TECHNIQUE

Lovett Brothers: The Relationship Between The Cervical and Lumbar Vertebra.
TECHNIQUE
Lovett Brothers: The Relationship Between
The Cervical And Lumbar Vertebra.
ABSTRACT
Introduction: For years, chiropractors have used the term
“Lovett Brothers” to describe the relationship between specific
vertebra in the lumbar and cervical spine.
Purpose: This paper seeks to investigate the rational behind
this “Lovett Brother” relationship and present possible theories
for its existence. These theories vary from fascial and myological
interrelationships, referred pain patterns, and facilitating
tonic neck reflexes involving intersegmental spinal pathways.
Introduction
The chiropractic profession since the early 20 th century has
incorporated the theory that there is a relationship between the
lumbar and cervical vertebra and has used this concept with its
methods of evaluating and treatment. This concept has empirically
been accepted by chiropractors for decades and was based
on the work of Robert W. Lovett. 1 Walther notes that, “The
spine appears to function with a specific harmonious movement
as an individual walks, runs, and otherwise performs daily
activities… The vertebra working in conjunction with each other,
such as the 1 st lumbar and 5 th cervical, are known as Lovett
Brothers” 2
As the name Sacro Occipital Technique (SOT) implies,
DeJarnette a chiropractor and osteopath, found a relationship
between the sacrum and occiput, as well as between the cervical
and lumbar vertebra 3 . He described that a relationship exists
between the atlas and the 5 th lumbar vertebra, axis and the
4 th lumbar vertebra and so forth, following that pattern all the
way to the mid thoracic region. He called this relationship R +
C factors (for resistance and contraction ) and found that each
vertebra within a pair affected one another.
These concepts have been readily used, are broadly accepted
in the field of chiropractic and there are some theories as to
why this relationship exists. They vary from fascial and myological
interrelationships, referred pain patterns, and facilitating
tonic neck reflexes involving intersegmental spinal path-
Charles L. Blum, DC, Private Practice
1752 Ocean Park Boulevard, Santa Monica, California 90405
Charles L. Blum, DC
Discussion: While there have been no definitive studies evaluating
the use of “Lovett Brothers” as a diagnostic and treatment
modality there have been some reported case studies which
support its use.
Conclusion: Future research is necessary to further understand
this phenomenon that is already readily accepted in the chiropractic
profession.
Key Words: Chiropractic, Sacro Occipital Technique, Lovett
Brother, Applied Kinesiology, Upper Cervical, Subluxation
ways. Apparently “Lovett Brother” relationships can affect or
be affected either in a cervical to lumbar caudal direction or
lumbar to cervical cephalad direction. That would mean trauma
to a lumbar vertebra would also affect its cervical component
and trauma to a cervical vertebra would affect its lumbar component.
Fascial Relationships
The dura mater is a tough fibrous membrane. It is the outermost
covering of the brain and the spinal cord. The dura of the
brain and that of the spinal cord are similar and continuous with
one another at and through the foramen magnum. The dura
mater is the outermost envelope of the central nervous system,
however within the cranium, aside from surrounding the cerebrum
and cerebellum, the dura mater also compartmentalizes
each structure and separates them from each other and the right
from the left side. The external layer serves as the internal periosteum
for the cranial bones and is continuous through the
sutures with the periosteum of the external surface of the skull
where it anchors and attaches itself. The internal meningeal
layer has four folds; the falx cerebri, the tentorium cerebelli,
the falx cerebelli, and the diaphragma sellae. The dura anchors
strongly to the different areas of the inner cranial vault especially
where the meningeal layer comes in contact with the periosteal
layer. 4-14
The cranial dura is firmly adherent to the different points
within the cranium, to the ring of the atlas and extends as the
spinal dura having firm attachments to the foramen magnum,
J. Vertebral Subluxation Res. - JVSR.Com, April 12, 2004 1

second and third cervical vertebrae. The posterior cervical epidural
ligaments anchor the posterior dura mater to the ligamentum
flavum. 15
A connective tissue bridge also has been noted between the
rectus capitis posterior minor muscle and the dorsal spinal dura
at the atlanto-occipital junction. 16 Continuity was also “observed
between the ligamentum nuchae and the posterior cervical spinal
dura as the latter passed deeply from the midline toward the
dura, but only at the first and second cervical vertebral levels.
The ligamentum nuchae also passed bilaterally on to the occipital
bone as far as the sutures between the occiput and the
temporal bones, approaching the inferior nuchal line superiorly.”
17
Along the spinal canal towards the lumbar area, meningovertebral
ligaments (ligaments of Hofmann) have been located
between the L5/S1 intervertebral level cephalad to T1. These
ligaments appear to be more prevalent in the lumbar vertebral
column but are also present throughout the thoracic vertebral
column. It is theorized that the dural sac attachments to the posterior
aspect of the vertebral bodies and the posterior longitudinal
ligament could act to traction the dural sac in the event of
nuclear bulge or herniation. 18
Due to these dural, ligamentous, and fascial connections,
tensions at either end of the “dural tube,” which connects to the
sacrum and foramen magnum, could reflexly affect one another.
This concept is illustrated by holding a relatively inflexible tube
with both hands and stabilizing one end and twisting the other.
The tension that is applied to the twisted end would also be felt
at the other end which is being stabilized.
Sutherland an osteopath developed and researched methods
of evaluation and treatment relating to the relationship between
the cranium and sacrum. He described a relationship between
spinal and cranial meninges and called this relationship the reciprocal
intraspinal membranes. This relationship related the
cervicocranial aspects of the dura with the lumbosacral dura.
Sutherland theorized, “ The intraspinal membranes enable the
cranium and sacrum to function in unison. Therefore, just as
the cranium can affect the sacrum or spine, the sacrum can affect
the spine or cranium.” 19
Myologic Relationships
The multifidus muscles extend from C4/5 to S4 with insertions
from C2 to L5 and has a very complicated structure.
Dvorak and Dvorak describe the muscle’s function: “Bilateral
contraction results in extension of the vertebral column, and
unilateral contraction results in rotation of the vertebral column
to the opposite side.” The affect of this muscle is theorized
to affect the distal ends of the spinal column and could act
as a functional and spondylogenic unit. 20 Chronic lumbar
myofascial contracture could theoretically be implicated in cervical
spine splinting or antalgic positioning.
Referred Pain Patterns
Dvorak and Dvorak also describe some clinical experiments
noting “that local and referred pain occurs upon mechanical or
chemical stimulation of different spinal and paraspinal structures.”
20 “When injecting hypertonic sodium chloride solution
into the paravertebral musculature, ligaments, and apophyseal
joints, or when scratching the periosteum with a needle, local
Lovett Brothers: The Relationship Between The Cervical And Lumbar Vertebra.
and referred pain was elicited in every instance according to
the segmental innervation.” 20-23
On one experiment it was determined that stimulation at the
L1 region created referred pain to the gluteal and inguinal region
and referred pain to the supraspinous, levator scapula and
(anterior and posterior) deltoid regions. 22 Since the levator
scapula muscle has a direct attachment to the lower cervical
spine irritation to this muscle could have a cervical response
over prolonged periods of lumbar vertebra irritation. It is also
not unreasonable to envision an indirect relationship between
the supraspinous and deltoid muscles and the cervical spine
due to antalgic head or neck positioning during upper extremity
physical activity.
Facilitating Tonic Neck Reflexes Involving Intersegmental
Spinal Pathways
Nansel, Waldorf, & Cooperstein, attempted to “determine
whether spinal adjustments, delivered to the upper vs. lower
cervical spine, might result in tonic neck reflex-induced alterations
in the activity of the lumbar paraspinal musculature.”
[24] They noted “lower cervical adjustments induced increases
in tissue compliance (decreases in tone) which were highly significant
(p < .001) and relatively robust compared to those found
following upper cervical adjustments (p < .01).” 24 Results from
this study “indicate that cervical spinal manipulation can have
significant effects on the tone of the lumbopelvic musculature,
presumably by facilitating tonic neck reflexes involving intersegmental
spinal pathways.” 24
This specific study illustrates the Lovett Brother relationship
as a cervical region might affect its companion lumbar region.
What would need to determined in further studies would
be if these “intersegmental spinal pathways” can be associated
with facilitating tonic lumbar reflexes and hence describe a lumbar
to cervical route.
Discussion
The Lovett Brother relationship has been discussed in literature
and proposed as a diagnostic and treatment modality. 25-29
A few chiropractic studies have investigated the relationship
clinically between the effect of treatment to the cervical spine
to the lumbar region. 30-31 Chinappi and Getzoff found a clinical
relationship between the lumbosacral spine and cervicocranial
regions. 31
In the study by Kessinger it was attempted to assess “changes
in spinal motion of the lumbar spine following the correction
of an upper cervical subluxation and compare those results with
the spinal motion of the lumbar spine in a control group that
did not receive upper cervical care. Significant improvement
in lumbar range of motion was noted in both the short- and
long-term range of motion studies within the care group.” 30 This
trend however was not evident in the control group. This study
suggested a positive correlation between an upper cervical subluxation
and the improvement in lumbar range of motion.
Chinappi and Getzoff found that “the position of the jaw,
head and vertebral column, including the lumbar region, are
intricately linked.” 31 Chiropractic treatment to the cervical spine
and jaw allowed the lumbosacral and sacroiliac regions in their
case study to reach greater stability. It was suggested that there
was a relationship between the lumbar spine and cervicocranial
J. Vertebral Subluxation Res. - JVSR.Com, April 12, 2004 2

egion and that this intricate link allows one region to affect the
other. In another study, Gregory found a direct relationship
between the sacroiliac joint and the temporomandibular joint
(TMJ). 32 These clinical findings illustrate a modification of
Lovett Brother relationships and how distal ends of the spine
can influence one another.
Conclusion
The implications of the Lovett Brother relationship allow
for diagnostic evaluation as well as specificity in treatment
modalities. Since one region of the spine can affect a specific
counterpart, evaluating each component of this vertebral relationship
can guide therapeutic application.
Future studies need to evaluate arthritic changes33 in the cervical
or lumbar regions and whether this Lovett Brother relationship
maintains consistency. It would be anticipated that
long-term disuse or trauma to one part of the spine would be
reflected in its associated counterpart. Greater research and
clinical correlations are needed since the Lovett Brother methodology
is integrated into many aspects of chiropractic techniques
and treatment.
References
1. Lovett RW, Lateral Curvature of the Spine and Round Shoulders, P.
Blakiston’s Son & Co.: Philadelphia, PA, 1913: 1-192.
2. Walther, D.S., Applied Kinesiology: Volume I, Basic Procedures and
Muscle Testing, Systems DC, Pueblo, CO, 1981: 67.
3. DeJarnette, M.B., Sacro Occipital Technique Convention Notes 1965 :
Part Two, Nebraska City, NB, 1965: 51-69.
4. Gardner, E, Gray, DJ, O’Rahilly, R, Anatomy – A Regional Study of
Human Structure, 3 rd Edition, Philadelphia, Toronto, London, W.B.
Saunders Company , 1969, 555-60
5. Goss, CM, Gray’s Anatomy of the Human Body , 28 th Edition,
Philadelphia, Pennsylvania, Lea and Febiger , 1966, 882-7.
6. Breig A, Adverse Mechanical Tension in the Central Nervous System,
New York, NY: John Wiley & Sons; 1978: 11-53.
7. DeJarnette, MB, Cranial Technique, self published, Nebraska City,
Nebraska, 1975, 21-37, 106-7, 181-2
8. Upledger, JE, Craniosacral Therapy II: Beyond the Dura, Seattle,
Washington, Eastland Press, 1987, 115-30
9. DeJarnette, MB, Cranial Technique, self-published, Nebraska City,
Nebraska, 1976, 50-2, 105, 200-13.
10. DeJarnette, MB, Cranial Technique, self-published, Nebraska City,
Nebraska, 1979-1980, 1, 8, 41-2, 81-93, 156-9.
11. Upledger, JE, Vredevoogd, JD, Craniosacral Therapy, Seattle, Washington,
Eastland Press, 1983:77-87
12. DeJarnette, MB, Sacro Occipital Technique, self-published, Nebraska
City, Nebraska, 1984 , 2-7, 46-50, 92-100.
13. Magoun HL, Osteopathy in the Cranial Field, 3 rd Edition, Meridian, Idaho:
Sutherland Cranial Teaching Foundation; 1976: 1-72.
Lovett Brothers: The Relationship Between The Cervical And Lumbar Vertebra.
14. Walther DS, Applied Kinesiology, Vol. II, Systems , Pueblo, CO: Systems
DC; 1983: 9-88.
15. Shinomiya, K, Dawson, J, Spengler, DM, Konrad, P, Blumenkopf, B,
An analysis of the posterior epidural ligament role on the cervical spinal
cord. Spine , September 1996, 21(18): pp. 2081-2088.
16. Hack, GD, Koritzer RT, Robinson WL, Hallgren RC, Greenman PE,
Anatomical relation between the rectus capitis posterior minor muscle
and the dura mater. Spine , December 1995, 20(23): pp. 2484-2486.
17. Mitchell, B, Humphreys, BK, O’Sullivan, E, Attachments of the
ligamentum nuchae to cervical posterior spinal dura and the lateral part of
the occipital bone, Journal of Manipulative and Physiological
Therapeutics, March/April 1998, 21(3).
18. Bashline, SD, Bilott, JR, Ellis JP, Meningovertebral ligaments and their
putative significance in low back pain, Journal of Manipulative and
Physiological Therapeutics , Nov-Dec 1996, 19(9): pp. 592-6.
19. Sutherland WG, Contributions of Thought, Meridian, Idaho: Sutherland
Cranial Teaching Foundation, 1967.
20. Dvorak J, Dvorak V, Manual Medicine: Diagnostics, Thieme Medical
Publisher, Inc.: New York, NY, 1990: 53,253.
21. Kellgren JH, Observations of referred pain arising from muscles, Clin
Sci 1939; 3: 175.
22. Kellgren JH On the distribution of pain arising from deep somatic
structures with charts of segmental pain areas Clin Sci 1939; 3:35.
23. Lewis T, Kellgren JH Observations relating to referred pain viscero-motor
reflexes and other associated phenomena Clin Sci 1939;4:47
24. Nansel, D.; Waldorf, T.; Cooperstein, R.; Effect Of Cervical Spinal
Adjustments On Lumbar Paraspinal Muscle Tone: Evidence For
Facilitation Of Intersegmental Tonic Neck Reflexes Journal Of
Manipulative And Physiological Therapeutics. 1993 Feb ; 16(2): 91-5.
25. Farmer, JA, Blum, CL, Dural Port Therapy Journal of Chiropractic
Medicine Jun 2002;1(2): 54-61
26. Blum CL, Chiropractic and Pilates Therapy for the Treatment of Adult
Scoliosis Journal of Manipulative and Physiologic Therapeutics May 2002;
25(4):
27. Blum CL, Incongruent sacro-occipital technique examination findings:
Two unusual case histories. Proceedings of the ACC Conference IX,
Journal of Chiropractic Education Spr 2002; 16(1): 67.
28. Blum, CL, Spinal/Cranial Manipulative Therapy and Tinnitus: A Case
History Chiropractic Technique Nov 1998; 10(4): 163-8.
29. Hochman JI, Analysis of the Cervical Spine, Today’s Chiro, Jul/Aug 1992;
21(4): 15-20.
30. Kessinger RC; The Influence of Upper Cervical Specific Chiropractic
Care on Lumbar Range of Motion Chiropractic Research
Journal. 2000 Fall; 7(2): 80
31. Chinappi, AS; Getzoff, H; Chiropractic/Dental Cotreatment of
Lumbosacral Pain With Temporomandibular Joint Involvement Journal
of Manipulative and Physiological Therapeutics. 1996 Nov; 19(9): 607-12.
32. Gregory, TM. Temporomandibular Disorder Associated with Sacroiliac
Sprain Journal of Manipulative and Physiological Therapeutics May
1993; 16(4): 256-65.
33. Berkson DL Osteoarthritis, chiropractic, and nutrition: osteoarthritis
considered as a natural part of a three stage subluxation complex: its
reversibility: its relevance and treatability by chiropractic and nutritional
correlates. Med Hypotheses 1991 Dec;36(4):356-67.
J. Vertebral Subluxation Res. - JVSR.Com, April 12, 2004 3