Atlas displacement c1 forward misalignment
We are going to talk about atlas misalignment versus forward atlas displacement. This is a very key concept that doctors and especially people who are suffering from chronic headaches, head pressure, chronic neck pain, need to learn about. We are going to explain why certain people do very well with low velocity instrument adjustments that the upper cervical chiropractors do and why some people have worse symptoms after low velocity instrument adjustments. We will also explain the different kinds of techniques that we utilize and other doctors do to align the atlas. This is a companion article to Forward head posture symptoms and complications.
Dr. Ross Hauser and colleague Dr. Brian Hutcheson, DC.
These are among the many typical symptoms of atlas misalignment.
- Cervicogenic headaches: Migraines, tension headaches at the base of the skull
- Ear fullness, tinnitus, sound distortions
- Jaw pain and TMJ
- Neck instability and shoulder pain
Atlas displacement c1 forward displacement and misalignment
In the image below the caption reads: “Lateral c-spine x-ray showing decent neck curve with atlas displacement. Some people do retain the cervical neck curve but still have a forwardly displaced Atlas displaced Atlas is what was compressing this person’s carotid sheath causing numerous conditions and symptoms including increased brain pressure intracranial hypertension
Atlas misalignment vs atlas displacement
Atlas misalignment means the atlas is off alignment a little, one or two millimeters off of ideal anatomy. Atlas displacement, which is a condition we are seeing more and more, as people do the face down lifestyle, such as looking down at a cell phone 5 – 6 hours a day, eventually the atlas is displaced forward.
One of the main differences between an upper cervical or atlas misalignment versus a forward displacement is that the misalignment can typically be adjusted from any perspective, such as an an adjustment from the rear or the front.
Because you can approach this misalignment from different perspectives and make small adjustments you can improve the neck dynamics and open up the spinal canal space take pressure and compression off the carotid sheath, the vagus nerve, internal jugular vein, relieve pressure on the vertebral artery which traverses around the posterior part of the atlas. We don’t recommend anybody try to self-adjust on their own at home because the atlas is a very important structure and you can make your situation worse.
An atlas that is displaced forward, we see this periodically, the patient is going to a really great clinician but they do not realize that the atlas has been displaced forward and these people are being adjusted from the back forward which is more common. The patient may be laying face down on an adjustment table and then they have their head/neck pushed forward and these people can feel worse. The adjustment is perpetuating the injury over time even though they may get the misalignment corrected, the atlas is still forwardly displaced.
We are going to discuss a patient case. We did a cone beam CT scan (Upright cone beam computed tomography (UCBCT) is a radiographic imaging method for three-dimensional imaging of the bony structures of the head (cranium), neck (cervical spine), and facial bones), and then adjusted him and then performed another adjustment, and we were able to bring the atlas backwards from a frontal adjustment and his symptoms resolved.
If you go to an upper cervical chiropractor and it’s just not helping you may have forward displacement. You can determine this by bilateral X-ray showing the atlas has moved forward.
In the image below:
The caption of the image below reads: Subtle findings of upper cervical instability on Cone beam CT scan. This particular patient’s cervical spine is curved but bone spurring is noted from the atlas and axis (displayed by arrows) and a slightly tipped back dens (The odontoid process of the C2 vertebrae) with a clival axle angle of 145° suggesting minimal invagination or upper cervical instability. The clival is a boney part at the base of the skull.
In the image below:
This is a cone beam CT Scan x-ray image. It shows a ponticle – an enlargement of bone that could cause headaches, migraines, double vision, dizziness, or orofacial (mouth and face) pain.
A patient case
When your atlas if forwardly displaced you are going to have to do something about it. Cervical curve correction may be a possible treatment, ergonomic changes in the office or home so you are not looking down all the time, or changes in sleep position. When there is Cervical spine instability and Atlantoaxial instability caused by cervical neck ligament weakness, then treatment addressing the ligament laxity should be discussed. A great majority of the time when a patient suffers long-standing forwardly displaced atlas there is cervical instability.
In the patient we are discussing, he had just gotten one adjustment from a really good chiropractor but his case is so unique because his C1 is sliding forward and that’s producing a lot of the symptoms. This goes back to our discussion on atlas forward displacement as opposed to atlas misalignment. He was adjusted in a way that applied force (it was a low force technique) from behind and pushed the atlas further forward and that’s what made him feel really terrible. He felt worse because the adjustment moved an already vulnerable C1 that goes forward a little bit more forward. We were able to help him by moving the atlas backward very carefully.
Compression of the jugular veins
At 9:30 of the video click here the patient’s scans demonstrate a compression of the jugular veins. The caption of the image below reads: Upright cone CT scan axial view at the levels of the atlas (C1) showing no space between it and this person’s bilteral styloid bones (shown by the arrows). This person’s jugular veins were getting compressed anteriorly by their elongated styloid bones and posteriorly by their anterior subluxed atlas.
This is the patient’s Cone Beam CT showing improvement in overall curve after adjustment focused on the subtle backward movement adjustment of the C1 atlas.
This simple backward adjustment took compression off the carotid sheath and its important contents including the common carotid artery, internal jugular vein.
the vagus nerve, part of the recurrent laryngeal nerve and the deep cervical lymph nodes.
In this patients case there was no space between the styloid and the lateral mass of the atlas. So we adjusted the atlas and we were able to create just a few millimeters of space that allowed the carotid sheath to have a little bit of room. Right after we did this, the patient reported he was feeling better.
Please see our article and video Chiropractic adjustments and cervical traction – addressing cervical lordosis.
The effect of atlas misalignment on upper cervical spinal canal space.
The caption of this illustration reads:
A. Normal alignment.
As can be seen the axial canal space for the upper spinal cord and/or brainstem and cerebrospinal fluid is severely compromised when the atlas misaligns. Symptoms can range from suboccipital and head pain and pressure to severe neurological compromise.
For treatments and further discussion of atlas misalignment and c1 forward misalignment please see these articles:
- A review of upper cervical instability and symptoms treatment with Ross Hauser, MD
- Ehlers-Danlos Syndrome, Atlanto-axial instability, and Craniocervical instability
- Craniocervical ligament injuries: Focus on the alar ligament
- Ross Hauser, MD. Reviews of Diagnostic Imaging Technology for Cervical Spine Instability
- Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability
- A Review of Prolotherapy injections for Craniocervical instability with Ross Hauser, MD
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this article informative and that it helped answer many of the questions you may have surrounding instability at C1. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.