{"id":10834,"date":"2025-09-17T16:23:10","date_gmt":"2025-09-17T13:23:10","guid":{"rendered":"https:\/\/www.atlasterapi.com\/en\/?p=10834"},"modified":"2025-09-17T17:00:55","modified_gmt":"2025-09-17T14:00:55","slug":"atlas-subluxation-complex-and-dizziness","status":"publish","type":"post","link":"https:\/\/www.atlasterapi.com\/en\/atlas-subluxation-complex-and-dizziness\/","title":{"rendered":"Atlas Subluxation Complex and Dizziness"},"content":{"rendered":"<h2>Atlas Subluxation Complex, National Upper Cervical Chiropractic Association Intervention, and Dizziness Improvement: A Narrative Review of Historical Perspectives, Literature Synthesis, and a Path for Future Care<\/h2>\n<style type=\"text\/css\">\nh1.jeg_post_title{display: none;}\n.table-wrapper {\n  width: 100%;\n  overflow-x: auto;                 \/* Ta\u015farsa kayd\u0131r *\/\n  scrollbar-gutter: stable both-edges; \/* (ops.) layout z\u0131plamas\u0131n\u0131 azalt\u0131r *\/\n}<\/p>\n<p>.table-wrapper table {\n  width: 100%;\n  border-collapse: collapse;\n  max-width: 100%;\n}<\/p>\n<p>\/* Masa\u00fcst\u00fc varsay\u0131lan\u0131: do\u011fal sar\u0131m, kayd\u0131rma yok *\/\n.table-wrapper th,\n.table-wrapper td {\n  padding: 8px 12px;\n  border: 1px solid #ddd;\n  text-align: left;\n  white-space: normal;              \/* sat\u0131r k\u0131r\u0131labilsin *\/\n}<\/p>\n<p>\/* SADECE mobilde geni\u015f tabloyu zorla kayd\u0131r\u0131labilir yap *\/\n@media (max-width: 768px) {\n  .table-wrapper {\n    -webkit-overflow-scrolling: touch;\n  }\n  .table-wrapper table {\n    min-width: 640px;               \/* tablo geni\u015f kals\u0131n ki yatay kayd\u0131r\u0131ls\u0131n *\/\n  }\n  .table-wrapper th,\n  .table-wrapper td {\n    white-space: nowrap;            \/* h\u00fccreleri tek sat\u0131rda tut *\/\n  }\n}\n<\/style>\n<div class=\"new-article-content-section\">\n<div class=\"article-content-body article-tab\">\n<h3 id=\"abstract\" class=\"reg\">Abstract<\/h3>\n<p>Dizziness is a non-specific and common condition in which the afflicted individual experiences abnormal sensations such as lightheadedness, imbalance, or a false sense of spinning (vertigo).\u00a0The experience of &#8220;dizziness&#8221; can result from a wide spectrum of abnormal physiological states, including exhaustion, hypotension, and hypoglycemia, but could also indicate a serious underlying health issue. Since it has many potential generating causes, accurate identification of the underlying etiology of dizziness can present a challenge to clinicians, often resulting in ineffective treatments. We present a hypothesis that atlas subluxation complex (ASC) may comprise an etiological agent of dizziness that can be successfully addressed with National Upper Cervical Chiropractic Association (NUCCA) chiropractic care. In this review, we discuss the pathophysiology of the ASC, introduce the NUCCA chiropractic procedure, and complete a literature review and synthesis.\u00a0Conceptual evidence, case reports, and theory provide foundational evidence that the ASC may be a contributory factor of dizziness generation and that NUCCA chiropractic corrective care of the ASC may produce favorable dizziness outcomes.\u00a0However, high-quality studies are lacking. The foundation evidence provides indication that further research via observational studies and randomized controlled trials (RCTs) is warranted.<\/p>\n<\/div>\n<\/div>\n<div class=\"new-article-content-section\">\n<div class=\"article-content-body article-tab\">\n<h3 id=\"introduction_and_background\" class=\"reg\">Introduction &amp; Background<\/h3>\n<h4>Background<\/h4>\n<p>Dizziness is a common condition, affecting over 20% of adults in the United States annually\u00a0<a class=\"content-anchor refs-anchor\">[1,2]<\/a>. &#8220;Dizziness&#8221; is a term used to describe many sensations, such as vertigo (a false sense of spinning), lightheadedness (a sense of floating and faintness), and imbalance.\u00a0Dizziness is one of the top reasons geriatric patients visit their primary care provider\u00a0<a class=\"content-anchor refs-anchor\">[1,2]<\/a>. Though benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and has a resounding cure rate, this is not the case for\u00a0chronic conditions that cause dizziness\u00a0<a class=\"content-anchor refs-anchor\">[3,4]<\/a>.\u00a0Unfortunately, overall, the diagnosis of the generating cause of dizziness is suboptimal, and the treatments are relatively ineffective, leaving about half of patients with long-term disability\u00a0<a class=\"content-anchor refs-anchor\">[4,5]<\/a>. Dizziness patients don&#8217;t always fit into the perfect &#8220;diagnostic box&#8221; either\u00a0<a class=\"content-anchor refs-anchor\">[1]<\/a>. These staggering facts present the need for better diagnostics, more informed providers, and expanded treatment options. In this narrative review, we\u00a0present a hypothesis that atlas subluxation complex (ASC) may comprise an etiological agent of dizziness and\u00a0evaluate the potential role of the National Upper Cervical Chiropractic Association (NUCCA) corrective care of ASC in addressing the condition of dizziness.<\/p>\n<h4>Definitions<\/h4>\n<p>Due to dizziness being a non-specific diagnosis and used to describe many sensations, along with chiropractic historically having profession-unique nomenclature, this review shall use the following descriptions for its definitions (Table\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1410375\"><em>1<\/em><\/a>). The definitions were compiled from recent PubMed\u00ae indexed papers, the published NUCCA standards and protocols consensus, the World Health Organization (WHO), and the B\u00e1r\u00e1ny Society\u2019s Consensus papers\u00a0<a class=\"content-anchor refs-anchor\">[6]<\/a>.<\/p>\n<\/div>\n<\/div>\n<div class=\"table-wrapper\">\n<style type=\"text\/css\">\n.tg  {border-collapse:collapse;border-color:#ccc;border-spacing:0;}<br \/>.tg td{background-color:#fff;border-color:#ccc;border-style:solid;border-width:1px;color:#333;<br \/>  font-family:Arial, sans-serif;font-size:14px;overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg th{background-color:#f0f0f0;border-color:#ccc;border-style:solid;border-width:1px;color:#333;<br \/>  font-family:Arial, sans-serif;font-size:14px;font-weight:normal;overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg .tg-cly1{text-align:left;vertical-align:middle}<br \/>.tg .tg-ce7y{background-color:#de7517;font-weight:bold;text-align:left;vertical-align:middle}<br \/>.tg .tg-yjjc{background-color:#f9f9f9;text-align:left;vertical-align:middle}<br \/>@media screen and (max-width: 767px) {.tg {width: auto !important;}.tg col {width: auto !important;}.tg-wrap {overflow-x: auto;-webkit-overflow-scrolling: touch;}}<\/style>\n<div class=\"tg-wrap\">\n<table class=\"tg\" style=\"undefined;table-layout: fixed; width: 671px;\">\n<colgroup>\n<col style=\"width: 235.2px;\" \/>\n<col style=\"width: 228.2px;\" \/>\n<col style=\"width: 207.2px;\" \/> <\/colgroup>\n<thead>\n<tr>\n<th class=\"tg-ce7y\"><span style=\"font-weight: bold; color: #fff;\">Term<\/span><\/th>\n<th class=\"tg-ce7y\"><span style=\"font-weight: bold; color: #fff;\">Definition<\/span><\/th>\n<th class=\"tg-ce7y\"><span style=\"font-weight: bold; color: #fff;\">Comment<\/span><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Vertigo<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">The sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement. <\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Dizziness<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">The sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion. <\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Vestibulo-visual symptoms<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Visual symptoms that usually result from vestibular pathology or the interplay between visual and vestibular systems. These include false sensations of motion or tilting of the visual surround and visual distortion (blur) linked to vestibular (rather than optical) failure. <\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Postural symptoms<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Balance symptoms related to maintenance of postural stability, occurring only while upright (seated, standing, or walking). <\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Lightheadedness<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">The feeling of impending blackout or faint in the absence of spinning and positional vertigo.<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">ASC \u00a9<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">This term is a neologism intended to denote the far reaching and damaging effects of the subluxated occipital-atlanto-axial area of the cervical spine upon the spinal column and the human organism. It differs in meaning from the commonly used chiropractic term \u201catlas subluxation\u201d or \u201catlas-axis subluxation\u201d in that the term &#8220;atlas subluxation complex&#8221; embraces the demonstrable mechanical and neurological phenomena which, through research, have been found to be associated with the subluxation of the occipital-atlanto-axial spine. Therefore, by definition, the term includes the atlas vertebra in all its planes of misalignment, its positional relationship to the occiput, subjacent vertebrae and pelvis, inclusive of the excursions of these structures into any or all of the bodily orientation planes; and resulting in concomitant detriment to the susceptive neurological components.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">NUCCA definition: \u00a9 Dr Ralph R. Gregory<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">ASC \u00a9<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">A structural misalignment of the CCJ resulting in neuropathophysiological changes and bodily dysfunction.<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Layman\u2019s simple definition<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">ASC Syndrome \u00a9<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">In this term, the word &#8220;syndrome&#8221; is limited in meaning to include only the observable and measurable signs of an ASC: objective signs. ASC is defined, therefore, as those signs which are always present and measurable in proportion to the intensity of ASC: misalignment factors as shown by X-ray, resulting traction of the neurological component, presence of spastic contracture of the lumbar and pelvic musculature, distortion of the pelvic girdle, displacement of the body\u2019s center of gravity, contractured leg, and deviation of the spinal segments from the vertical axis of the body.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">NUCCA definition: \u00a9 Dr Ralph R. Gregory<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Restoration Principle \u00a9<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">The reduction to normal of the misalignment factors of the ASC. This includes all methods and systems that reduce to or towards normal, the misalignment factors of the ASC. The Restoration Principle, which is based upon specific and acceptable principles of misalignment reduction, therefore is a pre-determined and pre-directed process of correction. In further simplification, \u201cThe principle that misaligned vertebra must be maximally restored to normal.&#8221;<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">NUCCA definition: \u00a9 Dr Ralph R. Gregory<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Misalignment factors<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">The misalignment factors are the measurable misalignments of the vertebrae of the spinal column and the positional relationship of the occiput to the spinal column and include the relationship of these structures to the vertical axis of the body and into any and all planes of motion as well as the ratio of magnitude that exists between an excursion into any given plane to that of any other plane of motion.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">CCJ<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">The junction of the base of the skull and the cervical spine, including the occipital bone, surrounding the foramen magnum (occiput) (C0), C1 (atlas), C2 (axis), and the intervening tendons and ligaments. The specialized articulations between the occipital condyles and the complex ligamentous system link these three structures into one functional unit. This includes neurovascular structures extending from the skull base to C2.<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">CCJ misalignment<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Improper orthogonal positioning of the skull, atlas, axis, and lower neck in relation to one another. The CCJ misalignment is the structural component of the ASC.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">No comment<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Vertebral subluxation<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">Vertebrae that are misaligned relative to the vertical axis in one or more orientation planes resulting in neurological stresses which produce measurable distortion of the spine, pelvis, and contiguous structures.<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">NUCCA definition<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">Vertebral subluxation<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity, and\/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">WHO definition<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">UCLF<\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">A calculated and vectored manual force given by the chiropractor to the patient to reduce the misalignment factors; also commonly referred to as the \u201ccorrection\u201d, or the \u201cadjustment\u201d. <\/span><\/td>\n<td class=\"tg-yjjc\"><span style=\"color: #222;\">UCLF is not a manipulation. Manipulation occurs when a joint is brought into its paraphysiological joint space with an HVLA force. UCLF has very little excursion and focuses on joint realignment. Manipulation\u2019s primary goal is to restore motion to a fixated joint. <\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">UCT<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">A chiropractic specialty with an established set of procedures that uses image-guided analysis to measure misalignment factors, addresses the ASC, and uses UCLF as its intervention.<\/span><\/td>\n<td class=\"tg-cly1\"><span style=\"color: #222;\">The UCT organizations that belong to the International Chiropractors Association \u2013 Council on Upper Cervical Care are as follows: NUCCA, Orthospinology, Atlas Orthogonal, Advanced Orthogonal, Blair, Knee Chest Upper Cervical Society, Evolutionary Percussive Instrument Corrections, Grostic, and HIO<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div id=\"table-anchor-1410375\" class=\"article-attachment-wrap table-attachment-wrap\" data-number=\"1\">\n<div class=\"attachment-metadata\">\n<h6 class=\"attachment-title\">Table 1: Definitions <a class=\"content-anchor refs-anchor\">[6-13]<\/a><\/h6>\n<div class=\"attachment-caption\">\n<p>ASC: Atlas subluxation complex; NUCCA:\u00a0National Upper Cervical Chiropractic Association; CCJ:\u00a0Craniocervical junction; UCLF:\u00a0Upper cervical low-force (procedure); UCT: Upper cervical technique; HVLA: High-velocity, low-amplitude; HIO: Hole-in-one<\/p>\n<\/div>\n<\/div>\n<div class=\"fancy-bottom\"><\/div>\n<\/div>\n<h4>Historical overview<\/h4>\n<p>Chiropractic care is a separate and distinct healthcare discipline focusing on care of the functional condition of the spine with respect to its influence on the function and adaptability of the nervous system.\u00a0In 1895, then energy healer D.D. Palmer was attempting to treat\u00a0a patient with deafness that was acquired after a spinal trauma\u00a0<a class=\"content-anchor refs-anchor\">[14,15]<\/a>. Palmer\u2019s energetic treatments were ineffective, leading him to try new methods.\u00a0He noticed the patient had what he perceived to be a spinal bone \u201cout of place.\u201d\u00a0With ingenuity, Palmer decided to use a\u00a0high-velocity, low-amplitude (HVLA) force by hand to manually direct the vertebra back into place (Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368808\"><em>1<\/em><\/a>). The patient reported a complete restoration of hearing after this treatment.\u00a0Palmer termed this new practice as &#8220;chiropractic.&#8221;<\/p>\n<div id=\"figure-anchor-1368808\" class=\"article-attachment-wrap\" data-number=\"1\">\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignleft size-full wp-image-10837\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/DDpalmer-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><\/p>\n<\/div>\n<\/div>\n<p><strong>Figure 1: D.D. Palmer showing how the chiropractor places his hands for an adjustment<\/strong><br \/>\nCourtesy of Special Collections and Archives, Palmer College of Chiropractic. Published in NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association [16]. Permission was obtained from both sources for use in this article.<\/p>\n<p>His son, B.J. Palmer, was known as the developer of the chiropractic profession\u00a0<a class=\"content-anchor refs-anchor\">[17]<\/a>. Soon after the inception of chiropractic, B.J. took an interest in the idea that spinal misalignments were the leading cause of whole-body dysfunction.\u00a0He named this vertebral abnormality a subluxation\u00a0<a class=\"content-anchor refs-anchor\">[18]<\/a>. Though the term &#8220;subluxation&#8221; already existed to describe a minor, or \u201cless than\u201d a dislocation, Palmer rephrased it to mean a misalignment of spinal bones, placing physical pressure on neurological structures, resulting in \u201cnerve interference\u201d and ultimately end-organ disease\u00a0<a class=\"content-anchor refs-anchor\">[18]<\/a>. Therefore, his definition required two components, the structural misalignment of spinal vertebrae and the resulting nerve interference.\u00a0His intervention was the chiropractic adjustment, a vectored force by hand used to guide the vertebrae into proper alignment, relieving the nerve interference and restoring bodily function\u00a0<a class=\"content-anchor refs-anchor\">[18]<\/a>.<\/p>\n<p>In 1931, a subset of the profession further focused on the analysis and postural correction of the upper neck region or craniocervical junction (CCJ), where they believed the primary subluxation of the spine existed\u00a0<a class=\"content-anchor refs-anchor\">[19]<\/a>. Though proper research was almost non-existent at the time, they believed the CCJ region was the primary area of concern due to observation and its proximity to the brainstem.\u00a0The belief was that subluxation of the CCJ lead to &#8220;secondary&#8221; subluxations elsewhere in the spine.\u00a0Therefore, instead of focusing on addressing all of the spinal subluxations, their belief was that correcting the CCJ subluxation would fix the secondary subluxations.<\/p>\n<p>The hole-in-one (HIO) technique was introduced as the first upper cervical chiropractic method.\u00a0The method utilized radiographic imaging to objectively measure and assess the alignment of the atlas (C1).\u00a0The measurements create a two-dimensional vector that the chiropractor would use to improve the alignment by administering an HVLA force using the atlas transverse process as the contact point with the patient lying on their side.\u00a0The headpiece of the table used a cocking mechanism that allowed it to drop down about two centimeters during the adjustment for added movement.\u00a0Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368821\"><em>2<\/em><\/a>\u00a0shows Palmer demonstrating how the chiropractor places his hands for an HIO adjustment.<\/p>\n<p><img decoding=\"async\" class=\"alignleft size-full wp-image-10838\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/hio-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><br \/>\n<strong>Figure 2: B.J. Palmer showing how the chiropractor places his hands for a HIO adjustment<\/strong><br \/>\nCourtesy of Special Collections and Archives, Palmer College of Chiropractic. Published in NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association [16]. Permission was obtained from both sources for use in this article.<\/p>\n<p>HIO: Hole-in-one<\/p>\n<p>The HIO concept was later expanded upon in 1938 by Dr John Grostic Sr and Dr Ralph R. Gregory, who wished to incorporate metrics to improve inter-practitioner reliability\u00a0<a class=\"content-anchor refs-anchor\">[19]<\/a>. They introduced the concept of intra-procedural post-adjustment imaging to objectively measure alignment changes after the initial intervention.\u00a0They created X-ray positioning equipment to reduce radiographic alignment errors (Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368842\"><em>3<\/em><\/a>). They also expanded upon the analysis to provide a three-dimensional vector for the adjustment\u00a0<a class=\"content-anchor refs-anchor\">[18]<\/a>. The nasium radiograph view was added for more in-depth analysis (Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368849\"><em>4<\/em><\/a>). Emphasis was also added on the total orthogonal alignment of the center of the skull, atlas and axis (C1 and C2), and base of the cervical spine\u00a0<a class=\"content-anchor refs-anchor\">[18,19]<\/a>. The adjustment, developed by Gregory, was updated to be low force and low amplitude, with no movement of the table headpiece.\u00a0A recent study on inter-examiner reliability of the radiographic analysis using the NUCCA protocol found almost perfect agreement (&gt;96%), without proportional bias\u00a0<a class=\"content-anchor refs-anchor\">[20]<\/a>.<\/p>\n<p><img decoding=\"async\" class=\"alignleft size-full wp-image-10839\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig3-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><\/p>\n<p><strong>Figure 3: Head clamps used for accurate X-ray positioning<\/strong><br \/>\nCourtesy of and published in NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association [16]. Permission was obtained for use in this article.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-10841\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig4-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><\/p>\n<h6 class=\"attachment-title\">Figure\u00a04: NUCCA radiographs and analysis examples<\/h6>\n<div class=\"attachment-caption\">\n<p>Lateral cervical (left), nasium (middle), and vertex (right)<\/p>\n<p>Courtesy of and published in\u00a0<em>NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association<\/em>\u00a0<a class=\"content-anchor refs-anchor\">[16]<\/a>.\u00a0Permission was obtained for use in this article.<\/p>\n<p>NUCCA: National Upper Cervical Chiropractic Association<\/p>\n<p>In 1966, Dr Ralph Gregory and colleagues formed the NUCCA organization to further expand the orthogonal chiropractic management of what Gregory referred to as the &#8220;atlas subluxation complex&#8221; (ASC)\u00a0<a class=\"content-anchor refs-anchor\">[19]<\/a>. They chose the name to end the era of forming technique protocols around an individual figure as a leader.<\/p>\n<p>One of the most significant expansions of NUCCA protocols, further developed by Dr Ralph Gregory, was the adjustment refinement broken down into several phases\u00a0(Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368855\"><em>5<\/em><\/a>)\u00a0<a class=\"content-anchor refs-anchor\">[21]<\/a>. NUCCA protocol was also defined by four major types of misalignment presentations.\u00a0It enhanced the understanding of spinal biomechanics, from how the spine compensates for injury and added to the essential factors needed to correct the misalignment optimally (Figure\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1368861\"><em>6<\/em><\/a>)\u00a0<a class=\"content-anchor refs-anchor\">[22]<\/a>. In 1971, NUCCA formed a research organization to scientifically scrutinize and advance the NUCCA procedure instead of relying on blind faith and philosophy, which was common at the time.\u00a0Since then, the National Upper Cervical Chiropractic Research Association (NUCCRA), now known as the Upper Cervical Research Foundation (UCRF), has studied and published findings on how the ASC impacts human health and how to optimize the NUCCA procedure\u00a0<a class=\"content-anchor refs-anchor\">[23]<\/a>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-10842\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig5-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><\/p>\n<\/div>\n<h6 class=\"attachment-title\">Figure\u00a05: NUCCA intervention setup showing step 2 of phase 1 (left), step 2 of phase 2 (middle), and step 6 of phase 5 (right) as a few examples of the entire process<\/h6>\n<div class=\"attachment-caption\">\n<p>Courtesy of and published in\u00a0<em>NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association<\/em>\u00a0<a class=\"content-anchor refs-anchor\">[16]<\/a>.\u00a0Permission was obtained for use in this article.<\/p>\n<p>NUCCA:\u00a0National Upper Cervical Chiropractic Association<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-10843\" src=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6.jpg\" alt=\"\" width=\"1600\" height=\"900\" srcset=\"https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6.jpg 1600w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-300x169.jpg 300w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-1024x576.jpg 1024w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-768x432.jpg 768w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-1536x864.jpg 1536w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-750x422.jpg 750w, https:\/\/www.atlasterapi.com\/en\/wp-content\/uploads\/2025\/09\/fig6-1140x641.jpg 1140w\" sizes=\"(max-width: 1600px) 100vw, 1600px\" \/><\/p>\n<\/div>\n<h6 class=\"attachment-title\">Figure\u00a06: The basic type 1 misalignment pattern (left) and the factors needed to correct the alignment (right)<\/h6>\n<div class=\"attachment-caption\">\n<p>Courtesy of and published in\u00a0<em>NUCCA Protocols and Perspectives: A Textbook for the National Upper Cervical Chiropractic Association<\/em>\u00a0<a class=\"content-anchor refs-anchor\">[16]<\/a>.\u00a0Permission was obtained for use in this article.<\/p>\n<div class=\"article-content-body article-tab\">\n<p>The first mention of chiropractic being used for dizziness intervention was in 1906 when Palmer published, &#8220;vertigo [is] the result of deranged nerves\u201d\u00a0<a class=\"content-anchor refs-anchor\">[24]<\/a>. Over 100 years later, NUCCA practitioners continue to care for patients with dizziness.\u00a0Advertisements and online discussions regularly host NUCCA chiropractors suggesting their care is effective for dizziness from M\u00e9ni\u00e8re&#8217;s disease (MD).\u00a0However, as health care and health sciences continue to move towards an evidence-informed model, we must examine the available evidence and identify gaps.\u00a0This narrative review shall accomplish the following: 1) synthesize the available evidence that the ASC may generate dizziness; 2) synthesize the available evidence on NUCCA intervention\u2019s effect on dizziness; 3) report on gaps in the knowledge base to guide future research.<\/p>\n<\/div>\n<div class=\"article-content-body article-tab\">\n<h3 id=\"review\" class=\"reg\">Review<\/h3>\n<h4>Methods<\/h4>\n<p><em>Databases and Inclusion Criteria<\/em><\/p>\n<p>Index to Chiropractic Literature (ICL), PubMed\u00ae, and Cochrane Library of Systematic Reviews (CLSR) databases were searched using the terms \u201cNUCCA AND Dizziness\u201d, \u201cAtlas Subluxation AND Dizziness\u201d, \u201cUpper Cervical Spine AND Dizziness\u201d, \u201cCraniocervical Junction AND Dizziness\u201d, and \u201cChiropractic AND Meniere\u2019s\u201d from 2014 through July 2024. Articles selected for the synthesis met one or more of the following inclusion criteria: (1a) specifies using upper cervical technique (UCT) for the ASC; (1b) human subject(s); (1c) diagnosed with &#8220;dizziness&#8221;; or (2) basic\u00a0science research on the ASC affecting vestibular anatomy. Articles that used spinal manipulation, or any other form of manual therapy that is not UCT, were excluded.\u00a0The search results are found in Table\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1368921\"><em>2<\/em><\/a>.<\/p>\n<\/div>\n<\/div>\n<div class=\"table-wrapper\">\n<style type=\"text\/css\">\n.tg  {border-collapse:collapse;border-spacing:0;margin:0px auto;}<br \/>.tg td{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px;<br \/>  overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg th{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px;<br \/>  font-weight:normal;overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg .tg-1yv1{background-color:#de7517;border-color:inherit;color:#ffffff;font-weight:bold;text-align:center;vertical-align:top}<br \/>.tg .tg-kqki{background-color:#F9F9F9;border-color:inherit;color:#222;text-align:left;vertical-align:top}<br \/>.tg .tg-ats7{background-color:#FFF;border-color:inherit;color:#222;text-align:left;vertical-align:top}<br \/>@media screen and (max-width: 767px) {.tg {width: auto !important;}.tg col {width: auto !important;}.tg-wrap {overflow-x: auto;-webkit-overflow-scrolling: touch;margin: auto 0px;}}<\/style>\n<div class=\"tg-wrap\">\n<table class=\"tg\">\n<thead>\n<tr>\n<th class=\"tg-1yv1\"><span style=\"font-weight: bold;\">Database<\/span><\/th>\n<th class=\"tg-1yv1\"><span style=\"font-weight: bold;\">Search Terms<\/span><\/th>\n<th class=\"tg-1yv1\"><span style=\"font-weight: bold;\">Number of Hits<\/span><\/th>\n<th class=\"tg-1yv1\"><span style=\"font-weight: bold;\">Number of Papers Meeting Criteria<\/span><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">ICL<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">NUCCA AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">3<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">3<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">ICL<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Atlas Subluxation AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">9<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">7<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">ICL<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Upper Cervical Spine AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">8<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">5<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">ICL<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Craniocervical Junction AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">1<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">1<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">ICL<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Chiropractic AND Meniere\u2019s<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">11<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">8<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">PubMed\u00ae<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">NUCCA AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">PubMed\u00ae<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Atlas Subluxation AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">4<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">PubMed\u00ae<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Upper Cervical Spine AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">49<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">PubMed\u00ae<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Craniocervical Junction AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">15<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">PubMed\u00ae<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Chiropractic AND Meniere\u2019s<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">2<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">CLSR<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">NUCCA AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">CLSR<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Atlas Subluxation AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">CLSR<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Upper Cervical Spine AND Dizziness<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">22<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">CLSR<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Craniocervical Junction AND Dizziness<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">CLSR<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">Chiropractic AND Meniere\u2019s<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<td class=\"tg-kqki\"><span style=\"color: #222;\">0<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">TOTAL<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">Not Applicable <\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">124<\/span><\/td>\n<td class=\"tg-ats7\"><span style=\"color: #222;\">24<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h4>Discussion<\/h4>\n<p><em>Literature Synthesis<\/em><\/p>\n<p>124 total papers were identified.\u00a024 papers matched the inclusion criteria for synthesis by clearly identifying ASC as a clinical entity in a patient that was diagnosed with dizziness and who underwent upper cervical low-force (UCLF) care.\u00a0Of these papers, 10 appeared in multiple searches, leaving 14 original articles.\u00a0All 14 articles were case studies or series reporting on 20 total patients (Table\u00a0<a class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1368923\"><em>3<\/em><\/a>). Taken together, this collection of case studies comprises a cohort of dizziness patients who harbored ASC, and who experienced improvement or resolution of their symptoms after UCLF care.\u00a0No experimental studies such as clinical trials, basic science studies, or review articles were found in this search, leaving the results susceptible to bias and placebo effects.\u00a0Of the 14 case studies\/series, three were specific to NUCCA UCT, while 11 utilized a different UCT as their intervention. Of the 14 case studies, the dizziness-generating diagnoses were as follows: five involved concussion or other physical trauma to the CCJ, seven involved MD, one involved primary CNS tumor, and one involved dysautonomia to include low heart rate.\u00a0Listed below are multiple conditions found within the literature review and are discussed in further detail how the ASC is relevant to each condition, how NUCCA intervention may improve outcomes, and further research recommendations.<\/p>\n<div class=\"table-wrapper\">\n<style type=\"text\/css\">\n.tg  {border-collapse:collapse;border-spacing:0;margin:0px auto;}<br \/>.tg td{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px;<br \/>  overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg th{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px;<br \/>  font-weight:normal;overflow:hidden;padding:10px 5px;word-break:normal;}<br \/>.tg .tg-c3he{background-color:#DE7517;color:#FFF;font-weight:bold;text-align:center;vertical-align:top}<br \/>.tg .tg-brl1{color:#222;text-align:left;vertical-align:top}<br \/>@media screen and (max-width: 767px) {.tg {width: auto !important;}.tg col {width: auto !important;}.tg-wrap {overflow-x: auto;-webkit-overflow-scrolling: touch;margin: auto 0px;}}<\/style>\n<div class=\"tg-wrap\">\n<table class=\"tg\">\n<thead>\n<tr>\n<th class=\"tg-c3he\">Author<\/th>\n<th class=\"tg-c3he\">Date Published<\/th>\n<th class=\"tg-c3he\">UCT Used<\/th>\n<th class=\"tg-c3he\">Diagnosis<\/th>\n<th class=\"tg-c3he\"><span style=\"font-weight: bold;\">S<\/span>t<span style=\"font-weight: bold;\">u<\/span>d<span style=\"font-weight: bold;\">y<\/span> <span style=\"font-weight: bold;\">D<\/span>e<span style=\"font-weight: bold;\">s<\/span>i<span style=\"font-weight: bold;\">gn<\/span><\/th>\n<th class=\"tg-c3he\">Comments<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Berner, Steward<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">03\/14\/2020<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Orthospinology<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">68-yo female with self-reported symptom improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Chung<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">08\/31\/2019<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">NUCCA<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Post-concussion syndrome<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case series of two<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">16-yo female and 30-yo female with self-reported symptom improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Moore<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">02\/11\/2019<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">NUCCA<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Post-concussion syndrome<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case series of six<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Age ranges from 39 to 82 with objective outcome measure improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Finn, Ierano, Doyle<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">06\/16\/2022<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Atlas Orthogonal<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Axial trauma<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">49-yo female with subjective improvement and self-reported quality of life improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Burcon<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">05\/10\/2021<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">HIO<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD and concussion<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">51-yo female with subjective improvement stating her vertigo went from a 10 to a 1<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Osborne, Rauch<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">01\/27\/2021<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Atlas Orthogonal<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Dysautonomia<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">74-yo female with objective heart rate variability changes and subjective improvements<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Null, Null<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">03\/04\/2019<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Grostic<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Traumatic brain injury<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">19-yo male with self-reported improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Ball<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">07\/03\/2017<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">HIO<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Primary CNS tumor<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Unspecified age and gender with objective outcome measurement improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Burcon<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">03\/21\/2023<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">HIO<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">48-yo female with self-reported symptom resolution of all complaints except hearing loss<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Belcher, Barnes<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">12\/19\/2022<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Atlas Orthogonal<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">59-yo female with self-reported resolution of vertigo<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Malachowski, Britt<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">08\/17\/2020<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Knee Chest Upper Cervical Specific<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">64-yo female with self-reported improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Grey, Ellis<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">09\/30\/2019<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Blair<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">59-yo female with positive improvement<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Chung, O\u2019Connell<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">01\/09\/2017<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">NUCCA<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">45-yo male with self-reported quality of life improvement and symptom resolution<\/span><\/td>\n<\/tr>\n<tr>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Pennington, Miller<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">11\/30\/2015<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Atlas Orthogonal<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">MD<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">Case report<\/span><\/td>\n<td class=\"tg-brl1\"><span style=\"color: #222;\">63-yo female with reported symptom reduction<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h6 class=\"attachment-title\">Table\u00a03: Summary of literature review\u00a0<a class=\"content-anchor refs-anchor\">[25-38]<\/a><\/h6>\n<div class=\"attachment-caption\">\n<p>NUCCA: National Upper Cervical Chiropractic Association; MD:\u00a0M\u00e9ni\u00e8re&#8217;s disease; HIO: Hole-in-one<\/p>\n<p><strong><em>ASC as a Cause or Contribution to Dizziness: Pathophysiology<\/em><\/strong><\/p>\n<p>Four mechanistic rationales exist in the literature to explain how the ASC can cause or contribute to the generation of dizziness.\u00a0The four, described below, are: proprioceptive dysafferentation, craniospinal\u00a0hydrodynamic dysfunction, direct mechanical irritation from spinal cord tension, and venous compression from spinal cord tension.<\/p>\n<p><strong>Proprioceptive dysafferentation:<\/strong> Also referred to as somatosensory input hypothesis, proprioceptive dysafferentation holds the highest level of biological plausability and most significant scientific community acceptance regarding dizziness resulting from cervical soft tissue according to the B\u00e1r\u00e1ny Society\u00a0<a class=\"content-anchor refs-anchor\">[39]<\/a>.\u00a0Mechanoreceptors are a group of proprioceptors within the sensory portion of the nervous system\u00a0<a class=\"content-anchor refs-anchor\">[40]<\/a>. Their function is to relay tactile sensations and position sense to the neuroaxis.\u00a0The muscle spindle mechanoreceptors are located in musculoskeletal tissue and respond to length and stretch changes.\u00a0Muscle spindles are in great abundance within the suboccipital muscles\u00a0<a class=\"content-anchor refs-anchor\">[41,42]<\/a>. A positional change of only 0.4\u00ba in the upper cervical spine is sufficient to cause an increase in afferent discharge\u00a0<a class=\"content-anchor refs-anchor\">[43]<\/a>. The central vestibular system relies on a constant sensory flow of peripheral information for processing spatial awareness.\u00a0At rest, the healthy and normal functioning visual and vestibular labyrinth organs relay their typical afferents.\u00a0However, if the ASC is present, it is hypothesized proprioceptive afferents will increase, resulting in a sensory mismatch and dizziness.<\/p>\n<p><strong>Craniospinal hydrodynamic dysfunction:<\/strong> A new area of investigation into how the ASC can cause neurological dysfunction, and ultimately dizziness, is through hydrodynamics\u00a0<a class=\"content-anchor refs-anchor\">[11,44-46]<\/a>. The CCJ is an essential and sensitive anatomical convergence for all fluids moving to and from the brain.\u00a0An uninterrupted inward flow of arterial blood, outward flow of venous blood, lymphatic movements, and dual movement of cerebral spinal fluid must occur for proper brain and nerve function\u00a0<a class=\"content-anchor refs-anchor\">[10,11]<\/a>. An obstruction to the arterial blood to the brain is one of the leading causes of death worldwide\u00a0<a class=\"content-anchor refs-anchor\">[47]<\/a>. However, a non-obstructed, functional reduction of arterial flow can result in nervous dysfunction, such as in cerebral hypoperfusion from orthostatic hypotension, which is known to cause dizziness\u00a0<a class=\"content-anchor refs-anchor\">[7,48,49]<\/a>. Flammer researched and reported on non-obstructive, functional hypoperfusion of the optic nerve resulting in visual acuity problems, which could also be expected to result in the experience of dizziness\u00a0<a class=\"content-anchor refs-anchor\">[50]<\/a>.\u00a0Since the vertebral artery makes four 90\u00ba turns within the CCJ and traverses through the atlas transverse processes, it is susceptible to obstruction of blood flow from bony malposition; 20% of cervical rotation and extension is enough to limit blood flow\u00a0<a class=\"content-anchor refs-anchor\">[51-54]<\/a>. A transverse misalignment of the atlas\u00a0(rotated atlas) over the axis would potentially reduce the amount of cervical rotation and extension needed to restrict the lumen.\u00a0The vertebral artery eventually branches off to supply nutrients to the vestibular nuclei\u00a0<a class=\"content-anchor refs-anchor\">[55]<\/a>. A misalignment of the CCJ may ultimately lead to hypoperfusion of the vestibular nuclei, resulting in dizziness. A clinical component of Wallenberg syndrome, which is a blockage of the posterior inferior cerebellar artery (PICA) that supplies blood to the central vestibular anatomy, is vertigo\u00a0<a class=\"content-anchor refs-anchor\">[52]<\/a>. Therefore, hypoperfusion, but not complete blockage, is hypothesized to result in vertigo\/dizziness as well. Since the CSF has cranial-caudal\u00a0movement through the C0, C1, and C2 vertebrae of the CCJ, the flow pattern is also susceptible to bony misalignment, particularly from the dentate-ligament spinal cord-distortion hypothesis, as discussed in the next section\u00a0<a class=\"content-anchor refs-anchor\">[11,56]<\/a>. The CSF traverses the spine and enters the cranium, in a cranial direction, by way of the subarachnoid space. It moves out of the cranium in a caudal direction from the fourth ventricle through the central canal of the spinal cord. Since the spinal cord has direct soft tissue attachment to the bony segments of the CCJ (see the dentate-ligament spinal cord-distortion hypothesis), a structural misalignment is hypothesized to disrupt the normal CSF flow through the CCJ\u00a0<a class=\"content-anchor refs-anchor\">[11]<\/a>.<\/p>\n<p>Improper flow of the CSF and glymphatic pathways can result in waste buildup and reduced nerve function, including the central vestibular processing anatomy\u00a0<a class=\"content-anchor refs-anchor\">[57]<\/a>. Venous outflow from the cranium can also be altered by jugular vein compression by the transverse process of the atlas\u00a0<a class=\"content-anchor refs-anchor\">[58]<\/a>. Dysfunctional craniospinal hydrodynamics has been associated with many neurological conditions such as Parkinson\u2019s (known to lead to orthostatic hypotension and dizziness), multiple sclerosis (MS) (known to lead to dizziness and imbalance), and dementia\u00a0<a class=\"content-anchor refs-anchor\">[59-73]<\/a>. In fact, an MRI study on MS patients with prior craniocervical trauma found that their upright CSF flow and pressure gradients had significant obstruction\u00a0<a class=\"content-anchor refs-anchor\">[74]<\/a>. Only further research will help us determine if it plays a role in vestibular pathophysiology.<\/p>\n<p><strong>Spinal cord tension and direct mechanical irritation and venous compression:<\/strong> One of the original hypotheses on how the ASC can result in distal bodily dysfunction is the dentate-ligament spinal cord-distortion hypothesis presented by John D. Grostic Jr\u00a0<a class=\"content-anchor refs-anchor\">[56]<\/a>. This hypothesis presents two mechanisms: direct mechanical irritation of nerves and venous compression.\u00a0The spinal cord is directly attached to the foramen magnum, the second and third cervical vertebrae, the posterior longitudinal ligament, rectus capitus posterior minor muscle, and through dural attachment to the periosteum of the atlas\u00a0<a class=\"content-anchor refs-anchor\">[75]<\/a>. Between the attachments of the nerve roots exist bands of tissue called the dentate ligaments.\u00a0These ligaments are incredibly strong and have their peak strength within the upper cervical spine\u00a0<a class=\"content-anchor refs-anchor\">[76]<\/a>.<\/p>\n<p>The dorsal spinocerebellar tract (DSCT) ascends on the lateral portion of the spinal cord. The DSCT relays proprioceptive afferents from the periphery to the ipsilateral cerebellum. Due to the DSCT\u2019s anatomical location, it is the most vulnerable to mechanical irritation from inappropriate tension applied by the dentate ligaments, for example from ASC. Mechanical irritation of the DSCT is hypothesized to result in dysafferentation, as described above, which may result in sensations of imbalance.\u00a0The small veins of the upper cervical spinal cord are scarce compared to other regions of the spine. Mechanical obstruction of these veins can cause stasis of blood and local ischemia.\u00a0These veins move blood at a very low pressure, predisposing them to easy occlusion by compressive forces\u00a0<a class=\"content-anchor refs-anchor\">[56,76]<\/a>. Gillilan stated that the dentate ligaments may be a means of transmitting mechanical stress to the cord and resulting in small vein occlusion\u00a0<a class=\"content-anchor refs-anchor\">[77]<\/a>. Local ischemia by means of venous compression and direct mechanical tension on the DSCT are two theories as to how a CCJ misalignment may affect the normal proprioceptive afferents through the dentate ligaments, causing spinal cord tension.\u00a0The DSCT carries proprioceptive afferents from the periphery to the cerebellum for higher-order processing. The cerebellum corrects posture based on the information it receives from the DSCT.\u00a0If the information is faulty due to the mechanism(s) explained above, postural abnormalities (and postural symptoms) may result. This hypothesis also adds fuel to the two previous hypotheses, as cord distortion may result in altered craniospinal hydrodynamics and proprioceptive dysafferentation.<\/p>\n<p><strong><em>ASC and MD<\/em><\/strong><\/p>\n<p>MD is a vestibular disorder characterized by spontaneous episodes of vertigo, sensorineural hearing loss, and fluctuating aural symptoms\u00a0<a class=\"content-anchor refs-anchor\">[78]<\/a>. Historically, MD is associated with over-accumulating endolymph in the semicircular canals and otoliths.\u00a0The most accepted pathophysiology is that this over-accumulation, termed endolymphatic hydrops (EH), damages cochlear anatomy and over-stimulates the peripheral vestibular organs, leading to a unilateral vestibular imbalance, resulting in the symptoms mentioned above\u00a0<a class=\"content-anchor refs-anchor\">[79]<\/a>. However, recent evidence suggests that EH alone is not enough to cause MD\u00a0<a class=\"content-anchor refs-anchor\">[80]<\/a>. Endolymph is created by the secretory cells in the vascularis of the cochlea and the dark cells of the labyrinth, which moves to the semicircular canals.\u00a0It is drained through the endolymphatic duct into the endolymphatic sac.\u00a0There it extends through the distal vestibular aqueduct and out the external aperture of the aqueduct, where it ends in the epidural space of the posterior cranial fossa.\u00a0The endolymph has a high K+:Na+ ratio, resembling intra-cellular fluid, as opposed to the perilymph, which has a high Na+:K+ ratio.\u00a0The perilymph bathes the exterior portion of the membranous labyrinth\u00a0<a class=\"content-anchor refs-anchor\">[81-84]<\/a>.<\/p>\n<p>Not present in the primary literature search because it is a newer publication and not yet indexed is Steward\u2019s retrospective case series on UCT and vestibular rehabilitation on eight patients with vestibular diagnoses\u00a0<a class=\"content-anchor refs-anchor\">[85]<\/a>. The author measured dizziness handicap inventory (DHI) scores before and after a 30-day plan of care.\u00a0Of the eight participants, four of them were diagnosed with MD.\u00a0Their DHI improvement was 64% (Case 1), 28% (Case 2), 92% (Case 3), and 78% (Case 4).\u00a0It is worth noting that Cases 1-3 received an individual plan of vestibular rehabilitation in addition to UCT, while Case 4 only received UCT.\u00a0As listed, seven other case reports were found in the literature on UCT and MD&#8217;s improvement.\u00a0Steward\u2019s paper noted an objective reduction of the CCJ misalignment, as visible on X-ray, after the UCLF intervention in all cases.<\/p>\n<p>Also not present in the primary search was Burcon\u2019s paper, which retrospectively reported on the health outcomes of 300 MD patients who underwent UCT care\u00a0<a class=\"content-anchor refs-anchor\">[86]<\/a>. Of these 300 patients, the average pre-care reported vertigo severity on a scale of 1-10 (10 being the worst) was 8.5.\u00a0At six weeks post care, the average lowered to 3.\u00a0In one year, it reduced to 2.\u00a0At six years, it dropped to 0.8.\u00a0A notable reported cohort feature was that 100% of the cases had a history of whiplash trauma (cervical acceleration-deceleration injury).<\/p>\n<p>Though the pathogenesis and pathophysiology of MD is still not fully established, we can use contemporary knowledge of vestibular anatomy and physiology to understand what is being affected.\u00a0Since vertigo is the main vestibular symptom, we can reduce the generating anatomy to a unilateral imbalance of the semicircular canals, the central processing anatomy of the canals, and\/or the neurological pathway between the two\u00a0<a class=\"content-anchor refs-anchor\">[78,81,82]<\/a>. Therefore, further research on the ASC\u2019s association with MD pathophysiology should focus on the intimate connection between the CCJ and this anatomy.\u00a0Disrupted hydrodynamics of the CSF with a subsequent restriction of endolymph movement due to CCJ misalignment should be evaluated.<\/p>\n<p><strong><em>ASC and Vestibular Migraine<\/em><\/strong><\/p>\n<p>Vestibular migraine is a migraine disorder that accompanies the vestibular system.\u00a0It is estimated that it may affect up to 1% of the general population.\u00a0Though no evidence was found in the primary literature search on UCT and vestibular migraine, a clinical trial on NUCCA intervention on non-vestibular migraine has been published\u00a0<a class=\"content-anchor refs-anchor\">[87]<\/a>. The study found that NUCCA intervention significantly increased neurologist-measured quality of life measures and had some improved influence on blood and CSF flow patterns post treatment. No adverse events were reported.<\/p>\n<p><strong><em>ASC and Concussion<\/em><\/strong><\/p>\n<p>It is estimated and theorized that the cervical spine ligaments are injured in every single concussion due to the force and cervical torsion that it takes for a concussion to occur\u00a0<a class=\"content-anchor refs-anchor\">[88-90]<\/a>. Since the CCJ is the most mobile unit of the cervical spine, it is the least stable, allowing for ligamentous damage, structural misalignment, and ultimately for the ASC to form\u00a0<a class=\"content-anchor refs-anchor\">[91]<\/a>. Post-concussion syndrome occurs when symptoms last beyond three months\u00a0<a class=\"content-anchor refs-anchor\">[92]<\/a>. A common symptom of post-concussion syndrome is dizziness.\u00a0ASC and cervical spine-related dizziness research is complicated when studying concussions due to the vestibular anatomy typically being injured during a concussion.\u00a0However, Moore\u2019s paper on using NUCCA to intervene with post-concussion patients found objective clinical improvement with many symptoms, including dizziness\u00a0<a class=\"content-anchor refs-anchor\">[27]<\/a>.\u00a0Moore also noted an objective reduction of the structural misalignment, as measured on X-ray, after the UCLF intervention in all cases.<\/p>\n<div class=\"new-article-content-section\">\n<div class=\"article-content-body article-tab\">\n<p><strong><em>ASC and Autonomic Function<\/em><\/strong><\/p>\n<p>A pilot, placebo-controlled, randomized clinical trial assessed NUCCA intervention on hypertension outcomes\u00a0<a class=\"content-anchor refs-anchor\">[93]<\/a>. The study concluded, \u201cRestoration of Atlas alignment is associated with marked and sustained reduction in BP similar to the use of two-drug combination therapy\u201d\u00a0<a class=\"content-anchor refs-anchor\">[93]<\/a>. The mechanisms of how this was possible were discussed in the craniospinal hydrodynamic dysfunction section above.\u00a0Since this study found that realignment of the ASC achieved ideal blood pressure, it would be wise to follow up this study in postural orthostatic tachycardia syndrome and orthostatic hypotension patients to assess for improvements in lightheadedness, dizziness, and improved orthostatic blood pressure.<\/p>\n<p><strong><em>Cervical Dizziness (CD)<\/em><\/strong><\/p>\n<p>In the B\u00e1r\u00e1ny Society\u2019s consensus paper on CD, appropriate terminology is discussed.\u00a0They state, \u201cThe aetiology is unclear, or at least the data to support underlying mechanisms in humans are inconclusive, and there is no diagnostic test, the term Cervicogenic\u00a0implies a mechanistic knowledge that is currently lacking.\u00a0Hence, we propose the term Cervical\u201d\u00a0<a class=\"content-anchor refs-anchor\">[39]<\/a>. Since our paper discusses the ASC as a specific etiology of dizziness, we have decided not to use the terms &#8220;cervical dizziness&#8221; or &#8220;cervicogenic dizziness&#8221; for discussion.<\/p>\n<p><strong><em>Acute Cerebral Vascular Ischemia and BPPV<\/em><\/strong><\/p>\n<p>As discussed in this review, many conditions can generate dizziness.\u00a0Saying this, there are some that UCT intervention should not be studied for efficacy.\u00a0Firstly, acute cerebral vascular ischemia, such as a stroke.\u00a0A stroke is an acute life-threatening emergency that should only be treated in the emergency medicine setting\u00a0<a class=\"content-anchor refs-anchor\">[94]<\/a>. Secondly, classic BPPV.\u00a0Accurately diagnosed BPPV has nearly a 100% cure rate with the appropriately administered canalith repositioning maneuver\u00a0<a class=\"content-anchor refs-anchor\">[3]<\/a>.<\/p>\n<p><strong><em>ASC Without Dizziness<\/em><\/strong><\/p>\n<p>Studies exist that document patients presenting with ASC, yet they do not have dizziness\u00a0<a class=\"content-anchor refs-anchor\">[87,93]<\/a>. A fair question is, why doesn\u2019t every patient who presents with an ASC also have dizziness?\u00a0Since four theories were reported as to how the ASC can generate dizziness, it may be a combination of the pathogenic mechanisms plus genetic predisposition, previous vestibular trauma, demographic factors, and lifestyle, amongst many other variables that are required.\u00a0In other words, the ASC might be a contributor to dizziness generation rather than a cause.\u00a0Studies must be conducted to answer this question without speculation.<\/p>\n<p><strong><em>Future Research<\/em><\/strong><\/p>\n<p>While healthcare and health sciences continue to move towards an evidence-informed model, resources must be allocated to conducting gold-standard, high-quality, placebo-controlled, statistically measured experimental research. Since the NUCCA intervention uses very minimal force, most patients report that they are unaware that an intervention took place during care.\u00a0This puts NUCCA in a strong position to remove participant bias by implementing a placebo-control in clinical trial research, such as used in the NUCCA hypertension study\u00a0<a class=\"content-anchor refs-anchor\">[93]<\/a>.\u00a0This review has outlined four gaps in the literature and expresses a need for the following:<\/p>\n<p><strong>Clinical trials:<\/strong> Well-designed, blinded, randomized, and placebo-controlled clinical trial research should be conducted to examine NUCCA\u2019s effect on specific vestibular conditions.\u00a0Since vestibular diagnosis has historically been weak, every attempt should be made to accurately include only participants that meet the current and specific diagnostic criteria per inclusion of each study. This may include collaborating with specialist such as neurotologists and radiologists. In addition to objective dizziness changes, the studies should also assess quality of life measures.\u00a0A foundational starting point may be to form a practice-based research network (PBRN) and compile data on many different vestibular diagnoses and how they improve under NUCCA care.\u00a0Clinical trials should then be conducted on the diagnoses that responded the most favorably during the PBRN.\u00a0This strategy will help focus resources and save on research costs.\u00a0Studies must follow the NUCCA protocol closely and observe the Restoration Principle to accurately assess the intervention\u2019s effect\u00a0<a class=\"content-anchor refs-anchor\">[8]<\/a>.<\/p>\n<p><strong>MD:<\/strong> A further and deeper exploration of the ASC\u2019s possible contribution to MD pathophysiology.\u00a0Future studies should examine the relationship between the CSF and the endolymph and whether the ASC affects endolymph hydrodynamics. Also, studies should assess for a proprioceptive contribution from the ASC to MD pathophysiology.\u00a0Recent advances in MRI technology have allowed the endolymph to be viewed, which is helpful in future studies\u00a0<a class=\"content-anchor refs-anchor\">[95]<\/a>.<\/p>\n<p><strong>The ASC&#8217;s affect on vestibular anatomy:<\/strong> To better understand the neurophysiological changes from the ASC, suboccipital muscle mechanoreceptor afferent discharge should be compared to individuals presenting with ASC versus a normal group. Sensorimotor testing may be valuable to determine differences between the ASC and normal groups. Further and deeper exploration of how the ASC can have negative consequences and imbalances in relation to the peripheral vestibular organs and the central vestibular processing anatomy is warranted. For example, testing if the ASC has direct negative sensory consequences to the vestibular semicircular canals.<\/p>\n<p><strong>The ASC&#8217;s affect on craniospinal hydrodynamics:<\/strong> Though Flanagan&#8217;s paper examined how the CCJ can be a &#8220;choke point&#8221; for craniospinal fluid movement, it did not directly examine the ASC as a cause\u00a0<a class=\"content-anchor refs-anchor\">[11]<\/a>.\u00a0Woodfield et al. found improved cerebral spinal fluid flow patterns post-NUCCA intervention of the ASC in migraine cases, laying a solid foundation to follow up this study for a better understanding of hydrodynamics as they relate to the ASC\u00a0<a class=\"content-anchor refs-anchor\">[86]<\/a>.<\/p>\n<\/div>\n<div class=\"article-content-body article-tab\">\n<h3 id=\"conclusions\" class=\"reg\">Conclusions<\/h3>\n<p>The present review describes multiple theoretical mechanisms by which ASC-evoked dizziness may be mitigated by UCLF intervention, and presents a literature synthesis with observational evidence suggesting that further studies (randomized controlled trials (RCTs)) are warranted to explore the relationship between upper cervical chiropractic care and resolution of dizziness symptoms. Such studies may inform clinicians of novel intervention strategies for patients presenting with complaints of dizziness, thereby augmenting a current deficit in success of treatment of this symptom.<\/p>\n<\/div>\n<\/div>\n<div class=\"new-article-content-section\">\n<div class=\"article-content-body article-tab\">\n<p>\u00a9 Copyright 2025 Steward. 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