Home | A New Approach | Specific Up C Techniques | IUCCA/AUCB
UPPER CERVICAL BIOMECHANICS [AUCB]
©International Upper Cervical
Chiropractic Association [IUCCA]
WHAT DIFFERENTIATES APPLIED UPPER CERVICAL
BIOMECHANICS (AUCB) FROM OTHER UPPER CERVICAL TECHNIQUES?
neurophysiologic imaging and radiographic analysis to adjustive
procedures, AUCB is unique when compared
to other upper cervical techniques. Its foundation is built upon
Dr. Palmer's 15 years of unprecedented research into the effects
of upper cervical technique on the global physiology of the human
body. Since that time, decades of clinical research and recent
advances in diagnostic technology have caused an evolution in Dr.
Palmer's procedures to form what we currently know as Applied Upper
For over 100 years the foundational premise of our profession
has been that health and disease are nervous system dependent;
that the spinal adjustment restores the human nervous system
to normal function. AUCB is the only upper cervical technique
that objective neurophysiologic infrared imaging be used on every
patient encounter both before and after an adjustment is rendered
to substantiate this premise. Without an objective analysis of
neurophysiology, it is impossible to determine if neuropathophysiology
is present and if the adjustment has effectively restored normal
nervous system function to the patient. The IUCCA was the first
upper cervical association to incorporate peer-review research
based normative data for the detection of abnormal neural function
via paraspinal digital infrared imaging. We as a profession insist
that we can improve nervous system function, those that practice
AUCB can objectively prove it.
To determine the adjustment listing capable of producing maximal
neurologic benefits, AUCB uses a complex and unique form of upper
cervical radiographic analysis. The entire cervical spine is analyzed
arthrokinematically for aberrant function of the upper cervical
articulations. This information is used to determine the precise
line-of-drive for adjustment procedures to the first, second, or
third cervical segments. Adjustments based on this system of analysis
have consistently produced full body neurophysiologic benefits
on patients, which has been objectively substantiated by both high-resolution
camera and paraspinal infrared imaging.
The adjusting procedures used in AUCB are a modified form of
that which was used by Dr. Palmer. Research performed on over
individual case radiographs has shown that a reliable C1 transverse
process contact point can only be achieved in approximately 5%
of patients. With this in mind, AUCB uses a specialized adjusting
table that allows for a precise contact on the osseous spinal
structures in the upper cervical spine. The design of the table
joint cavitation and full control over all line-of-drive vectors
(Modern arthroscopic and cineradiographic research has demonstrated
the need for both precise line-of-drive and cavitation to resolve
intra-articular adhesions in order to restore normal arthrokinematics).
Consequently, lateral C1 transverse process approaches, drop
table use, and the inadequate force transference used in many
techniques has demonstrated significantly lower reliability in
resolving objective signs of neuropathophysiology.
The main objective of AUCB is to increase the predictability of
clinical results, thus improving the percentage of patients that
respond to care. The IUCCA is constantly striving, through continued
research, to increase this percentage. As such, we are always open
to any new form of care that can objectively demonstrate consistent
improvements in neurophysiologic responses over what we currently
observe clinically. As health care providers, we should all be
continuously seeking ways to provide better care for our patients
- salus populi est suprema lex.
William C. Amalu, DC, DABCT, DIACT, FIACT
Radiology, otherwise known as x-ray imaging, has been an established
method of evaluating bone structure for many years. It is often
helpful in locating bone tumors, certain types of arthritis,
fractures and other disorders. Nonetheless, other valuable
information can be gleaned from these films as well. Analysis
of spinal alignment
can often yield critical information as to the source of a
condition given the relationship between the spine and the
system. Standard radiological equipment, however, introduces
numerous errors that compromise the accuracy of the images
when used for this purpose.
When x-ray is generated, one portion of the beam is projected
straight ahead and is called the central ray. The rest diverges
center and spreads out in the shape of a cone. If the radiological
unit is not properly aligned, or the patient is positioned
incorrectly, the image will distort. For some conditions, this
is not a problem.
However, when evaluating the spine, distortion can change the
relative position of the bony segments causing the appearance
of false misalignments.
This can produce disastrous effects when the information from
the images is used as a basis for treatment.
Precision radiology takes standard imaging to the next level.
Unlike conventional equipment, precision radiology is meticulously
for accuracy using laser technology and a specialized frame
designed to maintain its alignment. The patient is then
the central ray using advanced laser system pioneered by
thus virtually eliminating image distortion. With clear accurate
images to start, a precise analysis of each view can be made
gleaning the most amount of information possible from this
The clinical need to x-ray is determined on a case-by-case
basis and is not a set policy of the IUCCA. Not every patient
to be x-rayed. Every effort is made to keep x-ray exposure
a minimum. This includes the use of specialized equipment
that serves to reduce the amount of x-ray needed to produce
DIGITAL INFRARED IMAGING
Paraspinal Digital Infrared Imaging confines the area of
examination to the regions located directly next to the
signs of nervous system dysfunction will be detected in this
area first if the cause is from the spine. The images also provide
objective information to evaluate the effectiveness of treatment
after it has been rendered.
Given the critical role of the nervous system in health
and disease, the IUCCA insists that paraspinal imaging
be performed on each
visit to monitor the response of the nervous system to treatment.
A hand held unit is utilized instead of a camera for ease of
use and to reduce the cost of the procedure for the
patient. The protocols
are identical to the camera studies with a few slight differences.
In the case of a cervical spine (neck) examination, the acclimation
occurs in the waiting room since no disrobing is required. Offices
should be climate controlled to allow for this convenience. The
patient simply loosens their collar and removes all jewelry from
the neck. If the entire spine is to be imaged, then the patient
will acclimate in a treatment room. With the patient seated,
the doctor will move the paraspinal unit along the
spinal region of
interest. This information is then sent to a special computer
for analysis. Measurements are compared with research
values to determine how well the nervous system is functioning.
This examination takes approximately 5-10 seconds to complete
making it very practical for daily use.
Images are taken before and after treatment is rendered.
By comparing these daily pre and post images, the effectiveness
of care can
be immediately determined. The effectiveness of a course of
treatment can be judged by evaluating a series of images
taken over a period
Image taken before treatment noting many
areas of abnormal nervous system function
Image taken after treatment showing normalization
of nervous system function.
Following precision radiology, an analytical radiographic method
of combined mensuration and arthrokinematics is used to determine
if biomechanical abnormalities exist at the atlanto-occipital
and atlanto-axial articulations. From the accumulated degree
of aberrant biomechanics found at the upper cervical articulations,
corrections can be determined. Before treatment is rendered,
patients are advised that exacerbations in symptomatology might
occur as part of the normal response to care due to the global
impact of neural reintegration.
In order to insure proper segmental
contact and line-of-drive (LOD) control, the patient is placed
on a specially designed
table with the posterior arch of his/her atlas as the contact point.
An adjusting force is introduced using a specialized upper cervical
adjusting procedure (1). The patient is then placed in a post-adjustment
recuperation suite for 15 minutes as per thermographic protocol (2-4). Correction of the subluxation is determined by resolution
of the patient’s presenting neuropathophysiology on the post-adjustment
paraspinal infrared scans. All subsequent office visits include
an initial cervical paraspinal scan, and if care is rendered another
scan is performed to determine if normal neurophysiology was restored
(Fig. Opp.). Since the patient’s care is focused in the upper
cervical spine, only cervical paraspinal infrared scans are taken
during normal treatment visits with full spine paraspinal scans
performed at 30-day re-evaluation intervals.
The single most important factor in the management of these cases
is our ability to objectively monitor the adjustment’s affects
on the patient’s neurophysiology. Many different examinations
for “subluxation abnormalities” are used in our profession
such as leg length, cervical challenge, motion and static palpation,
and others. However, these tests lack objectivity, possess inherent
errors, and have no confirmation of their ability to monitor neurophysiology
(5-8). Infrared imaging, however, has been researched for over
30 years compiling almost 9,000 peer-reviewed and indexed studies
confirming its use as an objective measure of neurophysiology.
By using this technology, our method of upper cervical care has
been able to consistently produce reproducible and dramatic positive
neurophysiologic improvements in our patients.
- 1. Amalu, W., Tiscareno, L., et al. Precision
Multivector Adjusting: Module 3 and 7 -- Applied Upper
Cervical Biomechanics Course. International
Upper Cervical Chiropractic Association, 1993.
- Thermography Protocols - International
Thermographic Society 1997.
- Thermography Protocols - American Academy of Thermology
- Thermography Protocols - American Academy of Medical Infrared
- DeBoer, K., Harmon, R., et al. Inter-
and Intra-examiner Reliability of Leg Length Differential Measurement:
Preliminary Study. J
Manipulative Physiol Therap 1983;6:61-66
- Falltrick, D., Pierson, S. Precise Measurement
of Functional Leg Length Inequality and Changes Due To
Rotation in Pain-Free Students. J Manipulative Physiol
- Keating, J. Inter-examiner Reliability
of Motion Palpation of the Lumbar Spine: A Review of Quantitative
Am J Chiro
- Nansel, D., Peneff, A., Jansen, R., et al. Interexaminer
Concordance in Detecting Joint-Play Asymmetries
in the Cervical Spines of Otherwise
Asymptomatic Subjects. J Manipulative Physiol Therap
Adobe Acobat Reader)