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Diagram of the upper cervical joints a chiropractor examines, seen from the front: the skull base, the atlas (C1), the axis (C2) with its dens, C3 and the first neck disc at C2-C3, with the vertebral artery on one side

Upper Cervical Chiropractor: C0-C3 Chiropractic in KL

An upper cervical chiropractor in Kuala Lumpur looks after the top of the neck, from the skull down to C3. Upper cervical chiropractic covers three joints there: the occiput and atlas (C0-C1), the atlas and axis (C1-C2), and C2-C3. People seek it for stiffness or limited turning high in the neck, or a headache at the back of the head. A thorough assessment of these joints, their muscles and the nerves comes first.

A common misalignment of the atlas is a rotation or a slight shift to one side. I adjust it with a non-force method, using the slightest pressure on the side of the atlas. The angle is set by each person's needs, and there is no twisting. Alongside it, I work on the jaw, the rib joints and the lower neck when the examination calls for it.

I never use forceful neck pulls, towel yanks or strap traction, and my video Neck Cracks Are Dangerous explains why. Care is kept within what you can comfortably tolerate, and chiropractors and physiotherapists plan it together. The sections below cover the joints, assessment, methods, emergency signs, the muscles and nerves linked to symptoms, home care and exercise.

This guide, Upper Cervical Chiropractor KL: Non-Force Atlas Adjustment, is published by Chiropractic Specialty Center, Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Upper Cervical Chiropractor: Key Takeaways

QuestionShort answer
What are the occiput and atlas (C0-C1)?The skull base, the occiput, rests on the atlas, the first neck bone. Their atlanto-occipital joints carry the weight of the head and do much of its nodding (Kaiser and colleagues, 2023). My occiput and atlas (C0-C1) guide covers the anatomy, symptoms and my adjustment.
What are the atlas and axis (C1-C2)?The atlas turns on the axis, C2, around a bony peg called the dens. Their atlantoaxial joints do more of the turning of the head than the nodding (Kaiser and colleagues, 2023). My atlas and axis (C1-C2) guide covers the nerve symptoms, misalignment and my method.
How is a jaw problem linked to C1?In my experience, a jaw problem is often at its most intense in parallel with a C1 problem on the same side. That is why my jaw care is not only chiropractic, physiotherapy and exercises for the jaw. It also includes upper cervical care, and that is the most important part. My jaw chiropractor guide covers the jaw side of that care.
Can the upper neck play a part in ringing in the ears?In my view, it can in some people. The ears and other causes still need checking, by a doctor where needed, with the neck and jaw examined alongside. The ear ringing (tinnitus) guide explains when a jaw or neck problem can change the sound and when to see a doctor first.
Is upper cervical chiropractic safe?In Is Chiropractic Safe? 13 Questions Answered I say chiropractic is safe when a competent, registered chiropractor gives it and it is condition based. How safe it is depends on the chiropractor, their experience and the technique.
Which upper neck joints have no disc?Neither C0-C1 nor C1-C2 has a disc; the bones there meet at small joints. The neck's first disc sits between C2 and C3, so a disc problem can only begin at C2-C3 or lower.
Is the neck twisted or cracked?Rarely. I keep rotary manipulation for a neck where I am certain no disc is damaged. In my Back Pain to Leg Pain talk, I admit that is almost never.
Do all upper cervical clinics work the same way?No. Many use the name, and their methods differ. On C1 itself I use a non-force method; on the muscles beside it, the Activator at level one at most, very gently, with you seated.
Why are towel pulls and Y-Straps risky?A hard pull can strain the vertebral artery, and a bone spur beside it can injure it. The jolt also reaches the brainstem and the spinal cord, as I explain in Neck Cracks Are Dangerous.
Who must be most careful about forceful neck pulls?In Neck Cracks Are Dangerous I name women on birth control pills and people with high blood pressure. I add anyone with an unstable neck, a bulging or herniated disc, or spondylosis, meaning wear in the neck's discs and joints.
Is a scan needed first?Not always. In Is Chiropractic Safe? 13 Questions Answered I say an X-ray should come only after a thorough assessment, and only when it shows a need. For the neck, that means a sectional X-ray, not a full-spine film.
How is progress checked?Is Chiropractic Safe? 13 Questions Answered sets my rule: if the fifth session brings no improvement, I reassess why. If the tenth brings none, stopping or continuing is talked through together.
How are the deep muscles under the skull linked to symptoms?Small bridges of tissue tie these suboccipital muscles to the dura, the spinal cord's covering. A 2026 review links changes there with headaches and dizziness from the neck. In my view, these links can also heighten Eagle-like symptoms.
Upper Cervical Page Guide: Sections at a Glance

Occiput and Atlas (C0-C1): The Atlanto-Occipital Joints

The occiput is the back and base of the skull. Beneath it sits the atlas, C1, a ring of bone with no vertebral body. On each side, a rounded knuckle under the skull, the occipital condyle, fits into a cupped socket on top of the atlas. These two small joints are the atlanto-occipital joints (Kaiser and colleagues, 2023). Spine charts count the occiput as level zero, so the level is written C0-C1.

This level passes the weight of the head down to the spine, does much of the nodding and limits sideways sliding of the skull (Kaiser and colleagues, 2023). A stiff nod tends to point here. Tension under the skull or a headache at the back of the head can come from this joint or from the small muscles around it, and the examination sorts out which.

At C0-C1, I use a non-force contact on the lateral mass of the atlas, the thick block of bone on each side that holds the skull. The neck is never twisted, and there is no pull under the skull. My occiput and atlas guide goes further, from finding the occiput by touch to the nerves and arteries around this joint.

Atlas and Axis (C1-C2): The Atlantoaxial Joints

The axis, C2, has a bony peg called the dens that rises into the front of the atlas ring. When the head turns, the front arch of the atlas pivots on the dens. The two bones meet at three joints: that one at the front and one on each side. These three are the atlantoaxial joints (Kaiser and colleagues, 2023).

The side joints are shallow, which allows a lot of movement, and this level does more of the turning of the head than the nodding (Kaiser and colleagues, 2023). Stiff turning, often first noticed when reversing a car, tends to point here. The C2 nerve leaves between the two bones on each side. Pressure on its branch to the scalp, the greater occipital nerve, can bring brief, stabbing pain over the back of the head (Djavaherian and Guthmiller, 2023).

A jaw problem on the same side can add to strain at C1-C2. At C1, I use the same non-force contact on the lateral mass, with no twisting. My atlas and axis guide covers this level's nerve symptoms, the hospital warning signs and my method in full.

What Is Upper Cervical Chiropractic?

Upper cervical care and upper cervical chiropractic are two names for the same work: chiropractic for the upper neck, from the skull to C3.

Upper cervical chiropractic, also called upper cervical care, is chiropractic care focused on the top three joints of the neck. The neck is seven bones stacked one on another, joined by ligaments and discs. In Neck Cracks Are Dangerous I show how small its joints are and how soft its discs are.

JointWhere it isWhat it does
C0-C1The base of the skull rests on the atlas, the first neck bone. The atlas is a ring with no body, which leaves room for the spinal cord (Kaiser and colleagues, 2023).A large part of the nodding of the head. There is no disc here.
C1-C2The front arch of the atlas pivots on the dens, a peg that rises from the axis, the second neck bone.Mainly turning of the head, more than nodding. There is no disc here either.
C2-C3The axis meets C3, the first of the more typical neck levels.Joins C2 to C3 through the first disc of the neck.
Diagram of the atlas (C1) seen from above, front at the top: the front arch, the dens of C2 held by the transverse ligament, the lateral masses, the spinal cord in the ring and the vertebral artery in the opening on each side
The atlas (C1) seen from above, front at the top. A ligament behind the dens holds it against the front arch, and the spinal cord passes through the space behind.

Each vertebral artery climbs through small openings in the neck bones. It then bends over the arch of the atlas and enters the skull (Kaiser and colleagues, 2023). In Neck Cracks Are Dangerous I call it even more critical than the nerves.

The brain leaves the skull through an opening at its base as the brainstem, and continues down as the spinal cord. As I explain in that video, brain and cord are one organ inside one covering, the dura, which runs down to the tailbone.

In my Back Pain to Leg Pain talk, I speak of a disc pressing on the spinal cord. My words there explain why the top of the neck calls for extra caution: “The higher up, the more important.” Every nerve below passes through there.

Atlas Misalignment and the Non-Force Adjustment

Rotation is one common misalignment of the atlas. The other is a slight shift to one side, which I call a lateral listhesis. I look for both, along with how the joint moves, the muscles around it, the symptoms and any scans.

My non-force adjustment contacts the lateral mass of the atlas, the thick block of bone on each side of its ring. I use the slightest pressure, at an angle set by each person's needs. Care is kept within what you can comfortably tolerate: just a gentle pressure along the atlas. That is what I mean by a non-rotatory adjustment.

For a stable neck, I may use an Activator, a small hand-held instrument, at its lowest setting, level one, with a cushion. You stay seated, and I deliver it very gently along the muscles at the back of the neck. It goes on the soft tissues beside the lateral mass, not on the bone itself. At times I send the level one impulse through my contact finger, which lessens the force further. When a neck proves unstable, the non-force method is the next choice.

Many clinics describe their work as upper cervical care, and the methods behind that name differ a great deal. In my view, care at the upper neck, the atlas above all, may not be suitable if it uses anything other than a non-force method. The same goes for the soft tissues around it if they receive more than a very low force. The questions worth asking any clinic are in the FAQ below.

At the same visit, I also adjust the jaw, the lower neck, and the rib joints where they meet the spine and the breastbone. The examination decides which. When the disc in the jaw has slipped, C1 may need the utmost attention as well. Trouble at C1 can sit on the same side as the jaw problem. In my experience, that calls for chiropractic and physiotherapy together, or this non-force adjustment. The jaw guide covers the jaw itself.

Arranging an Upper Cervical Assessment in Kuala Lumpur

An upper neck assessment can be arranged at either of CSC's two centers in Kuala Lumpur, Malaysia. After a long interview, the first visit checks the joints from the skull to C3, the nerves of the arms and balance. It takes half an hour to two hours. The contact page has directions and opening hours for each center.

When you book, say whether the symptoms followed an injury and whether you have scans. Also mention any new numbness, weakness, dizziness, severe headache, fainting, or change in vision or speech. Bring a list of your medicines, including blood thinners, steroids and any taken for bone strength, migraine or blood pressure. If any of these come on suddenly, call 999 first; the stroke signs are listed under When a Hospital Comes Before Neck Care.

How an Upper Cervical Chiropractor Assesses the Neck

The first visit starts with a long interview: how the problem began, what changed it and everything already tried. It also covers bone health, inflammatory joint disease, past neck surgery, migraine, blood pressure and medicines such as blood thinners or steroids. Bring the imaging itself, on a CD or film, as well as the reports. I do not rush the visit, and the slightest discomfort during the examination should be mentioned at once.

The examination then covers:

  • Turning, nodding and tilting of the head, compared side to side. Turning should be equal both ways.
  • The joints from the skull to C3 and the muscles around them.
  • The upper back, which I call the foundation for the neck in Neck Trigger Points and Exercises.
  • Nerve checks in the arms and hands: feeling, strength and reflexes.
  • Balance and walking, and the jaw when it is involved.

Problems with the blood vessels of the neck are rare. Even so, the international framework for examining the neck asks that they be considered before any planned neck treatment. That means careful questions and an adapted examination (Rushton and colleagues, 2023).

Not everyone needs imaging, and no X-ray is taken until the assessment is complete and points to a clear reason. In Is Chiropractic Safe? 13 Questions Answered, I call an MRI the gold standard for the neck. It involves no X-ray radiation, and it shows the bones, joints, muscles and ligaments, along with the room around the nerves.

A scan finding and a symptom do not always match. A review of MRI studies covered people over 16. In about one healthy person in four, it found some pressure on the spinal cord in the neck, without symptoms (Smith and colleagues, 2021). My Back Pain to Leg Pain talk puts it plainly: “the most common symptom of spinal disc damage is zero.”

Upper Cervical Chiropractic Treatment: How I Choose a Method

Chiropractic has hundreds of techniques, and the one I choose has to fit the condition underneath the symptoms. I make that point in Is Chiropractic Safe? 13 Questions Answered.

SituationWhat I use or avoid
A stable atlasThe non-force contact on the lateral mass, with an Activator at level one on the soft tissue beside it when suitable.
An unstable upper neckThe non-force method, my next choice in place of the Activator.
Moderate or severe degeneration, a disc problem or a pinched nerveCare that does not twist the spine. My examples are chiropractic manipulation that is non-rotatory using the Activator instrument, and SOT, which uses padded wedges. Flexion-distraction uses a moving table section, and the Thompson technique uses table sections that drop slightly.
In the forties or older, with wear, a bone spur or a pinched nerveNo method that makes the joint crack.
A jaw problem with C1 involved on the same sideChiropractic and physiotherapy together, or the non-force, non-rotatory upper cervical adjustment.
AnyoneNo towel pulls, Y-Strap or other forceful neck traction.

The crack sometimes heard during an adjustment is a cavitation, a release of gas from the joint. It does not mean a bone has popped in or out.

I am not a big fan of rotary manipulation. My rule in Sciatica vs Slipped Disc: Video Explanation is to use it only “when I am 100% sure that there's no spinal disc damage.” Even a very well experienced chiropractor should not crack or twist a spine whose disc is damaged.

Two more answers from Is Chiropractic Safe? 13 Questions Answered shape every visit. The first is about comfort. If care brings any discomfort, it is being done too aggressively. Say so to the clinician straight away, however slight it feels. My motto has always been “No pain, more gain.”

The second is about combining care. I have always recommended chiropractic and physiotherapy together, and my advice is “Don't choose between one or the other. Choose both.” In my words there, “The chiropractic adjustment is not sufficient to impact every tissue, at that depth. That is where physiotherapy comes in.”

Around the adjustment, my plan for the upper neck usually draws on these:

  • Gentle trigger point and myofascial work on the trapezius and the rhomboids, the muscles over the shoulders and between the shoulder blades. Myofascial work is on a muscle and the thin tissue wrapping it, a few seconds a point and never deep. It stays away from the front of the shoulder and past its top, where the artery, vein and nerves of the arm run.
  • Cold therapy with the QMD cryothermal device. For a neck with a disc or facet joint problem, its heat setting stays off. The facet joints are the small joints at the back of the spine. My Back Pain to Leg Pain talk explains that heat raises inflammation as well as blood flow. Hot packs therefore stay off a damaged disc or an inflamed area.
  • Exercise and balance work once the neck is ready, described below.
  • Eye and head coordination exercises when the neck's position sense is involved, and a graded plan for returning to work, driving and sport.

Is Chiropractic Safe? 13 Questions Answered

Forceful Neck Pulls: Why I Avoid Them

In Neck Cracks Are Dangerous, I explain why I avoid every aggressive neck method. One is a towel wrapped around the neck and yanked. Another is a Y-Strap set behind the skull and under the jaw, then pulled hard. A third is grabbing the sides of the neck and pulling.

The neck's joints are small and its discs soft. A forceful pull can disturb the vertebral artery, and where bone spurs sit near it, damage it. That can lead to bleeding, an aneurysm or a stroke.

A yank also jolts the brainstem and the spinal cord. It can push a mild bulge on to a severe herniation, or split a worn disc; an MRI report may call that an annular tear.

Years without a problem are no protection, and forceful pulling is not justified at any age. I single out women on birth control pills and people with raised blood pressure, disc bulges or herniations, spondylosis or an unstable neck. They need to be extremely careful about what is done and who does it. If anyone starts such a pull, “ask them to stop.”

Neck Cracks Are Dangerous

The Ring Dinger guide covers another forceful neck pull of this kind, never used at CSC, and its risks.

When a Hospital Comes Before Neck Care

Some signs point beyond the neck joints and need a hospital first, with or without neck pain. The US Centers for Disease Control and Prevention lists these signs of stroke:

  • Sudden trouble walking, dizziness, loss of balance or poor coordination.
  • Sudden trouble seeing.
  • Sudden numbness or weakness of the face, an arm or a leg, especially on one side.
  • Sudden confusion, or trouble speaking or understanding speech.
  • A sudden, severe headache with no known cause.

If any of these appear, call 999 for an ambulance straight away rather than driving. Several causes are possible, and a hospital is the place to check them.

Weakness in an arm or hand that keeps getting worse should not be ignored. It calls for a careful assessment by a competent provider, and conservative care can continue only while the weakness itself is improving. Conservative care, as I mean it, is focused care built on the imaging and examination findings, never run-of-the-mill neck treatment. Many forms of it are useless.

A disc pressing on the spinal cord in the neck can reach beyond the arms. My Back Pain to Leg Pain talk describes weakness in the legs and trouble standing or walking. New unsteadiness on the feet is therefore assessed promptly. Any loss of bladder or bowel control, or a new change in it, needs urgent medical attention at a hospital emergency department straight away, within hours. Neck pain after a serious fall or road accident is examined carefully before any method is chosen, and imaging may come first.

Upper Cervical Symptoms: What People Notice

People usually arrange an upper cervical assessment because of one or more of these:

  • Pain or stiffness at the base of the skull.
  • Head turning that is limited or uncomfortable, often more to one side.
  • Upper neck symptoms after long desk work, driving, a bad night's sleep, exercise or an old injury.
  • Headaches that seem to follow neck movement or a held posture.
  • Symptoms spreading toward the upper back, a shoulder blade, the shoulder, the jaw, an arm or a hand.
  • A scan report that names C0-C1, C1-C2, C2-C3, the atlas or the axis.
  • Dizziness, unsteadiness, ringing in the ears, visual changes, facial symptoms or trouble swallowing alongside the neck symptoms.

None of these places the problem at one level for certain. Muscles, joints, nerves, the jaw, the upper back and the inner ear can all produce similar symptoms. Facial numbness, trouble swallowing or a change in vision also needs the right medical, dental, eye or nerve assessment. A neck examination never delays that assessment. Sudden stroke signs, listed under When a Hospital Comes Before Neck Care, need 999 first.

Headaches, Dizziness and Ringing in the Ears

Headaches that seem to start in the neck, sometimes called cervicogenic headaches, are examined along with the upper neck joints. Headaches also have many other causes, and the headache and migraine guide covers them.

Dizziness when moving the neck has several possible causes, including the inner ear. One is benign paroxysmal positional vertigo, an inner-ear disorder that brings repeated spells of spinning when the head changes position (Bhattacharyya and colleagues, 2017).

Dizziness can mean spinning, light-headedness, unsteadiness or feeling faint. Conditions to rule out include inner ear and brain balance disorders, vestibular migraine, neck artery problems and whiplash (Reiley and colleagues, 2017). Medicines, dehydration, anxiety and eyesight problems can also cause it.

The neck can contribute as well. Its sensory receptors feed the balance and visual systems. In neck disorders, changed signals can show up as poorer joint position sense, eye movement control and steadiness (Treleaven, 2008).

Ringing in the ears and changes in vision call for wider checks of the ears, eyes, blood vessels and nerves, by a doctor where needed. A neck examination does not replace those checks, and none of these symptoms is assumed to come from the atlas. In my view, the upper neck can still play a part in some of them, such as ringing in the ears. Cranial Nerves, the Styloid and Eagle-Like Symptoms explains why.

When ringing in the ears comes with jaw or neck symptoms, my tinnitus treatment guide sets out who provides which care, from ear checks to neck and jaw care.

Four Suboccipital Muscles and the Myodural Bridges

Four small muscles lie under the base of the skull, the suboccipitals. They hold the head steady and let it tip back and turn. The suboccipital nerve, from C1, supplies all four (George and Tadi, 2023).

MuscleRuns from and toWhat it does
Rectus capitis posterior majorSpinous process of C2 to the skull's inferior nuchal lineTips the head back and turns it to the same side
Rectus capitis posterior minorRear tubercle of C1 to the skull's inferior nuchal lineTips the head back
Obliquus capitis superiorTransverse process of C1 to the skull, between the nuchal linesTips the head back and bends it to the side
Obliquus capitis inferiorSpinous process of C2 to the transverse process of C1Turns the head to the same side

Bands of tissue called myodural bridges join three of these muscles to the dura, the spinal cord's tough covering (Xu and colleagues, 2016). In dissections, the minor rectus had such a band where the skull meets the atlas in all 11 specimens (Hack and colleagues, 1995).

The inferior oblique sent visible strands to the dura in 12 of 12 specimens. A microscope confirmed the link in 75 percent, and the rest could not be assessed (Pontell and colleagues, 2013). A review describes a major rectus bridge too. Because of its larger cross-section, it may pull harder on the dura than the minor rectus bridge (Enix and colleagues, 2014).

A 2026 review treats these bridges and the nuchal ligament as one structure, the myodural bridge complex, anchored where the skull meets the spine. Its proposed jobs include keeping the dura from folding during head movement and a part in spinal fluid flow. It may also pass position signals from the muscles to the brain and spinal cord. The review also ties changes in the complex to neck-related headaches and dizziness, and to Chiari malformation type I (Zhang and colleagues, 2026).

Human scans show that head movement affects spinal fluid flow. In 40 healthy adults, a minute of turning the head increased spinal fluid flow at the skull's base on MRI (Xu and colleagues, 2016). A minute of nodding lowered some measures of that flow in 60 healthy adults (Xu and colleagues, 2021). Those authors propose that the muscles tug on the dura through the bridges. In rats, shrinking or enlarging these muscles changed how fast spinal fluid was made and absorbed (Yang and colleagues, 2023).

These muscles hold many muscle spindles, sensors that report stretch and tell the brain where the head is. A study of fetal tissue counted about 242 per gram in the inferior oblique and 190 in the superior oblique. The rectus capitis posterior held 98 per gram (Kulkarni and colleagues, 2001). Such signals feed into posture and into coordinating the eyes with the head.

Symptoms Linked to the Suboccipital Muscles

StatPearls connects these muscles with cervicogenic headache, which starts in the neck and is felt in the head. One idea is that their tension passes through the bridges to the dura. In people with this headache, one study found these muscles tighter and stiffer than in healthy people (George and Tadi, 2023).

Where the C1 to C3 nerve branches leave the spine, tight suboccipital muscles can trap them. The trapezius and splenius capitis, which lie over them, can do the same (Kaprive and Das, 2023). One of these nerves, the greater occipital nerve from C2, passes the lower border of the inferior oblique and crosses the suboccipital triangle. That muscle is one place it can be compressed, and this nerve accounts for 90 percent of occipital neuralgia cases (Djavaherian and Guthmiller, 2023).

Because these muscles report head position, changes in them may affect balance. A small study found that people with chronic neck pain swayed more when standing than people without it. On MRI, their major and minor recti were wasted and infiltrated by fat (McPartland and colleagues, 1997). A pilot study of six people with long-standing head and neck pain found fat replacing the recti in some (Hallgren and colleagues, 1994).

After whiplash, these muscles can be strained or go into spasm, and the suboccipital nerve can be injured. Spasm in these muscles or damage to that nerve can keep pain going (George and Tadi, 2023). A sudden snap of the neck forward and back may also pass tension through the bridges to the dura (Enix and colleagues, 2014).

Broader studies of the neck, not of these muscles alone, allow for a wider set of symptoms. Neck pain affected 85.7 percent of people with migraine or tension-type headache within a year, against 56.7 percent of those without (Ashina and colleagues, 2015). Across 22 whiplash studies, a review suggested a consistent pattern of reduced thinking skills, such as memory and attention (Kessels and colleagues, 2000). Dizziness is put down to the neck only once other causes have been ruled out (Reiley and colleagues, 2017).

In my experience, an upper neck problem can bring headaches and migraines of varying severity, mental fog, dizziness and a range of other symptoms. It is rare, but it can happen. In my view, these muscle and dural links are one reason an upper neck disorder can heighten Eagle-like symptoms or sensations, described below.

Posterior Brain Circulation and the Neck

The two vertebral arteries carry part of the brain's blood supply up through the upper neck. They join inside the skull as the basilar artery, which supplies the brainstem directly (Kaprive and Das, 2023). This posterior circulation also serves the cerebellum, thalamus and occipital lobes (Benjamin and Lui, 2025).

On its way, each artery crosses the suboccipital triangle, framed by three of these muscles, and gives them a muscular branch (George and Tadi, 2023). In significant atherosclerosis, StatPearls notes, contraction of the muscles may compress the artery a little and reduce the flow through it. This can cause light-headedness or dizziness (George and Tadi, 2023).

Above C3, branches of the first three neck nerves run alongside the artery. Whether these nerves control its flow has not been shown. In monkeys, electrically stimulating the artery's sympathetic nerves, rather than these branches, changed vertebral flow very little (Bogduk and colleagues, 1981).

Head position matters as well. Turning the head fully lowered vertebral artery flow inside the skull in healthy young adults, with a larger drop on the opposite side (Mitchell, 2003). I avoid forceful twisting at the top of the neck, for the reasons in Neck Cracks Are Dangerous.

Cranial Nerves, the Styloid and Eagle-Like Symptoms

Just above the atlas lies the brainstem. Serious injuries at this level carry a high risk to life, because the brainstem and blood vessels lie close by (Kaprive and Das, 2023). Below the skull, four cranial nerves pass the atlas: the glossopharyngeal, vagus, accessory and hypoglossal. With the internal jugular vein, these four run through a narrow gap between C1's transverse process and the styloid process (Ozveren and colleagues, 2003). C1's transverse process is its bony side wing, and the styloid process is a thin projection of the skull below the ear.

Five cranial nerves, in my view, run within a short distance of the lateral mass of C1. StatPearls, describing the styloid rather than C1, places the facial and hypoglossal nerves on its outer side. The glossopharyngeal, vagus and accessory nerves lie on its inner side (Abuhaimed and colleagues, 2023).

Case reports show that a broken or dislocated atlas can affect these nerves. Atlas fractures in one patient came with palsies of all four lower cranial nerves (Hsu and colleagues, 2004). The skull base in that case was also abnormal from birth. In another case, a patient with ankylosing spondylitis had a rotational dislocation of C1 on C2 and a tongue nerve palsy (Chien and colleagues, 2005).

The atlas can press on the internal jugular vein as well. One study examined 69 narrowed jugular veins. The transverse process of C1 compressed 35 by itself and 31 together with the styloid (Ding and colleagues, 2020).

Eagle syndrome is caused by an overly long or angled styloid, or by calcification of the ligament attached to it (Dua and Mohseni, 2026). Long styloids turn up in about one person in 25, and only about one in 25 of those produces symptoms. Women report symptoms more often (Dua and Mohseni, 2026).

The glossopharyngeal nerve is the one most often compressed, bringing throat and neck pain. Other symptoms include a feeling of something stuck in the throat, trouble or pain swallowing, ear pain, headache and facial pain. Pain on turning the head or chewing, ringing in the ears and voice changes are also described. Turning or swallowing can worsen these symptoms (Dua and Mohseni, 2026).

Pressure from the styloid on the carotid artery can instead cause brief stroke-like attacks, vertigo or fainting. Brief stroke-like attacks, fainting or a new loss of nerve function in one area need urgent medical assessment (Dua and Mohseni, 2026). Call 999 at once for the sudden stroke signs listed under When a Hospital Comes Before Neck Care.

The upper neck can imitate Eagle syndrome, in my view, anywhere from the occiput to C3, because the same nerves run there. I also believe a moderately or severely malpositioned C1 can mimic all the symptoms often linked with Eagle syndrome. StatPearls also notes that neck pain can resemble Eagle syndrome, especially with limited neck motion and bony change on imaging (Dua and Mohseni, 2026).

A styloid at the long end of normal often causes nothing on its own. In my experience, when it meets an upper neck malalignment, Eagle-like symptoms of differing degree become possible and even probable. Recognizing this takes an alert, experienced clinician who can judge whether the upper neck is involved. That clinician looks for upper neck involvement, which the styloid may complicate and a jaw joint problem may worsen.

Doctors judge the styloid's length, angle and closeness to nerves and vessels on CT with 3D reconstruction, the preferred imaging (Dua and Mohseni, 2026). Our Eagle syndrome guide explains the condition and its care in full.

Jaw Problems and Upper Cervical Care

Jaw and upper neck function appear to be linked. One study compared 37 people with painful jaw disorders with 20 people without symptoms. Upper neck rotation on the flexion-rotation test was reduced in the jaw group (Grondin and colleagues, 2015).

The two often go together. In my experience, a jaw problem tends to be at its most intense in parallel with a C1 problem on the same side. Jaw trouble can also stay silent at first: clicking, a jaw that drifts to one side as the mouth opens, or a joint out of alignment often brings no pain until a later stage. So my jaw care is more than chiropractic, physiotherapy and exercises for the jaw. Most importantly, it includes upper cervical care at C1, with the non-force atlas adjustment described above.

In my experience, the influence goes both ways. A chronic upper neck problem can trouble the jaw, and a jaw problem can affect the upper neck. Each of these guides looks at the jaw in more detail:

Upper Cervical Problems and the Lower Neck

In my experience, the upper neck does not work alone. From the occiput to C3, with the styloid and the jaw, the parts behave like one kinematic chain, a set of linked parts. When one goes, the other goes. None of them is a standalone problem.

In my view, the upper neck also relies on stability in the middle and lower neck. Instability, or nerve or cord compression lower down, can set off an upper neck problem as well.

Other factors shape upper neck symptoms and their assessment too. They include the shoulders and upper back, the eyes and inner ear, headache disorders, medicines, blood pressure, sleep, stress, illness and past injuries.

Why the Upper Neck Gets Strained

Many neck problems begin in the muscles, and if that goes on long enough, the joints and then the discs become involved. I explain that sequence in Neck Trigger Points and Exercises. In Poor Posture Damages Your Spine I trace the same path from poor posture. It strains the muscles, then the ligaments, then the joints, and eventually reaches deep into the disc.

Phones and screens add to the load. In my Back Pain to Leg Pain talk I warn young and old about tech neck, or text neck. Neck pain is fast catching up with back pain, mainly because of posture and technology.

As I say in Neck Cracks Are Dangerous, most people with a stiff neck have some wear or arthritic change. Turning to a chiropractor or physiotherapist for that stiffness is perfectly normal. Age is one factor among several, alongside posture, daily habits, past injuries and genetics. A fall, a sports knock or a road accident can strain the upper neck too.

Simple Self-Checks Before an Assessment

In Neck Trigger Points and Exercises I describe three simple checks:

  • Turn your head to each side. Discomfort on the side you turn toward could mean a joint is involved.
  • Look up, then down. When that causes discomfort in the upper back or around a shoulder blade, a joint or a disc is usually involved.
  • Compare both directions. A turn that is shorter on one side can come from a muscle or a joint.

In the neck, joint, nerve and disc problems can all feel muscular, so a pulling feeling can hide the real source. Show any home routine to your doctor or healthcare provider before trying it.

Until the assessment, keep a short note of what sets the symptoms off, any dizziness or headache, medicine changes and any numbness or weakness. Sudden stroke signs need a 999 call, not a note; they are listed under When a Hospital Comes Before Neck Care. Do not copy neck cracking or pulling from online videos.

Daily Habits for the Upper Neck

  • At a desk, raise the laptop or connect a monitor so your eyes sit slightly below the top of the screen, and look straight ahead. I go through the setup in Desk Posture Mistakes.
  • Keep the phone on the left if you are right-handed, or use a headset.
  • With neck or back pain, get up every 15 to 20 minutes, stand and walk for 30 to 60 seconds. If the neck and back are free of pain, getting up every 30 to 40 minutes is enough.
  • Sleep on your side with the spine in one straight line and no bend in the neck. Lying half turned onto the stomach twists the spine.
  • Lying on your back, rest your knees over a bolster and keep the curve of the neck supported. A rolled towel tied at each end suits people who barely move in their sleep, and it can go in the wash every week.
  • There is no perfect pillow. Choose a soft one, ideally with a thin side and a thick side.
  • Aim for at least six hours of sleep, and seven to eight hours unbroken where possible. I cover sleep positions in Neck and Back Self-Help Tips: Posture, Sleep and Movement.

For the neck and back, lifestyle changes matter more than any treatment, as I tell the audience in my Back Pain to Leg Pain talk. Change habits while it hurts, because once it feels better, little changes.

Neck Exercises: When They Start

My Back Pain to Leg Pain talk sets two criteria for exercise: condition specific and age appropriate. In Sciatica vs Slipped Disc: Video Explanation, I add that it starts only when you are ready; begun before then, it creates more problems.

The exercises I show in Neck Trigger Points and Exercises are gentle, and even these need your provider's approval first:

  • W, T and L positions, named for the arm shapes: shoulders pushed down and never shrugged, shoulder blades squeezed and the chest pushed out. Hold for five seconds, or three seconds if five is too much. Repeat W and T five to 15 times, and L 10 to 15 times.
  • Isometrics: press your head against your own hand, never someone else's, forward, back and to each side, without moving the neck. Hold for five seconds and repeat five to 15 times. Stop if numbness, tingling or any discomfort appears; it means you are not ready.

I strengthen the upper back this way because it is the foundation for the neck. With a disc problem, general neck stretching is not for you. My Back Pain to Leg Pain talk shows why: bending the head to one side squeezes the joints on that side and pushes the disc. Other exercises belong in a supervised setting, with a physiotherapist or alongside chiropractic care.

Balance exercise is part of rehabilitation for a neck problem, done in the clinic where someone can hold on to you.

Older Adults, Pregnancy and Children

From the forties on, with wear, a bone spur or a pinched nerve, I do not recommend a method that makes the joint crack. I explain why in Is Chiropractic Safe? 13 Questions Answered. Bone strength, medicines such as blood thinners, and balance are checked before any method is chosen.

Pregnancy can change positioning, comfort, medicines, blood pressure and how a headache is assessed, so care is planned around it. Previous neck surgery, known instability, inflammatory disease or a difference present from birth may call for records, scans, a specialist's opinion or a different method.

Very young children receive non-force care only. For teenagers, I may use a low-force method, chiropractic manipulation that is non-rotatory using the Activator instrument. A parent or guardian can stay with the child throughout every visit. The guide to neck manipulation in children covers the research on children.

Fees are listed on the chiropractic price page and the physiotherapy fees page. The fee for a plan is explained and agreed before care begins.

These pages cover each neck level, related neck, head and jaw problems, the main videos quoted above and the centers:

Neck Levels

Neck, Head and Jaw

Videos and Centers

FAQ About Upper Cervical Chiropractic

Is Upper Cervical Chiropractic Safe?

It is safe under my two conditions in Is Chiropractic Safe? 13 Questions Answered: a competent, registered chiropractor, and care that is condition based. At the atlas, my adjustment is non-force and non-rotatory, with the slightest pressure on its lateral mass. Strap and towel pulls play no part in my care, for the reasons in Neck Cracks Are Dangerous. Before any method is used, its possible effects and its risks are explained, and you can ask questions or decline it.

How Do I Choose an Upper Cervical Chiropractor Near Me?

Look for a registered chiropractor who assesses you before choosing a method and explains what will be done and why. Care should stay within what you can comfortably tolerate. A scan should be ordered only when the assessment shows it is needed, and forceful neck pulls should play no part. Before deciding, describe the neck problem to each center you are considering and ask which method it would use at C1 and C2. Ask how much force that involves, whether there is any twisting or quick thrust, and what changes if the neck proves unstable.

Is Upper Cervical Care Different From Neck Pain Treatment?

Upper cervical care centers on the three joints from the skull to C3. Neck pain can start at any level down to the top of the back. In practice the two overlap. My examination covers the whole neck and the upper back, which I call the foundation for the neck in Neck Trigger Points and Exercises. At the same visit, I may also adjust the lower neck, the jaw and the rib joints when the examination calls for it. The neck pain treatment guide covers the lower neck levels in more detail.

How Many Visits Will I Need?

No number can be set before the assessment. How quickly things change depends on how severe the problem is, what lies underneath it, and how closely the advice is followed. My two checkpoints come from Is Chiropractic Safe? 13 Questions Answered. Should the fifth session bring no improvement, I reassess at once rather than wait. If there is still none by the tenth, whether to continue is decided together. Active care ends at what I call maximum medical improvement: the point where two to three further weeks of care change nothing.

Is Upper Cervical Care Suitable After Whiplash?

It depends on what a careful examination finds after the accident or fall, and a scan may be needed first. Whether the upper neck is stable decides the method. For a stable neck, an Activator at its lowest setting may be used beside the atlas. When a neck proves unstable, the non-force method is my next choice. Sudden weakness, dizziness or loss of balance, trouble seeing or speaking, or a severe headache need a hospital before any neck care. Call 999 for an ambulance rather than driving. The whiplash guide covers injuries of this kind.

Can I Have a Consultation Without an Adjustment?

Yes. A first visit is an assessment and a discussion. You can ask questions, decline any method, ask for a gentler one or choose not to go ahead. Bring your scans, your questions written down and perhaps a family member, because questions are easily forgotten once you are in the room.

Can Upper Neck Problems Affect Blood Flow to the Brain?

In some people they may. The vertebral arteries carry blood to the back of the brain and pass between the suboccipital muscles on the way. StatPearls notes that in significant atherosclerosis, those muscles may squeeze the artery a little as they contract, with light-headedness or dizziness (George and Tadi, 2023). The C1 to C3 nerve branches run with the artery (Bogduk and colleagues, 1981). They have not been shown to control its flow. Sudden stroke signs need 999 first; the full list is under When a Hospital Comes Before Neck Care.

Can an Upper Cervical Problem Cause Dizziness or Mental Fog?

In my experience it can, though rarely. Dizziness, mental fog, and headaches or migraines of varying severity are among the symptoms I see with upper neck problems. Research allows for some of this. Changed signals from the neck's receptors can be related to dizziness and unsteadiness (Treleaven, 2008). Whiplash studies also suggest a consistent pattern of reduced thinking skills, such as memory and attention (Kessels and colleagues, 2000). Dizziness also has many other causes, including the inner ear, so those are checked first. The neck is named as the cause only when they are excluded (Reiley and colleagues, 2017).

Can Symptoms Show Which Upper Cervical Level Is Involved?

Not with certainty. Where a symptom is felt guides the examination. Still, muscles, joints, discs, nerves, the jaw, the upper back, headache disorders and the inner ear can all overlap. Some patterns lean one way: a stiff nod points toward C0-C1 and stiff turning toward C1-C2. The C2-C3 joint is involved in about 70 percent of cervicogenic headaches (Al Khalili and colleagues, 2022). The examination of each joint, its muscles and its nerves decides.

What Are the Suboccipital Muscles and Why Do They Matter?

They are four small muscles under the back of the skull: the major and minor rectus capitis posterior and the superior and inferior obliquus capitis. They steady the head, tip it back and turn it. They also hold many position sensors that feed balance and eye movement. Because they are tied to the dura and frame the vertebral artery, they may play a part in some headaches and dizziness. The section on these muscles above covers them in depth.

How to Read This Guide

Where a position is mine, it is written in the first person. Where it comes from one of my videos or my talk, that video or talk is named. Each study is cited by first author and year and linked to its published record. The guide is general, and what applies to any one neck can only be decided by examining it.

References

None of these sources evaluated care at Chiropractic Specialty Center; they describe the neck, its muscles and nerves, dizziness, Eagle syndrome and stroke in general.

The Author of Upper Cervical Chiropractor KL: Non-Force Atlas Adjustment

Upper Cervical Chiropractor KL: Non-Force Atlas Adjustment was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.

Last Updated: Upper Cervical Chiropractor: C0-C3 Chiropractic in KL

Upper Cervical Chiropractor: C0-C3 Chiropractic in KL was last reviewed and updated on October 28, 2026.

Baca halaman ini dalam Bahasa Malaysia: Kiropraktor Servikal Atas: Kiropraktik C0-C3 di KL

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