Chiropractic & Concussion
CASE STUDY CONCUSSION
Michael S. Greene
DC, FIAMA, ND, Dipl. Ac. (AACMA)
Minor Traumatic Brain Injury (mTBI) is not minor! Any time one has an injury to the brain, even if consciousness is not lost, it is a major event. Age is not a factor in the number of concussions per year, children and adults are equally affected.1,2 Chiropractors are uniquely qualified to be the physician of choice for treatment.
There are many evaluation tools for concussion. The Sports Concussion Assessment tool (SCAt 3)4 is one of the best for comprehensive evaluations. It can be found on the Internet and was developed by European sports teams. Acute Concussion Evaluation (ACE)5 was developed by the Centers for Disease Control (CDC) and is in use in high schools throughout the United States. A computerized evaluation tool is ImPACT.6 Many school districts will use it as a baseline test before any sport is undertaken. If the athlete is injured, there is a preexisting “normal” that determines the level of damage and when the athlete is ready participate again.
The CDC has a free course on concussion located on the CDC website.7 Video, evaluation tools, and other checklists are available for both coaching staff and physician.
Post-concussive syndrome is a condition that is a sequalae to the initial symptoms. Many people have a lingering set of symptoms from their initial injury. These can include brain fog, focus issues, and irritability, in addition to chronic headaches, especially after periods of lack of focus or concentration. These symptoms don’t seem to improve with time but are a constant in their lives. I have treated many chiropractors for concussion, some even 15 years post-event. They have been adjusted, but the concussion symptoms have persisted. Once the other factors are addressed, the concussion symptoms are gone.
OBSERVATION
When we examine a concussion patient, usually the symptoms are related to cranial nerves. Photophobia, tinnitus, sour stomach, and headache all are directly traced back to the cranial nerve roots and can be caused by a change in blood flow to that area. The vertebral artery is often the culprit.
With a blow to the skull, the normal cranial respiratory movement is often changed. Cranial respiratory movement is important for cerebral spinal fluid circulation3 and is a factor that is often undertreated by chiropractors.
Often, the orbit of the eye is altered in size, allowing the doctor to observe and treat the affected side of the skull. Pain over the superior orbital arch (the center of the eyebrow), and on the zygomatic arch (center of cheek bone) are indicators of the location of the cranial respiratory inhibition. One side is more sensitive than the other and will be the side of involvement.
The other complaints of brain fog, memory issues, irritability, and inability to focus are often related to the corpus callosum. The corpus callosum consists of about 200 million axons that interconnect the two hemispheres. The primary function of the corpus callosum is to integrate motor, sensory, and cognitive performances between the cerebral cortex on one side of the brain to the same region on the other side. It seems to work as a switchboard to connect the two hemispheres of the brain and offer coordination between them. If the circuits are interrupted, the coordination is inhibited. This change doesn’t appear to be remedied by chiropractic adjustment.
Trauma to the axons or axonal shearing is a major factor in the trauma to the brain. As these connections between neurons are damaged or destroyed, the ability to focus, make logical connections in the brain, and other aspects are affected.
TREATMENT
I have developed a protocol for treating concussion that has been effective on over 200 patients, with concussions ranging from fresh (1 day old) to over 15 years old. In almost every case, the protocol was effective within 2 visits. This protocol addresses the three areas affected by the trauma of the concussion:
• Vascular — The blood flow issues created by a
blow to the head are apparent with the symptoms. Migraine-like symptoms including vision, hearing, balance, sense of taste and smell, nausea, and vomiting are part of the post-concussion experience. Decreased blood flow through the vertebral artery is most often the cause of these symptoms.
• Cranial Respiratory Motion — The normal respiratory motion of the skull is essential for cerebral spinal fluid flow. A blockage in this flow can cause changes in brain function, especially as the brain regenerates during sleep.3
• Corpus Callosum — The circuits that are damaged by the blow to the head need to be restored. This can be accomplished by eye movement exercises coupled with right and left hemisphere-specific exercises.
The neurometabolic changes of this type of trauma are often one-sided and will offer up specific symptoms as to the location of the injury. When axons tear, a flood of potassium is released into the brain.8 For the short term, this excess can be treated with magnesium supplements until healing is well under way.9
Case Study
Patient DB presented complaining of short-term memory loss, confusion, brain fog, loss of concentration,
headache and neck, shoulder and back pam. He had fallen on an icy road and hit his upper back and head. He was unable to remember how he had gotten from one place to another. He was told he had a concussion and was removed from work.
He was told to rest and not do much thinking, he was prescribed mild painkillers for the headache. He presented to my oflice six days later, concerned that he shouldn’t be driving in his condition. Examination showed reduced range of motion in the cervical spine, some bruising of the right thenar area where his hand was caught during the fall, reduced range of motion in the right shoulder, and pain in the right gluteal area. His skull was tender on the right posterior side and his right orbit was slightly larger than his left. Point tenderness was noted on the right supraorbital arch and the right zygomatic arch.
Spatial and time parameters seemed intact; however, there was some lag in answering questions, as if he needed to be sure of the answer before offering it.
Concussion protocol was done with adjustment to the first rib on the right, cervical adjustment of C7 left, C6 right, and atlas right. Cranial adjustment was done on the right side of the skull and sacroiliac adjustment on the right also. He was then treated with the eye movement
and hemisphere specific treatment and asked how he felt.
His symptoms of pain and reduced range of motion were notably improved, his brain fog and confusion seemed to be reduced also.
A second visit two weeks later showed much improvement in the concussion symptoms. The only major symptom left was a headache that occurred after several hours of work.
Conclusion
Neurologists can diagnose and offer bed rest, brain rest, and painkillers, but only chiropractors can cause the symptoms to abate. A simple three-step protocol can end much of the suffering that follows a blow to the head, no matter the age of the patient or the age of the injury.
References:
1. https://www. cdc.gov/trawnaticbraimnjury/get_theJ~acts. html
2. https://concussion.weillcornell.org/about-concussions/kids-and-concussions
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC401663 7/
4. bjsm. bmj. com/content/bjsports/47/5/259.full.pdf
5. https: //www. cdc.gov/headsup/pdfs/providers/ace_care _plan_schoolyersion_a.pdf
6. https ://impacttest. com/about/
7. https://www.cdc.gov/headsup/youthsports/index.html
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC155411j'
9. https://www.integrativepractitioner.com/topics/brain-health/feed-concussion-reviewing-nutritionrole-brain-recovery/
Michael S. Greene, DC, is a graduate of Logan College of Chiropractic and has been in practice since 1977. He developed this protocol over the last five years and has had amazing results with concussion patients. He has been teaching post-graduate classes for CEU’s for the last 15 years. Please direct any questions to his email: dr. mgreene a shcglohal. net. He can also be reached by phone at 816-213-0583.
