During the last month or so, Drs. Elder, King, and myself have received numerous calls about where the atlas is. Further investigation into this perplexing matter revealed an unbelievable amount of different locations as to where the atlas actually lies. I seems that the different chiropractic college technique departments teach atlas locations that are significantly different. Yesterday I received a number of calls from disgruntled students telling me that one of their professors had just informed the entire class that he personally knew of six or seven doctors of chiropractic that had fractured the styloid process while attempting to adjust the atlas. Perhaps a review of the anatomy of the head and neck is in order. I was not aware that we adjusted the styloid process.
After conducting a literature search on Medline and Gratefulmed, I was unable to confirm any reported cases of styloid fractures by manipulation done by anyone. Yet we have a technique instructor dumping all over the Gonstead atlas adjustment, according to the students, which utilizes the thumb as the specific contact. When we consider that the Gonstead adjustive procedures are used by more chiropractors than any other technique, it's baffling why someone would go out of their way to upset and confuse the student population of our colleges.
Where is the styloid process and can you really get to it?
Question: From the surface of the skin just how far is it to the styloid process?
Answer: If you take a dry skull and measure the distance from the tip of the mastoid process to the nearest portion of the styloid process, remember that the styloid projects downward and slightly medial in direction so that the distal tip of the styloid is much further away, the distance is between one-half inch and five-eights of an inch. I used one dozen skulls picked at random.
Question: What structures overlie the styloid process that one would have to pass through or damage before the styloid could be reached?
Answer: Starting with the skin, the thickness of which is not a constant but is a function of the physical mass of the patient, we find connective tissues and fat overlying the parotid gland and cutaneous branches of the cervical plexus. Under the gland we will find the facial, retromandibular, internal jugular vein and other smaller vessels; the external carotid artery places the styloid process, the stylopharyngeus muscle with the glossopharangeal nerve, the styloglossus muscle, and the pharyngeal branch of the vagus between the internal and external carotid arteries, but leaves all of this deep to the posterior belly of the digastric, stylohyoid muscles, and the parotid gland with its veins and facial nerve buried in it. It is also worth noting that cranial nerves seven, nine, ten, and twelve are intimately related to this area as is the sympathetic trunk and the beginnings of the ansa cervicalis. So how far is it to the styloid process really? Half an inch? One inch? How about on a 250 pound patient with a 20 inch neck -- one and one-half inches?
The above anatomical description is interesting but really unnecessary because when delivering a Gonstead atlas adjustment, the atlas falls to the side of lateral flexion which makes you even further away from the styloid process. Perhaps the root of the problem is hidden in one of two places: 1) teacher's inability to recall simple anatomy leads teacher to dump this inadequacy on unsuspecting students in an attempt to display very powerful information and become the topic of conversation on the college campus; 2) inability to become proficient in the finest adjustive technique in the world, the Gonstead adjustment. Drs. Cox, Stoenner, and Clinton would be only too happy to have you attend a few courses at "The Mount" to refresh your memory of how, where, and when to adjust your patients.
With all the events occurring in the United States at this time, we the profession, do not need to create internal stress and infighting. If you must argue for your inadequacies and limitations, then do so, but leave the students alone. They are the future of chiropractic. Oh, yes, please go find the atlas.
Keith Innes
Scarborough, Ontario
Canada
Editor's note: Dr. Innes will be conducting his next MPI Seminars in Toronto Feb. 12-13 (S1 -- Lumbars and Pelvis); Los Angles Feb. 26-27 (S2 -- Cervicals and Thoracics); and Chicago March 26-27 (E1 -- Lower Extremities). You may call 1-800-359-2289 to register.
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