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?