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Common complaints associated with the first cervical vertebra, C1

Learn some basics about the importance of the upper cervical spine.

7/18/2024

The spine is the core foundation of the body. In humans, it consists of 7 cervical vertebrae which carry the head, 12 thoracic vertebrae which articulate with the ribs, 5 lumbar vertebrae, the sacrum which articulates with the hip bones, and the coccyx (the “tailbone”). Let's take a deeper look at the one of the cervical vertebrae, C1.

Most of the bones of the spine are separated by intervertebral discs which allow for movement and flexibility of the vertebral column. The cervical vertebrae in the neck support the skull and contribute to motion of the head, neck, upper back and shoulders. They are the conduit housing the neurological signals passing from the brain to every other part of the body.

The topmost vertebra, C1, or “Atlas”, articulates directly with the occiput of the skull and C2, or “Axis”. It is the only vertebra that does not have intervertebral discs above or below. It is shaped like a ring with an opening in the middle called the “vertebral foramen”. Atlas rotates on Axis accounting for the majority of head rotation. This is sometimes referred to as the “mouth of god” since it is directly adjacent to the brain stem’s transition into the spinal cord through which all the vital neurological messages of the brain-body connection pass. This opening also allows for the pumping in and out of cerebrospinal fluid (CSF) which bathes the brain and central nervous system. The CSF nourishes the brain and allows removal of metabolic waste products. (Side note: interestingly, neurodegenerative diseases like Alzheimer’s and Multiple Sclerosis may be linked to reduced CSF flow (1)(2)). So, clearly, this upper cervical region of the body is of great importance and related to the function of the entire body.

Is C1 more susceptible to injury and dysfunction?

Life is all about tradeoffs. Joints with high mobility usually have less stability. For example, the shoulder joint allows for a significant amount of movement of the arm, yet often gets injured due to the decreased stability in much of its range of motion. This may also be the case for C1. The high degree of movement at C1-2 may lead to a predisposition and susceptibility to injury. (3)

Proprioception

The multiple suboccipital muscles have attachments between the occiput, C1, and C2. In addition to the other soft tissues and joints of the upper cervical area, they represent the most densely innervated area of the body with respect to proprioceptive sensory nerve endings. These nerve endings are special sensors that the nervous system uses to figure out where the parts of your body are in space. This special sense is called “proprioception”. Just like your eyes allow you to see light, the proprioceptors throughout your body allow your brain to see your body’s position and map it out. However, if your brain isn’t getting normal information from these sensors, if that information becomes dysfunctional, it leads to an improper map that is created. So the brain cannot properly control the body because it is working with inaccurate information. This is known as dysafferentation (4).

What conditions are associated with the upper cervical spine?

Given the critical importance of upper cervical proprioception in balance, head position and movement, and reflexes associated with sights and sounds, it makes sense that dysfunction of the upper cervical region might be associated with symptoms of dizziness and vertigo conditions (e.g. Meniere’s disease, vestibular migraines), headaches, chronic pain, pain when turning or moving the head, dysautonomia, whiplash, post-concussion syndrome, and mild traumatic brain injury (mTBI).

Chiropractic care for complaints of the C1 vertebra

At TOPCHIRO, we perform a thorough history and physical examination to understand the root cause of your health concerns. When there is dysfunction in this region, we often find postural compensations such as a head tilt, unlevel shoulders and hips, and even functional leg length difference. These are just some of the tests we perform during our initial assessment to determine if this is a factor in a patient’s particular case.

Are you suffering from symptoms associated with C1? If you have questions about how we may be able to help your case, please book a complimentary call here.

References:

  1. de Leon, Mony J., et al. "Cerebrospinal fluid clearance in Alzheimer disease measured with dynamic PET." Journal of Nuclear Medicine 58.9 (2017): 1471-1476.

  2. Damadian, Raymond V., and David Chu. "The Possible Role of Cranio-Cervical Trauma and Abnormal CSF Hydrodynamics in the Genesis of Multiple Sclerosis Physiological Chemistry and Physics and Medical NMR September 20, 2011; 41: 1–17." Physiol Chem Phys Med NMR 41 (2011): 1-17.

  3. Eriksen, Kirk. "Upper cervical subluxation complex: a review of the chiropractic and medical literature." (2004).

  4. Kent, Christopher. "Proposed neurobiological processes associated with models of vertebral subluxation: dysafferentation, dyskinesia, dysponesis, dysautonomia, neuroplasticity and ephaptic transmission." Arch Neurol Neurosci 3 (2019): 10-33552.

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