Relationship between craniocervical orientation and center of force of occlusion in adults.

OBJECTIVE: Clinical observation and anecdotal reports suggest changes can occur to dental occlusion following intervention with the National Upper Cervical Chiropractic Association (NUCCA) procedure. This case controlled study discerned if occlusion changes are measurable using a dental force plate (T-Scan®) following an adjustment to the craniocervical junction (CCJ). METHODS: A degree of case control was established by active patients being assessed twice prior to and following intervention. Before-after intervention assessment included posture evaluation and dental occlusion (T-Scan®). RESULTS: Findings suggest that changes in posture and occlusion can be observed after the NUCCA chiropractic procedure. Not all patients demonstrated a more balanced contact pattern following the adjustment, indicating a need for further investigation. DISCUSSION: These findings may suggest interconnectivity between the CCJ and an individual's occlusal contacts and support the need for further integration between chiropractors and dentists seeking to co-manage temporomandibular joint disorders.

Injury Threshold of Rectus Capitis Muscles at the Atlanto-occipital Joint.

OBJECTIVE: The objective of this study was to collect muscle stiffness data from the 4 rectus capitis (RC) muscles to better understand their role in stabilizing the atlanto-occipital joint. The passive load displacement properties of these muscles have not been previously reported. METHODS: Rectus capitis muscles were removed from 3 unembalmed head and neck specimens. Passive length-force (stiffness) data were collected by using a servo-controlled hydraulic test machine. Multivariate analysis of variance with Bonferroni correction was used to assess the significance of the differences among passive stiffness within the elastic region of each muscle and the load and strain at the yield points. RESULTS: Rectus capitis lateralis (RCL) muscles failed at significantly higher levels of load and strain compared with the other 3 pairs of muscles. Passive stiffness of both RCL and RC anterior muscles was significantly higher than the other 2 pairs of muscles. CONCLUSION: The anatomic location of the RCL muscles, along with their high levels of passive stiffness, would be expected to facilitate the maintenance of atlanto-occipital joint congruence during normal daily activities. The level at which the RC posterior minor muscles failed could put them at risk of a strain injury during a rear end motor vehicle accident. Diagnostic and treatment protocols that apply forces to the upper cervical spine should be tailored to consider the patient's age, gender, and history of previous injuries to avoid overstretching RC muscles.

Técnica de inhibición de la musculatura suboccipital / Inhibition technique of the suboccipital musculature

Las técnicas de inhibición son procedimientos de tratamiento osteopático aplicado en los tejidos blandos, que buscan una inhibición en dichos tejidos, como elemento integrador del tratamiento, donde gracias a la aplicación constante de presión ejercida durante un tiempo establecido, consigue equilibrar y normalizar el tono muscular y la actividad refleja correspondiente al área lesionada. Concretamente en la musculatura suboccipital se busca la normalización del tono muscular en el segmento C0-C1-C2, para actuar directamente sobre las estructuras musculoesqueléticas del segmento cervical alto y el paquete vásculo-nervioso, teniendo gran repercusión sobre una multitud de síntomas que observamos a diario en nuestros pacientes, que describiremos, convirtiendo a esta técnica en una excelente herramienta para el tratamiento osteopático, la cual ha demostrado su utilidad (AU)

Inhibition techniques are methods of osteopathic treatmente applied to soft tissues, seeking the inhibition of these tissues, as an integral element of treatment, where, thanks to the constant application of pressure exerted during a set time, muscle tone and corresponding reflex activity are balanced and normalized. Specifically, normalization of muscle tone in the C0-C1-C2 segment is sought in the suboccipital musculature in order to act directly on the musculoskeletal structures of the high cervical segment and the vascular-nervous package, having a great effect on a multitude of symptoms that we see every day in our patients, which will be described, making this technique an excellent tool for osteopathic treatment, which has proved its usefulness (AU)

Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial.

OBJECTIVE: The purpose of this study was to measure the immediate differences in craniocervical posture and pressure pain threshold of the greater occipital (GO) nerve in asymptomatic subjects with a history of having used orthodontics, after intervention by a suboccipital muscle inhibition (SMI) technique. METHODS: This was a randomized, single-blind, clinical study with a sample of 24 subjects (21±1.78 years) that were divided into an experimental group (n=12) who underwent the SMI technique and a sham group (n=12) who underwent a sham (placebo) intervention. The sitting and standing craniovertebral angle and the pressure pain threshold of the GO nerve in both hemispheres were measured. RESULTS: The between-group comparison of the sample indicated that individuals subjected to the SMI technique showed a statistically significant increase in the craniovertebral angle in both the sitting (P<.001, F1,22=102.09, R2=0.82) and the standing (P<.001, F1,22=21.42, R2=0.56) positions and in the GO nerve pressure pain threshold in the nondominant hemisphere (P=.014, F1,22=7.06, R2=0.24). There were no statistically significant differences observed for the GO nerve mechanosensitivity in the dominant side (P=.202). CONCLUSION: Suboccipital muscle inhibition technique immediately improved the position of the head with the subject seated and standing, the clinical effect size being large in the former case. It also immediately decreased the mechanosensitivity of the GO nerve in the nondominant hemisphere, although the effect size was small.

Tratamiento osteopático mediante la técnica manipulativa occipucio-atlas-axis y de inhibición de suboccipitales en la cefalea tensional / Technique in the osteopathic treatment of patients with tension-type headache atlanto-occipital joint manipulation and suboccipital inhibition

Introducción: La cefalea tensional tiene una elevada prevalencia, con repercusión en el ámbito laboral y social de los sujetos que la padecen. Objetivo: Evaluar la eficacia de varias intervenciones con terapia osteopática en pacientes con cefalea tensional. Material y Métodos: Se ha llevado a cabo un estudio a doble ciego, aleatorio, con 76 pacientes (81,6% mujeres) diagnosticados de cefalea tensional (edad media 39,9±10,9 años), distribuidos en cuatro grupos de estudio, integrados por 19 pacientes cada uno de ellos (tres grupos experimentales y un grupo de control). Los tratamientos aplicados a los grupos experimentales incluyen terapia osteopática con: 1) técnica de inhibición de suboccipitales (IS); 2) técnica manipulativa de occipucio-atlas-axis (OAA); 3) la combinación de ambas (IS+OAA). Se aplicaron 4 sesiones, (1 por semana), y seguimiento a los 30 días. Se evaluó antes, después del tratamiento y en el seguimiento, la movilidad cervical, el impacto producido por el dolor y la frecuencia e intensidad del dolor. Resultados: El grupo IS mejoró significativamente en el impacto del dolor (p=0,02). Los grupos OAA y IS+OAA, mejoraron en impacto e intensidad del dolor (p<0,001 a p=0,05), y en flexión y extensión suboccipital (p<0,001 a p=0,04). El grupo OAA mejoró también en las rotaciones cervicales (p=0,008 a p=0,007). El grupo IS+OAA obtuvo resultados significativos en la frecuencia e intensidad del dolor (p<0,001 a p=0,05). Conclusiones: Los tres tratamientos aplicados son eficaces en el impacto del dolor y en la intensidad del dolor. El tratamiento OAA es el más eficaz en la ganancia de la movilidad cervical, seguido del tratamiento IS. El tratamiento combinado IS+OAA, resulta más eficaz en la reducción de la frecuencia e intensidad del dolor (AU)

Introduction: The tension-type headache is extremely common, and has repercussions in both the work environment and the social life of the people who suffer from them. Objectives: To evaluate the efficiency of two manual therapy treatments in patients with tension-type headaches. Material and Methods: A random, double-blind trial was undertaken, with seventy-six (n=76) patients (81.6% women) diagnosed with tension-type headache (39.9 ± 10.9 years), distributed in four groups (n=19 each one), three experimental groups and one control group (without intervention). Interventions in experimental groups included osteopathic manual therapy with: 1) Suboccipital soft tissue Inhibition Technique (SIT); 2) Occiput-Atlas-Axis global manipulation (OAA); 3) The combination of both (SIT+OAA). Treatments were applied during four sessions (one per week), with follow-up at 30 days. Patients were evaluated before and after treatment and during follow-up, by monitoring cervical mobility, the impact of pain and the frequency and intensity of the headache. Results: The SIT group significantly improved the impact of the pain (p=0.02). The OAA group and the SIT+OAA group, improved the headache impact and intensity (p<0.001 to p=0.05), and suboccipital flexion and extension (p<0.001 to p=0.04). The OAA group also improved cervical rotations (p=0.008 to p=0.007). The SIT+OAA group obtained significant results in the frequency and intensity of the pain (p<0.001 to p=0.05). Conclusions: The three treatments applied were effective in the impact of headache and in pain intensity. The OAA treatment is the most effective in increasing cervical mobility, followed by the SIT treatment. The combined treatment SIT +OAA was the most effective in reducing the frequency and the intensity of the pain caused by tension-type headache(AU)

Resolution of whiplash-associated allodynia following cervicothoracic thrust and non-thrust manipulation.

Whiplash injuries of the cervical spine comprise 30% of injuries reported following motor vehicle accident (MVA) and often progress to chronic painful conditions. The purpose of this case report is to describe the management of a 37-year-old female referred to physical therapy with neck and shoulder pain after whiplash injury. The patient demonstrated limited cervical and shoulder active range of motion as well as quantitative sensory testing (QST) results consistent with central nervous system sensitization. She was treated for 11 visits over a 6-week period with manual therapy and specific exercise directed to the cervicothoracic spine. Her pain decreased from 9/10 to 2/10 by the end of treatment and remained improved at 1/10 at the 6-month follow-up. Her Copenhagen Neck Functional Disability Scale decreased from 23/30 to 4/30 by the 11th visit. In addition, she demonstrated clinically significant increases in cervical active range of motion and normal somatosensation. Manual therapy of the cervicothoracic spine may be a beneficial adjunct to the standard care of patients with signs and symptoms of central sensitization after whiplash-associated disorder and primary report of neck and shoulder pain.

Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs.

There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a Goel-Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005-2007). Six patients were treated using Goel-Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3-4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.

Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain.

OBJECTIVE: The purpose of this study was to investigate the effects of a spinal thrust manipulation directed to the upper cervical segments (atlanto-occipital joint) on active mouth opening and pressure pain sensitivity in a trigeminal nerve innervated region (sphenoid bone) in women with mechanical neck pain. METHODS: Thirty-seven women, ages 21 to 50 years old (mean age, 35 +/- 8 years) with mechanical neck pain were recruited for this study. Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone. A 2-way repeated measures analysis of variance (ANOVA) with time (pre-post) as the within subjects variable and group (control, experimental) as the between subjects variable was used to examine the effects of the intervention. The hypothesis of interest was group-time interaction. RESULTS: The ANOVA showed a significant effect for time (F = 23.1; P < .001) and an interaction between group and time (F = 37.7; P < .001) for active mouth opening as follows: the experimental group showed a greater improvement when compared to the control group. A large positive within-group effect size (d > 1.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group were identified. The ANOVA showed a significant interaction between group and time (F = 14.4; P < .001) for PPT levels at the sphenoid bone as follows: the experimental group showed a greater improvement when compared to the control group. A medium positive within-group effect size (d = -0.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group was found. CONCLUSIONS: Our findings suggest that the application of an atlantoaxial joint thrust manipulation resulted in an increase in active mouth opening and PPT over a trigeminal nerve distribution area (sphenoid bone) in women with mechanical neck pain.

Palpatory diagnosis of plagiocephaly.

INTRODUCTION: The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. METHODS: The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. RESULTS: We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). CONCLUSION: We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.

Dorntherapy: its effect on electroencephalographic activity in tinnitus patients with craniocervical dysfunction.

Dorntherapy was developed in the 1980s by Dieter Dorn, a nonmedical person, to cure his and his family members' vertebral problems. This technique achieves correction of dysfunctions of the vertebrae and joints simply by using natural movements of arms and legs or by applying gentle pressure (thumb) to the spinous process. Various observations suggest that craniocervical dysfunction can lead to tinnitus, thus causing changes in the electroencephalographic patterns. This study demonstrates that the successful application of Dorntherapy induced prominent changes of the electroencephalographic activity. Data analysis revealed a significant increase in the power of the alpha (8-13 Hz) and the alpha2 (9-11 Hz). Besides electrophysiological effects, changes in the quality of tinnitus and in the intensity of the tinnitus were noted. These results suggest that Dorntherapy must be an integral part of any tinnitus therapy.

[Therapy of functional disorders of the craniovertebral joints in vestibular diseases]. / Zur Therapie funktioneller Kopfgelenksstörungen bei Vestibularisaffektionen.

Cervicogenic vertigo is caused by functional disorders of the craniovertebral joints. Improvement of vertigonous symptoms by chiropractic treatment was often described. The therapeutic effect of chiropractic treatment in 28 patients with vertigo and purely functional disorders of the upper cervical spine or with a combination of functional disorders of the upper cervical spine and the labyrinth was evaluated. Improvement of vertigonous symptoms on patients with purely functional disorders of the craniovertebral joints as well as on patients with combined functional disorders of the craniovertebral joints and labyrinth could be seen. Two of the 28 patients showed persistent relief of symptoms and normalisation of cervical motility whereas the vestibular deficit persisted. One patient with persistent vestibular dysfunction showed recurrent malfunction of the upper cervical spine and vertigo. In our opinion chiropractic treatment is mandatory for the therapy of patients with vestibular affections and functional disorders of the craniovertebral joints.

[Chiropractic diagnosis of the atlanto-occipital joint with reference to the Palmer-Sandberg-Gutman functional aspects from the traditional medic-radiologic viewpoint]. / Die chiropraktische Kopfgelenksdiagnostik "unter funktionellen Gesichtspunkten" nach Palmer-Sandberg-Gutmann aus schulmedizinisch-radiologischer Sicht.

Owing to joint mechanics, movement of the atlas alone, as envisioned in HIO diagnosis for producing a superior or inferior position, is not possible when the tranverse ligament is intact, since an atlas movement of this kind would necessitate a change in the statics of the dens amounting to kyphosis or lordosis. Only in the superior or inferior position, as defined by Decking and ter Steege, is there a true malposition of the atlas as a result of atlas movement, and this is only possible if the dens assumes a lordotic or kyphotic position. In such cases all the segments of the cervical spine are used to modify dens statics. Aside from this, superior and inferior positions in HIO diagnosis do not represent any pathology requiring treatment, but normal positions of the atlas within a relatively broad physiologic range. In the vast majority of cases, providing the angle of view is horizontal, there are no findings reflecting the current position of the atlas, but rather a finding due to the development of a condyle movement.

Roentgenographic measurement of atlas laterality and rotation: a retrospective pre- and post-manipulation study.

Case records (523) were chosen at random from the files of J.F. Grostic, D.C. (deceased) for retrospective determination of the effects of chiropractic adjustments on atlas positioning relative to the occiput and axis. For each patient the recorded degrees of (1) atlas rotation and (2) laterality, both before and soon after spinal manipulative therapy, were extracted from the x-ray reports. Frequency histograms were made of pre- and post-adjustment degrees of laterality and rotation and the relative change of values analyzed statistically. Before manipulation, nine patients had zero atlas rotation and none were zero with respect to laterality. The mean deviation from zero degrees of "misalignment," was 2.75 and 2.63 respectively for rotation and laterality. After manipulation the corresponding values were 1.43 and 140, which is a statistically significant change. The numbers of patients who had zero rotations and laterality after adjustment were 156 and 151 respectively. In 63 patients the post-adjustment values were zero for both parameters. Under the circumstances presented in this retrospective study, these data tend to show that spinal manipulative therapy altered the position of atlas in the postulated direction.