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JanuarY/Fe~r~y 1985

~_ READ BY CHIROPRACTORS AROUND THE.w'oCiJBLD,~ . ~, ~

THE MAGAZINE THA T REFLECTS THE LIFE PRINCIPLE IN CHIROP/~J, ''if'

by Roy W. Sweat, D.C.

About the Author: Dr. Roy W Sweat'spractice is in Atlanta, Georgia. He is agraduate of Palmer College. In 1952,he began a course of study specializingin the upper cervical occipital-atlanto-axial complex under Dr. JohnF. Grostic. Dr. Grostic chose him asan instructor at his seminars. Sweatcompleted a three-year program inchiropractic orthopedics from theNational College and is an associateprofessor at Life College.

Dr. Sweat designed the cervicalanalysis instrument. In 1981 hecreated the program of chiropracticAtlas Orthogonality and wrote a seriesof five books. Dr. Sweat has designeda chiropractic adjusting instrumentand also a series of x-ray machinesand the orthogonal adjusting tables.

T he spinal nerves are formedby the union of ventral anddorsal spine nerve roots whichare attached in series to the

side of the spinal cord. There are 31pairs of these nerves grouped asfollows: 8 cervical, 12 thoracic, 5lumbar, 5 sacral, 1 coccygeal.

"The course of the first two spinalnerves runs dorsally to the interver-tebral joints while all others leave theforamina intervertebralia in front ofthe articular processes." (Detlef vonTorklus and Walter Gehle.)

"The absence of.posterior articula-tions between the head and atlas andbetween the atlas and axis leaves thefirst two nerves without actual inter-vertebral foramina." (Ruth Jackson.)

Today's ChiropracticfJanuary-February. 1985

ScanningPalpation

The first cervical nerve exists fromthe vertebral canal between the oc-cipital bone and the atlas. The firstcervical dorsal ramus is larger thanthe ventral ramus, and emerges su-perior to the posterior arch of the atlasand inferior to the vertebral artery. Itenters the suboccipital triangle andsupplies the muscles which bound thisregion, the rectus capitis posteriormajor and the superior and inferioroblique; it gives branches also to therectus capitis posterior minor and thesemispinalis capitis. A filament fromthe branch to the inferior oblique joinsthe dorsal ramus of the second cervi-cal nerve. The nerve occasionally givesoff a cutaneous branch which accom-panies the occipital artery to the scalp,and communicates with the greaterand lesser occipital nerves.

The superior articulation of the atlasoverhangs the artery and nerve rootposteriorly- an important anatomicalfact to be considered under themechanism of cervical nerve root ir-ritation . The ventral ramus of the firstcervical nerve appears above the pos-terior arch of the atlas vertebra andpasses forward laterally to its lateralmass, and medially to the vertebralartery. It supplies a branch to the rectuslateralis, and emerging on the medialside of that muscle, descends in frontof the transverse process of the atlasand behind the internal jugular vein,and joins with the ascending branchof the second nerve.

The second cervical dorsal ramus isslightly larger than the ventral and allthe other cervical dorsal rami. It e-~erges between the posterior arch ofthe atlas and the lamina of the axisbelow the inferior oblique. It suppliesa twig to this muscle, receives a com-municating filament from the dorsalramus of the first cervical and thendivides into a large medial and a smalllateral branch. Its close proximity to

Cervical Spine

the lateral joint and the posterior archmake it potentially vulnerable to ir-ritation or compression.

The medial branch (also called thegreater occipital nerve) ascends o-bliquely between the inferior obliqueand the semispinalis capitis, and piercesthe latter muscle and the trapeziusnear their attachments to the occipitalbbne. It is then joined by a filamentfrom the medial branch of the dorsalramus of the third cervical, and as-cending in the occipital area with theoccipital artery, divides into brancheswhich communicate with the lesseroccipital nerve and supply the skin ofthe scalp as far forward as the vertexof the skull. It gives muscular branchesto the semispinalis capitis and occasion-ally a twig to the back of the auricle.

The lateral branch supplies fila-ments to the splenius, longissimuscapitis and semispinalis capitis and isoften joined by the correspondingbranch of the third cervical.

The ventral ramus of the secondcervical nerve issues between thevertebral arches of the atlas and axisand runs forward between the trans-verse processes of these two vertebrae.It passes in front of the first posteriorintertransverse muscle, emerging onthe lateral side of the vertebral arterybetween the longus capitis and levatorscapulae. But when the scqlenusmedius takes origin from the trans-verse process of the atlas, it intervenesbetween the nerve and the levatorscapulae. It divides into an ascendingbranch which joins with the firstcervicalnerve and a descending branch whichunites with the ascending branch ofthe third cervical nerve.

C-1 and C-2 spinal nerves are uniquein their peripheral distribution. Theydo not travel through an intervertebralforamen. They are associated withdiarthrodial (freely moveable) joints.The occipital condyles and the superior

23

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Fig. 1atlas facets are synovial joints and haveno intervertebral discs. The inferioratlas facets and the superior axis facetsare synovial joints and have no inter-vertebral discs. This area has thegreatest range of spinal motion. Theremaining vertebral bodies from theaxis down to the first sacral articulationare united by intervertebral discs andare classified as symphyses. (Fig. 1)Scanning Palpation

Scanning palpation is the tactileexamination of the cervical spine withobjective findings of muscular spasms,contractions, enlargements, swellingor osseous protuberances. Subjectivefindings will be extreme tenderness,pain, hypersensitivity, hyperirritabilityand neurological insult in the positivepalpated areas.

Begin at the atlas and examine downto the 7th cervical vertebra on eachside. They are listed as:C-l R IC-2 R IC-3 R IC-4 R IC-S R IC-6 R IC-7 R IThey are graded as 1, 2, or 4; with 3being the most severe.

The doctor begins his examinationwith his fingers medial to thesternocleidomastoideus muscle areaand lateralto the centerofthe posteriorarch and cervicalspinouses. He thenbegins at occiput and C-1 with themiddle finger on one side and con-tinues down to C-7.Then, he uses thethumb on the opposite side at occiputand C-l level down to C-7. (Fig.2)

The grades 2 or 3 willalwaysrelate

24

to a short leg and the patient needingan adjustment. Witha grade 1,or less,the leg should be even, or satisfactory,and the patient not needing an ad-justment. The same grade willreturnto the same area when the patientneeds another adjustment

When the scanning changes dra-matically from previous scanning,usually there has been some newtrauma and the patient's adjustmentlistings may have changed. Post-scanning examination should reveal80 to 100 per cent improvement inreduction of the findings after theproper adjustment. When the scan-ning examination does not revealreductions, it usually indicates errorsin the adjustment or the subluxationlistings.Neurological Insult and TriggerPoints

"Trigger point, trigger zone, triggerspot, trigger area: a focus of hyperir-ritability in a tissue that, when com-pressed, is locally tender and, if suf-ficiently hypersensitive, gives rise toreferred pain and tenderness, andsometimes to referred autonomicphenomena and distortionof proprio-ception. Types include myofascial,cutaneous, fascial, ligamentous andperiosteal trigger points." (Janett G.Travell and David G. Simons.)

Sensory, motor and autonomicneurological insult and myofascialtrigger points can produce neuro-muscular dysfunction and disease.Conclusion

In the atlas orthogonal program,the scanning palpation correlateswiththe supine leg check to determine

Fig. 2

when to adjust and when not to adjustthe patient. When the scanning pal-pation is positive in the C-l and C-2area it relates to direct neurologicalinsult or neurological insult with re-sultant trigger point. When the scan-ning palpation is positivefrom C-3 toC-7 it relates to muscle spasms, con-tractions, trigger points, and posteriorzygapophyseal joint compression.

The doctor of chiropractic is ex-tensively trained and is a specialist inthis important science of scanningpalpation examination..

References1. von Torklus, Detlef. The Upper CervicalSpine, New York. Grune & Stratton, 1972,Page 1.2. Jackson, Ruth and Thomas, Charles C.TheCervicalSyndrome, Springfield,Illinois.Pages47-48.3. Travell, Janet G. and Simons, David G.Myofascial Pain and Dysfunction, Baltimoreand London. Williams& Wilkins,Page 4.4. Warwick and Williams. Gray's Anatomy,Philadelphia.W.B.Saunders Co., Pages 1030,1032, 1034,388 and 411.5. Cailliet, Rene. Neck and Ann Pain. Page25.6. Weaver, Macon. "Dissection Class," UfeChiropracticCollege.7. Pemkoph. Atlas of Topographical andApplied Human Anatomy, Volume 1: Headand Neck. Urban& Schwarzenberg,Page 50.

Today's Chiropractic/January-February, 1985