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Upper cervical specific chiropractic

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Upper Cervical Specific Chiropractic is a branch of chiropractic developed and promoted by B.J. Palmer beginning in the 1930s until his death. According to Upper cervical chiropractic, a vertebral subluxation can only occur in upper cervical vertebrae. Therefore this technique places great importance on the anatomical structures of the atlanto-occipital joint, pointing out that it floats on two toed-in spoon like surfaces and is a potential source of instability. This potential instability of the atlanto-occipital joint is theorized to predispose people to an "adaptational imbalance" in the head/neck region.



This theory was brought to Palmer's attention by Al Wernsing, another chiropractor. Soon thereafter, Palmer abandoned his ties to traditional full-spine spinal adjustments and allowed only adjustments of the upper cervical vertebrae, a technique which he termed "Hole in one" (HIO). The technique was the only one to be taught during the remainder of his life at Palmer School of Chiropractic. Afterwards the school adopted the work of chiropractors Clay Thompson and Clarence Gonstead, but eventually labelled its technique curriculum the Palmer Package.

The techniques are characterised by:

1. Main influence on the upper cervical articulations of the occiput, and the atlas and axis vertebrae

2. Focus on vector calculation based upon the theory that kinematic joint dysfunction is related to a positional disturbance.

3. Attempted radiographic analysis of positional disturbance of the atlanto-occipital joint

4. Documentation of post-adjustment results with objective measures [citation needed]

5. Use of a specific vectored force


According to Upper cervical chiropractic, a subluxation can only occur in upper cervical vertebrae. A subluxation must have the following components:[1]

1. A vertebra out of alignment with its co-respondents above and below.

2. Occlusion of a foramen or foramina

3. Pressure upon nerves

4. Interference with transmission of the normal quality flow of mental impulse supply between brain and body

List of named upper cervical techniques

  • Palmer Upper Cervical Specific Toggle Recoil (HIO)
  • Grostic hand adjustment[2]
  • Advanced Orthogonal Techniques & Procedures (AOTP)
  • Atlas Orthogonal Technique (AO)
  • Blair Upper Cervical
  • National Upper Cervical Chiropractic Association (NUCCA)
  • Chiropractic Orthospinology
  • KCUCS Knee Chest Upper Cervical Specific
  • Kale Specific Knee Chest Brainstem
  • Laney Technique
  • Applied Upper Cervical Biomechanics
  • Upper Cervical Orthogonal - Cowin
  • Zimmerman (SAM)
  • Sutter Specific Atlas Correction
  • Life College Upper Cervical Technique
  • Pettibon Upper Cervical Specific Technique


Textbooks such as Eriksen's "Upper Cervical Subluxation Complex"[2] argue for the technique on the basis of empirical evidence in private practice and a review of associated concepts in published literature.

A pilot study[3] concludes that alignment of the atlas vertebra results in notable and sustained reduction in blood pressure.

A review of case studies [4] found upper cervical technique to be promising in the management of neck pain.

A systematic literature review in 2001[5] found upper cervical techniques to be in the least effective group of treatments for low back pain among several chiropractic techniques reviewed.


  1. Palmer, B.J. The Subluxation Specific, The Adjustment Specific, Vol. XVIII, p. 67
  2. 2.0 2.1 Eriksen, K. Upper Cervical Subluxation Complex. A review of the chiropractic and medical literature. Lippincott Williams & Wilkins, 2004. ISBN 0-7817-4198-X
  3. Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B (May 2007). "Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study". J Hum Hypertens 21 (5): 347–52. doi:10.1038/sj.jhh.1002133. PMID 17252032. 
  4. Rochester RP (Aug 2009). "Neck pain and disability outcomes following chiropractic upper cervical care: a retrospective case series". J Can Chiropr Assoc 53 (3): 173–85. PMID 19714232. 
  5. Gatterman MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ (Sep 2001). "Rating specific chiropractic technique procedures for common low back conditions". J Manipulative Physiol Ther 24 (7): 449–56. PMID 11562653.