QSM³: History of Upper Cervical Chiropractic So Far

Chiropractic began in D.D. Palmer’s appreciation of the systemic effects of local breakdown (a lesion termed subluxation) in the electrical/mechanical flow system that modulates the distribution (arrangement) of forces (both internally derived from volitional muscle activity as well as externally received from interaction with the environment) within the body. He was originally what we might now term a ‘polarity therapist’ and he was aware of how local lesions affect the whole person. This necessarily involves assessment of the nervous system since muscular forces are initiated and modulated through sensory–motor feedback in the peripheral and central nervous system. Practically, this resulted in an outside-in model of care in which the peripheral effects were followed back to the spine where integrative effects were possible and innate above-down healing could occur.

Chiropractors began to assess every spinal segment for motion and alignment and found success in using specifically applied forces to individual segments to open and realign them. This was a laborious and time-consuming process and eventually evolved into a Majors and Minors concept in which certain segments were understood to have more mechanical advantage and when properly adjusted, resulted in resolution of mechanical breakdown throughout a specific area of the spine, ‘correcting’ the minor subluxations without direct contact with every segment. The Gonstead technique is a good example of this approach.

By the mid 1920’s it was becoming apparent to some chiropractors that the upper cervical region constituted the major subluxation and that resolution here could and often did result in overall resolution of body-wide alignment and optimization of joint function. The complexities of this area presented many challenges and various procedures evolved to understand both misalignment and correction. The first upper cervical approach, Hole-In-One (HIO), evolved from work by Wernsing (AA), Palmer (BJ), and others. By the later 1930’s, Grostic (JF) had begun to formulate his orthogonally-based upper cervical approach based on analysis of   biomechanical lever systems operational in the head and upper cervical spine. He viewed this area using aligned x-ray equipment and strict patient positioning techniques. The three dimensional (3D) misalignment was extrapolated through analysis of three different 2-D flat plates both before and after initial adjustment.

Clinically, the Grostic work depends on supine leg length analysis which reveals a functional ‘short leg’ when upper cervical misalignment (as defined by the above noted x-ray analysis) is present. Thermographic pattern analysis was (and is) also commonly used. Once correlation between x-ray analysis and supine leg check was established, the presence of a ‘short leg’ on supine leg check became the indicator for upper cervical adjustment obviating the need to x-ray patients on an ongoing basis. Pt was considered to have a ‘misalignment pattern’, which would remain fairly stable barring new traumas that altered the dynamics of the system.

Gregory (RR) expanded the Grostic definitions and biomechanics in order to educate doctors to understand the biomechanical factors and to discern how to adapt the calculated vectored force for re-adjustment when reduction was inadequate or disproportional. Four basic types of misalignment were identified and optimal biomechanical strategies were developed for each type. Gregory and Seeman (D) also developed a device (the Anatometer) to measure posture in the neutral standing position. This opened up postural distortion to measurement and the functional short leg became just one factor in the whole body accommodation to disordered forces with respect to gravity. The Anatometer demonstrated that the whole body was adapting and compensating to the subluxation. Findings include altered bilateral weight balance, unleveling of the pelvis, rotation of the pelvis, movement of the fixed point (C7 or T1) into the right or left frontal plane. Proper upper cervical adjustment was now seen to resolve the misaligned posture and restore optimal alignment with gravity.

After several decades of clinical practice, several issues began to become apparent. In 2002, Thomas (MD) pointed out that the bony structures do not touch which makes fulcrums impossible and challenged the current concept of analysis which was based in lever systems. While the lever system approach resulted in a safe, powerful and corrective adjustment much of the time, there were consistent problems that occurred in a minority of cases which indicated that a lever system approach did not answer all of the observed problems. “Fudge factors” (the adding or subtracting of height and rotation vectors) became common in the work which used a very disciplined system for patient placement and analysis both of which required extreme precision and yet after analysis, vectors would often need to be shifted by significant amounts in an arbitrary manner to obtain adequate upper cervical reductions on x-ray analysis. This non-scientific approach initiated investigation by Russell Friedman, DC, a NUCCA and Orthospinology Board Certified Chiropractor.

The spine is essentially a closed kinetic chain. Adjustive force can be transmitted throughout the chain. Basic examination of the skeletal elements reveals the pelvis to, by far, have the greatest mass in the kinetic system (chain). One of the questions that initiated the founding of Quantum Spinal Mechanics (QSM3) was frequent observation that while the upper cervical spine was often proportionately reduced to an orthogonal normal, the alignment of the head and neck were frequently not directly on the vertical axis but rather 1 or 2 degrees away from the vertical. Dr. Friedman realized that the head represents the fine-tuning in the kinetic chain and that if the pelvis (and hence the body’s center of gravity) is not aligned with the vertical axis, then the cranial elements cannot just line up vertically but must compensate with (at the very least) head tilt.

Alignment of the upper cervical spine (regardless of perfect alignment with gravity) will resolve a multitude of problems associated with the local structures including the cervical elements, the cranial nerves, and blood and cerebral spinal fluid flow through the head. This ‘wow!” factor is well known to upper cervical doctors. However, because of post-reduction head tilt and several other issues, Dr. Friedman believed he could do better for his patients.

Dr. Friedman started evaluating the pelvis and began to correlate the misalignment of the pelvis to the misalignment above. The question became: with so many misalignment patterns below, why only evaluate of the structures in the upper cervical region? An atlas in one position could have right weight asymmetry in the frontal plane, a different short leg, and a different pelvic rotation. Friedman started looking at the pathways that connect the upper cervical region to the pelvis in a simplistic bone-to-bone model at first. Different headpiece and patient positions were initially used to steer the vector to ‘move lower segments back into place’. This system evolved well and made great strides in correctability by the QSM³ doctor.

This brought Drs. Thomas and Friedman to a crossroads. The developing analysis was revealing that the pelvic/lumbar complex was of primary importance. The upper cervical region was now being understood as a region of compensation for pelvic misalignment. The righting reflex, vestibular apparatus, and the dense beds of mechanoreceptors in the pelvis and the C0/C1/C2 region support this concept. The C1 area was not, however, abandoned. Its proximity to brainstem as well as its remarkable access to the MFE (myofascial envelope) gives 3D access to every area of the body and makes it a uniquely powerful corrective input. The realization that it is necessary to first correct the largest lever (pelvis) via the UC area was a profound advance. It created the first connection relationship.

At first, the measured rotation of the pelvis replaced the rotation vector component in the adjustment. To the amazement of many, the atlas rotation would correct on x-ray analysis even when counter-rotated to the pelvis. Eventually, the whole vector system was abandoned and replaced with clearing of the frontal and rotational quadrants. The shoulder rotation was incorporated as the next piece. The evolution of understanding regarding the necessary order required to restore orthogonality was tedious but progressively more successful, as challenges arose and new paths opened.

Gregory and Seeman’s Anatometer (a postural measurement device) was necessarily modified because of its design limitations. The Anatometer has a center post upon which the hip calipers can be moved up and down as well as rotated. Pelvic misalignment however, is a coupled process that requires movement in the frontal, transverse, and sagittal planes. Because of the center post, rotation is essentially constrained to posterior rotation as it necessarily follows the post in a circular orbit. Accurate measurement of any anterior rotation of the pelvis is hampered by the constraints of the center post. Pelvic theta z rotation (rotation in the sagittal plane) is also unclear and immeasurable with the Anatometer. A new device that overcomes the design limitations of the Anatometer is now being manufactured by QSM³.

While the medullary and pontine reticulospinal tracts in the brainstem modulate tension in the paraspinal musculature, the distribution of tension throughout the body is facilitated by another intrinsic design element that answered the limitations of the fulcrum-lever biomechanics which had been previously used. This is the principle of Tensegrity. Tensional integrity or Tensegrity was a concept first formulated by Kenneth Snelling and Buckminster Fuller. It has been extensively examined and refined at the cellular level by Donald Ingber at Harvard and at the level of the organism by Levin and others. Briefly, tension is continuous (the myofascial envelope) throughout a tensegral structure and the compressive elements (for us the bones) are discontinuous (they don’t touch). Tension is always distributed throughout the structure dissipating and storing otherwise potentially damaging forces and optimizing potential for movement.

A human being has a nervous system that continually adapts to its environment and modifies its own structure to optimize function. Humans neurologically moderate tension in the axial skeleton while relying on the distributive nature of the myofascial envelope to store, transmit and dissipate tension to match current needs. This understanding reveals not a bone-out-of-place, or a segmental dysfunction but rather a whole organism shifting its wholeness as best it can, given the possibilities.   The adjustment is not rendered to a bone, not even the transverse process of the atlas, but rather to the whole organism at a point of entry that is acceptable to the body and results in a transformation of the whole organism.

The whole body consequences of tensegrity led Dr. Friedman to look at what happens when tensegrity breaks down and results in asymmetrical compressive forces that distort the body posture. This was a significant break through. Chiropractic and Upper Cervical Chiropractors alike use a downward corrective force. Dr. Friedman recognized on all full spine views a commonality of bowing and spiraling. The new perspective initiated examination of the mechanics and consequences of decompression. Removing compressive forces that held the body in a downward spiral (curvilinear)and restoring it to a linear misalignment which could then be corrected was now understood to be essential. Clinically, the use of the “Grid” (a large 2D Cartesian grid poster) facilitates visual measurement of the low shoulder and the side of body compression. QSM3 has now evolved to understand how and when to best release the compression. Working synergistically and releasing structures towards the vertical allows the tensegral structure to release most efficiently. Just as a compressed spring would be best released (and with least non-harmonic resonance) towards neutral zero (the gravity line).

One observation that intrigued Friedman on x-ray analysis was the frontal plane curvature of the spinouses on the Nasium. The x-ray film analysis creates a line from C2 to VP but the spinouses often did not follow this line on the pre or, more importantly, the post. He realized he was looking at a process of structural compression under gravity. This spinal bending created a locking of the structures that made linear reduction impossible. It was also present in the rotation observed on the vertex and the loss of lordotic curve (or even reversal) on the lateral cervical film. While this compression is not visible as a direct misalignment factor on the line analysis, it is a system wide problem that inhibits linear correction of the misalignment factors. Dr. Friedman saw decompression of the cervical spine as imperative if optimal reduction of all misalignment components were to be achieved. Without reduction of the compression, Adjustive force tends to jam patterns into orthogonality but under some deleterious loading.   While this may clear the upper cervical elements, it leaves unbalanced forces in the body. The body remains under deleterious tension. Chronic problems may become better but remain chronic.

Tensegrity led us back to Vitalism and our endless search for cause. Dr. Friedman kept saying: “If you don’t know the cause, how can you fix it?”

The human body can be subjected to multiple traumas that cause postural misalignment patterns that are either balanced or unbalanced. The human body uses the majority of its energy to maintain postural balance. It is the coordination and orchestration from nervous system proprioception to the 3D motor response by the myofascial envelope (MFE) that facilitates the maintenance of a minimal energy, minimal stress position. The MFE at a 3D level coordinates balances through a matrix of pathways that originate in the feet, and anchor superiorly until they all insert into the skull. Modulation of the superior structure via the righting reflex, vestibular apparatus, and proprioception (with most dense beds at C0/C1/C2 and pelvis) create tension lines though the MFE to create and support balance. The support of the human frame is obviously a neuro-myofascial response. This system minimizes structural misalignment above a trauma acting as a first class lever. The spine is in effect, the long lever arm, the weight of the head acts as the load and C0/C1/C2 functions analogously as a fulcrum. This is the only 3D modulator in the whole human body. Ralph Gregory termed the various misalignment factors ‘resistant pathways’ indicating he was aware of the progressive breakdown occurring after trauma. It is in the QSM³ protocol that we finally have clearly identified the progression from trauma to whole body misalignment, revealing Gregory’s prescience. The insertion points of all the pathways end at the top of this 3D gyroscope called the skull.

Thousands of hours of clinical examination and being endlessly open to the empirical findings led Dr. Friedman to look at the occipital fibers (DeJarnette (MB)) that attach both anteriorly and posteriorly to the skull. Mechanically active sheets of fascia interpenetrate all aspects of the body and most of them terminate (or begin!) in the area around the transverse process of atlas. Defining the pathways from initial trauma to reaction to secondary traumas and more led Dr. Friedman to an algorithm which can sequentially assist the body to release these restrictions, restoring the body to both standing posture alignment as well as orthogonality on post films. This work does not change the outcome measures; it changes how we get there.

Examination of the patient reveals how their body is responding to gravity at the moment of examination. Adjustment based upon these examinations addresses the factors that are currently present. QSM³ examines the orientation of the pelvis and uses this information to refine and define the adjustment. Other techniques have measured aspects of pelvic misalignment but none have used the measurements to help guide the upper cervical adjustment. Information regarding the greatest mass (the pelvis) in the kinetic chain is imperative to restoration of the system to optimal function.

Measure, Access, remove, and release are the biomechanical tenants of the QSM3 method. Patterns are measurable. They are accessed through a tier of protocols for patient and headpiece placement. The pathways are released via a dynamic correction approach that involves a ‘connectivity’ flow of matter and energy from doctor to patient.

Static measurement of dynamic systems is always problematic because a snapshot of a moving object can only tell a limited part of the tale. Measurements of nonlinear dynamics have now become available due to vastly improved ability to process data with computers. Obtaining accurate and reproducible measurements of wiggly human beings has always been a problem. Nonlinear dynamics measures patterns over time. We are now investigating ways to measure function that more closely match our dynamic natures.

A most interesting feature of complex dissipative systems (systems like us that need to exchange air and food and water and have relationships, etc.) is that they come to balance far from equilibrium. We find that these complex systems have what are termed ‘emergent properties’. These are properties that are not predictable from looking at the individual ‘pieces’ or components that comprise the ‘whole’. Who could look at fifty trillion individual cells and imagine that they could all be integrated perfectly as ‘you’? You yourself are an emergent property in this context. Emergent properties only occur at a specific level of complexity and are quite different from what preceded them. Language is another example of an emergent property. Ilia Prigogine won the Nobel Prize in Chemistry for this concept in 1977.

Many of the universal, fractal like qualities that Chiropractic and others have always assigned to ‘the vital force, the life force, among a multitude of names, may well be better understood through the model of non-linear dynamics and dissipative systems. Integration of consciousness and cognition with the upper cervical model of healing is a goal of QSM³. This work is ongoing.

Michael Thomas DC, QSM³ Innovator

“In upper cervical work we see that the body works to maintain itself with respect to gravity.  This is necessary if we want to move about and live life.  When there is an optimal state, the body (when measured in a neutral standing position) is aligned with the vertical axis; the center of gravity of the individual is aligned with the gravity line.  Bipedal weight balance is equal.  Pelvis is centered, level and untwisted with reference to the gravity line.  The rest of the body is then perched directly over the pelvis in a vertical orientation creating a minimal energy, minimal stress position that minimizes torque forces and maximizes potential for movement.”

Michael Thomas DC, QSM³ Innovator