What Is Orthospinology? How It Differs From NUCCA, Blair, and Atlas Orthogonal
Many of the patients who find my Mandarin office have already done a lot of reading. They have learned that upper cervical chiropractic focuses on the top of the neck, and then they run into a list of names: Orthospinology, NUCCA, Blair, Atlas Orthogonal. Some have tried one of these techniques in another city and want to know whether what I do is the same thing. Others are simply trying to make sense of it all before they choose a doctor.
I practice Upper Cervical Orthospinology here in Jacksonville, and I want to explain it in more depth than I can on my Orthospinology service page. That page covers what a visit looks like. This post covers where the technique came from, how the X-ray analysis actually works, how doctors are trained, and how it compares to the other well-known upper cervical techniques. If upper cervical care is new to you entirely, my patient guide to upper cervical chiropractic is a good place to start first.
Where Upper Cervical Care Began
In the early 1930s, B.J. Palmer, the son of chiropractic's founder, began focusing his work on the very top of the spine: the atlas (C1), the axis (C2), and the base of the skull. His reasoning was that this region surrounds the brainstem, so a misalignment there could have effects far beyond the neck.
Dr. John F. Grostic and the Measurement Problem
One of the doctors drawn to that idea was Dr. John F. Grostic, a chiropractor in Ann Arbor, Michigan. Grostic had a personal reason to care. According to NUCCA's own history, he had struggled to find a corrective atlas adjustment anywhere outside of B.J. Palmer's clinic. That experience pushed him toward a question the profession had not answered well: how do you measure an atlas misalignment precisely enough that any trained doctor can correct it the same way, every time?
Between 1941 and 1946, Grostic worked closely with Dr. Ralph Gregory of nearby Monroe, Michigan. Together they developed a way to analyze the relationship between the skull, atlas, and axis on X-rays and turn those measurements into a specific correction. That system became known as the Grostic procedure, and nearly every analysis-based upper cervical technique practiced today can trace part of its thinking back to that work.
How One Procedure Became Several
Dr. Grostic died in 1964. Two years later, in 1966, Dr. Gregory founded the National Upper Cervical Chiropractic Association, known as NUCCA, to carry forward and refine the hand-delivered version of their work.
In 1977, a group of doctors who had trained in the Grostic procedure organized to continue developing it under the name Orthospinology. One of their key changes was adding instrument adjusting alongside hand adjusting, with the goal of making the correction more consistent from visit to visit. Today, the Society of Chiropractic Orthospinology teaches and certifies doctors in the procedure, and its textbook, Orthospinology Procedures: An Evidence-Based Approach to Spinal Care, is built on the Grostic model.
Dr. Roy Sweat introduced Atlas Orthogonal in 1981, built around a table-mounted percussion instrument. Dr. William Blair developed the Blair technique separately, with a strong emphasis on the individual shape of each patient's joints. So when you see these names side by side, you are looking at related branches of the same family, each with its own priorities.
What "Orthogonal" Means
You will see the word orthogonal often in upper cervical care. It means "at right angles." In a balanced upper neck, the head sits level and centered, and the atlas lines up squarely with the skull above it and the axis below it, so the spine underneath can stack straight rather than bending to compensate.
When the atlas shifts out of that position, the head tilts or rotates slightly, and the rest of the body adapts to keep the eyes level. I wrote about how far that compensation can travel in my posts on low back pain and the atlas connection and jaw problems that start in the neck. The goal of an Orthospinology correction is to move the atlas back toward that orthogonal position.
The Math Behind the X-Rays
This is the part of Orthospinology that surprises most patients. The adjustment itself takes a moment. The analysis behind it takes much longer.
Three Specific Views
Standard neck X-rays are not enough. Orthospinology uses a specific set of upper cervical films, typically:
A side view to see the angle of the atlas from front to back
A front view taken through the bridge of the nose to see side-to-side tilt of the head, atlas, and axis
A view from the top of the head to see rotation
Together, these let me look at the upper neck in three dimensions instead of one.
Lines, Angles, and Degrees
On each film, I draw reference lines along specific landmarks of the skull, the atlas, the axis, and the center of the neck. Then I measure the angles between them in degrees, often down to fractions of a degree. Those measurements tell me how much the head is tilted, which way the atlas has shifted, and how much it has rotated.
Precision matters at every step, including how the films are taken. If you are positioned even slightly crooked in the X-ray equipment, the measurements will be off, so patient positioning is a skill in its own right.
Turning Measurements Into a Correction
Those measurements are combined into what upper cervical doctors call a vector: the exact direction, angle, and depth of the correction your atlas needs. You lie on your side with your head resting on a firm support, and the instrument is set to that calculated angle. The force involved is comparable to light pressure on the tip of your nose. There is no twisting or cracking.
Confirming the Correction
After the adjustment, I take follow-up X-rays to see whether the atlas actually moved toward the corrected position. This is one of the defining features of the Grostic tradition. Instead of relying on how the adjustment felt, we both get to see objective confirmation of the change.
How Orthospinology Compares to Other Upper Cervical Techniques
I want to be fair here. I respect the doctors who practice each of these techniques, and many of them are skilled clinicians helping a lot of people. The differences are real, but they are differences in method, not in commitment to patients.
Orthospinology and NUCCA
These two are the closest relatives, since both come directly from the work of Grostic and Gregory. Both rely on detailed X-ray analysis, both aim for an orthogonal correction, and both confirm results with follow-up films. The main difference is delivery. NUCCA corrections are given by hand using a very light, controlled technique. Orthospinology trains doctors in hand adjusting as well, but it also incorporates instruments, which is what I use in my office.
Orthospinology and Atlas Orthogonal
Atlas Orthogonal, introduced by Dr. Roy Sweat in 1981, also comes out of the orthogonal tradition. It uses a table-mounted instrument with a small stylus that delivers a percussive impulse along a pre-calculated vector while the patient lies on their side. Orthospinology uses a similar approach to analysis, and some Orthospinology instruments work in a comparable way, but Orthospinology does not limit doctors to a single instrument or delivery method.
Orthospinology and Blair
The Blair technique, developed by Dr. William Blair, pays particular attention to the fact that the joints of the upper neck are not always symmetrical from person to person, or even from one side to the other. Blair doctors use specialized X-ray views to study the shape and angle of each joint, then deliver a quick, light hand adjustment with the patient on their side, often using a drop headpiece. Orthospinology tends to emphasize the overall orthogonal relationship of the skull, atlas, and axis, while Blair builds the correction more specifically around each joint's individual shape.
What All Four Share
Whatever the name, quality upper cervical care has a lot in common:
Careful, specific X-ray analysis before any correction
Low-force corrections with no twisting or cracking of the neck
A focus on the atlas and axis rather than adjusting the whole spine every visit
Adjusting only when the spine actually needs it, so the body can hold the correction
Some way of checking whether the correction worked
How Orthospinology Chiropractors Are Trained
Upper cervical techniques are not taught in depth in most chiropractic schools. Doctors learn them through post-graduate training after earning their Doctor of Chiropractic degree.
For Orthospinology, that training runs through the Society of Chiropractic Orthospinology. Doctors complete a series of seminars that build from foundational to advanced levels. They learn the history and principles of the procedure, X-ray positioning and analysis, leg checks and postural analysis, paraspinal thermography scans, and the adjusting procedures themselves. Certification requires passing an advanced graduate exam.
My own path: I earned my Doctor of Chiropractic from Palmer College of Chiropractic in 2011, completed my Upper Cervical Orthospinology certification, and pursued advanced training in Cone Beam CT (CBCT) imaging. I am currently a candidate for the Diplomate of Chiropractic Craniocervical Junction Procedures (DCCJP). Fewer than 1% of chiropractors in the United States hold Orthospinology certification, and in the Mandarin area, I am the only one. I share that not to say this is the only right way to practice, but so you know what kind of training stands behind the care you receive. You can read more on my page about Dr. O's background and credentials.
Which Technique Is Right for You?
Here is the honest answer: no single upper cervical technique has been shown to be better than the others for every patient. Research comparing these techniques directly is limited. In my experience, the training, precision, and honesty of the doctor matter at least as much as the name on the technique.
If you are choosing an upper cervical chiropractor, in Jacksonville or anywhere else, these are the questions I would ask:
Do they take specific upper cervical X-rays, and will they show you the measurements?
Do they confirm the correction with follow-up imaging?
Do they adjust only when your spine needs it, rather than at every visit?
Is the correction low force, with no twisting or cracking?
Are they honest about what they can and cannot help with?
Do they encourage you to keep working with your physician and other providers?
I covered more of this in my posts on how to find a good chiropractor in Jacksonville and red flags to watch for in chiropractic care. If you are moving away from Jacksonville and cannot find an Orthospinology doctor near your new home, a well-trained NUCCA, Blair, or Atlas Orthogonal doctor who meets those criteria may be a good fit. If you have seen one of them before and are coming to me, bring any previous films or records you have.
Why I Chose Orthospinology
My reasons are personal. Years ago, while I was working as a pharmacy technician and preparing for pharmacy school, I had 30 ear infections in 36 months, and a surgeon recommended ear tubes. One upper cervical adjustment changed that, and my migraines and elevated blood pressure improved as well. That experience is why I became a chiropractor.
When I looked at the upper cervical techniques available, Orthospinology fit the way I think. I wanted an approach where every correction is grounded in measurement, where instruments help keep the force consistent from visit to visit, and where follow-up imaging holds me accountable. That last part matters to me. If a correction did not do what it was supposed to, I want to know, and I want you to know too.
"I switched to San Jose Chiropractic just a few months ago and it was a great decision. Dr. Owais and her team remind me most of my father's ways, and he was an amazing chiropractor who cared for his patients first. Knowledgeable, invested in you, accurate. It is just a pleasure to go see her." Jennifer O.
What Orthospinology Can and Cannot Do
Patients come to me for many reasons, including vertigo and dizziness, migraines, neck pain, jaw problems, and low back pain. For some, the atlas turns out to be a major factor. For others, it is one piece of a bigger picture, and for some it is not the main driver at all.
Orthospinology is not a cure for any condition, and it does not replace your physician, dentist, or specialist. What it offers is a precise, measurable way to find out whether your upper neck is part of your problem, and a gentle way to correct it if it is. If your exam suggests you need a different kind of care, I will tell you.
Frequently Asked Questions
Is Orthospinology the same as the Grostic technique?
Orthospinology grew directly out of the Grostic procedure developed by Dr. John F. Grostic. In 1977, a group of doctors organized to carry that work forward under the name Orthospinology and added instrument adjusting alongside hand adjusting. The X-ray analysis at its core still traces back to Grostic.
Which upper cervical technique is best?
No single technique has been shown to be better than the others for every patient. Orthospinology, NUCCA, Blair, and Atlas Orthogonal share the same goal and all rely on careful X-ray analysis. The training, precision, and honesty of the doctor matter at least as much as the name of the technique.
What X-rays are taken for Orthospinology?
Orthospinology uses a specific set of upper cervical X-rays, typically a side view, a front view taken through the bridge of the nose, and a view from the top of the head. Together they allow the head, atlas, and axis to be measured in three dimensions, and follow-up films confirm the correction.
How are Orthospinology chiropractors trained?
After earning a Doctor of Chiropractic degree, doctors complete a series of post-graduate seminars through the Society of Chiropractic Orthospinology covering X-ray analysis, leg checks, postural analysis, and adjusting. Certification requires passing an advanced graduate exam.
Can I switch to Orthospinology if I have seen a NUCCA or Atlas Orthogonal chiropractor?
Yes. Because these techniques share the same orthogonal principles, many patients transition comfortably. Bring any previous upper cervical X-rays or records if you have them, though I will usually take new films to measure where your atlas is today.
Does Orthospinology use hand or instrument adjustments?
Both are part of the procedure. In my office, I use instrument-assisted corrections, which deliver a consistent, low force comparable to light pressure on the tip of your nose, with no twisting or cracking.
Want to See Your Own Measurements?
If you have been researching upper cervical care and want to find out whether your atlas is part of the picture, I would be glad to talk with you. Whether you live in Mandarin, San Jose, Fruit Cove, or elsewhere in Jacksonville or St. Johns County, your first visit is a complimentary upper cervical care consultation, about 45 to 60 minutes. No pressure, no commitment, just answers.
Visit my new patients page to get started, or call (904) 683-4476. You can also read more about upper cervical care in Jacksonville before your visit.
Dr. Thuraia Owais, DC, is an upper cervical chiropractor at San Jose Chiropractic in the Mandarin area of Jacksonville, FL. A 2011 graduate of Palmer College of Chiropractic, she is the only chiropractor in the Mandarin area certified in Upper Cervical Orthospinology, has advanced training in CBCT imaging, and has cared for Jacksonville patients since 2014.