By utilizing 3D X-rays to determine the vector force, the NUCCA technique continues the work of Palmer, Grostic and Gregory...

It is the basic National Upper Cervical Chiropractic Research Association (NUCCRA) premise that an atlas or C1 subluxation is the most damaging subluxation in the spinal column. It is the first vertebral opening through which the nervous impulses pass to and from the brain. As it is located at the lower end of the brain stem, the subluxation's misalignment factors are capable of upsetting the central nervous system's inhibitory control over the extensor muscles of the spinal column, causing spinal imbalance, bodily distortions and stress.

Our leaders, Palmers, Wernsing, Grostic, Gregory, Dickholtz, Sweat, Berti, et. al. have developed our knowledge base sufficiently to unite us. This has been accomplished through extensive research and the development of equipment.

Theory

National Upper Cervical Chiropractic Association (NUCCA) theory states that less than 1 mm of atlas laterality is enough to trigger a spastic contracture, therefore precision comes first in both X-ray taking and analysis. It is like a three-legged stool: each is of equal importance - X-ray placement, X-ray analysis and the adjustment. Some patients have a lot of head tilt in neutral posture as in a wryneck. This will give unequal magnification of the skull and must be manually corrected on the second prenasal film. This second film is used only for C1 laterality and the neutral natural film used for the other components. This first natural film head tilt must match the neutral standing posture observed and noted on the card before the X-ray. A horizontal line chart on the wall helps determine how much head tilt there is in neutral position. If more than 5 degrees of head tilt is seen on the nasium film, it is wise to take another film with the tilt manually taken out. Doctors should draw a line between the tips of the mastoid processes and check the angle it makes with the perpendicular bisector of the skull. This angle must be consistent on all the nasal films so the accuracy of the central skull line can be ensured. This tells the doctor how consistent he or she is in the analysis and adjustment. It also breeds confidence - which is priceless.

X-ray Analysis

The routine use of X-ray has been criticized by some, but the benefits far outweigh the risks. Sixty-three percent of Chiropractors take X-rays routinely for biomechanical evaluation and location of subluxations by line drawing.1 The Grostic X-ray analysis2 has proven reliable for evaluating roentgenographic measurements of atlas laterality and rotation, pre and post adjustment. It is recommended that the doctor take a post X-ray immediately fol lowing the first ad justment to make certain the accu racy of the line of drive.

Subsequent adjustments may have to be modified if the reduc tion of the subluxation is not acceptable. The headpiece setting must be correct, or the adjustment will not reduce proportionately the way it should. It soon becomes obvious that the direction of the force is key in the success of the adjustment. Doctors can't rely on Innate to put the vertebrae back where they belong; they must be precise with their forces. When the c-spine and skull are returned to the vertical axis, the rest of the spine and pelvis is allowed to do so also as the spastic contracture releases the splinted joints. Head and brain asymmetry has been shown to have a direct influence on the spinal curvatures. 3 This is a full spine technique.

The Eight Phases

Once the X-rays are analyzed and the line of drive calculated, all the Chiropractor has to do is follow the Eight Phases of the NUCCA Adjustment. 4

1. Approach. To establish a base of support, neck lock and plantar reflex.
2. Settleback. To convert the adjustor's pelvic and shoulder levers to a more vertical plane so that the adjustor's action lines are aligned to the notch-transverse resultant.
3. Turn-In. To turn the adjustor's spinal column so as to bring the adjustor's episternal notch directly above the contact point. (C1 transverse process)
4. Arch. The formation of arches of the hands to control divergent forces from the triceps muscles and make the hands rigid.
5. Roll-In. To bring the divergent forces emanating from the triceps muscles to a single point and to prevent the forces so produced from scattering around the transverse process.
6. Conversion. To align the adjustor's action lines to the same plane in which the Notch-Transverse Resultant lies and to return the adjustor's spinal lever to an exact 90 degree angle to the Horizontal Resultant at the settleback point.
7. Triceps Pull. To convert the potential energy of the adjustment into kinetic energy.
8. Pelvic Lever. To obtain still greater conversion of the adjustor's trunk into a more vertical plane with better action line align ment to the Notch-Transverse Resultant. The Pelvic Lever Phase is only used when the adjustor normal settleback is not sufficient to obtain the degree of angulation necessary for a particular subluxation.

The performance of these steps will produce a controlled force sufficient to reduce the particular subluxation and no more. The amount of force cannot be pre-determined, and the force needed is individual to each subluxation.

Equipment Innovations

Some recent innovations that have contributed to the success of the technique include the Anatometer [1], the adjustable table and the headclamp/film carrier.

Anatometer. All patients are measured pre and post on the Anatometer [2]. The anatometer is used to quantify body distortion, and it measures the degree of vertical pelvic tilt, pelvic rotation in the horizontal plane and lean of the spinal column at the shoulder level (fixed point). It also takes the patient's weight how much is carried on each foot and what percentage that is of the total weight. A United Slates patent allowed all the claims NUCCRA made and granted NUCCRA a process patent on the anatometer. Consequently, the process for determining the relative location of vertebrae in the human spine and the several steps that comprise the process are now patented in NUCCRA's name.

Adjusting Tables. High-Low tables for upper cervical adjustments are a recent developmentthathas made manual adjusting easier on the doctor as well as the patient. The table is designed to move from 6 to 42 inches off the floor to accommodate the adjustor's spinal lever angulation and settleback point.This allows the adjustor more latitude in the notch-transverse resultant and reduction pathway of the force vector dictated by the X-ray analysis. Like playing golf, one must watch the stance (base of support), the grip, (roll-in), head position (neck lock), center of gravity (pelvic lever) and follow-through (triceps pull).

Headclamp. A newly designed headclamp and film carrier on separate tracks has made the taking of X-rays faster and easier. With this "X-YZ" equipment, doctors can position the patient in the headclamps properly and still move the film carrier anywhere without having to re-set the headclamps.

Discussion

Anatometer checks are given to the patient both before and after the adjustment. This test, after the adjustment is far more informative than the leg check. It tells the doctor immediately if he or she should re-adjust or post X-ray. Two other very helpful tests are straight leg raising and the use of hip calipers on the ASIS in the supine position. The doctor can show the patient how much the pelvis has untorqued just seconds after the adjustment. These outcome tests are excellent because they are objective and subjective.

Contraindications of this NUCCA adjustment are few, but osteoporosis and vertebral fracture are two conditions that could be problematic.

The advantages of this procedure include safety, little pain, measurability, predictability, reliability and stability so the body can heal itself. No more chasing pain: find it, fix it and leave it alone. To help find the exact contact location of the C1 transverse process, place a lead pellet at the tip of the palpable mastoid process before taking the X-rays. Use no more than 3 pounds contact or the stretch reflex can lock the joints to be adjusted. After a while, the adjustor develops a feedback and that tells the adjustor when a proper adjustment has been accomplished.

Glossary of Terms

ACTION LINES: Parallel forces. Energy emanated in perpendicular direction out from the center of the adjustor's shoulder and pelvic levers.

ANGULAR ROTATION: Rotation of a body segment about a fixed axis.

BASE OF SUPPORT: The positioning of the feet in relation to the Horizontal Resultant. Where they are placed will greatly determine the direction the action lines are pointed.

CENTER OF MOTION: Fixed axis of motion.

HORIZONTAL RESULTANT: Resultant on a horizontal plane, composed of vectors from nasium and vertex X-ray films.

NECKLOCK: The action of the adjustor drawing his/her chin back as in a military stance. This creates a reflex action that will retract shoulders, straighten cervical spine and promote synergistic action of spinal musculature.

NOTCH-TRANSVERSE RESULTANT: A calculated line from the episternal notch of the adjustor to the transverse process of the patient along which the adjustic force should be directed in order to correct the A.S.C.

PELVIC LEVER: Straight line between the center of one acetabulum to the center of the opposite acetabulum.

PLANTAR REFLEX: The reflex produced by dragging the plantar surface of the foot across the floor. This reflex will cause a synergistic action between the leg musculature and the posture musculature to create more stability in the adjusting procedure.

SETTLEBACK POINT: A point that is one inch beyond the Horizontal Resultant along a line drawn perpendicular to the Horizontal Resultant at its distal end. The adjustor's tie or plumb bob should align with this point at the end of the conversion phase. The base of support is aligned to this point.

SHOULDER LEVER: Straight line from the center of one glenoid fossa to the opposite glenoid fossa.

VECTOR: A force specified by direction and magnitude.