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Letter #60:
Hi,
The following is a quote from the oncause survey
"Here is a very simple method of determining the accuracy of your palpation:
1. Prior to taking your lateral film, palpate to locate what you estimate to be your contact point.

2. Mark that point with a washable pen.

3. Tape a lead shot, BB or split shot (any small piece of dense metal will work) on the mark you have made.

4. Shoot the film.

5. Check contact location with marker location.

If you miss contact, you miss a certain level of results and thus a certain level of referrals."

I just wanted to add some addition consideration to the above comment. When one takes the lateral film, on must make sure of 3 things before the above method will be "accurate" for measuring to find the C1 TP on the patient or determining whether or not one palpated the TP contact correctly.

#1 You MUST take the lateral film using the specific method outlined by Dr. Grostic, i.e., the x-rays traveling through the C1 area of the cervical spine must be perpendicular to the film at that level. If the lateral film is taken with the central ray at 90 degrees to the film, but at C4 like a typical lateral is taken, the BB method above will be INACCURATE for measuring to find the TP on the patient, but will still remain helpful. This is due to divergent rays and the BB being 1/2 - 1 inch away from the TP. The BB will project on the 2 dimensional x-ray higher than the TP and be inaccurate.

#2 The C1 vertebra would have to be in the center of the film (from the left side to the right side of the film) If not, divergent rays will project the BB to far anterior or posterior of the C1 TP and be an inaccurate
representation.

#3 No Head and Cerv. spine rotation compared to the film could exist. This would create 2 C1 TP visualized with projection error of the BB and the TPs.

Even with the BB method above it still will be difficult to accurately find the C1 TP on every case. Taking into account the BB attaching method along with proper x-ray placement will surely increase your odds of
contacting the Atlas in most cases but one must take into account patient placement for the x-rays or the "BB" method will not tell you whether or not you can palpate the C1 TP reliably. A standard lateral film (central ray at C4) using a "BB" as outlined above is just as likely to be a projection error of the "BB" as opposed to palpation error. My point, one cannot be a Master of the C1 adjustment by Mastering inaccurate methods. Mastering inaccurate methods will lead to inaccurate results and tremendous frustration for the doctor.

Dr R.__________, Georgia

Reply oncause to letter #60:
Dear Dr. R.,
Again thank you for your input. As always, it is clear that you are thinking about THE PROBLEM, we need more of YOU in UC work.

Of course it is assumed that the atlas must be as close as possible to the hypothetical central ray (that is in the classic Grostic cervical analysis).

If you will recall, in our last entry we described the BB shot exercise as a method of checking the accuracy of palpation, not as a method of finding the TP contact point. The thinking being that the UC DC should be aware that he or she is not on contact most of the time.
Actually, finding the contact is a whole other matter requiring a whole other three-dimensional approach using all three films.

I might add here that Grostic was oblivious to the inaccuracy of locating contact by palpation. He simply palpated and gave the matter little if any time in class, and therein may lie one the reasons for so much lack of uniformity on a practical, results level of the technique that he taught. A miscalculated vector and a miscalculated contact – sometimes they randomly converge to produce the type of correction that is needed, and the miraculous results we all know are possible with C1 adjusting. Much more frequently the combination of the two inherent errors results in an adjustment that is not in the ballpark, and the DC then trips on down to the thoracic, lumbar or sacral area, and the patient proceeds through life carrying UC interference.

Letter # 59:
Dear doctor,
The website of yours has been a most entertaining site. I have checked it out for a while. I feel like I have found someone with the same mindset ...finally.

My name is M____. I am a chiropractor and practice upper cervical ( HIO procedure). Due to my thick headedness I have disassociated myself from all clubs and organizations because their hypocracy is just killing me. I figure if I can look at myself in the mirror more then a minute, then I must be happy with myself and what I am doing as an upper cervical ( CHIROPRACTOR ) doctor.
Thanks again for the website.
innately yours,
Dr A.__________, Florida

Reply oncause to letter #59:
We don't blame you for disassociating yourself from the clubs and organizations. You hit the nail on the head with the hypocrisy statement. Keep thinking for yourself.

Letter #58:
OK let me get this straight. You don't want others to benefit from your research because you paid for it and they didn't. You want others to repeat the research you have done so they to have to pay for it as well. What kind of sense does this make? What if other professions did the same. What if the medical profession did this? I would say it would be a sure demise of the profession, as the costs of research would have to directly be passed on to the patients. Lucky for them they don't do that. They share research and allow one study to take the next step based on the past research. How do you expect this profession to grow and attain its rightful place as the leader in health care when we guard are secrets like a schoolchild does his snacks? As a new doctor I don't have the resources to do "real" research, and I rely on my education and the knowledge from others to help guide me to deliver the best care possible to the patients I serve.

Are you familiar with Dr. Bud Crowder of Davenport Iowa? I would hope so, if not I would have to ask a few more questions about your study of UC. He, as a leader in the profession, has for many years trained and shared his knowledge with students from Palmer. Because of his knowledge and generosity many UC chiropractors are now practicing this most efficacious form of care. Because of his mentoring and teaching doctor are out there creating successful practices which can support furthering the profession both in research and public awareness.

What have you done to help further the profession? Its true that changing one persons health continuum is outstanding for that person, but doing the same thing on a greater lever would benefit all mankind.

BJ Palmer did research, the best available at the time. The BJ Palmer research clinic was not a money making endeavor. My understanding is that the clinic, as well as the school was subsidized by WHO, BJ did this because he knew that what he was doing was going to benefit mankind. He did not hoard his knowledge, if he had we would all be selling Amway as you suggest in your other posts.

I'm not asking you to tell me your secrets. I am asking that you take an active role in furthering the profession and creating better Doctors to serve more people to create a better world.
That's about all I have to say about that.
Chiropractically yours,
Dr P. __________, Michigan

Reply oncause to letter #58:
Dr. P.,
First of all, regarding your knowledge and your description of the workings of research in the biomedical field, I don’t think it quite works that way. This is probably the way it works: A check of the NYSE and the NASDAQ/AMEX shows the listing of 457 firms in the pharmaceutical/biotech business. These corporations are, it seems (from what I have read over the years), operated on an extremely rapacious, profit-motive basis. They are obviously equity-financed firms, very competitive, whose management is under considerable pressure (very considerable pressure) to produce a good rate of return on their stockholders’ investments. And, believe it or not, some of these firms have actually gone so far as to engage in high-level industrial espionage. From that, I think it would be reasonable to infer that they are not really one big, happy family, idealistically working hand in hand to overcome the scourge of human disease – stockholder profits be damned.
But, maybe it was the university setting to which you were referring – where all the sharing of biomedical research between campuses takes place?

The following is a quote from a very eminent university researcher published in an article in the New Yorker magazine: "One of my professors at Harvard had said that to tell anyone there about an idea before one had published it was, ‘like throwing a silver coin into a den of thieves.’"

Since a good portion of the biomedical research that occurs on university campuses is sub-contracted out and bankrolled by equity-funded corporations, and keeping in mind that espionage also occurs in campus labs, it is probably reasonable to assume that a great deal of competition and secrecy exists there, too.

I was also under the impression that the costs of the research were, to a great extent, passed on to the patient, and that that was one of the reasons that the costs of medical care has skyrocketed so much. And that that might be one of the reasons for the inception of Managed Health Care.

Moving on to Dr. Crowder and the work he does with Palmer students in Davenport: I did have Crowder for several classes, mostly Principles and Practice classes, as I recall, and I have no doubts concerning his sincerity and dedication to cause-and-effect chiropractic. Problem is, he has been doing the same thing for over forty years now with groups of student protégés – and it’s not producing much in the way of successful, straight UC doctors. We certainly respect his efforts, but I think the question that has to be asked is: Dr. Crowder’s sincerity and conviction notwithstanding, does the teaching of his particular interpretation of UC work in the vicinity of Brady Street with its resident student population really prepare the students for the reality of what they will be up against when they open their offices on Main Street in the various cities and towns throughout the country and throughout the world. What seems clear and evident in Davenport, Iowa, a few blocks from the Palmer campus, may not be washing too well when offices are opened in Salina, Kansas, Boston, Massachusetts or San Francisco, California.

Now, as far as the last point you made in your e-mail letter: "I am asking that you take an active role in furthering the profession and creating better Doctors to serve more people to create a better world."
That’s what we be doin’ right now, Dr. P.

Letter #57:
At first I was upset with you & your web site. However, you have caused me to "think" about what I am doing with atlas and have changed a few things and to my amazement I am getting better results. I will continue this just as I always have. My only allegiance is to what works, that is why I am now practicing my third UC tech., NUCCA, AO, and now Blair , looking for what works 100% of the time not 80-90%. So to learn more I have decided to come out to your office and pretend to be a patient so I can see some of what you are doing since you will not tell me!! Not really. But I will continue to look for what works. I understand why your not so ready to tell other UC Drs. what has taken you years to figure out and I am not asking you to, but it would be nice if you could point me in the right direction as you already have with your "pool & sponge " analogy . Next???
Thanks
Dr G.__________, Georgia

Reply oncause to letter #57:
Thanks for your response, DR G.
That's the way it's supposed to work. Good luck!

Letter #56:
Interesting web site. I have read many arguments here regarding such fancy things as line drawings, torque, R values etc. But, what about contact points. What have you found regarding the atlas contact?
Dr L.__________, Michigan

Reply oncause to letter #56:
Yes, we have done quite a bit of work on contact location, specifically atlas TP location.

Having graduated from Palmer in the mid-fifties (when HIO was in it’s prime and when there was no question about locating the atlas transverse process – all you had to do was palpate), I was shocked by an informal experiment that I conducted at my office in the mid-sixties.

For some reason, which I have forgotten now (probably having to do with the continuing legislative push by California Medipractors to expand the scope of practice further into allopathic medical territory), I hosted a meeting of the Southern California UC doctors at my office.

These, of course, were not all exclusively UC practitioners. Some did various full-spine techniques along with their cervical adjusting. However, the group was a fair representation of HIO and Grostic (and I believe there were some Blair practitioners present).

Before the meeting I decided that it was rare enough to have a bunch of primarily UC doctors get together, and that beyond the usual clatter and chatter of a DC meeting, it might be a good opportunity to learn something.
I had already done some work on atlas TP location, first palpating and then using a lead shot taped to the patient’s neck when I took the lateral film to verify the palpation (the results of which were both embarrassing and demoralizing to me). But I assumed that, since it was a given that the atlas TP was quite readily palpable, the fault lay within me. I was just a lousy palpator. And so I asked the DCs present to participate in a little experiment. I asked them to pair-off, palpate each other to locate the atlas TP and then mark the spot with a pen.

Then, first placing a lead shot on each doctor on the marked spot, I shot lateral films on about twenty DCs.
Result: no one had correctly palpated the location of atlas TP. The palpator who had marked the spot closest to the TP was about ½ inch off. Most had marked some point on the body of C2; many had marked the inferior aspect of the body of C2.

Further work on this led to the conclusion that the atlas transverse process cannot, with any consistency, be located by palpation.

Troubling!? You can feel it right there, can’t you?

Problem is, it ain't there where you think it is!

I’m sure in the intervening thirty-five years other people have played around with various contact location methods. We certainly did. In the late sixties and early seventies we worked with a number of contact systems until we were sure we were where we wanted to be for the introduction of the adjusting force.
But, at that time (the time in the mid-sixties when it became apparent that the atlas TP cannot be palpated with any consistency), the larger question that occurred was not how to actually locate the contact, the much larger and much more disturbing question was: WHY, after attending The Palmer School Of Chiropractic for four years and after attending six Grostic seminars, I was never informed that the atlas TP is not readily palpable. And beyond that, another even larger question that had to be considered was: if one of the main assumptions regarding cervical adjusting (HIO, Grostic, Blair, whatever technique) proved to be false – then Good Lord, what other UC assumptions might also prove to be false?

Letter #55:
Dear Doctors,
I am curious. I have not seen you listed in the NACUCC directory. Maybe you are unfamiliar with it, you can check it out at www.uppercervical.org. This is a group that is supporting UC Chiropractic, by teaching the lay public about the benefit of UC Chiropractic. I have read stories of how this group helps get struggling doctors new, well educated patients.
Dr. M.__________, CA

Reply oncause to letter #55:
No, we are not members of NACUCC.
Why?
First of all, Dr. M, if the UC doctor understands the neuromechanics of the UC region and delivers his or her work with common, professional sense and integrity, it should not be necessary to beat the bushes, in a retail manner, to acquire patients. As a matter of fact, in our opinion, it is unseemly and degrading to do so.

Letter #54:
I have just read your response to my first inquiry, and will take some of the things you pointed out into consideration. I am very disappointed in your response regarding your own technique. What kind of person would not want to share their experience and study with those who are searching for some
answers? As I stated before if it were not for BJ, pestering his father to teach, we would not be practicing this profession today. If your only goal is to make people think then post questions not discouraging remarks. I cannot respect those who will not share their knowledge for the benefit of mankind. You are definitely not doing your part to perpetuate your " cause and effect" chiropractic. I am trying to be sincere her but your responses have me wanting to attack, but my better judgment will prevail.

I have just finished some study on the thermography and have only seen mention of leg check in your analysis. Are you analyzing the nerve system with these testing procedures? If so, is this the closest you can get to the nerve system? Visually we know there is only one nerve that we can look at in the body, but which gives us little information re: subluxation. However thermography (measuring vasodialation/constriction under direct autonomic control) seems a much closer evaluation of autonomic function than leg check (muscle contraction in relationship to blood perfusion with regard to skeletal framework and finally visual alteration of leg length). I haven't thought this one out completely but it was posed to me by a good friend and UC chiropractor and I to allow you to ponder the question.

Oh yeah, I thought about your remarks re: Blair torque. I really don't think you understand the mechanics behind the adjustment. If, as you say, are adjusting through a sponge then what diference would it make what vector you were on? I think we can agree that even through a sponge the vector of the thrust changes the outcome, can't we? If this be true, then the physics behind the Blair adjustment make perfect sence. You do realize that its not about spining the bone right? We are talking about a change of vector force
which initially, cleaves the misaligned joint surface, then pushes the bone back down the opposide condular surface.

I have found that patients hold this adjustment based on prone leg checks (Modified Derefield, Modified Prill) and thermographic pattern work. These patients sometimes feel good, sometimes feel bad, but generally hold the adjustment. We all know that thew way you feel has little to do with health, so I don't judge a technique on its ability to reduce pain. I judge it on its ability to reduce a subluxation and allow that adjustment to hold. The feeling better is a side benifit which we all know eventually comes with reducing subluxation.
Chiropractically yours,

DR P.__________,Michigan

Reply oncause to letter #54:
Dr. P, another question that might possibly occur to you is: what kind of person would want to freeload on decades of research, the real thing – thousands of hours and thousands of dollars-worth?

How about splitting our costs with us? Or, since you seem to be a sincere enough young man, do we just hand our body of work over to you in complete confidence, resting assured that you will take good care of it? That you won’t screw it up, mix it in with every other notion that comes into your head along the way?
Your example of the BJ/DD controversy makes the point perfectly. The profession has taken special care of BJ’s ideas on the Philosophy, Science and Art of Chiropractic, hasn’t it? And when you think about it, there was no bona fide scientific research in any of BJ’s work was there? BJ’s genius and dedication notwithstanding, there was no body of researched information involved in the BJ/DD controversy. (This does not in any way disavow the fact that BJ was one of the geniuses of the century, and that without him, none of us would be here. As a matter of fact, we have a bust of BJ in a prominent position in our main office, and a BJ pictorial museum in our branch office.) But the simple truth of the matter is that the father/son conflict you mention above pivoted on the question of whether their notions about what was going on with spinal adjusting should be shared with other people. Shared research was not the issue.

Have we made you think?

Yes?

Good!

No?

Okay, let’s try a different approach to the issue, maybe a better idea!

You are obviously on your way to putting together a package – your own grasp of Blair work, thermography and the spinal balance tests that you use.

Is there anything preventing you from doing some real research – not the chiropractic variety in which some notion enters the head of the researcher about how the UC region should be analyzed and adjusted, and then the researcher proceeds to adjust patients accordingly, develops a very forgiving, non-symptomatic rationale ("We all know that the way you feel has little to do with health, so I don’t judge a technique on its ability to reduce pain.") and then asserts that the whole exercise is research.

Incidentally, "the way you feel has little to do with health" – pretty forgiving stuff! Only a chiropractic researcher could come up with a statement like that. Believe it or not, most of what is termed retracing by chiropractic researchers is simply a manifestation of different elements of UC nerve interference.
Let us know. Do some real research that challenges and questions notions that you entertain about spinal neuromechanics. Attempt to disprove them, be your own devil’s advocate. See where the chips fall. Swallow your ideas when the facts refute them, and we’ll be glad to pay you a fair fee for your investment, your time and your effort.

We have first-hand knowledge of how costly, time consuming and frustrating real research is, and we would not expect it to be handed out to us at a weekend seminar for a few hundred bucks. As we have mentioned, employing the scientific method is something quite different than a person going through an elaborate exercise to verify his or her own hunch or hunches as to how things should be done.

But, come to think of it, in view of the fact that the most recent survey of the profession by Chiropractic Economics indicates that 88% of chiropractic offices peddle retail products in their offices (nutritional products – 81%, pillows – 84%, orthotic supports – 75%, topical creams and ointments – 53%, weight-management products – 21%, other merchandise – 7%), we would be very understanding if you were to demure about releasing your research to a collection of small shopkeepers, retailers and merchandisers.

Yeah, we surely would understand your position.

Letter #53:
I am currently starting a practice and learning, and applying the Blair UC work. Having read your postings it seems you are not extreemely informed on this work. I am by no means an expert and I have been reading your posts re: torque and I believe you may be misunderstanding the adjustment. Remember I
am just starting this work and obviosly don't claim to understand all the nuances involved, but I will try to tell you the reasoning behind the torque adjustment so you may critique my understanding that I may better serve my patients. The initial thought behing the torque in the adjustment was that you spun the atlas around the condyles this later showed not to be the case. In fact the initial start of the adjustment actually cleaves (separates) the misaligned joint followed by a rotational thrust which changes the vector of the force and pushes the atlas back down the opposite condyle. The physics behind torque also allow for constant acceleration and therefore more force translation. This is also seen in the Karate punch rotaion increases force by creating constant acceleration. Any input into this will be gladly accepted.

I have had some study in NUCCA, and Classis Toggle recoil as well as some exposure to AO, and I have cosen to study Blair because of the concept of atlas misalignment. The theory of direct lateral movement of Atlas makes no clear sense as the atlanto-occipital articulation will not allow for this type of direct movement to take place. Instead a translation of the Atlas down one A-O surface will produce a lateral component on the other joint surface. The amount of laterality and anteriority is proportional to the
convergence angle of the tracking joint surface. Thus if there is a high convergence angle then the laterality component if increased and a low convergence produces a more significant anterior component. This seems to me the most sane explanation of Atlas misalignment, and the work as I'm sure you know take assymetry into account. For these reasons I have chosen to further study this technique. I have run into those who do not wish to wonder why, and those who wish to give only hype and no explanation. I am in search of information so I may best make decisions re: Subluxation and it's correction/reduction.

In another post you were questioning where the malformation/assymetry statistics came from and my understanding is that there were over 3000 specimins examined, actual bone (dead of course) not thought X-ray exams. I would say this would cut out a lot of the distortion.

I am slightly frustrated by your lack of input re: your own technique. If you are actally interested in promoting UC chiropractic it would serve you well to let us in on what you know. They say we see our greatest visions
only by standing on the shoulders of giants. Your post is similar to that of D.D.'s trying to keep his discovery to himself, luckily his persistent son pursuaded him to teach and then allow humanity to benifit from the discovery. I can oly hope that you will allow other to benifit from your study and experience.
Chiropractically yours,
DR P.__________, State Unknown

Reply oncause to letter #53
Dear Doctor,
I have just finished reading your letter and I appreciate the sincerity of your inquiry, and above all, your desire to learn more and thus, help more sick people get well.

As we have said previously, our intention is to create a forum that will influence the UC doctor to think.
Now, after reading your description of what the Blair adjustment is purported to do, my own thoughts are as follows:

Does it really make common sense that an impulse traveling through a semi-solid medium could accomplish all that on its journey? Think about it! A toggle recoil adjustment does not even come close to generating a rectilinear force. The toggle is accomplished by the pulling of the forearm in a circular motion around the distal end of the humerus while the humerus is being pulled around the scapula with the glenoid cavity as its pivot point. It should be obvious that the adjuster’s pisiform is scribing a path of extreme curvilinearity as it travels – torque, or no torque.

What are you trying to do with that UC vertebra?

Would you like to play pool trying to poke the cue ball around the table by toggling it? You would not win many tournaments, would you? You would not increase your win percentage by torquing your arms, either. Now, put a sponge (semisolid medium) between your pisiform and the cue ball, and regardless of what kind of an exotic assertion someone has made about what that type of force can do, with the sponge in the picture, the assertion becomes even more ludicrous.

Fact is, you may use Blair analysis and adjustment and, at some time in the patient’s care, have a patient utter the words, "I feel better." And that makes all the steps you went through with your analysis and adjustment correct. Ergo, Blair work is the answer. Right?

But think about this: every day that same process is occurring in an Orthospinology office, a NUCCA office, an AO office and an HIO office, each utterance of the words "I feel better" verifying and sanctifying the myths and pronouncements of a particular technique originator.

Speaking of myths: if we were to tell you that we would pay you $1,000,000 to locate and examine 3,000 dry upper cervical specimens, just how would you go about doing that? Where would you start? Who would you call and where would you go to do that?

By the tenor and the general direction of your letter, it is obvious to us that you are trying very hard to be a good doctor. Keep up the good work! But remember, keeping up the good work in chiropractic entails analytical, questioning thought. Don’t just rubber-stamp and accept something because it was told to you.
Now, as a last point, you ask why we do not teach our work. Please see reply # 44 on our website.
Our best advice to you is: Think! Be honest and confrontational with yourself and proceed to get sick people well.

Letter #52:
ok, I'm sitting here doing the old torque exercise that we learned in toggle class...you know...try to torque your whole arm in the air without moving your wrist. I'm pretty good at that! Hmm. I don't feel any force coming through my pisiform. In fact, when I put my pisiform on an object and torque my arms leaving my hand/pisiform stationary, guess what? The object is not spinning. So obviously nothing is coming through and there is no force when torquing unless you spin your hands as well. Now when I apply a downward
thrust, I feel the force and the object moves. Duh. But maybe we should spend about $500,000 to research this just to be sure.

Now, maybe it's just me. But all these inquiries about the technical aspects of upper cervical care seem a bit redundent. To be good at what we do, I believe we all know that we need to perfect our skills, beginning with our analysis right on through to our adjustment. Whether we're all perfecting ourselves or just going through the motions is what we all need to answer for ourselves.

For me, I'd like to see more on this site about how to run an upper cervical practice on a day-in day-out basis. How do you get patients to understand what you're doing and why you're doing it? What do you tell them?

I find that more people leave, not for lack of results, but because they don't understand what is being done and how it will help them. Just my opinion. And the better I can communicate it to them, the more time they'll give me to help them, even if my skills aren't totally perfect.

Anyway, that's what I would like to see: more how to, less technical.

Dr S.__________, Michigan

Reply oncause to letter #52:
Your thoughts on torque are pretty well on target; even the sarcasm is on target. Keep thinking!
Regarding your question on educating patients, we might suggest the following: take a poll among your own patents. Ask them if they understand what the adjustment is intended to do. Ask them how they think the adjustment works. How does the adjustment get an asthma case well, a stomach ulcer case well, low resistance to colds and flu, bulging disc, skin conditions? I think you will be amazed at how little comprehension there is among your patients. (Not your patients specifically, but all patients, including ours.)
Therefore, why do they come to you for their health care?

Obviously, because of the results you get and, just as important, you. You, your dedication to your work and the honesty and professionalism of your delivery of your work.

Education of patients is fine. We all need more and better-educated patients -- but educating the patient takes a back seat to what you have within you.

We have many patients who say, "I don’t know how you do it, but you sure work miracles and I’ve sure told a lot of people about you."

Incidentally, since we don’t use torque in our adjustment, how could it possibly be that patients say such things about our UC work? Just think what would happen it we started using torque!

Letter #51:

I wanted to throw in my, independently, scientifically, thought out 2 cents to this discussion. I do admire that you are a proponent of that way of thinking as am I! So, let me pose a question.

Wouldn't you say torque is a very confusing choice for the description of what actually, physically takes place during a hand adjustment via Grostic? Torque is defined in the Webster's dictionary as "twisting force." In a Grostic hand adjustment the only thing that is "twisting" is the doctors arms. And that should occur ONLY at the very end of the trust. The pisiform should NOT "twist" in any way against the patient's skin. If it does, I have to concur with your position, that it transfers NO force to the atlas transverse process and thus a "notion." With that said, I would suggest the term "MULTIANGULAR VECTORED ADJUSTING" or "BIANGULAR VECTORED ADJUSTING," as a concept for the "torque" in the Grostic hand adjustment. You see, it is my independently arrived at conclusion (for what ever that is worth to anyone besides me) that during the Grostic hand adjustment with "torque" executed as taught, with the torquing of the doctor's arms occurring at the very end of the trust, creates a force that is vectored down the resultant and at the very end of the trust creates a small force at about a 60 degree angle, from the initial angle of the vectored adjustment force, towards the patient's feet (inferior/down) depending on the C1 rotation. Also, let me add that I am not sure that "torque" or BVA is needed in very many cases...

With that said, torque via the Holder instrument, logically, seems that it would not transfer "twisting force" to the atlas for reasons that you have made clear. One of the things that Orthospinology teaches in the hand adjustment with "torque" is to watch the thumb of the contact hand. If that thumb moves during the trust with torque, it will not provide the force that is needed (in theory).

One last question, Which is more important the answer or the question?

With respect,

Dr R.__________, Georgia

Reply oncause to letter #51:
Again, thank you for your input.
We are obviously getting into the very fine points of UC adjusting; and like all fine points in any discipline, the finer they get, the more subject to individual interpretation they become, and thus, the more debatable they are.

So, with this in mind, I will proceed with the information that I have gathered over the past forty years about torque in the UC adjustment and my interpretation of that information.

First of all, I must explain that we have a disagreement as to at what point in the thrust the torque is to be applied. According to J.F. Grostic, Sr., even though the travel of the thrust is very short, torque should be applied throughout the entire linear travel of the thrust.

Your mentioning of the idea that the torque "should occur ONLY at the very end of the thrust," may be an updated version based on the interpretation of one of Grostic’s disciples, or maybe even a scriptural misinterpretation. Who knows, applying torque at the very end of the thrust may even be a better way of doing it. (IF, and in my opinion this is a very big IF, if one subscribes to the validity of the concept of torque at all).

But, if we begin a debate on the end of the thrust, or throughout the entire travel of the thrust question, we will just be involved in another ephemeral disputation, much like the "how many angels can dance on the head of a pin" controversy.

To come to the point regarding the reality and function of torque: I spoke with John Grostic, Sr., about torque, I spoke with John Grostic, Jr., about torque, I spoke with Ralph Gregory about torque, and not one of them had a scientifically acceptable explanation for what torque actually did.

Q. "What does torque in the adjustment do?"
A. "It corrects the axis spinous factor of the subluxation."

Q. "How does torque in the adjustment act to correct the axis spinous factor of the subluxation?
A. "Gobbledygook."

Q. "Could you use terms that are more specific? How does spinning your elbows in coordination with the thrust cause a reduction of the axis spinous misalignment? What are the forces involved?
A. "Accept it because I say so!"

"Thank you."

Now, as to the term that you suggest: "MULTIANGULAR VECTORED ADJUSTING" or "BIANGULAR VECTORED ADJUSTING." okay, let’s call it that.

But we are back again to the same point in the question: how does the BVA correct the spinous process misalignment factor?

Now, let’s look at this a different way: if someone tells you something that they cannot explain in logical terms, to your satisfaction, they have forced you into a position in which you have two choices: 1) you can simply accept what that person says, abdicate your reason and your responsibility to the sway of that person’s personality and live obliviously and perhaps happily ever-after, or 2) you can think it through by the seat of your own pants and arrive at your own conclusions (usually, by far the more difficult course to take).
The bare truth of the matter in this case is that no one, NOT BJ, NOT GROSTIC, Sr., NOT GROSTIC, Jr., NOT GREGORY, NOT BLAIR, has come up with a well-grounded, plausible explanation for the use of torque in the adjustment.

Should you accept it?

If you accept it, you are simply blurring in your mind the issue of what needs to be done with the UC adjustment, and this will most certainly affect your ability to remove interference and your ability to build a practice.

Under these circumstances it would seem that the most logical and beneficial thing to do is to MOVE ON! There is much more ground to be covered in understanding the dynamics of the UC subluxation.
Best wishes, and thanks again for participating in our ONCAUSE format.

Letter #50:
Dear oncause
I recently reviewed a past issue of VECTOR, put out by the AUCCU, in the school library, and to say in the least I am somewhat embarrassed, confused, shocked and feel pity for (I could use more adjectives, but you get my point) DR Sweats article. I am sure that some of you felt the same upon reading it. The title of the article was "Chiropractic in the Twenty First Century" I was expecting an uplifting article on how in the next millennium Upper Cervical Chiropractic will prosper etc. What I read is beyond belief. I hope that the whole thing was due to some very sloppy editing on behalf of the AUCCO and that some pages got out of order or were missing.

In reading Dr Sweat's article he alluded that the atlas is not as important as he preaches. Thus I must ask is he getting the proper atlas adjustment himself? If he was he would not need to stray.
Student G.__________, Georgia

Reply oncause to letter #50:
You got that right!

Entry #49: (a reprint of letter #43, received 6-13-00:)
The following is a reprint of letter #43. It was originally published in the order that it was received. We asked the readers to take a stab at answering the very last question of this letter, "what about b.j.'s discard the rotary break?" We received no input, so we are offering our thoughts on this matter.

Letter #43:
Let us see more about upper cervical chiropractic. what about the academy
of upper cervical chiropractic organizations? what about thoroughbred
chiropractic? what about b.j.'s "discard the rotary break"?

Reply to entry #49: (a reply to letter #43 regarding: "Discard the rotary break?")
We have had no replies from the field to this question, so we’ll take a shot at it.

Please keep in mind that this answer is very much an extrapolation based on what we know of B.J., his philosophy and his psychology.

Also, as a preface, we might recommend a very fine biography of B.J: "B.J. of Davenport," authored by Joseph Keating Jr, PhD.

Now, on to the question -- first of all, we think that it is not quite framed correctly. To the best of our knowledge, B.J. never used the "rotary break," at least he never advocated the use of it. (If we are wrong about this, we certainly would be open to hearing otherwise.) So, "discard" is probably not the proper word to use.

Why did he not advocate the use of the rotary break?

From what we know of B.J., regardless of what is said about him, good or bad, he did all he could in his lifetime to see that the profession stayed "on cause" -- that is, stayed on the purpose for its existence: the location and removal of nerve interference. Having the responsibility for this enormous task, and being the man of foresight that he was, it seems reasonable that he anticipated the possibility that the chiropractic principle (location of and removal of nerve interference) would eventually be eroded by a wide ranging methodology of bone-popping merely for the sake of bone-popping – attempting to render relief for musculoskeletal aches and pains. Does this sound familiar?

The next step in the erosion would naturally be a heating of the joint, or part that was to be manipulated, followed by an icing of that joint or part. Does this sound familiar?

If what you are primarily interested in is the mobilization or the manipulation of the joint or part, why not heat or ice it? Another service, something for which you could charge the patient, or in later years, the insurance company. Does this sound familiar?

From there it was just a very short step to the enormous grab bag of third-rate, medical mimicry that is now commonly accepted as part of chiropractic.

Chiropractic colleges listing among their various options for chiropractic "treatment" "Chiropractic Manipulative Therapy" -- just one of the many wonderful options that we have in our armamentarium.

But the patient! How about the patient!? The patient leaves the DC’s office heated and freezed, twisted and jerked, braced and supported, therapeutically massaged, topically medicated, nutritionally supplemented, still carrying neurological interference which is making him or her sicker by the day.

And what has chiropractic done to itself in the process? IT HAS WILLFULLY AND QUITE OBLIVIOUSLY SQUANDERED ITS PROFESSIONAL CAPITAL – ITS ABILITY TO LOCATE AND REMOVE NERVE INTERFERENCE! ITS ABILITY TO GET SICK PEOPLE – MEDICAL FAILURE CASES -- WELL!

We suspect that B.J saw this trend, saw it beginning in his lifetime. Therefore, he attempted to maintain the identity of the adjustment as being a specific correction of a specific condition (a specific subluxation) which is causing nerve interference at a specific point in the Central Nervous System.

All things considered, the pre-analyzed, and directionally focused chiropractic thrust fills this bill better than any other chiropractic procedure.

In our opinion, that is what B.J. had in mind.

Letter #48:
Fox in the Hen house? That’s kind of a strong word, isn’t it, Dr. Molthen?
Dr. C.__________, AL

Reply oncause to letter # 48:
Could be. However, keep in mind that I am speaking from experience, forty-two years of it. I took the elementary Grostic class in 1958, and for the next ten years I considered Dr. Grostic to be virtually infallible. But then, I began to ask questions -- soft questions to begin with, then increasingly harder questions. And as the questions got harder and increasingly explicit, an interesting phenomenon began to show up: the answers got softer, less and less satisfying. Eventually, I found myself dealing with the same type of "intellectuality" that I had dealt with at Palmer in the ‘50s: do it my way because I have done the research (?) and I am now telling you to do it my way.

You have no doubt seen a good portion of this "follow-the-leader" type of thought expressed by the DC’s who have sent us e-mails.

It is not healthy for any profession to be in this condition. So what has happened to true "Cause-and-Effect" Chiropractic as a result of this type of reactionary thinking? It is in a steady downhill slide. There is less of it being practiced today than there was ten years ago, and far less than there was thirty years ago. Project it out. Where is it going?

As a last note on this particular point, I might point out that asking hard questions and the employment of independent thought is exactly what has led to the development of the largest exclusively UC practice in the world.

Try it! You might like it. It also might make your phone ring!

Letter #47:
Thank you, once again, for sharing your knowledge and stimulating thought about UC chiropractic.
I appreciate the "Patient influenced factors of error:" list and the fact that you are trying to help those of us who use it to gain a greater measure of consistency in the practice of checking for spinal balance.
I do, however, have a major question regarding the procedure itself...What do you mean when you refer to the "Pull down, push up" cycles? I have taken numerous seminars on UC technique in which we spent what seemed like an extrordinary amount of time on the "leg check" or body balance check, but I don't recall ever having heard of this "pull down, push up cycle."

Perhaps you could take us through a step-by-step description of how you do a "body balance check?" I, for one, would truly appreciate such a description. Though it is not my only criteria for adjusting or not adjusting, body balance is quite important and if I can improve my technique, my patients benefit...
Thanks again.

Dr. W.__________,WA

Reply oncause to letter # 47:
The "Pull-Down," "Push-Up" phase of the Spinal Balance Test is just that: before we make the leg deficiency measurement with the patient lying on the table, we tell the patient to pull down about three inches, and then push up about three inches.

The reason for this is very simple and straightforward: it helps eliminate major variables on the long axis of the patient’s body. Since the spinal balance test is a measurement of the patient’s pelvic distortion as a result of UC nerve interference, the proper alignment of the patient on the table is the only way to eliminate one of the major variables in the application of this test.

In order to realize the importance of this statement, watch patients as they lie down on the table. They all lie down differently. Not only do they all lie down differently, but there is a large variation in the way an individual patient will lie down on the table – one time, one way and one time, another. All of these differences are variables that can and will have a major effect on the answer the doctor gets.

In our practice, we try to eliminate as many variables as possible. Therefore, with the doctor observing closely, we want the last motion that the patient engages in to be a "pull down" of about three inches, followed by a "pull up" of about three inches. If we observe the patient’s pelvis moving straight up along the long axis of the table, we know that we have eliminated a major variable to start with. If on the other hand, the patient pushes up using more force with one arm or the other, it will cause the pelvis to cant sideways, making an accurate leg deficiency reading impossible.

We suggest that you try the following in your own office: ask the patient to pull down and then push up, pushing a little harder with the arm on one side. If you watch the patient’s pelvis, you will find that it cants up on the strong side.

There are two ways of eliminating this major variable: (1) it is absolutely necessary to have handles installed on the sides of your tables which will aid the patient in an even "pull-down," " push-up" motion; (2) observe the patient’s hips as he or she does the "pull-down," "push-up" motion, making sure that the long axis of the patient’s spine and pelvis moves straight up along the long axis of the table.

If you do not eliminate this variable, what you are observing with your Spinal Balance Test is not a distortion of the pelvic balance as a result of nerve interference, but simply a look at how the patient happened to lie down on the table, or the effect of one of the patients hands being stronger than the other.
(Comment regarding letter #43.)

We still have had no opinions from the field as to why B.J. discarded the rotary break.
We do have an opinion, but obviously, it can only be an educated guess.
We think it is an important question. C’mon, let’s hear your opinions.

Letter #46:
Ok, I will be the first to admit it. My post films frequently show no correction. Of course I make the films dance sometimes and show a correction to my staff or patients, but when I am at the office alone and do an analysis without looking at the name or date of the film, I see little affect. Now, I did not say that my patients don’t get well. They do great. I am building a nice practice for myself, my referrals are increasing and I am having fun with chiropractic, but my posts don’t improve. I suspect this is why so many Upper Cervical D.C’s try to hide their films from each other.

Now that I have said this, anonymously, I can breathe a sign of relief. Will I tell my patients, staff, wife…No. Will I still adjust them the same way…yes. What I am trying to say is that we as U.C. chiropractors are missing some of the puzzle I suspect. With all of this said, I must ask you, oncause, what have you noticed? Do you shoot post films.
Dr A.__________, Florida

Reply oncause to letter # 46:
Yes, we agree! The thing that causes the puzzle and confusion is a lack of understanding of the fundamentals. When you are dealing with UC films you are dealing with an enormous number of variables, both in the taking of the films and the analyzing of the films; and those variables can be taught to dance for whoever the self-designated orchestra leader may be.

Yes, we do take post X-rays.

Our advice to you is: don’t just accept the word (or more likely the words) of any DC regarding his or her post X-ray reductions. Learn the fundamentals. Politely ask to see the films. Be careful. If you know the fundamentals it is much more difficult for someone to bamboozle you by word (typical huffing and puffing type reductions), or deed (pencil reductions). In other words, you will become immune to the "FOX IN THE HENHOUSE" phenomenon, which is so prevalent and which is the current means of ascendancy in the UC community.

Letter #45:
I heard about a doctor Holder who has a takeoff of the activator and what is supposed to make it special is the torque. In my U.C. classes they discussed torque for twisting the atlas back into place. What do you think of torque? On some cases I have used it and on other cases I have not and they seem to do well regardless of it. I find it hard to believe that twisting the skin is going to cause the atlas to twist, clockwise, or counter clockwise when it is 2 inches deep under a lot of meat. It sounds like garbage to me, but every time I asked this question I got looks of scowl from my professor making me feel stupid for not understanding such a simple concept.
Dr. S.__________, Iowa

Reply oncause to letter # 45:
Regarding torque: we suggest you check our responses, # 41 and 44.
As you will see, yes, you are correct in your thinking. In our opinion "torque" in the adjustment makes no scientific sense whatsoever.

Sounds like you have the ability to think for yourself, which makes you one-up on your logically challenged professor. You may be on your way to becoming a very good DC.

We would love to hear from some advocate of torque explaining exactly how it is capable of influencing vertebral mechanics. We promise to print whatever is sent to us on this subject.

We’d love to hear from you again!

Letter #44: (This letter responds to oncause's reply to letter # 41.)
Once again, YOU claim to have all the answers in regards to UC work. When are you going to explain in detail what it is YOU do in regards to adjusting??? Is there a good reason why you have not thus far? Why not give others a chance to evaulate YOUR work! ALSO, why do you think you can give ANY advice to the Palmer student in regards to the Blair adjusting when in fact the only thing you do know about it, is from information that I sent to you???

In regards to torque you must know more about it than B.J. Palmer did. Because he seemed to think it was the key to unlocking the upper cervical area.
DR. G.__________,

Reply oncause to letter # 44:
Dr. G, thank you for your letter.

But we have to say, "Nope!" You got that wrong, Dr. G!

In our reply to the Palmer student we did not mention Blair, or Blair’s technique.
Check back and you will see that the student asked us to "Please explain about torque."
And that is exactly what we did. We confined our comment to torque. If the Blair technique happens to use torque in its adjustment, c’est la vie.

However, let’s put the topic of torque aside for a moment and go back and look at a couple of other issues in the first part of your response: you say, "Once again, YOU claim to have all the answers in regards to adjusting."

Once again, nope! We have never said that, or anything like that.

The point we have tried to get across is that it might be a good idea for all concerned if UC doctors, or for that matter DCs in general, were to approach issues of technique with an attitude of logical, independent thought.

Another questions that you asked was, "Is there a good reason why you have not thus far [explained what we do]?"

Why on earth would we want to explain to you what we do in our offices?

Why on earth would we want to explain to you, for your evaluation, the conclusions we have drawn, conclusions which were aided by consultants in the fields of both engineering and neuroscience and which are the result of 35 years of very difficult, in-depth analysis of the UC region?

Now, back to the question from the Palmer student: as we mentioned above, what we did discuss was torque.
If you disagreed with what we said, then please send us your explanation of torque and how it affects vertebral mechanics. We promise you that we will publish your response on our website.

But of course, the grand question (the Wicked Witch?) that hovers behind all of this discussion (or any other misconception about chiropractic technique) is: do you use torque in your adjustment simply because someone told you to? BJ? Blair? Or do you use torque because you have thought it through logically and independently and have decided that torque is the way to go?

We look forward to hearing from you.

This type of discussion is what oncause.com is all about. Independent, scientific thought and discussion can only lead to greater success for everyone who is involved in "cause and effect" chiropractic.

Thank you again for your obviously sincere concern and participation.

Letter #43:
let us see more about upper cervical chiropractic. what about the academy
of upper cervical chiropractic organizations? what about thoroughbred
chiropractic? what about b.j.'s "discard the rotary break"?

Reply oncause to letter # 43:
Since they are short and direct, let’s take your questions, one by one.

"Let us see more about upper cervical chiropractic."

We’re trying! We’re trying! Ask specific questions and we will respond to the best of our ability.
"What about the Academy of Upper Cervical Chiropractic?"

Two of our doctors are members, but we have heard nothing from the Academy in some time.
"What about thoroughbred chiropractic?"

Good word – "thoroughbred." We assume you mean "cause and effect" chiropractic: the only true form of chiropractic. To be more exact, the type of practice in which the DC considers the "When," "Where," and "How" before attempting the adjustment. The "Why" of the adjustment, the incredible responses within the human nervous system that bring severely sick people back to robust health, can only be grasped by the DC if he or she applies the "When,’ "Where," and "How" rule with diligence in daily practice, and thus has the opportunity to personally observe the results in the patients he or she is caring for – not treating.

To put it more succinctly, IF YOU CAN’T DO IT, IT WILL NOT WORK.

Therefore, all too often, the results that are claimed by "thoroughbred" UC doctors sound as preposterous to the generic chiropractor as they would to a practitioner of pharmaceutical medicine.

Also, you asked, "…what about B J’s ‘discard the rotary break’?"

We would like to ask our readers to offer their opinions on this question.

Letter #42: (This letter responds to oncause's reply to letter #31)

WOW!!! Thank you SO much for your balanced, well-thought-out, and VERY helpful answer to my question on rotation in the nasium film. I will begin using your advice immediately and expect that it will help me get better pre's and post's in no time. It makes so much sense to compare the nasal septi and other landmarks on the pre and the post, it just "clicked in" for me, like an epiphany.

Thank you too for your kind and encouraging words concerning my practice, I'm just trying to love my patients and do what is best for them. With all of the bickering among the profession and infighting within organizations it is sometimes hard to keep the patient as the focus. Thank you for helping me do just that.
Sincerely,
Dr W.___________WA

Letter #41:

Hi
I am a student at Palmer and was reading your discussion about the physics
behind the uc adjustment. Could you explain to me the physics or
biomechanics behind the "Blair" adjustment, there have been a great deal of
people criticizing it but pre and post xrays show it works...so please
explain the torque to me.

thanks.

Reply oncause to letter # 41:
We briefly cover torque in our website entry: The Physics of the Upper Cervical Thrust. A reprint from an article in Chiropractic Economics.

Further comment:
In techniques where the hand (pisiform) of the adjustor is intended to "spin" as the thrust is made, since there is a low "coefficient of friction" between the skin of the adjustor’s hand and the skin on the neck of the patient, when the thrust is made, what results is mainly a "skid." The skin of the adjustor’s hand "skids’ on the skin of the patient’s neck.

Moreover, the notion that rotary moments of force can be transmitted through the semi-solid medium of the skin and cervical musculature and somehow "couple" with the vertebra, which on average, lies one inch deep to the surface, is simply that – a notion; another among countless chiropractic notions.
Regarding techniques that claim that the adjustor, by "spinning" his arms in coordination with the thrust, while at the same, not "spinning" his pisiform, can somehow influence vertebral mechanics: this is simply another chiropractic notion.

In reference to what DC’s say about post X-ray corrections: I would be very careful about this. Comparing Post cervical X-rays to Pre cervical X-rays requires an extremely precise X-ray set-up, extreme X-ray clarity, both in contrast, detail and reproduction, and above all, extreme honesty and objectivity on the part of the person, or persons who are taking and analyzing the films.

Chiropractors who have a deep faith and/or a proprietary interest in a particular technique are prone to make many claims about that particular technique. Claims are made, but who is there to analyze those claims, and when necessary, refute them?

The point is: if you wish to arrive at reliable answers, it is best to use your own brain to look at things logically and with objective honesty and proceed from there.