Q and A 7

Letter #140:
This is a continuation of our answers to Dr. M. from Georgia letter #138.
In the later part of his letter he asked:
"However, there is one question that keeps coming up in my head, that I have not found the answer to yet. Do you know of anyone that has proved that a subluxation exists, neurologically? I have read of the neuroencephalopentigraph (sic) machine that BJ was using in the 1950's, and that seems to be the only attempt to actually measure nerve interference.

Since our profession was founded on the basis that we remove this nerve interference as part of our job, it would be comforting to know that someone has proved that there is nerve interference and that once adjusted, this nerve interference has been corrected, or at least reduced. However I have not been able to find any proof of this to this point.

I have read numerous articles on the measurement of bilateral skin temperature, surface emg, and leg length analysis. However, at this point I feel that those are all measuring the effects of a possible subluxation, and not the actual subluxation.

If you do know of anyone that has measured nerve interference directly and could reference me to it, or at least another possible direction to go in, I would appreciate it. I love the chance to learn new things and UC has opened a huge door of new knowledge to learn, and has made me even more excited in chiropractic. "
Sincerely,
Dr M.__________, GA

Reply oncause to letter #140:
I used the Neurocalograph while I was a student at Palmer. I practiced with my father for about a year and used one in his practice, and when I opened my own practice, I used one for several years before I discarded it. Also, in later years as part of our research in our practice, we did extensive studies with the use of heat measuring instruments, some of them chiropractic instruments, some of them from various industries outside the profession. We could find no valid pattern, no valid explanation, therefore no valid reason for their use. In our opinion, the reason for their use is in the "eye (and the mind) of the beholder". We, on this website, have challenged the use of heat measuring devices and asked for explanations of the physiology supporting their use.

No response.

We have also done well-controlled and extensive studies in the use of the E.M.G. One of our doctors constructed a very sophisticated computer-analyzed unit that included anti-static mats for both the doctor and the patient, and while we did, as expected, see some evidence of Pre and Post muscular pattern changes, there was not nearly enough substance in our finding to warrant the use of the E.M.G. on a day-to-day analytical basis in our offices.

As for the leg-length analysis: that is the test that we use in our offices. I feel that Dr. J. F. Grostic, Sr. did an excellent job of putting that test together in all of its components, and WHEN it is done properly, and that is a big, big WHEN, it is an excellent test for the presence of nerve interference. However, it is a very difficult test to apply with the degree of accuracy that is necessary to eliminate the large number of variables that are inherent in it. Because there is a strong tendency for bad habits to develop, we have found that it takes constant drilling to maintain accuracy. The problem is that even when a doctor’s set-up is grossly in error, he or she still sees something – either a positive or a negative, that may be entirely false, because the test was not applied properly. Nevertheless, he or she has seen it and it is real in his or her mind, and this leads to a great deal of confusion. Very often, because things are not going well with a particular case based on the Spinal Balance Test, the DC begins to shove and twist the backbone around. The subtle thing here it that the DC has both a conscious and a subconscious incentive to begin to shove the spine around – the financial factor. Shortsighted as it is, there is no doubt that the F.F. is a great influencer. So now the DC has actually lost control of his or her practice, and the practice is no longer fun; it is drudgery, and the enthusiasm that should be there is gone because the DC is practicing more to please the patient in an immediate, symptomatic sense, rather than get the patient well. And this obviously leads to a dull, work-a-day, musculoskeletal aches and pains type of practice, and the resultant loss of enthusiasm and eventual loss of satisfaction and income.

You mentioned in the body of your letter that, "You have me thinking about what I am doing, instead of blindly following someone else".

You are going in the right direction. Hang in there!

Letter #139:
There have been no specific questions regarding torque. Below is our answer to the general response that we have received on this topic.

Reply oncause to letter #139:
In our last publication, we discussed the theory of the employment of "torque" to correct the spinous process of the axis. In response, we have had a number of e-mail's, all asserting and extolling the virtues of "Torque Power". However, not one of our correspondents has explained how it works. They just say, "It works"!
Okay. If you "torquers" out there can’t explain how it works, can’t explain what actually pushes or pulls the axis spinous, then maybe you can demonstrate what makes you such a firm believer.

To aid you in your endeavor to prove your point we are offering $200 to any DC who can demonstrate an axis spinous correction of 3 degrees or more on accurate Pre and Post nasium films.

In addition, we are raising the amount of our reward to $200 for anyone who can demonstrate an atlas laterality reduction of 2 degrees or more on accurate Pre and Post nasium films. (See details for submission here.)

Come on you "Angle Aligners" and "Spinous Spinners", we’re "cooing" like a pigeon, waiting to be taken advantage of.

This couldn’t be another instance of just saying it makes it real, could it? Another case of Chiroscience?

Letter #138:
Dear chiropractor,
I am a recently graduated chiropractor now practicing in Georgia. After Graduation I practiced full spine technique, and was never satisfied with the erratic results. I moved on to Thompson Drop technique, and seemed to help more patients consistently, but was still not satisfied with the results.

I started to read information on upper cervical technique about a year and a half ago. Over the past year I have studied and practiced toggle and have started to use vector based adjusting with a hand held instrument over the past month, and have seen patients hold their adjustments much better than before. I feel like the more I learn, the more there is to learn. I am really enjoying all there seems to be to learn with upper cervical, and at the same time having a hard time figuring out where to start. I have been reading through your website almost everyday, and really do like your approach to your answers to the questions asked. You have me thinking about why I am doing what I am doing, instead of blindly following someone else.

However, there is one question that keeps coming up in my head, that I have not found the answer to yet. Do you know of anyone that has proved that a subluxation exists, neurologically? I have read of the neuroencephalopentigraph (sic) machine that BJ was using in the 1950's, and that seems to be the only attempt to actually measure nerve interference.

Reply oncause to letter #138:
First of all – you are on the correct course. The only way you can progress and develop in your professional life is to rid yourself of chiropractic dogma. As we have been continuously pointing out, all DC techniques have evolved from the personalities of the people who asserted them, transmitted to the personalities of the people who are willing to accept them.

Has any DC technique "researcher" ever, in the course of his or her research, disproved his or her contention? The thing that causes the dominance of any technique is the assertiveness and dominance of its originator’s personality.

A classic example of this is the issue of torque, which we discussed in this current entry. No one has been able to come up with an explanation for the assertion regarding torque to the surface of the skin and the soft tissue which overlies the atlas TP being capable of rotating the axis spinous, yet when it is questioned, emotion takes over. Why? Simply because the assertion was made with such dogmatic authority.

Now, as to the proof of the existence of nerve interference: we do not know what happened with the electroencephaloneuromentimpograph. No one really does. However, we can try to reason our way through the question.

1) The electroencephaloneuromentimpograph was put into use 68 years ago, and keeping in mind the level of electronic technology of 1935, does it figure that the instrument was capable of doing what was attributed to it?

2) If the instrument had not been able to do what it was supposed to do, would B.J., after purchasing it with all the promotional hoopla, have told us so?

3) If the electroencephaloneuromentimpograph disproved the theory that interference exists only in the UC area, would B.J. have backed down in what he had so adamantly asserted?

4) As mentioned before on Oncause, we, in our practice, have ultimate respect, even veneration for B.J. and what he accomplished. There is no doubt that none of us would be here without his life of dedication to the cause of locating and removing nerve interference. However, B.J. was essentially a businessman and a promoter; also, thankfully, a visionary. But, knowing what we know about B.J.’s personality, does it figure that he would be a fastidious, objective scientific researcher? Remember, he was a great admirer of Barnum and Bailey.

The two types of personalities are inimical to each other; they don’t come wrapped up in the same individual.

So, as we have recommended previously: Think for yourself!
We will answer the last parts of your questions in a future entry.

Letter #137:
I enjoy your web site, but I am troubled, my wife would say I am very troubled, but that is beside the point. I am at a loss to admit what I am doing as a "UC practitoner". I took the challenge that you laid out and I put a little lead fishing weight on a piece of scotch tape before I took a series of films. I found through palpation, or at least thought I did, the atlas TP. I would have bet a $1000 that I had the TP. Well what do you think happened when I looked at the films? I was off by quite a bit, approximately 7/8 of an inch. In studying the films the TP appears to be impossible to palpate because it so high under the mastoid.

I tried another experiment where I used a few pieces of taped sinker and mapped out the outline of the mastoid based upon palpation and discovered that the bone you see on a film is then covered with a lot of gristle. It is not as it appears to be on film. I think it is almost impossible to adjust the atlas TP, much less palpate it. There are most likely some exceptions, but I have not found one in the 7 cases that I have played with.

On one case when I did a classic Grostic analysis, I calculated my height factor to be a High 3. I plotted the trajectory of the vector on the films and it appears that you will send the force into C 2 or 3 with this degree of angulation. Yes this is still considered upper cervical, but we are not adjusting what we think we are. This was a very disappointing and enlightening experiment I urge all D.C.’s to try it and open their minds.

Now to another troubling point: these 7 cases are holding and feeling better. Is what we do all placebo? All the x-ray work and exam does not correlate with what we are moving?

I wish to maintain total anonymity since I have an upcoming UC seminar to attend and I do not want to be the fly in the punch bowl, but this topic needs to be discussed.
Sincerely,
Dr X.__________, XYZ

Reply oncause to letter #137:

If you continue to think and experiment for yourself, you will get closer and closer to what you need to know. We have been talking about this forever on OnCause, now you are finding out for yourself. Keep working at it, experimenting and thinking. Fire more questions at us and we will give you more clues along the way.
Now, tune into the next Q. and A., below, and you will see, in light of what you are finding out, how off course and convoluted by personalities and assumptions U.C. work is.

Letter #136:
Being the busy U.C. Practitioner that I am (Sarcasm) I finally got to a Chiropractic Journal???...magazine that had been laying on my desk. From the Sept/Oct 2002 issue of Todays Chiropractic I read an interesting article on the mystery of torque. I know this has been a hot topic on your web site. I am curious if you saw it and what you thought of it? I am including a paragraph for you to comment on.

Sincerely,
Dr A.__________, AZ

Reply oncause to letter #136:
Of course we have seen the article. A couple of our readers forwarded it to us at publication time, but we chose not to discuss it. However some recent, behind the scenes, correspondence changed our mind and we will dive back into torque. The article is written by Dr. Laney and is touting his torque instrument. To read the whole article follow the link: http://www.todayschiropractic.com and look in the past issues under technique. The following is the paragraph that was forwarded to us by Dr. A.

To Quote Dr. Laney quoting Dr. Gregory. "According to Dr. Ralph R. Gregory, "Frequently, it is necessary to deliver both a linear and angular motion in the adjustment at the same time. The combination of directing a linear force with an angular force (torque) is required when the axis spinous has misaligned differently from the axis body and atlas." (Gregory, Ralph R., Chiropractic Economics, July/Aug 1981.) This article is published in its entirety on this web site.

Okay, you asked my opinion and here it is!
This is just another classic example of "chiropractic science". "According to Dr. Ralph Gregory…etc." That was just something that Dr. Gregory said. The scientific method -- the method employed by legitimate scientific investigation does not proceed based on things that people say, pronouncements made by self-proclaimed experts. Can you imagine what would happen to any branch of science if it just went off in some direction based on something someone said?

Now, with regard to the statement itself: what does that statement mean?
Please keep in mind that the force in question is being transmitted through a semi-solid medium (skin, muscle, fat, blood vessels and tissue fluid) that averages about and inch in thickness.

And beyond that, even if you were able to transmit an "angular force" along with the "linear force" through that medium, how would that force couple with the axis vertebra and cause it to rotate? I am speaking now in terms of "nuts and bolts".

It is very facile to say that, according to so-and-so, such-and-such happens. But, precisely how does it happen? What pushes or pulls on what to cause the axis spinous to rotate on the transverse plane? Remember, we are talking about a force that is applied from a distance of approximately one 1 inch through a semi-solid medium into a different structure (the atlas) than the one we are speaking about trying to move (the axis), and that those two vertebrae are separated by cartilage pads bathed in an extremely efficient lubricating agent – the synovial fluid.

Looking at the issue of torque, back in the late 60’s, I discussed this with two close friends whom I had known for some time, mechanical engineers of considerable accomplishment, both senior project engineers with aerospace companies. At my request, they both looked closely at the anatomy – osseous and surrounding tissue – and considered the question of torque administered into the atlas and attempted to calculate any kind of influence that force might have on the axis. To be perfectly honest, it was my impression that they both would have liked to laugh, but since I was a close friend, out of politeness and respect for our friendship, they just, in a somewhat amused way said, "No, it can’t work that way." Moreover, the looks they gave me said, "Where in the hell did you get an idea like that?"

In addition, what makes their reactions even more striking is that they were both looking at the anatomical mechanics strictly from a "dry specimen" standpoint. They were not factoring in the extremely low coefficient of friction between the two vertebrae, which is provided by the cartilage and the synovial fluid and is necessary for the vertebrae to be as freely moveable in relation to each other as they are. The fact is that the surfaces of these two vertebrae very efficiently slip and slide on one another during any movement of the head and neck on any plane.

But before we use more of your time and my time, I strongly recommend that you study the entry just prior to this, #137. Start there. Find the atlas T.P. before you worry about projecting a combination of "linear" and "angular" forces through a semi-solid medium into the atlas T.P. in order correct the atlas on the coronal plane and simultaneously rotate the axis on the transverse plane. Your time and effort will be much better spent, and I might add, much more profitable to both you and your patients.

Letter #135:
I have been a reader for quite a while. I want to thank you for the forum that you are providing the U.C. Community. You have made it very clear that at one time you did practice a "Grostic based" technique. In fact you appear to know the work very well. In past entries you have made reference to Grostic work and Grostic based work. Why the differentiation?
Thanks,
Sincerely,
Dr A.__________, CA

Reply oncause to letter #135:
First of all, I have never practiced a "Grostic based" technique. However, I have practiced Grostic Technique as taught by J. F. Grostic.

The term "Grostic based" is a neologism coined by DCs who combine certain elements of the Grostic technique with various full-spine techniques. This contradiction in terms and practice has been put into usage in order to take advantage of the veneer of "science" which is inherently associated with Grostic Technique. It allows the practitioner to paint his or her shingle with that veneer and yet wander around the backbone to his or her heart’s content, not to mention his or her wallet’s delight.

The obvious irony here is that if "Grostic based" practitioners knew enough about X-raying and adjusting the U.C. area, and stuck with cause-and-effect chiropractic both their hearts and their wallets would be better off, along with their patients’ health.

In the past, there have been huge pure U.C. practices, many with a 1-2 month waiting period for new patients. I have been there myself. Although I still see a good number of patients, I am not there now because I have taken four other DCs into my practice in order to take up the backlog. Plus, I no longer wish to work that hard. (That way I have more time to field questions from all of the dedicated U.C. DCs out there who are intensely interested in finding better ways of attracting new patients into their practices and better ways to get those patients well quicker and to move on to other sick people who are suffering from nerve interference and need help.)

Back to reality! The thing to keep in mind is the size of some of the past U.C. practices. The really big ones were U.C. exclusively, not "U.C. based"! Why? Why were they not U.C. based?

Oncause would like to see comments, theories and/or questions from our readers as to why the dynamism of the pure, cause-and-effect type of concept and practice has faded from the chiropractic scene.

Letter #134:
Let's say a patient has a 3/6 contralateral subluxation. You adjust and post x-ray them. The legs are now balanced. The post x-ray shows that the PL has reduced and the misalignment now measures 2/4.5. Would you readjust to try to further reduce the angles or would you go by the leg check and leave it alone until the leg pulls short again? I have heard different views on this and am interested in your opinion.

Sincerely,
Dr X.__________, MI

Reply oncause to letter #134:
The "Grostic answer" to your question is as follows: You can adjust the patient as many times as you like in a given period, but once they have had a "night’s sleep" you should not adjust again until the leg pulls up.

That was what J.F.G. said about your question.

Now, as to what we do: we do not practice the Grostic Technique, therefore we go about solving the cervical problem much differently.

However, as a general rule, if the S.B.T. (Spinal Balance Test) is negative, do not adjust anywhere.

I have underlined the anywhere for the benefit of the contingent of the chiropractic profession that has conveniently coined the term "Grostic based" in order to euphemistically describe the economic necessities of their daily practice.

Letter #133:
You don't believe in any outside marketing or advertising. So what internal things do you do to stimulate referrals? Newsletters? Brochures? Special offers? Family Plans?

Now onto X-ray analysis. In your opinion, which is the best and most accurate method for determining the side of atlas laterality? Grostic/AO/NUCCA central skull line relationship to the atlas frontal plane line, or vertex view by Zimmerman, or Base posterior a la Duff/Blair or APOM via Kale?

Again thanks. I hope you realize that I'm asking all these questions to try to figure out what I need to be doing or stop doing in order to build the practice I want. I don't want to struggle and I certainly don't want to be a failure. I know that UpC care is right! I just need to make sure everything I do is right (analysis, when, how) and figure out how to "promote" myself to my patients so they refer.

Sincerely,
Dr X.__________, MI

Reply oncause to letter #133:
1) We do not do newsletters.
2) We do use brochures of our own authorship that explain the removal of cause/ restoration fundamentals of our work.

3) We do not do "special offers". (Why would you need to do special offers when you can remove the cause of disease?)

4) We do some family plans, but not with the "incentive" motive. When we do family plans, it is strictly to make our work available to family members whose care is being covered out of one pocket book.

Dr. X’s next question .

"Now onto X-ray analysis. In your opinion, which is the best and most accurate method for determining the side of atlas laterality? Grostic/AO/NUCCA central skull line relationship to the atlas frontal plane line, or vertex view by Zimmerman, or Base posterior a la Duff/Blair or APOM via Kale?"

The best way I can answer this question is to refer you back to answer # 87 in our Oncause correspondence.

All of the techniques that you mentioned were developed in exactly the manner that was described in answer #87.

To reiterate: Questions were not asked of the various "technique notions" by the chiropractic "researchers" who concocted them. No orderly challenge to their "technique notion" occurred. They merely asserted in their own mind the way it worked and confidently pushed on. If any of the above mentioned "approaches" were done base on the scientific method – the real scientific method, not the chiropractic scientific method – then there would be no debate, would there?

As mentioned before, our work has been done quite differently and we will not throw our hat into that ring.

We would like to have you reply as to your thoughts regarding this.

Letter #132:

In oncause letter #129 we discussed X-ray analysis for finding the Transverse Process of the atlas. In correspondence #129 we described one method for transposing the T.P. location from the lateral film to the Nasium. Published below is a second method from our research journals.

Contact location method #2
I taped a piece of lead shot (a shotgun pellet slightly flattened with a hammer) to each ear lobe at their point of the juncture with the side of the face/neck. I used two sizes of shot on the same patient in order to differentiate right from left. With the marker in place, I took the conventional three films: lateral, nasium and vertex. This gave me views of the shot location (on the side to be adjusted) with respect to T.P.
1) By viewing the vertex film as to where T.P. that was to be adjusted, would appear within the shadow of the atlas itself on the lateral film – many times one T.P. will be projected significantly forward or backward than the other.

2) By viewing the T.P. on the nasium film as to where the T.P. that was to be adjusted, was located within the shadow of the atlas itself on the nasium film – many times one T.P. will be projected significantly downward or upward.

This cross-reference brought me to the location of the appropriated T.P within the shadow of the atlas on the lateral film.

This T.P. location was then referenced to the location of the appropriate shot on the lateral film– either the larger or the smaller shot depending on the side of laterality. This distance, the distance from the juncture of the ear lobe to location of the T.P. on the film was then measured in millimeters with a small, transparent ruler and reduced by 1/3 to allow for X-ray magnification.

If the shots were more than 10mm apart on the lateral film the film, I considered the lateral film to be rotated and retook it.

This process may appear to be laborious and time consuming but it is not at all. The time it takes to tape the shot in place takes but a few seconds. At the view-box, it also takes only takes a few seconds to make the measurement and record it on the patient’s card, and measuring at the time of the adjustment only takes a few seconds as well.

I drew the diagram below on the patient’s listing card:

So, as busy as all UC DCs are these days, this whole process shouldn’t take too much of your time.

I recommend that you palpate for where you believe the atlas T.P. and then go through the above process or something similar.

What you will find is that you are seldom on contact, often way off contact, and that goes for posterior arch adjustors as well.

And, believe it or not, when you are on the contact that your technique specifies you will get far more sick people well much quicker, get more referrals and have a much more successful practice.

Letter #131:
Dear Doctors,

I'm a brand new upper cervical doctor in practice (hypothetically). I want to practice straight cause and effect, upper cervical chiropractic. I've seen on your web site that you don't believe in advertising. All your patients come from referrals. But I don't have any patients yet! And I have to pay the rent, building lease, equipment loans, utilities, etc.

What practical things can I do to start getting new patients?

Sincerely,
Dr. X__________,Mi

Reply oncause to letter #131:
That’s always a tough situation, and I suppose anyone who has survived and is in practice realizes how tough it really is.

However, I believe that even in the situation you describe advertising will only have an overall, long-term negative effect on the growth of a practice. When you advertise you are identifying yourself as a doctor who needs business (i.e., patients), and if you attract anyone through your advertising it will be from the subculture in town that is shopping and drifting around, looking for some kind of deal on their health care. Not only will you attract the wrong type of patient, but also you will repel the right type of patient.

What’s the difference between the two?

There is a world of difference. Because of your advertising, the wrong type of patient comes through your door with the idea that you need them. Therefore, you have a problem with them from the start. They know that you need them or you wouldn’t have spent the money for advertising, and so they sense that they are in control of the situation, and they are not nearly as likely to follow your instructions. Not only does this make for a difficult and frustrating doctor/patient relationship, but, in a very subtle but very real way, it is conceptual poison for the doctor.

People who respond to “health care” ads are almost invariably not from the substantial part of the community, and you are setting the tone and identity for your practice. Do you want a practice made up of the solid responsible, financially capable part of the community, or do you want a marginal/shopper/drifter type of practice? When a shopper/drifter talks about the results he or she got, who listens? If anyone does, it is only the shopper/drifter element.

On the other hand, when someone from the more substantial part of the community (here I mean someone who pays their bills and is considered a person of stability and sound judgment) speaks they have more credibility, and people of the same type tend to listen. They do not listen to the marginal/shopper/drifter types.

Also, it’s a lot more fun and more rewarding to take care of people of sound judgment whose judgment is sound enough so that they recognize what your care has done for them and are not only capable of paying their bill, but happy to do so and happy to tell others about you and your work.

Now, as to what a new doctor can do: I recommend, first of all, that they have enough capital saved so that they have the “staying power” to get them through the tough financial period that comes with starting a practice, particularly a practice that has a future in the substantial element in the community.

A new doctor has to be able to circulate. I don’t mean in a phony, glad-handing way. Join groups that share your hobbies or interests. It’s a matter of making yourself known. Also, you can join civic groups, providing that you are really sincere in doing something for the community and not just interested in the exposure that you get out of it. If you aren’t really sincere and you are joining only for your own self promotion, don’t join. Our good friend, INNATE KNOWS.

That would be my best advice. And, I would say to any new doctor who is really sincere in his or her work, “Hang in there.” As I mentioned above, INNATE KNOWS!

Letter #130:
I wanted to take the time to answer your question on how one would go about analyzing the spine for subluxations below the atlas-axis area. (letter #126)

The analysis method I use is called advanced muscle palpation. It is a method by which the intrinsic muscles of the spine are palpated bilaterally. What I am feeling for is a working sensation in one muscle as compared to the other. Since these small muscles attach directly to the spine, they will respond with the stretch reflex when stretched. The idea is that when there is a force put into the spine that creates the misalignment, the muscle stretches dynamically to stop the misalignment and then will remain in static contraction if the dynamic contraction was unable to stop the subluxation. The analysis is specific and allows for a specific and gentle force to be utilized to facilitate correction of the vertebral subluxation. A post check is always done to make sure the correction was made.

I hope that answers your question.

Thanks Dr. D.__________, CA

Reply oncause to letter #130:
The technique you describe obviously relies on a bank of highly subjective impressions – your impressions digitally perceived from your palpation of the paraspinal musculature. No doubt changes will occur in these muscles when any type of adjustive force is introduced and no doubt you have many patients who utter the words “I feel better” after they have been adjusted. But you are dealing with only two factors: 1) your impressions (digitally), and 2) your patients’ impressions (symptomatic responses), anecdotally communicated to you. So I will ask you the same question that I asked previously: How could your procedure be subjected to a scientific study? How would you design the study?

Dr. D., I’m sure you are getting results in your practice, but as you can see, your technique does not appear to be amenable to scientific study, at least as it is described in your correspondence with us.

If you have some idea as to how your work could be scientifically investigated, please let us know.

Letter #129:
Dear Dr. Molthen,
Thank you for your upper cervical website. I certainly have learned to clean up my thinking, in many areas of life besides just upper cervical chiropractic, by reading your responses. My practice is just over 1 year old, here in Florida.

I use the AO percussion instrument. Before adjusting a patient I try to carefully locate the C1 transverse process on the sagittal film, relative to the mastoid and the jaw. What is the best way to use this information to be sure I am positioning the instrument stylus accurately, when I'm standing there in the adjusting room with the patient on the table? Thanks for your help.
Peace and Health,
Dr. C.__________, FL

Reply oncause to letter #129:
Realizing that we have been in a tough battle with CNN for market share for the past few weeks, we have been reluctant to publish on ONCAUSE. However, after perusing the following response to a question on contact location, we suspect that our, always being vitally interested in any information that will improve their work, faithful will spread the word and we will again assume our rightful position, challenging, if not surpassing, network TV.

Dr. C., you are definitely on the right track with your thinking.
Since this is such an important issue, I will reprint one of my earlier responses regarding the issue of "contact".

Response #56:
Yes, we have done quite a bit of work on contact 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?

Dr. C. now, in response to your question, here are two different approaches to locating the atlas T.P. These are entries from my research journal of the early 70’s.

"The following investigation was initiated because, to the best of my knowledge, the procedure for contact location had never previously been looked into. That the atlas T.P. can be located from the surface of the skin simply by palpation was another basic assumption that had grown up with chiropractic and was considered a "given", but like all chiropractic "givens", it had never really been subjected to investigation.
"The contact point is no doubt one of the most critical factors in the delivery of a UC corrective force. It would seem obvious from the standpoint of basic mechanical logic that being off contact even slightly would markedly vitiate the effect of the adjustive force and thus negatively affect the outcome of the case.

(Still quoting)
Method #1
"I had precise columns of holes drilled in two pieces of Plexiglas material. Each Plexiglas piece was about 1 1/4 inches square. The holes were very small and I had them filled with tiny drops of melted lead. (I had this done at a local machine shop that had done most of the work for me on my previous R and D projects. One of the co-owners was a very good patient of mine.) The holes were equally spaced forming a grid, and in one piece of Plexiglas, the holes were of a slightly different size than the holes in the other. Thus, I had two pieces of Plexiglas with grids of lead "dots" with the dots differing in size. Three-eighths of an inch of one corner of each square was cut out. Using the cut out areas as locators, which fit up into the slot where the lobe of the ear attaches to the side of the neck, the devices were placed on each side of the neck so that the grids would cover the general area of the location of the atlas T.P. on the lateral film. The Plexiglas grid with the larger sized leaded holes was placed on the right side of the patient’s neck, which in our X-ray set-up, when taking the lateral view, was farther from the film, thus giving the columns of lead dots on the right side of the patient’s neck a larger appearance on the film than the dots on the left side.

"A third piece of clear plastic with exactly the same pattern of holes as the other two Plexiglas pieces was used as a template when it came to marking the contact. The holes in the clear plastic were open and large enough so that the point of a pen with washable ink could be inserted to make the mark on the patient’s neck. The grid pattern on all three pieces was laid out with the holes 3 millimeters apart. The horizontal grid lines were given numbers, 1 through 5. The vertical grid lines were given letters, "A" through "E".

"After determining the laterality of the atlas, and deciding on which side the patient was to be adjusted, the location of the atlas T.P was marked on the lateral film and given a location coordinate, such as C3, for example, which referred to that particular grid point. That coordinate, C3 (in this case) was the contact point for the adjustment and would appear on the patient’s listing card.

	1	2	3	4	4	5
A
B
C			X
D
E

"At the time of the adjustment, the clear plastic piece was placed on the patient’s neck in exactly the same position as the appropriate leaded one was – the same as when the x-ray was taken. The doctor would then mark the contact point through the hole in the clear plastic (C3) with the pen.

"There was some inaccuracy in this method because the reference points – the lead markers – could, by nature of their design, only be used on the lateral film and therefore I could not get a three-dimensional fix on the actual location of the atlas T.P. within the field of the atlas itself. In addition, I found that many times the T.P. is not where you might think it is, even within the shadow of the atlas itself. Some T.P.s project downward quite steeply on the nasium view and some project quite anteriorly or posteriorly on the vertex view. So, I realized that I had to use some other method for locating my starting point on the lateral film – the atlas T.P.
"The above was an improvement in contact location, but it gave way to other methods."

(End of journal entry quotation).

We will further discuss a second method of finding the true location of the atlas T.P. in a subsequent entry on ONCAUSE.

Letter #128:
Dear Doctors,
My innate has lead me to your website, and for that I am deeply grateful. I am a student at Logan Chiropractic, but an Upper Cervical fanatic. Sadly however, the only UC experience I can get thru this particular institution is thru a weekend HIO seminar.

I have met a few UC docs during my time here and their work has proved to me that UC is the path I'm called to follow. I've researched some of the various UC techniques and have focused my primary interests towards HIO and Knee-Chest <Kale> styles. Without the benefit of going to Palmer, I don't know much about which UC technique was BJ's true choice. Could you fill me in on the possible advantages/disadvantages of these techniques?

Any guidance you can offer would be greatly appreciated. Thank you, and God bless!

Yours in health,
Student T.,__________MO

Reply oncause to letter #128:
Regarding B.J.’s "true choice," I suggest you find a copy of volume XX.

The other part of your question – investigating the field of UC techniques – can best be answered with an admonition: no technique, including B.J.’s published "research" in volume XX, has been scientifically, honestly and objectively researched.

All techniques are merely notions that originated in the mind of some practitioner. The process of UC technique "research" begins in the following manner within the mind of the researcher: "I have an idea (notion) that it works in such and such a way. So now, I will go about doing it in such and such a way and let's see what happens to the patient symptomatically. And guess what!? Viola! Many of the patients who had such and such done to them – that is, a ritualized and codified X-ray analysis and adjusting procedure – eventually utter the words, "I feel better."

Therefore, in the mind of the chiropractic "researcher" and in the minds of his or her acolytes, the following conclusion is drawn: "We have found the answer, the one, true technique, and all of the practitioners of all of the other UC techniques are sadly misguided people.

So, inevitably you have a natural culture for disagreement and dispute based only on what some strong personality asserted.

Back to B.J.
As we have mentioned previously on this website, without B.J. none of us would be here, and for that we have the greatest gratitude and reverence for him.

But to make our original point, let us use Volume XX as an example. When you study it, you will notice that it does not ask questions. It merely describes the way they went about the delivery of UC technique in the B.J. Palmer Chiropractic Clinic and the symptomatic results they achieved. However, all UC techniques produce results, so you have not had decided for you the question of which is the best UC technique because there has been no objective comparison made. What you have seen in Volume XX is a list of cases that were X-rayed and adjusted in a certain way, and, and as mentioned above, their subjective, symptomatic response. It is a collection of primarily anecdotal responses to a particular UC technique that have been assembled and published by a person who had a proprietary interest in the project.

That is not science.

Therefore, I’m afraid what it all cones down to, as the old saying goes, "You pays your money and you takes your cherce (choice)."

Letter #127:
The following letter is from Dr. X.__________, Michigan. We have integrated his questions into the answers.

Reply oncause to letter #127:
Dear Dr. X.,
You asked six questions. We will tackle the first three this time, but since we have recently been flooded with questions, we’ll get to the next three at a later date.

Q. # 1: A person comes to your office and I'm assuming they fill out the usual standard paperwork. You have a consultation & exam. Then you explain what you found (Is this where you give some type of UpC "lecture"? ) Then take x-rays.

A. # 1: No, we do not give "patient lectures." We have done so in the past, but they have proven to be too time consuming and cumbersome.

Q. # 2: Then they come back for the second visit. You explain that they have interference - that's what's causing the problem - and you're going to fix it. You take post x-rays, but you haven't elaborated whether or not that was after the first adjustment. I assume that it is. You rest people after the adjustment.

A. # 2: We take post X-rays after the first adjustment. After the first adjustment, we have the patient rest for 20 minutes, then we take the Post and after the Post, we do a Post Spinal Balance Test.

Q # 3: You don't give care plans, but you have a person come in 3x a week for the first two weeks. What criteria do you use to cut back visits after that?

A # 3: We tell the patient that it will be three time per week for the first two weeks; but in the majority of the cases, the patient is holding the adjustment and we can cut back on the frequency of the office calls before the two weeks have elapsed. I would guess that most of the cases are seen four to five times in the first two weeks. However, as you no doubt know, some cases are more difficult and will have to be seen more often, particularly at first. Occasionally, we run into cases that have to be seen as many as 10 times in the first month and six or seven times in the next month. Also, the frequency of the office calls is not based on the severity of the symptoms, or the symptomatic response, but on how well the patient is holding the adjustment.

My own feeling on the issue of frequency of office calls is as follows: after about the first five or six office calls over a two week period, I am tired of seeing the patient that often and I’m sure they are tired of seeing me. So the quicker they hold their adjustment and get well, the better we both are for two reasons: 1) we don’t get sick of seeing each other, and 2) I can move on to other cases. After all, that’s what it’s all about, isn’t it? – getting as many sick people well as possible, and getting our message out to the sick and suffering.

Letter #126:
Hey Guys. I have enjoyed reading your answers to your questions and appreciate your enthusiasm for your art and for Chirorpactic! I have a question regarding UC exclusive practice. I receive care from a NUCCA practitioner and have enjoyed it immensely. I guess my question is. Why not evaluate / examine the rest of the spine for the presence of vertebral subluxations? Is it due to the belief that there are no subluxations below atlas/axis?
Thanks Dr. D.__________ CA

Reply oncause to letter #126:
Dear Dr. D.,
Thanks for your clarification.
I don’t mean to be testy or contentious, but just how would one go about doing what you suggest?

Letter #125:
I remember hearing how the upper cervical practices were some of the largest practices around. That no longer seems to be true. In fact, from my own personal experience, I can tell you that I saw more people and got more NPs as a DE diversified non-specific chiropractor than I have since I began doing upper cervical work in 1984. In fact, I'm struggling in practice just to make ends meet. This doesn't seem right. Zimmerman, Grostic, Duff, and now you folks seem to have some "formula" for being able to practice exclusive UpC work, get large numbers of NPs, get "sick" people as patients instead of "back pain" cases and lots of referrals.

So what is the A-Z formula?

What do you do and say from the time a new patient walks in your door to train and educate these people that they understand the Big Idea of UpC care and refer people from out of state?

Dr. X.__________, Michigan

Reply oncause to letter #125:
Dear Dr. X.,
I think you answered your own question.
Isn’t it strange that not one of the three DCs that you mentioned were "Certified". And isn’t it strange that a comment such as yours regarding the fortunes of UC practice comes at a time when a good many UC DCs are in the process of becoming "Certified"?

The following is a reprint of Q #78 with Oncause’s response:

Letter #78
What is your opinion of the Sherman College Diplomate Program in Upper Cervical Technique which starts Sept. 8 & 9 2001?
Dr. F.__________, Canada
Reply oncause to letter #78:
I suppose I have read the same things you have read about the diplomate program, so I can only comment in a general way based on over 40 years of experience practicing UC work exclusively.

First of all this is obviously an attempt, like many other aspects of the current chiropractic scene, to mimic the medical profession. There is an old saying that goes something like this: imitation is the truest form of adulation. Could it be that this is simply another indication of insecurity, the lack of understanding of who we are?

And as I think about this, a couple of other questions come to mind:

In the spirit of true mimicry, could you imagine a medical diplomate program in which various phases of the presentation actually directly contradict other phases of the same presentation.

Could you imagine internal contradictions in some medical Board certification program where one part of the curriculum teaches that things should be done one way, and within the same certification ordainment other parts of the curriculum disagree and teach that things should be done very differently indeed? But they all wind up with the same "Board Certification?"

You see how silly we can make ourselves through insecurity, not knowing who we are? Maybe there’s a reason why we don’t have the overflow practices anymore. Maybe there’s a reason why there is such financial weakness in UC work today.

As a matter of fact, this brings to mind another little lesson in history. BJ, when he was still alive and had control of the P.S.C., had been through enough wars to get chiropractic to where it was, had practiced chiropractic enough and thus was wise enough to maintain one technique as the technique taught and fostered at the P.S.C. Other full-spine techniques were taught because P.S.C. graduates had to know them to get through the various state boards; but they were not fostered, they were taught tongue-in-cheek. No doubt BJ knew that the vast majority of P.S.C. graduates would not actually stick to pure UC practice; however, he maintained the stance of a pure UC philosophy and technique for one simple reason: he knew that the teaching of a multiplicity of techniques would lead to a confusion within the DCs’ minds as to what should actually be done, how the patient should actually be adjusted, and that that confusion would inevitably lead to a weak presentation in their offices.

Soon after Dave Palmer came into power, I received (being a member of the alumni) a letter from him in which he stated that (here I am paraphrasing, but this is very close to the original quote) – "We want to graduate doctors who have learned a wide variety of chiropractic techniques and thus will be like carpenters who have a variety of tools available to them to address whatever type of job they need to do."
Dr. Dave never practiced chiropractic.
Ergo confusion!

If you will go back through our Q and A section, you will find that this has been an ongoing topic on our website (see in particular Q and A’s # 83 and #92).
The truth of the matter is that the dynamic of the UC philosophy of practice has vaporized.

My own opinion is that the overwhelming majority of UC practitioners do not have the slightest notion of what I am referring to when I mention the dynamic philosophy of UC chiropractic practice.

Letter #124:
Dr. M,
Thanks for your continued dialog because I believe this is an very important point.

For clarity, atlas laterality is simply how far the atlas has migrated around the occipital condyles relative to the central axis of the skull as measured on the nasium film. Atlas laterality is measured with the skull in a neutral position relative to the x-ray film and the central ray. Atlas laterality requires a description of two planes, one, the central skull line and two, the atlas plane line for its measurement.

Atlas laterality is a measurement that is a simplification of a complex 3 dimensional movement and is only measured in one plane. It is a 2D description of a 3D event, but if quality control measures in the taking of the nasium are adhered to, it is a very good measurement. In a perfect world the skull is always placed perfectly, but in the real world one places the skull as perfectly as humanly possible. Since humans are not perfect, there is a range of error in the placement of the patient (skull) that has been researched and the results published in the paper I referred to before. On average, the doctors tested placed the skull with plus or minus 1/2 degree of image rotation remaining on the nasium. 1/2 degree of image rotation remaining on the nasium film will change the atlas plane relative to the horizontal .2 degrees, higher on the side that the skull is rotated toward on average. But, the central skull line or axis of the skull is also affected, tilting it away from the side the skull is rotated toward, slightly less than .2 degrees. The end result is that the measurement of Atlas Laterality is unaffected with this size of image rotation remaining on the nasium film.

The key to expanding our understanding of this phenomenon is that as the S-Line and thus tube tilt angle becomes steeper, image rotation remaining on the nasium becomes more critical. The flatter the S-line and tube angle, the less image rotation affects the measurement of Atlas Laterality. In upper cervical lingo, said another way is that 2 degrees of skull rotation remaining on the nasium film would be a critical error on a S-5 (S-Line from lateral film) and a very minimal error on an S-1 when talking about the measurement of Atlas Laterality.

I do want to through you a bone here though. There is one type of case that a right skull rotation remaining on the film could favor a left laterality and that is if the patient has a tall slender skull and a very flat S-line (S-zero). In this case your statement would be correct, but on the example that we are talking about in the Orthospinology article your statement is not correct, nor is it correct in the vast majority of cases.

One last statement concerning the Orthospinology film in the article, the skull in this film actually has little image rotation remaining on the film, but it is the head tilt remaining in the film that could create a small error in measurement. The reason that one can observe, as you pointed out, a difference on inner skull lines between the pre and post x-rays is due mostly to head (skull) tilt in the film on the pre, but that is a whole different discussion!

Dr. M, I appreciate you and your forum, keep up the good work.

Dr. R.__________, Georgia

Reply oncause to letter #124:
Dr. R.,
The following is a quote from your response to us on 7-2-02 regarding our previously pointing out the head-rotation that was present on the published Orthospinology films:

"You are exactly backwards! Right skull image rotation causes the plane line on the right to raise, the C2 spinous to move to the left and the head to appear slightly tilted to the left as the plane line raises. If the amount of image rotation is small (less than 2 degrees depending on the tube tilt) there is no net distortion to the measurement of C1 laterality. This image distortion occurs only if the tube tilt/S-line is not parallel with the floor. An S-Zero with no tube tilt will not create a distortion to the C1 plane line with image rotation."

Oncause response:
In the above quote, you refer to what happens to the atlas plane line (APL), but the question is: what happens to atlas laterality?

I’m sure that you will agree that the measurement of atlas laterality and the measurement of the atlas plane line, although they are both derived from the same line - a line drawn through the inferior attachments of the posterior arch – are two different measurements. One yields the amount of atlas laterality; the other yields the position of the atlas in the horizontal plane.

Therefore, if you describe what happens to the atlas plane line when there is head rotation it really means nothing other than what happens to the plane of the atlas on the nasium film. Of course, the plane of the atlas tends to change as you rotate the skull. But, as mentioned above, the question is: what happens to the atlas laterality when you rotate the skull!? In reality-nothing. The amount of laterality remains a constant through all placement errors. Head-rotation will only cause an incorrect measurement perception of atlas laterality due to the X-ray placement error which has caused a distorted view of the skull-which is the source of one of the two lines used to find atlas laterality. If this were not true, you could radiographically remove atlas laterality simply by rotating the skull, thus, as the case may be, either dropping or raising the atlas plane line.

I hope we are not getting too tedious for our vast audience, Dr. R., but with regard to this same issue and in regard to our previous debate on those same published films:

Here is your comment regarding our critique from letter #122:
"This is a very good observation on your part and some of it may be marking error, but let me propose how your description above could occur. First of all this is an extreme case an not representative of the average case. Due to the large size of the misalignment of the upper cervical components, the lower cervical spine has to laterally flex. From spinal biomechanics we know that rotation of the lower cervical spine is a coupled response with lateral flexion. The lower cervical vertebrae are significantly rotated on the PRE film due to the large misalignment components in the upper cervical spine but are much less rotated in the POST film. One, if thinking 3 dimensionally would EXPECT the Pre lower cervical width to be smaller than the Post lower cervical width if the film are marked accurately through identical structures."

Oncause response to the above:
I’m sure that you will agree that the skull is a much larger object than the lower cervical vertebrae. Therefore, its lateral borders lie much further from the central portion of the X-ray field than the lower cervical vertebrae, causing the skull to be projected in a far less parallel portion of the X-ray field than the lower cervical vertebrae, thus causing the skull to be far more prone to image distortion than the lower cervical vertebrae. In addition, the skull, whose borders you use to establish your central-skull-line, is a less round, more elliptical object than the bodies of the lower cervical vertebrae; therefore, it is inherently more prone to X-ray image distortion than the lower cervical vertebrae.

Yet, in the first case, in your letter dated 7-2-02 which was in response to Oncause’s pointing out the head-rotation error that was present in the published Orthospinology films, you argue that head rotation did not affect the analysis.

But then, in the second case, in your letter of #122 which was in response to Oncause’s pointing out the difference between the pre and the post in the published measured width of the lower cervical vertebrae in those same films, you argue that the difference in the measurement was because the lower cervical vertebrae were rotated.

I think you will have to admit that in the shadowy world of radiographic imagery, big ones distort more than little ones, especially when the big one is a lot bigger and not as round as the little ones.

And, while we are on the subject of the published Orthospinology films, it is obvious that there is a considerable difference in the tube angle at which the two films were shot. In the case of the Pre, even though the film was shot with the tube much too high, the posterior arch can, with difficulty, be seen. If the shadow of the posterior arch does not overlay the lateral masses, it has been projected much too high. In this case it is projected above the superior margins of the lateral masses, which indicates, as mentioned above, that the tube was way too high. However, it can be seen. But the Post film is a different story. If you will observe the right orbit in the Pre film and compare it to the right orbit in the Post film, you will see that the vertical dimension of the orbit in the Post has been significantly decreased – "squeezed down" because of even a higher tube angle. This indicates not only that the two films were shot at such significantly different angles that they would not be suitable for Pre and Post comparison, but also that, since the Pre film was shot at a questionable tube angle, the Post film would not be a valid, analyzable film.

Dr. R., try as you might -- you could even hire an entire shift of coal miners to work at making those two published films look like accurate cervical work -- I just don’t think it would come to pass.

Letter #123:
Thank you for putting this site up. I have practiced Nucca for 2 years. I just bought an AO instrument. I love this work. It has helped me tremendously. I just find that no one person in NUCCA does same thing. They say they are but they are artists. They all have their spin on things. I haven't mastered my game yet. That is why I bought the AO instrument. But I haven't been very successful with that. I am ready to quit all of this stuff and do F/S. So many people out there doing that help people and have fun. I am exhausted. I have been around all the greats doing this work but it is so inconsistent work.
Thank you for your time.
Dr. S.__________, State unknown

Reply oncause to letter #123:
Dear Dr. S.,
First of all, sorry we haven’t got back to you sooner. As we mentioned in our E-mail to you, your letter just slipped through the cracks.

What you are describing is nothing new. It would fit perfectly as a description of Grostic work in the 50’s and 60’s. I suspect that Grostic, enforcing the requirements that he initiated for attending the advanced and the "May classes", exerted a tighter control than you have experienced with NUCCA. What seemed to bug him most was the numbers of "Grostic practitioners" who used "full spine" in their offices, but who, when they came to Ann Arbor, claimed to be pure UC practitioners. DCs went to such great lengths to deny that they used other techniques in their offices when it was common knowledge that they did, that, to me, it just became entertaining. Grostic was extremely unforgiving on that point – the point of mixing other techniques in with his UC work – but the bar seems, by some type of collective osmosis, to have been lowered now.

At that time, in the 60’s, my practice was growing so fast that I had trouble finding the physical energy to keep up with it; and I always found it difficult to understand why DCs added other techniques to their work. Like everyone else, I had a lot to learn (still do), but the really big practices that I observed and then studied and learned from were all strictly UC practices.

What has happened? I don’t know. It seems as though the conceptual basis for UC work is just not being taught anywhere. We got a good dose of it at P.S.C. in the 50’s. Obviously, it didn’t stick to a lot of the graduates, but it was there if you were truly interested and knew what you really wanted to be and what you really wanted to do with your life.

I’m sorry I can’t give you any more than this. To some extent, that’s what Oncause is about. We are trying to pass it out in dollops, because, as I have learned over the four plus decades that I have been in practice, if we passed it out in heaping spoonfuls, it would make most DCs uncomfortable and we would lose readers by the thousands.

Speaking of fun: two of my favorite hobbies are skin-diving and bowhunting. They are both fun, but neither is nearly as much fun as locating interference, removing it and getting sick people well.

Letter #122:
Dr. M, Thank you for your response. As you may know we test for INTER examiner reliability as well and our result for this are published also: Inter and Intra - Examiner Reliability of the Upper Cerviical X-Ray Marking System: A Third and Expanded Look. Chiropr Res J, 1994; 3(1):23-31

Looking at page 30 we see that the average standard deviation for the Lower Angle measurement for INTER examiner reliability is .80 degrees. What this means is that the probability is 67% that a measurement of the Lower Angle will be between + .80 degrees due to marking error. If you want a 95% confidence you simply double the .80 degrees to 1.6 degrees +. What science says about the measurement of the Lower Angle is that a post x-ray that shows more than 1.6 degrees of change in the LA measurement has a 95% probability of NOT being from measurement error.

Now compare that to the lower angle measurement shown in the Orthospinology article of R 19 degrees pre and R 1 degree post demonstrating an 18 degree change in lower angle, well science will conclude with very nearly 100% certainty that a change of that magnitude did NOT come from marking error.

With that said let me address your pointing out a potential error in marking of the lower angle in the Orthospinology article.

Oncause Said: Reply oncause to letter #117: "Sounds like an impressive drill, Dr. R.; and according to your claims, it should lead to a high level of "intra examiner reliability" - uniformity when the X-ray analysis of one doctor is compared to the X-ray analysis of another doctor. But, how about "inter examiner reliability - where a doctor's measurements in one film are compared to his own measurements in another film (same measurments - same view)?

As I pointed out in the Oncause posting of letter #109, regarding the Pre and Post Orthospinology films by Dr. Eriksen published in the March/April 2002 issue of Today's Chiropractic.

On the illustrations that you see in the magazine, if you will measure the width of the lines that demark the width of the lower cervicals on the Pre film, you will see that the lower cervicals measure 13mm, and on the post film they conservatively measure 16mm - an increase in the width of the lower cervicals by 3mm on the shrunken down magazine illustration. Keeping in mind that the originals were 10 x12 films that had been shrunken down in the illustration by a factor of 3, the lower cervicals have gained 9mm in anatomical width from the Pre to the Post."

Dr R continues: This is a very good observation on your part and some of it may be marking error, but let me propose how your description above could occur. First of all this is an extreme case an not representative of the average case. Due to the large size of the misalignment of the upper cervical components, the lower cervical spine has to laterally flex. From spinal biomechanics we know that rotation of the lower cervical spine is a coupled response with lateral flexion. The lower cervical vertebra are significantly rotated on the PRE film due to the large misalignment components in the upper cervical spine but are much less rotated in the POST film. One, if thinking 3 dimensionally would EXPECT the Pre lower cervical width to be smaller than the Post lower cervical width if the film are marked accurately through identical structures.

We see that your excellent observation of the width being narrower on the PRE than the Post does not indicate an error in measurement as you have pointed out, but in fact argues that the film are marked VERY ACCURATELY. Thank you for pointing that potential error in measurement to your readers, but shame on you for not using CRITICAL THINKING analysis for discovering the real reason for the change.
Cordially,
Dr. R.__________, Georgia

Reply oncause to letter #122:

Dear Dr. R.,
Okay, lets talk some more about the Orthospinology films published in Today’s Chiropractic March/April 2002 issue:

In a previous entry #109, I mentioned the obvious head-rotation – the difference between the Pre film and the Post film that would make a difference in the laterality measurement.

And here is your response from letter #115:
"5. The problem that I have with your comment is that you insinuated that the left laterality on the X-rays in the Orthospinology article (March/April 2002) [oncause question #109] was due to right image rotation and that is NOT correct. You see the central skull line does favor a left laterality if you ONLY look at the central skull line. The plane line of the atlas is also affected by right image rotation and to a GREATER degree than the central skull line and favors a Right Laterality. Right Image rotation cause [sic] the Central Skull line [to] tilt to the left, (as your quote correctly points out), But the plane line rises on the right at an equal or quicker rate and right image rotation remaining on the nasium film, if large enough, with [sic] create a "Right Laterality" not a Left Laterality as you has [sic] mistakenly indicted (and published for all to see with the potential to perpetuate non factual information). The last time I checked it takes the central skull line and the atlas plane line to determine atlas laterality."

First of all, a portion of what you say is not quite true. I didn’t insinuate that left laterality in the films in question was due to right head-rotation. I said that right head-rotation will cause the false perception of a greater left laterality than actually exists, and that, since there is less head-rotation in the Post film than there is in the Pre film, part of the assumed laterality reduction was due to an X-ray placement error – the difference in head-rotation between the Pre and Post films.

And I did, in a subsequent entry #109, regarding the same films, point out the difference between the Pre and the Post in the measured width of the lower cervical vertebrae.

But for now, let’s forget about the lower cervical measurement and stick to our original exchange regarding the head-rotation factor.

In your response, (which we reproduced above) you repeatedly refer to the atlas plane line changing as the result of head-rotation in the film, and because of that, I have the impression that you are considering the atlas plane line factor and atlas laterality to be one-and-the-same.

Is this your meaning?

If I have misinterpreted your meaning, I stand corrected, even contrite (at least momentarily).

Please clarify so we can go on with our dialogue.
Thanks!

Letter #121:
It seems like whenever you discuss practice building questions you do so in vague terms. I am not complaining, but I would like a little more meat with my potatoes if you don't mind. I enjoy your web site and find its content valuable, but I am sure you could help me with nuts and bolts of practice building.
Dr. A.__________, CA

Reply oncause to letter #121:
Not to worry. Our next publication will be devoted to answering practice building questions. We got a bit behind with the web site the last few weeks. One of our doctors, the one who manages the computer nuts and bolts was lounging around in Kauai for a week snorkeling and fly fishing, thus we have some catching up to do.

Quote from A.D. Speransky, "A basis for the theory of medicine."
"Morphological changes in nerve cells are delayed in comparison with functional changes."