A friend of mine recently visited a personal trainer at her local gym. As part of her assessment she was was asked to march on the spot with her eyes closed. She found that she moved some distance froward and turned to the right. She came away unsure as to what the test was for? Can you help?

Mark,
The test you are talking about is actually a Upper Cervical Spine evaluation for the atlas or atlantoaxial complex. This test should not be used by itself and must be used in conjunction with many other tests, such as ROM of the cervical spine, assessment of the odontoid and apical ligaments, assessment of the vertebral artery, supine and standing palpation tests of the atlas, as well as many other upper cervical proprioception tests, full kinetic chain assessments (breathing, jaw, shoulder, nose, hearing, vision, cervical spine, entire body, pelvis and so forth) and X-Rays. What I am actually saying is that one should not perform this test unless for one they are licensed to, fully understand the atlas, as well as its affect on the entire body.

There are many other things that should be done when doing this test. It is a proprioception test, so it must be done with a blind fold and earmuffs as well, within a quiet/low lit environment. The atlas is a very complex structure that can create dysfunction through the entire body. Erikson states in Upper Cervical Subluxation Complex that through research that most people that have some type of back pain actually have a subluxed atlas. This is secondary to the pull of the dentate ligaments on the dura mater of the cord, which is closely related in orientation to the spinocerebellar and spinothalmic tracts (pain, temperature, joint and muscle movement, etc). As well, within the dorsal aspect of the cord, the lumbar and sacral innervations are most caudal, which would be affected by the pull of the dentate ligaments.

Due to all the neurovascular structures that run through, attach to and run around this structure, you might see someone move forward, to the right, to the left, etc. This should be correlated with many other assessments, but as well it is not always an atlas issue. If someone has a disc derangement, they will move away from the pain (same goes for a nerve root irritation). If someone has a postural imbalance (for example, scoliosis), they might move away or even towards the imbalance. There are many other reasons, but you can see how this test alone is not conclusive.

As a CHEK Level 4, we are skilled in assessing this, as well as we use N.U.C.C.A Chiropractors for adjustment of this. We come into play to assist with the assessment, but designing programs to help the atlas stick in place. My first recommendation with any client that you suspect of having an atlas issue or that you feel is out of your league, refer them out or refer them to an N.U.C.C.A Chiropractor if you have any suspicions it is the atlas.

It is great that trainers want to add assessments to their process, which I feel adds a lot of value. But make sure that you just don’t know how to do the assessment, but being able to correlate the results to anatomy and other assessments. To read more on atlas and its complexity, you can read Upper Cervical Subluxation Complex by Erikson.

What to do?
1. Read up so you know exactly what you are doing
2. Refer out, when in doubt

Josh Rubin