Journal of the American Chiropractic Association 2003 (March)
Robert Cooperstein, D.C.
Chiropractic Philosophy & Clinical Technique
One evening nearly 10 years ago, I met with a table manufacturer in Woodside, Georgia, visiting the factory and place of business that fabricated a table patterned after my own design. The so-called fiction--reduced table [1-3] is a smart table optimized for the detection and measurement of leg-length inequality. Purely by chance, another chiropractor walked in to discuss a table based on his own design, which mounted a cervical adjusting device called the Torque Cervical Instrument at the head of the table. That other chiropractor was Dr. Cecil Laney, famed upper cervical doctor and pioneer in instrument adjusting. He and I agreed that my table could be just right to investigate his concept of how upper cervical subluxations might relate to leg-length inequality. We asked the table maker to lie down on the table, whereupon Dr. Laney administered a series of upper-cervical adjustments with a hand-held adjusting instrument while I carefully scrutinized the position sensor mounted between the table man's legs.
As a result of that chance meeting, Dr. Laney presented me with a downhome measuring device for estimating upper-cervical subluxation, a device that I treasure to this day.
It is hard to believe that at this time, only 1.7 percent of modern practitioners claim to be upper-cervical,  according to a survey by the National Board of Chiropractic Examiners. Yet for over two decades, Palmer College was exclusively upper cervical in its program. On the other hand, there are reasons to believe that this select population of chiropractors is far more likely than others not to respond to a survey mailed out by the National Board. The survey result, therefore, may understate their numbers--perhaps dramatically. Sherman College and Life University continue to emphasize the Upper Cervical Technique concept in their chiropractic programs, and several other colleges continue to offer Upper-Cervical Technique courses in their core curricula. Whatever the actual number of Upper-Cervical Technique practitioners, they make up in zeal whatever they lack in numbers, thus continuing to exert a considerable impact on this profession.
There have been historically many upper-cervical techniques. Despite notable differences in their adjustive methods and equipment, they tend to be very similar in their analytic methods and, of course, in their fervent loyalty to the Upper-Cervical Technique (in its most extreme form, "atlas only") concept. Indeed, the differences among upper-cervical techniques tend to show up in the adjusting area, not in the subluxation theory, analysis, x-ray protocols, or other examination procedures. Upper Cervical Technique intends to correct the atlas subluxation, at the limit, in one adjustment, so as to eliminate nerve interference at the only location at which B.J. Palmer thought, during much of his career, it could really arise.
History of Upper-Cervical Technique
According to Dye  the upper-cervical concept was in the air at Palmer College in the late 1920s. B.J. Palmer introduced the concept of the primacy of the upper-cervical subluxation to his contemporaries in the early spring of 1930,  apparently emphasizing axis at first. By this time, he felt that this was the only place where interference with the neurological connection between the brain and the rest of the body was possible. Not all of the chiropractors who had previously followed B.J. Palmer every step of the way were equally enthused to now learn that, "Every case you and I ever got well through adjustment was an accident." Hole in One (RIO) in B.J. Palmer's hands required four items for an analysis: the neurocalometer, the spinograph x-ray, the toggle-recoil-innate adjustment to put the vertebra in motion, and the knee-chest table.  The toggle-recoil adjustive approach, although originally used in full-spine adjusting,  was adapted for atlas adjusting by B.J. Palmer himself. 
Because of some personal health problems, A.A. Wernsing began developing his own upper-cervical technique concepts in conjunction with G.P. Loomis around 1932. In 1934, Wernsing, having become convinced that it was atlas, and not axis, that should be emphasized, and that atlas side-slips were more likely than atlanto-occipital rotational misalignments, took his work to Palmer College. [9-11] This included his revolutionary upper-cervical technique radiographic series,  the forerunner to the atlas orthogonal x-ray techniques of today. Wernsing also invented the light force technique that led directly to the Grostic/NUCCA practitioners:
"In making correction in any case, I do not advise a heavy thrust. The heavy thrust many times will accomplish less than a light force given with greater speed. Having available an accurate analysis, and proper placement of the patient being made according to the analysis in degrees, with proper care having been taken in palpation of the transverse process of the atlas, and correct contact being made on the transverse process of the atlas, a greater degree of correction can be accomplished with a light, speedy thrust."
[12, p.59 ]
Modern practitioners in the tradition of B.J. Palmer have included Kale [13-18] and Mears, as well as their adherents. Dr. Donald Mears, who passed away in 1991, developed his Mears Technique [19, 20] starting from the proposition that others of the HIO practitioners had inadequately identified primary occiput problems-that is, x-ray methods and adjustive approaches for thrusting upon the occiput, as compared with the atlas. Mears' contemporary, William Blair, also sought to correct what he believed to be an inadequacy in the HIO analysis, an inadequacy that had to do with congenital asymmetry in the upper cervical spine.  According to modern day Blair practitioner E. Addington, "Despite the proliferation of orthogonally based upper-cervical techniques deriving from the work of John R Grostic, and ultimately from B.J. Palmer, the Blair Technique remains the only non-orthogonal precision spinographic and adjustive technique for the cervical spine in the chiropractic profession."  Blair altered the thrust, eliminating the recoil, and also performed his adjustments in sideposture using a cervical drop piece, rather than on a knee-chest table with the head turned (in B.J.'s style). J.C. Thompson also used a side-posture, drop-assisted atlas adjustment starting around 1952. 
Apart from HIO, a whole other style of upper-cervical care developed out of Wernsing's original contribution, one that used a lighter contact. In 1941, J.F. Grostic walked into R.R. Gregory's office. At that moment, Gregory was going through Wernsing's The Atlas Specific,  seeking an effective upper-cervical adjustment. That date marked the beginning of a collaboration that lasted until Grostic's death in 1964.  J.D. Grostic wrote that his father's analytic innovations, mostly having to do with radiography and its interpretation, were first presented in 1946.  The original HIO high-velocity, lowamplitude toggle-recoil thrust of B.J. Palmer was replaced by a "closed stance, lighter contact, and a shallower thrust" around 1952. Gregory was present at Grostic's first upper-cervical teaching seminar, and so were several other chiropractic pioneers: Cecil Laney attended his first Grostic seminar in 1951, Roy Sweat his first in 1952, and Burl Pettibon in 1956.
Low-force, upper-cervical practitioners, like J.F. Grostic, his son J.D. Grostic, and Gregory, accepted the upper-cervical thesis on the primacy of atlas subluxation, but developed a gentler and more measured adjustive approach. [25, 26] Harrison comments that J.F Grostic leaned heavily on the original atlas-specific technique of Wernsing, appropriating from him much of the x-ray series, the use of the Vernier side-posture table, his cervical measuring instruments, the triceps-pull atlas adjustment, and his post-x-ray procedures.  According to Sweat, Grostic introduced the post-x-ray into chiropractic in 1946.  One can read, however, that Wernsing advocated taking such radiographs in his 1941 text. 
Following Grostic's death, there was a schism in this low-force, highly measured upper-cervical milieu,  which led Gregory to found the National Upper Cervical Chiropractic Association, Inc. (NUCCA), a fraternal organization, on April 16, 1966. The National Upper Cervical Chiropractic Research Association (NUCCRA) was incorporated for research purposes only on Oct. 6, 1971. It received tax-exempt status from the federal government, and Daniel C. Seemann of the University of Toledo was appointed research advisor in 1971.
The earliest atlas adjusting instruments were developed by Arden Zimmerman  in the 1930s with the goal of duplicating the manual toggle recoil adjustment.  In essence, according to McAlpine,  the original goal of instrument adjusting was to duplicate the hand adjusting of John D. Grostic. Williams et al., in rationalizing its use, stated, "The use of adjusting instruments allows precise and repeatable thrusts to be delivered with little physical effort and shifts the emphasis of training to analysis for the determination of adjusting direction factors."  Several types of adjusting instruments have been devised, beginning with the earliest flywheel/ crankshaft 1930s devices, followed by solenoids like those devised by Laney around 1956, to dental-hammer derivatives like that used by J.K. Humber in 1967 and Activator doctors today, and cam-stylus devices like the Pettibon device.  Some of the cervical adjusting instruments are hand-held, while others are mounted on devices that sit on the floor, and still others are mounted on adjusting tables.
Commentary Upper-Cervical Technique
Summing up the diversity that developed from B.J. Palmer's original upper-cervical concept, we count as HIO descendants the NUCCA adherents (Gregory, etc.), the milieu that developed around Life Chiropractic College (J.D. Grostic, Roy Sweat, Cecil Laney, etc.), D.B. Mears, William Blair, and HIO practitioners Kale (recently deceased) and Kessinger. Grostic wrote that the orthospinology taught at Life Chiropractic College was a variant of the Grostic methods.  We must also classify Pettibon and Harrison as HIO descendants, given that their full-spine techniques retain a distinctly upper-cervical cast. According to Tiscareno,  although this does not seem entirely accurate, the practice of upper-cervical chiropractic remained essentially unchanged after the closing of the B.J. Palmer Research Clinic in 1951. More recently, he states, there have been advances in spinography, thermography, fiber optics, and neurophysiological research that promise a "new paradigm" for upper-cervical-specific chiropractic. 
According to Dr. Ed Owens, research director at Sherman College of Straight Chiropractic, which retains a strong emphasis on upper cervical technique, the offshoots of Grostic work (NUCCA and Atlas Orthogonal) are having more success building numbers than the followers of the original RIO work of B.J. Palmer. lie also comments that Advanced Upper-Cervical Biomechanics (AUCB) is taught by the International Upper Cervical Chiropractic Association, a group doing and teaching a form of 1110 in California. Finally, according to Dr. Owens: "There are two types of HIO. . . The older HIO is done on a knee-chest table with a posterior arch contact. Kale and AUCB both derive from that kind of HIO. In 1954, B.J. added the drop-head piece and went to a side-lying posture with a Transverse Process contact. Grostic and Blair derive more from that kind of HIO. Life College only taught the side-posture version of HIO, but Sherman teaches both." 
Depending on how one feels about the concept of the primacy of upper-cervical subluxation, the practitioners of Upper-Cervical Technique may be seen as members of either a bizarre cult to be avoided, or a sage group of visionaries who are tuned in to the essence of chiropractic. We would recommend that anyone attempting to formulate a seasoned evaluation of what Upper-Cervical Technique has to offer ignore these twin stereotypes, which are actually opposite sides of the same coin, and pay more attention to the relative abundance of clinical research on the effects of upper cervical care.
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Dr. Ed Owens was kind enough to offer comments on an earlier draft of this paper; as always, any inaccuracies that remain are the sole responsibility of the author.
This column is coordinated by Robert Cooperstein, DC, Palmer West College of Chiropractic. Dr. Cooperstein accepts manuscript submissions at:
Cooperstein email@example.com or by fax at (408) 944-6118
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