Atlanto Occipital Joint

Keywords; atlanto occipital joint, Grays anatomy, headache chiropractic, symptoms of whiplash.

It's the uppermost joint in the neck.

The bone that makes up the base of the skull is called the Occiput. If you place your hand on the back of your neck, and slide it up, those first boney protuberances you feel are the occiput.

The first bone in the neck is called the Atlas. It's really just a ring.

So the joint between them of course is called the Atlanto Occipital joint. It's where the nodding action of the head occurs.

Structurally, it requires some very demanding engineering features. It has to be extremely strongly bonded, or else the head would fall off the neck the first time a person experienced some trauma. Not good. This is achieved with very powerful stiff ligaments, and equally strong but flexible muscles.

Here you can see it on an xray. Fearfully and wonderfully made.

There were several exclamation marks above but Google doesn't approve of them, so out they came; it makes the sentences rather droll; apologies. One must appease the internet god, other wise he zaps your site.

The spinal cord passes through a hole in the base of the occiput, called the Foramen Magnum, and down through the large hole in the Atlas. This is a cross sectional view, as seen from below, looking up at the skull, through the overlying atlas and Foramen Magnum. All sorts of interesting structures have to pass through that hole.

For example, two very important arteries wind their way up inside the spine, and make their way through the Foramen Magnum too.

They supply the posterior part of the brain and the balance organs in the inner ear.

Joints and Headache Chiropractic

Strongly bonded but this region must also be fully movable, so it has to have a joint. Two, in fact. The joint surfaces are covered with very hard cartilage that fortunately doesn't usually become arthritic. But they can become jammed up, or fixated as we call it. Then the neck becomes very stiff, and headaches often start.

The sensory nucleus of the largest cranial nerve, the Trigeminal, which supplies the jaw joint, sinuses, teeth, gums and face lies in this upper part of the neck.

Consequently, oddly, jaw joint pain, sinus pain... is often felt in the upper neck either as well as said jaw joint pain, or instead of it. This is very confusing sometimes for both the clinician and patient. Is this atlanto occipital joint pain, or is it referred from the TMJ anatomy? Or, both? I now routinely do a quick assessment of every patient with upper cervical pain.

If you have upper neck pain, and a popping jaw, pain in front of the ear or facial pain it is imperative that you tell your chiropractor. The problem may not lie primarily in your neck at all.

This jaw joint can also cause blinding migraine headaches and very severe facial pain.

Facet Joints

In due course, I'll add a page on the muscles of the region. They too are vitally important in the management of

Symptoms of whiplash 

For those who survive whiplash there are a myriad of symptoms of whiplash from very severe symptoms (paralysis) to quite minor irritation (occasional headaches). Others include lack of concentration, dizziness ... Read more: SYMPTOMS OF WHIPLASH ...


Prolonged flexion of the occiput on the atlas, the nodding action, as in reading a book on a flat desk, places the suboccipital muscles under ongoing stretch. Devices such as this simple mobile desk are a must for every student, teacher, accountant ... in my view no home should be without at least one.

At a cost, delivered, of about three chiropractic consultations, it will pay for itself with weeks. 

If you spend long hours at the computer then intermittent ergonomic exercises are vital if you want less upper cervical joint pain, and general backpain and arm pain ...

VERTIGO @ atlanto occipital joint

Vertigo is a nasty condition that gives one the feeling that the world is spinning. It can be mild, a sudden feeling of dizziness when the head turned that last a few seconds only, but it can be very serious causing one to vomit repeatedly.

During an attack one has the distinct sense that your eyes are spinning, even if you close your eyes. And so they are. The careful observer will note that the eye are moving in a specific fashion depending on which canal is affected; it's called nystagmus and lasts from a few seconds to a minute or more.

The most common cause is debris forming in one of the canals in the inner ear causing a condition known as benign positional paroxysmal vertigo. The good news is that bppv responds very quickly to a series of careful movements of the head called the Epley maneuver a course for your chiropractor.

How long does vertigo last? If the cause is bppv, and it's estimated to be 70% of cases of vertigo, then usually not long, often ceasing with a few minutes after the Epleys are done. But an infection in the inner ear, or Meniere's syndrome can cause the vertigo to last much longer.

Another cause is a subluxation of the occiput bone, and a gentle chiropractic adjustment is the treatment of choice. However, it should not be done until BPPV has been ruled out using a test known as the Hallpike Dix test ... or if you are showing signs of an upper respiratory tract infection. In these cases a Chiropractic adjustment can make the vertigo worse. It's generally agreed that medicines, other than antibiotics if you have an infection, have little or no place in the treatment of vertigo dizziness ...

The Epleys should only be done by a person trained in their use. Ask your chiropractor if s/he has done a course on the Epleys if you are suffering from vertigo. They should be done BEFORE the atlanto occipital joint is adjusted (and NOT on the same day).


Henry Gray was a truly gifted man. A qualified medical doctor, Gray was also an exceptional artist. He was the first to make a text book that would become the standard text for medical students for generations. Read more about this remarkable man.


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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.