What Is Upper Cervical Chiropractic?
How It Works and How It's Different
Upper cervical chiropractic is a specialized approach to chiropractic care that focuses on the top two bones of the neck: the atlas (C1) and axis (C2). These two vertebrae are responsible for much of the movement between your head and neck, and the surrounding muscles and joints provide important sensory information to your nervous system.
What makes upper cervical chiropractic different isn't simply where we adjust. It's how we evaluate the spine, how we decide when an adjustment is necessary, and the attention we give to the relationship between the upper neck and the rest of the body.
At Axia Chiropractic in Chattanooga, Tennessee, we see people who have often been dealing with persistent health challenges for years. Some come because of migraines, dizziness, neck pain, or other symptoms that have interrupted their lives. Others are trying to better understand their nervous system and why their bodies don't seem to adapt or recover the way they once did.
Many have already tried a lot of things.
My job isn't to assume the upper neck explains every problem. It's to investigate whether something important has been overlooked and help patients understand what we can do about it.
Why the Upper Cervical Spine Matters
The Atlas and Axis: Where Your Head Meets Your Neck
The atlas and axis are unlike any other vertebrae in your spine. The atlas supports the head, while the axis allows much of the rotational movement you use when looking over your shoulder. Together, they create remarkable mobility in a relatively small space.
They're also located at an important neurological junction, near the transition between the brainstem and spinal cord.
But when I explain why this region matters, I don't focus exclusively on what passes through it. I'm also interested in the information it sends.
Your brain is constantly trying to understand where your body is in space. It combines information from your eyes, your inner ears, and sensory receptors within your muscles and joints. That last part is called proprioception.
The upper cervical region plays a particularly important role in sensing the position and movement of your head. The brain uses this information to help coordinate posture, movement, and balance.
When the neck isn't functioning well, those sensory relationships may become relevant to certain symptoms. Researchers have investigated this connection in conditions such as cervicogenic dizziness, where neck dysfunction and problems with balance or spatial orientation may occur together.
This is one reason I believe the upper cervical spine deserves careful attention, particularly in patients with a history of neck injuries, recurring headaches, dizziness, or persistent muscular tension.
A Foundation, Not Just a Body Part
When I explain this to patients, I often compare the upper neck to the foundation of a house.
If something is off at the foundation, you may not notice the problem there at all. You see it somewhere else: a door that sticks or a crack in the drywall upstairs. You can patch the drywall every few months, but if the foundation keeps shifting, the crack keeps coming back.
Our bodies are more complicated than houses, of course, but the analogy helps explain the way I think.
Your posture, muscles, and nervous system are constantly working together. Sometimes the place where you feel a symptom isn't the only place worth investigating.
Rather than chase every place that hurts, I want to understand what may be contributing to the larger pattern.
What Does Upper Cervical Chiropractic Have to Do With the Nervous System?
The nervous system is involved in nearly everything your body does. It helps you move, maintain balance, interpret pain, regulate essential functions, respond to stress, and adapt to your environment.
When people talk about nervous system regulation, they're often referring to how well their bodies respond to demands and return toward a comfortable state afterward. That conversation frequently includes stress, sleep, recovery, and the autonomic nervous system, which helps regulate functions like heart rate and digestion.
Those are important topics, and they're part of how I think about whole-person health.
But there's another side to nervous system function that receives less attention: the constant flow of information between your body and brain.
Your muscles and joints are full of sensory receptors. Every time you turn your head, change position, or move across a room, your brain uses that information to coordinate what happens next.
The upper cervical spine contributes to this process through its relationship with head position, movement, and proprioception.
At Axia, that gives us a specific clinical question to investigate: Could dysfunction in the upper neck be contributing to the symptoms this person is experiencing?
For some patients, especially those with neck-related symptoms, that question is worth exploring. It also gives us a way to connect a broader interest in nervous system health with an actual examination and a specific plan of care.
Upper cervical chiropractic isn't a universal treatment for nervous system dysregulation, and an adjustment hasn't been established as a way to reset every aspect of autonomic function. But cervical function is part of the larger neurological picture, and addressing an appropriate cervical problem may be valuable for some patients.
Our clinical focus is specific. Our interest in the patient's health is much broader.
How Upper Cervical Chiropractic Is Different From Traditional Chiropractic Care
Most people picture a chiropractic visit as a series of adjustments up and down the spine.
Upper cervical care works differently. There are several techniques within the specialty, but they share an emphasis on the upper neck and on evaluating whether another adjustment is indicated.
At Axia, that means our examinations guide our decisions rather than following a routine of adjusting the same areas at every appointment.
Assessment Comes First
I think of every new patient a little like a mystery.
If someone has been dealing with migraines or dizziness for years and has already tried a lot of things, the answer probably isn't obvious. My job is to slow down, gather enough information, and avoid jumping to conclusions.
We begin by discussing what you're experiencing, when it started, what may have contributed, what you've already tried, and what you hope to get back to doing.
Then we examine the relevant clinical findings and determine whether upper cervical care makes sense.
One Focused Adjustment, Not a Bandaid
When an adjustment is appropriate, we focus on the upper cervical spine and use a planned direction of correction based on our examination and technique-specific analysis.
I don't believe more adjustments automatically mean better care.
The goal is to deliver an appropriate adjustment, evaluate the response, and make thoughtful decisions about what happens next.
When Not to Adjust
This surprises a lot of people.
In our office, there are plenty of visits where a patient isn't adjusted. We still perform an assessment, but we may decide another correction isn't indicated that day.
Within our upper cervical approach, we're interested in how well the patient is maintaining their response between visits, not simply how frequently we can intervene.
Sometimes the best decision is to let the body continue doing what it's doing.
The Toggle-Recoil Upper Cervical Adjustment
There are several upper cervical chiropractic techniques, and they differ mainly in how the neck is analyzed and how the adjustment is delivered.
I practice the Toggle-Recoil technique in the Knee-Chest position, which I trained in at Sherman College of Chiropractic in Spartanburg, South Carolina. I've continued developing my skills through postgraduate education and years of clinical experience.
The Knee-Chest name comes from the position of the patient during the adjustment. You're positioned on a specialized table, kneeling with your chest supported, while I carefully position the upper neck.
The adjustment uses what's called a toggle-recoil delivery: a very quick, focused input along a specific angle and direction determined through our upper cervical analysis.
It isn't the twisting or rotational neck adjustment many people picture when they think of chiropractic.
Most patients are surprised by how different it feels from what they expected. The adjustment itself is brief, and the planning that goes into it takes far longer than the procedure.
Afterward, patients rest in a zero-gravity chair before we repeat relevant examination procedures to evaluate their immediate response.
How We Evaluate the Upper Cervical Spine at Axia
Because the adjustment is so specific, the examination process matters tremendously to the way I practice.
Alongside a detailed history and physical examination, we use several tools to evaluate the upper cervical spine and inform our clinical decisions.
Paraspinal Thermography
We use a Titronics Tytron system to measure small temperature differences along the neck and spine.
In our upper cervical protocol, we're interested in patterns within these readings and how they change over time. We use them as one piece of information when considering whether an adjustment is indicated.
Thermography doesn't diagnose migraines, vertigo, or other diseases. The relationship between these temperature patterns and specific nervous system conditions also remains an area of research, so we don't interpret the readings as a complete picture of neurological health.
Their role in our office is to contribute to our broader assessment, alongside the patient's history and other findings.
Specialized Cervical X-Rays
When clinically appropriate, we use specialized cervical imaging, including views that help us examine the anatomy and movement of the upper neck.
I use the images for my own upper cervical analysis, which informs the direction and delivery of an adjustment within the Knee Chest technique.
I also send them to a DACBR, a board-certified chiropractic radiologist, for a formal radiological report.
That independent interpretation is important to me. It's another opportunity to evaluate the anatomy carefully and identify findings that may require additional attention.
Radiographs are one tool in clinical assessment; they don't independently establish the cause of a patient's migraines, dizziness, or other symptoms.
Posture, Movement, and Muscular Findings
We also look at posture, cervical range of motion, and relevant muscular patterns.
Together, these findings help us understand how someone is moving and how their symptoms relate to the examination.
I'm not looking for one number or test that explains everything. I'm looking for a pattern of findings that can guide an informed clinical decision.
Why I Practice This Way: Erin's Story
I didn't come to upper cervical care through a textbook. I came to it thanks to my wife.
While I was in chiropractic school, Erin was working for a general chiropractor. She had “normal” headaches migraines on and off for years and all of a sudden they became more frequent over the course of a year until she was having one about once a week.
They were debilitating. She couldn't drive or function. All she could do was lie in a dark, quiet room and wait for them to pass, and more than once I had to go pick her up because she couldn't get herself home.
She was receiving chiropractic care during that time, but her migraines continued to get worse.
A friend of mine in chiropractic school told us about upper cervical care and a doctor he had started seeing, Dr. Tony Giordani of the Upper Cervical Spine Center in Taylors, South Carolina.
Erin went to see him.
His approach was noticeably different. He performed a detailed upper cervical examination and developed a specific plan based on his findings.
Within a few weeks, her migraines had diminished significantly. Within six months, they were gone.
I can't say with certainty why she responded so differently, and her experience isn't a promise of what will happen for someone else. But watching it happen changed the direction of my career.
It shaped the kind of practice I wanted to build, one where testing comes first, the correction is specific, and the patient is given time to respond.
Dr. Tony has since become a close friend and mentor. Erin's experience remains one of the main reasons I'm so committed to this approach.
A Century of Upper Cervical Care and What Research Tells Us
Upper cervical chiropractic isn't a new approach.
Its modern development is closely associated with B.J. Palmer, who introduced his focused upper cervical Hole-in-Oneapproach in 1931. His work, including his clinical investigations and extensive development of upper cervical methods, helped establish a specialty that continues to be practiced, taught, and refined today.
Knee Chest toggle recoil is part of that historical tradition.
The science surrounding the cervical spine has also developed substantially. Researchers have explored its role in movement, proprioception, headaches, balance, and neck-related dizziness. These investigations help us understand why a relatively small region of the body can be clinically important.
There's also published research examining upper cervical chiropractic itself.
A 2011 prospective multicenter study followed 1,090 patients receiving upper cervical care and reported improvements in several patient-reported outcomes, including measures of pain and disability. Because the study didn't have a randomized comparison group, it couldn't establish how much improvement was directly attributable to the treatment.
A 2022 systematic review examining cervicogenic dizziness also found evidence that certain forms of cervical manual therapy can help reduce dizziness and related neck symptoms. This adds to our understanding of the cervical spine's potential role in balance disorders, although it doesn't establish the effectiveness of Knee Chest toggle recoil specifically.
Upper cervical chiropractic represents a smaller specialty within the profession. As with many specialized approaches in healthcare, the research examining individual techniques is narrower than the broader literature surrounding the region and the conditions involved.
That distinction is worth understanding without mistaking it for a lack of clinical history. Upper cervical chiropractic has been developed and practiced for generations. At the same time, further controlled research is valuable for establishing which approaches help which patients, how much benefit to expect, and what risks are involved.
In my own practice, I've worked with people experiencing longstanding migraines, headaches, dizziness, neck pain, and other persistent challenges. Some notice changes fairly quickly, while others take months to experience meaningful improvements.
We formally reevaluate patients every 12 visits, typically within one to three months depending on their care plan. We compare their experience with relevant examination findings and decide whether to continue, modify our approach, or recommend additional care.
I think clinical experience and scientific research should inform one another. Ultimately, the patient deserves more than a theory. They deserve thoughtful decisions and an honest assessment of their progress.
What Conditions Bring People to an Upper Cervical Chiropractor?
One of the most common misunderstandings about upper cervical chiropractic is that, because we focus on the upper neck, we only see people with neck problems.
At Axia, people come to us with a variety of concerns, including migraines and recurring headaches, vertigo and dizziness, TMJ and jaw pain, chronic neck discomfort, and symptoms following head or neck injuries.
These conditions have different causes, but some patients experience them alongside cervical dysfunction or other findings that make the neck worth evaluating.
Someone with dizziness, for example, may have an inner-ear problem, vestibular migraine, a cervical contribution, or another medical condition entirely. A patient with jaw pain may also need dental or TMJ-specific treatment.
That's why I value collaboration with other providers. I want to understand what part of the problem belongs within my expertise and what may require additional support.
We also see people who are particularly interested in nervous system health, often because they're experiencing chronic tension, poor recovery, or symptoms they associate with prolonged stress.
For those patients, upper cervical care may be one consideration within a broader conversation about sleep, activity, stress, health history, and the body's ability to function comfortably.
The objective isn't to make every concern into a chiropractic problem. It's to determine whether our particular approach may be useful.
Is Upper Cervical Chiropractic Safe?
Safety is one of the most common questions people ask about chiropractic care involving the neck, and it's a fair question.
The Knee Chest technique I use doesn't involve the large twisting or rotational movement commonly associated with some forms of cervical manipulation. The adjustment is delivered through a quick, focused toggle-recoil input.
That mechanical difference is meaningful when explaining the procedure, although it doesn't mean all potential risks are eliminated.
Published studies of upper cervical care have documented short-term reactions such as soreness, headache, or fatigue. These reactions are often mild, but patients should understand that they can occur.
Another question concerns cervical artery dissection, a rare but potentially serious vascular injury. Research examining the relationship between cervical manipulation and dissection continues to develop. Observational studies can help investigate associations, but they cannot establish that any neck procedure carries zero risk.
Part of our responsibility is to identify when someone needs a different approach. We review health history, examine for concerning findings, and determine whether further medical evaluation or referral is warranted before considering an adjustment.
If someone experiences sudden, severe or unusual head or neck pain, especially with new weakness, trouble speaking, double vision, loss of coordination, or other neurological symptoms, they should seek emergency medical attention.
My goal is to provide appropriate care, not to adjust someone simply because they've come to a chiropractor.
Frequently Asked Questions About Upper Cervical Chiropractic
Does an Upper Cervical Adjustment Hurt?
The Knee Chest adjustment is quick and focused, without the large rotational movement people often associate with chiropractic neck adjustments. The area may be tender, particularly when someone is already experiencing significant discomfort, and temporary soreness is possible afterward.
How Many Visits Will I Need?
That depends on your history, examination findings, and response to care. Some people notice changes early, while more complex or longstanding concerns may take longer. We perform formal progress examinations every 12 visits to evaluate how care is going and whether changes to the plan are appropriate.
Do I Need X-Rays?
Specialized cervical imaging is part of our upper cervical approach when clinically appropriate. We use the images to examine anatomy and inform our technique-specific analysis, and our films are reviewed by a board-certified chiropractic radiologist.
Will I Be Adjusted at Every Appointment?
No. Each visit includes an assessment, and we use our findings to decide whether another adjustment is indicated.
Can Upper Cervical Chiropractic Help With Nervous System Regulation?
The upper cervical spine contributes important sensory information that your brain uses for movement, posture, and balance. In patients with relevant cervical dysfunction, addressing the neck may be helpful for associated symptoms.
Nervous system regulation also involves sleep, stress, autonomic function, activity, and other health factors. An upper cervical adjustment hasn't been shown to universally reset those systems, so we evaluate the patient's particular concerns rather than promise a single solution for everyone.
Is Upper Cervical Chiropractic Only for Neck Pain?
No. Many people seek an upper cervical evaluation because of migraines, dizziness, headaches, or jaw problems, especially when those symptoms overlap with neck discomfort or previous injuries. We assess whether the cervical spine may be contributing and refer or co-manage when other causes need attention.
Could Upper Cervical Chiropractic Be the Right Next Step for You?
If you've been dealing with a health problem that hasn't resolved, especially if you feel like you've tried everything, I understand how discouraging that can become.
By the time many people reach our office, they've already invested considerable time and effort trying to get well. They aren't looking for another generic explanation. They're looking for someone willing to take their experience seriously and investigate what may have been missed.
That's what I want Axia to offer.
We begin with a conversation, learn your history, and evaluate whether our upper cervical approach may be appropriate for your situation.
If the findings point toward a problem we may be able to help with, we'll explain our recommendations. If something else needs attention, we'll help you understand the next step.
I believe health is worth the time, and I believe the right care begins with understanding the person in front of us.
Axia Chiropractic
315 N. Market St., Suite 107
Chattanooga, TN 37405
If you'd like to learn whether upper cervical chiropractic could be a good fit for you, reach out to our office to begin the conversation.
Upward in Health. Forward in Life.
References and Further Reading
Woodfield HC III, et al. Craniocervical chiropractic procedures — a précis of upper cervical chiropractic. Journal of the Canadian Chiropractic Association, 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4486989/
Eriksen K, Rochester RP, Hurwitz EL. Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study. BMC Musculoskeletal Disorders, 2011. https://doi.org/10.1186/1471-2474-12-219
De Vestel C, et al. Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness. Journal of Manual & Manipulative Therapy, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9487935/
About the Author
Dr. Chris Collins is the founder of Axia Chiropractic in Chattanooga, Tennessee, where he specializes in upper cervical chiropractic care. His clinical approach focuses on understanding the foundational factors that may contribute to persistent health challenges and helping patients build a healthier relationship with their bodies.
Beyond the clinic, Dr. Collins is a writer, speaker, and community advocate whose work explores nervous system health, human behavior, and the habits that help people thrive.
