|Picture 1 – A lateral cervical film displays a decreased cervical lordosis, which is one of the criteria for a Stucky Stack adjustment.
A 35-year-old male army cadet presents to the clinic with neck pain and stiffness. The patient notifies the doctor that the neck pain began following enrolment into the armed service, and has progressively worsened over the past five years. The patient also notifies the doctor that his neck movement is extremely limited and that he feels as though he is actively forcing his neck to move in certain positions. The patient also mentions that he has taken a variety of pain medications over the years. These temporarily alleviate the symptoms but they return when the medication wears off.
Physical examination reveals that cervical flexion and extension are limited. Motion and static palpation reveals a subluxation at C2 on the right, with associated facet inflammation. Palpation of the subluxation and irritated facet joint reproduces the pain immediately on the patient. Neurological examination is unremarkable, and no indications for X-rays are seen at this time.
The chiropractor begins a regime of chiropractic adjustments to the C2 subluxation, consisting of supine rotary cervical adjustments to the affected segment. Over the course of four weeks, the patient is re-evaluated to determine the progress of treatment. The patient remarks that the pain is slightly better, but that he still feels that his overwhelming stiffness has not improved. At this point, the chiropractor sends the patient for X-rays, due to the lack of significant improvement with the patient’s chronic problem. X-ray examination reveals a decreased cervical lordosis. All other radiological findings are unremarkable.
Have you had this type of case present in your office? Have you been adjusting a patient, confident that you are dealing with a straightforward case, but only achieving mediocre results with your adjustments?
In this edition of Technique Toolbox, I will be discussing Stucky Integrated Methods, and in particular the Stucky Stack Adjustment for a chronic C2 problem. As you will see, sometimes a simple modification to the adjustment can provide tremendous results.
FIRST, SOME HISTORY
Dr. L. Joe Stucky is a 1957 graduate of Northwestern Chiropractic College, and founder of the Stucky Chiropractic Centre in Eau Claire, Wisconsin. Dr. Stucky is a true pioneer of chiropractic. He was in full-time practice for 50 years (he still practices on a part-time basis) and was an international lecturer, speaker and mentor for most of his 50-year career. He is a distinguished fellow of the International Chiropractic Association, and was a founding member of Life Chiropractic College, in Marietta, Georgia (now Life University). Dr. Stucky was a technique pioneer, combining Gonstead, Thompson, Pettibon and his own techniques to create the Stucky Integrated Methods. I was fortunate enough to learn directly from Dr. Stucky. It is by combining information that I received directly from his lectures with my own clinical findings that I am able to share the proper implementation of the Stucky Stack for a chronic C2 problem.
Going back to our case study: to understand the difference in this particular subluxation pattern, one must have an understanding of the biomechanics involved with a C2 subluxation that make a Stucky Stack Adjustment necessary.
SUBLUXATION BIOMECHANICS (SEE DIAGRAM BELOW)
In this situation, the C2 vertebra subluxates primarily posterior, with slight spinous rotation away from the side of the inflamed facet (thick black arrow). This subluxation pattern causes the facet joints to separate (thin black arrow). The dashed grey arrow represents the eventual line of correction, focusing P-A, to correct the subluxation and restore the cervical lordosis.
|Picture 2 – Contacts for the Stucky Stack are
displayed on a skeletal model. Note how the thumb pad contacts the
posterior cervical facet of the C2 subluxation.
|Picture 3 – Proper patient setup for the Stucky Stack is displayed. Note how the patient’s head is stabilized across the doctor’s forearm, as the contact hand delivers the proper P-A adjustment.|
In fact, research has demonstrated a statistically significant association between a decreased cervical lordosis and neck pain. One study suggests that a cervical lordosis of 31 degrees to 40 degrees should be a clinical goal for chiropractic treatment. Furthermore, patients having a cervical complaint were 18 times more likely to have a decreased cervical lordosis.1 Therefore, it is critical to focus on the posterior component of the subluxation for proper biomechanics, as well as for symptomatic relief.
SO, WHEN IS A STUCKY STACK ADJUSTMENT UTILIZED?
Step One – There are two criteria required to justify the use of the Stucky Stack:
- Chronic C2 cervical subluxation.
- Loss of proper cervical curve as seen on lateral cervical X-ray (see Picture 1).
Step Two – Correction: Stucky Stack Adjustment (see Pictures 2-3) :
- Patient: Supine. Table at a 45-degree incline (if working on a high-low table).
- Doctor: Head of table.
- Contact: Thumb pad on the
- C2 facet.
- Stabilization: Cradle the patient’s head. Have them rest their head across your arm, while simultaneously holding their chin. The head will be turned away from the contact.
- LOC: P-A.
Until next time . . . Adjust with Confidence!
1. McAviney, J. Determining the relationship between cervical lordosis and neck complaints. JMPT. 2005. 28(3):187-93.