By: Kevin Wapelhorst, DC and Wayne Henry Zemelka, DC [ed.]
The “Overcompensated Cervical Syndrome” or “Rotated Cervical Syndrome” is a condition that is not all that common in our patient population, and to the average doctor it is a challenge to manage. The Thompson Technique, however, provides the doctor of Chiropractic a procedure to manage and eventually correct this condition. You must understand that Dr. Clay Thompson used the segmental drop table to not only move bones, but to also affect the associated muscles with certain conditions. The “Rotated Cervical Syndrome” is one of those conditions where the underlying muscles are directly affected with the adjusting procedure.
Q & A
Some of you may be asking yourselves, just what is the “Overcompensated Cervical Syndrome?” This just happens to be a situation in the cervical spine where the vertebrae have rotated to one side, hence, “Rotated Cervical Syndrome.” On occasion, you may be able to palpate this on a petite patient, but to truly confirm this condition you must visualize it on the AP X-ray of the cervical spine. On the X-ray you will see the spinous processes of C6 – C2 rotated to one side. Generally, C2 will be rotated the most, but on occasion I have seen C3 take this role. The next question most likely will be, how does this occur in a patient? This will occur either in a traumatic fashion, such as a “CAD” (Cervical Acceleration Deceleration) accident, or a repetitive situation. A stomach sleeper, who sleeps with the head to one side consistently, will present with this condition. Someone who works on an assembly line may present with this as well, where they may be primarily looking in one direction while performing specific job tasks.
Rotation Leads to Adaptation
The rotation of the vertebrae is not the only aspect of this condition that makes it a challenge. When the rotation occurs, there is an adaptation by the cervical muscles that occurs, which complicates matters. Typically, on the side of spinous process rotation, the muscles will be spasmodic or in a shortened contracted state. On the side of the body rotation, the muscles will be taut due to lengthening. In both cases, the muscles will be weakened and the normal tone of the muscles affected.
Now that I have explained what the “Overcompensated Cervical Syndrome” is, I will let you know how your patients may present. Notice that I said “may” present—there is no one specific sign or symptom that a patient may present with. A patient may present with something as simple as restricted cervical motion, but many times it is more complicated than this. Patients may present with: restricted motion; spasms in the cervical muscles; radiating pain from the side of the neck into the shoulder or arm; pain in the shoulder(s); headaches; pain in the upper back; and there may be numbness and tingling in the arm(s).
The first thing you must do is to perform a detailed history, then perform a thorough exam, and take X-rays. Remember that X-rays are the only way to truly confirm this particular condition, which would enable you to manage this to the best of your abilities.
The Adjusting Procedure
Now that you know what you are confronted with, you will be able to proceed with the adjusting procedure that will correct this condition. This is as much of a soft-tissue (muscle) procedure as it is an osseous one, and you will understand why as I explain. In working up this patient, follow the normal Thompson Technique Protocol. I say this because this may present as a Cervical Syndrome when performing the Derifield – Thompson Leg Checks, at which time you would adjust this first, and then proceed with the Protocol.
Patient placement is prone on the segmental drop table. Remember that following the Thompson Technique Protocol means you perform these adjusting procedures on a drop table that has pelvic, lumbar, dorsal, and head pieces. The doctor’s stance is straight away on the side of body rotation. The segmental contact point on the patient is at the base of the neck just lateral to the head of the first rib. The contact point on the doctor is #8 or near the first metacarpal-phalange joint of the superior hand. The thumb of the superior hand is pointing towards the patient’s feet with the doctor’s arm parallel to the floor.
This will be your line of drive/line of correction. Instruct the patient to turn the head (face) away from you or toward the side of spinous rotation, and lay the head down on the headpiece. Turning the face toward the side of spinous rotation rotates the spinous processes back towards the midline of the patient, allowing for better correction.
As your patient rests the head on the headpiece, the doctor stabilizes over the zygomatic arch with the metacarpal-phalange joints of the inferior hand (Fig. 1). The headpiece is deflected 10–15˚ to help traction the cervical spine. Thrust 3–4 times from S-I (superior to inferior) and slight P–A (posterior to anterior). Multiple thrusts enable you to override the patient’s “fight or flight” response and affects the Afferent – B fibers in the muscles. By stimulating the Afferent – B fibers, the body begins to reinstate a more normal muscle tone, therefore allowing for proper function of the cervical spine.
There are special considerations you must keep in mind when managing your patients with this condition: Advanced DJD/DDD, Advanced Osteoporosis, Any Cervical Arterial Dysfunction, and Cervical Ribs. In cases such as these, you may need to alter your approach to adjusting by not turning the head. Proceed with a lighter P-A (posterior to anterior) thrust on the side of body rotation. You may institute a specific exercise program to help re-establish normal muscle tone and function. Correction of this condition may take longer in instances such as this, but it is safer for the patient.
In conclusion, there is no set time frame or number of adjustments for this condition. It is purely, on an individualized basis, dependent upon the patient’s lifestyle, overall health and activity level, and their willingness to do the exercises to help bring about normal muscle tone and function. This is a combination osseous and soft-tissue approach that Dr. Thompson used to manage and correct the “Overcompensated Cervical Syndrome.”