The Upper Cervical Chiropractic Handbook: Patient Edition


Welcome to The Upper Cervical Chiropractic Patient's Handbook, designed to provide current and prospective patients with a comprehensive guide to upper cervical chiropractic care. In this blog, we will explore the background, science, history, and terminology of upper cervical chiropractic, aiming to bridge the knowledge gap between doctors and patients.

What is Upper Cervical Chiropractic?

Upper cervical chiropractic is a specialised branch of chiropractic care that focuses on the alignment and function of the upper cervical spine, specifically the atlas (C1) and axis (C2) vertebrae. These vertebrae are crucial for supporting the head, protecting the brain and brainstem, and facilitating proper nervous system function, enabling effective communication throughout the body (Woodfield et al. 2015).


Upper cervical chiropractors use specific assessment techniques, such as thorough postural analysis, and advanced imaging, and thermography to help identify misalignments in the upper cervical spine that can interfere with nerve and brainstem function (Woodfield et al. 2015).


The goal of upper cervical chiropractic is to detect and correct these misalignments through gentle and precise adjustments. While adjustments are typically performed manually, some practitioners may also utilise low-force techniques or specialised instruments (Woodfield et al. 2015).


By restoring proper alignment and function to the upper cervical spine, upper cervical chiropractors aim to eliminate interference to the nervous system, promote optimal communication between the brain and body, and facilitate the body's natural healing processes, empowering you to live your best life.

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Where Did Upper Cervical Chiropractic Come From?

Upper cervical chiropractic was developed by B.J. Palmer, the son of the founder of chiropractic D.D Palmer, in the 1930’s. After years of observation and research, B.J. Palmer concluded that the upper cervical spine was the most critical area and the root cause of many conditions seen in his clinic (Palmer 1934).


With the help of professionals like Dr. Thompson and Dossa D. Evins, he created the ‘Hole in One’ Upper Cervical procedure; a precise, accurate, and life-changing approach that encompasses philosophy, science, and art (Palmer 1934).

B.J. Palmer
B.J. Palmer

Why Does Upper Cervical Chiropractic Work?

The effectiveness of upper cervical chiropractic is grounded in scientific principles. This specialised approach has always placed a strong emphasis on understanding the intricate relationship between anatomy and neurology. By addressing the alignment of the upper cervical spine, upper cervical chiropractic aims to facilitate optimal communication between the brain and the body.


Research now confirms the critical role of the upper cervical spine in maintaining a healthy nervous system, with an astounding 95% of nervous system interference occurring at the C1/2 level (Collins & Pfleger 1994). Furthermore, this region serves as a vital conduit for the flow of cerebrospinal fluid, which is essential for brain health (Rosa 2018). By prioritising the well-being of the brain, upper cervical chiropractic promotes overall bodily health and vitality.

Understanding Terminology

To help you better understand your upper cervical chiropractor, here are some important terms:


Upper Cervical: This term refers to the region consisting of the occiput (base of the skull) and the atlas (C1) and axis (C2) vertebrae of the cervical spine. In medical literature, this region is often referred to as the craniovertebral junction. It is a crucial area that connects the skull to the spine and plays a significant role in supporting head movement and protecting the delicate structures of the brain and brainstem.


Occiput (C0): The occiput is the base of the skull, forming the posterior part of the cranium. It directly rests upon the atlas (C1), which is the first cervical vertebra. The occiput provides important attachment points for muscles and ligaments and contributes to the stability and mobility of the upper cervical spine.


Atlas (C1): The topmost vertebra in your neck that supports the base of the head (occiput) and is prone to misalignments due to its high mobility.


Axis (C2): The vertebra below the atlas (C1) that has a projection called the Dens, which protrudes through the middle of the atlas.


Misalignment: When a vertebra has moved out of its normal position, but not to the point of dislocation, often due to trauma or wear and tear, disrupting optimal spinal movement and potentially interfering with the nervous system.


Subluxation: A chiropractic vertebral subluxation is defined by the World Health Organisation as – ‘A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity, and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity’. Upper Cervical Chiropractors believe that this is only possible in the Upper Cervical Spine.


Adjustment/Correction: The application of force by the chiropractor to correct misalignments. It is typically quick, painless, and can be performed on a table or chair.


ASR/ASL/PIL/PIR/PRI/PLI: These abbreviations represent different directions of possible misalignments of the Atlas (C1) and Axis (C2) vertebrae. For instance, C1 ASR indicates that the Atlas has shifted in an anterior, superior, and right direction. It's important to note that misalignments of the C1/2 vertebrae occur in three dimensions, requiring careful assessment and correction to restore proper alignment.


'Let's get you checked': Refers to using a digital thermography device to assess the function of the autonomic nervous system.


Thermography: The study of spinal temperature changes over time. Upper cervical chiropractors use thermography to analyse temperature patterns and their responses to factors like adjustments, rest, and stress.


HRV (Heart Rate Variability): A method of assessing the autonomic nervous system, by analysing variations in the intervals between heartbeats, reflecting the balance between the sympathetic and parasympathetic branches.


Holding: The ability of a patient's spine and nervous system to maintain integrity. Thermography helps determine if a patient's spine remains aligned and their nervous system adaptable, indicating their progress.


Adaptive scan: A positive sign that the patient's body is responding to chiropractic care and adapting to the changes made by the chiropractor. It indicates that there is still progress to be made in the healing process.


Leg Length Inequality: Refers to a postural change associated with an upper cervical misalignment, causing a difference in the perceived length of the legs. This is not due to anatomical differences in leg bone length but is related to neurological interference. Upper cervical chiropractors focus on addressing functional leg length inequalities (Collins & Pfleger 1994).


Brainstem: The brainstem, situated below the brain and adjacent to the cerebellum, plays a vital role in coordinating and controlling the nervous system. Misalignments in the upper cervical spine can potentially affect the brainstem and its functions, leading to various health issues.

B.J. Palmer Adjusting
B.J. Palmer Adjusting

Different Upper Cervical Techniques

There are several upper cervical techniques employed by chiropractors. Here are some of the most popular ones:


HIO (Hole in One): Developed by B.J. Palmer, this technique utilises the toggle recoil method of adjusting. HIO adjustments are performed with a focus on the atlas (C1) and involve a drop and light force to correct misalignments. Thermography is an integral part of this technique.


Blair: This technique involves in-depth X-ray analysis to calculate misalignments. Blair doctors also address the C3 and C4 vertebrae. The adjustment method used in Blair technique also incorporates toggle recoil.


AO (Atlas Orthogonal): This technique utilises a specialised device to correct misalignments, with an emphasis on returning the upper cervical spine to a straight and neutral position.


NUCCA (National Upper Cervical Chiropractic Association): NUCCA is a technique that focuses on correcting misalignments through precise adjustments aimed at restoring the normal position of the atlas (C1) and improving spinal balance.


Knee Chest Upper Cervical: This technique, developed by Dr. Michael Kale, involves gentle and precise adjustments performed on a unique table called a knee chest. It incorporates thermography and a strong understanding of neurology to provide effective care.

(Woodfield et al. 2015)

Experience the Top Chiropractic Difference

We utilise advanced 3D CBCT imaging for precise evaluation of the spine, and calculated correction of misalignments. Our practice incorporates cutting-edge digital thermography and HRV technology to evaluate your autonomic nervous system function and monitor your progress.


Our highly skilled chiropractors specialize in the gentle and precise knee chest technique for effective upper cervical adjustments. With clinics in central London and Birmingham, we offer easy accessibility and convenience for our clients.


To book a complimentary discovery call with Dr. Luke, please click here!

If you are curious and would like to read more about chiropractic, feel free to explore our blog posts here.


*Remember, this handbook is designed to empower you as a patient, providing valuable insights into upper cervical chiropractic care, its benefits, and the terminology you may encounter during your treatment. By understanding the principles and techniques involved, you can make informed decisions and actively participate in your journey towards optimal health and well-being.*


  1. Woodfield, H. C., 3rd, York, C., Rochester, R. P., Bales, S., Beebe, M., Salminen, B., & Scholten, J. N. (2015). Craniocervical chiropractic procedures - a précis of upper cervical chiropractic. The Journal of the Canadian Chiropractic Association, 59(2), 173–192 [Online].
  2. Palmer, B.J. (1934) The Subluxation Specific – The Adjustment Specific; An Exposition of the CAUSE OF ALL DIS-EASE. 1ST Edition. Davenport, Iowa: Palmer University.
  3. Collins, K.F, Pfleger, B. (1994). The Neurophysiological Evaluation of the Subluxation Complex: Documenting the Neurological component with somatosensory evoked potentials. Chiropractic Research Journal 1994; 3(1): 1-4. [Online]
  4. Rosa, S., Baird, J.W, Harshfield, D., Chehrenama, M. (2018). Craniocervical Junction Syndrome: Anatomy of the Craniocervical and Alantoaxial Junctions and the effect of misalignment on the Cerebrospinal Fluid Flow. Intechopen; Hydrocephalus Water on the Brain; DOI: 10.5772/intechopen.72890 [Online]
  5. Collins KF, Pfleger B. Significance of Functional Leg Length Inequality Upon Somatosensory Evoked Potential Findings. 11th Annual Upper Cervical Spine Conference, Life College, Marietta, GA, November 19-20, 1994.

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