While each of us should try to avoid cookbook rehab or confirmation/treatment bias, with a tool like NKT that lets us compare the power and impact of various dysfunctional elements and place them in an accurate order on a causal hierarchy, there are several patterns which I find with extreme frequency and regularity that are well worth being aware of and checking for with most or even every patient. The pattern we will be talking about today is C2 displacement and the causal and dysfunctional chain that springs to/from it.

GW520H600 We are told, rightfully so, to start local and then go global. The local area is important to find the direct thing causing the symptoms that we notice, in part to give symptomatic relief and in part to track down the causal hierarchy. Much, if not the majority of the time, however, the issue will be of a global/core nature when a recent or concurrent known acute injury is not present (and even then). The axial skeleton and deep front line, the soft tissue equivalent to the spine and the tension element of the intrinsic tensegrity unit, is usually this ‘core’ we need to look to. The cervical spine is the saddle of our head on top of this structure and has an enormously profound effect on balance and ‘steering’ the body.

Since this particular dysfunction was pointed out to me by one of our NKT colleagues a month or two ago, literally EVERY single patient since has had their issues tracked back to C2 displacement and related issues up or down the chain (what caused it directly or originally), except one patient who had had a fractured C4. No surprise that the C4 was her top of the totem pole. Again, because of our ability with NKT to place this dysfunction on a hierarchical order without any doubt, we can show whether or not the C2 is an issue, or the issue, if it is dysfunctional. If you don’t know what I mean, check out my hierarchy placement protocol article Here.

So how do we know if the C2 is an issue and why are we looking there in the first place? The easiest way to tell is to look at head tilt and angle. Have them close their eyes and move their head around a bit, returning it to what they feel to be neutral. If their neutral is tilted one way and rotated, you have an upper cervical rotation. If they have just a head tilt, it may be lower down the cervicals, or simply a muscular tension issue not related to cervical displacement (though the muscular tension can result in the cervical displacement anyway). If they have SI dysfunctions or seem to have one side of the body trying to launch into space (hip compression, SI compression, hip height and shoulder height, can be some or all), that’s a good clue as well, and we’ll speak about them a bit more shortly. Sometimes you can also palpate the C2 and feel it shifted considerably out of place (usually to the left, anecdotally, which I imagine is a left/right handed thing but I am just not getting any lefty’s these days). Obviously imaging wouldn’t hurt either, but isn’t a necessity for our purposes here.

head tilt rotation dysfunction (Note that it does not need to be this severe. It is best viewed from supine.

Origins:

One of the most important processes in NKT and rehab overall is tracing back symptoms to the direct and the original cause. If you don’t try to walk the line back then have you really cleared the whole problem? Maybe, but probably not. If you haven’t, there’s a good chance it’s going to come back. Sometimes you get things dealt with without tracing something back and you can definitely get much symptom relief otherwise, but we’re here to fix the cause. With the C2, it’s definitely important. Have it adjusted and don’t fix the soft tissue or the original issue driving in the need for the soft tissue dysfunction and it will just come back eventually or cause a dysfunction elsewhere, usually pretty damn quick due to the high priority of the dysfunction.

Every time so far I find an fairly early age (birth to puberty, but sometimes teen years and I would somewhat expect it at any age, it just increases the impact when it’s during formative years) injury to the head from a fall off a tree, running into furniture, etc. which causes a sense of vulnerability or instability leading to some kind of protective compression strategy. Either the scalenes or the levators (or both) often end up being an element of this strategy and it’s usually the left side being facilitated and pulling the C2 to the left (that whole potentially right handed thing I mentioned). It’s not always the facilitated muscle, however, as sometimes the inhibited muscle (usually the levator/scalene on the other side) is defensively tight and needs to be turned on, not released. Lastly, sometimes there is this defensive relationship pulling the C2 one way causing dysfunction, but once that’s cleared the C2 is still being pulled from the other side. Either way, normalizing tension between the scalenes and levators is vital to getting it to stay centrated and obviously the rest of the neck needs to be cleared and general hand-shoulder-neck, core-neck stability established for lasting results.

Signs and Symptoms:

As mentioned elsewhere in this article, there is quite a bit of dysfunctions that can be found directly and through a hierarchical causal chain due to the C2’s importance as a saddle for the head on the axial skeleton. Severe inhibitions around the neck resulting in headaches of all kinds, shoulder, elbow, hand and core issues are common. It can also directly cause a jam to the SI (especially it seems via scalene facilitation) and is often then related to a shortened leg via hip compression, hip raise, and shoulder raise all on one side (in part or all of the above). Anytime I see an SI jam I check out what it’s doing locally and then fix it around the C2 in the scalenes. It hasn’t been a long time but I’ve had 100% success in this so far.

With facilitated or inhibited scalenes there is a high chance of inflammation at a certain point which can put pressure on the brachial plexus, so especially if your patient has ipsilateral tingling, numbness, or other nerve based issues in the fingers, hand and arm, this is a good place to start. That said I’ve seen bilateral neuropathies stemming from a cervical displacement/compression but also from one scalene being over facilitated, and the other defensively tight from inhibition, thereby resulting in interdependent bilateral brachial plexus pressure.

The list goes on quite a bit, and I’ve found symptomatic inhibitions with the C2 displacement being the top of the discovered hierarchy going as far as inhibited toe flexors. Spasms, especially in the neck, but sometimes elsewhere due to severe facilitation/inhibition is also an occasional related finding. I’ll end the list here but because of its importance and core role/placement, I keep it in mind for pretty much everything.

Before we get started on fixing the issue, I am a big fan of the SFMA or a decent equivalent that lets us see how the neck is functioning before and after our treatment. Especially if there is a one sided imbalance in cervical rotation (though because of the respective facilitation and defensive inhibited relationship it is probably more often bilateral) I want to see this cleared up after some good work on the C2, related structures and the causal elements. If you think you’ve cleared the C2 issue and related dysfunctions but they can’t pass an SFMA cervical assessment, it’s time to keep looking.

Treating The Issue:

Firstly, testing issues against the C2 is where we want to start to get an impression of what’s going on. If you can feel the C2 being actually displaced, then it’s all the easier. Hold light pressure on the C2 from the left or right side of the spinous process as a TL and then test part of the neck, core, hips, nearly anything and seeing what it does. One direction should make it substantially better or lock, while the other will usually knock it out pretty substantially (it’s been fun to use as almost a ‘party trick’ in initial consultations when appropriate to have someone sit up straight with ease with the C2 held and then pull it away and watch them instantly slump). If it doesn’t, it isn’t likely the direct issue or the muscle(s) causing the displacement or the injury in the first place is the more important element in the equation for what you’re testing it against. Refer to my article on hierarchical placement to figure out what needs to be dealt with. Sometimes, however, there is enough compensatory ‘noise’ that you may need to lightly clear some of this stuff to get a clearer idea of where to go and how to progress.

As I am not a chiropractor I don’t do adjustments on my patients, but from my experience in this particular cervical displacement simply getting the tension regulated around the neck and the C2 in particular takes care of the issue and I have not found the C2 having to be directly adjusted to stick. I have however seen adjusted C2’s that did not stick due to a continuing soft tissue issue that was causing the displacement from some kind of head trauma, as I imagine all of you have.

As stated above, clearing the neck as far as ensuring it is stable, and the same with the shoulders, hands, and then the core will be crucial. Most issues in any of these areas are likely to be directly connected to the others anyway. To make defensive muscles feel less threatened I have found it very useful to go down that anatomy train(s), especially for the scalenes, but the levators as well (check the subclavius on the inhibited side). A personal favorite for the scalenes, which can blow out a lot of SFL/DFL and some LL, as well as cause dysfunction in the neck and arms, is the point on the antero-distal ribs near where the RA and EO fascia meet at the most protruding area (and in the surrounding fascia) circled in the image below. This area is most over-active when the abdominal musculature is dysfunctional so it appears that the abdominal fascia tries to step into this role in the same way the IT band does for the TFL in lateral ankle stability. I’ve found it standing in for the glute medius, TFL, pretty much anything in the core, the QL’s and parts of the neck with fair frequency.

oblique I am hoping to find a subject to do a short video on clearing the neck and the C2 dysfunction in particular in the near future. As with all things, do not simply release something because it is tight or painful. Making sure that the levator or scalene (or whatever else you’re looking at) is truly facilitated and not just defensively tight is crucial, or the problem will simply worsen.

So how do we find and treat the origin? Usually it’s a head trauma or scar (including oral surgery) that happened in a formative age but can be much later. To get an idea of whether they are the issue or not you can TL them, and go through the hierarchy placement protocol to confirm. I know some of you have non-NKT scar techniques that work, and in either level 2 or 3 (no idea which) scars are addressed and will give you the necessary tools to conclude C2 displacements sprouting from them. Until then if you can find that one of these issues is the hierarchy, then send them to an appropriately qualified practitioner as until that top issue is dealt with, the dysfunction likely won’t clear, it will just send the symptom elsewhere at best a little bit further down the line (time wise).

When it comes to concussive head trauma it may have caused a past sense of instability and injury which resulted in the protective compression chain to the displaced C2 and directly fixing it may be all you need to do. I imagine some cranial fascial work may be in order, and cranio-sacral work may be of great benefit (I don’t do this myself yet so my experience is limited with it. I’d love input from any of you who do). I’ve been told otherwise that when it comes to inter-cranial injuries really the best, if not only, decent option is a class four laser. I will likely be experiencing this myself in the near future for a 10 year old severe concussion which appears to be the root of my many dysfunctions.

I would love more input from any of you concerning head traumas and your treatment methods, especially on the side affecting neuromuscular and joint function.

So using the hierarchical placement protocol, or another method achieving the same ends, you will know which thing needs the most treatment. Sometimes it is a head trauma, sometimes the C2, sometimes the muscle causing the displacement, regardless of the chronological order. Clear the top issue and usually the others will clear automatically (sometimes chronologically but sometimes just the one causing the most issues). To ease things along better and faster I don’t mind hitting a few levels at once especially during the session but in the patients’ homework as well. Sometimes also it will be the head injury and compression to say, the extensors, while it is the over-facilitated levator to the TVA, over-facilitated scalene to an SI jam, etc instead of just one top facilitator against all the inhibited tissues. Check the issues you find against a few crucial issues to make sure you aren’t missing something crucial. TVA, multifidi, general hip stabilizers (illiacus, psoas, QL), and general neck function is obviously high on the list.


Wrapping Up:

The other proximal cervical vertebrae can have similar effects and so should be checked out, especially if you are having a head tilt with rotation and any of the above discussed symptoms but are not finding success with treating the C2 or possibly causative head traumas/scars (Don’t forget oral surgery and oral scars, they aren’t usually the issue, but sometimes they are). I decided to discuss the C2 because it is what I find causing the issue with the vast majority of these cases. Part of my intake assessment is to run the entire spine looking for tender or displaced vertebrae and those which are tender or displaced are often the source of dysfunction to anything attaching to them. That said, however, while I do find some T2 or T4 and sometimes the surrounding thoracic vertebrae often give me locks on the local area and core, I have typically found them to be lower on the causal chain to the cervical dysfunction. Good to keep in mind though and to check during your follow up after the patient has done cervical normalizing homework to see if it has fixed itself or not. If not, this may be the next most important step to pursue.

For this article in particular because of its trek through the chiropractic realm, I would love input from the chiropractors, osteopaths, and other most relevantly related professionals, not to mention anyone else that has some experience with this or good insight!

Filed under: The Practitioners Corner

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