Much like the Atlas in Greek mythology who supported the entire world, the function of the atlas bone is critical: it supports your entire head.

The atlas bone (C1) connects your skull to your spine, and with the support of the axis (C2) just below, it gives your head its range of motion.

Misalignments in the atlas bone can cause chronic pain, stress, and tension in the head and neck. When seeking help, it’s important to understand the purpose of this critical piece of your spine and how to know when it’s causing discomfort.

What is the atlas?

The atlas bone is the top bone or first cervical vertebrae connecting your skull to your spine. It’s also known as the C1 vertebra in your cervical spine.

For a quick anatomy lesson on your complete spine, you have 7 cervical vertebrae that connect to the 12 thoracic vertebrae, which in turn connect to your lumbar vertebrae. Those 5 vertebrae make up the lumbar spine.

A unique feature of the atlas vertebra at the very top of your spine is that it lacks a vertebral body, spinous process, and the intervertebral discs found elsewhere in the spinal column.

It’s essentially a ring that joins the occipital bone above it with the axis, or C2 vertebra, below it thanks to both the atlantooccipital joint and the atlantoaxial joint.

These joints belong to a class of synovial joints that act as pivot points in the body. In this case, the pivot is your head movements.

Let’s dive into the atlas bone’s support structure and general anatomy to get a deeper understanding of how it works.

Lateral masses

The lateral masses (Massa lateralis atlantis) of the atlas bone are its thickest and sturdiest parts. This is by design. The pair of masses supports the weight of your skull. Superior and interior facets, or small joints, are found on each side.

The superior articular facets on the superior surface connect to the occipital condyles on your occipital bone. These structures allow for neck flexion and nodding movements of the head. This part of your anatomy allows you to shake your head “no” or “yes.”

The inferior articular facets on the interior articular surface allow articulation with the axis, or second cervical vertebra, and head rotations. Essentially, this is where the two joints meet.

Anterior arch

The anterior arch is concave on one side and convex on the other.

That shape allows it to work as a connecting segment for the odontoid process (dens) of the axis below and the transverse ligament. From above, it attaches the long muscle of the neck (longus colli muscles) with the anterior tubercle.

The upper border of the anterior arch attaches to the anterior atlantooccipital membrane. The lower border attaches to the anterior atlantoaxial ligament and the anterior longitudinal ligament. Most importantly, these connections are a pivot point with the axis.

Posterior arch

The thin posterior arch that ends behind the posterior tubercle makes up about two-fifths of the circumference of the atlas ring. A groove in the posterior arch allows the vertebral artery to pass through here and the foramen magnum and continue along the spinal column.

Defects in this area that lead to interference between the atlas and your skull can cause neurological problems down the line if left untreated. 

Vertebral foramen

The vertebral foramen is a large opening in the bone for both the spinal cord and the odontoid process of the axis. On the axis side, it serves as the start of a pivot point for your C2 vertebra. 

Transverse processes

The transverse processes are large projections from the lateral masses that attach to the muscles here and help you rotate your head and neck. These muscles include the rectus capitis lateralis, a small muscle important to lateral bending of the occiput, or the back of your head.

The transverse foramen in the transverse processes is a hole for your vertebral artery.

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Atlas Misalignment

Atlas misalignment can cause pain and affect the structural integrity of your spine over time.

How does your atlas get misaligned? Your atlas can get misaligned due to injury, abnormalities in your bone structure, or a variety of conditions affecting the spine and musculoskeletal system. Poor posture can also cause atlas misalignment over time.

One rare injury that directly affects the atlas is a Jefferson fracture, most often seen alongside spine or head injuries. Generally, atlas fractures are more common in the elderly.

It can be difficult to know how many people are out there with an atlas misalignment, as many patients don’t seek care immediately. Compared to other treated conditions, it is one of the most common addressed by chiropractic care.

What are the symptoms of a misaligned atlas? The symptoms of a misaligned atlas include headaches, pain in the jaw, neck, and back, and muscle stiffness. It is also be a trigger for migraines.

A misaligned atlas may also cause:

  • Hearing problems, e.g. tinnitus, hearing loss, inner ear conditions
  • Shoulder pain or misalignment of the scapulae, or shoulder blade
  • Restricted movement, including limited movements of the head
  • Dizziness, including vertigo
  • Balance problems
  • Difficulties with coordination and concentration
  • Muscle spasms
  • Pelvic and hip misalignment 

What are the dangers of an atlas misalignment? The dangers of an atlas misalignment include increasing pain and stiffness in the affected area over time and misalignment in other areas of the body. Severe misalignments can affect the natural curves in the neck and spine.

Patients with a history of migraines may find that atlas misalignments trigger and prolong their headaches. The good news is, the atlas can be adjusted to help prevent long-term complications.

When You Need an Adjustment

If you’re experiencing pain or other symptoms that signal issues with the atlas bone, a correction or atlas adjustment can help alleviate some of those symptoms. The first step is contacting a chiropractor who specializes in upper cervical care and cervical instability to diagnose the issue.

There are ways to support proper atlas alignment on your own. Stretches to strengthen your neck muscles, breaks from computer work, and a focus on proper posture while at a desk can all go a long way toward improving your cervical spine health.

Adjustments are best left to the professionals, though.

How do I adjust my atlas bone? To adjust your atlas bone, a chiropractor who specializes in upper cervical care will lead you through a series of gentle corrections.

Your chiropractor may then show you at-home exercises to support your vertebral column. It’s important not to attempt adjustment on your own without a professional modeling it first.

An adjustment brings the atlas bone and the spine back into alignment. The ideal benefit is reduced, even eliminated pain, and a reduced risk of symptoms. 

How Atlas Orthogonal Treatment Works

Atlas orthogonal treatment is a chiropractic technique that brings the C1 vertebra back into alignment. It is a gentle, precise, and painless approach that typically begins with x-rays ahead of treatment. These scans allow chiropractors to be more precise with their adjustments.

Once trouble spots are noted, your chiropractor uses handheld instruments to deliver the appropriate adjustments. These tools eliminate the need for excessive pressure in this delicate area of the upper cervical spine.

How often should the atlas be adjusted? The atlas should be adjusted as often as needed for improvement of symptoms. For many patients, that means one or 2 adjustments, with follow-up visits down the line as necessary.

Post-treatment x-rays confirm the correct adjustments were made, measure progress, and inform follow-up treatment decisions. Treatment plans vary from patient to patient.


Instrument-assisted treatments used in chiropractic care make treatments much safer, but there are possible side effects to any adjustment.

Those include muscle soreness, worsening symptoms, and bone fractures, especially if you suffer from brittle bone disorders or osteoporosis. Stroke or paralysis are the most severe possible side effects following any adjustments.

Again, instrument-assisted corrections reduce potential side effects dramatically.

Your chiropractor will also share any precautions you should take following adjustments. Here are a few common precautions recommended by upper cervical spine specialists: 

  • Focus on your posture. Continued poor posture in the shoulder and neck area can trigger future atlas misalignment. 
  • Consider your workday. Look at the ergonomics of your workspace and take stretch breaks throughout the day.
  • Eat right and exercise. A healthy diet and movement routine improve the muscles and ligaments throughout the body.
  • Work with a chiropractor. You already know a chiropractor can bring your atlas back into alignment. They can also get you on track for long-term upper cervical spine health.

It is also important to work with a chiropractor who specializes in upper cervical care and precise neck adjustments.

Upper cervical chiropractors focus on the atlas and the axis. While the C1 vertebra provides stability, the C2 allows for movement. Both are important to neurological processes, including brainstem function.

Denver Upper Cervical Chiropractic is a leading provider of upper cervical care and addressing pain in those two 2 vertebrae. Contact us today to take control of your healing and correct misalignments causing your discomfort.

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