Upload
jon-chung
View
393
Download
4
Embed Size (px)
Citation preview
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?