This is where IME evaluations fall short of being truthful, because a hidden problem may exist while being compensated for. Subjective symptoms at this level may or may not be present. The evaluation for rotation and lateral flexion on the right side of the neck will not reveal segmental restrictions. As a matter of contrast, the right side presents with normal to increased motion (hypermobility) in the examination of rotation and lateral flexion. Examination for A to P motion (testing for anterior fixations utilizing two supine double-check techniques) will reveal an overall tendency for the right side of the cervical spine to seek the anterior direction, and an overall seeking of the posterior direction on the left side.
Within this setting, C-1/2 and/or C-2/3 on the right side may have increased resistance in A-to-P motion upon challenge. In other words, the C-1/2 and/or C-2/3 level on the right side may show A-to-P hypomobile fixations.
If these left and right upper cervical fixation patterns are symptomatic, they can present with the following complaints:
- Unilateral headaches, which include pain behind, within, and over the eyes;
- Bilateral headache symptoms, which include pain behind, within, and over the eyes;
- Posterior and/or anterior cervical pain:
- The anterior pain corresponds to the right anterior fixation of C-1/2;
- Posterior pain presents on the left side and/or at the level of C-1 or C-2 anterior fixation on the right side. (C-2 anterior right fixation can cause pinpoint right C-2/3 pain with spasm, and be mistaken for a posterior or extension fixation);
- The anterior pain corresponds to the right anterior fixation of C-1/2;
- Left or right levator scapula pain, going up the neck periodically.
Now the problem arises: An attempt to correct these left posterior and/or right anterior upper cervical fixations with a left-sided contact is met with complete and absolute failure and frustration. It may be accompanied by embarrassment and increased pain or discomfort by the patient. Possibly, a second or third attempt to correct what appears to be an unmistakable fixation pattern is met again and again with failure.
Even beyond this, the dedicated and determined doctor may rationalize and say to himself/herself that:
- The patient cannot relax.
- There is too much inflammation.
- It is too early in the day.
- There are other factors at work here, their causes as yet unknown.
The result of this unfortunate process is that the patient is scheduled for another visit, possibly in a tranquilized state, and the doctor attempts again to adjust this fixation complex from the left side.
You can probably guess what this outcome will be - more failure, of course! Even more ominous than this is the possibility of injury to the client. What injuries would you suppose are lurking in anticipation of this approach?
There are other solutions to consider, however, in contrast to repeated efforts to topple this upper cervical blockade. This problem may be related to a structural lack of integrity, or it may be a compensatory reaction to another problem. A common finding, from my experience, has been that of a mechanical hypomobile restriction in another region, the most typical being that of a right-sided occipital/C-1 blockade. Here, occiput/C-1 articulation on the right side has overall restriction in motion. This is not picked up commonly during a hands-on or radiographic examination of the neck. The examiner may be thrown off the track because the cervical spine on the right side presents with such good integrity and mobility. If you take go one step further and test the occiput bilaterally in the supine position, as you would a cervical segment; and you test it bilaterally for rotation; lateral bending; extension; and forward glide, you can often locate these occipital mechanical dysfunctions on the right side. This occipital lesion often is present in other clinical settings, as well as this one.
If this right-sided occipital fixation complex is properly adjusted, the right occipital/C-1 level will motion palpate with increased movement and ease. The left and right-sided C-1/2 and/or C-2/3 mechanical restrictions also will palpate with more freedom and decreased complaints. The right-sided occipital/C-1 fixation adjustment takes some practice, but it can become a welcome challenge because its correction is definitive.
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.