(Keywords: ATLANTO OCCIPITAL JOINT, Grays anatomy, headache chiropractic, symptoms of whiplash )
It's the first (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 protruberances 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 x-ray. Fearfully and wonderfully made!
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.
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.
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. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
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. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
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.
Your own unresolved problem. Pose a question
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