Why the Cervicothoracic Junction Must Be Addressed When Treating Upper Cervical Dysfunction

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul

Upper cervical spine dysfunction—particularly involving the atlas (C1) and axis (C2)—rarely exists in isolation. To ensure complete clinical resolution and prevent recurrence, it is essential to examine and, if necessary, treat the Cervicothoracic Junction (CTJ), particularly the C7–T1 segments, which serve as a critical transitional zone between the mobile cervical spine and the more stable thoracic spine.

1. Anatomical and Biomechanical Continuity

The CTJ forms a structural and functional bridge between the neck and thorax. It plays a vital role in force transmission and segmental mobility.

  • About 50% of neck rotation occurs at C1-C2, but the rest is distributed across the lower cervical spine and CTJ.

  • Restrictions at the CTJ can alter upper cervical biomechanics, leading to compensatory strain or failed therapeutic outcomes.

References:

  • Kapandji IA. The Physiology of the Joints, Vol. III. Churchill Livingstone; 2008.
    → "The cervicothoracic junction acts as a biomechanical buffer between the flexible neck and the rigid thorax."

  • Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum, 4th ed. Elsevier; 2005.
    → “C7-T1 restrictions may lead to upper cervical compensatory dysfunction.”

2. Autonomic Nervous System Involvement

While the upper cervical spine influences parasympathetic tone via the vagus nerve and brainstem structures, the sympathetic chain ganglia—notably T1-T2—reside near the CTJ.

  • Muscle tightness, joint fixation, or fascial restriction at the CTJ can provoke sympathetic hyperactivity, potentially causing palpitations, anxiety, and poor upper extremity circulation.

  • These effects may persist unless CTJ imbalances are addressed alongside C1-C2 dysfunction.

References:

  • Barral JP, Croibier A. Manual Therapy for the Peripheral Nerves. Churchill Livingstone; 2009.
    → “Somatic dysfunctions near the CTJ can influence upper cervical sympathetic activity.”

  • Uematsu S et al. Quantification of Thermal Asymmetry: Part I. J Neurosurg. 1988;69(4):552–555.

3. Fascial Chain Integration

The Deep Front Line and Superficial Back Line myofascial chains pass through both the upper cervical region and the CTJ, linking cranial stability with thoracic posture and breathing mechanics.

  • Dysfunction in either region affects the other due to continuous fascial tension, resulting in pain, fatigue, and poor postural control.

Reference:

  • Myers TW. Anatomy Trains, 4th ed. Elsevier; 2020.
    → “CTJ restrictions disrupt fascial continuity, compromising both cranial and diaphragmatic dynamics.”

4. Clinical Application: Why CTJ Treatment Enhances Outcomes

Even after correcting atlas or axis misalignment, residual imbalance may persist if the CTJ remains unaddressed.

  • Postural leg checks, head rotation response, and motion palpation often reveal remaining restrictions at C7–T1.

  • Techniques such as soft tissue release, joint mobilization, and posture retraining targeting the CTJ often enhance clinical recovery and reduce recurrence.

Reference:

  • Peterson D, Bergmann T. Chiropractic Technique: Principles and Procedures, 3rd ed. Elsevier; 2011.
    → “In recurrent upper cervical cases, the cervicothoracic junction must be assessed for restriction.”

Conclusion

For a complete, stable, and lasting resolution of upper cervical dysfunction, it is imperative to evaluate and treat the cervicothoracic junction. Anatomically and neurologically, the CTJ plays a pivotal role in neck–thorax integration. Addressing this region can improve treatment response, reduce recurrence, and restore systemic balance, particularly in patients with chronic neck pain, dizziness, and autonomic symptoms.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

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