NUCCA: The National Upper
Cervical Chiropractic Association
Presented by the Palmer NUCCA
What is upper cervical?
Many who go through Chiropractic College
hear of upper cervical but do not
understand completely the reasoning
behind an upper cervical technique.
So, how does adjusting the atlas help my
lumbar or my thoracic problem?
Do you know the answer to this question?
An orthogonal upper cervical technique
can truly be called a full spine technique.
The premise of NUCCA: An unbalanced
position between the head and the rest of
the cervical spine can cause debilitating
problems in the rest of the body,
neurologically and biomechanically.
The rationale
Look at it from the top down.
Take a weight and raise it above
your head, so that it feels
centered and balanced.
move that weight to the side or
an imbalanced position, do you
When the delicate articulations
between occiput, atlas and axis
become subluxated our head is
placed in an unbalanced position.
The rest of the body has to
compensate due to the righting
reflex and other proprioceptive
input. This can cause fixations
and pain down through the rest
of the spine.
Why Postural Changes Occur
Accidents and injuries tear connective tissue.
Creates weakness and the spine breaks down.
For stability it locks into position
If the skull and atlas complex lock into a position where the eyes
and ears aren’t level with the horizon, the righting reflex takes over
coupled with other proprioceptive input.
Other portions of the spine must adapt to bring the eyes and ears
back to level
This causes twisting and bending of the spine, all of which is
mediated by the musculature.
Correcting this
misalignment can
objectively predict
restoration of the
entire spine to a
more normal and
balanced position.
NUCCA, like Gonstead and other techniques, uses a
listing system.
50 + years clinical research, (90+ if you include BJ)
indicate that the subluxation exists and can be
captured on X-ray.
If it came out in one specific direction, there is one
specific vector or line of correction that will “put it
back” to where it belongs.
In NUCCA we take
measurements to find a precise vector that will
reposition the head with cervical spine using the least
amount of force necessary.
Measurement Cont.
To illustrate this point…imagine that you want to open a door.
door. You start pushing on the side closest to the hinges.
Finding this difficult and effortful, you step back and think
where would be the spot on the door where, if I push, the
door will open with the least amount of effort. So it is with
NUCCA and other orthogonally based techniques. We measure
to see where is the easiest place “ to push”.
Measuring Subluxation
taken off of Pre-adjustment
X-rays. The subluxation and
x-ray listing should not
change except with trauma.
Some people would say that
subluxation on an x-ray;
however, when the atlas is
out of alignment the body
will respond in a manner
which we can measure. You
can say that the x-ray is
showing how the body looks
in a subluxated state.
Chiropractic Evaluations of
You must find a system that works for you and
your understanding of the human body.
Dual probe? Static palpation? Motion Palpation?
X-ray? Titron/Myovision? Leg Checks?
Whatever you choose in chiropractic, your post
adjustment findings should be better than your
pre adjustment findings.
NUCCA Evaluation of Subluxation
Deals mainly with postural changes
- Supine leg check
- Anatometer
The Adjustment
Atlas is used as an anatomical lever
Adjustment takes into account what will
happen to C2 and occiput during the
Gentle and vectored controlled force is
applied down the ideal line of correction
that will align the head and neck together
at the same time
No twisting or popping – patients love it!
Some patients feel nothing, others feel
the atlas move back into alignment.
Regardless of what is perceived to be
happening from the patient’s perspective,
restoring alignment to the head and neck
will balance the body.
How does it happen?
NUCCA believes that occiput, C1 and C2
are all going to move. Their anticipated
movement is calculated before the
adjustment. With the model of
Wernsing and Grostic, which states
“atlas moves as if on the rim of a circle”
we can see how using atlas as a lever
will influence the Occiput and C2.
Outcome of the adjustment
Clinical research has shown that the closer
you are able to get someone’s head sitting
upright on their atlas with the lower neck
underneath that head, the more likely the
chance you will remain unsubluxated.
Unsubluxated correlates with being both
objectively and subjectively in a healthy
Post Adjustment
Supine leg check – return to normal
Anatometer – more balanced posture
This makes NUCCA a full spine technique.
If I change the position of your pelvis by
putting your head and neck back in
alignment, is this not a full spine
Post Films
Post x-rays are taken to make sure the body responded
the way in which the doctor intended.
NUCCA measures the reduced amount of misalignment
after the adjustment on this post film
If the subluxation has been reduced, the doctor knows
the listing is correct and no other films are needed.
Patients are not x-rayed every office visit, usually only
the first visit.
It is essential to shoot a post film to ensure you are
giving the correction the patient deserves.
Leg Check pre-post
Eriksen pg 468 F
Thoracic and Lumbar
Eriksen pg 454D
Eriksen pg 455D
Lateral Cervical
Eriksen 447C
Nasium Analysis
What the lines represent
Ericksen pg 442-B
Eriksen pg 442-B
Pre Chiropractic Adjustment Eriksen
pg 183
Post Nucca Adjustment
Same Patient
Eriksen pg 183
Post Diversified Adjustment Same Patient
Eriksen pg 183
Post Nucca Adjustment after Diversified
Eriksen pg 183
Images graciously donated/”borrowed” from Kirk
Eriksen and the NUCCA Textbook
Eriksen, Kirk. Upper Cervical Subluxation
Complex – A Review of the Chiropractic and
Medical Literature. 2004. Lippincott Williams &
Thomas, Michael. NUCCA Protocols and
Perspectives – A Textbook for the National
Upper Cervical Chiropractic Association, 1st
Edition. 2002. Edwards Brothers

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