Chiro adjustment for neck disorders

and upper thoracic and Xray lines

Muscle attachment: to find which segment
misaligned
Acute muscle pain (ache, stiff) 1-3weeks: symptoms mainly coming from
muscles
1. Release muscle tension until RoM of that muscle to at least 60%
2. Find muscle attachment: do adjustment for misaligned segment with 80%
of force maximum to just release muscle tension deeply to just reduce Pain
significantly
3. Duration: treat until Pain Scale to 3-4/10, usually 2-3weeks with 4-
5times/week
So at the 1st visit: Patient in Acute pain without Images: Can we treat them?
Yesss but only for reducing Pain temporarily. Telling them first few treatment
only for reducing Pain, not treat their main causes of their prob.
Posterior neck muscles

• 1. Superficial (2): Trapezius, splenius (capitis and cervicis).

• 2. Deep (3): cervical transversospinalis (semispinalis capitis,

semispinalis cervicis, multifidus cervicis): CORE MUSCLES

• 3. Deepest (4): suboccipital, interspinales cervicis and

intertransversarii colli
Trapezius
Unilaterally: lateral flexion and
contralateral rotation of head

Bilaterally: extension of head.

Elevation, depression, retraction

and rotation the scapula.
Patient got HA+neck
pain+shoulder pain at all
directions of shoulder. Plz treating
Trapezius at the first
descending part
- FROM: nuchal line and the external
occipital protuberance of the occipital
bone
+ occiput:
https://www.youtube.com/watch?v=Y-zice
Ur3ZA
https://www.youtube.com/watch?v=0BNAD
N-qI2M

+ c1:
https://www.youtube.com/watch?v=1WK1-K
DVdGA
https://www.youtube.com/watch?v=0BhGz4
mE7CA
+ C2
transverse part:

+ from SP of C1-C6 & C7-T3.

Usually C6-T3/4
https://www.youtube.com/watch?v=kRHANx2pjjg
Double Thenar (DTh) T3-T12
https://www.youtube.com/watch?v=TLulQAzquRI
Supine Diversified (SuD) C2-C6

to scapular spine.
https://www.youtube.com/watch?v=I7p7b6D6Ezc
How We Treat Pain Between The Shoulder Blades
• The ascending part:
+ from SP of T4-T12.
ADJUST: T4-T8 mainly, why not T9-T12?
https://www.youtube.com/watch?v=Q6I-qiebrno
Modified Diversified Pisiform (MDP) T1-T3

+ to: scapular spine

https://www.youtube.com/watch?v=ESNxlOkNai8
SHOULDER BLADE PAIN!
Splenius muscles
• extend the head: bilaterally
• unilateral contraction: lateral flexion and rotation of the head to the
same side.
• the splenius capitis and splenius cervicis.
Splenis capitis

From SP of vertebrae C7-T3 to mastoid process

of temporal bone.
Adjust mainly: C7-T1/T3-T4

https://www.youtube.com/watch?v=hNnA15-Z
1y8
Diversified Pisiform (DP) C7-T2

Pain at upper cervical and occiput areas: FROM

lower cervical and upper Thoracic
splenius cervicis

• From SP of T3-T6 to TP of C1-C3

• Again think about lower cervical
and upper thoracic when
treating upper cervical prob

• https://www.youtube.com/watc
h?v=e8KBUL1Z_RE
Supine Diversified (SuD) Atlas
Cervical transversospinalis muscles
• extend the head and neck: bilateral contraction
• laterally flex and rotate the head to the same side: unilateral
contraction.
Semispinalis capitis

• from articular processes of C4-

C7 and TP of T1-T6 to nuchal
lines of occipital bone.

• https://www.youtube.com/watc
h?v=Xdmck7Az-8U
Supine Diversified (SuD) Occiput
Semispinalis cervicis

from TP of vertebrae T1-T6 and to

SP of C2-C5.
https://www.youtube.com/watch?
v=XQ6I7FUytaE
Double Transverse (DTv) T3-T11
(Simple Listings)
Multifidus cervicis

from the articular processes of C4-

C7 to SP of C2-5 levels above the
origin.
https://www.youtube.com/watch?
v=3VeGOpkNbmI
https://www.youtube.com/watch?
v=ZDnKFb5CXHk
Deepest layer
• THINK: How we get there

• Suboccipital muscles:
+ four small muscles found in the suboccipital region
+ maintaining posture
+ extension, lateral flexion and rotation of the head at the atlanto-axial
joint.
Rectus capitis posterior major

from SP of axis-C2 to lateral part

of inferior nuchal line.

https://www.youtube.com/watch?
v=EDNDe6d-2dg&t=4s
Seated Diversified (SeD) C2
Rectus capitis posterior minor

From posterior tubercle of atlas-

C1 to medial part of inferior
nuchal line.
https://www.youtube.com/watch?
v=8Fa1XWnDi28
Chiropractic Adjustment | Side
Posture Toggle Recoil Upper
Cervical | Dr. Eddie Weller | Atlas
Obliquus capitis inferior

• From SP of axis-C2 to TP of atlas-C1

• Supine Diversified (SuD) Atlas

https://www.youtube.com/watch?v=e8KBUL1Z_RE
Obliquus capitis superior

+ from TP of atlas-C1 to occipital bone

https://www.youtube.com/watch?v=a1v5DL07_9o
Supine occipital lift
Interspinales cervicis
• arise from the superior aspect of
spinous processes of vertebrae
C3-T1 and insert onto the
spinous processes of vertebrae
C2-C7.
• https://www.youtube.com/watc
h?v=NB7xvoNpyR4
• Chiropractic Adjustment Prone
Upper Thoracic Spine
Intertransversarii colli
• arise from transverse processes
of C1-T1 and insert into
transverse processes of the
superior adjacent vertebrae.
• only assists in lateral flexion of
the head and to stabilize the
cervical spine during movement.
most superficial in the anterior neck
• Sternocleidomastoid muscle
+ clavicular head originates from the medial third of
the clavicle
+ sternal head arises from the manubrium of
sternum.
+ insert onto the mastoid process of the temporal
bone.
+ Unilateral contraction: lateral flexion of the neck
on the same (ipsilateral) side and lateral rotation of
the head to the opposite (contralateral) side.
+ Bilateral contraction: flexion of the
neck
https://www.youtube.com/watch?v=sLmOCXxk3FY

Acute Torticollis Case - Atlas Adjustment

Lateral neck (vertebral) muscles
• anterior, middle and posterior scalene muscles

• mainly produce ipsilateral flexion of the neck.

 Anterior scalene
+ arises from the anterior tubercles of TP of C3-
C6
+ inserts onto the scalene tubercle and first rib.
+ flexion of the neck.
+ elevation of the 1st rib with action of the
external intercostals expands thoracic cage,
important during forced respiration.
https://www.youtube.com/watch?v=lyue4sxWXxk

Session Sit In: Trap and Scalene Release to Treat Thoracic Outlet
Syndrome in a Baseball Player
 MID SCALENE

+ arises from TP of axis (C2) and atlas

(C1), and TP of C3-C7. + insert onto
first rib.
+ it stabilizes or raises the 1st rib
during forced inspiration.

https://www.youtube.com/watch?
v=AiFLFn9UzRE
SUPER RELAXING SCALENES SOFT
TISSUE WORK
Posterior scalene muscle
• From TP of C4-C6 and inserts
into the second rib.
• stabilization or elevation of the
second rib
Neck Pain and Headache: The Most
Common Upper Cervical Disorder
Symptoms
https://www.youtube.com/watch?v=AxxFlDBOfJs

https://www.youtube.com/watch?v=sLmOCXxk3FY
Relaxing Sinus Release & Class 4 Laser Treatment

https://www.youtube.com/watch?v=CJOLMf83Dtg
Difficulty Breathing, Acid Reflux, and Anxiety HELPED!

https://www.youtube.com/watch?v=EmQHWI4_2HU
The *Biggest Emotional RELIEF* on the Internet experienced by
married couple! Dr. Rahim Chiropractic
Cervical Myelopathy and Spinal Cord
Compression
• About Myelopathy

• More common in adults age 50 and older

• Most often affects the cervical spine (neck)
• Less common in the thoracic spine (mid back)
• Sometimes affects the low back (eg, severe lumbar spinal stenosis)
• Usually a gradual and progressive disorder
• Can develop quickly (eg, trauma, injury)
Symptoms

• Neck pain and stiffness

• Tingling
• Numbness
• Weakness
• Find yourself dropping things
• Hand clumsiness (eg, buttoning a shirt)
• Balance problems
• Difficulty walking
Possible Causes
• Cervical kyphosis
• Cyst or tumor
• Degenerative spondylosis (spinal arthritis)
• Epidural abscess, infection
• Herniated disc
• Inflammatory diseases (eg, Rheumatoid Arthritis)
• Osteophytes (bone spurs)
• Spinal Stenosis
• Spondylolisthesis
• Vertebral body abnormality
Exam
• The neurological exam: evaluates sensory and motor functions
+ Sensory functions: senses, hearing, eye movement, and touch
+ Motor functions: gait (how you walk), balance, coordination, reflexes,
range of motion, and muscle movement.
• The goals to treat myelopathy are:
+ remove pressure from the spinal cord
+ prevent symptoms from becoming worse
+ improve your condition.
Vertigo
• Gostead is the best: Why?
• Vertigo and Hip Pain Dramatically Improves After ONE Chiropractic
Adjustment
• https://www.youtube.com/watch?v=o8gFXXG_uKs

https://www.youtube.com/watch?v=nDSunA8EH1A
Dizzyness and Ringing in Ears Gone with Chiropractic Treatment
Migraine Relief
• https://www.youtube.com/watch?v=2UJEvNuFqEo
• 20 Years of Migraines Improved with Gonstead!

• But if Gonstead didn’t work well, what should we do

• https://www.youtube.com/watch?v=AExxWZDMWFU
Headaches
• https://www.youtube.com/watch?v=141tUldPosk
• Highly Effective Treatment for Tension Headaches
 Thoracic
https://www.youtube.com/watch?v=oXiEmYozeF0

https://www.youtube.com/watch?v=ukAIfqvjb3U
MID BACK Thoracic Chiropractic Treatment

https://www.youtube.com/watch?v=mDLP76WeeUU
Supine Thoracic Thrust Manipulation - most comfortable thoracic
manipulation
T4 syndrome
SEVERE UPPER BACK PAIN
*RELIEVED* WITH SPECIFIC T4
ADJUSTMENT
• https://www.youtube.com/watch?v=8SCNJpItQkc
passive treatment:
active treament:
Cervical Gravity Line
• created by first locating the center of the tip
of the Odontoid Process, then dropping a
line downward, perpendicular to the
bottom of the film. This line should just
touch the anterior body of C7.

If the line falls forward of C7 there is

anterior head placement, also known as
Forward Head Posture
ADI

• measured from the inferior border of the anterior

tubercle of the C1 arch to the Odontoid process
(Dens) of C2. The normal width is 1–5 mm for
children & 1–3 mm (maximum) in adults.

• This space may increase in old age as a response to

degeneration of the atlantodental joint complex.
This is best appreciated in flexion views. It may also
increase with trauma, which may rupture the
transverse atlantal ligament.

Laxity of this ligament is noted in Down's

Syndrome.

The ligament may also rupture with inflammatory

arthropathies like rheumatoid or psoriatic arthritis,
Reiter's Syndrome, and ankylosing spondylitis
• The Retropharyngeal Interspace (RPI) is
measured from the anterior inferior
part of C2's body to the pharynx.
Normal maximum is 7 mm.

The Retrotracheal Interspace (RTI) is

measured from the inferior anterior
aspect of C6 to the trachea. Normal
maximum is 20mm.

Following trauma (like Whiplash)

prevertebral hemmorrhage may cccur.
This can be appreciated on lateral films
as an increased RPI or RTI. This may
occur with, or without vertebral
fracture or partial disc avulsion.
George's Line (or the Posterior Body Line)
• is a curved line that should touch the
posterior body margin of all the segments
of the spine in any of the 3 main
curvatures.

• This is preferrable to Ulman's Line for

finding spondylo's.

• You may also use the Spinolaminar Line as

a 2° check to see if all vertebrae are on
the same line. The space between these 2
lines is where the spinal cord resides.
 The Lumbar Gravity Line

created by first locating center of the L3 body & then droping a

line downward from there, perpendicular to the bottom of the
film.

This line should pass thru the anterior 1/3 of the sacral base.

If the line falls forward of sacrum there is anterior weight

bearing.

If the line falls behind there then the lumbar spine has
posterior weight bearing.
 sacral base line (SBL)

Construct the sacral base line (SBL) & then erect a

perpendicular line to it at the sacral promontory.

L5 should be on or behind this line.

If L5 is anterior to it, anterolisthesis or spondylolisthesis exists

at L5.

Spondylolisthesis is graded from I-IV based on whether the L5

vertebra has slipped anterior
by 25%, 50%, 75% or 100%
Stroke: How Chiro can help
• https://www.youtube.com/watch?v=dJBO7VMc6IM