Continued
Anterior Cervical Subluxation - 2
Examination
The anterior cervical subluxation is located at C5, C6, or C7. Characteristically the spinous process tip of the subluxated vertebra will be very tender. Spinous process tip tenderness and a forward head position are body language indicators of the condition.
When this subluxation is present some muscles supplied from C5 to C8 will usually test weak with cervical flexion. If many or all of the muscles below the subluxation level test weak, there is probably spinal cord involvement from the disc.
Cervical subluxations have been considered to typically have a posterior component rather than an anterior one as in this different type of subluxation. The anterior subluxation must be corrected properly or there will likely be a reaction. To avoid iatrogenic complications, challenge for an anterior subluxation in the lower cervical spine before adjusting for a posterior subluxation in the lower cervical spine. Consider an anterior cervical subluxation if a patient has an adverse reaction to your cervical manipulation or that of another doctor.
There are two types of challenge that reveal this disturbance: (1) axial compression to the cervical spine, and (2) vertebral challenge.
Axial compression is applied by having the patient press on the vertex of his head in a caudal direction. Any possibly involved muscle can be tested for weakening while the axial pressure is held. Conversely, cervical traction strengthens muscles that test weak because of an anterior cervical subluxation.6 Goodheart uses the wrist extensors, if strong in the clear, as general indicator muscles for challenging this cervical problem. Often the wrist extensors or other muscles will be strong when the patient is non-weight-bearing and weak when standing or sitting because of the head’s weight on the cervical spine causing axial compression.
When any muscle fails to correct with the usual five factors of the IVF, including local muscle treatment, have the patient apply axial compression to the cervical spine by pressure on the vertex of his head. Test strong C5 to C8 muscles for weakening while axial pressure is applied to confirm the vertebral level of involvement.
This involvement will usually not show positive therapy localization in the clear. Therapy localization can be used to enhance the cervical spine weight-bearing test. Simply apply therapy localization in conjunction with pressure applied to the vertex of the head, compressing the cervical spine. In some cases, the weight of the upright patient’s head on the cervical spine is adequate compression to cause positive therapy localization.
The usual caveat that there are often many disturbances that may show positive therapy localization in one location applies. Make certain that the weakening of a muscle occurs because of the axial pressure on the cervical spine and not because of conditions such as an active neurovascular reflex, stress receptor, or cranial fault. If muscle weakness results from the patient touching the top of his head, find the problem and fix it prior to applying the axial pressure test. There should be correlation of the axial compression with the vertebral challenge described next.
The vertebral challenge is done by pressing on the anterior portion of one or both transverse process(es) in a posterior inferior direction in alignment with the facet plane, and then releasing. When the vertebra is subluxated and causing dysfunction that may include disc involvement, a previously strong indicator muscle will test weak with this rebound challenge. A muscle weak as a result of the subluxation will test strong when the vertebra is held in the position of correction (posterior and inferior). The challenge may be positive bilaterally or unilaterally. There will be a considerable amount of tenderness on the inferior aspect of the subluxated vertebra’s spinous process, which is characteristic of anterior subluxations.
The optimal vector of vertebral challenge indicates the contact and direction to apply an adjustive thrust to the vertebra. It will always be in a posterior inferior vector, i.e., down the facet plane.