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Measuring and Correcting the Atlas/Axis Complex
– an exciting role for the massage therapist
By John D Barrera
In this article, John D Barrera neurology, physiology and functional
discusses the fascinating C1/C2 anatomy. This new role will vary widely
depending on the level of training and
region of the cervical spine.
approach is very effective in the short term
but needs additional support to attain
longer lasting relief.
C1/C2 displacements can have far reaching
implications on both anatomy and
physiology. Literally billions of neurons
traverse this region providing essential,
life sustaining information to the entire
body. Compromised fluctuations in
normal bloodflow by way of vertebral
artery occlusion due to C1 mal-position
may contribute to vascular type headaches
and dizziness as well as pressure related
injury (stroke). A myriad of pain patterns
with bizarre phenomena are possible with
C1/C2 vertebral mal-position due to
increased joint pressure and undue
influence on the cranial nerves. The
measurement and correction of upper
cervical spine subluxation complexes i.e.
C1 and C2 vertebra, is essential if long
term relief is to be attained.
This article will help massage therapists
better understand their role and ability to
treat the cervical spine. Massage therapists
will learn the importance of working well
within their scope of practice i.e. soft tissue
treatment, corrective stretching and
corrective movement therapy. We are not
‘adjusting’ the spine as our friends in the
osteopathic and chiropractic professions
are licensed to do. With this new
understanding, the massage therapist is
likely to develop solid referral networks
with other allied healthcare professionals.
Further, this article can help the massage
therapist realise his or her powerful role
and ability to positively influence
the cervical spine via specific soft
tissue manipulation and active/passive
stretching.
This new field of pain relief and pain
management is multifaceted. Today’s
massage therapist must be well versed in
To be effective in this simple but complex
area, the massage therapist must more
thoroughly understand the role of Form
vs. Function. Wolf ’s Law of Bone
Transformation states ‘every change in the
form and the foundation of a bone, or in
its function alone, is followed by certain
definite changes in its internal architecture
and secondary alterations in its external
conformation.’ A muscle’s primary
mandate is movement and a bone’s primary
mandate is one of structural support. This
law basically tells us that form and function
are inseparable.
The loss of cervical curvature is a
change in the function of the structure that
can result in ‘certain definite changes’ in
the form of the bone. When the loss of
cervical curvature has occurred, usually as
a result of trauma, we see vertebral body
remodeling take place i.e. spurs, lipping of
end plates, degenerative disc disease and
arthritic changes. A functional/mechanical
stenosis may also occur at the dural tube
level as internal ligaments are tensioned
due to vertebral body position. Many
mysterious symptoms develop when a loss
of cervical curve is present.
Muscles and ligaments help determine
exactly where the C1 vertebra will come to
rest on its articular facets. The superior
and inferior articular facets that exist
between C1/Occiput and between C1/C2
allow for great movement within this
region. These joints create a majority of
the cervical spine’s ability to rock, tilt, flex
and extend. The articular facets between
C1 and C2 and C1 and Occiput allow the
C1 vertebra to essentially float in place.
These joints are saucer-like and glide easily
upon one another especially if lax ligaments
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work experience. A therapist desiring a
career in a rehabilitation setting should
seek advanced level clinical courses and
insist on working in clinical/medical
settings. This placement is likely to provide
the exposure necessary for a successful
clinical/medical massage therapy career.
Brief history of techniques
Atlas/Axis adjustment techniques have
been around since the early 1900s in
the form of chiropractic manipulation.
Chiropractic originators such as D D
Palmer and his son B J Palmer realised that
cervical vertebra displacement at any level
could and usually did play a major role in
body pain syndromes. Unfortunately, little
if anything was known about the
connective tissues that encapsulate,
stabilise and maintain these joints. With
the exception of Dr Raymond Nimmo’s
receptor tonus work, strategic massage
technique and specific muscle stretching
designed to target the soft tissue component
of cervical imbalance were mostly
nonexistent.
Grostic Chiropractic made its debut in
the 1960s. This form of upper cervical
manipulation specifically targeted the
upper two cervical vertebras. Interestingly,
the late Dr John Grostic was a Palmer
College graduate. Dr Grostic used high
velocity low amplitude (HVLA)
chiropractic techniques to ‘adjust’ C1 and
C2 vertebral subluxation. This particular
approach if indicated, usually offered
instantaneous relief in the form of a
decrease in proprioceptive joint pressure.
Unfortunately, the relief was usually
shortlived as neurological energy in the
form of muscle tonus would re-establish
the joint pressure instantaneously relieved
by the adjustment. Generally speaking this
Techniques in practice
Journal of the Australian Asso ciation of M assage Therapists
Massage
Therapists
exist. Pressure from the loss of cervical
curvature and or the hypercontraction of
certain musculature can cause the vertebra
to displace and or shift. Relatively speaking,
and for the purpose of this discussion;
there are two distinct types of movement:
functional and dysfunctional.
Functional movement may be defined
as the joint’s normal inherent movement
capability. This includes but is not limited
to movements within the joint complex
that allow flexion, extension, lateral
movements, circumduction, etc. These
movements are attainable provided the
joint is healthy and free from soft tissue
hypercontraction and dysfunction (joint
pathology). Generally speaking, a
moveable spine is a healthy spine.
Dysfunctional Movement (DM) may
be defined as aberrant movement patterns
that include hyper and hypomobility and/
or a position in space that may have
resulted from habitual patterns and or
trauma. DM is created by work and play
habits, accidents, hereditary factors and
other activities of daily living. A system of
categorisation has been created by the
author to measure and quantify the degree
of movement within the C1/C2 complex
that is thought to be pathological. Potential
imbalances can be documented as Lateral
Shearing (Atlas) Rotation (C1/C2)
Projection (C1) and Tilt dimensions.
These imbalances may also exist in
combinations. An example of this is an
atlas that is in both a rotated and tilted
position in space relative to known
landmarks.
The potential for healthy movement
usually turns to dysfunction with the
imposition of violent acceleration/
deceleration forces similar to those
commonly experienced in car crashes.
These forces act to undermine the integrity
and stability of the capsular ligaments and
muscles thus leading to hyper and hypomobility and positional displacement.
Additionally, muscle pathologies such as
ischemic contraction and Trigger Points
further the potential for imbalance. Once
a joint is hyper or hypo-mobile, its position
in space, especially the atlas, becomes
secondary to muscular tension, habitual
postural patterns and activity.
Upper cervical vertebra displacements
usually go undiagnosed, causing a myriad
of seemingly mysterious negative
symptoms. The measurements and
evaluation process set forth in this course
of study will greatly aid the MT
in determining C1/C2 position.
Measurements can be taken using known
landmarks as points of reference. One
particular point of reference is the mastoid
processes of the temporal bone. These
boney protuberances are located directly
above the lateral processes of the Atlas.
Using them as reference point, it can be
determined whether the atlas is in a
normal or pathological position.
The resultant pain due to mal-position
of the C1 and C2 vertebra is largely due to
the increase in proprioceptive pressure
within the joint, compression of spinal and
cranial nerves and alterations in structural
bloodflow to the brain due to changes in
the cervical architecture. Deep internal
facial pulls may also exist and can create a
myriad of symptoms. The dural tube is
anchored at C2 and the area around the
foramen magnum usually suffers
unnecessary connective tissue pulls that
compromise health. This deep internal
dural tube pulling will affect vertebral
bone position. Muscular imbalance due to
trauma wills likely result in abnormal
muscle pull (imbalance) and other
dysfunctions of the connective tissue thus
leading to Atlas/Axis mal-position.
A qualified massage therapist has a
distinct advantage regarding this area in
that he or she can not only perform
appropriate soft tissue techniques but also
apply specific Atlas/Axis corrective
stretching techniques that can potentially
provide long term, pressure relieving
positional balance. Leveraging, blocking
(inhibition) and capturing a vertebra, so
that the soft tissues that reside above and
below it are stretched are well within an
massage therapist’s scope of practice. The
addition of an active phase movement to
this stretch allows the massage therapist to
utilise the client’s muscle recruitment
ability to further enhance the stretching
strategy.
Atlas/Axis balancing from a soft tissue
perspective is in its infancy. Research in
the form of hands-on therapy and by trial
and error was performed that fostered the
development of the technique known
today. Formal research has not been
conducted in the massage therapy field.
Clinical massage therapists in the USA
have had great success with their soft tissue
approach to headache situations. It is
widely known that the specific release of
ischemic muscle hypercontractions and
trigger points is effective for a myriad of
pain syndromes. This work takes massage
therapy to the next level.
The Atlas/Axis treatment flow charts
are an integral part of healing this vital
region of the body. The charts memorialise
the potential for both balance and
imbalance. A massage therapist in our
opinion needs to know how to measure
and determine whether or not vertebral
mal-position is responsible for the
pain a client may experience. Once this
information is understood, correction of
the imbalance is quite easy in most cases.
A manual therapist must also realise the
importance of not only the preparatory
benefits of clinical massage but also its role
Summer 2007
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Feature
in the long term stabilisation of the C1/C2 complex.
This new field of massage treatment targets one of the root
causes of cervicogenic pain. By balancing the area between the
Atlas and Axis and the area between the Atlas and the occiput,
pressure is lifted from vital cranial nerves and blood vessels that
reside in the area. The restoration of the cervical curve allows
bloodflow to the brain to normalise as well as the minimisation
of mechanical structural stenosis. Pressure is also relieved from
the dural tube via the C2 and foramen magnum attachments.
John D Barrera RMT CNMT MTI is a clinical massage
therapist and international presenter with more than 22 years
of active medical/clinical massage experience. He has spent
the last six years furthering the development of Atlas/Axis/
Cranial Base balancing for the massage therapist. John has
authored two measurement and treatment strategy flow charts
that will further the understanding of the massage therapist and
other allied health professional in this emerging and fascinating
field of study. The Atlas/Axis/Cranial Base Connection could be
an answer to relentless head, neck and body pain.
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Jou rna l of t h e Au st r a l ia n As s o c iat i on of M as s ag e Th e r a pi sts