Upper Cervical Concepts

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Dan Murphy, DC

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

            A key component to understanding the upper cervical spine is to understand the Trigeminal-Cervical Nucleus. In his 1995 article Nikolai Bogduk, MD, PhD¹ makes these points:

            The point is that the trigeminal nerve afferents and the upper cervical afferents are neuro-mechanically linked. Upper cervical spine afferent mechanoreceptors arising from the capsules, ligaments, and discs are well documented. Importantly, the sub-occipital muscles are documented to be the most densely innervated (by far) with muscle spindle mechanoreceptors.²

• Neuroanatomical Pathways

            “Our first conscious muscular act is nursing at the breast. The neuronal pathways mediating and stipulated by nursing from the beginnings of our awareness of ‘self’ as well as the neuronal substratum upon which all future emotional and mental experience is interpreted and recorded. The tactile and oral sensations that accompany this extremely important act, namely pleasure, warmth and security, are conveyed centrally primarily by the trigeminal nerve, the trigeminal sensory nuclei in the brain stem, the trigeminal tracts, the nucleus VPM [ventral posterior medial] in the thalamus and its myriad connections.”

            “Conceivably whether a person is basically happy and content in life, whether he or she is trusting of others human beings, and whether he or she is capable of loving another human being may all depend upon the sufficient stimulation, activation and persistence of these neurons, their connections and their neurotransmitters.”

• The Brain and Behavior:

            There are monosynaptic inputs to the hypothalamus that arise from within the trigeminal spinal nucleus. “These fibers project directly to many areas of the hypothalamus. The monosynaptic pathways provide a route for reflex autonomic and endocrine behaviors.” 

• Integration

            The central nervous system (spinal cord, brain stem and brain) is built upon the quality of its afferent (sensory) stimulation. Apparently the first and most important sensory afferent input for the development of the synaptic array of the spinal cord, brain stem, and brain is to the trigeminocervical nucleus. The quality of the input into the trigeminocervical nucleus is ultimately linked to the following:

• Headache perception
• Emotional and mental experience
• Happiness and being content in life
• Trusting of other human beings
• Being capable of loving another human being
• Autonomic (visceral) nervous system function
• Endocrine hormonal function

DISCUSSION

            The KEY is the understanding that the sensory afferent input into the trigeminocervical nucleus originates from two primary sources:

1)    Mouth/temporomandibular function (TMJ)

2)    Upper cervical spinal mechanical afferentation

These concepts are well supported by German physician Heiner Biedermann, MD.^3-5 

SUMMARY

            The powerful systemic influences of upper cervical chiropractic improvement of mechanical afferentation is linked to the most important mechanical (not to mention nutritional) influences on central neurological development: breast feeding.

 

References

1)    Nikolai Bogduk, MD, PhD Anatomy and Physiology of Headache Biomedicine and Pharmacotherapy; 1995, Vol. 49, No. 10, 435-445.

2)    Boyd-Clark et. al., Quantitative Study of Muscle Spindles in Suboccipital Muscles of Human Foetuses; Neurology India, 2001, 49, 355-359.

3)    Kinematic Imbalances Due To Suboccipital Strain In Newborns. Journal of Manual Medicine; June (No. 6) 1992, pp151-156.

4)    Manual Therapy in Children, Churchill Livingstone; 2004.

5)    Manual medicine of functional disorders in children. Medical Veritas: The Journal of Medical Truth; 2006; Vol. 3; pp. 803-814.

New Chiropractic BioPhysics® Training Institute and Spinal Health Center will Open in Boise-Eagle, ID

 

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            On June 22, Drs. Deed and Shirlene Harrison, of CBP® Seminars, procured an 11,000 sq. ft. class A professional building in down town Eagle, Idaho; just outside of Boise, ID. The purpose of this building is twofold:

1. To operate a Chiropractic BioPhysics (CBP) training facility where Chiropractors around the world, interested in learning all aspects of CBP Technique, will come to acquire the knowledge and skills necessary to practice CBP and become CBP Certified Chiropractors. Thus, part of the new facility will be a state of the art 2,000 sq. foot conference room capable of running 2-sessions simultaneously; and
2. To operate a full scale, multi-doctor, CBP patient spine rehabilitation and health center. Currently, the Chiropractors chosen to run this CBP patient center are Drs. Deed and Shirlene Harrison, Dr. Todd Pickman, and Dr. Joe Betz.

            For Dr. Deed Harrison, this is a dream come to fruition. It has always been challenging to train Chiropractors in the technicalities and nuances of CBP Technique in a hotel conference setting without the necessary equipment (adjusting tables and instruments, traction equipment, exercise and rehabilitation equipment, and radiographic facilities). Also, the perspective of how a full scale CBP office looks, feels, functions, and operates is lost in the 'hotel convention center' environment. This new facility will solve these dilemmas. Also, CBP will launch its new Chiropractic Assistant (CA) training certification program out of this facility.

            The new CBP facility is just west of Boise in Eagle, ID and is approximately 20 minutes from the Boise international airport. The facility is located in Eagle's premiere business complex: The Eagle River Business park and is at 950 E. Riverside Drive in Eagle, ID. The amenities of this business complex are outstanding with a Hilton hotel, local favorite restaurants, parks, and a paved-maintained trail system for walking and biking along the Boise river.

            The CBP patient center is scheduled to open in October of this year (2012) while the CBP training institute will open its doors in January of 2013. Watch CBP's website (www.idealspine.com) for the 2013 conference schedule and for further details.

CBP Lumbar Extension Traction Evidenced in Two Recent RCT's

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            In the last couple of months, two new randomized controlled trials have been published having strong impact on CBP Technique protocols and procedures. These two randomized trials were authored by Ibrahim Moustafa, PhD and Aliaa Diab PhD; both from the Basic Science Department, Faculty of Physical Therapy, Cairo University, in Egypt.^1,2 The two trials built on and expanded the knowledge of a previous non-randomized trial on supine lumbar extension (3-point bending) traction published by Deed E. Harrison, DC and colleagues.³

            Moustafa and Alia's trials demonstrated that lumbar extension traction increases the lordosis and improves pain, disability, and nerve function in patients with chronic low back pain¹ and chronic discogenic lumbo-sacral radiculopathy² and concomitant lumbar hypo-lordosis. For complete study abstracts see the CBP NonProfit, Inc. research update in this issue by Dr. Oakley.

1. Moustafa IM, Diab AA. Rehabilitation for Pain and Lumbar Segmental Motion in Chronic Mechanical Low Back Pain: A Randomized Trial. Journal of Manipulative and Physiological Therapeutics Volume 35, Issue 4 , Pages 246-253, May 2012.
2. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil June 8, 2012 Published online before print June 8, 2012.
3. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(11): 1585-1591.