Dr. Gregory, the founder of NUCCA, often said he didn’t care how the spine got adjusted, -even if someone was adjusting the big toe-, if it resulted in correction on the post film. The outcome defined by the post film has become the gold standard for outcome measurement within upper cervical work. This makes great sense because the post film will not be orthogonal (with gravity) if the pelvis and all the ascending elements are not aligned with the vertical axis, gravity. We have learned that even if all the elements are ‘zeroed out’ on the film, -if the neck and skull are not on the vertical axis-, then the correction is not complete –nor often is the whole symptomatic picture of the patient. In fact we now realize it is possible to ‘force’ the elements into relative alignment as measured on the post films but that there is a difference. Reduction of the upper cervical elements but continued misalignment of the pelvis sets up an ongoing situation of aberrant tension in the whole kinetic chain. The clinical clue is in the stability. Some patients tell me that their dog can just nuzzle them, touching their face, and they go back out of adjustment. The whole kinetic chain remains under tension and one nudge can cause the misalignment pattern to return.
The upper cervical spine is the terminal end of the kinetic chain that originates in the pelvis. Forcing alignment of the skeletal elements in the neck and head is not the same as un-torqueing the whole array, bringing all of the elements back to the minimal energy, minimal energy state that we strive for on postural measurements. We all know of the immense improvement that resolution of upper cervical misalignment can have on health and function. Now we are beginning to understand how release of compression can un-torque the whole kinetic chain creating real equipoise for the patient.
One of my friends noted that he had tried to ‘turn people over’ when he was having trouble and while he could get reductions on the post he wasn’t getting the ‘wow factor’ he had come to expect after the adjustment. He had concluded that this wasn’t a viable idea. By itself, ‘turning people over’ is certainly not an answer. In the context of the biomechanical process, addressing the misalignment from the side which will give the most mechanical advantage and decompress the whole spine is the bigger picture here. Having a process by which you can reason through your measured data and know exactly what to do next is imperative and fundamental to safe and effective care of people’s spines.
Although the use of roentgenography in chiropractic has a very long history, no one has yet been able to show in the peer reviewed, indexed literature (the papers available to the scientific and healthcare community at large in the world) that we can set people into the x-ray chair, clamp them in, take a proper picture, and analyze the films with the degree of accuracy which is fundamental to a ‘gold standard outcome measure’.
Unfortunately, the current literature shows the opposite. Twenty seven years ago, a grossly flawed study was published in JMPT which asserted that doctors can only be within 2 degrees of each other in terms of inter-examiner accuracy. This is what the rest of the world knows about us. In the current paradigm, atlas laterality is the cornerstone of the work, the ‘biomarker’ so to speak. We know through long clinical experience that ¾ of a degree is all it takes to see loss of optimal alignment with gravity and initiation of the postural distortion associated with upper cervical misalignment. Rochester has verbally asserted that we probably can’t resolve accuracy to less than one degree. To “prove” the validity of using atlas laterality as a gold standard outcome measure, we would have to be within ½ degree of precision and accuracy.
UCRF is currently attempting, after all of these decades, to finally do a study that will assess what is possible for both inter and intra-examiner accuracy in x-ray marking. Since the whole basis of the NUCCA work rests on this critical issue it is timely if long overdue. The study should be complete at the end of the year. We wish them well. A rising tide carries all boats.
Dr. Friedman is now showing that while the misalignment of the upper cervical elements is critical and probably causal to the neurological effects that people experience, it may not be a primary cause but rather an effect of the disarray in the tensegral system of tension and compression throughout the body. It is not in dispute that once misalignment of the upper cervical elements has occurred that they cause the progressive and degenerative effects we have come to know as the ASC. It is rather that the misalignment pattern represents the best fallback position the body can accomplish given its options. The adjustment can correct the local misalignment of the upper cervical spine and greatly diminish or eveneliminate the neurological distress at the brainstem. It may not resolve the dis-relationships in the rest of the kinetic chain including the largest mass, the pelvis. The heretofore undisclosed cause (compression) constitutes the long unexamined ‘elephant in the room’.
Upper cervical chiropractic is indeed a full spine technique but it must acknowledge and resolve all of the deleterious factors causing disharmony in the entire kinetic chain. QSM3 represents the first systematic process by which this critically important aspect is recognized and resolved. Many offices using the QSM3 protocols are now reporting phenomenal successes in correcting previously ‘impossible’ misalignments. While we have long acknowledged the full spine implications of upper cervical work, now we are able for the first time, with QSM3, to directly address this elephant in the room and give all patients an adjustment that frees the body from its compressive prison.
As an example, the patient I referred to earlier that would go out of adjustment from a simple nudge of his dog’s nose on his chin, is a long time patient. The NUCCA work had long been a great blessing to him in his life and had actually transformed his health and profession. Even so, he was a frequent visitor to the office. Once the QSM3 protocols began to come together, his misalignment was re-examined and the vector was greatly modified. He began to hold for many weeks at a time and related one day, that he had been playing volleyball in the sand. At one point, he dove headfirst for a ball and landed in a crumpled pile. His alignment remained intact. He wasn’t ‘holding’ it, He had an ease in his whole body that allowed him to absorb the force of hitting the sand without disrupting the structural elements. His happy story is now multiplied by many people in my practice. Reducing aberrant tension in the body increases resilience and vitality.
QSM3 protocols continue to evolve. While this may be frustrating for people who are used to a stable set of procedures, it actually an incredibly exciting time when old limits are being left behind and new possibilities are coming to light which are and will change the work forever and open it up to humanity in a way that hasn’t been possible before. No longer are we ignoring the elephant in the room, we are riding it!