Atlas Alignment - What does the Science Say?

Posted in Chiropractic Did You Know? on Mar 21, 2022

According to a recent research report, the alignment of the upper cervical spine following surgery does not have any significant impact on clinical outcomes.

In other words, science says that atlas alignment isn’t really that important.


Request Appointment

Okay, now let’s back the truck up here. This article is going to be much more casual, and probably more tongue-in-cheek than I usually write. It is because I want to showcase this particular article to raise a few very important points on the difference between the medical and the Blair chiropractic perspectives on the importance of atlas alignment. Because in this particular article, the researchers describe their findings as if atlas alignment does not really matter. However, as a Blair upper cervical specific chiropractor, I read this paper and find that this is the exact line of thinking that causes so many people with genuine problems with atlas alignment to suffer needlessly:

  • Headaches and migraines
  • Dizziness and vertigo
  • Chronic fatigue and fibromyalgia
  • Brain fog and concussion
  • Multiple sclerosis and neuralgia

I also want to showcase how using the word “science” as a noun (as in, “The science says …”) is a tragic mistake used by people who do not understand science. Science is a verb. It is a process of discovery. It is a methodology. And it is possible for two different groups with two different perspectives to look at the same data but from different perspectives, and thus reach different conclusions. And any time you may hear the phrase, “The science is settled,” I think you may want to find a new source of information.

Related article

The FREE Life Hack to Sit Up Straight

The FREE Life Hack to Sit Up Straight

Feb 02, 2017

Atlas Alignment - A Medical Perspective

Let’s review this study. They had a bunch of people requiring surgery for a disc replacement in the lower neck. So, they had a significant degree of degenerative arthritis, and it had gotten to the point where surgery was really the only option. We don’t disagree with them here.

So they wanted to know if the alignment of the upper joints in the neck - the atlas (C1 vertebra) and axis (C2 vertebra) - could have been a precipitating factor that lead to the generative damage in the lower neck. So what did they measure? Well, lots of things: 

  • The plane of the base of the skull relative to the horizontal plane
  • C1 tilt relative to the horizontal plane
  • C2 tilt relative to the horizontal plane
  • The plane of C1 relative to the base of the skull
  • The plane of C1 relative to C2
  • The plane of C2 relative to the base of the skull
  • The arc of the neck as a whole
  • The arc of the upper neck
  • The arc of the lower neck 

And so forth. And what they found was that pre-and post-surgery there were no statistically significant changes. As a result, the researchers concluded that there is “no clinically significant relationship between upper cervical and subaxial cervical alignment.” Without a deeper dive into the numbers or the perspective that I have as a Blair upper cervical chiropractor, it would be easy for me to jump to a false conclusion that atlas alignment does not have anything to do with damage to the lower neck or any other symptoms or clinically relevant findings.

However, there are a few logical flaws that I should like to point out in this article. It is not to say that the research is all bad, mind you. It is simply to point out that just because “the science” shows something does not necessarily mean it is true.

Related article

What is Atlanto-axial Instability?

What is Atlanto-axial Instability?

Jul 23, 2021

Atlas Alignment - An Upper Cervical Chiropractor’s Perspective

First, let me point out that all of the measurements that the researchers used to study atlas alignment are stock standard angles. They are measurements of the characteristics of vertebrae as a whole. However, these angles are not direct measurements of the actual joints between any of the vertebra, which is where the actual unit of motion occurs in the neck. And the orientation of these joint surfaces for atlas misalignment is completely different in every single human being.

Although we are all cut from the same general mould, the build of our individual bodies makes subtle modifications as we grow up, which means that our architecture is different not only on the outside but also on the frame on the inside. Therefore, when you want to really understand atlas alignment and the other alignment of the vertebra in the spine, the most accurate place to measure these differences is at the level of the individual articulations.

And in order to do this, it requires a more in-depth series of images that are customised for your unique bone structure. The researchers in this study did not do that. As a result, I have serious concerns that there may have been an abundance of atlas misalignment issues that were never properly identified.

In our own upper cervical chiropractic practice, we frequently see cases who have been to an abundance of medical doctors, specialists, and even other chiropractors who are convinced that there is something wrong with their atlas alignment … but they just can’t quite put their finger on it.

The difference we often find is that when you take customised types of diagnostic images, that allows you to see the atlas alignment and realise that you need to change the angle of your treatment in order to make the difference. (I’d like to say that there is some magic in what we do, but really it is simply making a minor tweak.” 

Related article

What is the Altas Body Alignment?

What is the Altas Body Alignment?

Oct 17, 2019

Atlas Alignment - Symptoms are Variable

The other issue with this particular study that we have is the false belief that atlas alignment or an atlas misalignment always causes immediate symptoms or pain in the neck. This is not true.  We have written many times that when we are dealing with major injuries just as fractures or dislocations, yes, you’re going to have pain! However, when you have small yet significant injuries such as partial joint misalignments and entrapment as we see in upper cervical chiropractic practice, these types of injuries take time to amass.

Think of it as a snowflake on the top of a mountain. A single snowflake is a small thing. However, if you add momentum to that snowflake, a small slip at the top can gather great speed and cause great damage as it accelerates as an avalanche towards the bottom of the mountain.  Similarly, a small offset in your joint alignment - much smaller than the researchers considered here - may not cause immediate pain. However, if this type of problem may go uncorrected for a prolonged period of time - months, years, or even decades - it can show up seemingly out of the blue!

And it is not because it is a new problem per se. It is simply that the problem has accelerated long enough that it now comes to your conscious attention. Similarly, it frequently takes time to undo the damage and even undo the symptoms associated with atlas alignment. Plus, they are highly variable, 

At the beginning of this article, we mentioned several symptoms ms including headaches, vertigo, dizziness, chronic fatigue, facial and occipital neuralgia, which are all associated with an atlas alignment problem. However, because each individual’s neurology is also slightly different, there is not a direct link between A and B in the body. 

Unfortunately, this is still very much the way that medical science views disease in the body. And until they make the change in order to view conditions and disease from a different perspective, there will remain a huge percentage of people who suffer needlessly, if only they would realise that the source of all healing resides within you. It is simply that it needs the opportunity to express itself.

Related article

Do You Know the Story of the First Chiropractic Adjustment?

Do You Know the Story of the First Chiropractic Adjustment?

Sep 18, 2018

Atlas Alignment - Chiropractor, North Lakes, Brisbane

At Atlas Health Australia, our focus is on helping people with health conditions related to their atlas alignment that can show up in any number of ways: migraines, dizziness, vertigo, neuralgia, fibromyalgia, and other neurological conditions.  We believe that it is the innate wisdom, the source of life and health that resides within your body that allows you to heal. It is simply that when we suffer physical injuries that affect the alignment of the top vertebrae in our spine that it disrupts the normal healing flow between the brain and the body.

In this way, upper cervical care or atlas alignment is not a treatment for any particular disease, but a natural approach to healing and wellbeing that restores the normal flow, and allows those healing impulses to work the way that your system is designed. Our principal, Dr. Jeffrey Hannah, is a Blair upper cervical specific chiropractor with over 15 years of experience in treating people with disorders of the atlas and upper neck. He is a published author, international lecturer, and recognised leader in the field of upper cervical-specific chiropractic care.

For more information and to schedule an appointment to consult with Dr Hannah to find out if the Blair upper cervical atlas alignment technique may be right for you, click the Contact Us link on this page, or call us at 07 3188 9329.


Bogduk N. The cervical-cranial connection. J Manipulative Physiol Ther. 1992;15(1):67-70.

Related article

Why is Resting so Important Post Chiropractic Adjustment?

Why is Resting so Important Post Chiropractic Adjustment?

Aug 29, 2016

Damadian RV, Chu D. The possible role of cranio-cervical trauma and abnormal CSF hydrodynamics in the genesis of multiple sclerosis. Physiol Chem Phys Med NMR. 2011;41:1-17.

Eriksen K. Upper Cervical Subluxation Complex: a review of the chiropractic and medical literature. Lippincott, Williams, and Wilkins. Baltimore (MD). 2004.

Flanagan MF. The Downside of Upright Posture. Two Harbors Press, 2010.

Flanagan MF. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International, 2015; Article ID 794829: 

Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).

Vernon H.The cranio-cervical syndrome. London, Butterworth-Heinemann, 2001. Cramer GD, Fournier J, Henderson C. Degenerative changes of the articular processes following spinal fixation. J Chiro Educ 2002;1:7-8. 

Related article

Upper Cervical Treatment

Upper Cervical Treatment

Jul 25, 2022

Cramer GD, Henderson CN, Little JW, Daley C, Grieve TJ. Zygapophyseal joint adhesions after induced hypomobility. J Manipulative Physiol Ther 2010;33(7):508-18. 

Cramer GD, Fournier JT, Henderson CN, Wolcott CC. Degenerative changes following spinal fixation in a small animal model. J Manipulative Physiol Ther 2004;27(3):141-54.

Lambrechts MJ, Maryan K, Whitman W, et al. Comorbidities associated with cervical spine degenerative disc disease. J Orthop. 2021;26:98-102. Published 2021 Jul 16. doi:10.1016/j.jor.2021.07.008. 

Taylor DN. A theoretical basis for maintenance spinal manipulative therapy for the chiropractic profession. J of Chiropr Humanities (2011) 18, 74–85.

Divi SN, Karamian BA, Canseco JA, et al. The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion [published online ahead of print, 2022 Mar 16]. Clin Spine Surg. 2022;10.1097/BSD.0000000000001310. doi:10.1097/BSD.0000000000001310.

Leave a comment