Bilateral Cervical Syndrome: Analysis and Adjustment

 

se22#1 Zemelka bilateral cervical syndrome - Fig 1By: Wayne Henry Zemelka, DC

Adjusting Procedures of the Thompson Technique

Analysis

To detect a Bilateral Cervical problem, place the patient in the prone position on the table and check the leg length in extension. They will appear even in the extended position and when flexed will remain even. Lower the legs to the extended position, lifting them slightly off the footrest, and ask the patient to turn the head to the right. If a bilateral problem exists the right leg will become slightly shorter. Have the patient turn the head to the left and the left leg will become shorter.

The term “bilateral cervical syndrome” is really a misnomer, in that it really addresses an occipital problem similar to an AS Occiput found in the Gonstead Technique. The difference is the manner in which it is adjusted on the segmental table. Palpation will also confirm this, as there will be taut and tender fibers at the base of the Occiput and, in many cases, radiating pain down the cervical region.

se22#1 Zemelka bilateral cervical syndrome - Fig 2This particular problem is quite evident in the population, especially those people who are sitting in front of a computer for hours on end. What brings on the problem in many instances is that the monitor is not placed properly and the individual is tilting the head back into extension.

Adjustment

We will use both the cervical and dorsal drops with the cervical piece tilted 10–12˚ down in order to place the Occiput in the proper position for the adjustment. The doctor may stand on either side with the episternal notch of the doctor over the centerline of the patient. The contact point is left and right thenar placed on the posterior inferior aspect of the Occiput lateral of the EOP (Fig. 1). The fingers are splayed out and toward the ceiling to minimize the P-A effect in this move. The line of correction is inferior to superior with emphasis on horizontal line of drive and up toward the ceiling as noted in Fig. 2.

By keeping the doctor’s upper torso over the patient as much as possible, and the shoulders squared off with the patient, you will be capable of delivering an equal amount of adjustive thrust to each side of the Occiput (Fig. 3).

Remember that as the doctor delivers the adjustment there is very little P-A motion in this move since this is accomplished by the drop headpiece that drops forward and down (Fig. 4). The fingers should be pointed toward the ceiling, and the thrust is horizontal and toward the ceiling. The objective is to place your focus on moving the occipital condyles on the atlas from anterior to posterior, thereby aligning the articulations. The low force, high velocityse22#1 Zemelka bilateral cervical syndrome - Fig 3 motion introduced by the adjustment affects the afferent “b” fibers causing them to reverse their tendency to be in a contractured state.

Patient Profile Example

The symptomatology often found with a bilateral cervical syndrome covers a range of sinus inflammation, ear infections, TMJ pain, and difficulty in chewing, and may contribute to TMJ disorders. In some cases a “Cyclic Event” is developed with problems in the TMJ affecting the Occiput, and in some cases the reverse is found. (Note: There is a specific adjusting procedure for the TMJ that we will cover in a later article.)

The rationale for this position is that the attachments of various muscles are inter-related, such as the attachment of the posterior belly of the digastric muscle to the mastoid notch and the anterior belly to the internal portion of the TMJ. This attachment is completed with a common tendon through the hyoid bone. The mylohyoid nerve that serves the anterior belly receives its innervation from the Fifth Cranial, and the posterior belly from a branch of the facial nerve.

What this means is that because of a problem that may arise in the occipital area, pain may be referred to the front lower portion of the TMJ. In turn, a TMJ problem may precipitate an occipital reaction. Therefore, when doing your examination, be sure to list all the various possibilities that may contribute to the problem as you gather the necessary data to make a decision as to what to adjust on your patient.

se22#1 Zemelka bilateral cervical syndrome - Fig 4The occipital problem may also be affected by or affect other muscle groups of the cervical region, such as the splenius capitis, splenius cervicis, semispinalis capitis, etc. Problems in the head and neck may arise from any number of muscle and nerve involvements related to a subluxation, or causing a subluxation.

Another major concern when considering muscles that may affect the Occiput is involvement of the sternocleidomastoideus and trapezius muscles that make their attachment into the occipital region. If for some reason these muscles become contractured, it produces a complex problem that the doctor must examine, analyze and determine if additional care may be needed for the patient. This may involve consideration of adjustment of the dorsal vertebrae or the sternum and clavicle that may contribute to the overall problem.

These very problems are why it is important to know how to adjust not only the articulations of the spine, but to also have the knowledge and the segmental drop table to perform adjustments on articulations throughout the areas in question.

It is important to realize that the adjusting procedures of the Thompson Technique be done only on a drop table. There are no exceptions to this rule; for if you follow the procedures properly and be conservative in your adjusting, you can adjust the spine, the rib cage, and extremities on the same table.

The Foot/Cervical Spine Connection

I mentioned earlier in this article that problems in the head and neck may arise from any number of muscle and nerve involvements related to a subluxation, or causing a subluxation. Keep in mind: The body is a chain of interconnected segments, with the feet as its base. Foot instability may contribute to observable postural distortions as far up the chain as the cervical spine. Examining for and treating (and I’m thinking here both of applicable adjustments and Foot Levelers’ custom-made, flexible orthotics) any detectable foot conditions should be an integral part of neck pain management.

About the Author

Dr. Wayne Henry Zemelka is a 1975 graduate of Palmer College of Chiropractic. He was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department. “Dr. Z” also taught in the Technique Department, Business Management and Continuing Education. In 1997 he was elected once more as Faculty President. He retired from Palmer in 1998.