Edit Atlanta – it is difficult to explain the manipulation of the two upper vertebrae of the cervical spine, which has become fashionable in recent years: chiropractors willingly explain the need for such manipulation in chronic headaches, dizziness, depression, chronic fatigue syndrome and some other ailments. For a more convincing argument of this appointment, experts refer to the results of MRI and show not experienced in medicine patient some “not so standing vertebrae.”
But in order for the patient to make an informed decision about whether he should decide on this procedure, he needs to understand something and understand something. In any case, in textbooks on traumatology and orthopedics such a “diagnosis” is not considered.
But first a few words about terminology:
- dislocation (luxatio) is the complete separation of the articular ends of two articulating bones with a rupture of the capsule and ligaments;
- subluxation is a partial displacement of the articular surfaces.
That is, in any case, it is a direct neck injury, or whiplash injury.
It is also necessary to understand the anatomical structure of this area of the body.
The cervical spine is the most mobile part of the spine. Its function is to determine the position of the head in a 180 degree radius sector in both vertical and transversal directions (i.e. up-down, right-left). To this mobility is added and location potential dangers.
The cervical spine is not only the most mobile, but also the most fragile segment! This part of the human body is almost always open, so it is more exposed to danger than murderers sometimes use, twisting the neck or cutting its soft tissues. Therefore, it is necessary to use the cervical spine (SHOP), especially after damage, with great care.
The cervical spine is not only the most mobile, but also the most fragile segment, so use it, especially after damage, you need to be very careful.
In General, the cervical spine consists of two anatomically and functionally different segments:
- The upper, or sub-occipital, segment consists of the first vertebra (C1 — cervicalis, that is, cervical), or Atlanta, and the second vertebra (C2) — axial, or axis. These vertebrae are connected to each other and to the back of the head by a complex chain of joints with three degrees of mobility — this is the first feature!
- The lower segment extends from the lower surface of the axial vertebra (C2) to the upper surface of the first thoracic vertebra.
Atlant (C1) has a ring shape with a small oval articular surface for the axis dentition (C2) — this is the second feature of the atlantoaxial joint!
The axis (its upper surface) has a centrally located dentate process, which is also called the axis tooth and works as a point of rotation for the atlantoaxial joint. You can compare this joint with the Griffon (tooth axis) that is worn on the pancake (Atlant), but it’s just visual Association. To remove the pancake (Atlanta) with the neck (Aksis), you need to remove the lock that secures the pancake (ligaments, muscles), and pull the damn outwards, but not completely. That is, you need to tear, stretch these deep muscles and move the” chain ” of joints from the axes. But this only happens in trauma, where there is no overwhelming numbers of patients seeking a chiropractor, who “shoots the shit” to “return” to “tighten the castle, fixing the damn neck”. If such manipulations are performed by an athlete with a barbell, then everything is simple, everything is visible, everything is clear: the lock tightens the pancake so that it does not jump off the neck when moving. But what does an MRI show the doctor? Only vertebrae and their certain position relative to each other. MRI does not reflect the state of ligaments, muscles, vessels and nerves of the Atlanto-axial joint (C1–C2). The head turns, and more or less is another matter.
When the “subluxation” (that is, jumping off the axis of Atlanta), which, in theory, should follow the injury, the doctor should pull the patient’s head, turn it to the right or to the left (that is, remove the Atlas from the axis) and “put” it in place… How to do it, because the lock, like a bar, no? Castle really, but there are ligaments and muscles (often weak), which, of course, can be stretched, but the movement of the ligaments and muscles will regain its elasticity and strength, rather the contrary. But this is not all: mechanically Atlas and axis are connected by means of three (!) interconnected joints, and this is the third feature of the atlantoaxial joint!
But it’s not even one joint — there are three! Flexion and extension in this joint is due to the transverse ligament, which keeps the anterior arc of the Atlas and the dental process in close contact! In this regard, the transverse ligament plays a vital role, since it prevents the sliding of the Atlas in relation to the axial vertebra. This is the fourth feature of the Atlanto-axial joint.
Dislocation (subluxation) of the joint can only be in the injury leading to immediate death by compression of the medulla by the odontoid process! At offset Atlanta anterior to odontoid process literally immersed in a nerve trunk. During forcible extension, the posterior arc of the Atlanta can be clamped, as in forceps, between the occipital bone and the posterior other axial vertebra and…fractured. The total volume of extension and flexion in the Atlanto-axial joint is 15 degrees.
But the numerous ligaments of the posterior spine (a total of 15 plus the capsule of the joint) are very powerful! This is the fifth feature of the upper cervical spine.
What, then, is the meaning of manual action? Incomprehensibly…
Now a few words about injuries. During an accident or frontal collision, the cervical spine is severely damaged, as it first unbends and then bends. As a result, there is a whiplash injury associated with stretching and even rupture of different ligaments and in extreme cases leading to anterior dislocation of the articular processes (in addition to the axis tooth in the cervical spine, there are transverse processes, articular processes and plates forming the base of the spinous process, which, in turn, is double).
The lower articular surfaces of the upper vertebra are hooked to the anterior-upper beak-like outgrowth of the articular process of the lower vertebra. This type of dislocation is very difficult to correct, in addition, it threatens the medulla risk of death, tetraplegia (General paralysis) or paraplegia (paralysis of the lower extremities). This explains the care with which such victims should be released and moved. In this regard, the instability of the Atlanto axial joint can only be the result of a rupture of the transverse ligament, as in the normal two inferior oblique muscles of the head act simultaneously and play a major role in the dynamic maintenance of the Atlanto-odontoid joint, the instability of which leads to disastrous consequences. However, ruptures of the transverse ligament are less common than fractures of the dental process (this kind of damage is fixed by MRI). The fracture of the dentate process makes the Atlantean completely unstable with respect to the axis, which can tilt backward or, worse, forward with a fatal risk associated with spinal cord compression.
Therefore, when lifting an injured person, one of the rescuers should be personally responsible for maintaining the head strictly along the axis of the spinal column and even slightly unbend it to prevent the alleged fracture at the sub-occipital level and below.
But why do you need to know such details? The fact that the Internet has a lot of incorrect information explaining the need to set Atlanta, which, from the point of view of some authors, is a common bone in the human body, allowing you to do all sorts of turns of the head. But at the same time about the second cervical vertebra, tooth-shaped, not a word is said! These authors write that there are many vital communication channels through Atlanta-nerves, blood vessels, and Atlanta, from the point of view of these authors, can “squeeze” them. They write that 90 % of people (where such statistics? – S. M. B.) on the planet have subluxation Atlanta and live with this trauma entire life. They explain this injury as the result of a miscarriage, during which the baby is simply wrung the neck (no more no less?! — S. M. B.). And supposedly in ancient times our grandmothers-the women knew this, so after birth, immediately set the vertebrae in place. And later, with the advent of maternity hospitals, this technology was lost, and now no one cares about this problem anymore. Here is such absurd arguments can be fish out from the Internet!
This began to prikarmlivanija chiropractors, because 90% of the people — scary thought! — I live with a subluxation of Atlanta! So, it is necessary to correct the situation!
But let us turn again to anatomy, of which our midwife grandmothers had a very vague idea.
The anatomical structure of Atlanta shows that the vertebral artery, and with it the first and second cervical nerves, pass through an opening in the transverse processes of the vertebrae and deviate as much as possible backward and medially, skirting the posterior edge of the lateral mass of Atlanta! That is, in the so-called displacement of Atlanta, it is purely mechanical can not squeeze any vessels or nerves. This is another feature of the anatomical structure of Atlanta.
The posterior branch of the third cervical nerve passes through the intervertebral opening, that is, in front of the joint! And if we talk about the Atlanto-occipital joint, its rotation is secondary to the rotation (rotation) of the Atlas on the axis around the vertical axis passing through the center of the dental process. For this reason, the real axis of rotation corresponds to the anatomical axis of the brain stem — the best possible position to rotate the axis of the nerve trunk.
But those doctors who consider the structure of the spine only on the basis of x-ray or MRI studies, miss, perhaps, the most important component of its structure-the muscular system, which is not analyzed by these types of studies, because the muscular system to a greater extent (68 %) consists of water and therefore is invisible in the rays of these devices, primarily in dynamics.
The functional part of the vertebral movements is carried out by muscles. For example, lateral bending and rotation of the occipital bone is performed using a short suboccipital muscles. We will not list the names of these muscles. Their function is to produce subtle tuning movements so that only the desired component of each movement occurs. It’s a kind of collective fine-tuning. On the other hand, the lower part of the cervical spine, in which there is a complex movement of rotation, lateral inclination and extension, is provided by muscles that are ideal for this type of movement, that is, long muscles running obliquely back, sideways and down.
This mechanical model allows us to understand the anatomical and functional relationship of all vertebrae of the cervical spine. In addition, the movement of the cervical spine is also responsible for the sternocleidomastoid muscles, deep paravertebral muscles, long muscle of the neck, head, front and lateral rectus muscles of the head, prevertebral stair muscles, posterior muscles of the neck (four layers). It is difficult to understand why neurologists do not take into account the function of the muscles of the spine, which directly affects the speed and volume of blood flow, and hence the flow of oxygen into the vessels of the brain. Hypoxia (lack of oxygen) is the fundamental cause of headaches, dizziness, depression and chronic fatigue syndrome.
Maybe it will be much better if a person with any symptoms of cerebral insufficiency will be shown exercises that will improve the speed and volume of blood flow, and thus relieve vascular disorders, than twist his neck with the risk of injury to the Atlanto-axial joint with an unpredictable result?
I want to note that the vast majority of people suffering from the above symptoms have exactly muscle failure. So I urge everyone to do push-UPS and pull-UPS, gentlemen! Perform the TRP! And if for any reason you are not able to do this, please contact the center of modern kinesitherapy Dr. Bubnovsky, where you will help to restore your physical body, so you can better manage it.
The main cause of headaches, dizziness, depression and chronic fatigue syndrome is hypoxia caused by muscle failure. Regular exercise will help to solve this problem without the doubtful help of chiropractors.