I want to share with you my own recent, personal experience involving the atlas and axis, the first two cervical vertebrae of the spine. I have written about these upper cervical vertebrae previously on my website, but its importance in skeletal, structural stability really hit home with me this week.
First, bear with me as I give you a little background about my left knee. I injured this knee during December 1971 in a fall while ski jumping that required surgery to repair a torn medial collateral ligament and the joint cartilage. Since then, it has always been the weakest link in my skeletal and structural stability, experiencing intermittent symptoms of joint aching and pain, but nothing sharp and debilitating. I have always been able to manage these symptoms through exercise so it hasn’t limited my activities. That is, until this week.
After returning from Minneapolis/St. Paul to watch my “Twins” get embarrassed by the “Yankees”, I started to have more than the usual aching and pain of my left knee that would not let up. With each passing day, the symptoms increased and then I started to experience significant instability and pain of my left knee with each step I took. It got so bad, I was afraid to put any weight on my left leg. I continued to work on the muscles that impact the position and motion of my left hip, knee, and ankle with no change in the symptoms. That went on for several days until I changed my strategy remembering that the biology of physical, bodily pain is never straightforward, even when it appears to be.
I then started to look at my neck and focus on the atlas and axis. The atlas is the vertebra that articulates with the occiput at the base of the head and the axis is the second cervical vertebra. Just hearing the name, “atlas,” emphasizes its importance in maintaining our skeletal and structural stability.
Remember, Atlas is from ancient Greek Mythology who was a Titan responsible for bearing the weight of the heavens on his shoulders. He is usually portrayed as an enormous, bearded man, always slightly bent over and in pain under the weight of the heavens depicted as the globe sketched with the most famous constellations.
Bear with me again before I continue because an understanding of the anatomy, biomechanics, and neurophysiology of the atlas and axis is required to understand my story. The atlas and its articulations with the occiput and axis are described by many of the body experts as the “most complex joints of the axial skeleton both anatomically and kinematically.” The upper cervical spine as the atlas and axis are commonly referred to sacrifice stability for mobility as evidenced by 50% of cervical or neck rotation occurs between this atlantic-axial articulation.
The neurological dysfunction related to the misalignment of these two very important vertebrae involves mechanoreceptors. The mechanoreceptors are specialized nerves that perceive mechanical information due to positional change and motion at a joint such as the atlas-axis articulation causing reflex activity by the nervous system. Stimulation of these receptors results in reflex muscle contraction about the joint and in this case a group of muscles referred to as the sub occipital muscles as an adaptive control to the different stimuli from within and outside the environment of the body. These mechanoreceptors primary input is to the cerebellum of the brain from our bodies working with and against gravity and its effects.
It is known that the upper cervical spine has more mechanoreceptors per surface area than any other region of the spine. Also, there is direct evidence that these upper cervical mechanoreceptors feed into the vestibular system housed in the middle ear for control of skeletal, structural balance and equilibrium by affecting the muscle tone throughout the body.
It has been my experience in the past that misalignment of the atlas-axis articulation can manifest clinically in various forms of postural distortion such as a functional leg length difference, pelvic distortion, head and shoulder tilt and shift, and unequal weight distribution between the legs. It is the latter that I started to focus on with my sudden onset of left knee pain.
I then started to work on the muscle tone or tension of several sub occipital muscles including the rectus capitis lateralis, obliquus capitis superior, and the obliquus capitis inferior. Muscles that are really small in comparison to the size of the muscles that affect the position and motion of the hips and lower extremities. I started to do isometric exercises in order to facilitate these sub occipital muscles and affect their tone that would ultimately affect the position of my head.
I also knew from experiences in ski jumping the importance of head position in the performance of any bodily motion. When ski jumping, we were always instructed not to drop our heads when flying through the air unless we wanted to flip over in mid flight. I had always kept that in the back of my mind when treating my clients in physical therapy, but really did not understand its importance until this recent episode with my left knee. “The body follows the direction of the head!”
Once I started doing the isometric neck exercises with eye movements to alter the tone of the sub occipital muscles mentioned, my knee symptoms dramatically began to change. The eye movements done with the isometric neck exercises are referred to as the vestibular-ocular reflex in that the position of the eyeball will be opposite of the position of the head so as to give us a straight ahead gaze and level horizon.
In trying to understand the reason for the onset of my left knee pain without doing anything physical or experiencing a traumatic event, I came up with this scenario. I know that when flying by air in today’s world the body takes a beating because of the very poor ergonomically designed seats and the cabin pressure. These two factors affect ones skeletal and structural stability and posture even though it is only a two hour flight.
Prior to commencing with the isometric exercises for the sub occipital muscles, my left knee would intermittently give out stressing that surgically repaired medial collateral ligament from the 1970’s that runs along side the medial or inner aspect of my knee causing a very sharp pain that would at times take my breath away.
Therefore, I had to walk very slowly and guarded in attempt to control the forces due to walking aggravating my now very unstable, left knee. In an attempt to alter the mechanoreceptors at the knee, I applied “kinesiotape” along where the medial collateral ligament runs which did help the isolated stability of my left knee. But, it was the isometric exercises altering the tone or tension of the sub occipital muscles that stabilized my left knee and the rest of my skeletal structure.
By changing the position of my head in doing these very simple neck exercises, it altered the input from the mechanoreceptors at the atlas and axis resulting in a more vertical and neutral position of my head. As the position of my head changed, the distortion of my pelvic girdle and the weight bearing into my lower extremities changed. It changed the integrated reaction of my skeletal structure to ground and gravity.
Within several days, I started to experience less and less aching and pain. In addition, I was no longer experiencing the intermittent episodes of my left knee giving out and the resultant sharp pain. As a result, my anxiety and fear of pain I had with each step started to diminish. With each passing day, I grew more confident in my movements. That is because the “sympathetic chain,” a bundle of nerve fibers that run from the base of the skull to the tailbone just lateral to the vertebral bodies were no longer being stimulated. Remember, the “sympathetic nervous system” which is part of our “autonomic nervous system” is facilitated when the body is under stress such as with the instability and pain of my left knee. It’s the “fight or flight” response to this apparent threat of skeletal and structural instability.
Fortunately, I am now able to walk again without the instability and pain and I am getting back into my daily walks. Whew! I accomplished this without surgery and months of rehabilitation which I did before in the 1970’s. All it took this time was to put my “head on straight!” As long as I do that, my dysfunctional left knee will be able to function normally against gravity and its effects on a daily basis. It is my hope from this story that you can see how important the atlas and axis are to our skeletal and structural stability allowing us to perform the activities of our daily living.