Koch Functional Chiropractic: A Whole Body, Instrument Assisted Approach to The Dynamic Correction of The Cervical and Thoracic Spine

by William H. Koch, DC

During over 50 years of chiropractic practice, my technique approach has evolved, advanced and been refined.?I now consider my Koch Functional Chiropractic Protocols to be at the forefront of 21st Century Chiropractic Technique. The results I get are phenomenal.?Faster, more complete and long lasting than most imagine possible.

In previous articles I wrote extensively about establishing pelvic balance as a prerequisite to all spinal corrections. I now turn my attention to the cervical and thoracic spine, their unique functional anatomy and the techniques I have found most effective for their correction.

Much of the chiropractic profession is still rooted in the concepts and technology of the early to mid-twentieth century.?But we are now twenty years into the twenty first century!?While our philosophy is engraved in stone and is as valid and relevant as it was in 1895, our science, art and technology have evolved, grown and developed.

The idea of the vertebral subluxation as being a single bone out of place putting pressure on a nerve is a gross oversimplification. Subluxation is much more complex than that, with ramifications that affect the entire body.

Each region of the spine and pelvis plays a unique role in the bio-mechanics and neurology of the body. In order to be maximally effective in our chiropractic corrections, we must have the understanding of how each segment functions individually and as part an integrated, interrelated, complex mechanical system.?Very simply, we must understand how something works before we can fix it. This understanding is vital to the development of the technology that will allow us to make the whole-body structural corrections that both we and our patients want.?

Each regional component of the spinal subluxation complex requires a specific adjusting technique.?Each adjustment should be done in anticipation of how it will affect the entire spine, not just the point of contact.

?The chiropractor should plan multiple moves ahead, visualizing the spine like a chess master visualizes the chess board and the consequences of each move he makes. In order to be truly effective, we must have a clear picture in our mind’s eye of the correction to be made and carefully calculate the sequence of adjustments needed to accomplish it.

Basic Bio-mechanics of the Cervical and Thoracic Spine

It is important to realize that there is a difference between the anatomical and the functional cervical and thoracic regions of the spine.

?This is best explained by The Pettibon Spinal Model which describes the spine as having six interactive groups of vertebrae known as spinal motor units. Each of the six grouped vertebrae function as a unit in relationship to the others.

The six spinal motor units are:

1.????Skull and C1/Atlas

2.????C2-C5

3.????C6-T2

4.????T3-T7

5.????T8-L2

6.????L3-S1

The cranial-cervical complex is at the top of the neurological and bio-mechanical hierarchy. While the anatomical cervical spine consists of C1-C7 vertebrae, the functional cervical spine consists of spinal units 1 and 2 that is the skull and atlas and C2-C5, the fifth cervical being at the apex of the normal cervical lordotic curve.

The functional thoracic spine begins at the sixth cervical vertebrae and extends down to the second lumbar vertebrae, the apex of the normal lumbar lordotic curve.

The apices of the cervical and lumbar lordosis are pivot points or fulcrums that are critical to spinal motion and shock absorption, providing mechanical advantage for the musculature to work with maximum efficiency and minimal energy expenditure.

Understanding the functional relationship between the cervical and thoracic spine is the key to effective correction of the cervical component of the subluxation complex.

The thoracic region, which includes the T spine, the attached rib cage and the organs within (the heart, lungs and liver) makes up approximately 60% of the mass of the body. ?It’s sheer size and weight make the thoracic region the functional base against which the cranial-cervical and lumbar-pelvic motor units work. This was discovered in the early days of the NASA space program as the astronauts were observed moving about in a weightless environment.

NASA scientists observed this thoracic region as the stable base connecting the balancing and counterbalancing mechanisms of the cranial-cervical and lumbar-pelvic opposing gimbals.??Under the influence of earth’s gravity, these complex coupled joints are critical to our neurological self-righting reflex which allows us to walk upright with balance, strength and agility.

It is this same system of gimbals that allows us to compensate for spinal imbalances caused by subluxation and decompensate when subluxations are corrected by good chiropractic adjustments.

The engineering of the thoracic region of the spine is unique because it is designed to deflect direct force away from the core of the body in order to protect the vital organs from injury.??Because of this design characteristic, the thoracic spine repels and dissipates the posterior to anterior adjustments that are commonly used by many chiropractors.??Although well intended, P-A adjustments in the thoracic spine are not only ineffective and bio-mechanically incorrect, they can, and often do, radiate forces into the lower cervical and upper lumbar pivotal vertebrae adversely affecting their alignment by a whiplash like action.?This kind of unintended consequence only serves to complicate treatment.

The adjustment of the thoracic spine is an important component of a complete spinal correction, but it must be done in a way that the body can accept rather than reject.

Successful bio-mechanically correct adjustments of the T spine are done A-P with the patient supine or standing. The force is directed up the plane of the ribs and toward a fulcrum provided by the doctor’s hand placed at the point of the spine where a sheer force or movement is desired.?This thrust is applied at the bottom of the patient’s expiration for the best result.?

There is however another technique approach that is easier on the doctor and the patient.?I will discuss that alternative which utilizes the hand held VibraCussor and ArthroStim instruments later in this article.

The thoracic spine is the least mobile region of the spine due to the attachment of the twelve pairs of ribs to the vertebrae posteriorly and the sternum, via the costal cartilages anteriorly.?The greatest freedom of movement is the flexion and extension which occurs in conjunction with the expansion and contraction of the rib cage during the respiratory cycle of inhalation and expiration. ?This same cycle of physiological movement is an integral part of the primary sacral respiratory motion which propels the cerebrospinal fluid up, down and around the spinal cord and brain.?That makes the movement of the thoracic spine doubly critical to life and health.

Fixation is the primary thoracic spinal malfunction.?It occurs in response to lumbar misalignment and pelvic imbalance from below and cranial-cervical misalignment from above. Thoracic fixation not only inhibits the fullness of the breathing cycle, it also prevents the normal, smooth and free interaction between the cranial-cervical and lumbar-pelvic gimbals.?The consequence of this is loss of overall spinal motion, resiliency and shock absorption.?Very importantly, it also creates a resistance to the correction of the subluxation components above and below it.

This makes the mobilization to the thoracic spine critical to the corrective process!?When we fail to integrate the mobilization of the thoracic spine with our adjustments of the other areas of the spine, those corrections are doomed to fail. Therein lies one of the chief complaints among chiropractic patients: “adjustments do not hold,” necessitating a seemingly endless series of office visits for readjustment. When adjustments do not hold it frustrates and discourages patients, creating conflict between the doctor, the patient and insurance companies.

The obvious solution is better adjustments that hold!

It is important to first understand the basic physics of the subluxation complex which is expressed by this simple equation:?The degree of spinal misalignment X the degree of resistance holding it = the work force needed to correct it.?Therefore, the reduction of the resistance component is the logical first step toward effective, lasting subluxation correction.

Most chiropractors recognize the importance of “loosening up the spine” in preparation for an adjustment by reducing muscle spasms. Typically, they use such things as hot packs and massage or one of a number of electronic modalities, all of which are marginally effective, providing only temporary relief at best.

The reduction of subluxation resistance is best accomplished by the restoration of intersegmental spinal motion that had been locked by muscle splinting and guarding directed by the motor cortex.??This is a normal defensive sensory-motor reaction caused by the firing of joint and muscle mechanoceptors when they detect tissue stress, injury and inflammation. ?

Much of the chronic pain and restricted spinal and extremity motion we see in our patients is the result of the continued firing of the mechanoceptors long after the guarding and splinting spasms are needed to protect an injured area.?

The exciting news is that advanced adjusting techniques using the ArthroStim and VibraCussor instruments by Impac Inc. allow us to reset the mechanoceptors which send updated status reports to the brain. The brain then revises its map. The ability of the brain to reprogram and revise its mapping of the body is known as neuroplasticity.?When the brain map no longer includes report of an injury, muscle splinting is not needed, spasm is eliminated as is resistance to subluxation correction. The body may now freely accept adjustments and allow them to “hold.”

Twenty first century chiropractic instrument adjusting techniques allow us to utilize the somatosensory and motor functions of the body and nervous system to orchestrate structural corrections better, faster, more comfortably and with longer lasting results than was possible with conventional manual adjusting techniques.

The most serious and stubborn resistance to cervical correction is in the upper thoracic segments T1-T4. This block of vertebrae is the least movable in the spine. ?T1 being the least movable.?T1 is the posterior anchor point for the cervical erector muscles and the supraspinous ligament which is a continuation of the ligamentum nuchae which attaches to the external occipital protuberance( EOP) of the skull and the spinous processes of the cervicals and continues inferiorly attaching to the spinous process of all vertebrae ?thoracic and lumbar vertebrae ultimately attaching to the posterior sacral tubercles and blends into the neighboring fascia.

The significance of this is that T1 and the spine inferior to it is under constant stress when we are engaged in any activity in which the head is down and the neck is in forward flexion.?That means almost everyone spends much of their day with their spine under excess tension.?The position called “Tech Neck” is the best example as the posture assumed while using electronic devices (computers phones and tablets). The result is the chronic anterior head translation that so many people have.?This is the reason so many people now suffer from neck, upper back and shoulder tension and pain, headaches and cervical/brachial radiculopathies.?This chronic anterior translation of the head causes an accelerated development of degenerative joint disease and disc narrowing at C5/C6 as well as the dreaded Dowager’s hump that so many women and some men develop.

The combination of anterior head translation and thoracic fixation can inhibit the breathing mechanisms, causing up to a 30% reduction of vital lung capacity. In fact, it has been my experience with several of my patients who had been diagnosed with COPD and required oxygen concentrators to maintain blood oxygen levels, that after successful reduction of anterior head translation and thoracic fixation, they were able to breathe well and maintain blood oxygenation without the concentrator.

There are also several important mechanisms of neurological stress that are caused by subluxation of the skull - atlas and C2-C5 motor units relative to the upper thoracic C6-T7 motor unit. It is important that every D.C. fully appreciate and understand these nerve pressure and tension applying mechanisms and the steps necessary to reduce them.

The benefits of restoring motion to a previously misaligned and fixated spine are tremendous. Among the mechanoceptors we are resetting with the ArthroStim instrument are the Type 1,2 and 3. Besides providing the sensory cortex with a cascade of new information, causing it to create a revised brain map or picture of the body, the type 4 nociceptive pain and alarm related mechanoceptors are inhibited.

Because pain and other nociceptive input to the brain triggers the sympathetic portion of the autonomic nervous system, reduction of the nociceptive input suppresses the sympathetic allowing the reestablishment of normal parasympathetic dominance.?In other words, it takes us out of “Fight- Flight” and back to “Rest-Relax.” ?Restoration of the normal autonomic nervous system balance is necessary to healing on every level.

Loss of the cervical lordotic curve is an almost universal spinal misalignment.?It has the effect of increasing spinal cord tension by as much as 24%.?The resulting extrusion of the dura can apply as much as 30 lbs. per sq. inches of pressure to the spinal cord. This excessive cord tension can pull the medulla and brain stem down too tightly against the floor of the cranium especially in the area of the foramen magnum.

Upper cervical subluxations involving the occiput, atlas and axis, put serious pressure on the brain stem which extends through the foramen magnum, ring of the atlas and down to the inferior aspect of the neural canal of the axis.

Most cervical subluxations have a rotational component.?Those which involve counter rotation between atlas and axis add a complicating factor and are usually associated with ligament and other soft tissue injury posing an additional challenge to the D.C.???

Few would argue that conventional chiropractic techniques are done mainly with the patient lying still in the prone position.?(I have heard several practice management consultants actually say that the only part of the chiropractor the patient should ever see after the first visit is his shoes, viewed through the face piece of a Hi Lo table.)?Let me say here and now that my views about patient care, practice management and technique are totally contrary to most of the practice management gurus.?If this is not already obvious, it soon will be.

In conventional chiropractic techniques the patient lies still on the adjusting table taking a passive role.?With Koch Functional Chiropractic Protocols, the patient plays an active role and is directed by the doctor through various movements of the spine and extremities during the corrections.?Active participation creates a dramatically different experience for the patient. They feel a greater connection when actively working with their doctor. And most importantly, patients experience an immediate improvement in body balance, strength and range of motion. Positive outcomes are then objectively confirmed via post correction muscle testing.

Rather than static spine-only adjusting of earlier chiropractic techniques, Koch Functional Chiropractic is an innovative, dynamic, whole body approach with an organized system of protocols representing much of the best of 21st century chiropractic.

Now that I have given you a new vision and the rationale behind this departure from traditional bone moving chiropractic, I will describe the actual adjusting techniques.

A 21st Century Approach to Thoracic and Cervical Corrections

I begin cervical corrections by mobilizing the thoracic spine to reduce fixations and normalize intersegmental motion. This is accomplished quickly and comfortably by using the VibraCussor and ArthroStim instruments by Impac, Inc.

With the patient seated on the adjusting table, the doctor contacts the sacral base with the soft padded VibraCussor head.?The instrument is set on a medium frequency and the patient is instructed to rotate their head and neck through the complete right and left rotatory range of motion. ?It takes only a few moments before both doctor and patient notice a definite improvement in that range of motion.?

Next, while the doctor continues to percuss the sacral base, the patient is instructed to exhale fully as they bend forward at the waist with the head and neck in flexion.?They are then told to inhale as they move from flexion to full spinal extension. This is repeated 2 to 3 times while the doctor continues to percuss the sacral base.

This simple, comfortable and non-threatening procedure is remarkably effective at releasing fixations throughout the spine and can be used even on frail, timid or frightened patients.

The procedure works by utilizing the engineering design of the spine in which the 24 vertebrae decrease in size and density from L5 to the Atlas.?When the wave of percussive energy is introduced into the sacral base, it radiates up the spine, amplifying and accelerating as the vertebrae reduce in size. The combined cervical rotation and spinal flexion/extension motion with respiration in conjunction with the action of the VibraCussor is highly effective in reducing spinal fixation and increasing intersegmental motion.

?Then the doctor switches to the ArthroStim instrument, fitted with a bifurcated gliding sleeve. With the instrument set at its maximum 12 toggle-recoils per second, the doctor glides the ArthroStim instrument from L5 through the upper cervical spine using a gentle level of pressure that is comfortable to the patient. After one or two passes of the instrument, again ask the patient to flex and extend their cervical spine through the complete range of motion while you continue to glide the ArthroStim from the upper thoracis through the top of the cervical spine. Because T1 is strategically important to the corrective process due to the extreme fixation that occurs here, it is beneficial to spend some extra time at this segment.?

Also, because there is often rotation of T1 (as in a Gonstead PLS or PRS listing) the ArthroStim can be used to adjust it accordingly using the appropriate line of drive.

To the casual observer this procedure might appear to be using the ArthroStim to “jackhammer” the bones into place.?Nothing could be further from the truth. The objective is not to move vertebrae in the traditional sense.

The aberrant afferent input is, instead, a resetting of the joint mechanoceptors which send a cascade of updated, revised information to the sensory cortex, resulting in a revised brain map that reflects a correcting, rather than a subluxated spine.?This information is relayed to the motor cortex which facilitates the correction.?This is 21st Century Chiropractic!

At this point the doctor should palpate the cervical spine to check for any remaining subluxations. The good news is that if we have established a solid, stable pelvic foundation and adequately mobilized the spine, the powerful self-righting reflex will already have begun to de-compensate and disengage, making any cervical subluxations easier to correct. The body will welcome rather than resist the adjustment.

Specific Instrument Assisted Cervical Corrective Procedure

After T1 correction, what remains will usually be some combination of Occipital, Atlas and Axis misalignments.?In most cases there will be a left or right rotation of 2C (as in Gonstead PLS or PRS listing).

My preferred technique for these cervical corrections (Atlas and Axis) is using the ArthroStim instrument fitted with a single round (ball tip) or small straight flat tipped adjusting sleeve.?

In the case of a 2C PRS, the procedure would be as follows:?The patient is instructed to first turn their head as far as is comfortable to the left and then to slowly turn from left to right against resistance provided by the doctor as he applies adjusting thrusts with the instrument in a P to A and right to left line of drive at the right lamina pedicle junction of 2C. This process can be repeated up to 3 times.?Reverse procedure for 2CPLS.

If the doctor decides that the Atlas needs to be adjusted, it can be done with the ArthroStim using the small straight sleeve.?Position the tip of the instrument on the transverse process of the Atlas, direct the line of drive as appropriate to move the Atlas either A to P or P to A (ASRA, ASRP, ASLA or ASLP).

If head tilt or upper cervical fixation persist, a manual occipital adjustment is indicated.?I do this as an occipital lift which incorporates cervical decompression, slight rotation and a scooping motion.?This is a very technique intensive adjustment requiring training and practice to bring all three force components together at a precise instant.?This adjustment has the greatest potential to relieve the most serious brain stem or spinal cord pressure.?Learning and perfecting this adjustment is worth any effort it takes.

Chiropractic is a thinking persons profession. The Master Chiropractor learns to think three dimensionally and strategically, like the aforementioned chess master.?Always consider the patient holistically and functionally, evaluating, balancing and tuning up the entire body. ?Have a plan and systematic approach. Think ahead. Visualize what you want to achieve and how you will do it. Think three dimensionally. Observe your objective indicators before and after each adjustment. They will help both you and the patient know when you have achieved a desired result.?And always record what you do in detail. Not only will this put you in a very strong medical-legal position to justify your treatment protocols, it will also assist you greatly as you review pre and post treatment findings prior to beginning your next session.

This methodical and interactive approach to patient care and record keeping will pay off in ways you might not expect. It allows you to consistently provide the highest quality of individualized care for your patients and also gives the patients a very high level of confidence in and respect for you, their doctor.?And when they feel, as many of my patients have said, “this is the kind of care I have been looking for from a doctor,” they eagerly refer their friends and family members. Providing this kind of personalized, exceptional care is the best practice building tool you could hope for.

Some illustrations of technique below.

Adjusting Cervical Spine in motion with the ArthroStim Adjusting Instrument.

Mobilizing the Lumbar and Thoracic Spine

Dynamic Adjusting While Marching in Place. Especially useful for those who have difficulty getting onto table to sit or those who cannot lie face down.

Adjusting in Motion with Reciprocal Arm and Leg Movement.