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The Atlas Subluxation Complex as
a Correctable Entity of
Cervicogenic Post-Concussion
Syndrome
The Medicalization of
Cervical Spine Dysfunction
• Cervicogenic PCD – characterized by persistent
concussion symptoms and impairments caused by
dysfunction of the cervical spine and somatosensory
system.
• Ellis, Leddy, Wiler. Physiological, vestibulo-ocular,
and cervicogenic post-concussion disorders: an
evidence-based classificatio system with directions
for treatment. Brain Injury 2014.
Examination of Cervicogenic PCD
• “Patients with PCD should undergo careful
examination of the c-spine, posture, and gait.”
• “Cervical lordosis is often reduced in patients with
cervicogenic PCD with frequent static head tilts
observed.”
• “Palpation of the cervical musculature may reveal
diffuse muscle spasm and tenderness involving the
paraspinal and subocciptial muscles”
Management
• “Techniques that can reduce pain and improve ROM
include stretching, passive and active ROM
exercises, massage, and low velocity cervical
spine mobilizations”
The Role of the C-Spine in Post-
Concussion Syndrome
• 5 subject case-series
• Identifies upper cervical joint dysfunction as an
instigator of PCS pathophysiology
• Utilized spinal manipulation, soft tissue mobilization,
and proprioceptive exercise to treat the UC spine
• Cameron MM, Vernon H, et al. The Role of the
cervical spine in post-concussion syndrome. The
Physician and Sportsmedicine. 2015.
Using the ASC to define
PCS
• Cervicogenic post-concussion
syndrome is new terminology, but it
sounds an awful lot like atlas
subluxation complex
• What if you could correlate reduction
with ASC with improvement in main
PCS symptoms
Brain or Strain?
• Investigators thought that you could differentiate a
physiologic (metabolic brain problem) concussion
from cervicogenic concussion by symptoms alone.
• Hypothesis: Physiologic concussion would have
more pronounced cognitive symptoms.
• Brain fog
• Anxiety
• Difficulty with concentration
• Depression
Result:
• Cervicogenic and physiologic concussion have the
same symptoms. Can’t tell by symptoms alone
• Historically, concussion has been a heavily symptom
based diagnosis
• Leddy J. Brain or Strain? Symptoms alone do not
distinguish physiologic concussion from
cervical/vestibular injury. Clinical Journal of Sports
Medicine. 2013
PCS or Whiplash?
Post-Concussion
Syndrome
• Headache
• Vertigo
• Cognitive dysfunction
• Brain-fog
Whiplash Associated
Disorders
• Headache
• Vertigo
• Cognitive dysfunction
• Brain fog
• Neck pain/radiculopathy
“YOU GUYS ARE MIRACLE
WORKERS….”
Dr. John Leddy
•Medical Director at
University of Buffalo
Concussion Clinic
•Numerous publications on
concussion/headinjury
Interview available on
Healyourselfradio.com or
iTunes
Case Series
• 2 Female patients
• Age 16 and 30
• Post-traumatic headache and dizziness primary
complaint
• Diagnosed with PCS by neurologist
• Both with recent history of chiropractic care with no
improvement in PCS symptoms
Case 1
• 16 y/o female
• MOI – fall off horse striking occiput with helmet
• No riding since fall for 3 months b/c of dizziness
• Pre Adjustment ASC
• Left laterality 1.08 degrees, left head tilt 1 degree,Anterior
rotation 3.69 degrees
• Post Adjustment
• Laterality .75 degrees, head tilt .31 degrees, rotation 2.44
degrees
• Improvement in headaches in 2 days. Resolution of
vertigo in 1 week. Return to riding in 1 month.
1 year follow up
• Symptoms return when subluxated
approximately 3 months.
• Symptoms resolve with NUCCA
correction each time
Case 2
• 30 y/o female
• MOI – car accident with roll over. Head struck the
head rest and knocked unconscious
• Daily migraine headache, dizziness, and shoulder
pain
• Pre adjustment
• Right laterality 2.41 degrees, 1.75 degrees head tilt,
posterior rotation 3.42 degrees
• Laterality .79 degrees, head tilt .63 degrees, rotation .85
degrees
• Improvement in migraine in 1 week, dizziness
improved immediately. Shoulder pain unresolved
1 year follow up
• Migraine and dizziness still resolved.
• Surgery for torn rotator cuff resolved
shoulder pain and neck pain
The Argument for ASC
• If cervicogenic PCS was just a result of
proprioceptive/fixation problem, why
didn’t patients respond to spinal
manipulation?
• ASC may be a Measurable and
correctable entity that is causing PCS
Thoughts to Chew on
• Avg concussion takes 96 G’s of force
• Avg whiplash injury takes just 4-6 G’s
• Almost unthinkable to think that a
concussion can happen in the absence
of a neck injury.
Concussion as a Model for
VSC
• Biomechanics of head trauma provides a digestible
mechanism for how ASC happens
• Neurology of proprioceptive insult and altered
venous drainage are both concepts discussed in
concussion literature and chiropractic literature
• Poor postural control is a hall mark of concussion
identification which fits well into NUCCA analysis.
Final Thots
• What if a concussion was the most
acute and symptomatic form of ASC?
• What if less severe traumas were
causing ASC and creating the
physiologic similar to concussion?

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NUCCA Case Study Presentation - Post Concussion Syndrome

  • 1. The Atlas Subluxation Complex as a Correctable Entity of Cervicogenic Post-Concussion Syndrome
  • 2. The Medicalization of Cervical Spine Dysfunction • Cervicogenic PCD – characterized by persistent concussion symptoms and impairments caused by dysfunction of the cervical spine and somatosensory system. • Ellis, Leddy, Wiler. Physiological, vestibulo-ocular, and cervicogenic post-concussion disorders: an evidence-based classificatio system with directions for treatment. Brain Injury 2014.
  • 3. Examination of Cervicogenic PCD • “Patients with PCD should undergo careful examination of the c-spine, posture, and gait.” • “Cervical lordosis is often reduced in patients with cervicogenic PCD with frequent static head tilts observed.” • “Palpation of the cervical musculature may reveal diffuse muscle spasm and tenderness involving the paraspinal and subocciptial muscles”
  • 4. Management • “Techniques that can reduce pain and improve ROM include stretching, passive and active ROM exercises, massage, and low velocity cervical spine mobilizations”
  • 5. The Role of the C-Spine in Post- Concussion Syndrome • 5 subject case-series • Identifies upper cervical joint dysfunction as an instigator of PCS pathophysiology • Utilized spinal manipulation, soft tissue mobilization, and proprioceptive exercise to treat the UC spine • Cameron MM, Vernon H, et al. The Role of the cervical spine in post-concussion syndrome. The Physician and Sportsmedicine. 2015.
  • 6. Using the ASC to define PCS • Cervicogenic post-concussion syndrome is new terminology, but it sounds an awful lot like atlas subluxation complex • What if you could correlate reduction with ASC with improvement in main PCS symptoms
  • 7. Brain or Strain? • Investigators thought that you could differentiate a physiologic (metabolic brain problem) concussion from cervicogenic concussion by symptoms alone. • Hypothesis: Physiologic concussion would have more pronounced cognitive symptoms. • Brain fog • Anxiety • Difficulty with concentration • Depression
  • 8. Result: • Cervicogenic and physiologic concussion have the same symptoms. Can’t tell by symptoms alone • Historically, concussion has been a heavily symptom based diagnosis • Leddy J. Brain or Strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clinical Journal of Sports Medicine. 2013
  • 9. PCS or Whiplash? Post-Concussion Syndrome • Headache • Vertigo • Cognitive dysfunction • Brain-fog Whiplash Associated Disorders • Headache • Vertigo • Cognitive dysfunction • Brain fog • Neck pain/radiculopathy
  • 10. “YOU GUYS ARE MIRACLE WORKERS….” Dr. John Leddy •Medical Director at University of Buffalo Concussion Clinic •Numerous publications on concussion/headinjury Interview available on Healyourselfradio.com or iTunes
  • 11. Case Series • 2 Female patients • Age 16 and 30 • Post-traumatic headache and dizziness primary complaint • Diagnosed with PCS by neurologist • Both with recent history of chiropractic care with no improvement in PCS symptoms
  • 12. Case 1 • 16 y/o female • MOI – fall off horse striking occiput with helmet • No riding since fall for 3 months b/c of dizziness • Pre Adjustment ASC • Left laterality 1.08 degrees, left head tilt 1 degree,Anterior rotation 3.69 degrees • Post Adjustment • Laterality .75 degrees, head tilt .31 degrees, rotation 2.44 degrees • Improvement in headaches in 2 days. Resolution of vertigo in 1 week. Return to riding in 1 month.
  • 13. 1 year follow up • Symptoms return when subluxated approximately 3 months. • Symptoms resolve with NUCCA correction each time
  • 14. Case 2 • 30 y/o female • MOI – car accident with roll over. Head struck the head rest and knocked unconscious • Daily migraine headache, dizziness, and shoulder pain • Pre adjustment • Right laterality 2.41 degrees, 1.75 degrees head tilt, posterior rotation 3.42 degrees • Laterality .79 degrees, head tilt .63 degrees, rotation .85 degrees • Improvement in migraine in 1 week, dizziness improved immediately. Shoulder pain unresolved
  • 15. 1 year follow up • Migraine and dizziness still resolved. • Surgery for torn rotator cuff resolved shoulder pain and neck pain
  • 16. The Argument for ASC • If cervicogenic PCS was just a result of proprioceptive/fixation problem, why didn’t patients respond to spinal manipulation? • ASC may be a Measurable and correctable entity that is causing PCS
  • 17. Thoughts to Chew on • Avg concussion takes 96 G’s of force • Avg whiplash injury takes just 4-6 G’s • Almost unthinkable to think that a concussion can happen in the absence of a neck injury.
  • 18. Concussion as a Model for VSC • Biomechanics of head trauma provides a digestible mechanism for how ASC happens • Neurology of proprioceptive insult and altered venous drainage are both concepts discussed in concussion literature and chiropractic literature • Poor postural control is a hall mark of concussion identification which fits well into NUCCA analysis.
  • 19. Final Thots • What if a concussion was the most acute and symptomatic form of ASC? • What if less severe traumas were causing ASC and creating the physiologic similar to concussion?