An Manual therapy prospective of the Occipitoatlantal Joint

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Occipitoatlantal (OA) joint is the most superior weight-bearing synovial joint in the body. Because the OA articulation is one of the final locations at which the body can adapt to asymmetry or dysfunction below, hence this joint requires evaluation in the context of the entire body. The Atlanto-occipital joint (articulation between the atlas and the occipital bone) consists of a pair of condyloid joints.The ligaments connecting the bones are:

* Two Articular capsules
* Posterior atlantoöccipital membrane
* Anterior atlantoöccipital membrane
* Lateral atlantoöccipital

The movements permitted in this joint are:

* (a) flexion and extension, which give rise to the ordinary forward and backward nodding of the head.

* (b) slight lateral motion to one or other side.

Flexion is produced mainly by the action of the Longi capitis and Recti capitis anteriores; extension by the Recti capitis posteriores major and minor, the Obliquus superior, the Semispinalis capitis, Splenius capitis, Sternocleidomastoideus, and upper fibers of the Trapezius.

The Recti laterales are concerned in the lateral movement, assisted by the Trapezius, Splenius capitis, Semispinalis capitis, and the Sternocleidomastoideus of the same side, all acting together.


The Atlanto-occipital joint features predominantly in the symptoms of tension-like headaches as a result of prolonged inappropriate posture from poor ergonomic adaptation.

In such cases, patients typically report cracking of the neck, discomfort when sitting, continuous migraine-like headaches, dullness, dizziness, tingling in the fingers, sensitivity to light and a feeling the head is expanding.
There must be a concise physical evaluation process for the OA joint complex with reference to prominent clinical findings indicative of dynsfunction. Further manual therapy is planned particularly in a fashion of "integrated manual care" approach. Evaluation procedures include:

* postural assessment;

* muscle and joint manual palpation techniques;

* range-of-motion testing; and

* anterior-posterior and lateral gliding tests.

Treatment methods upon finding OA dysfunction are organized around clinical findings of the examination. The suggested treatments are:

* positional release;

* direct methods (low velocity, muscle energy, high velocity);

* myofascial release; and

* general techniques (ischemic compression, isometric contractions, deep stroking massage, friction, etc.).
Reference:
1. Manual care of the occipitoatlantal joint. Chiropractic Technique, August 1999:11(3), pp116-124.
2. gray's anatomy
3. Physiology of joints-Kapandji

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