PT on the Net Research

Upper Spine Eval (Atlas Test)


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


The test you are talking about is actually an upper cervical spine evaluation for the atlas or atlantoaxial complex. This test should not be used by itself. It 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 this test should not be performed unless the individual is licensed to do so and fully understands the atlas as well as its affect on the entire body.

There are many other things that should be considered when doing this test. It is a proprioception test, so it must be done with a blind fold and earmuffs and in a quiet/low lit environment. The atlas is a very complex structure that can create dysfunction through the entire body. Research has shown that most people who 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 of the neurovascular structures that run through, around and attach to this structure, when this test is performed, you might see someone move forward, to the right, to the left, etc, but it is not always an atlas issue. If someone has a disc derangement, she will move away from the pain (same goes for a nerve root irritation). If someone has a postural imbalance such as scoliosis), she might move away or even toward the imbalance. There are many other reasons, but this test alone is not conclusive. If you suspect your client has an atlas issue, or if you feel this client is out of your league, refer her to an N.U.C.C.A Chiropractor.

It is great that trainers want to add assessments to their process as they add a lot of value. But make sure you not only know how to do the assessment but are able to correlate the results to anatomy and other assessments.

To read more on atlas and its complexity, read Upper Cervical Subluxation Complex by Erikson.