The Twisted Neck: A Multidisciplinary Model for Neck and Airway Management




One of the core factors that makes our PRIME program unique and effective is our multidisciplinary model of treatment.  For many issues, especially chronic issues that don’t resolve with traditional treatment,  success usually involves more than one professional in the care of that person.

We are privileged in our PRIME program to work with many different practitioners excited to work with other like-minded professionals who have embraced this model of care.  We even have a dedicated room to consult and treat patients at an orthodontist’s office.  Dr. Rebecca Hohl, who is a part of our PRIME team, has been gracious enough to intentionally build a space for us to be present in her office for the benefit of both of our patient case-loads.  We are happy to be in that office for many reasons, but primarily because we know that without a multidisciplinary model successful treatment of some patients will be impossible.

Our dedicated room at Dr. Rebecca Hohls office.

One of the primary reasons we work with Dr. Hohl is to assist us with management of neck (cervical spine) position when the position of a patient’s bite (occlusion) is a primary driver for the position of the head on top of the neck.  Our primary objective with our multidisciplinary model is to address influencing factors that contribute to asymmetrical patterned upright posture. Postural orientation, ideal or not ideal, has a direct influence on multiple systems, their activity, and therefore a wide variety of potential symptomology.

“Efficient breathing requires 2 primary things to be managed.  1) proper positioning and support for the diaphragm muscle which is addressed often with manual and non-manual techniques for the pelvis and rib cage along with establishing full body proper postural orientation, and 2) an open unrestricted airway.”

Some of the primary symptomology that we see in terms of physical and neurological issues includes such things as dizziness, neck pain, headaches, TMD, brain fog, and other dysautonomic (brainstem) issues.  These things, along with lower half issues related to an inability to move efficiently from side to side such as lower back and SI joint or hip pain, are prevalent in our PRIME patients history.  One primary contributing factor to the “upper half” or head and neck symptoms can be related to an inability to breathe efficiently.  Efficient breathing requires 2 primary things to be managed.  1) proper positioning and support for the diaphragm muscle which is addressed often with manual and non-manual techniques for the pelvis and rib cage along with establishing full body proper postural orientation, and 2) an open unrestricted airway.  Our airway (trachea) sits directly in front of the cervical spine and is influenced considerably by the position of the head and neck (See Picture # 1,2 below for orientation of the trachea/airway with the cervical spine.)


Top Left: lateral view of airway and spine.  Note airway in front of spine.

Top Right: top down view showong orientation of airway (trachea) directly infront of spine(vertebral body).

Left:  Lateral Cephalogram which is used by Dr Hohl to show spine posiiton and airway patency.

There is a lot of clinical discussion in terms of forward head posture and airway which is often managed by dental professionals utilizing splint therapy or other means to manage bite position (occlusion) including braces and surgery.  Unfortunately often what is missing in that method of management is the rest of the team looking at the other issues that may be affecting the position of the neck (which directly affects the airway).  There is often a factor of twisting and side bending affecting the neck when other factors are at play which when addressed can often assist with the management of forward head positioning.  The chart below shows a few of the factors and their interplay in how they all have influence over one another.  Neck orientation and position is purposely placed in the middle to show its influence over and by multiple systems involved.


For example if the lower body orientation and weight shift (influenced by your visual system and other issues) is to the right, requiring upper body (and neck) rotation  to the left will be required for right upper extremity use (a normal right dominant pattern). This compensatory rotation can and will have an influence on neck orientation and position and therefore temporal bone (TMD) position, occlusion and airway position.  If the airway is twisted, bent, and thus obsturcted or narrowed,shifting the head forward to open the airwy is a common compensatory activity. This all can have an has influence over the other systems mentioned above.

Our PRIME program utilizes the expertise of a dentist/orthodontist, and postural minded optometrist to untwist the neck and place it in a more ideal position, matched by a body orientation managed from the floor up by a podiatrist and physical therapist.  This interdisciplinary integration has a strong influence in the managment of the airway and therefore the symptoms potentially associated with airway obstruction and cervical spine malalignment.  Some of the more common issues include dizziness, headaches, autonomic dysfunction, chronic fatigue, brain fog and more.

If you have questions about our program and how it may be able to assist you feel free to contact us at or call us and speak with one of our care coordinators at 402-975-8533.

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