Chiropractic adjustments and cervical traction – addressing cervical lordosis
The traction may not be the best treatment for the patient
In this video, Dr. Brian Hutcheson, DC describes different types of adjustments depending on the diagnostic findings. We will also show you two examples of performing supine or laying down traction and how different patients’ necks look during that traction.
The first one you’ll see today is the patient, a female, who does not maintain any lordotic curve during traction. (please see our article Cervical Spine Realignment and restoring loss of cervical lordosis). The second patient, a gentleman, maintains the backward lordotic curve throughout the entirety of the traction.
A lot of research shows that one of the most important parts of performing cervical traction is maintaining the cervical lordosis during performing traction. This is something to consider, Performing traction may not always be the best therapy for patients and if they do have a lot of instability you would want to be careful with doing a lot of traction because you don’t want to expose too much motion to an area that’s already moving too much.
Later in this video, we show different types of adjusting techniques and demonstrate why, it may be a better idea to use a more specific and subtle instrument adjusting tool in a patient that has instability and also how sometimes somebody may appear to have a stiff neck, for one reason or another, however, they could have significant amounts of upper cervical instability. For that patient that does have upper cervical instability, at the end of this video, you will see that we do perform a manual adjustment. The manual adjustment is performed with minimal force and in the direction that is going to bring healing to the patient. Because the C1 slides forward so far on the digital motion x-ray, we position the patient in a way that we were moving the C1 bone slightly from the front to the back.
We are seeing a significant rise in the population where people have C1 sliding forward off of C2 likely due to car accidents, being on our phones all day, and our technology use. So we have changed the way that we adjust the C1 with the times. Very often, perhaps 80 – 90 % of the time, I find that I’m moving the C1 from the front to the back in order to bring it into a place of integrity.
A January 2021 study in the International Journal of Environmental Research and Public Health (1) suggested that addition of one C0-C1 and C2-C3 manual therapy session to cervical exercise can immediately improve flexion-rotation test and cervical range of motion and reduce pain intensity in chronic neck pain patients.
The controversies surrounding which patients would benefit from traction or manipulation and who would not was shown in a December 2020 study in the journal Musculoskeletal Science & Practice. (2) The researchers here wrote that “understanding the 3D-kinematics of the upper cervical spine during manual mobilization is essential for clinical examination and therapy. Some information about rotational motion is available in the research but translational components (the movements during flexion-extension and axial rotation) are often ignored, complicating the understanding of the complex inter-segmental motions.
The researchers in this cadaver study found that 3D displacement was larger at C1-C2 during axial rotation, and Atlanto-occipital flexion displayed the greatest variability in the C0 trajectory. During a right rotation, the left C1 facet moved mainly forward, and the right C1 facet moved backward. During a left rotation, the left C1 facet moved backward, while the right C1 facet moved forward. During passive spinal motion, there is an important variability in the magnitude and trajectory of joints’ displacement.
An example of an adjustment that you would not want to perform
At 2:35 of the video Dr. Hutcheson explains adjustments that should not be performed in upper cervical instability cases:
Here is an example of an adjustment that we would not want to do with this patient. This patient presented with neck pain and headaches and we found out on the Digital Motion X-Ray evaluation that she has 5ml of instability to one side of C1-C2 and four and a half millimeters to the other side.
- Every time she bends her head from side-to-side, her C1 slides over her C2, about 9 to 9-1/2 millimeters that is almost one centimeter or more than a third of an inch.
- An adjustment we would not want to do with her is a motion that takes her to an extreme range of motion by having her drop her left shoulder and said rest your neck and then went “boom” and put a lot of force into her neck. While there maybe instances where this may be a preferred adjustment, for her this is going to be too much of a manipulation for her nervous system to tolerate and it may over time caused her even more laxity in the ligaments and worsen her symptoms. Her prognosis would be worse overall.
A more preferred adjustment
Dr. Hutcheson is holding an activator method chiropractic tool or activator adjusting instrument, which is an alternative to traditional manipulation. The tool delivers a quick, low-force impulse to help realign the spinal vertebrae. The benefit to using this tool is said to be in its high speed application. The high-speed adjustment can prevent neck muscle tension that may reduce the effectiveness of the adjustment. Secondly, the adjustment is made in a localized manner reducing twisting of the neck.
An activator adjusting instrument is a more preferred adjustment for this patient with a nine and a half millimeters of instability bilaterally. The instrument creates a super gentle and specific force, barely moving C1 into a better position. Her nervous system will be able to assimilate and tolerate this kind of force and really adapt to the new position it is put in. In many patients their spinal tension disappears they end up having reduction of headaches and this adjustment can hold for some-time.
A paper in the Journal of Manipulative and Physiological Therapeutics (3) wrote: “Conservative chiropractic treatment may provide an effective therapeutic intervention in selected cases of cervical disc protrusion. Instrument-delivered adjustments may provide benefit in cases in which manual manipulation causes an exacerbation of the symptoms or is contraindicated altogether.”
Dynamic Ortho neurological Correction
Specific spinal manipulations are the basis for dynamic ortho neurological correction. In this correction we observe the vertebrae movement under Digital Motion X-Ray and then try to correct the vertebrae’s position into a better alignment.
In the image below we see a high-riding (cowboy) atlas. The cowboy atlas is riding so high in the cervical spine that there appears no space for the vertebral artery or C1 nerve root (what the arrow is pointing at). The combination of dynamic ortho-neurological adjustments, curve correction, and Prolotherapy to the various areas of cervical instability can improve the C1 space and reduce symptoms. Please see our article on treatments for Atlas displacement c1 forward misalignment.
1 Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO, Pérez-Bellmunt A, Carrasco-Uribarren A, Fanlo-Mazas P, Corral-de-Toro J, Hidalgo-García C. Effects of the manual therapy approach of segments C0-1 and C2-3 in the flexion-rotation test in patients with chronic neck pain: a randomized controlled trial. International Journal of Environmental Research and Public Health. 2021 Jan;18(2):753. [Google Scholar]
2 Siccardi D, Buzzatti L, Marini M, Cattrysse E. Analysis of three-dimensional facet joint displacement during two passive upper cervical mobilizations. Musculoskeletal Science and Practice. 2020 Dec 1;50:102218. [Google Scholar]
3 Polkinghorn BS. Treatment of cervical disc protrusions via instrumental chiropractic adjustment. Journal of manipulative and physiological therapeutics. 1998 Feb 1;21(2):114-21. [Google Scholar]