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

5. No vertebrae is subluxated unless it is off normal position in three directions and remains such (Vol. XVIII)

List of named upper cervical techniques[edit]

  • 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


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 systematic literature review in 2001[3] 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. ^ a b Eriksen, K. Upper Cervical Subluxation Complex. A review of the chiropractic and medical literature. Lippincott Williams & Wilkins, 2004. ISBN 0-7817-4198-X
  3. ^ 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. doi:10.1016/s0161-4754(01)75655-2. PMID 11562653.