This paper is reprinted from the November 2011 Quantum Spinal Mechanics Newsletter published by Dr. Russell Friedman.
Michael D. Thomas, D.C.
Note: Tensegrity is the way nature designs structures. In a tensegral array, the compressive elements are said to be discontinuous. This means they dont touch each other. Bones are compressive structures. The tensional elements in a tensegrity array are continuous. This means that the muscles and ligaments and the whole myofascial envelope is continuous and forces are dissipated evenly throughout the entire array. Dr. Friedman has discussed tensegrity at some length in the past but this is a short explanation. The reader is already aware of the historical definition for the Atlas Subluxation Complex.
Grostic and Wernsing contemporaneously and yet independently, according to the Orthospinology text, conceived of the possibility that the frontal plane rotation of the atlas under the skull, what we have called atlas side-slip, or atlas laterality, could be measured in degrees (a situation apparently analogous to Liebnitz and Newton who simultaneously but independently discovered the principles of calculus) . This idea was one significant aspect of Grostics basic elemental relationship between the condylar and axial circles (C/A).
Grostic believed that atlas laterality was the primary cause of neurological interference. Postural distortion is not measured in the absence of at least ¾ degree of atlas laterality. This confluence of events came to be seen in upper cervical work as cause and effect.
The area is dense with neurology and the dentate (pia) ligaments often attach at the craniovertebral junction. J.D. Grostic hypothesized a dentate ligament tractionization theory to explain the possible effects of upper cervical (atlas) misalignment. It appears that even a small amount of atlas laterality is associated with changes in blood flow into and out of the head as well as associated tractional or torsional changes. It is established that mechanical forces alter function at the cellular level as well as in the nuclei of the upper cord and brainstem.
Current studies in the chiropractic profession as well as medicine are examining the role of upper cervical misalignment and alteration in blood flow (compliance) into and out of the head. CSF flow may also be altered. Restoration of alignment appears to greatly improve compliance. Misalignment is asymmetrical by its nature and therefore affects blood flow differently on each side.
The concept of tensegrity as promulgated by Levin and Ingber (as well as many others) was seen as debatable until fairly recently. It seems now however, that the literature has been able to define the cell as a tensegral structure, although looking at the whole body biomechanically as a tensegral array remains a bit controversial. Work has been done to define the pathways used in the array (Thomas Myers- Anatomy Trains).
Our perspective as orthogonally based upper cervical doctors predisposes us to see relationships that are not apparent to others who do not consistently look at the aspects we focus on. The concept of tensegrity has been empirically accepted by Dr. Friedman who has expanded the concept of bone out of place, segmental misalignments, and other partial examinations of the soft tissue/skeletal system to include the whole organism. His biomechanical conceptualization regarding the principle of tensegrity in the upper cervical area as well as the rest of the body has begun to make the longstanding understanding that the upper cervical adjustment is a full spine approach an integrated reality.
In a tensegral array there are no actual lever systems because there are no fulcrums. When in proper apposition, the skeletal elements do not touch each other. A lever arm must have a fulcrum with which to do its work. It is the tensional elements (the muscles, ligaments and tendons and the whole myofascial envelope that are under continuous tension. The skeletal (compressive) elements are discontinuous (separate) in the system. When a tensegral array comes under axial tension, the compressive elements (the bones) line up with the tensional elements, stiffening the whole system in order to resist these deleterious torsional forces.
Bones do not lock out of place. They dont even touch each other unless there is local collapse of the tensegral array. The tensional elements may, under deleterious forces, buckle or compress. When this occurs in the low back, there is progressive degeneration of the spinal elements as they attempt to adapt to deleterious forces. When this occurs at the craniovertebral junction it appears to cause a change in the symmetry of the paraspinal musculature with resulting reset of the individual elements. This includes the position of the atlas.
We have long realized in orthogonally based upper cervical chiropractic that although the pelvis is the greatest mass in the kinetic chain of the spine, it is not necessary to address its misalignment by directly adjusting the pelvis. We have long found that upper cervical adjustments can affect the whole system and restore alignment to ALL of the spinal elements (with respect to gravity) because the tensegral array that we ˜are is neurologically modulated. A small amount of misalignment in this area is magnified due to its neurologically central location.
Embryologically, the nervous system arises out of the neural tube. The anterior aspect goes on to form the brain. The caudal aspect becomes the spinal cord and connects to the rest of the body. The craniovertebral junction is the origin. The nervous system begins right where we go to adjust.
Ghysen commented on the three dimensional nature of the nervous system:
The central nervous system of all triploblasts is essentially a three-dimensional structure derived from a two-dimensional epithelium. It is built along three axes, antero-posterior, dorso-ventral, and apico-basal. Development along each axis relies on its own development mechanisms, and generates its own range of cell specificities. The central nervous system is, therefore, basically an orthogonal structure.(my emphasis).
[p. 556. Ghysen A. The origin and evolution of the nervous system. Int. J. Dev. Biol. 47:555-562 (2003).]
[Note: triploblasts are bilaterally symmetrical animals with three germ layers.]
So if bones do not lock out of place, what causes the atlas laterality and rotation that we can consistently measure on x-rays?
In the tensegral model the spinal elements (bones) are passive, they are utilized to maintain shape, but it is the soft tissue elements that are active. Force is distributed throughout the whole system as evenly and as immediately as possible. If the neurology has become imbalanced causing the tensegral array to have to deal with asymmetric non-anatomical forces, the whole body distorts. When the center of mass in the pelvis moves away from the gravity line, the body immediately adapts, usually by leaning back toward the gravity line. The atlas, in its function as a coupling between the head and the C2-pelvis kinetic chain will move to equilibrate the forces of the kinetic chain and the head. This is an effect not a cause. (Small mass doesnt rule big mass in terms of mechanics). Again, measurement of ¾ of a degree or more of atlas laterality is certainly coincident with postural distortion.
Dr. Friedman is now showing, in an ever growing number of successive cases, that the misalignment we have recognized for the last 70 years is comprised not just of the upper and lower angles and rotation of C1 and 2, but also of a compressive component existing throughout the entire tensegral array that can impede and sometimes preclude correction of the linear elements. If compression remains in the spine, the attempt to restore the skeletal elements to the vertical axis will only jam the structures into line. This may and does reduce the neurological component regarding blood flow to the head as well as diminution of the tensional forces affecting the upper cervical spine and brainstem but the entire array can remain under adverse mechanical tension. This can lead to chronic mechanical issues in other aspects of the array.
Friedman is finding that the bow (of the spinouses) we often see in the frontal plane, the loss of curve (or even reversal of curve in the sagittal plane) as well was the rotation in the transverse plane all constitute radiographic evidence of this progressive, compressive force. Another indicator is the presence of more weight on the side opposite the short leg. The last blog by Dr. Friedman discussed the primary importance of decompressing the misalignment before attempting to restore it to the vertical axis. We have long done with this type IIs (Into-the-Kink) when we drop the head so that we close the facets on the side opposite laterality and allow the circular forces to restore the lower angle to the vertical, taking the bow out. Using the weight of the head to decompress the misalignment and restore the lower angle to the vertical axis has long been seen as a successful process. Type IIs are also known for their emotional aspects which may have become obvious when the decompression opened up the system, literally taking tension off the brainstem and relieving the chronic compression. However, believing that the atlas laterality is the CAUSE of the problem, we have had a more difficult time with opposite angle misalignments because to decompress the spine one would have to adjust the patient on the side opposite laterality. If atlas laterality is the cause and not a critically significant effect (with the attendant neurological sequelae), then we would expect atlas laterality to increase and we would have no choice but to stay on the side of atlas laterality. Indeed, many people have had to accept the continued presence of lower angles that wont reduce when the head is supported in a neutral plane for this very reason.
Dr. Friedman reasoned that atlas laterality may be an effect of distortion in the whole tensegral array and that decompression of the array could facilitate not just improved reductions but improved stability and truly unencumber the whole system. Up and open he calls it. Over the last few months he has been working with many dozens of patients and this in fact is the bottom line. He is restoring people to the vertical axis and unwinding previously intractable lower angles and rotations. Properly used, this new system of biomechanics proportionately reduces all aspects of the misalignment including atlas laterality- even if the adjustment is on the side opposite atlas laterality. Dr. Friedman showed several of these cases pre and post in his last webinar.
The cardinal rule in orthogonally based upper cervical work has always been that we must adjust on the side of atlas laterality. This rule has been predicated on the assumption that atlas laterality is the cause of the postural distortion as well as other attendant effects of the ASC. This harkens back to the HIO days when the adjustment consisted of a brief but significant thrust designed to direct and encourage the atlas on its journey back to its normal position. Long ago we set the thrust aside and began to use the triceps ˜pull. Conceptually, we have continued to see the adjustment as directly moving the atlas back under the skull into a normal (midline) position.
The body is however an integrated system. If you affect one part of the array, you affect the entire array. The neurological and biomechanical consequences of atlas laterality are not in dispute. This conceptual shift occurs in understanding of the rest of the system. Restoration of the head and lower angle to the vertical accompanied by orthogonal positioning of the atlas is only part of the resolution of subluxation. This can be seen in posts which resolve the relationships of head and neck without return to the vertical axis (gravity line). The elements cranial to the pelvis must coordinate with the position of the pelvis in order to create stability and agility for movement. Since the pelvis constitutes the largest mass in the kinetic chain of the spinal elements (as well as being the center of mass for the whole body) the spine and head cannot return to the vertical axis if they are not positioned over the orthogonal pelvis. Instead they will adapt and compensate. Indeed, the excursion of the upper cervical misalignment is a direct function of pelvic misalignment. It is a circular relationship since the pelvic obliquity occurs due to altered neurological modulation of the nuclei in the brainstem, which in turn occurs due to adverse mechanical tension from misalignment of the upper cervical spine.
Dr. Cockwill published a paper entitled, Angular Measurement of the Upper Cervical Spine in the Neutral and Laterally Flexed Positions, in The Upper Cervical Monograph 5(7):10-12, May 1996. Cockwill was examining a critical point: This study is simply an attempt to detect any angular change while the upper-cervical spine is in a state of motion. (p.10) The study took three patients and filmed them using the normal NUCCA procedures for nasiums. After the nasium was taken, the patients were then placed in a (cervically) laterally flexed position (Requiring the test subject to actively laterally flex the skull until the end range of motion is perceived is important in accurately determining if normal motion is present in this area.) and the film retaken. The patients heads remained vertical in the head-clamps and care was taken not to change head position. The atlas laterality was calculated individually by three different experienced upper cervical practitioners. Change in measured atlas laterality between the first and second nasium was measured to be between one and ½ degrees and four and ½ degrees. Also noted was that average change in axis spinous was contralateral to the side of lateral flexion by seven millimeters. The largest change seen was 14 millimeters. On a 3 inch condylar circle, this equates to a change of 21 degrees. These results follow the published results of others who have examined normal motion in the upper cervical spine. Dr. Cockwill listed 15 different peer reviewed, indexed references for this point. In 1997, Dr. Dickholtz, Sr. replied to these findings in The Upper Cervical Monograph. He strongly rejected these findings and NUCCA has never examined this idea again. However, in light of the principle of tensegrity, these findings only make sense. There are no ˜locking joints in the upper cervical spine. Bones do not touch each other. Distribution of forces in a tensegral array always equalize throughout the entire system. This new viewpoint allows a greatly expanded understanding of the biomechanics.
The primary finding here is that resolution of the atlas to orthogonal position does not constitute the entire answer to postural distortion and the other pathological consequences of upper cervical misalignment. It is a critical component but incomplete by itself. As historically utilized, the lines of misalignment on the films do not capture the entire process. The bowing of the cervical spine, in the frontal plane is not adequately expressed by the marking of a line between the top and bottom of the cervical spine. We have long made this line and that is what we tend to see when we look. The frequently attendant bowing of the spinouses on the nasium is underappreciated as a significant indicator of distress in the system. This bowing can still be seen on films where the head and lower angle line have returned to the vertical. We have been looking at the lines we draw for a long time. Perhaps it is time to re-examine what we are seeing.
It is also critical to acknowledge the importance of the pelvis in calculations regarding the biomechanics. Upper cervical work has long noted its effects to be body-wide. This has never been seen as a segmental adjustment at just one level. However, the greatest potential resistance in the system (kinetic chain) is the pelvis. It has the greatest mass and the center of gravity is centered within it. This is an objective reality of the body. If the pelvis is not centered on the vertical axis, the cranial components of the skeleton are unable to center on it. They must adapt and compensate for the mis-position of the pelvis away from the vertical axis (gravity line). In addition, the pelvis must be taken into consideration when the listing for spinal correction is calculated. There are times when the upper cervical spine and the pelvis are counter-rotated to each other and a force that corrects one aspect has a much different effect at the other end of the chain. Dr. Friedmans biomechanics addresses this issue in a thorough and systematic manner. This is not a simplistic plea to just ˜turn people over.
Part of this misreading of the situation occurs because the nasium film as taken by NUCCA (and the other orthogonally based upper cervical techniques) only allows a relative position of the head, atlas and lower angle. When the head is clamped in the center of the film by the self-centering head clamps any actual relationship to the true vertical axis arising from the center of mass of the pelvis is altered. Therefore any return to the ˜vertical axis on the post nasium is without reference to the actual center of mass of the pelvis and may constitute local correction of the upper cervical elements (as defined by the line drawings) but not restoration and integration with the primary mass of the pelvis. This why Dr. Friedman has altered the positioning protocol for x-ray placement to ˜build the film from the base (center of mass on the vertical axis) and not requiring that the atlas be centered on the pre film. This represents the actual excursion of the atlas from the true vertical axis (arising from the center of mass). If a proper corrective adjustment has been delivered, the post film should find the atlas in midline on the vertical axis arising from the center of mass. Dr. Gregory stated more than once that he didnt care if you adjusted the big toe -if the post film showed proportional correction.
This work has always been driven by empirical results. Dr. Friedman uses his practice as a laboratory to search for ways to improve the adjustment. Long ago, it was common knowledge that the world was flat and if you sailed west from Europe that you would fall off the world. It was once common knowledge that it wasnt necessary to wash your hands between patients. The spread of puerperal fever (childbed fever) was epidemic and loss of life was rampant. Semmelweiz suggested washing hands between patients. He had the audacity to suggest that doctors themselves might be transmitting the contagion. The medical profession destroyed him and he eventually went insane and committed suicide. It took more than 200 years for England to begin feeding their sailors citrus to prevent scurvy after it was recognized as a deficiency. Mark Twain once said, It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so. All of us are blinded by what we think we know. We tend to see what we believe and not the other way around.
The profundity of upper cervical correction has been shown in hundreds if not thousands of offices over many decades. This new insight does not lessen the importance of the atlas. It does help to integrate understanding of the atlas with the rest of the body and provide a more efficient way to reduce interference to the nervous system and restore the power of life in people. The clinician who reads this has two choices: one, ignore this idea which is different than the way the work has been conceptualized for the past 70 years, or learn the biomechanics and see if its true. Maybe we can do better. Isn’t that why we came to upper cervical work in the first place?
Twain said something else that might be of pertinence here:
Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.