Structural Diagnosis

The anatomy and biomechanics of the cervical spine result in five somatic dysfunctions.  The typical cervical segments (C3-C7) have non-neutral dysfunction with either a forward-bending or backward-bending restriction together with a coupled side-bending and rotation restriction to the same side (Type II motion).

At the atlantoaxial (C1-C2) junction, the primary somatic dysfunction is that of restriction of rotation to one side or the other.  While there may be minor forward/backward-bending and side-bending components to the rotational restriction, adequate treatment to the rotational restriction restores the minor movement motion simultaneously.

At the occipitoatlantal (C0-C1) junction, there are two dysfunctions possible.  There will either be forward-bending or backward-bending restriction with coupled side-bending and rotation to opposite side (Type I motion).

The structural diagnostic process starts by identifying levels of palpable deep muscle hypertonicity.  This identifies segments that need motion testing.  The diagnostic and the therapeutic processes seem to be most satisfactory by beginning from below and moving cephalad.

The bony landmark of most value in the typical cervical segment is the articular pillar.  They are palpated in the deep fascial groove between the semispinalis medially and the cervical longissimus laterally.  The paired examiner’s fingers can localize to the right and left articular pillars of any given cervical segment and introduce motion testing.

The typical cervical segment pillar is the size of the examiner’s finger pad.  The identification of the articular pillars begins by first identifying the spinous process of C2 and C7.  The C2 spinous process is the first bony prominence in the midline caudad to the external occipital protuberance (inion).  The spinous process of C7 (vertebra prominens) is the spinous process that remains palpable during cervical backward-bending.  The articular pillars of C2 and C7 are at the same level as the spinous processes.  Placing the examiner’s fingers between the pillars of C2 and C7 puts the finger pads in contact with with C3, C4, C5, and C6.  This provides the ability to localize to any specific cervical segment.  The structural diagnostic process can be performed in patients in both sitting and supine positions.

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