This is a tricky condition. The first time I saw it was when another DC referred a case to me with right-sided unrelenting headaches. The headaches had also caused pain in the patient's face, and eyes, and was so debilitating that she had to quit work. When the headaches occurred while driving, she would have to pull off the road and just wait it out. She had received scans with various diagnoses, but no relief.
When I motion palpated in the supine position, I found that the left side palpated as a restriction in rotation from left to right; the right side was marginally fixated in rotation right to left. The right side was also more fixated from anterior to posterior. Most specifically, C-1/C-2 was restricted in motion from left to right. C-1/C-2 was restricted when testing C-1 in motion from anterior to posterior, right to left. When describing C-1/C-2, I mean that the contact is on C-1 in testing C-1 in relation to C-2.
The result has been years of experimenting with errors and successes. What emerged was a common mechanical listing or listings. It was embarrassingly common. It primarily involved the C-1/C-2 and C-2/C-3 levels. C-2/C-3 was not always involved, but C-1/C-2 was involved the majority of the times. The major listing usually was C-1 LPS-RA:
L: left side P: posterior, resists posterior to anterior motion S: superior (means convex side or resists lateral to medial motion) R: right A: anterior, resists anterior to posterior motion
C-1 on the left resisted rotation from left to right, posterior to anterior; being called posterior left. It resisted lateral bending from left to right, or lateral to medial. It resisted right-sided rotation from anterior to posterior. Statically, it would be called left posterior and right anterior.
The jamming of the facets of C-1/C-2 on the right appears to cause the symptoms. I would wager that it is a compressive disorder on the facet cartilage, and it causes some portion of the facet capsule to overstretch. The result is continual proprioceptive stress and inflammation. Not only can the neck, head and eye hurt on the right side, but it can radiate into the right shoulder and arm.
The solution is to adjust with the contact in two places. The index or third finger or both take a soft tissue pull behind the TP or arch of C-1; the second contact is a second finger or index contact on the left arch or posterior TP soft tissues. The tissue slack is further taken to tension in slight flexion, rotation, and lateral bending. You have to search for the correct tension. When you find maximum resistance, that is your vector force. The indifferent hand simultaneously pulls the head in an equal and opposite direction. When you retest, there should be more established motion left posterior to anterior, and right anterior to posterior. C-2/C-3 is secondarily involved often, but the C-1 adjustment usually is the main one. The use of intermittent cold therapy at the pain areas can be helpful. Interferential microcurrent on (+) polarity following the adjustment may completely remove the headache within 15 minutes. Several visits may be required to achieve total resolution. Sometimes, the headache can be resolved in one visit.
Often C-2/C-3 will motion palpate as a restricted joint on the right and left side. On the left side, it is usually subservient to C-1, and C-1 is the major. On the right side, C-2 will palpate as a marginal or significant fixation. It seems like C-2 will compensate for the C-1/C-2 fixation by assuming a posterior listing on the right. With motion palpation testing, it palpates as a restriction from posterior to anterior, right to left. If the left sided C-1 adjustment does not clear the headache, C-2 on the right may have to be corrected. Beware of the C-1 palpation on the right. There can be hypertonus and make the C-1 appear as a right-sided posterior to anterior fixation on the right, but it isn't.
Back to C-2, which can have developed a life of its own. Use caution and be patient. Getting into C-2 too soon can be disastrous. Very occasionally, the occiput on C-1 (on the right) may also compensate in a manner like C-2, with a fixed posterior to anterior listing. The mechanism of compensation is simple. C-1 is anterior and fixed on the right; so C-2 or occiput fixes posterior on the right, resisting P to A motion. One can also see other right-sided compensations, such as C-3 or C-4. But this is an occasional occurrence in comparison to C-2 compensations. You may think that when C-2 or C-3 are right-sided compensations they will self-correct after correcting C-1. But if a compensation exists long enough, it may live on after the major listing is corrected with a life of its own.
My main caution is not to rush in immediately and aggressively on the right side. Analyze carefully. There will be many times when a right-sided adjustment may do the trick, but wait to see the result of the left-sided C-1 LPS-RA adjustment. If the right side sticks you in the face with a strong upper cervical fixation, it may complete the requirements. However, my advice is to take it a step at a time. Learn what a significant C-2 or C-3 feels like on the right. If it is marginal, leave it alone until you have thoroughly tested the results of the left-sided C-1 adjustment.
If you make a mistake and adjust C-1 on the right because it felt tight, when in reality it was muscle hypertonus; you may have a scare on you hands, such as dizziness/disorientation. You may want to just get that balance, as you have been programmed to believe both sides have to be adjusted. If you adjust that right-sided minor C-2 fixation, you again may face that scary reaction that makes you think about a potential lawsuit.
If you adjust that significant C-2 right fixation after the headache kept hanging on after the lift-sided adjustments, you will probably see significant immediate relief. In these cases, C-2 often also exhibits a compression fixation. A contact at the C-2 spinous process with a short, rapid pull can deliver a crisp traction release. Adjust no other cervical prior or after these discussed.
Joseph Kurnik, DC
Torrance, California
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.