Level 1 (Primary)
Blair Upper Cervical Specific
Presented by Dr Jeffrey Hannah
Advanced Blair Certified Instructor
The Rationale of Blair
Upper Cervical Specific
Neuroanatomy Review
Dr Jeffrey Hannah
Advanced Blair Certified Instructor
Atlas Health Australia, Pty Ltd
North Lakes, QLD
The Upper Cervical Rationale
“Separate & Distinct Profession”
CHIROPRACTIC
Medicine
• Philosophy • Outside-In
INSIDE-OUT
• Science
•S
Germs,
UBLUXATION
Genes
• Art
• Drugs,
ADJUSTMENT
Surgery, Therapy
RESTORE
(treat
/CORRECT
effects)CAUSE
• Subluxation
M isalignment
O cclusion
P ressure on Nerve
Dr BJ Palmer, DC PhC
I nterference of Mental Impulse
1882-1961
3D Inability to Self-Correct
The Upper Cervical Rationale
Researching the Known Man
MO3 • Spinograph (X-Ray, 1910)
PI • Neurocalometer (24 Aug 1924)
+ ‘Tempometer & ’Calograph
PI • Electroencephaloneuro
mentimpograph (1934)
MO3 • “Wet Specimen” (1938)
C1-C3 Architecture
Three-Dimensional Motion
• FLEXIBILITY VS STABILITY
• NO INTERVERTEBRAL DISC
C1-C3 Neurocanal Stability
• DENTATE LIGAMENT STRUCTURE
• MYODURAL BRIDGES
Lack of Corrective Control
• NO ACCESSORY INNERVATION
• NO COLLATERAL MUSCLES
Mechanical Cord Sensitivity
Local Effects
• Medullary Nuclei
• NUCLEUS TRACTUS SOLITARIUS
• RVM & RVL NUCLEI
• DORSAL MOTOR NUCLEI
• Craniocervical Nuclei
• V, VIII, IX-X, XI, XII
• C1-C4
• Sensory
• Motor
Mechanical Tract Sensitivity
Distant Effects
• Tracts
• Descending
• Ascending
• Bidirectional
• SUPERIOR CERVICAL
SYMPATHETIC GANGLION
• VASCULAR BRANCHES
• LYMPHATIC BRANCHES
• Vagus Nerve (X)
• Visceral Plexuses
Dystrophy
Local Effects (Upper Cervical)
• Neurocanal
• CEREBROSPINAL FLUID
• VERTEBROBASILAR ARTERIES
• CEREBROSPINAL VEINS
• Trophic Supplies
• Direct
• Brainstem
• Cerebellum
• Indirect
• Hypothalamus
• Cortex
• Spinal Cord
Dysafferentation
Subluxation (MOPI3) →
• Malposition & Dyskinesia
• Aberrant Gen Somatic Afferent (GSA)
• “Congestion” (Gate Theory)
• “Re-routing” (Plasticity)
• “Spillover” (Interference)
Craniocervical Syndrome
Grostic JD. Dentate ligament-cord
distortion hypothesis. Chirp Res J.
1988;1:1.
[Kessinger R. The Medullary Lock.]
Sharpless SK. Susceptibility of spinal roots
to compression block. The Research Status
of Spinal Manipulative Therapy. NINCDS
monograph 15, DHEW publication (NIH)
76-998:155, 1975.
“A pressure of only 10 mm Hg produced
a significant conduction block, the
potential falling to 60% of its initial value
in 15 minutes, and to half of its initial
value in 30 minutes.”
Upper Cross Syndrome
Cailliet R. Neck and Arm Pain (2nd Ed).
FA Davis. 1981.
[The effective weight of the head, 3-5Kg,
on the lower cervical joints doubles per
2.5 cm of anterior head carriage.]
Schleip R. Fascial plasticity - a new
neurobiological explanation: part 2. J
Bodywork Movement Therap, 2003;7(2):
104-116.
“Fascia is densely innervated by
mechanoreceptors which are responsive
to myofascial manipulation. They are
intimately connected with the central
nervous system and specially with the
autonomic nervous system.”
Central Processing Errors
Haavik-Taylor H, Holt K, and Murphy B.
Exploring the neuromodulatory effects of
the vertebral subluxation and chiropractic
care. Chiropr J Aust, 40;2010:37-44.
Haavik-Taylor H and Murphy B. The effects
of spinal manipulation on central
integration of dual somatosensory input
observed after motor training: a crossover
study. J Manipulative Physiol Therap. 33(4);
2010:261-272.
“This study suggests that cervical spine
manipulation not only alters cortical
integration of dual somatosensory input
but also alters the way the central nervous
system responds to subsequent motor
training tasks.
HPA & HPT Axis Dysfunction
Zoccal DB, Furuya WI, Bassi M,
Colombari DSA, Colombari E. The
nucleus of the solitary tract and the
coordination of respiratory and
sympathetic activities. Frontiers in
Physiology. 2014;5:238.
Bakris G, Dickholtz M Sr, Meyer PM, et
al. Atlas vertebra realignment and
achievement of arterial pressure goal in
hypertensive patients: a pilot study. J Hum
Hypertens. 2007 May;21(5):347-52.
“No adverse effects were recorded. We
conclude that restoration of Atlas
alignment is associated with marked and
sustained reductions in BP similar to the
use of two-drug combination therapy.”
HPA & HPT Axis Dysfunction
Marty V, El Hachmane M, Amédée T. Dual
modulation of synaptic transmission in the
nucleus tractus solitarius by prostaglandin
E2 synthesized downstream of IL-1β.
European Journal of Neuroscience. June
2008;27(12):3132–3150.
Selano JL, Hightower BC, Pfleger B, et al:
“The effects of specific upper cervical
adjustments on the CD4 counts of HIV
positive patients.” Chiropractic Research
Journal 1994;3(1):32.
“The effect of specific upper cervical adjustments on the
immune system CD4 cell counts of [10] HIV positive
individuals was measured by CD4/mm3 in the blood. … A
48% increase in CD4 cells was demonstrated over the six
month duration of the study for the adjusted group.”
Neurodegenerative Conditions
Elster EL. Eighty-one patients with multiple
sclerosis and Parkinson's disease undergoing
upper cervical chiropractic care to correct
vertebral subluxation: a retrospective
analysis. J Vertebr Sublux Res. 2004;2:1-9.
Sandro Mandolesi S, Marceca G, Moser J, et
al. Preliminary results after upper cervical
chiropractic care in patients with chronic
cerebro-spinal venous insufficiency and
multiple sclerosis. Ann. Ital. Chir., 2015 86:
192-200.
”We believe that the Upper Cervical correction on C1-C2 could be the main
non-invasive treatment of the CCSVI mechanical type in patients with MS.”
Neurodegenerative Conditions
Flanagan MF. The Downside of Upright Posture.
Two Harbors Press, 2010.
Flanagan MF. The role of the craniocervical
junction in craniospinal hydrodynamics and
neurodegenerative conditions. Neurology
Research International, 2015.
“The craniocervical junction (CCJ) is a potential
choke point for craniospinal hydrodynamics and
may play a causative or contributory role in the
pathogenesis and progression of neurodegenerative
diseases such as Alzheimer’s disease, Parkinson’s
disease, MS, and ALS, as well as many other
neurological conditions including hydrocephalus,
idiopathic intracranial hypertension, migraines,
seizures, silent-strokes, affective disorders,
schizophrenia, and psychosis.”
Myalgic Encephalopathy
Rosa S, Baird JW.
The craniocervical junction:
observations regarding the
relationship between misalignment,
obstruction of cerebrospinal fluid
flow, cerebellar tonsillar ectopia, and
image-guided correction.
Smith FW, Dworkin JS (eds): The
Craniocervical Syndrome and MRI.
Basel, Karger, 2015, pp 48-66.
Vestibular Syndromes
Kulkarni V, Chandy MJ, Babu KS.
Quantitative study of muscle
spindles in suboccipital muscles of
human foetuses. Neurol Indfa,
2001;49(4):355-9.
“The proprioceptive inputs from
the cervical musculature play an
important role in head-eye coordination and postural
processes. The spindle density of
superior oblique muscle was
found to be 190, that of inferior
oblique was 242 and the rectus
capitis posterior contained 98
spindles per gram of muscle. No
tendon organs were seen.”
danmurphydc.com
Vestibular Syndromes
Heikkilä HV, Wenngren BI. Cervicocephalic
kinesthetic sensibility, active range of cervical
motion, and oculomotor function in patients
with whiplash injury. Arch Phys Med Rehabil.
1998 Sep;79(9):1089-94.
Burcon MT. Health Outcomes Following
Cervical Specific Protocol in 300 Patients with
Meniere’s Followed Over Six Years. Journal of
Upper Cervical Chiropractic Research ~ June
2, 2016 ~ Pages 13-23.
“Vertigo intensity rated by 300 patients on a
scale of 0 to 10, with 10 being the worst
imaginable. Prior to treatment mean score
was 8.5, six weeks post treatment average
was down to 3.0 … Ninety seven percent
claimed a dramatic improvement in vertigo.”
Craniofacial Syndromes
Losert-Bruggner B, Hülse M, Hülse R.
Fibromyalgia in patients with chronic CCD
and CMD - a retrospective study of 555
patients. Cranio. 2017 Jun 5:1-9.
Westersund CD, Scholten J, Turner RJ.
Relationship between craniocervical
orientation and center of force of occlusion
in adults. Cranio. 2016 Oct 20:1-7.
“These findings may suggest
interconnectivity between the CCJ and an
individual's occlusal contacts and support
the need for further integration between
chiropractors and dentists seeking to comanage temporomandibular joint
disorders.”
Neuromuscular Conditions
Robinson SS, Collins KF,
Grostic JD.
A retrospective study;
patients with chronic low
back pain managed with
specific upper cervical
adjustments.
Chiropr Res J. 1993;2(4):
10-6.
Eriksen. Upper Cervical Subluxation Complex. 2004:247.
Neuromuscular Conditions
Schwatzbauer J, Koller J, Schwarzbauer M
et al. Athletic performance and
physiological measures in baseball players
following upper cervical chiropractic care:
a pilot study. J Vertebral Subluxation Res,
1997;1(4):33-9.
“The results showed significant
improvement in fourteen weeks in
muscle strength and long jump
distance in the group receiving
adjustments. … Evaluations of these
trends in the group receiving
chiropractic care revealed decreases
in resting blood pressure and pulse
rate as well as pulse rate following
tread mill activity.”
Additional Resources - Texts
Upper Cervical Subluxation Complex: A
Review of the Medical & Chiropractic
Literature. Eriksen. 2004.
The Craniocervical Syndrome & MRI.
Smith & Dworkin. 2015.
The Downside of Upright Posture.
Flanagan. 2010
The Craniocervical Syndrome. Vernon.
2001.
Additional Resources - Citations
Journal Upper Cervical Chiropractic
Research (JUCCR). McCoy Press.
uppercervicalsubluxation.com
Dr Kirk Eriksen
drkirkeriksen.com/research.html
UPC Spine (Greg Buchanan)
upcspine.com
Upper Cervical Advocates (J & R Tomasi)
uppercervicaladvocates.com
Additional Resources - Education
The Doctors Who Give No Medicine.
Hannah. 2012.
The Best Kept Secret in Healthcare. Drury.
2013.
The Power of Upper Cervical DVD
+ Upper Cervical Care: 17 Questions DVD
+ Other Resources
healthychiropractice.com/store/c1/
Featured_Products.html
Rationale & Research
Craniocervical Syndrome
Grostic JD. Dentate ligament-cord
distortion hypothesis. Chirp Res J.
1988;1:1.
[Kessinger R. The Medullary Lock.]
Sharpless SK. Susceptibility of spinal roots
to compression block. The Research Status
of Spinal Manipulative Therapy. NINCDS
monograph 15, DHEW publication (NIH)
76-998:155, 1975.
“A pressure of only 10 mm Hg produced
a significant conduction block, the
potential falling to 60% of its initial value
in 15 minutes, and to half of its initial
value in 30 minutes.”
Upper Cross Syndrome
Cailliet R. Neck and Arm Pain (2nd Ed).
FA Davis. 1981.
[The effective weight of the head, 3-5Kg,
on the lower cervical joints doubles per
2.5 cm of anterior head carriage.]
Schleip R. Fascial plasticity - a new
neurobiological explanation: part 2. J
Bodywork Movement Therap, 2003;7(2):
104-116.
“Fascia is densely innervated by
mechanoreceptors which are responsive
to myofascial manipulation. They are
intimately connected with the central
nervous system and specially with the
autonomic nervous system.”
Neuromuscular Conditions
Robinson SS, Collins KF,
Grostic JD. A retrospective
study; patients with
chronic low back pain
managed with specific
upper cervical
adjustments. Chiropr Res J.
1993;2(4):10-6.
Schwarzbauer J, Koller J,
Schwarzbauer M et al.
Athletic performance and
physiological measures in
baseball players following
upper cervical chiropractic
care: a pilot study. J
Vertebral Subluxation Res,
1997;1(4):33-9.
Eriksen. Upper Cervical Subluxation Complex.
2004:247.
Central Processing Errors
Haavik-Taylor H, Holt K, and Murphy B.
Exploring the neuromodulatory effects of
the vertebral subluxation and chiropractic
care. Chiropr J Aust, 40;2010:37-44.
Haavik-Taylor H and Murphy B. The effects
of spinal manipulation on central
integration of dual somatosensory input
observed after motor training: a crossover
study. J Manipulative Physiol Therap. 33(4);
2010:261-272.
“This study suggests that cervical spine
manipulation not only alters cortical
integration of dual somatosensory input
but also alters the way the central nervous
system responds to subsequent motor
training tasks.
Medullary Dysfunction
Zoccal DB, Furuya WI, Bassi M,
Colombari DSA, Colombari E. The
nucleus of the solitary tract and the
coordination of respiratory and
sympathetic activities. Frontiers in
Physiology. 2014;5:238.
Bakris G, Dickholtz M Sr, Meyer PM, et
al. Atlas vertebra realignment and
achievement of arterial pressure goal in
hypertensive patients: a pilot study. J Hum
Hypertens. 2007 May;21(5):347-52.
“No adverse effects were recorded. We
conclude that restoration of Atlas
alignment is associated with marked and
sustained reductions in BP similar to the
use of two-drug combination therapy.”
HPA & HPT Axis Dysfunction
Marty V, El Hachmane M, Amédée T. Dual
modulation of synaptic transmission in the
nucleus tractus solitarius by prostaglandin
E2 synthesized downstream of IL-1β.
European Journal of Neuroscience. June
2008;27(12):3132–3150.
Selano JL, Hightower BC, Pfleger B, et al:
“The effects of specific upper cervical
adjustments on the CD4 counts of HIV
positive patients.” Chiropractic Research
Journal 1994;3(1):32.
“The effect of specific upper cervical adjustments on the
immune system CD4 cell counts of [10] HIV positive
individuals was measured by CD4/mm3 in the blood. … A
48% increase in CD4 cells was demonstrated over the six
month duration of the study for the adjusted group.”
Neurodegenerative Conditions
Elster EL. Eighty-one patients with multiple
sclerosis and Parkinson's disease undergoing
upper cervical chiropractic care to correct
vertebral subluxation: a retrospective
analysis. J Vertebr Sublux Res. 2004;2:1-9.
Sandro Mandolesi S, Marceca G, Moser J, et
al. Preliminary results after upper cervical
chiropractic care in patients with chronic
cerebro-spinal venous insufficiency and
multiple sclerosis. Ann. Ital. Chir., 2015 86:
192-200.
”We believe that the Upper Cervical correction on C1-C2 could be the main
non-invasive treatment of the CCSVI mechanical type in patients with MS.”
Myalgic Encephalopathy
Rosa S, Baird JW.
The craniocervical junction:
observations regarding the
relationship between misalignment,
obstruction of cerebrospinal fluid
flow, cerebellar tonsillar ectopia, and
image-guided correction.
Smith FW, Dworkin JS (eds): The
Craniocervical Syndrome and MRI.
Basel, Karger, 2015, pp 48-66.
Vestibular Syndromes
Heikkilä HV, Wenngren BI. Cervicocephalic
kinesthetic sensibility, active range of cervical
motion, and oculomotor function in patients
with whiplash injury. Arch Phys Med Rehabil.
1998 Sep;79(9):1089-94.
Burcon MT. Health Outcomes Following
Cervical Specific Protocol in 300 Patients with
Meniere’s Followed Over Six Years. Journal of
Upper Cervical Chiropractic Research ~ June
2, 2016 ~ Pages 13-23.
“Vertigo intensity rated by 300 patients on a
scale of 0 to 10, with 10 being the worst
imaginable. Prior to treatment mean score
was 8.5, six weeks post treatment average
was down to 3.0 … Ninety seven percent
claimed a dramatic improvement in vertigo.”
Craniofacial Syndromes
Losert-Bruggner B, Hülse M, Hülse R.
Fibromyalgia in patients with chronic CCD
and CMD - a retrospective study of 555
patients. Cranio. 2017 Jun 5:1-9.
Westersund CD, Scholten J, Turner RJ.
Relationship between craniocervical
orientation and center of force of occlusion
in adults. Cranio. 2016 Oct 20:1-7.
“These findings may suggest
interconnectivity between the CCJ and an
individual's occlusal contacts and support
the need for further integration between
chiropractors and dentists seeking to comanage temporomandibular joint
disorders.”
Is Subluxation Real?
Blair WG. Primary and adaptative
malformations and Procedures for solving
malformation problems. Research Thesis.
Palmer College of Chiropractic. May 1968.
“In non-fractured, non-dislocated misalignment
of the Occipito-Atlanto segments at the
Occipito-Atlanto articulation, one Atlanto
lateral mass travels longitudinally, either
anteriorly or posteriorly, (whichever the case
might be) along the longitudinal articular axis of
its corresponding occipital condyle while the
partner lateral mass travels either transversely
or obliquely across the longitudinal articular
axis of its corresponding occipital condyle and
in a plane parallel to the longitudinal axis of the
articulation which presents true longitudinal
misalignment.”
Original Resources
GREEN BOOKS
• The Subluxation Specific, The Adjustment Specific ✭ (18)
• Researching the Known Man (19)
• Precise, Posture-Constant Comparative Spinographs ✭ (20)
• Modern X-Ray Prac & Chiropr
Spinography (21) - Remier
• Clinical Controlled Chiropr
Research ✭ (25)
• Answers (28)
Contemporary Resources - Texts
Upper Cervical Subluxation Complex: A
Review of the Medical & Chiropractic
Literature. Eriksen. 2004.
The Craniocervical Syndrome & MRI.
Smith & Dworkin. 2015.
The Downside of Upright Posture.
Flanagan. 2010
The Craniocervical Syndrome. Vernon.
2001.
Contemporary Resources - Citations
Journal Upper Cervical Chiropractic
Research (JUCCR). McCoy Press.
uppercervicalsubluxation.com
Dr Kirk Eriksen
drkirkeriksen.com/research.html
UPC Spine (Greg Buchanan)
upcspine.com
Upper Cervical Advocates (J & R Tomasi)
uppercervicaladvocates.com
Contemporary Resources - Education
The Doctors Who Give No Medicine.
Hannah. 2012.
The Best Kept Secret in Healthcare. Drury.
2013.
The Power of Upper Cervical. Storyville
Studios. 2007.
II. Blair & Supporting Research
1. Original Blair Research
a. Blair WG. Research; for evaluation; for progress. Intl Rev Chiropr 1968;22(8):
8-11.
b. Blair WG. Research: for evaluation; for progress. Intl Rev Chiropr 1968;22(9):
10-14.
c. Blair WG. Research: for evaluation; for progress. Intl Rev Chiropr
1968;22(12):14-16.
d. Blair WG. Blair Upper Cervical Spinographic Research Primary and Adaptive
malformations, Procedures for Solving Malformation Problems: Blair
Principle of Occipito-Atlanto Misalignment. Ph.C. Thesis, Palmer College of
Chiropractic, 1968.
2. Asymmetry
a. Gottlieb MS. Absence of symmetry in superior articular facets on the first
cervical vertebra in humans: implications for diagnosis and treatment. J
Manip Physiol Ther. 1994 Jun;17(5):314-20.
b. Febbo TA, Morrison R, Valente R. Asymmetry of the occipital condyles: a
computer-assisted analysis. J Manipulative Physiol Ther. 1992 Nov-Dec;
15(9):565-9.
c. Naderia S, Kormanb E, Cıtak G, et al. Morphometric analysis of human
occipital condyle. Clinical Neurology and Neurosurgery 107 (2005) 191–199
3. Articular Margins
a. Briggs L, Hart J, Navis M, Clayton S, Boone R. Surface area congruence of
atlas superior articulating facets and occipital condyles. Journal of
Chiropractic Medicine. 2008;7(1):9-16. doi:10.1016/j.jcme.2007.08.007.
“All 3 methods revealed that the articular surfaces of the atlas and corresponding
or contralateral condyle for specimens used in this study were not an exact match.”
b. Addington EA, Hubbard TA. Surface area congruence of atlas superior
articulating facets and occipital condyles. Journal of Chiropractic Medicine.
2009;8(2):92-93. doi:10.1016/j.jcm.2008.12.004.
“Blair does state broadly that “the articulations of the body perfectly match at the
articular surfaces”; but he subsequently restricts his consideration to the
“comparison of articular surfaces at their margins,” advancing no specific
hypothesis as to surface areas. Finding that the medial margins of the AO
articulations are “seldom well-defined” and “do not offer us articular surface
comparison,” he developed the Blair Oblique Protractoviews specifically to image
the most anterolateral or “distal condyle lateral mass margins” parallel to the
longitudinal axis of each articulation. Viewing even these distal margins at too
posterior or too anterior a point can be misleading as to articular alignment.”
4. X-ray Reliability & Analysis
a. Hubbard TA, Vowles BM, Forest T. Inter- and intraexaminer reliability of the
Blair protractoview method: examination of a chiropractic radiographic
technique. Journal of Chiropractic Medicine. 2010;9(2):60-68. doi:10.1016/
j.jcm.2010.02.004.
b. Hubbard TA, Pickar JG, Lawrence DJ. Radiographic analysis of the anterior
to posterior open mouth (APOM) cervical spine view: frequency of atlas
transverse process overlap of the inferior tip of the mastoid process. J
Manipulative Physiol Ther. 2012 Jul;35(6):477-85. doi: 10.1016/j.jmpt.
2012.07.007.
c. Eriksen K, The Sigler and Howe Study? Vector; 1999;2(4).
d. Harrison DE, Harrison DD, Troyanovich SJ. Reliability of spinal displacement
analysis of plain X-rays: a review of commonly accepted facts and fallacies
with implications for chiropractic education and technique.J Manipulative
Physiol Ther. 1998 May;21(4):252-66.
e. Owens EF. Line drawing analyses of static cervical X ray used in chiropractic.
J Manipulative Physiol Ther. 1992 Sep;15(7):442-9.
“Reliability studies exist showing that inter- and intraexaminer reliability are
sufficient to measure lateral and rotational displacements of C1 to within +/- 1
degree. It is not known how much of the changes that are seen in pre/postradiograph sets are due to positioning changes of the patient between
radiographic procedure, and how much are due to actual changes of skeletal
relationships brought about by adjustment.”
f. Harrison DE, Harrison DD, Colloca CJ, et al. Repeatability over time of
posture, radiograph positioning, and radiograph line drawing: an analysis of
six control groups. J Manipulative Physiol Ther. 2003 Feb;26(2):87-98.
“In 48 out of 50 measurements, the differences between initial and follow-up
radiographs are less than 1.5 degrees and 2 mm. These measurements indicate
that posture is repeatable, radiographic positioning is repeatable, and
radiographic line drawing analysis for spinal displacement is highly reliable. The
scientific literature on these topics also indicates the repeatability of posture,
radiographic positioning, and radiographic line drawing.
“… These results contradict common claims made by several researchers and
clinicians in the indexed literature. Chiropractic radiologic education and
publications should reflect the recent literature, provide more support for posture
analysis, radiographic positioning, radiographic line drawing analyses, and
applications of posture and radiographic procedures for measuring spinal
displacement on plain radiographs.”
g. Owens EF, Henderson CN, Gudavalli MR, Pickar JG. Head repositioning
errors in normal student volunteers: a possible tool to assess the neck's
neuromuscular system. Chiropr Osteopat. 2006 Mar 6;14:5.
“During the neck extension test, actively contracting the posterior neck muscles
evoked an undershoot of the target position by 2.1 degrees (p <0.001). No
differences in repositioning were found during the lateral flexion test.”
h. Hallgren RC, Andary MT. Undershooting of a neutral reference position by
asymptomatic subjects after cervical motion in the sagittal plane. J
Manipulative Physiol Ther. 2008 Sep;31(7):547-52. doi: 10.1016/j.jmpt.
2008.08.011.
i.
Eriksen K. Comparison between upper cervical x-ray listings and technique
analyses utilizing a computerized database. Chiropr Res J. 1996;3(2):13-24.
j.
Grostic JD, DeBoer KF. Roentgenographic measurement of atlas laterality
and rotation: a retrospective pre- and post-manipulation study. J Manip
Physiol Ther. 1982;5(2):63-71.
k. Eriksen K. Owens EF. Upper cervical post x-ray reduction and its relationship
to symptomatic improvement and spinal stability. Chiropr Res J. 1997;4(1):
10-7.
“The patients in this doctor’s practice had better outcome on the average, based
on the improvement of clinical signs and the rediuced need to follow-up
adjustment, when the occipito-atlanto-axial subluxation complex was reduced by
at lease 50% after the first adjustment.”
5. Leg Length Analysis
a. Cooperstein R, Morschhauser E, Lisi AJ. Cross-Sectional Validity Study of
Compressive Leg Checking in Measuring Artificially Created Leg Length
Inequality. Journal of Chiropractic Medicine. 2004;3(3):91-95. doi:10.1016/
S0899-3467(07)60092-5.
“Instrumented, compressive leg checking seems highly accurate, detecting artificial
changes in leg length of 2–3 mm, and thus possesses concurrent validity assessed
against artificial LLI. Pre- and post leg check differences should exceed about 4–6
mm to be highly confident a real change has occurred.”
b. Knutson GA. Anatomic and functional leg-length inequality: A review and
recommendation for clinical decision-making. Part I, anatomic leg-length
inequality: prevalence, magnitude, effects and clinical significance.
Chiropractic & Osteopathy 2005, 13:11 doi:10.1186/1746-1340-13-11.
c. Knutson GA. Anatomic and functional leg-length inequality: A review and
recommendation for clinical decision-making. Part II, the functional or
unloaded leg-length asymmetry. Chiropractic & Osteopathy 2005, 13:12
doi:10.1186/1746-1340-13-12.
d. Woodfield HC, Gerstman BB, Olaisen RH, et al. Interexaminer reliability of
supine leg checks for discriminating leg-length inequality. J Manipulative
Physiol Ther 2011;34:239-246.
“The examiners showed moderate reliability in assessing leg-length inequality at
1/8-in increments and good reliability in determining the presence of a leg-length
inequality.”
e. Schneider M, Homonai R, Moreland B, Delitto A.J Manipulative Physiol
Ther. Interexaminer reliability of the prone leg length analysis procedure.
2007 Sep;30(7):514-21.
f. Holt KR, Russell DG, Hoffmann NJ, Bruce BI, Bushell PM, Taylor HH.
Interexaminer reliability of a leg length analysis procedure among novice
and experienced practitioners. J Manipulative Physiol Ther. 2009 Mar-Apr;
32(3):216-22. doi: 10.1016/j.jmpt.2009.02.009.
6. Thermography Validity & Reliabilty
a. Uematsu S. Thermographic imaging of cutaneous sensory segment in
patients with peripheral nerve injury. Skin-temperature stability between
sides of the body. J Neurosurg. 1985 May;62(5):716-20.
b. Voloshyn HH. [The thermal pattern of skin in healthy persons]. Lik Sprava.
2002;(1):20-4.
“Based on data from published literature the author has reached the conclusion
that the thermal pattern in healthy people has many "hot" and "cold" zones the
occurrence of which is due to exposure to a number of anatomical and
physiological factors, in the first place,--to particular features of blood supply.
However, the distribution of infrared radiation relative to the middle line is in fact
symmetrical, the physiological temperature difference does not exceed 0.5 degree
C. The knowledge of normal thermal patterns is the necessary condition in
interpreting the thermogram in the patient.”
c. Zaproudina N1, Varmavuo V, Airaksinen O, Närhi M. Reproducibility of
infrared thermography measurements in healthy individuals. Physiol Meas.
2008 Apr;29(4):515-24. doi: 10.1088/0967-3334/29/4/007. Epub 2008 Apr
9.
“The results suggest that the IRT technique may represent an objective
quantifiable indicator of autonomic disturbances.”
d. Plaugher G, Lopes MA, Melch PE, Cremata EE. The inter- and intraexaminer
reliability of a paraspinal skin temperature differential instrument. J
Manipulative Physiol Ther. 1991 Jul-Aug;14(6):361-7.
e. Roy RA, Boucher JP and Comtois AS. Digitized Infrared Segmental
Thermometry: time requirements for stable recordings. Journal of
Manipulative and Physiological Therapeutics July/August 2006:468e1-10.
f. Roy RA, Boucher JP and Comtois AS. Paraspinal cutaneous temperature
modification after spinal manipulation at L5. J Manipulative Physiol Ther
2010;33:308-314.
g. Owens EF, Hart JF, Donofrio JJ, et al. Paraspinal Skin Temperature PatternsL
An Interexaminer and Intraexaminer Reliability Study. Journal of
Manipulative and Physiological Therapeutics March/April 2004:155-9.
“Intraexaminer and interexaminer reliability of paraspinal thermal scans using the
TyTron C-3000 were found to be very high, with ICC values between 0.918 and
0.984. Intraexaminer reliability is slightly higher than interexaminer reliability.
Changes seen in thermal scans when properly done are most likely due to actual
physiological changes rather than equipment error.”
h. McCoy M, Campbell I, Stone P, Fedorchuk C, Wijayawardana S, et al. (2011)
Intra-Examiner and Inter-Examiner Reproducibility of Paraspinal
Thermography. PLoS ONE 6(2): e16535. doi:10.1371/journal.pone.0016535
“This study revealed excellent intra-examiner and inter-examiner reproducibility of
paraspinal thermography using a commercially available unit.”
i.
Mansholt BA, Vining RD, Long CR, et al. Inter-examiner reliability of the
interpretation of paraspinal thermographic pattern analysis. J Can Chiropr
Assoc 2015 (Jun); 59 (2): 157-164.
“Overall inter-examiner reliability was fair (k=0.43). There was good agreement for
identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor
agreement was noted in partial categories (k=0.05-0.22).”
When, NOT Where
j.
Meeker WC, Gahlinger PM. Neuromusculoskeletal thermography: a
valuable diagnostic tool? J Manipulative Physiol Ther. 1986 Dec;9(4):257-66.
“In general, the literature reports high sensitivity and negative predictive value, but
lower specificity and positive predictive value.”
k. Triano JJ, Budgell B, Bagnulo A, et al .Review of methods used by
chiropractors to determine the site for applying manipulation. Chiropr Man
Therap. 2013 Oct 21;21(1):36. doi: 10.1186/2045-709X-21-36.
7. Blair Case Studies
a. Hubbard TA, Kane JD. Chiropractic management of essential tremor and
migraine: a case report. Journal of Chiropractic Medicine. 2012;11(2):
121-126. doi:10.1016/j.jcm.2011.10.006.
b. Hubbard TA, Crisp CA, Vowles B. Upper cervical chiropractic care for a 25year-old woman with myoclonic seizures. Journal of Chiropractic Medicine.
2010;9(2):90-94. doi:10.1016/j.jcm.2010.03.001.
c. Hubbard TA, Crisp CA. Cessation of cyclic vomiting in a 7-year-old girl after
upper cervical chiropractic care: a case report. Journal of Chiropractic
Medicine. 2010;9(4):179-183. doi:10.1016/j.jcm.2010.07.006.
d. Herman CA. Resolution of Low Back Pain in an 8-year-old Following Blair
Upper Cervical Chiropractic Care: A Case Report. Journal of Upper Cervical
Chiropractic Research;Jul 2016:24-30.
e. Burcon MT. Upper Cervical Specific Pattern Analysis Utilizing Paraspinal
Thermography, Leg Length Inequality and Heart Rate Variability in Two
Patients with Tachycardia. Journal of Upper Cervical Chiropractic
Research;Mar 2016:6-12.