Nucca chiro working with MD'S

By Daniel C. Seemann, Ph.D.
Vol. 5. No. 5, May 1995

There are approximately 1,000 chiropractors in the USA who are upper cervical adjustors. Of this number, NUCCA has about 150 members who adjust the atlas. It is not clear how many adjust the atlas exclusively or use other modalities. The guess is there are maybe 75 members who are hard-core manual adjusters. This figure has not changed much over the past 25 years, even though the training has improved and there is a much greater pool of field doctors available. Perhaps the most puzzling: Why so few, when the NUCCA work is generally considered the most challenging and rewarding of all the systems in chiropractic. This article will examine some of the issues which might be contributing factors. ln talking to the membership, there are many hypotheses and it is always a topic at the seminars.

It is possible to classify NUCCA members by training and experience. The first level would include students, recent graduates, or interested field doctors (Basic). The next group is those taking the intermediate work which includes the basic biomechanics and adjusting (Intermediate). The third tier are experienced field doctors who want to stay current but are not interested in certification (Advanced). The last level are those who are seeking certification or are certified.

Ideally, a growth pyramid should be in place, whereby those at the lowest level of training and experience would act as the broad base for the organization. With each step of the hierarchy, the numbers would narrow. At the top of the pyramid would be the certified doctors. Currently there are 31 doctors, either certified or in the process.

The reverse is true for NUCCA; there are considerably more certified doctors than new people coming into the work. This is bad news for NUCCA, because it signals little growth for the organization in the next few years and worse, patients who would benefit from an atlas adjustment will be denied.

The most frequent answer to why there are so few NUCCA doctors is that the work is too difficult. The two major divisions to master are the analysis and the adjustment. Within each part, there are probably areas which are hard to comprehend, but learning the analysis seems easier than the adjustment. A recent study (1994) showed that a majority of a large group of NUCCA doctors reading a positive film (under less than ideal conditions) were within a half of one degree of the correct laterality. Twenty years ago that high degree of accuracy would not have been realized.  lt also supports the notion that maybe the training has also improved. Certainly, the level of understanding about the analysis has changed.

Learning the adjustment might be what makes NUCCA work so difficult to master. The analysis is more of a cerebral cognitive procedure. There is measurement, and the relationships are understood. The analysis is logical and rational. On the other hand, mastering the adjustment is an art form. It requires skill and precision. Each adjustor brings a unique posture into play. A certain amount of physical dexterity is required. So, not unlike an artist, there is an emotional component involved. The adjustor has to feel the feedback and has to know when the vertebra are moving. This skill develops with practice but takes longer to master than the analysis.

Teaching the adjustment is more difficult than the analysis because of the many variables cited above. The coach can explain how to shoot the basketball, but the final skill rests with the player. The same is true with the adjustor. The step-by-step phases teach how to adjust, but working on a coordinator at a seminar is different than working on a patient in the office. The post X-ray can be very frustrating, especially if the subluxation has not changed or increased. Two seminars per year cannot reduce the learning curve for adjusting. It can be a slow, difficult process, especially if the field doctor is alone or geographically isolated from his/her colleagues.

While there is agreement among the other upper cervical groups with the cervical analysis, the adjusting instrument has become popular outside of NUCCA. They would probably agree that the hand adjustment is more precise than instrument adjusting, but the time it takes to learn the instrument and get reductions is considerably less than it would take to learn the hand adjustment. This becomes attractive to new field doctors.

This may be why NUCCA is having difficulty in either attracting or retaining new people. Perhaps the bottom line here is that if a choice is to be made to learn the NUCCA work, the individual must know it is going to take time, sacrifices, and patience. If NUCCA had a residency program, it probably would take as long as five years.

Another factor is an economic one. The amount of debt a recent graduate has is about $100,000. They are told they should be making big money in a relatively short period of time. This might be true if the new doctor is willing to prostitute himself at the expense of the patient. NUCCA has never made the claim about a lot of money. Most NUCCA folks will tell you that it was a struggle early on, but they felt good about the solid growth of their practices and the fact that they had helped their patients. So the pool of new graduates will be quickly screened out if they think they will make a lot of money early on, especially if they have major debt.

Attracting doctors who have been in the field for a few years is even more difficult. Once in the field and making a good living, it becomes almost impossible to change, even though the NUCCA work is more attractive. Lee Yardly and Otto Portman can relate how hard it can be switching to NUCCA after coming from big, successful practices. This pool, therefore, is not potentially a good one for NUCCA.

This paper has basically examined two problems as to why there are so few NUCCA doctors: That the NUCCA work is difficult to learn, and this, in turn, dissuades new doctors from considering NUCCA as a professional option.

As we indicated earlier the learning curve with the adjustment must somehow be shortened. The training for adjusting has not really changed much over the past 30 years: Break down into groups and work on the coordinator. There must be some training device beyond the coordinator. With the technology today, something must be available. Perhaps there needs to be more regional seminars that concentrate solely on adjusting. The problem certainly is a legitimate agenda item for the NUCCA/ NUCCRA Boards.

There is a term used in psychology called Locus of Control. A person can be classified as either internal or external. People who are internally focused tend not to believe in luck or chance, and they are responsible for their behavior. So if they do good or bad, they will take credit for their actions. Externals believe in luck, chance, or fate. If they fail or are successful, they blame it on external factors. Scientists tend to be internal, because they are interested in cause and effect. Philosophers probably are more external.

It is the writer’s opinion that NUCCA doctors tend to be internal. They are analytical. They like the notion of pre and post X-rays that can be measured. They don’t want to leave things to chance. They want to know immediately if they reduced the subluxation. The term innate is not mentioned very often. They want to know how and why things happen. They tend to be critical of themselves and others if they can’t get the right answers. They are not impressed with modalities that have nothing to do with the reduction of the atlas subluxation. If you want to impress them, show your post X-ray. Most are not interested in fame or fortune. They are interested, though, in serving their patients the very best they can.

"In 1941 when Dr. John Francis Grostic of Ann Arbor walked into the office of Dr. Ralph R. Gregory seeking an atlas adjustment, a close friendship began which lasted until Dr. Grostic's untimely death in 1964. A victim of Hodgkin's disease, Dr. Grostic had been unable to obtain a corrective atlas adjustment prior to his visit to Dr. Gregory other than at the B. J. Palmer Chiropractic Clinic in Davenport, Iowa.

While both doctors had practiced full spine adjusting, their real concern was the upper cervical spine. It was only natural, therefore, that they should collaborate on this spinal area, making every possible attempt to evolve a more biomechanically accurate system of upper cervical subluxation correction.

To achieve this end, the installation of perfectly aligned x-ray equipment and precise patient placement became essential, permitting distortion free x-rays to be taken and making x-ray analysis with rotatory measurement acceptable. The first collimation was designed and installed.

Dr. Gregory had been reading Dr. A. A. Wernsing's The Atlas Specific about this time and was impressed by Wernsing's comment-due to the shape of the superior articular facets of the atlas, the atlas moves laterally as if on the rim of circle-" (1941). He showed the Wernsing book to Dr. Grostic, the axis superior articulations were added, and the condylar-axial concept became the starting point for what was to become the Grostic Technique.

In early 1943 Dr. Grostic, who was not satisfied with the former methods of determining atlas laterality, developed the prototype of the instrument which was to become the cephalometer, a skull-divider for establishing the central skull line. When joined to the atlas plane line, these two lines formed two angles with atlas laterality being on the side of the acute angle.

This system of establishing atlas laterality was checked for months by both Grostic and Gregory. It was found to be consistent and so remains today. Rapidly following were the concepts of atlas-odontoid relationship, axis-spinous position, the lower angle, the method for determining atlas rotation, the discontinuance of the recoil for the triceps pull adjustment, and the horizontal resultant. Analytical instruments were perfected, adjusting tables modified, and adjustment coordinators made.

While this work between 1941 and 1946 hardly deserved the appellation "research", it did provide a biomechanical basis for the further evolution of upper cervical though mostly a trial and error procedure. Several Chiropractors by this time had received personal benefit from the work and they were asking for a seminar. In the fall of 1946, the first Grostic seminar was held in Ann Arbor, Michigan, limited to eighteen participants. From that time forward into 1964, seminars were held at various times yearly. Dr. Gregory assisted Dr. Grostic in nearly all these seminars through the eighteen years.

Immediately following the death of Dr. Grostic in 1964, the group split into two factions, the larger one establishing headquarters in Atlanta, Georgia. Dr. Gregory did not wish to continue teaching seminars, but to concentrate on advancing the basic work. In early 1966, however, he was contacted by phone by Dr. L. H. McLellan of Mesa, Arizona who requested that Dr. Gregory conduct seminars for several Chiropractors because of his close affiliation with Dr. Grostic during the developmental years of the work. Dr. Gregory finally agreed and held the first seminar in 1966 at the Howard Johnson Motel in Monroe. By 1978 the seminars were approved for license renewal by the Michigan State Board of Examiners.

Dr. Gregory felt that in view of recent schism among Grostic practitioners, an organization should be started to conduct future seminars and research. He consulted with Mr. Donald A. Miller, a Detroit attorney and former friend and legal adviser to Dr. Grostic, who with other interested Chiropractors formed The National Upper Cervical Chiropractic Association, Inc. (NUCCA) a fraternal organization, on April 16, 1966. Mr. Miller completed all the legal arrangements, became the NUCCA attorney, providing counsel to the board.

Elected first President was Dr. Irvin Mathias of Indiana; Vice-President, Dr. Albert Dick of Michigan; Secretary, Dr. Robert Kemp of Michigan; Treasurer, Dr. Marshall Dickholtz of Illinois, and three NUCCA directors: Drs. Max Foster and Ralph R. Gregory of Michigan and Andrew Mathias of Indiana.

The newly elected board adopted the NUCCA emblem and authorized an official organ, NUCCA News, of which Dr. Gregory was appointed editor. The first publication was issued in December of 1966. Harry Long, Ph.D. was appointed the first research advisor in 1967.

As ever-increasing clinical observations arose, hypotheses were formulated that needed testing. Research expanded, re-examination of the original basic work had to be done, and newer methods of subluxation analysis and correction developed. To accomplish this task, the

NUCCA board was advised by Mr. Miller that a research organization must be set up. NUCCA, Mr. Miller stated, was a fraternal organization and could not conduct research.

The National Upper Cervical Chiropractic Research Association, (NUCCRA) was incorporated for research purposes only, due to the efforts of Mr. Miller, on October 6, 1971. Application for an exempt status was made to the federal government, and after examination, was finally granted. Professor Daniel C. Seemann of The University of Toledo was appointed research advisor in 1971.

It was decided that NUCCA should publish a more scientifically-oriented paper and the name NUCCA News was changed to The Monograph, meaning "learned treatise on a particular subject" and proposed by Dr. Seemann.

The accomplishments of NUCCA and NUCCRA have been many. Outstanding among them are: (1) The development of the double-pivot-point system in x-ray analysis; (2) The development of the triceps pull adjustment; (3) The designing of better film analytical instruments; (4) The development of biomechanical concepts in film analysis and adjusting; (5) The design and development over seven years of the Anatometer by Dr. Gregory and Peter Benesh which measures bodily distortions before and after the C-1 adjustment, providing proof of the effects of a C-1 subluxation on the body and their correction; (6) The design and development of a multiple support headpiece for extreme subluxations; (7) The establishment of a vertical axis for C-1 subluxations; (8) The classification of C-1 subluxations into basic types; (9) The location of the skull center of gravity and (10) The identification of the components of the lever system and their relationship inherent in an Occipital-Atlanto-Axial subluxation.

These developments, and many more, constitute an on-going process. Re-evaluation of the basic work is a constant procedure. Future goals in research now under advisement are an optical scanning feasibility study to scientifically prove the NUCCRA system, a read-out instrument to test the adjustment, and a fool-proof system for checking leg disparity from which better correlations can be made.

NUCCA has given the profession more biomechanical data than probably any other Chiropractic entity in the past twenty years concerning the subluxation, its effects on the spinal column and human body, how to restore its misalignments to the vertical axis, and has shown acceptable and measurable proof of the benefits of the Chiropractic adjustment on the human body. This it has done for the benefit of the patient, the Chiropractor, and the profession."

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