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Diagram of the occiput and atlas seen from behind: the base of the skull resting on the atlas (C1) at the two C0-C1 joints, with no disc, the axis (C2) below and the vertebral artery crossing the atlas

Occiput and Atlas (C0-C1): What This Joint Does

The occiput and atlas meet at the top of the neck, where the base of the skull rests on the first neck bone. Spine charts number this atlanto-occipital joint C0-C1. It bears the weight of the head and does much of its nodding, while the joint one level lower does far more of the turning. A stiff nod is one sign that this joint deserves a closer look. When this joint is stiff, an occiput adjustment at CSC uses the lightest contact on the atlas, never a twist.

My adjustment of the atlas is a non-force contact on its lateral mass. That is the thick block on each side of the ring, and it holds the skull. The pressure is the slightest, at an angle set for each person, and the neck is never twisted. The care plan around it follows the examination and may pair chiropractic with physiotherapy.

Every step is kept within what you can comfortably tolerate, and a hard pull under the skull plays no part. The sections below cover finding the occiput by touch, the nearby nerves, arteries and cranial nerves, and Eagle syndrome. They also cover the jaw, my examination, occipital lifts, hospital warning signs and home care.

This guide, Occiput and Atlas (C0-C1): Anatomy, Symptoms, Adjustment, is published by Chiropractic Specialty Center, Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Occiput and Atlas: Key Takeaways

QuestionShort answer
What is the occiput?The occiput is the back and base of the skull, formed mostly by the occipital bone. Its large opening, the foramen magnum, lets the brainstem pass down and become the spinal cord (Germann and Kashyap, 2023).
How is the atlas adjusted?That depends on stability. On a stable neck, I may use chiropractic manipulation that is non-rotatory using the Activator instrument, at its lowest setting, on soft tissue. If the neck proves unstable, the non-force contact is my next choice.
How is the jaw linked to the atlas?In my experience, a jaw problem is often most intense in parallel with a C1 problem on the same side. For the jaw, the most important part of my care is therefore upper cervical care, alongside chiropractic, physiotherapy and exercises for the jaw itself. The Jaw and Upper Neck: A Two-Way Link explains how each affects the other.
Why is the occiput called C0?Neck bones are numbered from the atlas, C1, downward. The occiput sits directly above it, so it counts as level zero, and the joint between them is written C0-C1 or Oc-C1.
Is a hard pull under the skull safe?No. In Neck Cracks Are Dangerous I explain that a yank at the top of the neck jolts the brain, spinal cord and nerves together. It can also damage the vertebral artery.
When does a hospital come first?After a crash, a bad fall or a hard blow to the head, assume a possible spine injury, even without numbness or weakness. Keep the person still and call 999. Sudden signs of a stroke need 999 straight away too.
Is there a disc at C0-C1?No. The occipital condyles, two rounded knuckles under the skull, rest in cupped sockets on top of the atlas. Discs join vertebral bodies, the solid front blocks of neck bones, and the atlas has none (Kaiser and colleagues, 2023).
Which cranial nerves pass near C0-C1?Four cranial nerves, among them the vagus, run down past the atlas between it and the styloid process (Ozveren and colleagues, 2003). In my view, five cranial nerves pass a short distance from the lateral mass of C1.
How common is neck pain?In 2020, neck pain affected about 203 million people worldwide, with a higher rate in women than men (GBD 2021 Neck Pain Collaborators, 2024). About 269 million are projected by 2050. Serious structural problems at C0-C1 are far rarer.
How far does this joint move?About 23 to 24.5 degrees of nodding, but only about 2.4 to 7.2 degrees of turning. The joint below, C1-C2, turns about 23.3 to 38.9 degrees (Lopez and colleagues, 2015).
C0-C1 Guide: Sections at a Glance

Where Is the Occiput? Finding It by Touch

The occipital bone is the skull bone farthest back, and it makes up most of the occiput. It shelters the cerebellum and the rear lobes of the brain, and many neck muscles and ligaments anchor to it (Germann and Kashyap, 2023).

To find it, slide a fingertip up the middle of the back of the neck, past the hollow under the skull. The firm bump on the skull just above is the external occipital protuberance, and its highest point is called the inion. A ridge called the superior nuchal line runs out to each side of it (Germann and Kashyap, 2023).

Neck muscles such as the semispinalis capitis attach along that ridge. The trapezius and a strong midline ligament attach at the bump. Below the ridge, deeper muscles fill the space between the skull and the atlas, among them the small suboccipital muscles.

Under the skull, the bone curves forward to a large opening, the foramen magnum. The brainstem passes down through it to become the spinal cord, and the vertebral arteries pass up through it to the brain. On each side of that opening sit the occipital condyles, two rounded knuckles that rest on the atlas. With the atlas, they form the two C0-C1 joints, one on each side.

Atlanto-Occipital Joints (C0-C1): How the Skull Sits on the Atlas

The atlas is a ring with no vertebral body, which leaves room for the spinal cord as it leaves the foramen magnum. Its two lateral masses carry cupped, inward-facing sockets that receive the occipital condyles (Kaiser and colleagues, 2023).

In 201 samples from a Thai population, the condyles were most often oval and the matching sockets on the atlas most often eight-shaped. Both were larger in men (Treranan and colleagues, 2025).

This joint passes the weight of the head down to the spine. It also does much of the forward and backward bending of the head. And it limits sideways sliding of the skull (Kaiser and colleagues, 2023).

The joint sits close to the brainstem, the upper spinal cord and the vertebral arteries. Each vertebral artery crosses the rear arch of the atlas before it enters the skull. It is not built for forceful twisting or yanking, one reason the methods used at this level are gentle.

Close-up of one C0-C1 joint seen from the side: the rounded occipital condyle at the base of the skull rests in the cup of the atlas lateral mass, both surfaces lined with cartilage, a thin joint space with no disc, a capsule around the joint, and an arrow showing the skull rocking when the head nods
One of the two C0-C1 joints up close, seen from the side. The rounded base of the skull rests in a cup on the atlas. Cartilage lines both surfaces, with no disc between them, and the skull rocks in the cup when you nod.

Measured ranges show how differently the top two joints share the work:

MovementC0-C1 (occiput on atlas)C1-C2 (atlas on axis)
Nodding forward and backAbout 23 to 24.5 degreesAbout 10.1 to 22.4 degrees
Bending to the sideAbout 3.4 to 5.5 degreesAbout 6.7 degrees
Turning to the sideAbout 2.4 to 7.2 degreesAbout 23.3 to 38.9 degrees

These ranges were gathered from several studies (Lopez and colleagues, 2015). They vary between people and with the way they were measured.

In 44 healthy adults, forward and backward bending at the neck levels measured varied widely between people (Dvorak and colleagues, 1991). Even in one healthy neck, the range varies with time and with the direction the head moves (Bogduk and Mercer, 2000). This split still matters in an examination. A stiff nod tends to point to C0-C1 and stiff turning to C1-C2, and each calls for different work.

In a small number of people, the atlas is partly or fully fused to the skull from birth, a change called atlanto-occipital assimilation. Estimates put it at 0.14 to 0.75 percent of people. Most have no symptoms, although some develop pressure on the spinal cord in the neck (Ho and colleagues, 2024).

How Common Are Problems at the C0-C1 Junction?

Significant structural problems at C0-C1, such as instability, are uncommon. Fusion of the atlas to the skull, described above, is one of them. Soft tissue injury can loosen a joint before much damage is visible. In pig neck spines, the first sign of injury was extra looseness around the resting position, with few visible lesions (Oxland and Panjabi, 1992).

Neck pain in general is very common. In 2020 it affected about 203 million people worldwide, and about 269 million are projected by 2050. Women had a higher rate than men (GBD 2021 Neck Pain Collaborators, 2024).

It is common in the young too. Global Burden of Disease data for people aged 10 to 24 show neck pain case numbers rising between 1990 and 2019 (Fu and colleagues, 2025).

Long spells looking down at phones are linked with more neck pain in the young. A clinic study looked at 180 children and teenagers with neck pain and muscle spasm (Fares and colleagues, 2017). Every one reported bending the neck and back forward while studying or using phones and tablets. In 622 Colombians aged 10 to 18, phone overuse and trouble cutting back were linked with neck pain (Parra-Fernández and colleagues, 2025).

How C0-C1 Relates to the Rest of Your Neck

C0-C1 is the top of a chain of joints. In my view, when one level is stiff, the levels next to it often take on more movement. C0-C1 and C1-C2 work as a pair, so stiffness at one changes the load on the other and on the muscles around them.

In my experience, none of the problems at the top of the neck stands alone, and that includes the jaw and the styloid process. When one goes, the other goes, much like a kinematic chain. The upper neck also relies on a stable middle and lower neck. As I see it, instability there, or pressure on a nerve or on the spinal cord, can lead to an upper neck problem too.

Each level below has its own role:

  • C1-C2 does most of the head's turning, about half of the neck's total (Kim and colleagues, 2024).
  • C2-C3 links the upper neck to the middle neck. Its joint is the most frequent source of headache that starts in the neck (Al Khalili and colleagues, 2022).
  • C3-C4 takes part in side bending and neck posture.
  • C4-C5 sits where nerves to the shoulder and the diaphragm emerge.
  • C5-C6 is one of the most loaded neck levels and a common site of disc wear.
  • C6-C7 is linked with grip and hand function.
  • C7-T1 joins the neck to the upper back.

Arranging an Upper Neck Assessment in KL

Both KL centers of CSC, in Bukit Damansara and Bandar Sri Damansara, examine the occiput, the atlas and the joints around them. Allow from half an hour to two hours for a first visit, since complex problems take longer. Bring any scans on CD or film with their reports. When you book, mention any recent injury, dizziness, changes in vision or new nerve symptoms. Directions and opening hours for both centers are on the contact page. Each center also has its own: the Bukit Damansara contact page and the Bandar Sri Damansara contact page.

Banner reading Occiput C1 Chiropractic and Physiotherapy Care, with a clinician's hands cradling the back of the head of a woman lying face up

Nerves, Arteries and Muscles Around C0-C1

On each side, a vertebral artery rises through a column of small openings beside the neck bones. Above C2 it bends outward into the opening in the atlas. It then turns back across the top of the rear arch and enters the skull (Kaiser and colleagues, 2023). In my video Neck Cracks Are Dangerous, I describe this artery as more critical even than the nerves.

The first neck nerve, C1, sends a branch backward called the suboccipital nerve. It lies between the rear arch of the atlas and the vertebral artery, and it supplies the small suboccipital muscles (Graefe and Jozsa, 2024).

One of those muscles, the rectus capitis posterior minor, is tied to the dura, the tough covering of the spinal cord. A cadaver study found a band of tissue joining the two at C0-C1 in all 11 specimens (Hack and colleagues, 1995). In Neck Cracks Are Dangerous, I explain that the brain and the spinal cord are one organ in a single sheath. That sheath, the dura, reaches all the way down to the tailbone.

The greater occipital nerve carries fibers from the second neck nerve, C2, up over the back of the head (Germann and Kashyap, 2023). The anatomy behind occipital neuralgia is the subject of an early study by Bogduk (1981). When this nerve or its neighbors are the source, the result can be occipital neuralgia. It brings brief attacks, often stabbing or shooting, over the back of the head, lasting seconds to minutes (Djavaherian and Guthmiller, 2023). Telling it apart from other causes takes an examination, and it is never assumed to come from the atlas.

Suboccipital Muscles and the Myodural Bridge

Four small muscles lie under the back of the skull: the rectus capitis posterior major and minor, and the obliquus capitis superior and inferior. They steady the head and let it extend and turn. All four are supplied by the suboccipital nerve, the rear branch of C1 (George and Tadi, 2023).

Two of them work directly across this joint (George and Tadi, 2023):

  • Rectus capitis posterior minor: from the rear tubercle of C1 to the skull, where it attaches at the inferior nuchal line. It extends the head.
  • Obliquus capitis superior: from the transverse process of C1 up to the skull between the nuchal lines. It extends the head and tilts it to the side.

The other two start on C2 and are covered in the C1-C2 guide.

The rectus capitis posterior minor does more than move the head. As described above, a band of tissue joins it to the dura in the gap between the skull and C1. Similar bridges join the rectus capitis posterior major and the obliquus capitis inferior to the dura (Enix and colleagues, 2014; Pontell and colleagues, 2013).

These links are called myodural bridges. A 2026 review describes them, with the nuchal ligament, as one complex that anchors the dura where the skull meets the neck. It is thought to steady the dura when the head moves and to assist the flow of spinal fluid. It is also thought to relay position signals from these muscles to the central nervous system (Zhang and colleagues, 2026).

The same review links changes in this complex with headache and dizziness that start in the neck, and with Chiari malformation (Zhang and colleagues, 2026). One early paper proposed the bridge as a cause of headache from the neck (Alix and Bates, 1999). In a single reported case, chronic headache lessened after surgery separated the bridge from the muscle (Hack and Hallgren, 2004).

These muscles are also rich in muscle spindles, the sensors that report stretch and position. In one study of fetal tissue, the superior oblique held about 190 spindles per gram. Their signals take part in head and eye coordination and posture (Kulkarni and colleagues, 2001). In a small study of people with chronic head and neck pain, MRI showed the rectus muscles partly replaced by fat (Hallgren and colleagues, 1994).

Symptoms have been tied to these muscles too. In one study of cervicogenic headache, they showed more tone and stiffness than in healthy people. After whiplash, strain or spasm in them, or damage to the suboccipital nerve, can keep pain going (George and Tadi, 2023).

In my view, these connections mean an upper neck disorder can make Eagle-like symptoms or sensations stronger. In my experience, people with an upper neck problem can also have headaches and migraines of varying degree, mental fog, dizziness and other symptoms. It is not common, but it can happen.

Research allows for each of these. Neck pain is far more common in people with headaches, 85.7 against 56.7 percent in one population study (Ashina and colleagues, 2015). Dizziness from the neck is recognized once other causes are ruled out (Reiley and colleagues, 2017). After whiplash, a review of 22 studies found a consistent pattern of problems with memory, attention and related skills (Kessels and colleagues, 2000).

The blood supply to the back of the brain passes through this region. The vertebral artery crosses the rear arch of the atlas inside the suboccipital triangle. Three of these muscles frame that space (George and Tadi, 2023). Where the arteries are badly hardened, StatPearls notes, these muscles contracting may press on the artery slightly and lower its flow. Light-headedness and dizziness can follow (George and Tadi, 2023). Above C3, branches of the C1 to C3 nerves run alongside the artery. In monkeys, though, stimulating the artery's sympathetic nerve supply barely changed its blood flow (Bogduk and colleagues, 1981).

Cranial Nerves, Brainstem and the Styloid Process

Several cranial nerves leave the skull close to this joint, among them the accessory and hypoglossal nerves. The brainstem lies just above the atlas. Serious injuries at the top of the neck are dangerous partly for that reason (Kaprive and Das, 2023).

Four of those nerves then run down past the atlas: IX (glossopharyngeal), X (vagus), XI (accessory) and XII (hypoglossal). With the internal jugular vein, they pass through a narrow gap between its transverse process and the styloid (Ozveren and colleagues, 2003).

The styloid is a slender point of bone below the ear, projecting down from the base of the skull. The facial nerve (VII) exits just behind it and runs along its outer side (Abuhaimed and colleagues, 2023). Counting the facial nerve, five cranial nerves pass a short distance from the lateral mass of C1, in my view.

Between them, these nerves serve swallowing, speech and taste, and the muscles that shrug the shoulders and move the tongue. Through the vagus, they also reach the heart, lungs and gut. Disorders of these nerves can show as speech or swallowing changes, throat or neck pain, or heart and digestive problems (Finsterer and Grisold, 2015).

Case reports show why the position of C1 matters to them. One patient with fractures of the atlas developed palsies of all four (Hsu and colleagues, 2004). A skull base difference present from birth was also found. Another, with ankylosing spondylitis, had C1 locked in rotation on C2 and a hypoglossal (tongue nerve) palsy (Chien and colleagues, 2005).

Facial numbness, swallowing difficulty, changes in vision, lasting dizziness or tinnitus need the right medical, ear, eye or nerve assessment. The upper neck is examined as one possible contributor, never assumed.

Eagle Syndrome and Look-Alike Upper Neck Symptoms

In Eagle syndrome, the styloid process is too long or wrongly angled, or the ligament attached to it has hardened (Dua and Mohseni, 2026). It then irritates the nerves or vessels beside it. About one person in 25 has an elongated styloid, and about one in 25 of those develops symptoms from it. Women are affected more often than men (Dua and Mohseni, 2026).

The glossopharyngeal nerve (IX) is the one most often involved. Others that can be involved are the trigeminal (V), the facial (VII), the vestibulocochlear (VIII) and the vagus (X) (Dua and Mohseni, 2026). An elongated styloid can also press on the hypoglossal nerve (XII) (Raina and colleagues, 2009). In my experience it is often five nerves, and it can be six. Their usual signs:

  • IX: a dull, constant sore throat and a sense of something caught in it. Swallowing can be hard or painful, with sharp pain into the ear or the back of the tongue.
  • V: pain in the face, discomfort in the jaw, or nerve-type pain.
  • VII: discomfort in the face, since it runs along the outer side of the styloid.
  • VIII: less often, ringing in the ears or dizziness from irritation or vascular change nearby.
  • X: symptoms in the throat or voice box, a changed voice for example, since it lies on the styloid's inner side.
  • XII: rarely, weakness of the tongue.

Turning the head or swallowing can make the symptoms worse. Pressure on the carotid artery instead can bring brief stroke-like episodes, vertigo and fainting. Fainting, brief stroke-like episodes or a new loss of function in a part of the body need urgent medical assessment (Dua and Mohseni, 2026). For sudden stroke signs, call 999; the full list is under Injury at C0-C1: When a Hospital Comes First.

In my view, the upper neck from the occiput down to C3 can mimic Eagle syndrome, because the same nerves pass there. A moderately or severely malpositioned C1 can mimic them most. StatPearls notes that cervical spine pain may mimic Eagle syndrome. This is especially so when neck movement is restricted and bony hardening shows on imaging (Dua and Mohseni, 2026).

A styloid can be a little long yet still within normal length. On its own, it often gives no symptoms. In my experience, once an upper neck malalignment is added, Eagle-like symptoms become possible and even probable, in varying degrees. The clinician assessing them must be alert to this, with the knowledge to work out whether the upper neck is involved. The styloid may complicate the picture, and a jaw joint problem may worsen it.

To measure the styloid, the preferred test is a CT scan with 3D reconstruction (Dua and Mohseni, 2026). The Eagle syndrome page covers the condition itself.

Symptoms Linked With the Occiput and Atlas

Stiffness when nodding, or a tight band just under the skull, is a reason to have this area examined. The FAQ below explains why such tension is not always muscular.

Problems here are most often linked with:

  • Headache at the base of the skull, often brought on by pressure there.
  • Occipital neuralgia: sharp pain behind the head.
  • Neck stiffness or restricted nodding.
  • Jaw tension alongside upper neck stiffness.

In a study of five volunteers without symptoms, an injection stretching the C0-C1 joint produced pain felt away from it every time. Where it was felt varied widely (Dreyfuss and colleagues, 1994). So this joint can be a source of discomfort, but where the discomfort is felt cannot identify it alone.

Strain at the top of the neck often starts in the muscles. In Neck Trigger Points and Exercises, I explain that muscle trouble left long enough goes on to affect the joints. In Poor Posture Damages Your Spine, I trace a similar path for posture: muscles first, then ligaments, then joints.

Dizziness, a full feeling in the ear, ringing in the ears and changes in vision can occur alongside neck problems. They also have many other possible causes, among them the inner ear, the eyes and the blood vessels. None of them is assumed to come from C0-C1, and the upper neck is examined as one possible contributor. When dizziness or trouble seeing comes on suddenly, treat it as a possible stroke and call 999.

Common Contributors to Upper Neck Problems

  • Forward head posture from desk or device use.
  • Whiplash and other neck injuries.
  • Jaw (TMJ) problems, which change upper neck muscle activity.
  • Repetitive strain, such as long drives or holding a phone between ear and shoulder.
  • Tight suboccipital or jaw muscles restricting movement.

Muscles and posture show up in research too. People with migraine on one side showed more active trigger points, mostly on the headache side, in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles. They also held the head further forward (Fernández-de-las-Peñas and colleagues, 2006).

The Jaw and Upper Neck: A Two-Way Link

The jaw (TMJ) and the upper neck share muscles and movement patterns, and people with jaw joint disorders often have less upper neck movement. Both are assessed when headaches, jaw tension and neck stiffness occur together.

The jaw is often part of the picture. In a study of 37 people with jaw pain, all had restricted upper neck turning on a test done with the head bent forward. None of 20 people without symptoms did (Grondin and colleagues, 2015).

When the disc in a jaw joint has slipped, I find that C1 often needs the utmost attention too. C1 can be affected on the same side as the jaw. For that, I use chiropractic and physiotherapy combined, or a non-force, non-rotatory upper cervical adjustment. The jaw guide covers the jaw itself.

The link is not limited to a slipped disc. A jaw problem is often at its worst when C1 on the same side is involved too, and the two run in parallel. So my jaw care has two parts: chiropractic, physiotherapy and exercises for the jaw itself, and upper cervical care, the more important of the two.

I see the link working in both directions. A long-standing upper neck problem can bring on jaw trouble, and jaw trouble can bring on upper neck problems. Each of these pages looks at the jaw more closely:

How the Upper Neck Is Examined

I start with a long interview: how the problem began, what changes it, and what has already been tried. The examination is not rushed, and any discomfort during it should be mentioned as it happens, however slight.

At CSC, the examination of the top of the neck covers:

  • Nodding, and turning to each side with the two directions compared. In Neck Trigger Points and Exercises, I note that turning should be equal both ways.
  • The base of the skull and the small muscles under it, checked by touch.
  • The atlas and the joints below it, through the neck to the upper back.
  • Nerve checks of the arms and hands, and the jaw when it is involved.

An international examination framework advises checking for signs of a blood vessel problem in the neck before any planned neck treatment (Rushton and colleagues, 2023). Imaging is arranged only when the examination points to a reason for it, as the FAQ below explains.

When imaging is needed, an open-mouth X-ray shows C1, C2 and the dens (Lacy and colleagues, 2023). Films taken bending forward and back can show instability. The plan is then built around the findings, and referral is discussed when they point elsewhere.

Is a scan needed before care? After a crash, a bad fall or a blow to the head, the hospital comes first. Otherwise, not necessarily. Is Chiropractic Safe? 13 Questions Answered is where I explain that not every patient needs imaging. An X-ray comes only once a full assessment shows a reason for it. For a neck problem, that means a sectional X-ray of the neck, not of the whole spine. I regard an MRI as the gold standard for neck imaging. There is no X-ray radiation, and bone, joint, muscle, ligament and the room around the nerves all show on it. Any scans you already have are worth bringing, both the images and the reports.

Atlas Adjustment: How I Work at C0-C1

Two misalignments of the atlas are common in my experience: a rotation, and a slight shift to one side that I call a lateral listhesis.

My adjustment works through the lateral mass, the part of the atlas that holds the occipital condyle. The contact is non-force: the slightest pressure, at an angle chosen for that person. The neck is not turned, and the contact is just a gentle pressure along the atlas. In my words, that is what a non-rotatory adjustment is.

For a neck that tests stable, I may use chiropractic manipulation that is non-rotatory using the Activator instrument. I set it at level one, its lowest force, cushioned. With you sitting, I apply it very gently to the muscles at the back of the neck. The contact stays on the soft tissue beside the lateral mass rather than on the bone. Sometimes I soften it further by sending the level one impulse through my contact finger. When a neck proves unstable, the non-force contact is my next choice.

Plenty of clinics now call themselves upper cervical, and how much force they use at the atlas varies. In my view, anything firmer than a non-force contact on C1 may not suit the top of the neck. The same is true of more than a very low force on the muscles beside it. Before care there begins, ask which method will be used and how forceful it is.

Alongside the atlas, I adjust the jaw, the lower neck or the rib joints at the spine and breastbone, as the examination directs.

Hands-on soft tissue work can go with it. In Neck Trigger Points and Exercises, I show light fingertip pressure on trigger points in the trapezius and the rhomboids. The trapezius starts at the base of the skull. Each point is held a few seconds, never deep, and kept comfortable.

Throughout, care is kept within what you can comfortably tolerate. In Is Chiropractic Safe? 13 Questions Answered, I explain that discomfort means care is being done too aggressively, so tell me right away. My motto has always been “No pain, more gain.”

Physiotherapy goes alongside the adjustment, and my advice in Is Chiropractic Safe? 13 Questions Answered is simple: “Don't choose between one or the other. Choose both.”

Depending on the findings, care may combine:

How soon changes show varies with the severity of the problem, the condition beneath it and how consistently the advice is followed. My checkpoints come from Is Chiropractic Safe? 13 Questions Answered. When the fifth session shows no improvement, I reassess straight away rather than wait. When the tenth still shows none, we discuss together whether to continue. In the same video, I ask patients to be honest about the day before. You may have gone for a run because you felt better, and that changes what the next visit should be.

Occipital Lifts, Towel Yanks and Y-Straps

Where an occipital lift means a quick, forceful pull on the base of the skull, it belongs with the towel yank and the Y-Strap. All three pull the head away from the body. The towel goes around the neck, and the strap behind the skull and under the jaw.

Neck Cracks Are Dangerous is the video where I set out why I avoid aggressive moves like these. The neck's joints are small, and a pull like this may push a mild disc bulge on to a severe herniation. At C0-C1, the brainstem passes just above the atlas, and the vertebral artery bends over its rear arch. A sudden yank jolts the brain, the spinal cord and the nerves together, and it can damage the artery, which can lead to a stroke.

Neck Cracks Are Dangerous also makes clear that no age makes such a pull acceptable. I ask for extreme care from women taking birth control pills. The same goes for anyone with an unstable neck, a disc bulge or herniation, or high blood pressure. It also applies to spondylosis, meaning wear and bone spurs that show on an X-ray. If someone wants to do such a pull on you, my advice in that video is to “ask them to stop.”

My summary in Neck Cracks Are Dangerous is plain: “Aggressive neck care is never good and should always be avoided.”

Neck Cracks Are Dangerous

CSC does not use quick, forceful pulls under the skull, towel yanks, the Y-Strap or Ring Dinger-style pulls. The Ring Dinger guide covers that method and its risks.

A PubMed search made for the Ring Dinger guide found no study of these pulls, so their safety and benefit are untested. The concerns are excessive traction on the neck and overstretched ligaments and blood vessels. An undiagnosed disc or instability problem could also be made worse.

Risks of Forceful and Rotational Methods

Some methods marketed for the upper neck use side-bending with an upward thrust, or a rapid rotation. Neck manipulation has been linked with tears of the vertebral artery and, rarely, with stroke (Cassidy and colleagues, 2008).

One large study suggests that much of that link reflects people with an early, undiagnosed tear seeking care for its neck pain. In Ontario, the raised risk of this kind of stroke after chiropractic visits matched the raised risk after family doctor visits (Cassidy and colleagues, 2008). A second study looked at US adults aged 65 and over (Whedon and colleagues, 2022). Artery tears were no more common after neck manipulation than in comparison groups.

The uncertainty is still a good reason to favor gentle, non-rotatory methods at this level. As I see it, the risk of cracking the neck goes beyond stroke: a forceful method can also make a neck problem worse.

Injury at C0-C1: When a Hospital Comes First

A road crash, a bad fall or a hard blow can put substantial force on the head or back. Mayo Clinic's first-aid advice is to assume a spine injury after any such injury. Severe neck or back pain, or a head injury with changing alertness, counts too.

So do weakness, numbness, paralysis or loss of control of the limbs, bladder or bowels, and a neck or body twisted out of position. Keep the person still, do not move the head or neck, and call 999.

My Back Pain to Leg Pain talk explains that pressure on the spinal cord in the neck can affect the arms, legs and even breathing. In my words there: “The higher up, the more important.”

A blow to the back of the head can also break the base of the skull. One sign is bruising behind the ears, known as Battle's sign. A break around the foramen magnum also puts the vessels and nerves passing through it at greater risk (Germann and Kashyap, 2023). After a blow like this, keep the person still and call 999.

Stroke signs need 999 straight away, whether or not the neck hurts. These are the signs listed by the US Centers for Disease Control and Prevention:

  • Numbness or weakness that comes on suddenly in the face, an arm or a leg, particularly on one side of the body
  • Sudden confusion, difficulty speaking or trouble understanding others
  • Sudden trouble seeing with one or both eyes
  • Sudden dizziness, loss of balance or coordination, or trouble walking
  • A sudden, severe headache that has no known cause

Call 999 for an ambulance rather than driving to the hospital.

Daily Habits: Increase Support, Decrease Strain

I put it to patients this way: increase what is good for the neck and, at the same time, decrease what strains it.

More of:

  • A screen set at the right height. Raise the laptop or add a monitor until your eyes are a little below its top edge, as I show in Desk Posture Mistakes.
  • Short breaks. With a neck problem, rise every 15 to 20 minutes and walk for 30 seconds to a minute. In that video the minimum is a brief stand every 15 minutes; a sore neck needs the longer break.
  • Side sleeping with the spine in one line and no bend in the neck. On your back, support the curve of the neck, for example with a rolled towel. Both tips come from my Back Pain to Leg Pain talk.

Less of:

  • Long spells with the head bent over a phone, which I call tech neck or text neck in my Back Pain to Leg Pain talk.
  • A phone kept on your writing-hand side at the desk. In Desk Posture Mistakes, I suggest the other side, or a headset.
  • Letting anyone yank on your neck, for the reasons in Neck Cracks Are Dangerous.
  • General neck stretching when a neck disc is damaged, as I warn in my Back Pain to Leg Pain talk.

Answering a question about the neck in my Back Pain to Leg Pain talk, I said: “The most important thing is not the treatment. The most important thing is to make lifestyle changes.”

Gentle Exercises: Check With Your Provider First

In Neck Trigger Points and Exercises, I ask viewers to show any exercise to their doctor or healthcare provider before trying it. The exercises there are gentle, and they still need that check:

  • Isometrics: press your head into your own hand, forward, back and to each side, without letting the neck move. Hold five seconds, or three if five is too much, and repeat 5 to 15 times.
  • Stop at once if this brings numbness, tingling or any discomfort. My words in Neck Trigger Points and Exercises: “you're not ready for this.”
  • W, T and L arm positions, with the shoulders pushed down and never shrugged. They work the upper back, which that video calls the foundation for the neck.

Neck Trigger Points and Exercises

Other gentle options, also to be checked with your provider first:

  • Small nods: gentle “yes” movements while lying on your back, 5 to 7 times.
  • Suboccipital rest: lie with the base of your skull resting on a rolled towel for 2 to 3 minutes.
  • Chin tucks: draw the chin straight back without tilting the head.

Stop and seek professional advice if you feel dizzy, have sharp pain or notice any nerve symptoms.

Summary: Methods to Avoid and Gentler Alternatives

AvoidUse instead
Quick, forceful occipital liftsGentle C0-C1 glides and non-rotatory mobilization
Thrusts that rotate the neckControlled mobilization with stability exercises
Cracking your own neckCare guided by a clinician, and home exercises your provider has checked

Current fees for chiropractic and physiotherapy are on the chiropractic price in Kuala Lumpur page and the physiotherapy fees in Kuala Lumpur page. The fee for a plan is explained and agreed before care begins.

A child's upper neck is still growing. The guide to neck manipulation in children sets out what guidance advises at each age. The checklist of questions to ask before chiropractic care for a child lets parents ask exactly what will be done to the neck.

Many readers of this guide go on to the upper neck (C0 to C3) guide and the page on headaches and migraines. The neck pain guide brings the neck, upper back and arm topics together.

Related pages on the rest of the neck, the jaw, ear and shoulder, and the methods and videos quoted above:

Neck Pages

Jaw, Ear and Shoulder Pages

Method and Posture Pages

FAQ About the Occiput and Atlas

What Are the Occiput and Atlas?

The occiput is the base and back of the skull, and the atlas (C1) is the first neck bone. Together they form the C0-C1 joint, which mainly allows nodding. The joint sits close to the brainstem, the upper spinal cord and the vertebral arteries. Four cranial nerves also run down just in front of the atlas (Ozveren and colleagues, 2003). That closeness is why care at this level stays gentle and non-rotatory.

Is Suboccipital Tension Muscular or From the C0-C1 Joint?

It can be either, and the two can feel the same. Joint, nerve and disc problems in the neck can all mimic a muscle problem. In Neck Trigger Points and Exercises, I say “all of them at times feel as though they're muscular.” The same video describes simple checks. If turning your head brings discomfort on the side you turn toward, a joint could be involved. If turning is shorter one way than the other, a muscle or a joint may be the reason. An examination of the joints, the muscles and the nerves is what tells them apart.

Which Symptoms Suggest an Upper Neck Problem?

Headache at the base of the skull, occipital neuralgia, neck stiffness and restricted nodding are the most typical. Jaw tension often comes with upper neck stiffness. Dizziness, changes in vision and ear symptoms have many other causes, so they are assessed carefully rather than assumed to come from the joint. In my view, an upper neck problem anywhere from the occiput to C3 can also mimic Eagle syndrome, because the same cranial nerves pass there.

How Can TMJ Problems Affect the Upper Neck, and Vice Versa?

The jaw and the upper neck share muscles and movement patterns. In one study, people with jaw joint disorders turned the upper neck less on a standard test (Grondin and colleagues, 2015). In my experience, the link runs both ways. When the upper neck has a chronic problem, the jaw can suffer, and a jaw problem can strain the upper neck. When symptoms overlap, both are assessed. If the jaw joint's disc has slipped, C1 often needs close attention too.

How Does CSC Assess Occiput and Atlas Problems?

The assessment starts with a full history, including warning signs that call for a hospital. The examination then covers the suboccipital muscles, nodding and turning, and the atlas and the joints below it. Nerve checks of the arms follow, with the jaw when it is involved. Questions about the neck's blood vessels come before any neck treatment (Rushton and colleagues, 2023). Imaging, such as an open-mouth X-ray, is arranged when it would answer a specific question.

Can I Adjust My Own Atlas at Home?

No. My answer in Is Chiropractic Safe? 13 Questions Answered is that chiropractic care can only be done by chiropractors. An atlas adjustment is no exception. Having a friend yank on your neck is the kind of aggressive move I warn against in Neck Cracks Are Dangerous. At home, look after your posture, your screen height and your sleep. Show any exercise to your doctor or healthcare provider before you try it.

Why Does CSC Avoid the Ring Dinger®, Y-Strap and Towel Jerks?

These methods apply a sudden, high-force pull to the neck. No study has tested their safety or benefit, as the Ring Dinger guide explains. The concerns are strain on ligaments and blood vessels and a worsened disc or instability problem. In Neck Cracks Are Dangerous, I explain that a yank at the top of the neck jolts the brain, spinal cord and nerves together. CSC uses gentle, non-rotatory methods instead.

How Common Are Structural Problems Here?

Significant structural problems here are uncommon. Fusion of the atlas to the skull from birth occurs in about 0.14 to 0.75 percent of people (Ho and colleagues, 2024). Neck pain overall is very common, affecting about 203 million people worldwide in 2020 (GBD 2021 Neck Pain Collaborators, 2024). In young people, bending over phones and tablets is linked with neck pain (Fares and colleagues, 2017).

How Does a Stiff Top Joint Affect Lower Neck Levels?

In my experience, when C0-C1 is stiff, C1-C2 and the middle of the neck often move more to make up for it. That can add to muscle tension and pain elsewhere in the neck. I see the neck as a kinematic chain: when one part goes, the other goes. It works the other way too: instability, or nerve or cord compression, in the middle or lower neck can lead to an upper neck problem.

Is Atlas Adjustment Suitable for Children or Older Adults?

Very young children receive non-force care only. For teenagers, I may use chiropractic manipulation that is non-rotatory using the Activator instrument. A parent or guardian can stay with the child throughout every visit. Research on children is summarized in the guide to neck manipulation in children. For people in their forties or older who have wear, a bone spur or a pinched nerve, I advise against methods that crack the joint. In Is Chiropractic Safe? 13 Questions Answered, I explain that such methods may be a bit too aggressive for them. The non-force contact on the atlas involves no crack.

How to Read This Guide

Everything written as “I” is my own position, taken from my videos, talks or written answers. Where a video or talk is the source, it is named. Studies are cited by author and year, with links in the references. Case reports and hypotheses are named as such. Nothing here can diagnose a neck; that takes an examination in person.

References

None of these sources evaluated care at Chiropractic Specialty Center. They describe the top of the neck, its nerves, Eagle syndrome, neck pain in general, the safety of neck care, first aid and stroke.

The Author of Occiput and Atlas (C0-C1): Anatomy, Symptoms, Adjustment

Occiput and Atlas (C0-C1): Anatomy, Symptoms, 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: Occiput and Atlas (C0-C1): What This Joint Does

Occiput and Atlas (C0-C1): What This Joint Does was last reviewed and updated on October 28, 2026.

Baca halaman ini dalam Bahasa Malaysia: Oksiput dan Atlas (C0-C1): Apakah Fungsi Sendi Ini?

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