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Orthopädische und unfallchirurgische Praxis
© Deutscher Ärzte-Verlag | OUP | 2012; 1 (10)

J. Heisel, Bad Urach

Functional Disturbances of the Atlanto-Occipital Joint – Functional Isometric Training with the Help of an Orthocybernetic Pillow

Preliminary remarks 
Dysfunctions of the atlanto-occipital joint are frequent, sometimes painful reversible disturbances with a distinctly variable clinical picture. Besides local symptomatic patterns with pain radiated to the forehead region they are not infrequently related to vegetative dysfunctions, such as nausea and shimmering vision.
Anatomically, the atlanto-occipital joints in the upper region of the cervical spine differ very considerably from the other cervical segments from C2/C3 downward, and paravertebral intervertebral disc buffers are missing. The structural arrangement of the dens and atlas enable the vast mobility of the atlanto-occipital segment C1/C2. In order to bear the weight of the head vertical loads, shock absorption, shear forces and movement in the atlas region are managed and controlled by muscles alone. This explains the lack of arthrosis due to exertion in the atlanto-occipital region. Due to the typical arrangement of the atlas ring muscles, an inclined position of the head leads to asymmetric tenseness, which can then be responsible for local pain symptoms. Above all in airplanes, with limited space between seating, unphysiological static and dynamic loading in the atlanto-occipital region frequently results from the restricted global mobility with the head in an inclined position and an inclined sitting position. In somewhat milder form, this loading also applies for all inclined positions of the spine and depends on the time factor as well.
The high degree of loading of the cervical spine region is intensified in children due to the  disproportionate relation of the already heavy head to the still poorly developed neck muscles. Therapeutically, above all the therapeutic approaches of manual medicine, atlas therapy and osteopathy are available for the treatment of symptomatic patterns [1].

Functional principle/Mechanism of action
The stable textile fiber pillow described here is intended to provide variable pressure distribution in the atlas region with the head in a resting position. In collaboration with the Matherm company in Philippsthal, Germany, the orthopedic specialist and degreed engineer Dr. med H. Koerner (Head of the Institute for Applied Human Cybernetics in Berlin) developed a special supporting pillow comprising three chambers for the cervical spine region (Fig. 1). Intended primarily for the prophylaxis of problems in the atlanto-occipital region for persons spending longer times on airplanes, it is proving to be increasingly valuable in the household and patient care areas. Decisive here is that the back of the head, up to the ear, fits exactly into the middle chamber of the pillow and the integrated neck bolster laying over this is optimally fitted. Variable variants for resting enable the integrated neck bolster to vary the tenseness and relaxation of the deep flexor and extensor muscles of the atlas region, with the additional effect of the isometric build-up training of these sensitive muscle groups. Simply turning the pillow over to the front side or the rear side increases or decreases the pressure on the atlas region in the inclined sitting position. This variable capacity of the pillow has the effect of stimulating the isometric build-up training of the stressed muscles. In inclined resting positions the pillow guarantees adequately active mobility and at the same time prevents extreme drooping of the head.
The filling level of the integrated neck bolster, and therefore the local cranial pressure on the cervical spine, can be dosed exactly by adapting the volume (variable amount of filler). The pressure of the head on the middle chamber enlarges the two lateral sections of the pillow in the ventral direction, so that the head can no longer rotate uncontrollably to the side (preventing exaggerated lateral reflexion; see Fig. 2). The fixing of the neck bolster to the middle chamber is by means of a Velcro fastener.
 

 

Applications
Monotonous sitting over a longer period of time frequently leads to tenseness of the neck muscles. Due to the inclined position of the head the muscles in the atlas region are additionally stressed. This knowledge explains the repeated muscle irritation in the atlanto-occipital region during long periods of restricted mobility, such as during long flights and during bus, rail and car travel. Thanks to its very simple handling, this special pillow for the neck is intended above all for use with persons who fly frequently and often experience symptomatic patterns and functional disturbances in the upper region of the cervical spine. In the meantime, this aid has also proven valuable for the treatment of patients with chronic dysfunction of the upper cervical spine and accompanying vegetative symptoms (e.g. in the sense of partial fixation of the cervical spine in a reclining position). For this group of patients a special variable filling (with dosed volume hardness) with a replaceable neck bolster has been developed, allowing individually adapted use with each patient. OUP


author:
Prof. Dr. med. Dr. h. c. mult. J. Heisel
Chefarzt Orthopädie
m&i-Fachkliniken Hohenurach
Immanuel-Kant-Str. 33
72574 Bad Urach

Literature
1. Koerner H, Würzner A.
Kleiner Impuls - große Wirkung. Eine Reflextherapie in der Atlasregion bewirkt Stoffwechselregulation, Leistungssteigerung, Schmerzlinderung und psychosomatische Stabilisation.
Orth Prax 2010; 46: 191–201.

2. Heisel J. Physikalische Medizin. Stuttgart: Thieme, 2005


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