The purpose of this article is to simplify the adjustment for NUCCA doctors. There have been too many doctors who have given up the NUCCA work and others who struggle because they believe that it is too difficult to learn. I believe that this is only true for those who do not have a clear understanding of the anatomy and proper mechanics involved. When doctors have taken the time to educate themselves or have been taught correctly, the triceps pull and adjustment becomes simpler and more efficient for the m. Doctors also will not hurt themselves adjusting patients if they have the correct understanding of the process involved.

First one must realize that there is a difference between the triceps pull and the adjustment. The triceps pull involves the mechanics of pulling the long head of the triceps muscle, compressing the shoulder girdle and other mechanics involved in the clos ed ring of the adjusting hands, arms, shoulders and episternal notch. The triceps pull is not the adjustment of the atlas vertebra. The adjustment occurs when the atlas vertebra reduces in its misalignment to its correct alignment as a result of the trice ps pull. There is no adjustment if there is not a correction in the misalignment of the atlas vertebra and thus reduction of neurological encroachment.

For a proper triceps pull, the humeral heads should be in the posterior one-third position of the glenoid fossa. It is important to visualize the glenoid fossa divided evenly, anterior to posterior, into three sections. If one were to raise his arm to a 9 0 degree angle with the arm projecting forward anteriorly, this would set the humeral head in the anterior one-third of the glenoid fossa. Now pulling the humeral head posteriorly into the center of the glenoid fossa will place the humeral head in the cen ter one-third of the glenoid fossa. To snugly pull the humeral head farther posterior in the fossa will place the humeral head in the posterior one-third of the glenoid fossa. In the adjustment this posterior one-third is the proper position in the glenoi d fossa for the humeral head. Any further posterior would be too far and the force of the triceps pull would be lost behind the shoulder girdle and would consequently be ineffective.

It is important for the doctor to understand and visualize the origin and insertion of the triceps muscle and the long head attachment of the triceps muscle. The triceps muscle inserts on to the olecranon process of the ulna bone and the long head attache s into the infraglenoid tuberosity of the scapula (see figs. 1&2). It is important to be able to visualize the infraglenoid tuberosity just below the inferior rim of the glenoid fossa on the lateral side of the scapula. If one can visualize the glenoid fo ssa and the infraglenoid tubercle, then one can visualize the long head of the triceps attaching to this tubercle (see fig. 3). This tubercle is the location of the beginning of the triceps pull. This is the proper anatomical location to visualize in begi nning the pull of the triceps long head.

The line of pull is a straight line between the insertion of the triceps on the olecranon process of the ulna bone, and the muscle origin of its long head on the infraglenoid tuberosity of the scapula. The direction of the line of pull is upward toward th e glenoid fossa. Initiate the triceps pull just one-quarter of an inch below the center of the fossa, which would be in the exact location of the infraglenoid tuberosity.

The doctor should not activate the triceps muscle below the elbow. Such action moves the elbow joint first causing too much force, depth and lack of control in the adjustment. The triceps long head is correctly pulled just below the shoulder joint. The do ctor needs to activate the shoulder girdle first. The shoulder girdle is the greatest lever in the adjustment, because it is the largest. This is what the doctor is adjusting against; it is the doctor's foundation and strength that will cause the atlas to move under its great force.

In the triceps pull the doctor pulls the long head of the triceps back against the infraglenoid tuberosity with a straight line of pull from the olecranon process to the center of the glenoid cavity. There is a slight backward movement of each shoulder, f ollowed by complete shoulder girdle compression. The scapulae will follow the shoulder girdle compression medially. The scapulae should not lead the shoulder girdle compression, only follow the compression.

As the doctor contacts the atlas transverse process, the pressure of the pisiform on the atlas vertebrae always remains the same throughout the adjustment. It should be no different at the time of the adjustment than it was at the time of first taking con tact. It is a firm contact of the atlas transverse process that remains the same throughout the triceps pull.

The doctor overcomes the resistance of the subluxation by overcoming the resistance of his/her own shoulder girdle. As the doctor contacts the atlas vertebra, he/she pulls the long head of the triceps muscle in a straight line to the center of the glenoid fossa compressing the shoulder girdle, thus compressing the closed chain ring that has been formed between the patient's atlas vertebra, the doctor's adjusting arms and shoulder girdle. This adjustic chain is set into action when the resistance of the sh oulder girdle is overcome. If ten pounds of force is the amount required to overcome and correct a subluxation, the vertebrae will move at the same instant the adjustor's triceps brachii have exerted ten pounds of force against his/her own shoulder girdle . This is a built-in mechanism in the adjustor that controls force and protects the patient. The doctor cannot use the same amount of force for every subluxation, it would be harmful and impractical. Each subluxation has its own resistance so that each su bluxation has its own individual adjustment.

The adjustment force must be delivered in the fraction of a second that it meets the resistance of the subluxation. It should be a surprise to the adjustor! If the adjustor tries to force the atlas to move, then the adjustor could push the atlas. The adju stor could then jam the subluxation or force the subluxation into a different pattern, or the atlas could possibly rebound and increase in its misalignment.

The adjustor must remember that the atlas corrects properly if it moves as a result of the adjustor overcoming the resistance of his/her own shoulder girdle. Once this pressure builds to a greater level than the resistance of the subluxation, then at that instant the adjustment is made.

With proper understanding and correct visualization the adjustment can be simpler for the doctor. Hopefully this article will help the doctor's understanding of the proper mechanics involved in the adjustment.

References:
1.
Gray's Anatomy, 35th British edition, Philadelphia, W.B. Saunders Co., 1973, 319-321, 539-542.

2.
Gregory, R. "How to Adjust the Atlas Subluxation Complex: The Triceps' Pull Phase," Upper Cerv. Mono., Jan., 1978, 2(4),3-5.

3.
Pond, L., Pond, L., "The Mechanics of the Shoulder Compression," Upper Cerv. Mono., Sep. 1991, 5(2),2-3.