Contact sports and even just a slight bump in the head can leave a lot of serious neurological issues. No one is immune to this. All of us can experience brain fog, headaches, difficulty in concentrating, and even depression. Getting down to finding a solution is Dr. Tyler Evans who puts forward the upper cervical as a gateway to help concussions and other neurological issues. Dr. Evans brings up a couple of studies from brain doctors and combines it to answer questions about how the brain and the neck are intertwined. He also lays down what upper cervical chiropractor does for people who are suffering from these neurological problems, and gives his recommendations around movement and physical therapy.
We have Dr. Tyler Evans. He is a Blair Upper Cervical chiropractor out of Portsmouth, New Hampshire. He holds an advanced certification in evaluation and treatment of the craniocervical junction as a diplomate awarded by the International Chiropractic Association. On the podcast, Dr. Evans enlightens us about concussion in sports, the research behind the upper cervical adjustment and a solution to help resolve many neurological issues people are suffering with today. Please welcome, Dr. Tyler Evans.
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Brain Doctors with Tyler Evans
Darren pushed me to go to do the Upper Cervical Diplomate for two and a half years from 2013 to 2015. I graduated and once I had done that, I was solid and set in my ways in the upper cervical profession. I haven’t looked back since.
There’s a lot of exciting stuff going on in the upper cervical chiropractic world. We have the Cone Beam CT Scan which has given us great results in new imaging. Which is further proving what Dr. Blair and Dr. B.J. Palmer we’re talking about so many years ago. There’s also a ton of research and stuff on concussions and chiropractic care. You are one of the best people to talk to about that so I’m very excited to dive deep into that and get your opinion on that. With all the sports injuries with football and hockey and all the contact sports, a lot of kids, teens and adults are left with a lot of serious neurological issues like brain fog and headaches and difficulty concentrating and severe depression. What we’re finding is there’s a solution it could be in the upper part of your neck. If we can just go dive into that and how upper cervical chiropractic can help concussions and other neurological issues like that, that will be phenomenal.
Right before we got on this call, I printed off two papers that I’ve talked with many people over the last years because they’re great. If you’re an upper cervical chiropractor, you should know these papers. If you’re a person that has experienced some concussion effect like post-concussion syndrome, understanding the physiology is important to healing. Concussions has been expanded in the last ten years into a full body effect. Before the last ten years, it was all just you hit your head, you shook your brain, I’ll get back out and play. For instance, I played high school football and I was a little guy, I weighed about 150 pounds and I was 6’1”. I took some good hits. I remember one hit, in particular, where two guys came from the side smacked me and I just remember being blacked out, waking up on the field. My teammates come up and are like, “Get up, come on.” That was a long time ago and concussion wasn’t in the news then. It wasn’t top of mind. Since then they’ve done a lot of work within the high school team environment to bring in experts and do some concussion analysis, the impact test. They’re doing a lot to change that but a lot of that came about what’s been happening in the NFL.
Sometimes you get smacked upside the head and you feel it. Other times it doesn’t even have to be that big. The last concussion that took me out of everything, nobody saw me got hit. It was just a little elbow to the head and it was probably the lightest one I’ve ever gotten and that’s the one that didn’t go away. That’s why a lot of people can’t connect the dots. That’s what’s frustrating.
Back in the early ‘90s, they started the inquiry in the NFL into concussion mostly because they were held to the fire by wives of former players that had literally lost their minds and were living out of their trucks doing terrible things to their bodies. They were a wreck. This came from Pittsburgh where it started with Dr. Omalu. He started looking at the brains of these players that were famous players in the ‘70s and ‘80s that then their brains had fallen apart. They had either committed suicide because they had lost their minds or they had just gotten to a point where they didn’t know where to turn. When they died, they donated their bodies to science. They’ve now done 200 studies on the brains of these people that have either played football and got many concussions or soccer or extreme sports where they’ve hit their head many times. They’ve studied these people’s brains and it’s not good. These long-term effects from hitting your head even slight hits at the head, they cause a terrible effect. There’s science coming out now that is showing that hitting your head and taking an impact on a consistent basis, it deteriorates your entire body through the brain, the nervous system and the neck. Then you have CTE, chronic traumatic encephalopathy. It eats away the brain.
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It’s sad to say but there are eighteen-year-olds that have been in this study. I try not to talk too negatively about football because I played it, I liked it, but you should be aware. Mothers and fathers of children that played peewee football or play high school football, we’re not making this stuff up. You can’t reverse it. It’s important that parents know this because there are children that have died in games from hits as well as brain changes that then led to them committing suicide. I don’t want to go too heavy on the negative stuff, but it’s important and people should know that. There’s a lot of research on that that is coming out of Boston. It’s called HOPE. The Boston Hospital, the doctors are studying the brains from these NFL players that are coming out. They’ve done 200 studies and 111 of them were NFL players. 110 of them had CTE and then 200 of the people were from other sports and most of them had CTE as well.
Why is the brain not healing after a concussion? What are the things that are happening? You have a glutamate response. The brain goes into a shock state and so it has this barrage of chemicals in the brain that slowly dissipates over time if we’re lucky. If you get so many concussions that now we’re wrapped up in this post-concussion syndrome because you didn’t heal from the last one, now you’re in trouble. The brain’s not healing. Why isn’t the brain healing? Part of it is because of the neck because that’s how the fluid escapes. That’s how the body heals is through the blood flow. If your neck is locked out of position, the blood flow can’t go back and forth and the CSF can’t go back and forth and neither can the nerve flow.
There’s a couple of papers here that are great. One is titled “The Role of the Cervical Spine and Post-concussion Syndrome.” If you deal with PCS patients, this paper tells them to get the neck checked. This is from John Leddy and, Howard Vernon and, a couple other guys. John Leddy is a highly respected post-concussion researcher in Buffalo. He’s the guy that came up with the Buffalo Treadmill Test. He is well-known in the concussion world and this paper talks about it takes 96.1 Gs on average to cause a concussion. He said 60 to 160 is a range Gs of force. How much force it takes to cause a concussion is 96.1 but if you break it down and you go through the paper, it takes 4.5 Gs of force to cause tissue damage in the neck.
What are we talking about here? What kind of forces that relative to?
If we’re talking about you’re getting bumped. That’s somewhere in one to two Gs there if you’re just getting bumped. You talk about 4.5 G’s that’s probably a rear-end accident. Somebody gets rear-ended. They’re not making it up when they have neck issues because they were rear-ended at ten miles an hour. People say, “You’re making it up.” They weren’t going fast enough. Dr. Rosa taught us in the Upper Cervical Diplomate about the history of insurance companies and how they try to protect themselves. Their job is not to pay out every single injury. Their job is to discriminate which ones are big enough and which one is determined that need paying out. Anything under 30 miles an hour for a long time, they just said, “They’re making it up.” They had videos where they trained their staff to swat down anybody that came in and said that they had neck pain after a low-speed impact. That’s rough. That’s not cool.
The point is, low amount of Gs can still cause a problem. What it says is 4.5 Gs is enough to cause tissue damage but then what we know is that up to ten to twelve Gs is what causes the condition turned whiplash. Whiplash gets a bad name. Whiplash is the action. It’s the deceleration acceleration of the neck. That’s the mode of the problem but whiplash associated disorders would be neck pain is stage one, stage two is neck pain with decreased range of motion, stage three is when you have maybe numbness and tingling or DTR that’s lowered because of the injury.
You have these stages of whiplash and depending on how hard you were hit you have more whiplash. If you have a concussion that happens at 60 to 160 Gs, what’s happening at low speed? It’s just wrecking the neck. If the neck is already in trouble at ten to twelve G’s, you’re going 60 to 160, what do you think is happening? The neck is just getting exploded and then we’ve got that brain problem, but the neck is in trouble. If we can get the neck aligned, it allows the brain to heal.
That craniocervical junction is right there with the brain stem that’s technically in the upper neck which is our control center.
There’s a couple of other papers that we could cite. There’s “The Role of the Craniocervical Cervical Junction in Craniospinal Hydrodynamics” by Michael Flanagan. If you get a chance, another book to read is The Downside of Upright Posture. Scott Rosa and him came out with the ideas at similar times about how fluid flow. The craniocervical junction is the gatekeeper for that fluid flow and information balanced between the brain and the body. You’ve got the contents of the brain, the cerebellum and the brainstem sits right in the CCJ. Then the upper cervical spine, that joint is the most freely movable joint in the spine. There’s no disc above or below it. What holds it in place are postural reflexes by muscles, ligaments and tendons. When you have an injury like a whiplash or a concussion, those reflexes are overridden that hold the joint in place and it’s the only joint that can’t self-correct. The rest of the joints down lower can self-correct. If you know that physiology, if you understand that physiology, maybe that’s the first place we should look after a concussion. Because it’s the most freely movable joint and a place where most of our automatic neurology is sitting, our breathing, heart rate.
I had a guy on my health class. He’s a good friend of mine. He came up to me and we were just talking about chiropractic is not about neck pain and back pain. It’s about whole body health. It’s about the nervous system and he says, for years he has attempted to lower his blood pressure with diet and exercise and he had no avail. Eight weeks of upper cervical chiropractic care, his blood pressure is now normalized. I know it happens and miracles happen in our practices every day but this is what I’m saying. That is the automatic nervous systems central control is the brainstem right up here. You can’t hit your head without hurting your neck.
The last to your point was the bump in the shoulder. This paper is fantastic, “Concussion with Primary Impact to the Chest and the Potential Role of Neck Tension.” This paper just came out and it blew my mind. You read the title of a paper and you’re like, “I know what that paper is about” so I read through it. They went through and studied. This just came out in 2018. Jaime Browning from Sherman, she sent me this paper. The helmeted ATD or dummy, they took two dummies and they hit them and then studied what happened in the dummy in the chest and the neck and the head. They found that there was a 40% increased neck tensile force with the dummy that had on a helmet because of its weight on the head. You put on a helmet and you think you’re safe and Riedel’s out there doing all this research trying to make the helmet concussion safe and make things safer. This is important information. This just came out in August.
There have been a few papers that are starting to point the neck has a lot to do with what’s happening in the healing of the brain. They did a dummy and then they also studied two live hits on NFL video that caused concussions in this paper and they were hits to the chest that caused a concussion. You’re increasing the tension on the neck and the neck is just a breakpoint and the joint can’t hold. If you come back to what’s happening at the CCJ, the most freely movable joint in the spine is only held together by ligaments, tendons and muscles, not a bony lock. The rest of the joints in the spine have bony locks. There’s your fuse breaker. It blows and it tries to save everything else but then long-term you have you have depression, anxiety, brain fog, memory loss and all that stuff.
What can upper cervical do for these people that have had the post-concussion syndrome or just straight off of a concussion? What can an upper cervical chiropractor do for these people and maybe people that have been suffering for twenty years with this that haven’t had any relief? What can you it for them?
It is a piece of the puzzle and it’s not a panacea, but the first place I would go is to the upper cervical chiropractor to get my neck checked so that my brain can heal. We work with an amazing optometrist. We worked with Dr. Prusinski a lot and she does amazing things with the eyes and healing. The eyes can be a very large influence healing from a concussion, but upper cervical I have seen in our office because Dr. Prusinski has referred a lot of her chronic brain injury patients that deal with depression, anxiety, brain fog, memory loss, fatigue. In the Seacoast community, we’ve positioned ourselves into the community as head neck trauma people. We’ve worked into that community and we’re familiar with what techniques and modalities are out there. The medical system is helpful because they analyze it. You do need that diagnosis and we send people to a Dr. Kevin Heaton who’s around here in the seacoast.
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He’s a great a great doctor to go through and then do some PT. They do some PT and help rehabilitate the body because you need to move the body. That’s part of the healing process but if that neck isn’t in alignment, you’re not going to get that lasting healing nervous system ability to come back to zero. I’ve had many young people, I’ve had many football players and just little kids that had injuries. They fell off something and hit their head and they have post-concussion syndrome. Sometimes they don’t know it right now. I can’t diagnose as a chiropractor. I just tell them “This is what I’m seeing. You should go see Dr. Heaton, you should go see Dr. Prusinski, you should go see these other people help you, but we see is over a course of six months and it takes time.
Sometimes we do get those amazing cases where the brain fog and the headaches and everything, they lift right off of the first week but there are a good amount of times where you’re not seeing much improvement the first couple weeks. It is a different type of injury, it takes a while to heal. There is a time aspect sometimes too.
I tell my patients there are four different tissues that we’re working within the body and they all heal at different rates. You have the muscles. They heal fairly quickly. If you go to the gym, you workout and you build muscle. It takes three days at a minimum a week to heal and if you tear a muscle, maybe it’s four weeks for it to heal but they heal quickly. Oftentimes that’s why people start to feel better quickly because neck pain or back pain goes away but you have to remember that you have nerves, ligaments and tendons in there. Those nerves, depending on where they’re at, 90 days at a minimum for a nerve to start to heal. If somebody has numbness and tingling, sometimes it’ll go right away. That’s nice but we see 90 days at a minimum for nerves.
If you’re talking about the brain, we’re talking about some serious nerve healing that has to happen. I always say that six months at a minimum. That way expectations are managed because that’s always an important piece of care, managing expectations and then supporting them. Make sure that they get their eyes checked by a neuro-optometrist. Make sure that they do get a full exam by a concussion expert medical doctor. Make sure they’re doing some PT. They need to move their body. A huge piece of healing is moving the body. I can adjust until the cows come home but if you’re not moving your body, you’re not going to heal.
We definitely want movement in everything, but you also have to be careful that this stays in alignment. What do you recommend as far as movement and physical therapy? Do you have them stay away from the neck and work on everything else? How do you do that?
Let’s avoid anything on the neck and the head for at least 30 days. That’s how we start. Usually when patients come in, if they aren’t already treating with some massage therapist or physical therapist, we build that in. Once we stabilize the neck because first you have to stabilize the joint and then the muscles have to build strength around that. Once they stabilized then you can start doing that other stuff. With PCS, after a concussion, they always say give it a week or two. If it starts to heal then you can get back to slowly adding in work. I’ve got one patient, she’s 21 or 22, she has hit her head so many times. She can’t count how many concussions she’s had but the last one was a bad one about a year and a half ago. She turned and hit her head on a cabinet in a lab in college.
She was studying to be a medical doctor and her whole life changed. She hasn’t been the same since. She was locked up in a dark room for six months, crying and couldn’t do anything. A chiropractic neurologist helped her rehabilitate slowly adding in life slowly. Depending on the case, some of these people, it’s tough. It’s hard. We’re talking about near-death stuff. It’s a slow process. For some people, it’s quick but for the most part, we try to air on the side of moving in slow. Getting back to rehabilitation stuff is something else that’s important and things that support care are supplements. I was always on defense on it and I’ve seen some good changes with CDB.
Do you sell CBD out of your office?
No, we don’t but I guide patients on where to go get it. CBD is very helpful. It is great because it lowers the inflammation process. That’s what we’re always trying to do. We’re trying to lower the inflammatory markers in the body and in the brain and in the nervous system. If we can lower that inflammation in the brain with CBD, if we can lower that inflammation in the brain with high potency Omega-3. We use a ProOmega from Nordic Naturals in our office that is 2000 milligrams of EPA and DHA. People bring in their supplements and they’re crap. Many wonder why supplements get a bad name. You wonder why people don’t get changes with supplementation. It’s because they bought their Omega3s at Costco or at BJ’s. That doesn’t work. That stuff is trash. Throw it out.
What makes a bad fish oil supplements? Is it the quality of the fish that they’re pulling through?
The quality of fish. There is a lot of trouble that you can get into with the fish. If you’re not getting cold deep water fish that are wild caught, you can run into some trouble with either the farming aspect where you’re getting hormones that are in the fish because the oil is the lifeblood of the fish. What’s in there is the reflection of how its health was. Fish accumulate heavy metals. The fish that we end up putting in the oil, those are the ones that accumulate the heavy metal toxins. We have to be careful about that. If you get a low-quality supplement, you don’t know what’s in there. Also, they don’t have the EPA and they don’t have the DHA and those are the healing components of the Omega-3.
It’s important that you’re taking a solid Omega-3. I’ve had patients that came in, we were getting good results on her MRI. Her brain is shifted to the left. We haven’t done a post-MRI, but she immediately felt huge changes in thought and consciousness and neck pain and back pain and all that. Slowly over time, we were like, “We’re plateauing here, what else can we do?” We added in good Omega-3 and she doubled her dose. You can take up to five or six grams of Omega-3 a day. You want to get as much of that in there as you can without thinning the blood because that’s what starts to happen. You start to thin blood and that becomes a problem for some people.
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Do you have to be careful if these patients are on any other medication?
Yes, you do. That’s why it’s important that they consult with the doctor. Make sure that whoever their concussion doctor or whoever their primary care doctor is that they’re on track with that.
Which ones you have to be careful?
Blood thinners. That’s about it though. Omega-3, you can up dose with those. That was four pills of the good-Omega-3 a day and she started to notice huge changes.
Dr. Tyler, when do you start the supplement implementation? Sometimes if you do too much all at once, it can be too much for the body to handle. I’ve had people that were doing a lot of things at once and they come in and they’re feeling so much better like, “It’s the supplementation that’s good.” In my mind, I’m like, “It’s the upper cervical care.”
It’s usually both and I always say that. What I always do say is, “Give this two to four to six weeks. Let’s stabilize things and then let’s start adding things in.” You can do too much at once and you get those two things that crop up. You get patients that come in and say, “I’m all better. I don’t think it was from your care.” The other side of it, sometimes you can overload the system or just people feel overwhelmed and you don’t want to overwhelm people but you have to lead them. Upper cervical care is an invaluable tool in healing the brain. That’s where the upper cervical profession needs to focus. Are you familiar with Heidi Haavik? She is a chiropractor out of New Zealand and she is doing some of the most cutting-edge research in the world on chiropractic. We think of misalignment in the spine being the subluxation, yes, that’s true. What the research is starting to show is that the bone goes out of place. C1 is the most freely movable bones so when it locks out, it locks out bigger than any other joint but the brain is what’s holding it out. The brain is what’s not able to pull. The brain is able to pull everything else back in if C1 is in place. Where things are locked are in the brain and we are brain doctors. You’ve got to get your head around that.
We are central nervous system doctors. What her research is showing is that when you adjust the cervical spine or when you adjust the thoracic spine of the lumbar spine, you’re making changes in the spine there but you’re making bigger changes in the brain, in the frontal cortex. That’s where the science needs to head. When we talk about concussions and healing, we’re making changes directly in the nervous tissue in the brain when we apply our corrective adjustment to the spine. That’s what her research is all about. Her research is not necessarily techniques specific. She’s very against like splitting up chiropractic and she’s more about verifying subluxation and what it does in the brain. She’s got these amazing studies that I don’t even understand the words that are in the papers there. They’re that high level but they’re beautiful papers. She’s building a case that chiropractic is about nervous system health and it’s about changes in the brain. That’s where we need to look in upper cervical because we are cutting edge on that. We are not just changing the way the nerves fire, but we’re shifting how the tissue sits in the skull and in that upper neck when we adjust properly and get things lined up.
What is one piece of advice that you have taken with you over the years that you would like to share with the audience?
It’s easy to get caught up in what’s happening to you and remember that there are other people out there that can support you and can be there for you. I’ve gone through a lot with healing my body and healing from these concussions and I got frustrated in the beginning. Even in chiropractic school, I felt I got over adjusted. I struggled with my health. I had to take a semester off because I got sick and I got frustrated but realizing that there are answers out there, just keep looking. It takes a team to heal the body, it’s focusing on nutrition. I always talk about the five pillars of health. Eat well, sleep well, think well, move well and have a healthy structure and functioning nervous system. It’s all those pieces. Just keep working at it. Reach out if you have questions.
Where can people find you online, website, social media?
Aretechiro.com is our website. We also have a YouTube page. I have put in a consistent effort to build videos short five to ten-minute videos that break down papers because that information needs to get out there. People need to understand it because we can all get this stuff. We’re in a day and age now where you have access to the world at your fingertips. Everyone has access to the same scientific information I do. I try to push people in that direction, try to understand the physiology because if you do, if you understand that better, you can better take care of yourself. You have to be the doctor. Our videos on YouTube, we push that and try to get education out on that. We have a Facebook page. That’s where we post a lot of our videos and do Facebook Lives.
Dr. Evans, thank you so much for coming on. I loved this episode and I look forward to it coming out.
Thank you, Kevin, for the opportunity. I appreciate it.
Thanks again for coming on. I’ll talk to you soon, Tyler.
Have a great day, Kevin.
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