we can with what we have, but no one is perfect.

We posit that the winnowing process that results in the actual formation of an upper cervical doctor is rigorous enough to guarantee a caliber of practitioner that is unusual in the general population. A parallel systems structure for ongoing inquiry into the diverse aspects of the work can offer hundreds of sets of eyes to the process; -eyes that are connected to years of study and practice. If one hundred people with ten years experience look at a topic, they form a collective pool of a thousand years of expertise. Within those thousand years of experience, someone among those one hundred is very likely to be able to make a cogent suggestion, ferret out an error, or come up with a possible solution. We are not suggesting some chaotic version of anarchy. Torvalds had a core group (perhaps analogous to the NUCCRA Board) that analyzed the plethora of comments and suggestions and using their own expertise, were able to find the solutions to problems that had been untenable in the past.

The Road Ahead

How did we come to our protocols? Where are our assumptions? What are we ignoring? What do we still need to know? What have we forgotten? This paper is offered as a beginning step toward opening up this conversation to our whole community. We can together, create an open forum for individual effort to be supported, critiqued, argued over, celebrated, modified and enhanced.

In order to successfully do this, we all have some learning and some “unlearning” to do. There is nothing quite so polar as “right” and “wrong”. This judgment leaves no room for maneuverability. It leaves no room for modification of your position. Real science does not make polarized stands without massive and long term overwhelming data in favor of a proposition. Even so, concepts like Newtonian physics that remained “bedrock” for hundreds of years have been greatly modified by new findings. Areas like relativity, quantum mechanics, and string theory have greatly enlarged our basic conception of the universe and changed our sense of what is possible.

In any scientific endeavor, the goal is to move toward progressive clarification of understanding regarding our observations. This is accomplished by observation, development of a hypothesis, implementation of an experiment designed to test the hypothesis, and evaluation of results. Proof and what constitutes “proof” is harder to come by. In fact, scientific methodology can ultimately falsify a proposition but it cannot ultimately make the case for the absolute truth of the hypothesis. Evaluation leads to three possibilities: equivocal results requiring further (and possible modification of) the experiment, falsification of the hypothesis by experimentally disproving it, or statement of apparent support of the hypothesis, possibly within certain constraints. The conclusion may also ask more questions which arise out of the experimental results. It is also important for others to duplicate the experiment to validate the results. Within our own work, each practitioner should be able to revalidate the results for themselves in their own experience.

The premature attempt to concretize the upper cervical protocols actually has an ultimately anti-scientific effect. This formalization of the protocols has not taken place for strictly scientific reasons, but also for important social ones. The teaching of the protocols requires some uniformity of action so that a core of shared knowledge can be created and so that the teachers have a depth of common experience to help the student master the task at hand. At the same time, the rote repetition of the task begins with the assumption that this answer is the “best fit” for the accumulated data. Any inquiry is directed only at doing the task as defined in an optimum manner. Again, this is very appropriate for those beginners who are engaged in learning the common body of knowledge. From the wider perspective, it is always necessary to examine our assumptions.

Chiropractic has a scientific aspect, but like all healthcare systems, it also has aspects, which fall under the categories of art and philosophy. Our own interactions as a group of practitioners are not a strictly scientific endeavor as our relations with patients in our practices hinge as much on art and philosophy as they do the scientific. To reiterate our position, we believe that these protocols so far appear to constitute the best way yet found to help our population of adjustors deliver safe and effective care to their patients. The danger lies in our unexamined assumptions and assertions.

The scientific method constitutes a way to logically and systematically understand the material world. The upper cervical procedures are a systematic method for adjusting people. The two concepts are related but not identical. It is certainly logical that the extent of our scientific inquiry would extend past the current protocols used in adjusting people. The official protocols will always lag behind the cutting edge. It is important to realize that the beauty of the current protocols is that they are an unbroken chain of procedures that together, allow effective care while minimizing any potential harm. Creating a way to move forward while maintaining the integrity of the work and ensuring patient safety is imperative. We are still struggling, fourteen years after Dr. Gregory’s death, to find a systematic way to do this.

So What Does it Look Like?

Upper cervical chiropractic has not yet made an incontrovertible case in the accepted scientific literature for its proposition that correction of the upper cervical subluxation complex is a major factor in restoration of health. We cannot expect others to uncritically accept the presently (meager) published data (in the indexed journals) as adequate proof necessary to sweep aside the current segmentally based chiropractic paradigm.
There are many in upper cervical work that much prefer to focus solely on improving accuracy and consistency in their own practice of the upper cervical protocols. This is laudable and even necessary in every upper cervical practice, but it is not enough to sustain the profession. The shifting healthcare environment can no longer be ignored if upper cervical work is to be kept alive in coming generations. We would like our children and their children to be able to receive an orthogonally based upper cervical adjustment.

NUCCA and upper cervical chiropractic in general faces challenges on many fronts. We do not pretend to understand all of the challenges we face nor do we have the definitive answers to them. This paper was designed for a different task. Instead, we make an offer to the reader. Upper cervical doctors are usually of definite opinions. We are asking you to look at your experience and relate your understanding of our current standing. We believe that the solutions are within our grasp, especially if we grasp loosely to what we think we know while stretching our sense of what is possible.

This paper will be disseminated as widely as possible so we can test the idea of developing a parallel system of upper cervical doctors. The paper is meant to serve as an open door not as an exhaustive list of current issues and/or problems. Our request of you as a committed member of our community is to seize this opportunity to respond to these topics and/or whatever you believe to be of critical importance to upper cervical chiropractic. We have written this paper as two NUCCA doctors. Some of these issues apply only to the NUCCA organization. Others are of wider practicality. We intend to distribute this paper beyond the NUCCA membership because we believe Linus Torvald was correct: “Given enough eyeballs, all bugs are shallow.”

Our intent is to gather all of your responses and publish them along with this paper in a special edition of The Monograph. These various responses will hopefully engender an ongoing cumulative process of organized but dynamic dialogue within our community providing an additional use for The Monograph. By its nature, we will likely find several different issues that are of interest to different segments of our population. Like minds can find each other and dialogue can greatly accelerate the learning process. The form this takes will depend on the issues that are developed by your responses.

Some Implications Regarding Tensegrity and the Upper Cervical Adjustment

(this paper was originally published in The Upper Cervical Monograph, May 2001)

Commentary:

Some Implications Regarding Tensegrity and
the Upper Cervical Adjustment
Michael D. Thomas

Origin of chiropractic embedded in the concept of tone and renitency.

D.D. Palmer conceived of the dynamics within a human organism as an interplay of two forces. He termed the two opposing forces “tone” and “renitency”. He believed that this tone or tension was opposed (and balanced) by resistance to tension or renitency. Abnormal increase in tone created localized areas of increased tissue temperature. These areas of increased heat could be palpated by the fingers. This soon led to the “following” (by palpation) of the hyperthermic tissue back to the spine. This localized hyperthermia became the initial diagnostic indicator for dys-function. Palmer hypothesized that abnormal alteration in structure (subluxation) created abnormal alteration in function (dis-ease). Correction of the abnormality in structure (the adjustment) allowed normalization of function to recur.

This train of thought requires the conviction that the self-organizing ability of the organism is adequate to maintain optimal health if interference to it’s function can be removed. This is very different from trying to “control” the altered physiology through “therapeutic” means. Attempting to “drive” the organism (even in a minor way) is very different from “removal of interference”.

The empirical nature of orthogonal upper cervical work.

Upper cervical chiropractic began as an empirical exercise. In the Grostic model, it has long been recognized that orthogonal arrangement of the upper cervical alignment is critical to overall biomechanical stability and optimization of function. It is apparent to many of us that correction of the atlas subluxation complex is the “specific” that chiropractic has sought.

The Grostic work was an extrapolation of this idea, forged into a practical protocol. Once the measurement system allowed more accurate analysis, (using measurement of the angular rotation of the structures in relation to each other, rather than linear measurement) it was understood that it would be necessary to work out a systematic protocol that could optimize maximal, proportional correction of each individual misalignment pattern. This process was largely empirical. There is an apocryphal story that at the very beginning, each misalignment was addressed as a H2A2 on the side of laterality. This is how empirical reasoning begins. Do something, see what happens. Change what you do, see how that changes the result. Soon, in the Grostic work, the four elements were identified for the misalignment pattern in the frontal plane. The proper algorithms to address the rotational patterns of the upper cervical spine in the transverse plane, were also soon investigated.

Much later, (in the NUCCA work) Gregory began to formulate a biomechanics of the upper cervical spine based on lever systems that he hypothesized to be operational in the area of C0-C1-C2. This biomechanical analysis resulted in an ability to reason out an optimal vector to more fully maximize proportional correction and to trouble-shoot problems when the spine did not reduce as expected. This system of biomechanical analysis has, for the first time, allowed the teaching of a practical protocol to large numbers of students who are then able to reproduce the corrective results in their patients.

The impact of this protocol cannot be over-estimated. Earlier versions of upper cervical chiropractic were often unable to be taught to large numbers of students because the variables were simply not yet understood in the depth necessary to allow consistent correction of complex subluxation patterns. Without firm grounding in an objective biomechanics, few individuals had the intuitive or intellectual abilities to codify the manifold complexities of the many variations of subluxation patterns and consistently correct them.

It will not be the attempt of this paper to overturn or even to question the value of this rational approach to the upper cervical spine. Indeed, I am grateful many times each day for the ability to adjust my patients from this perspective and to marvel at the results in their lives. Removal of the interference identified by this approach has amplified, and sometimes saved, the lives of millions of people over the last fifty years or so.

Newton’s understanding of physics revolutionized mankind’s ability to understand the physical forces of our world. In the last century, a new understanding of the quantum nature of the physical world has again revolutionized our perspective. However, we continue to use the equations of Newton in our various works because they are practical approximations that work very successfully at this level of magnitude. Attempting to use quantum mechanics to describe these same problems is possible and could result in correct answers, but the complexity of accounting for each quanta at this level of magnitude is virtually untenable even using the largest computers yet imagined. At the same time, this new perspective has revealed an understanding of reality that has fundamentally altered the way we look at our world. Our sense of possibility has quite literally taken a “quantum-leap”!

It is the hope of this author that an examination of some concepts which are currently surfacing in various investigations around the world may be of use to the evolution of upper cervical chiropractic in the future.

Tensegrity

“Tensegrity” was coined from the words “tensional integrity” by Buckminster Fuller to denote a structure that retains its integrity under tension. The concept was first formulated by Kenneth Snelson, an American sculptor and one-time student of Fuller. Tension may also be considered as “pulling”, and compression as “pushing”. This concept has obvious parallels with tone and renitency. A structure that uses tension as well as compression to support itself may be considered to use the property of tensegrity. This structural property can be seen throughout the physical universe, from atoms to galaxies, from snowflakes and radiolaria to human beings.

Traditionally, human-made structures have relied on the compressive forces of gravity. Indeed, if your home were suddenly removed to the vacuum of space, it would break apart because it relies on the compression of mass following the force of gravity to maintain its stability. Organic forms are mobile. If they relied only on compressive forces to maintain their stability, they could never shift their orientation with respect to gravity. If they did, they would completely lose their stability. Instead, organisms rely upon both tension and compression to maintain stability.

Until very recently, all mathematical models describing the spine have been based upon axial-loaded compression based mechanics. However these models all break down when the spine is observed to move away from the vertical axis. The same compressive forces that maintain stability in the vertical position will cause the spine to be, as Levin noted:

“…pulled apart…if tilted out of plumb. The mechanical laws of leverage that operate in the compressional system would create forces that far outstrip any strength of biologic materials. We could not use such a system to walk on our two legs, crawl on all fours, walk on our hands or stand on our heads without the addition of tensional forces to hold us together. Such a system is only as strong as its weakest link. The laws of leverage act differently when applied within the tensegrity system so that forces generated are dissipated and may actually strengthen the structure much as prestressed concrete or a wire under tension. External forces applied to the system are dissipated throughout it so that the “weak link” is protected. The forces generated at heelstrike as a 200 pound linebacker runs down the field, for example, could not be absorbed solely by the os calcis but have to be distributed-shock absorber-like- throughout the body.”(1)

The components of tensegrity structures are all “pre-stressed”. As tension increases and is distributed throughout, the structure is balanced by an equal increase in compression. Stability is maintained through what Fuller called “continuous tension and local compression”.

Ingber notes:
“Tensional forces naturally transmit themselves over the shortest distance between two points, so the members of a tensegrity structure are precisely positioned to best withstand stress.”(2)

This may recall Wolff’s Law to the reader’s mind. It has long been known that bones change shape according to the forces placed upon them. The very trabecular patterns forming the matrix of the bone structure shift over time, in response to alteration in load bearing as it is applied to the bone. It is now beginning to appear that this property is present in all the tissues of the organism.

Of at least equal importance, Ingber also relates that :

“ …tensegrity structures function as coupled harmonic oscillators. DNA, nuclei, cytoskeletal filaments, membrane ion channels and entire living cells exhibit characteristic resonant frequencies of vibration. Very simply, transmission of tension through a tensegrity array provides a means to distribute forces to all interconnected elements and, at the same time, to couple, or “tune,” the whole system mechanically as one.”(3)

Levin presented a couple of examples of tensegrity at work in the human structure.

“The entire support system of the upper extremity is a tension system being supported by the musculature interweaving the spine, thorax and upper extremity into a tension support system. The scapula does not press on the thorax. The clavicle has been traditionally recognized as acting more as a compression strut, as it would in a tensegrity model.”

And,

“The anatomist Grant, in his classic book, “Methods of Anatomy” describes the sacroiliac joint, the major supporting joint between the pelvis and spine and its superimposed structures. He states that the sacrum behaves not as a keystone but as the reverse of a keystone, and tends, therefore to sink for-ward into the pelvis. The spine and its superimposed structures are, of course, supported by the massive ligaments so that the sacrum-and all that is above it- is “slung” in the pelvis and not dependant on axial-compressive support.” (4)

In another paper, Levin goes into much more detail regarding the biomechanics of the shoulder girdle. In the abstract to this paper, he explains:

“The least successfully modeled joint complex has been the shoulder. In multi-segmental shoulder models rigid beams (the bones) act as a series of columns or levers to transmit forces or loads to the axial skeleton. Forces passing through the almost frictionless joints must, somehow, always be directed perfectly perpendicular to the joints as only loads directed at right angles to the surfaces could transfer across frictionless joints. Loads transmitted to the axial skeleton would have to pass through the moving ribs or the weak jointed clavicle and then through the ribs. A new model of the shoulder girdle, based on the tension icosahedron described by Buckminster Fuller, is proposed that permits the compression loads passing through the arm and shoulder to be transferred to the axial skeleton through its soft tissues. In this model the scapula “floats” in the tension network of shoulder girdle muscles just as the hub of the wire wheel is suspended in its tension network of spokes. With this construct inefficient beams and levers are eliminated. A more energy efficient, load distributing, integrated, hierarchical system is created.”(5)

Conceiving of the shoulder as a tensegrity structure helps to explain why compressive loads from the arm can be transferred from the scapula to the spine without any rigid, compressive load bearing structure which links the scapula and the axial skeleton together. Without this connection, there is also no adequate fulcrum.

Levin further explains:
“In a linked system a seamless continuum of compression elements are necessary. Bone must compress bone. The almost frictionless joints would require forces to be always directed at right angles to the joint. The scapula is not anatomically situated to transfer loads through the ribs to the spine. Even if it were, the ribs could not take those loads and act as levers to connect to the spine.

The ribs themselves, by shape, position and connection, are not structurally capable of transferring these loads. The clavicle is in no shape to transfer loads either. It is a crank shaped beam that connects the scapula to the sternum by a small, mobile joint that could not transfer compressive loads of any significant magnitude.”(6)

The description of the shoulder girdle as a tensegrity structure may sound somewhat familiar to the student of the NUCCA work. Although not defined as such, the adjustment was understood by Gregory as much more than merely an “arm” delivered adjustment. The procedure for the delivery of the adjustment requires proper alignment of the adjustor’s entire body. The magnitude and direction of the adjustic force is determined by the proper alignment of forces within the adjustor’s body. The concept of the “closed kinetic chain” effect (as described by Gregory) in the delivery of the adjustive force is certainly paralleled by the property of tensegrity.

It has been shown by several investigators that ligaments are under continuous tension even in a neutral position. The ligamentum flavum, anterior longitudinal ligament and the posterior longitudinal ligament all have been observed to maintain a baseline tone even when the spine is in a neutral position. (7a,b,c)

Clearly, the soft tissue elements are capable of continuously transmitting forces throughout the entire framework of the body. “Linking” of the tensegrity structures (through loading of the patient’s upper cervical joint complex by proper positioning of the adjustor’s body) between the pisiform of the adjustor and the atlas transverse process of the patient, allows distributive transfer of the tension present in the adjustor’s body down a specific vector (specifically defined through the adjustic stance). This force distributively affects the tensegrity structure of the patient. Ideally, it will do so in just the proper way to restore biomechanical integrity.

As Ingber states:

“…the 206 bones that constitute our skeleton are pulled up against the force of gravity and stabilized in a vertical form by the pull of tensile muscles, tendons and ligaments…In other words, in the complex tensegrity structure inside every one of us, bones are the compression struts, and muscles, tendons, and ligaments are the tension bearing members” (8)

If examining the NUCCA work in the light of the property of tensegrity leads to a wider view, the resulting new perspective can potentially improve biomechanical understanding of the upper cervical subluxation complex. At the same time, it is clear that the Newtonian formulation of the involved dynamics have been extremely successful.

The cell as a tensegrity structure

Not so long ago, the cell was “seen” as a “bag of concentrated solution of enzymes and metabolites mixed up at random, save for a few organelles and intracellular membranes.” (9) Much of this view came from the methods used to investigate the cellular components. The standard procedure of the time was to homogenate or grind up the various components of the cell and then separate the different “fractions” according to size or density. If a specific “fraction” was being investigated, the other “fractions” were removed. The resulting “pure” fraction was then dissolved in deionized water to which ultrapure substrates were added. A long process to “characterize” the enzyme activity then began. All of this, as Ho points out, serves to reinforce the notion of the cell being nothing more than a bag of enzymes and metabolites dissolved in solution.(10)

Ho brings us up to date:

“As electron microscopy and other specific staining techniques became available, it gradually dawned on us that the cell is highly structured. Nowadays, the generally accepted picture of a cell is quite sophisticated. It is bound by the cell membrane – a double layer of lipids, which is supported by and attached to the membrane skeleton composed of a basketwork of contractile filamentous proteins lying immediately underneath it. The membrane skeleton in turn connects with the three-dimensional network of various fibrous proteins collectively known as the “cytoskeleton”, which links up the inside of the cell like a system of telegraph wires terminating onto the membrane of the nucleus. In the nucleus, the chromosomes (organized complexes of DNA and proteins) are anchored directly to the inside of the nuclear membrane. The nuclear membrane and the cell membrane are also in communication via concentric stacks of membranous vesicles, the Golgi apparatus- with special secretory functions, and the endoplasmic reticulum – a system of three-dimensional canals and spaces believed to be involved in intracellular transport and occupying a large proportion of the cell volume. A substantial volume is also taken up by organelles such as the mitochondria, where simple carbohydrates are oxidized to CO2 and H20 with the generation of ATP, and ribosomes on which polypeptide chains are synthesized. Finally, what is left over is the cytosol (or ‘soluble’ cytoplasm).”(11)

In addition, it is now believed by many that most of the water found in the cell is bound (or structured) on the manifold surfaces within the cell. (12) This “bag of solution chemistry” is now being recognized as a solid state system. The implications of viewing the cell and by fractal reasoning, the organism, as a solid state system are most profound, though beyond the scope of this paper.

Ingber reports on the current understanding of the cytoskeleton (CSK):

“It is now accepted that the CSK of eukaryotic cells exists as a complex interweaving meshwork of three major classes of filamentous biopolymers… Most biologists agree that actomyosin interactions within contractile [microfilaments] generate CSK tension and that all three filament systems provide some structural function. However there is no model of CSK organization that can explain how these filament systems associate and integrate so as to form a continuous “solid” network that can change shape and move.”(13)

Ingber posits that tensegrity offers a globally integrated architectural model that explains the coordination between the “part and the whole that is so characteristic of the CSK”.(14) Cells spread and are motile, they undergo transformations in size, shape and function. Organismic function requires fluid and coordinated movement at every level, from tissue to cell to molecule. Again, quoting Ingber:

“If cells do use tensegrity, then we will need to change our frame of reference in studies on CSK remodeling and cell shape to include the concept of a pre-stressed CSK. In other words, we need to transform our image of cell architecture from a rigid static view that is largely based on local molecular binding events into one that is mechanically based, globally integrated and dynamic. Inherent in this form of architecture is a mechanism for mechanical information transfer…integration between all parts, both large and small…that is based entirely on provision of tensional continuity. Thus a central tenet of tensegrity is that every structural element with the system is poised to sense and immediately respond to physical stimuli from both inside and outside the cell. It is difficult to think of another type of building system that could explain how stretching a tissue such as skin, results in extension of the ECM [extracellular matrix], cell, CSK and nucleus in a coordinated manner without producing any structural breakage or disconnection….”(15)

Beyond explaining global integration of movement both intra and inter-cellularly, Ingber has hypothesized how tensegrity can also model coordinated information transfer:

“Tensegrity provides a mechanism to mechanically and harmonically couple interconnected structures at different size scales and in different locations throughout living cells and tissues…Thus cell and tissue tone may be tuned by altering the prestress of the system. This may be accomplished by altering the architecture of the system or the level of CSK tension…In either case, increasing the stiffness of the network will alter vibration frequencies and associated molecular mechanics of all the constituent support element. This may, in part, explain how the part (molecule, cell) and whole (e.g., cell, tissue, organ, organism) can function as a single mechanically integrated system…

This tuning mechanism also may play an important role in mechanical signal amplification, as well as in the adaptation responses that are necessary to tune out certain signals…Any one of these changes may feed back to tune the mechanotransduction response, as seen in studies with intact cells…

On a larger scale, alterations in CSK stiffness or in the number of load-bearing elements in the system will change how stress dissipates in the network before it reaches the molecular transducer. A cell that is very stiff may be able to sense lower levels of stress more quickly than a more flexible cell. Conversely, the more flexible cell may be able to sense larger strains. This adaptability may contribute to the different sensitivities exhibited by specialized mechanosensory cells; for example, the stiff hair cells of the inner ear sense small vibrations, whereas more flexible spindle cells of muscle recognize changes in length (stretch). A similar mechanism may explain why osteocytes, which contain highly extended (and hence stiffened) processes, preferentially respond to high frequency and low amplitude strains…

Finally, because the ECM physically interconnects with the CSK, its mechanical properties may also contribute significantly to the mechanotransduction response. If the ECM is highly flexible, then a rapid deformation may be sensed, whereas a sustained stress will dissipate before it reaches the cell…The resistance imposed by the relatively inflexible ECM induces global rearrangements in the CSK through a tensegrity mechanism, as measured by a linear stiffening response…These changes in CSK mechanics, in turn, may serve to simultaneously modulate multiple signaling mechanisms.”(16)

D.D. Palmer seems to have gotten it right. Structure does affect function. An interesting example can be found in a study by Wirtz and Dobbs who examined the effects of mechanical distension on alveolar type II cells. They found that a single stretch on one cell resulted in “a transient (less than 60 seconds) increase in cytosolic Ca(2+) followed by a sustained (15 to 30 minutes) stimulation of surfactant secretion.”(17) As the entire frame of an individual distorts secondary to the ASC, there is effect on every tissue and cell. There is increasing evidence that genetic expression too, is altered by changes in the mechanical forces acting on the cell. The effects of the ASC resonate deeply and on many different levels.

The organism as a tensegrity structure

An important property of tensegrity is that it does not vary with respect to macro-level. The property seems to be engaged at the atomic level, the galactic level and all the levels in between. Another way to say this is that tensegrity has a fractal quality. And so, the human organism can be understood as a tensegrity structure. This fractal quality which is present at the level of the atom, the molecule, the cell, the tissue, the organ and the organism, ultimately creates a surprising level of coupled harmonic coherence throughout the organism. When an arm moves, for example, the entire arm moves simultaneously with incredible coordination. Muscle activity is remarkably coordinated and coherent. Studies have shown that muscle contraction occurs in distinct synchronous quantal steps over entire muscle fibers.(18)

The implications for distribution of mechanical force have been briefly touched upon. Other implications regarding energy flow, coherence, and resonant transfer of information must be dealt with elsewhere.

It would appear that Gregory intuitively understood the property of tensegrity before it was formally identified, considering his systematic inclusion of the critical dynamics that are operational throughout the adjustor’s entire body in the delivery of the adjustment. The concept is also present in his discussion of the adjustic force, which he described as utilizing a “closed kinetic chain effect” to conduct the work of the adjustment. It was Gregory that really fleshed out the distributive effects of the ASC throughout the entire structure. With the help of the Anatometer, Gregory and Seemann were able to measure how the misalignment in the upper cervical spine correlates directly with compensation and adaptation throughout the system. Our description of the measurable aspects of the ASC on the body: functional short leg, unleveling and transverse rotation of the pelvis, coupled movement of the axial skeleton away from the vertical axis, twisting and moving into one of the frontal planes, is exactly the distribution of stress which is being described in the tensegrity structure.

The rational biomechanical reasoning which has followed the extensive empirical investigations has made the practical delivery of the adjustment possible, even in complex cases where the “numbers” alone are not adequate to maximally and proportionately reduce the ASC. There are many cases that defy simple first or second class lever explanations, as anyone who sits in on Dr. Denton’s lectures must see. He often discusses the “splitting” of the adjustic force in out-of-pattern misalignments and type fours. This is why the term “greatest resistance” is often used. There are innumerable potential “resistances” in every aspect of the system. The identified lever arms, and fulcrums represent practical approximations of the distributive and continuous tension and discontinuous compression inherent in the system. It is a very beautiful and useful abstraction of an unimaginable complexity.

It is this author’s hope that these ideas may lead to further understanding of the biomechanics underlying the physics of the adjustment as well as the biomechanics of the atlas subluxation complex.

References

1. Levin, Stephen M., “Continuous Tension, Discontinuous Compression: A Model of Biomechanical Support of the Body”. The Bulletin of Structural Integration. 8(1): Spring-Summer 1982.

2. Ingber, Donald E., “The Architecture of Life”. Scientific American January 1998.

3. Ibid., Ingber 1998.

4. Ibid., Levin 1982.

5. Levin, Stephen M., “Putting the Shoulder to the Wheel: A New Biomechanical Model for the Shoulder Girdle”. www.biotensegrity.com/shoulder.html

6. Ibid., Levin.

7a. Kazarian, L.E., “Creep Characteristics of the Human Spinal Column”. Orthop Clinics of North America, 6, Jan. 1975.
7b. Nachemson, A., Lumbar Intradiscal Pressure”. Acta Orthop. Scand., Suppl. 43, 1960.

7c. Tzaczuk, H., “Tensile Properties of the Human Lumbar Longitudinal Ligaments”. Acta Orthop. Scand. Suppl. 115, 1968.

8. Ibid., Ingber 1998.

9. Ho, Mae-Wan., “The Rainbow and the Worm: the physics of organisms”. World Scientific, Singapore. 1993 p.93.

10. Ibid., Ho 1993 p.94.

11. Ibid., Ho 1993 p.94.

12. Clegg, J.S., “Properties and Metabolism of the Aqueous Cytoplasm and Its Boundries”. Am J. Physiol. 246 (1984): R133-51.

13. Ingber, Donald E., “Cellular tensegrity: defining new rules of biological design that govern the cytoskeleton”, Journal of Cell Science 104, 613 (1993).

(Ingber also cites Yen, A. and Pardee, A.B., “Role of nuclear size in cell growth initiation”. Science 204 1315-1317. 1979; Nicolini, C., Belmont, A.S., Martelli, A., “Critical nuclear DNA size and distribution associated with S phase initiation”, Cell Biophys. 8. 103-117, 1986: and Ingber, D.E., Madri, J.A., Folkman, J., “Extracellular matrix regulates endothelial growth factor action through modulation of cell and nuclear expansion”. In Vitro Cell Dev. Biol. 23, 387-394, 1987.)

14. Ibid., Ingber 1993 p.613.

15. Ibid., Ingber, 1993 pp. 623-624.

16. Ingber, Donald E., “Tensegrity: the architectural basis of cellular mechanotransduction”. Ann. Rev. Physiol. 59, 593-595. 1997.

17. Wirtz, Hubert R.W., Dobbs, Leland G., “Calcium Mobilization and Exocytosis After One Mechanical Stretch of Lung Epithelial Cells.” Science 250 Nov 30, 1990 pp.1266-1269.

18. Iwazumi, T., “High Speed Ultrasensitive Instrumentation for Myofibril Mechanics Measurements”. American Journal of Physiology 252 (1987) 253-62.