Edited 9 July 2018
This information is not meant to provide a medical opinion or medical advice but I hope it will help readers understand the sort of things they should be considering and asking their own practitioners for help with.
I personally agree with the comments from manual therapists that these problems are extremely common, and often not understood. This is a real problem as it is possible to go to a doctor and show what is wrong- and he may say back “oh that’s normal”
These malalignments cause a great deal of symptomatology, often a long time after any injury. This reflects a slow deterioration of function after the injury.
In my own case there were always some symptoms (clumsiness, some emotional intensity) which would appear to have originated from a birth injury, but the worst symptoms came on gradually following a disc injury in my low back which worsened my posture and gait, followed by a whiplash injury in 1986. The symptoms were a background nuisance that did not start really progressing until about 1993. The background symptoms were there for many years.
I strongly recommend reading Greg Buchanan’s account of his injury at
and especially the list of symptoms he experienced:
“An eye twitch started in my right eye. This would on some days be there all day, and on others only for part of the day. One doctor had delight in telling me he had one and I was to watch his eye, so I could see it happen. As if to make it normal!”
So many of the symptoms are subtle, and they are often poorly accounted for in Medicine. they are the sort of things that often we don’t know what to do with, and they dont seem abnormal because we have them too!
Include, but are not limited to:
- Headaches- often involving the base of the skull, and referring to the sides of the head and around the sinuses.
- Migraines, often with marked agitation and nausea. I am speculating that some migraine like headaches might be caused by acute CSF obstruction caused by Dural torsion.
- Neck pains and stiffness and difficulty finding a comfortable position on the pillow at night.
- Sometimes crackling or grating noises at the base of the skull when turning the head. Often there are associated shoulder pains, especially between the shoulder blades.
- Jaw joint pains or dysfunction. Clicking jaw.
- Chest wall pain, and thoracic spine pain- due to mild thoracic kyphosis, distortion of the ribcage and obstruction of normal rib movement.
- Low back pain and/or disc injuries due to abnormal posture.
- Nerve root irritations at any level.
- Pains or injuries in one hip, knee or ankle, often repeated injuries to one side of the body. Some flattening of the arches of the feet.
- Patients may be told they have one leg shorter than the other.
- Other postural difficulties- forward head posture, functional scoliosis Symptoms based on nerve and blood flow and cerebrospinal fluid dysfunction
- Autonomic _ nausea, heartburn, irritable bowel, near fainting episodes, lightheartedness on standing up suddenly or on being upright for long (dysautonomia), high stress level, unstable attention, cold hands and feet, sweating- sometimes one sided, an intermittent one sided dilated pupil.
- Syndrome X issues due to chronic activation of the stress response (obesity, diabetes,
- Sleep disturbance- multiple kinds, difficulty sleeping due to discomfort or to low level restlessness, sleep apnoea and snoring, nocturia, nightmares, nocturnal hypersexuality, and sleep paralysis are all predictable outcomes of this knd of problem. I am unsure of how well they are all documented in the literature though.
- Mental dullness, fatigue, brain fog are common. Reports of their improving after successful atlas treatment (often within a couple of hours) are also common.
- Functional neurological symptoms due to disruption of afferent input- at a bare minimum, issues with balance, coordination, eye coordination (reading fatigue and other problems).
- Subtle and intermittent signs of neurological dysfunction like transient tinnitus, tremor in one or both legs, intermittent slurred speech, physical hypersensitivity to touch (clothes feeling painful), or to sound or to light.
Signs of Atlas Subluxation
The physical signs of atlanto- occipital subluxation are straightforward, and the diagnosis can usually be confirmed without investigations.
Posture- the head is carried forwards of the shoulders. ( In healthy posture the centre of the shoulder joint is vertically directly below the ear canals).
The patient may also have a degree of hunch or a sway back.
The patient will have great difficulty straightening up to hold his head in correct position.
The front on view will often clearly indicate the problem. The head may be tilted to one side, and the neck rotated a few degrees or so off straight ahead.
The midline of the trunk may not be vertical.
One shoulder will be higher than the other- the clearest marker of a mild functional scoliosis
Often the pelvis will visibly be off level as well (Usually high on the side of the low shoulder).
From the back the difference in the level of the shoulders will be more apparent, and one shoulder should be pushed out to the back. The head, shoulders, and hips may be out of alignment (viewed from above).
Viewed from behind the midline of the neck should be vertical and a line drawn across the base of the skull should be at right angles to a line drawn between the mastoid processes. If that angle is not square then there is very likely an issue with atlas alignment.
If there is a subluxation/ alignment issue, the neck will almost always be tender just below the ears and behind the jaw (over the transverse process of the atlas and related muscles). It may be possible to feel that the neck bone (transverse process of atlas) is closer to the jaw on one side than the other. Postural issues, muscle spasm, or a “bull neck” can make this sign difficult to identify. However the joint between the atlas and the skull is not one at which rotation naturally occurs (beyond about 3-4 degrees at the extremes of neck rotation) so this sign is always abnormal if found. Very rarely it will be because of an asymmetrical atlas.
Equally, tenderness at the back of the neck along base of the skull just lateral to the midline is a warning sign for dural torsion– see below..
It is necessary to know some anatomy to understand this- and thankfully there are some excellent anatomy apps to help understand the issues.
This video helps:
However the key landmarks are:
On the skull, the mastoid processes- below each ear.
The occipital protuberance- the bump on the midline of the skull at the back (posteriorly), just above the neck.
The transverse processes of the atlas (C1)- immediately below the mastoid processes.
These should be non tender to the touch and they should be symmetrical- both of them should be pretty much below the ear/mastoid process in the same line down from the ear canal. If one is rotated forwards that is outside the normal range of movement of the atlas.
If you can feel the gap between the mastoid process of the skull and the transverse process of the atlas you should be able to feel the gap open and close if you wiggle your head from side to side a little (The classic Vedic head wobble) If you can’t feel that movement then there is muscle spasm guarding the joint. That’s abnormal.
The green circle is the ear canal and the two green xs mark the mastoid process and the transverse process of the atlas.
The muscles are also relevant. Of particular interest are the small subocciptal muscles and the posterior atlanto occipital membrane, rectus capitis superior major and minor. (RCP major and RCP minor).
These Wikipedia accounts are adequate for the purposes of this discussion.
The areas of the posterior atlantoocciptal membrane deep to the RCP minor and minor are of particular interest, especially given the frequent dural attachments of RCP minor, and the high pain sensitivity of the dural membrane. These areas should not be tender to the touch and if they are that needs professional review.