Sunday, January 24, 2010

Aleck August Wernsing - Upper Cervical Chiropractic Pioneer

Without the contribution of Dr. Aleck August Wernsing, it's questionable if B.J. Palmer's focus on the upper cervical area of the spine would have been as strong as it was, or whether upper cervical techniques would look much like they do today, or even exist at all!

A.A. Wernsing was a 1926 graduate of the Palmer School of Chiropractic. He practiced in Hollywood, California. Like many early chiropractors, his discoveries began with a personal experience with a health problem. In his 1941 book, The Atlas Specific, Wernsing wrote:
It was by force of circumstances, in 1932, that I was led more definitely into this field of research for the relief of a condition from which I myself was suffering, and for which I had been unable to find relief. Noting that pressure applied to the neck just inferior to the mastoid bone gave instant relief, my natural reaction was that an actual correction of vertebral malposition at that point would give me lasting benefit. Further research justified that opinion and enlarged its scope.
Wernsing "credits" the Great Depression with "allowing" him the time to work on his research and refine his x-ray and adjusting techniques, due to the fact that there were so few patients who could afford to pay him for his service! At the time, in the middle of the country in Davenport, Iowa, Dr. B.J. Palmer was busy at work on his own theory of the importance of the upper cervical area of the spine and their paths would soon intersect.

Beginning in mid- to late-1920's, B.J. was working on a theory, through clinical research, that there were true subluxations of the spine as well as compensations (majors and minors). By using an instrument called the Neurocalometer (NCM), which B.J. opined gave direct insight into the "flow of mental impulse" along the nerves, B.J.'s team of doctors was able to note that, often, one adjustment would balance the paraspinal temperature and normalize the NCM readings. From this, B.J. developed an idea of a "Hole-in-One" adjustment, or one adjustment that would "clear" all of the patient's subluxations. B.J. was convinced that the ideal adjustment was the one given at the right place, in the right manner, at the right time, and his ideal view of the perfect adjustment was one that needed to be done, just once, to make a person subluxation-free for her lifetime. While B.J.'s goal was too idyllic to be possible in reality, he did find that, according to clinic records, the adjustment that seemed to clear out the NCM reading the most efficiently in most patients was that of the upper cervical spine (C1 or C2).

By the early 1930's, B.J. was teaching this Hole-in-One theory, and in 1934 he wrote and published a massive tome titled The Subluxation Specific - The Adjustment Specific. This was after he had met with A.A. Wernsing, however. Back in California, Wernsing was intently studying the anatomy and biomechanics of the upper cervical spine, specifically the C1, or atlas, vertebra. At the center of Wernsing's research was the idea that the atlas moves relative to the occipital condyles (base of the skull), "as if on the rim of a circle." In other words, as the atlas moves laterally, it also moves superiorly, as shown in the diagram here I've rendered.

Through the use of x-rays, Wernsing discovered that this type of movement was not as free as the other ranges of motion between the atlas and occiput, so he felt like it was this lateral-superior shifting of the atlas that was, essentially, the most important aspect of the C1 subluxation complex. Because the atlas moved in this way, Wernsing decided to describe this misalignment in degrees, and was the first chiropractor to "list" the misalignment component of subluxation in such a way.

In order to demonstrate the movement to others, Wernsing built the Mechanical Anatomical Demonstrator in March of 1934. Building this anatomical model required Wernsing to know "the relative position of an atlas in relation to its condyles in degrees of movement" and led him to invent an instrument called the Orthoprotractor No. 2, the first instrument used to do precision x-ray analysis in chiropractic.

As mentioned, Wernsing depended on x-ray for his biomechanical research. He invented a method of x-ray analysis he called True Plane Radiography, and utilized the Orthoprotractor No. 2 and Orthoprotractor No. 1 (another analysis instrument), to gain precise measurements from the x-rays. With some modification, Wernsing's methods for analyzing x-rays are essentially the basis of the majority of upper cervical techniques still in use today, as well as some of the postural techniques such as those of Pettibon and Chiropractic Biophysics©.

A.A. Wernsing's True Plane Radiography method required six films of the upper cervical spine: Scout A.P., True Lateral, Scout Lateral, True A.P., A.P. 45 and Superior Inferior view. The x-rays began with the Scout A.P., which was used to measure the true plane of the atlas vertebra, which is different in every patient. Without getting too technical, the point of True Plane Radiography was to take accurate x-rays of the atlas vertebra relative to the occiput in such a way so as to minimize projectional distortion that can happen with less carefully shot pictures.

In 1933, Wernsing attended a lecture in Oakland, California, given by one of B.J.'s upper cervical instructors, on the Hole-in-One (HIO) theory and his burgeoning chiropractic technique of the same name. Wernsing felt that B.J.'s work had serious flaws, and had this to say in an article in 1959:
After we had completed the class, we both knew that the Palmer School had no information on the advanced work I was doing in my office. Two of the basic differences between my work and that taught by the PSC were as follows, my work was and is based on determining the malposition of the atlas in relation to the occipital condyles: the HIO work taught by the PSC was based on the axis rule.
On January 5, 1934, Wernsing arrived in Davenport, Iowa, for a meeting with B.J. Palmer, Dr. "Laddie" Heath (B.J.'s brother-in-law) and Dean Herb Hender. Wernsing recalled seeing the trio reviewing a galley copy of a book titled The Atlas Subluxation and the Axis Adjustment, which was a textbook on the HIO material B.J.'s instructors were presenting around the country. B.J. was highly impressed by Wernsing's research, and after their meeting Wernsing had agreed to keep B.J. updated on any new developments. For his work, Wernsing was mentioned in the foreward of B.J.'s renamed book, published later in 1934, The Subluxation Specific - The Adjustment Specific, which incorporated most of Wernsing's ideas.

A month later, on February 5, 1934, Wernsing received a letter from B.J. exclaiming the value of Wernsing's work. An excerpt from B.J.'s letter clearly shows the excitement he felt:
We are working, testing, trying. IT WORKS. We are very much pleased with the idea. Have written it into the book as a verifiable idea worth knowing and using. Have given you an appreciation in the Preface of the book. You have rendered a REAL service. Shall try your idea of plane lines in x-rays and see what it produces. Always open to further suggestions you may render the cause. Gee, wouldn’t it be great if we had 1,000 like you thinking along CHIROPRACTIC lines?
Wernsing continued to refine both his analysis and adjusting technique over the years. In 1939 B.J. invited Wernsing to present his material to a rather lukewarm crowd at the Palmer Lyceum, but in the 1940's interest in Wernsing's work seemed to grow. Between 1940 and 1941, Wernsing wrote a series of five articles on his work for Los Angeles College of Chiropractic's Chirogram, and in it he made the first description of adjusting the atlas from a side-lying position. Wernsing had invented what he called a vernier adjusting table, allowing the patient to lie comfortably on her side while the headrest cushioned and blocked the occiput during the adjustment. This table could also accommodate the shoulder width of the patient in this position. At this same time, B.J.'s HIO technique was still using a knee-chest position, with the patient kneeling on a table and their head in full rotation, undoubtedly a less comfortable proposition for the patient.

The exact mechanics of Wernsing's adjustment are difficult to ascertain from his writings, but as far as I can tell, it involved a double-thumb (reinforced thumb) contact with a sustained, relatively light pressure, over the atlas transverse process, as opposed to the more dynamic Palmer Toggle-Recoil thrust used in HIO.

Wernsing published his work in a 1941 book called The Atlas Specific. He clearly had a huge influence on B.J. Palmer, and through Palmer's teaching of HIO, later adoption of a side-lying posture for adjustment (thanks largely to Clay Thompson's invention of the drop headpiece) and establishment of a group of loyal upper cervical collaborators called the Palmer Standardized Chiropractors Council, Wernsing's work went on to, perhaps unbeknownst to them, influence major players in the upper cervical technique world like John Grostic, Cecil Laney, Ralph Gregory and others.