Upper Neck Alignment and Its Domino Effect on Brain Circulation and Long Term Brain Disease

https://www.hindawi.com/journals/nri/2015/794829/

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For the past three weeks I have mostly been buried under the administrative tasks that come with the annual accounting cycle of a small business (after hours, of course, the office days have kept us hopping). This year has been a little worse than usual with the re-platforming of some software on the cloud , some very icy and slow driving conditions, and the residual paperwork of adding two new staff members, Anne and Dr. Kaila (although the latter is clearly the only bright spot of the trio).

I finally decided to treat myself this morning to a brief “nerd safari” through a big backlog of research podcasts that have been displaced by the admin work, and boy, I was in for a real treat! A colleague had recommended a book by the late Dr. Flanagan, a bit of a chiropractic genius that did research well ahead of his time and with late recognition. His book “The Downside of Upright Posture”, is on my reading list once I finally emerge from my administrative dog house, but in the meantime I still had a chance to peruse his fantastic research paper published in 2015. Dr. Flanagan’s research focused on the little explored relationship between the transition of humans from the four legged stance to the upright two legged posture, and how this shift of the head and neck in gravity has been the source of much problems as the design of our lower brain stem and upper neck junction is very vulnerable to compression and backflow with minor injuries. The venous backflow in the largest vein of the neck, the jugular, can be measured on MRI imaging.

While this excitement may seem irrelevant, there are some profound implications for the chiropractic profession, with focus on upper neck post trauma intervention. In his paper, Dr. Flanagan points to research showing that some of the most life altering chronic residuals from neck and head injuries can be autonomic symptoms (POTS, dizziness, anxiety, arrhythmias, fainting etc…), and in the long term, an increased rate of neurodegenerative disease (Parkinson’s, ALS, dementia). Those residuals may be the results of the venous backflow cascade to the brain, and may be improved by specific manual interventions to the upper cervical spine with a “draining” effect on the venous backflow. Obviously, there is a lot more research to be done to quantify that correlation, but the take home message for now is that chiropractors should really pay close attention to signs of upper neck trauma residuals in individuals with presenting autonomic symptoms and address them.

Already Thinking About Movement as Part of your 2020 Resolution???

Dr. Alvarez and I have some rather hilarious discussions about patient management, which get even weirder by the end of our very busy work weeks. When contemplating the topics for our first quarter monthly education series, the topic of continued exercise routines during the winter months was a natural choice, but what to call it wasn’t so easy. After tossing around some very boring headlines ( 5 tips for winter wellness, bluh ), we decided that we needed something with a little more bite without getting too insulting. Hence the title Winter Couch Potatoes 101, which, we hope will be a good happy medium (you be the judge).

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At any rate, I hope that in spite of your post Christmas blues you will brave the cold on January 13th at 5:30 to join us for a 70 minute hands on presentation of an assortment of half hour workouts that can be done at home with little equipment and little to no cost. After 25 years of practice I see a real alarming trend in patients who get extremely deconditioned in the winter months since they find it difficult to leave the house in the cold and dark, are justifiably concerned about walking on icy surfaces, have scheduling challenges, or lack funds for a gym or group exercise classes. The half hour workouts will include a variety of options that can match a variety of physical abilities including: yoga, light aerobic routine, strength routines, etc… We will use multiple online resources that are free or have minimal costs, and demonstrate the very basic needed equipment needed to effectively exercise at home. Come with your sweatpants and be ready to have a little fun.

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The Correlation between TMJ Symptoms and Neck Alignment

https://www.tandfonline.com/doi/abs/10.1080/08869634.2018.1498181

I came across this article during one of my “nerd safaris” last month and have been eager to comment on it ever since. It comes from some really great medical doctors in Turkey (the country, not the Thanksgiving meal…) . There were several interesting nuggets in this article:

  • The gold standard measurements of normal vs abnormal cervical curve measurements come from a contemporary chiropractic researcher that is often overlooked in our own profession (Dr. Harrison).

  • The research looked at the correlation between neck lateral alignment (referred to as sagittal alignment or lordosis), and TMJ symptoms, rather than jaw pain and neck pain. This is important because mechanical problems of the neck can cause pain and compensatory problems elsewhere in patients who have little to no neck pain. In other words, still important to look at the neck posture even if people think their neck is “fine”.

  • All of their TMJ symptomatic patients showed abnormal cervical curve.

  • Patients with the higher abnormal cervical curve measurements and TMJ pain also had higher depression scores. Pain and neurological stress from the upper spine is not good for mood management.

Bottom line- Patients with TMJ issues benefit from having their cervical spine evaluated for abnormal shifting, as it appears to be a contributing factor.

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Happy Thanksgiving!

Happy Thanksgiving!

With so much to be thankful for again this year, let’s not take our health for granted! The following are a few general tips you can try this holiday season to help reduce some stresses on your body with increased amounts of sitting and driving.

Neck Retractions: https://www.youtube.com/watch?v=Z2klmiodDHA

-          These can be done while driving to family gatherings or work parties.

Pelvic Rocks: https://www.youtube.com/watch?v=SlzYz7SQns4

-          These can also be done while driving or even give them a try while out in your deer stand!

Shoulder Rolls: https://www.youtube.com/watch?v=wVXK4DUoSj8

-          If you are up for some really long drives you could add these into your routine as well as the other two, but even better if you are doing any Black Friday shopping try these out while you are waiting in line!

Also, a quick reminder for shoveling:

-          Pushing the snow rather than lifting the snow will reduce low back pain risk. If you have to lift, remember to bend and lift from your knees.

-          Avoid lifting and twist at the same time, move your toes with your nose.

-          It is okay to take breaks and please do so.

-          Stay safe, but accidents do happen and are sometimes inevitable. If you are feeling some pains or discomforts call us at 507-263-2393 and set up an appointment. We can even discuss some exercises that may be more specific to your body and what it needs.

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Whiplash or Concussion is Like the Proverbial Chicken or the Egg

https://www.jospt.org/doi/full/10.2519/jospt.2016.7049

I was listening to a podcast on the subject earlier this week, while sliding my way to work on the first snowy, slick roads of the season. Motor vehicle accidents clearly occur year around, but the risk factors are about to increase for several months.

The article did not bring anything exceptionally new in the clinical dilemma of understanding the overlap of neck injuries and concussion in rear end motor vehicle accidents, but it highlighted a couple of important reminders:

  • The position of the head rest in a rear end collision is a big determining factor of the forces that will be applied to the upper spine and head. The headrest should be slightly above the occiput to block the head from hyperextending. If the headrest is lower than the occiput, it creates a buckling point for the head to sharply and violently hyperextend, a risk for both spine and brain injury.

  • Females tend to have longer and less complete recoveries than males in equal accidents, since the circumference of the neck to the head is on average smaller, and the head acts as a fulcrum weight on the lower neck during flexion and extension.

  • The force applied to the head and neck in rear end collisions at speeds as low as 10 MPH are equal to the hit taken by a football quarterback at full speed, if certain mechanical elements of the crash are not favorable, such as the position of the head rest and head rotation at the time of impact.

Not everyone in a rear end collision will have a serious neck injury, but many will have milder injuries that will linger on and come back to haunt them for the long run. In case of doubt, get checked.

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Multi vs. Single Sport Specialized Athletes

Over the last few years, I have seen an increase in specialized sports athletes and less multi-sport athletes. First and foremost, any athletic participation is great.  If we are talking sport vs no sport, sport in my opinion, will almost always win. Some of the best athletes have played more than one sport. Star examples such as Deion Sanders (Baseball & Football), Michael Jordan (Basketball & Baseball), Gene Conley (Baseball & Basketball), Bo Jackson (Baseball & Football), Russel Wilson (Baseball & Football), and Tim Tebow (Baseball & Football).  Now, not everyone that is a multi-sport athlete turns out to have this kind of success, but then why do it? Overuse injuries, adaptability, burnout to name a few, are some reasons that specialized sports do more harm than good. A number of high school athletes I talk to want to play college softball, I was in this same situation about 7 years ago so I get to speak from personal experience. When I was in high school I recall wondering if I should put all my focus, time, and energy into softball. I also played basketball and volleyball (not great at either of them but, enjoyed playing regardless). I recall talking to my father about this, who is a softball coach, and attended large coaching conferencing with big time college and professional coaches regularly. I can remember him telling me that a Division I coach stated that she hardly ever would recruit single sport athletes for a number of different reasons, and if you look at the second and third article that are attached you’ll read some additional opinions on recruitment.

Attached are a few additional opinion articles I have found regarding the topic.

https://www.sportscasting.com/star-athletes-who-played-more-than-one-professional-sport/

https://usatodayhss.com/2018/specialization-or-multisport-participation-heres-what-the-data-says 

https://www.hommenorthopedics.com/blog/the-multi-sport-versus-single-sport-athlete-12133.html

 

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Chiropractic, the Autonomic Nervous System and Cardiovascular Health: Pushing for New Explorations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884005/

This remarkable article did not get the press it deserved in our profession, much less the medical/cardiology specialties involved. It is a bit long and dense for a lay patient read, but still worth your time if you have 20 minutes to invest.

The article is quite remarkable for two “radical” implications:

  • The inter-phase between two seemingly distant branches of health care is proposed as being so intertwined as being virtually co-delivered, even in settings such as inpatient hospital rounds, where Chiropractors are (not yet) the norm.

  • The Cardiologist co-authoring the paper is very aware of the Chiropractic role in affecting the nervous system, and in this case more specifically the autonomic control of cardiovascular functions. This is a welcome departure from the “pigeon hole” of low back pain that Chiropractic seems to find itself relegated to as it starts to “integrate” within the larger medical complex.