I have not had the chance to meet Dr. Zachary Ward in person yet. However, I have interacted with him on Twitter and through email. I’ve been really impressed by the level of thought he puts into things, especially Upper Cervical Chiropractic.
I am excited about this interview because it is the first time I have done it in a conversation format. Dr. Ward and I emailed each other back and forth over the past several weeks and the following is the result. Also, he is the first NUCCA doctor to do an interview for this site.
I am grateful Dr. Ward took the time to answer these questions so thoughtfully for The Atlas of Life.
Brandon: Why did you decide to become a chiropractor, and more specifically, an upper cervical chiropractor?
Dr Ward: “Like most chiropractors, I entered chiropractic because I wanted to help people. My family had a positive experience with full-spine work, and I always reflected on that experience, and would defend chiropractic and chiropractors if anyone ever said anything bad about the profession. And I would recommend chiropractic care to people who were hurting.
The upper cervical part is a bit more complex.
Short answer: I’m an upper cervical chiropractor because I’ve been a front row witness to the amazing recuperative power of the body when under upper cervical care. A friend at Palmer introduced me to upper cervical in my first trimester, and really challenged me with her story of profound healing while under NUCCA care. It caused me to rethink the purpose of chiropractic care.
Now the long answer: I think upper cervical chiropractic offers the most clinically meaningful way to practice chiropractic as defined by the correction of vertebral subluxation. Let me explain.
Within a few months of starting at Palmer I was exposed to two lectures by two prominent NUCCA docs, Dr. Lee Yardley, and Dr. Milton Steele, both of Washington State, and both who had practiced some of the most well respected full-spine approaches, Gondstead and Activator Methods. Nonetheless, they turned to upper cervical care when the “chips were down” and they, or a family member needed a healing opportunity they weren’t getting under their full-spine practice model. (This introduced me to a common sentiment among even the most orthopedic-oriented chiropractors and students I met: when you’ve done so much you can’t do anything else, you might as well adjust the atlas and see what happens. It made me wonder…)
The lectures by Steele and Yardley were a rock that I clung to at the end of my first year of chiropractic college. I wanted to test what I was learning so far, and I began to search out the most anti-chiropractic propaganda I could find.
I wanted to know what the weaknesses of my future profession were. And all the criticisms, as over the top and ludicrous as they are, hinged on one thing: the inability to conclusively document the subluxation.
I heard a presentation from the late Dr. Jospeh Keating on chiropractic research who brought it all together into one clear sentence for me: “The subluxation may or may not exist, but even if it does, it’s NOT clinically meaningful.”
His opinion was this: The subluxation is not meaningful because you can’t measure it. You can’t define normal, so you can’t define abnormal. There’s no Gold Standard. Other than palpating bones feeling movement where there was restriction, you can’t validly measure that you’ve done anything, other than freed a restricted joint articulation. I think upper cervical doctors can agree that reducing spinal fixation is not necessarily correcting vertebral subluxation, so you can see where Keating may have been coming from. (BJ at one point said that true subluxations weren’t possible below C2.)
And, I had to agree. As I was learning about it, as I was getting care in the clinic, I was getting diversified adjustments every time I went in for an appointment. Some of my symptoms were improving. I was benefitting. But chiropractic, as strictly defined by the correction of the vertebral subluxation, was a good idea that was essentially meaningless to that good experience. After all, if you’re always adjusting, how are you correcting anything? From my patient’s point of view, I didn’t need the subluxation to benefit from spinal manipulation. The subluxation seemed to exist for the chiropractor’s understanding, not for my own.
What brought me back from delving into an abandonment of chiropractic as subluxation correction was the very fact that a core group of committed individuals were working to create that Gold Standard in subluxation measurement, documentation, and correction. They were the upper cerival doctors, and after listening to Drs. Yardley and Steele, I read about them starting in Kirk Eriksen’s the Upper Cervical Subluxation Complex, in BJ’s research, and in the Council Bulletins of the Palmer’s Standardized Chiropractors Council.
I watched a recorded presentation by the late John Grostic Jr., where he spoke about UC docs using mirrors to create low-fi three dimensional spinal imaging in the late 1930s, of chiropractors concerned with the instantaneous axis of rotation 30 years before White and Panjabi made it famous, of chiropractors being so far ahead of their time that current instructors in chiropractic colleges don’t even know about their work.
And they weren’t talked about because, to put it simply, they were upper cervical people… “BJ followers”… and that was enough to write them off entirely.
So, I began my own investigation of the upper cervical work, and found the model of biomechanics that makes the most sense to me. I found that you can plot an expected normal, and measure deviations from normal. I had upper cervical films taken in 3 different offices over the course of 18 months. These offices were 160 miles apart from docs who didn’t know anything about my care previously. All 3 of them created the same listing, with almost an identical vector. Now that’s a clinically meaningful subluxation!
So, I started sending my family to upper cervical doctors, and was blown away by the results…and how long they were holding their adjustments. And that sealed it for me. I needed to be an upper cervical doctor.”
Brandon: You have chosen NUCCA as your means of subluxation measurement and correction. Can you explain a little bit about NUCCA to the readers?
Dr. Ward: “What I can do is explain NUCCA as I understand it. The organization has official literature that puts everything into perspective. I don’t want anyone to think that I’m speaking officially for NUCCA as an organization.
That said, here’s the top 3 things I think everyone should know about the NUCCA:
1) NUCCA is an orthogonal approach, and is an outgrowth of the research of Drs. Ralph R. Gregory and John F. Grostic. It’s very much related to Orthospinology, Atlas Orthogonal, and other orthogonal techniques. We still adjust by hands only.
I believe that Grostic was one of the charting members of the Palmer Standardized Chiropractors Council, an organization of HIO doctors that worked semi-secretly to try to refine HIO to make BJs results more repeatable for field doctors. Grostic and Gregory followed the lead of A.A. Wernsing and paid serious attention to the angles of the occipital condyles. That led to seeing the mechanics of atlas motion as a relationship of balance between the circle of the occipital condyles, and larger circle of the superior surface of axis. With circles involved the linear measurements of HIO could be replaced with rotational measurements, and doctors could start talking about misalignment in quarters of degrees, not just millimeters.
Instead of dividing the foramen magnum, Grostic and Gregory divided the skull and used that bisection to determine neurological zero. It made sense that if that central skull line was a gravity line, then ideally that center of gravity would line up with the neck’s center of gravity, as determined by a line drawn from the center of the neural canal at C7 up to C2. And those 2 lines would be “parallel” to gravity.
Now we’re working the relationship of the balance between 3 lines: the skull’s vertical gravity line, the neck’s vertical gravity line, and the plane of the atlas. The goal became to unlock the whole structure at once to balance the head and neck optimally in relation to gravity, thereby removing nerve interference at the upper cervical spine. In a picture perfect world that would mean angles at 90 degrees to each other, or true angles, hence orthogonality. Sometimes limitations of matter, including asymmetries in bone formation or adaptive curvature, stop this re-alignment to a true 90 degrees.
For some reason there’s this fallacy present, even among upper cervical docs, that orthogonal approaches, including NUCCA, make no allowances for bony asymmetries. This just isn’t the case.
2) The NUCCA technique is a full spine approach. That is, it does its best work by applying a force with a specific direction into the upper cervical spine where the subluxation is best documented and reducible, but the effects are felt across the whole spinal column.
Generally speaking NUCCA practitioners pay less attention to patterns and scanning devices and more attention to functional leg length inequality, pelvic distortion, position of the shoulder girdle, and overall body posture. All of which is largely influenced by spastic muscle contracture which is most likely modulated in the lower brain stem. I think that if you can change a low back by correcting an upper cervical misalignment, then your approach deserves to be called full spine.
Scanning instruments do play a part in some practices, but are not absolutely necessary to practice NUCCA.
3) More than just a technique, NUCCA is also a non-profit, fraternal organization that’s been existence since 1966. Dr. Ralph Gregory formed it in order to continue teaching the Grostic/Gregory model of upper cervical correction.
NUCCA has tested and incorporated many of the contributions to “the work” of its own members, most of which can be found in the Upper Cervical Monograph. From my perspective as a student of chiropractic epistemology, one can draw a straight line from the Green Books, to the Council Bulletins, to the Upper Cervical Monographs and see what 80 years of thinking about the upper cervical spine does for the profession. I believe NUCCA has taken a strong stand about defines correction of the vertebral subluxation complex, and has asked some tough questions of the profession, both of the innate-drive vitalists, and the subluxation-skeptics, that really haven’t been answered yet. Hopefully with some of the research coming in the near future, we’ll know more about what’s really going in this awesome area of the body.
Personally, I like practicing under the NUCCA umbrella and know that I have a published body of work and protocols that I can point to and say this is the standard that I want to define my practice. Rightly or wrongly, NUCCA has worked to define the mathematics of the subluxation, and because limits have been drawn around it, I can place my finger on it and say “that this is what I’m correcting.”
Brandon: I have heard and read some Upper Cervical Chiropractors call themselves “technicians,” which tends to rub some people the wrong way. What are your thoughts on this subject?
Dr. Ward: “These technicians are responding to the self-proclaimed “physicians” who believe “any monkey can give an adjustment” (a professor at my alma mater liked to say this) and that the real value of chiropractic comes from our conservative management of disease. It’s just one more volley in the long debate about what chiropractic’s role should be within the health care system.
These UC docs are saying “I’m a spinal technician, and I’m proud of it, because the mechanics of the spine are complex enough to deserve it.”
And rightly so, they have a point. If you carry the thought process of some of the UC docs to its actual conclusion, then anyone who isn’t practicing some form of specific upper cervical work has only corrected a vertebral subluxation on accident, not on purpose. Hence all the talk about “that something.” And if you carry the subluxation-skeptics’s thought process to a real conclusion, we should be learning how to manipulate on the weekends, and spend most of our curriculum in differential diagnosis. The adjustment is an afterthought because the chiropractic lesion is largely limited to fixation and range of motion.
The UC pioneers who were really trying to chase the subluxation down with instrumentation, perfect x-rays, and adjustments that could hold for months or years had to be technicians of the spine to create the body of knowledge on which we stand. I think about the number of hours spent just to figure out x-ray alignment alone, and it boggles the mind.
Thank God for these technicians.
That said, I believe a true chiropractor will see the doctor vs. technician debate as a false controversy created by an inability to see a both/and relationship. We wear a doctor hat, and we wear a technician hat. There’s no controversy about that.
And it’s true, for some of us our pocket protectors bulge a little bit more than others, but technicians can’t grow a practice.”
Brandon: We’ve talked about the amount of specificity that goes into quantifying the vertebral subluxation, and the amount of work it requires to become proficient at accurately detecting and correcting the subluxation. With this in mind, what do you attribute the growing popularity of Upper Cervical Chiropractic to?
Dr. Ward: “I’m not sure I’m qualified to answer this question. I’m so new to the work that I can only imagine what it must have been like for our UC pioneers to labor and discover in absolute obscurity. But now it seems like things have changed, or are changing. Dr. George Bakris is addressing NUCCA conferences, the ICA has developed a Council on Upper Cervical Care, Marshall Dickholtz, Sr. is addressing the World Federation of Chiropractic (where UC was persona non grata), and all the upper cervical techniques are coming together at the Upper Cervical Evolution.
All I can do is reflect on what I’ve seen over the last four years, having recently come out of chiropractic college. And I say this new energy is all about building relationships. For me personally: it’s been meeting classmates who came to school to be upper cervical doctors; it’s been meeting James and Rhonda Tomasi in person, and having long phone calls with them now that I’m in practice; it’s been having access to Dr. Robert Brook’s class on taking care of people; it’s bee the opportunity to visit the office of 9 upper cervical doctors and seeing their waiting rooms full of people as they practice with passion; it’s been one-on-one sessions with Dr. Keith Denton, going over films and working with a force transducer to understand the NUCCA triceps pull; it’s been sitting around with fans of knee-chest, AO, Blair, and NUCCA, and just enjoying the camaraderie of being brothers in stead of being distant cousins; it’s been hundreds of moments of building a community, and I know this experience is true for the students of Blair or Kale as well.
Of course I think upper cervical is growing because of the incredible new research that is finally validating our practice model. But even that gets back to relationships.
This is the age of blogging, twittering, and a constant stream of information. In some ways upper cervical used to be a lonely calling. From here on out, no one is practicing alone.”
Brandon: Do you feel like this growing popularity and camaraderie within Upper Cervical Chiropractic is benefiting current patients and potential patients alike?
Dr. Ward: “Let’s face it, we’re just too small to make a dent in that stream of information I mentioned without banding together. Chiropractic has an image problem for a lot of different reasons, some of which is the fault of chiropractors, and some of it isn’t. We have a hard road ahead of us to distinguish ourselves as specialists in a profession where some want to sweep us into the dustbin of history. We do have something unique to offer that rightfully belongs under the greater umbrella of chiropractic care. (I’d say at the apex of the pyramid). However, we have to understand that the UC practice model, insofar as it works from the restoration principle, is a rock in the shoe of both subluxation based full-spine practitioners, and chiropractic managers of degenerative spinal conditions.
As much as I love the philosophy behind guys like Gondstead, DeJarnette, and Barge, they don’t live or die by the restoration principle. Clearly, they all adjusted the atlas, and had theories about nervous system tension arising from skull/vertebral structural misalignment that don’t necessarily require a change in bony position, even if that was their aim. I think it’s understandable that there has often been a friendly uneasiness between UC practitioners and ADIO driven full spine adjusters. That makes sense.
Also it makes sense that if you’re going to undermine the traditional chiropractic philosophy, in addition to using scary words like “dogma” and “antiquated,” you also have to disavow any existence of a legitimate chiropractic science in UC care. Just the other day I was searching for information on vertigo, I found a “expert” Q&A forum where the chiropractic physician advised a reader to avoid UC practitioners, because their methods are old-fashioned and unproven.
On one side we have philosophically like minded allies, who nonetheless, don’t need the restoration principle and x-ray privileges to survive. On the other we have chiropractors who have betrayed the basic ADIO principles of our founders, and consistently reproduce misleading information about UC docs, largely prejudiced opinion disguised as science.
In this environment I can’t believe it’s taken us this long to start getting together more often. Then again what a temperament it must take to practice alone, discover alone, and basically told you’re a lunatic by the rest of your profession while you watch these miracles happen before your eyes…It creates a strong cohesion within a small inner circle that doesn’t really have room for anyone else. Even other upper cervical techniques with a different approach.
So, to finally answer your question: yes, where our unity brings more attention to the unique service we provide, and helps draw people to the healing they need, I think it helps. Where I think it will do the most good in the long run, is to finally get the attention and support we need to get our studies done, published, and at the same time, test the principles we’re using. This is about creating a gold standard in chiropractic care. And I’m thankful that the Greg Buchanan’s of the world came on the scene to help make it happen.
That said, I think we have to work to avoid the groupthink that can sometimes show up when like-minded people get together. Just because things are looking up doesn’t mean that they are. The 80/20 rule still holds, and 20% of the people are still probably doing 80% of the work, and they’re going to get tired unless some of us step up and carry the torch. And if we’re going to do that as a unified UC voice, then all of us have to be involved.”
Brandon: Tell us what practice has been like for you up to this point.
Dr. Ward: “Practice is amazing. And challenging. It can be a scary thing to take a post-film, or a post-scan knowing you have someone’s hope for healing in your hands. There’s no such thing as a cavitation to tell you you’ve “got it.” As my friend JB of Davenport (Jason Blackketter) says, it’s just hundreds of small things added up throughout the day that you have to “DO” with absolute consistency and quality.
The easiest part is correcting the atlas subluxation. And the hardest part is correcting the atlas subluxation. And it’s amazing how easy it is on one day, and how hard it is the next. And then there’s all the finesse in between, like being a supportive and caring doctor for those cases that are retracing for time periods that seem to go on forever, who are just begging for an adjustment, and you know you can’t do it. You’ll make them worse. You know there’s science involved when compassion takes a back seat to objective measures of function, and you risk losing the patient. They don’t teach those kinds of communication skills in Chiropractic College. Needless to say, I’ve been making quantum leaps in my understanding. And what’s perfect about UC care is how its depth of knowledge is also reflected in other disciplines. Just like philosophy, physics, or math, the more you know, the more you realize you don’t know.
And that’s when the real learning begins. I’m lucky enough to be sharing a practice space that was set up by a Board Certified NUCCA doc, so when I’m having those “what if there’s a subluxation within the subluxation moments?” I can say, “Hey, can you just look at this a minute, and tell me what you think.” That’s totally awesome.”
Brandon: What is your vision for the future of Upper Cervical Chiropractic?
Dr. Ward: “What I love best about UC care, as a patient, are the aesthetics of it. There’s no experience anywhere else in the world, be it massage, acupuncture, manual therapy, physical therapy, energetic therapeutics, or hypnotherapy that can achieve what a proper UC correction can achieve: lasting head/neck balance which changes baseline human physiology.
We are a market completely unto ourselves, and therefore I’m not in competition with the any of the disciplines I just named, nor with the whole spine practitioner. Our competition is strictly the status quo on what your average American is willing to accept from our health care system. Right now, unless people are blessed with an upbringing that embraces holism and a healthy suspicion of outside-in thinking, people usually have to go through a conversion process in order to get UC care on their radar. Sometimes that conversion means years of pain and thousands of dollars of debt before they’re fed up with the system enough to accept an alternative.
I think it’s about time that we eliminate the length and cost of the conversion process by collaborating with inside-out medical practitioners. They’re out there, you just have to look, and understand the predicament that they find themselves in. And no, just because someone works in a multi-disciplinary setting doesn’t mean they have a holistic worldview. It just means they’re willing to pass off their low back pain patients to a skilled manipulator. That’s a step forward, but it really doesn’t upset the status quo, because the exchange still involves therapy applied to pain. I’m talking about something different.
I’m talking about challenging the purpose of health care to the very core, which, you have to understand, is what UC care does when it maintains its roots and philosophy. UC care as part of a new paradigm in health care, would basically split health care into the two competing philosophies that exist now, Hygean (supporting the health of the whole) and Asclepian (the treatment of the diseased parts), except that Hygea would have a rightful place at the table, and would be the first line of care for non-emergency situations. (Hat tip to Dr. Victor Strang at Palmer College.) As one of our NUCCA magi says, “It’s the difference between non-interference and intervention.”
What’s unique about the correction of the UC subluxation is the way it bridges the divide between non-interference and intervention. The first correction is an intervention. It’s the correction of an actual, measurable, and putative lesion whose presence is actually diminishing the health of the one who has it. Once a momentum towards proper healing is built, then the correction becomes a way of supporting a lifestyle of non-interference.
In that regard UC care would be an ambassador to the two necessary branches of a properly ordered health care system. UC docs would be in the intensive care unit, adjusting cancer patients. And they could be on wellness retreats correcting the subluxations of professional athletes. Two very different settings, yet, in each case the purpose is the same: remove that which is interfering with proper expression of life.
Which brings me back to those inside-out medical doctors and the aesthetics of UC care. By virtue of their degree, MDs work central to the system. By virtue of our size and our lack of credibility, we work on the periphery. To paraphrase an argument made by Wendell Berry about the town (center) versus the country (periphery) and the passing of information, we have to engage not just in communication, but a conversation about the values that drive us, and do it with key gatekeepers in the health care system. People in the center.
We’ve already seen the power of what can happen when this kind of conversation occurs with the NUCCA hypertension study and the absolute bloom in UC research that’s coming out of it. All of the sudden UC care is ripe for research when a couple of years ago it wasn’t. That’s because the periphery brought its knowledge to the center. And the delivery of that knowledge was through the aesthetics of the adjustment.
A man (who happened to be a DC) took a picture of another man’s head and neck (who happened to be an MD). He corrected the misalignment on the picture. He took another picture to prove to the man that the imbalance was no longer present. Lesion, correction, health, in that order. And that man digested what he experienced, and set that new information against the handful of cases of lesion, correction, health he had already seen in that order, in his own patients. And all of the sudden there was no boundary between the center and the periphery for the medical doctor. He was now on the periphery and realized he had an obligation to bring this new knowledge back to the center.
In my mind there’s no clearer way to engage in a conversation about the strength of the inside-out philosophy than the evidence of the UC correction. There’s no better way to reset our clinical understanding of what health is. It’s not manipulation as described in the literature. It’s not massage. It’s not colonics, or acupuncture, or tantric healing. It’s the scientific restoration of a bony misalignment. It’s what DD said it was.”
Recommended Reading
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{ 2 comments… read them below or add one }
Great conversation, guys! And here I thought I could wax eloquent fairly well about NUCCA – Zach, you write very cohesively and effectively. Thanks!
I hope I’ve represented my fellow NUCCA folks, well. Thank, Ben!
If anyone wishes to read more from the Upper Cervical Monographs, they are now available online here: http://www.nucca.org/monograph.php
There are some writings by some real greats in there.