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I'm in love with changing people's perspective of what is possible for them.

--Johanna Hoeller, D.C.


Back Pain? Neck Pain? Be Sure Your Head's on Straight
Dr. Johanna Hoeller and the Story of NUCCA

By Cat Saunders

    Have you heard that joke about the master mechanic who succeeded where all others had failed? There was this couple who owned a much-loved car that had chronic engine problems. They took it to mechanic after mechanic, but no one could offer more than a temporary fix.

        Then they heard about a master mechanic who could work miracles with cars. They took their car to him and stuck around to watch. The master mechanic opened the hood and peered inside. Without touching anything, he stooped and stretched to scope out the engine, observing it from every possible angle.

    When he was ready, the mechanic took out a simple tool, gently tapped one specific part of the engine, and pronounced it fixed. Then he handed the couple a bill for $2,000. "What?" they said, "All you did was tap the engine in one place!" He smiled and said the tap was free. The two grand was for knowing where to tap it.

    Dr. Johanna Hoeller is a "master mechanic" like that, but she doesn't charge $2,000 and she works with people, not cars. In specific, she practices a unique form of chiropractic called NUCCA work (National Upper Cervical Chiropractic Association), which aligns the entire spine through highly focused adjustments of a single vertebra, the pivotal "kingpin" atlas vertebra at the top of the neck.

    Johanna would be the first to say that this work is not about her, but rather about the body's own self-healing ability and NUCCA's exacting techniques for supporting this ability. Even so, I believe there are masters within any trade, and Dr. Johanna Hoeller is definitely a master.

    Cat: Would you talk about the atlas vertebra and its relationship to the body's self-healing mechanism?

    Johanna: The whole purpose of working with the neck is to use the atlas-which is the top vertebra on the spine-as a lever. The atlas vertebra, acting as a lever, is used to bring the foramen magnum into alignment with the cervical spine, and thereby bring the head into alignment with the entire spine. The foramen magnum is the hole at the base of the skull where the brain stem passes through to become the spinal cord.

    The atlas can be used as a lever to help bring these three structures into alignment because it's not anchored down like the rest of the vertebrae. Other vertebrae have big disks between them, so they're essentially locked in place. By using the atlas in its position of leverage, you can move the entire spine in relation to the head, and vice versa.

    When the head, neck, and spine are in alignment, the trillions of neural pathways that pass from the brain through the foramen magnum into the body have clear passage, which allows free communication between body and brain. This alignment is very important to the immune response and all functions of the body.

    Cat: Would you briefly describe the birth of NUCCA work?

    Johanna: Chiropractic was founded by Dr. D. D. Palmer, and his son was B. J. Palmer. B.J.'s style was quite different from his father's, and he used an adjustment of the upper cervical spine that was very harsh and intense. So from the early days of chiropractic, there were differences of opinion about how chiropractic really worked.

    Later, a man named Dr. Ralph Gregory also became interested in the upper cervical spine, and he began refining this work along with Dr. John Grostic. When Dr. Grostic died in the 1960s, Dr. Gregory founded NUCCA (National Upper Cervical Chiropractic Association).

    Cat: How did you come to upper cervical work?

    Johanna: I was a patient of a NUCCA practitioner, and because of how this work changed my life, I was motivated to become a NUCCA chiropractor. I attended Western States Chiropractic College in Portland, Oregon, and I studied NUCCA work through its own seminars and classes. I'm also involved in NUCCA's certification process, which is very difficult. I've practiced this work since 1986, and I'm halfway through NUCCA's third and final level of certification.

    Cat: I understand that you do all your own X-rays.

    Johanna: The films I take were designed by NUCCA to view the relationship of the head and neck in different ways than other chiropractors and conventional medical doctors view it. Because our goal is to balance the brain over the body, we must look very clearly and specifically at the articulations in that region. Standard cervical views don't provide the accuracy we require.

    Cat: Many people object to the use of X-rays.

    Johanna: Medicine is gradually moving to digital imaging technology and I look forward to that day. Right now, high frequency technology is the best diagnostic tool we have in the form of X-rays, and in this work, a degree matters!"

    If you flew from here to New York with just a half a degree off on your directional readings, you would not land in New York. Likewise, NUCCA practitioners could not help you get your brain fully connected-by aligning your head precisely over your body-if we weren't so exacting in our diagnostic measurements through X-rays.

    NUCCA practitioners are also extremely meticulous about how our X-rays are generated. We align our tubes carefully and check them regularly. We install lead shielding around the beam before it even comes out of the housing, to reduce "scatter" and radiation exposure overall.

    Cat: For me, the post-adjustment X-ray immediately following my first adjustment was particularly amazing, because it showed at a physical, structural level-how much my alignment had shifted from just one treatment.

    Johanna: Yes. People can do all kinds of bodywork and not make real progress. For example, people sometimes think that because a bone "pops," it means they've been adjusted. That's not true!

    Also, people might feel great for a while after bodywork, because you can create rushes of endorphins and do all kinds of things with the body. But the question is, how long does it last? That's what matters. In many kinds of physical healing work, people become reliant on their external environment (the practitioner) to "save" them. That's not my ideal.

    Cat: I was relieved to discover that you don't require patients to come for endless adjustments. Would you describe an average course of treatment?

    Johanna: I like to work with people a minimum of six weeks. In that time, we'll know if this work is helpful for you or not. After the initial two extended visits for X-rays, exam, and first adjustment, I generally see people once a week for the first six weeks. Once patients start holding their correction for two or three weeks, it might be six weeks before I check their alignment again.

    My job is to be able to measure the alignment. If the body is out of balance, the muscles on one side of the body will be working harder than the other side, which can cause all kinds of problems. Aside from the initial X-rays, the body's degree of balance can be measured with a simple level. If the level shows you're out of balance, then an adjustment is warranted. I don't adjust people unless my measurements indicate it's necessary.

    Cat: Would you talk about what you're actually doing when you adjust someone?

    Johanna: NUCCA practitioners use a leverage system. A leverage system is primarily designed to move large objects with minimal force. Levers have to do with effort, resistance, and fulcrum. The fulcrum might be the mastoid or some other structure in the patient's body-it depends on what you're trying to accomplish.

    Before I go to work on someone, I analyze all the X-rays, which are like "blueprints" for the patient's physical structure. When the patient comes, I carefully position him or her on the special table we use, which allows the body structures to move as needed, once I begin the treatment.

    Then I use my body as an instrument to generate enough force to move these structures. I'm not using brute force, but rather a system of levers. I lock my hips into position to form a solid base of support, then I position my body exactly where it needs to be in relation to the patient. Next, I slowly contract the triceps muscles in both of my shoulders, directing the energy down through my arms into my grasped hands, and then into the patient. At some point, the resistance in my own body is overcome, and a controlled force is generated that moves whatever structures need to move in the patient.

    Although my hands usually pop and I sometimes grunt at the point of exertion, I don't twist and pop the patient's body in any way. I don't apply excessive force, because any excess force that goes in would have to come out somewhere, based on the laws of physics. Therefore, I only apply the amount of force necessary to move the structure. Because I'm using a lever system, the actual force required is very minimal.

    Cat: For me, your touch is barely discernible, yet 25 years of chronic neck pain has been alleviated in just a few adjustments. Is it difficult for new patients to understand why NUCCA focuses on the neck, no matter what kind of spinal misalignment is involved?

    Johanna: Most of my patients come to me as you did, by referral from a trusted friend. Most people can understand the concept of NUCCA work, but they sometimes have trouble with the lightness of the correction. The adjustment itself is so gentle that some people don't get that anything happened.

    Most people don't realize what NUCCA adjustments can accomplish until they experience the results. As their bodies' unwind after an adjustment, their well-being increases and they gradually learn to trust the work. Simultaneously, they learn to trust their own bodies' healing process, because that's what it's really about.

    Cat: You taught me a valuable tip that I wish was included in all those pamphlets I've seen for back care. I call it "the chin tuck."

    Johanna: Yes, it's just tucking the chin down. Dr. Gregory clearly understood the reflexes in the body, and he discovered this technique when he was teaching practitioners how to stabilize their bodies in order to adjust patients. He found that by tucking the chin, muscles around the spine are engaged, which give the spine more support and thereby stabilize it.

    A way to test this reflex is to try running with your head up, then try pulling your chin down while running. The power that comes from this simple shift in alignment is extraordinary, because it "locks down" the spine and prevents wasted motion.

    The chin tuck is a protective technique that you can use if you need to lift something or reach a cabinet high above your head. It's not good to throw your head back when lifting or reaching. Instead, keep your chin tucked and be sure your lower body is stabilized on solid footing. Then you can lift or reach without jeopardizing yourself. The chin tuck is also helpful when you're driving, sitting, or standing.

    Cat: Any parting thoughts?

    Johanna: Most people are chronically in an unbalanced state. Under stress from chronic misalignment, people's behavior tends to be more reactive and less consciously processed by higher levels of the brain. I sometimes wonder, if everyone's head was on straight, what kind of world would we have?


    This interview was originally published by The New Times (August 2003).

    For more information about Dr. Johanna Hoeller and NUCCA (including referral information for other practitioners), please visit http://www.psbl.com/hoeller or call (206) 547-6370 in Seattle, Washington.

    The Seattle Post Intelligencer featured Johanna in an article (6/6/07) about how NUCCA work can help to lower blood pressure. To read it, see "Lower Blood Pressure from Neck Adjustment?   

    If you'd like to read Cat's personal endorsement of Johanna's work in "Links to Friends and Favorites" on this site, please click here.

    Special thanks to my longtime friend and colleague, Greg Ostergaard, M.S.W., for telling me about Johanna, who freed me from 25 years of chronic neck pain. I'm forever grateful to you, Greg!



Cat Saunders, Ph.D., is a counselor and consultant, death and dying researcher, and nonsectarian minister in private practice in Seattle, Washington. She is the author of Dr. Cat's Helping Handbook (available at Amazon.com). Click here to contact Cat or learn more about her work by returning to the home page. To schedule in-person or telephone consultations, please email Cat or call her 24-hour confidential voice mail at (206) 329-0125.