The Hruska Clinic Integrator

Torin Berge talks more about "Managing the Occipital-Atlas (OA) Region"

Atlas Management: What keeps your head on straight?
In my last blog I talked about how improper position of the head on the neck or the skull (occiput) on the Atlas bone (C1) can lead to a myriad of symptoms including neck pain and headaches/migraines, but also other dysautonomic symptoms and syndromes such as POTS (Postural Orthostatic Tachycardia Syndrome) and Chiari Syndrome.

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In general any issue that doesn’t allow the head to sit on top of the neck (or the neck to sit under the head) in an appropriate position with normal freedom of movement may lead to some of these symptoms. So how do we manage this if we feel this is an issue?

I feel strongly that a body’s normal asymmetrical structure, function, and wiring alone can lead to asymmetrical positioning of the head and neck. This doesn’t mean that everyone is going to have these symptoms as long as the body has the ability to freely move the neck and head without over relying on that position and pattern. Unfortunately for some the asymmetrical patterning and positioning becomes so over dominant, due to a potential number of factors, that they lose the ability to move in one direction or the other which leads to compensation and strengthening of the already over dominant pattern. When this becomes so locked up that freedom of movement is lost symptoms start to appear. It may start as neck tension or “stress knots” in one shoulder or the other, restricted movement of the neck, headaches, shoulder impingement low back pain, or other seemingly unrelated issues. For some people just learning new movement positions and patterns of movement through hip, core, and breathing activities, in a ground up approach will reduce neck tension and headaches. Yes, we have treated neck tension and head-aches successfully with a better pair of shoes or foot orthotics.

Unfortunately there are some people who do not respond to that ground up approach and those activities either don’t help or can even make neck symptoms worse. In this case we need to look at other issues or references that that person is doing to keep their head and neck in that asymmetrical state. In addition to the floor-up issues that we look at there are 2 main things that we use to position the head on your neck. In general our brains utilize sensory input (things you sense or feel) to make judgements of where you are in space compared to other objects and gravity to know how to hold you up. For example the nerves in your feet and ankles tell your brain if you are standing on a hill or uneven ground that your brain has to interpret and tell your body how to adjust to not fall over. This is a constantly changing situation that is felt and modified on a near constant basis. There are 2 main things that we can influence that have a strong influence on head position and that is how your body senses where your teeth come together to position your head (top teeth) on top of your neck (bottom teeth). The other is the visual system telling your brain not just what you are looking at but utilizing the whole picture of where you are at in the room compared to other objects, the walls, the horizon etc. That picture of where you are at in the room is a very strong reference to how to hold your head (and body) up in space.

There is a strong normal bite position that you feel every time your teeth touch and immediately positions your head and neck in a specific orientation. This is a highly sensitive system. If you get something stuck in your teeth or have a small piece of sand in your food you will sense it and know it immediately and your body will want to adjust or change it until you are back to “normal”. But if what your brain perceives as normal places your head and neck in an improper position every time your teeth hit you will put your neck and head in a poor position. This can happen because of poor occlusion (teeth not hitting right or at all), missing teeth (that can’t give your brain any input on where your head is at) or an over-reliance on a “normal” bite position that increases tension at the neck or head (i.e. tooth grinders). If this sensory input has a strong influence on an improper neck position we will need some help from a dentist to achieve a different occlusal sense to allow a proper position of the head and neck.

The other faulty input that your brain may be using to position the head on the neck comes from not what you see but how your body interprets what you see. If the message your brain perceives from your eyes is not giving the full picture the output of how to position your head and body will be faulty. Two common ways (but not the only ways) this can happen are imbalance between the 2 eyes or a skewed perspective of space commonly from an astigmatism. If someone had a significantly dominant eye for either near visual skills or far visual skills the brain will sometime ignore or dampen the message it is receiving from the opposite eye for example if my brain is only paying attention to the input from my right eye as I sit in front of this computer by head and neck will adjust to position that one eye to see the words the best as I type them. The reason we have 2 eyes to begin with is to give us three dimensional perspective on the world around us. The brain takes the message given to it by both eyes (that are slightly different) and melds those images together to give an accurate 3-D picture of the world. This makes it easier to position yourself in that 3-D space. If you don’t use both eyes together the 3-D picture you get is not there and you are not as confident or precise with how to positon yourself in that space. This can be a strong driver for postural issues. Astigmatism is also just a skewed perspective on special orientation that can cause your body to misjudge how to hold yourself up even though to you it seems “normal”. There is so much more that the eyes tell the brain in terms of postural orientation but these are a few examples to show why this is important. As a physical therapist I cannot treat vision alone, but l can identify and sow when it is a contributing factor as to why my PT program may not be as successful as I would like.

So what do you do if your PT program is not working with a ground up or traditional approach and these things may be an issue? Fortunately, as I described in my last blog, we have a team of professionals working together through Postural Restorative Integrative Multidisciplinary EngagementTM (PRIME). This allows us to utilize specialists with the same mindset to make sure our patients are getting the correct sensory input from the floor (podiatrist), teeth (dentist) and visual system (optometrist) to achieve a neutral position of the entire body, especially the OA region. Once this position is established our physical therapy program can help establish and train new patterns of movement without need for compensation which will alleviate symptoms that have been unable to be improved with each of those professions on their own. For more information on PRIME check out our website or contact us at 402-261-6793 or at the Hruska Clinic at 402-467-4545.