By Dr. Rusty Lavender, D.C. — upper cervical chiropractor, Lavender Family Chiropractic, Sarasota, FL. Reviewed and updated October 2026.
In short: Knee Chest Upper Cervical is the technique used for every correction at Lavender Family Chiropractic in Sarasota. You kneel on a dedicated table with your chest supported and your head in a measured neutral position, and the doctor delivers a brief, low-force correction to the atlas (C1) or axis (C2) along a line calculated from your 3D CBCT imaging. There is no twisting, cracking, or rotation of the neck. Paraspinal infrared thermography before and after confirms the nervous system responded. This page explains what the technique is, how a correction is performed, what the research says, and how to get started. Call (941) 243-3729 or book online.
What the Knee Chest Upper Cervical technique is
Knee Chest is one of several recognized upper cervical chiropractic techniques. All of them share the same starting point, described in a 2015 narrative review in the Journal of the Canadian Chiropractic Association: the primary misalignment is in the upper cervical spine, each technique uses imaging analysis to decide whether a correction is needed, and each re-assesses afterward to confirm it was delivered. Where they differ is in how the patient is positioned and how the correction is made.
What sets Knee Chest apart is the position. Instead of lying on the side or the back, you kneel forward on a purpose-built table with your chest on a padded support and your head resting on an angled headpiece. The position has a specific biomechanical purpose: it takes the weight of the head off the upper neck, lets the deep stabilizing muscles release, and removes the rotational tension that resists a correction when the neck is loaded. The doctor can then reach the atlas or axis with a precise contact and very little force.
The technique grew out of the original upper cervical research of the early and mid twentieth century, when the first upper cervical chiropractors spent decades working out how to correct the atlas and axis specifically. The modern form we practice, sometimes called Advanced Hole-in-One Knee Chest (AHKC), is taught through a structured, sequential certification with defined standards for positioning, thermographic interpretation, imaging analysis, and the correction itself. A 2024 paper in the Journal of Upper Cervical Chiropractic Research set out those contemporary standards; the abstract is here. The point for you as a patient is that the care is not improvised. The technique has standards, and we follow them.
How a Knee Chest correction is performed
First, the measurements. No correction is made without them. Your 3D CBCT image tells us the position of the atlas and axis under the skull in all three planes, so the direction and angle of the correction are calculated before you are on the table. Your thermography scan that day tells us whether the nervous system is showing an uneven pattern that calls for a correction at all. If the scan is balanced, we do not adjust.
Second, the position. You kneel on the padded knee support, lean forward so your chest rests on the chest pad, and your head rests on the headpiece. The headpiece angle (sometimes called the S-angle) is set to your own skull and neck geometry so the upper neck sits in a true neutral, decompressed position. This is the step that quiets the muscles that would otherwise fight the correction.
Third, the contact. The doctor places a specific hand contact, usually the soft pisiform area at the base of the hand, on the exact landmark the imaging identified: the lateral mass of the atlas or the posterior arch of the axis. The contact is placed to within millimeters.
Fourth, the correction. A brief, controlled, low-force thrust along the calculated line. It is over in a fraction of a second. There is no twisting of the head, no rotation of the neck, no popping or cracking, and usually no sound at all. Patients are routinely surprised to be told it has already happened.
Fifth, rest. You rest in a quiet room afterward so the nervous system can settle and integrate the change. This is unusual in chiropractic care and essential in Knee Chest practice.
Sixth, verification. We re-scan with thermography and compare it with the pre-correction scan. If the pattern has balanced, the correction took. If it has not, we address it. Results are confirmed, not assumed.
How Knee Chest differs from other upper cervical techniques
Every upper cervical technique has its own logic. Several use side-lying or supine positions with a sustained contact, a torque-and-recoil contact, or an instrument-delivered correction, and each lineage has its own training and its own body of clinical research. Our guide to upper cervical chiropractic techniques compares them in detail; the differences are different approaches to the same target, developed by different lineages.
Knee Chest is distinct in three ways. The kneeling position decompresses the neck and relaxes the deep muscles before the doctor makes contact. The correction is a short, precise thrust along a calculated line rather than a sustained or instrument-delivered one. And the technique is built around measurement at both ends: 3D imaging to calculate the correction and thermography to decide when it is needed and whether it held.
The measurements behind the technique
A Knee Chest correction without current, accurate information about your upper neck would be guessing. Every patient at our Sarasota office has three layers of assessment before a correction is delivered.
3D CBCT imaging. Cone beam CT produces a three-dimensional image of the atlas, axis, and base of the skull. A flat X-ray collapses a rotation, a tilt, and a forward shift into one view; the volume shows each separately, so the line of correction is calculated at the true angle. A 2022 review in Dose-Response on CBCT of the craniocervical junction in upper cervical chiropractic practice found the junction visualized in superior detail compared with plain films, at an effective dose equal to or less than conventional radiographs of the same region. Read more on our 3D CBCT X-ray page.
Paraspinal infrared thermography. A non-contact scan that reads skin temperature on each side of the spine, level by level. Skin temperature is regulated by the autonomic nervous system, so an uneven pattern that matches your earlier scans is the signal to correct, and a balanced pattern is the signal to leave the atlas alone. Two reliability studies, in PLoS One (2011) and the Journal of Manipulative and Physiological Therapeutics (2004), reported intra- and inter-examiner correlation coefficients between 0.91 and 0.98. Read more on our paraspinal infrared thermography page.
Neurological and orthopedic examination. Posture, leg length, range of motion, reflexes, balance testing, and specific upper cervical screening. This is the clinical foundation that ties the imaging and the thermography together.
What the research says
Upper cervical corrections delivered by a brief, specific thrust to the atlas or axis have been studied under the name “toggle recoil,” the closest research label for the Knee Chest correction. A 1994 pilot study in the Journal of Manipulative and Physiological Therapeutics followed 26 patients with chronic headache and upper cervical joint dysfunction through four toggle recoil corrections to the two upper cervical vertebrae over two weeks, tracking headache frequency and severity with daily questionnaires in a six-week time-series design. A 2016 pilot sham-controlled trial in the same journal randomized 51 adults with prehypertension or stage 1 hypertension to toggle recoil upper cervical manipulation or a sham procedure, twice weekly for six weeks, to estimate treatment effect and safety for blood pressure.
On the Knee Chest technique specifically, a 2026 case report in Cureus described a 44-year-old woman with a three-year history of episodic vertigo, imbalance, right-sided tinnitus, aural fullness, and headache carrying a working diagnosis of Ménière’s disease, whose examination showed upper cervical postural asymmetry, restricted cervical motion, positive balance testing, and thermographic findings consistent with upper cervical dysfunction, and who was managed with Knee Chest upper cervical care. A case report describes one person’s course rather than an average result, and we cite it for what it documents: the examination findings and the technique, applied to the kind of patient we see every week in Sarasota.
On safety, the 2015 Canadian review of upper cervical procedures above characterized adverse events after an upper cervical correction as mild symptomatic reactions lasting under 24 hours. A prospective national survey published in Spine in 2007 followed 19,722 chiropractic patients through 50,276 cervical spine manipulations and recorded no serious adverse events, with the most common minor effects being transient dizziness or light-headedness and headache. Knee Chest adds to that baseline a position and a correction that involve no rotation of the neck, which is the movement that places the most stress on the vertebral arteries and the structures around the brainstem. Results vary by person, and we measure before and after.
Conditions Sarasota patients bring to Knee Chest care
The Knee Chest technique is not a treatment for a particular disease. It corrects the alignment of the top of the neck, the region where the brainstem meets the spinal cord and where the nerves from the upper neck share a processing center with the trigeminal nerve. That is why the same correction is relevant to such different complaints. Patients commonly come to us for migraines, including vestibular and barometric patterns; vertigo and dizziness, including cervicogenic dizziness and post-concussion imbalance; POTS and dysautonomia; TMJ and TMD; car accident and whiplash injuries; Ménière’s disease and eustachian tube dysfunction; and trigeminal neuralgia, neck pain, fibromyalgia, and vagus nerve dysfunction. Many arrive after a long search for a cause. If the examination and imaging do not show upper cervical involvement, we say so and point you to the provider who fits.
Why patients choose Lavender Family Chiropractic for Knee Chest care
Knee Chest practitioners are a small group within an already small field. The training is sequential and ongoing, the imaging and thermography equipment is a significant investment, and many chiropractors who describe their work as “upper cervical” do not practice Knee Chest. At Lavender Family Chiropractic the technique is the foundation of the practice. Dr. Rusty Lavender and Dr. Jacob Temple have completed the specific training the technique requires and continue it through seminars and peer review. We are part of the NeckWise network of upper cervical chiropractic offices, which connects our practice to a wider community of training focused on this one region of the spine. Care is delivered through individualized care plans so that corrections have time to hold and progress is tracked objectively.
Our office is at 5899 Whitfield Avenue, Suite 107, Sarasota, FL 34243, at University Parkway and Whitfield Avenue. Hours are Monday through Thursday 10:00 am to 1:00 pm and 3:00 pm to 6:00 pm, and Friday 9:00 am to 12:00 pm. Patients come from across Sarasota and Manatee Counties, and we also see patients from Lakewood Ranch, Bradenton, and Venice.
Frequently Asked Questions about the Knee Chest Upper Cervical technique
Does the adjustment hurt?
No. The correction is brief, precise, and low force. There is no twisting, popping, or cracking. Most patients describe a quick, light pressure at the side of the upper neck and are surprised it is already over.
Will my neck pop or crack?
No. The Knee Chest correction does not produce the cavitation sound associated with traditional manual chiropractic. It is typically silent.
How long does a visit take?
The correction itself takes a fraction of a second. A visit in active care, including the pre-scan, the correction, rest, and the post-scan, usually runs 10 to 20 minutes.
Why do I have to be in the knee-chest position?
Kneeling forward with the chest supported takes the weight of the head off the upper neck, decompresses the cervical spine, and relaxes the deep stabilizing muscles. That is what allows a precise, low-force correction with no rotation of the neck.
What is Advanced HIO Knee Chest (AHKC)?
Advanced Hole-in-One Knee Chest is the modern, structured form of the technique, taught through sequential certification levels covering positioning, thermographic interpretation, imaging analysis, the correction, and case management. It is what we practice.
Is Knee Chest safe?
The position and the correction involve no rotation of the neck, every correction is calculated from 3D imaging that also screens for anatomy that would change our approach, and serious conditions are ruled out by a physician first. A prospective survey of 50,276 cervical manipulations recorded no serious adverse events, and a review of upper cervical procedures characterized adverse reactions as mild and lasting under 24 hours. Some patients feel warmth, relaxation, or mild fatigue afterward, which typically passes.
How do you know the correction worked?
Thermography before and after each correction. A balanced pattern afterward shows the nervous system regulating evenly; we compare the two scans and track them visit to visit. When the pattern stays balanced, no correction is made and visits are spaced out.
Do you only adjust the atlas and axis?
Yes. The technique focuses on the top two vertebrae. By correcting those precisely, the rest of the spine often re-balances because the brain is no longer compensating for distorted input from the upper neck. We do not deliver general full-spine adjustments.
How is Knee Chest different from other upper cervical techniques?
Mainly in position and delivery. Other techniques use side-lying or supine positions with a sustained, torque-and-recoil, or instrument-delivered correction. Knee Chest uses the kneeling position and a brief, calculated thrust. They are different approaches to the same target.
How do I get started?
Call (941) 243-3729 or book online. Your first visit includes a consultation, a neurological and orthopedic examination, paraspinal thermography, and, when the examination points to the upper neck, 3D CBCT imaging, followed by a report of findings where we walk you through everything we found. We hold time for same-day new patient visits.
Begin Knee Chest Upper Cervical care in Sarasota
Call (941) 243-3729 or book online. Lavender Family Chiropractic in Sarasota, Florida offers a thorough upper cervical evaluation to find out whether we can help.
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