Upper Cervical Techniques Explained: Blair, NUCCA, Atlas Orthogonal, Advanced Orthogonal, Knee Chest, and Orthospinology
If you’ve been researching upper cervical chiropractic, you’ve probably noticed something quickly:
There are multiple techniques—and each office may sound confident that their approach is the answer.
Here’s the honest truth: there isn’t one universally “best” upper cervical technique. Different approaches can work extremely well—sometimes one technique fits one person better than another based on anatomy, comfort, history, and how their body responds.
This post breaks down the major upper cervical techniques you’ll commonly see:
Blair, NUCCA, Atlas Orthogonal, Advanced Orthogonal, Knee Chest, and Orthospinology—what they have in common, what’s different, and how to choose without getting overwhelmed.
What all upper cervical techniques have in common
Even though the technique names vary, most upper cervical approaches share a few core principles:
They focus on the top of the neck (typically the atlas/C1 and axis/C2), where small alignment changes can influence posture and balance.
They prioritize precision and repeatability, typically using imaging and measurements to customize the correction.
They emphasize gentle corrections (usually without twisting/cracking of the neck).
They retest and recheck (posture, leg checks, scans, balance, symptoms, etc.) to decide whether another adjustment is needed.
In other words, the “brand name” matters less than the quality of analysis + precision of correction + consistency of results.
Why are there so many different upper cervical techniques?
Upper cervical techniques differ mainly in two areas:
How the misalignment is analyzed
Many techniques use radiographic analysis and measurements, but the model differs. In the literature, upper cervical techniques are often described broadly as orthogonal-based or articular-based approaches.How the correction is delivered
Some techniques are primarily hands-on and extremely light; others use a specialized instrument; some use a specific patient position (like knee-chest).
This is why two people can both love upper cervical care—yet prefer different approaches.
Technique snapshots
Blair Technique
What it’s known for: highly individualized analysis that emphasizes articular/joint surface relationships and asymmetry (because real human anatomy isn’t perfectly symmetrical).
Typical tools: precise imaging + spinographic-style analysis, with a correction tailored to the individual.
What it feels like: very gentle and specific; the setup and correction style can vary depending on the segment.
Who it may be a good fit for: people who like the idea of a very anatomy-specific analysis and a customized correction rather than a “one-model-fits-all” assumption.
In our office, Blair upper cervical is the primary technique we use.
NUCCA
What it’s known for: a very gentle, hands-only correction and detailed, measured X-ray analysis.
Typical tools: objective X-rays with measurement analysis to determine the correction, and follow-up checks to monitor change.
What it feels like: extremely light force—often no cracking/popping, no twisting.
Who it may be a good fit for: people who strongly prefer a hands-only, low-force approach and a structured measurement system.
Atlas Orthogonal (AO)
What it’s known for: instrument-delivered, low-force upper cervical correction guided by imaging and calculated vectors.
Typical tools: X-rays/measurements; a specialized percussion-style instrument/table system is commonly associated with AO.
What it feels like: usually a light “tap” style correction—many patients describe it as surprisingly gentle.
Who it may be a good fit for: people who prefer instrument corrections and want a consistent, engineering-style approach.
Advanced Orthogonal (AdvO)
What it’s known for: an evolution within instrument-based upper cervical care, using a percussive sound wave style correction with low force.
Typical tools: imaging + measured analysis, then a percussive instrument correction.
What it feels like: often very subtle—patients frequently report it feels like a small tap or pulse.
Who it may be a good fit for: people who want very low force with an instrument-based method and careful measurement-driven setups.
Knee Chest
What it’s known for: the knee-chest positioning—the patient kneels and rests their chest/head on a specialized table before a precise correction is delivered.
Typical tools: imaging and a specific table/positioning system; the correction is quick and targeted.
What it feels like: fast, specific, and typically gentle—often described as “surprisingly quick.”
Who it may be a good fit for: people who do well with that specific positioning and want a quick, precise correction style.
Orthospinology
What it’s known for: precise upper cervical analysis historically tied to Grostic-based measurement concepts and a highly specific correction protocol.
Typical tools: measured imaging analysis to quantify alignment and guide a specific correction line of drive.
What it feels like: generally gentle; correction may be delivered by hand or with an instrument depending on the practitioner.
Who it may be a good fit for: people who want a highly measured, protocol-driven approach and do well with a precision-focused correction style.
So… which technique is “best”?
A better question is:
Which technique is best for you—with the right doctor?
Here’s what tends to matter most:
Your comfort with the correction style
Hands-only vs instrument vs knee-chest positioning.Your anatomy and history
Past injuries, mobility, surgical history, and structural asymmetries can influence what approach feels best.How well you “hold” the correction
Some people respond quickly to one approach and not another. That doesn’t mean a technique is “bad”—it just means bodies are different.Objective rechecks and clarity
The best offices can explain what they found, how they decide to adjust (or not), and how they measure progress.
If you’re already under care with a different technique…
If you’re getting good results with NUCCA, AO, Knee Chest, Orthospinology, or another upper cervical approach—keep going. You don’t need to switch just because you read a blog post.
Upper cervical care is a small world, and many excellent doctors use different methods to get to the same goal: a precise correction that your body responds to.
What we do in our Encinitas office
At Upper Cervical Chiropractic Encinitas, we primarily use the Blair upper cervical technique and focus on:
Careful assessment and individualized analysis
Gentle, specific corrections (no twisting/cracking)
Rechecks that guide whether an adjustment is needed
If you’re not sure what technique you’ve had in the past—or you’ve tried a few and want a calmer, more objective plan—we’re happy to help you figure out the best next step.
Ready to get assessed? Book an initial exam and we’ll walk you through exactly what we see and how we approach care.
References
1) Woodfield HC III, et al. “Craniocervical chiropractic procedures – a précis of upper cervical chiropractic.” (2015)
https://pmc.ncbi.nlm.nih.gov/articles/PMC4486989/
2) National Upper Cervical Chiropractic Association (NUCCA). “What is NUCCA?”
https://nucca.org/what-is-nucca/
3) Blair Chiropractic Society. “The Blair Technique”
https://www.blairtechnique.com/the-blair-technique/
4) Atlas Orthogonal Program (Roy W. Sweat). “Doctors Directory / About Atlas Orthogonal (SCALE)”
https://atlasorthogonality.com/doctors-directory/
5) Advanced Orthogonal. “The AdvO Difference”
https://www.advancedorthogonal.com/certification/the-advo-difference
6) Society of Chiropractic Orthospinology. “Patients: What is Orthospinology”
https://www.orthospinology.org/patients
7) Grostic Procedure Society. “About Us”
https://grosticprocedure.org/about-us/
8) Knee Chest Specific Chiropractic (overview). “Why Knee Chest?”
https://boonsborouppercervicalchiropractic.com/why-knee-chest/
9) Eriksen K, et al. “Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study.” (2011)
https://pmc.ncbi.nlm.nih.gov/articles/PMC3204272/
10) Rochester RP. “Neck pain and disability outcomes following chiropractic upper cervical care: a retrospective case series.” (2009)
https://pmc.ncbi.nlm.nih.gov/articles/PMC2732255/
11) American Specialty Health. “CPG 97 Revision 21 – S: Upper Cervical Adjusting Techniques.” (Revised Sept 18, 2025)
https://www.ashlink.com/ASH/WCMGenerated/CPG_97_Revision_21_-_S_tcm17-41730.pdf
