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head tilt

Is Head Tilt Driving Your Brain Crazy?

Is Head Tilt Driving Your Brain Crazy?

 

A lot of people are starting to recognize the role that posture plays in overall health. Things like text-neck has made it’s way to major publications like the Washington Post, and the perils of slouching have been written about ad nauseum.

I won’t get into that today, because I think there’s a problem that is a lot more important but gets far less attention. Most doctors will ignore this, but chances are it’s a major contributor to headache, balance disorders, vision problems, and overall brain health.

Today we’re going to break down your head tilt.

Cute for Puppies and Sorority Poses, Bad for Patients with Neurological Issues

First we should clarify a couple of things. When we discuss head tilt, we’re not talking about the tilt that comes on when you intentionally tilt your head for a photo. If you are intentionally creating a momentary head tilt, it’s not a big deal. There’s no such thing as a bad posture if you are willfully and intentionally trying to create a specific shape with your body in gravity.

We only classify postures as negative when your body is doing something that it is not intending. If I ask you to stand up as straight as you can and your head tilts to side, it paints a much different picture of your brain than if I asked you to purposefully hold your head to the side. An inability for you to create a straight upright posture suggests that you have a deficiency in your brain’s ability to control your muscular system. You can read about that in greater detail here:

Why Your Posture Isn’t That Important

So what’s the big deal if your head tilts to the side?

It’s a sign that your brain is perceiving the world around it incorrectly.

If your brain is getting wrong information from your senses, then it can’t produce the right response to the world around it.

It doesn’t sound like a big deal when we’re talking about posture, muscles, and bones, but let’s apply the same idea to some of your other senses:

  • If you have a problem with one of your eyes, how will that affect your ability to catch a baseball?
  • If your ears are hearing a high pitched noise all of the time when everything is quiet, how will that make you feel?
  • If your skin is constantly itching, but you have nothing on your skin that is irritating it, will you keep scratching?

All of these are examples of your brain perceiving the environment incorrectly and they all lead to specific conditions from a lack of depth perception, tinnitus, to neuropathic itch. When left for a long time, these conditions can have a significant impact on your enjoyment of life.

So what are the consequences of a chronic head tilt?

The Physiology of Head Tilt

How your brain decides to hold the head up involves a lot more neurology than most people expect. Generally speaking, we think about head tilts being a result of tight muscles pulling the head out of place. When we use this model, treatments become a matter of rubbing one muscle and stretch another and the head will be straight again.

For better or worse, the way the brain moves the head is WAY more complex than that. Your brain decides where to put your head in space based on the interplay of your inner ear organ, your eyes, and the small muscles of your neck.  Here’s how it works:

Normal Head Tilt Reaction

So this is what happens when the system is working okay. When the system works, you can tilt your head when you choose to, but your brain will bring your head back to the normal upright position after it has achieved its purpose.

We see this system break frequently when someone has injuries like whiplash or concussion. The impact of these injuries disrupts normal function of all three systems. It scrambles the inner ear which distorts your eye movements. It also wreaks havoc on the muscles and ligaments of your neck.

What Happens When Your Head Tilt Breaks?

This is why the biggest problems associated with whiplash and concussion injuries are balance and vision issues. You can’t keep your perception of the world straight if your eyes, ears, and spine are giving you inaccurate information about gravity!

When your head and neck get scrambled by a hit and you disrupt these 3 systems, your body takes on an abnormal head posture which can make the other systems work inappropriately. One of the first things I’ll ask someone during a consultation is to sit up as straight as they can, and I’ll look at where they put their head in space. Very often they look like this:


Abnormal Tilt Reaction

 

 

But let’s be honest here; you don’t really care if you have a head tilt, crooked eyes, and tight muscles if it’s not causing you any pain or discomfort right?

Here’s the thing, your body can compensate like this for a little while. But if you’ve ever had to rely on a back up system before, you probably know that backup systems aren’t ideal and they’re more prone to glitches and failure. Your body is the same way with its own back up systems. They will get you out of a pinch for a short time, but they will eventually fail. Or even worse, you may suffer another injury while you are compensating and have even more damage to the brain.

So as your back up systems start to fail and your eyes and neck aren’t working normally you will start to have problems like:

  • Dizziness
  • Feeling off balance
  • Neck and back pain
  • Headache
  • Nausea

Why? Because if your eyes don’t move well, then it leads to difficulty reading or tracking targets in space. If your neck doesn’t move well, it causes pain and headaches. If you have all three systems saying different things, your brain has no idea how to determine it’s sense of balance.

Your Brain Hates Mismatches

Your brain hates it when its sensory organs give it conflicting information causing sensory mismatches. It hates it more than your significant other hates it when you walk out of the door with a brown belt and black shoes.

Your brain hates sensory mismatches even more than your significant other hates this fashion faux pas

Your brain hates sensory mismatches even more than your significant other hates this fashion faux pas. Image Credit to http://www.houseofmarbury.com/can-wear-black-brown/

All kidding aside, these sensory mismatches are the main trigger for the balance issues that can make people miserable. When you combine that with the fact that the balance system shares connections to your autonomic nervous system, then it gives us an understanding for why balance problems can really wreak havoc on our stress response system.

The abnormal movement of the eyes and head are also likely to create persistent headaches and pain in your joints and muscles from abnormal loading patterns.

When your head tilts, all of your spinal system starts to act screwy

When your head tilts, all of your spinal system starts to act screwy

While the symptoms can be bad enough, the biggest concern is the impact that these maladaptive patterns have on the functioning of the brain as a whole. If you can’t orient your world properly, then the parts of your brain that are responsible for normal function start to degrade while the parts of the brain that are producing these abnormal patterns get stronger. This persistent abnormal head pattern can change the way blood flow and oxygen get to various parts of the brain and lead to further problems with thought, focus, and movement.

If we want to make a real impact on the health of your brain, then we have to allow the brain to stop compensating and get your head on straight again.

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equestrians-and-concussion

Are Equestrians More Resilient to Concussive Injury Than Everyone Else?

equestrians-and-concussion

 

Concussions, Balance, and the Equestrian Advantage

Concussions are a hot topic in professional football, but it’s something that horse lovers have been familiar with for years. A 2014 paper in published in the Sports Health medical journal showed that almost 50% of competitive riders will have experienced a concussion during their life while riding. Surveys have also shown that helmet usage amongst equestrians is extremely low with estimates ranging from 9%-25% of riders opting to ride without head protection.

The sudden deaths of high profile professional football players have made the complications of head trauma a hot button topic in sports and medicine. Concussions are considered a mild traumatic brain injury, but the truth is that a brain injury of any sort is anything BUT mild.

While most people will recover from the effects of a concussion within 7-10 days, approximately 15% of patients will experience symptoms beyond 30 days. When these concussive symptoms persist,  the patient will likely receive a diagnosis of post-concussion syndrome or PCS. The symptoms of PCS include:

  • Headache and migraine
  • Vertigo or loss of balance
  • Brain fog/difficulty with concentration
  • Memory dysfunction
  • Dysautonomia and fatigue

Pro-Riding and Pro-Brains. Not Mutually Exclusive

There are risks to all sports, and as an athlete you have come to accept those risks as part of the game. Additionally, if you have been involved with riding for a while, it’s easy to accept head injuries as an inevitable part of the sport, and the truth is that most people will recover in a week or two.
It’s a common thread with sports doctors to say that sports like riding are too risky for the developing brain. The truth is that concussions shouldn’t be something that scares you from playing your sport. Getting into sports like riding are the most effective ways for people to stay active and fit throughout your life.

I try to teach my riders 2 important concepts:

  1. If you get an injury, make it an injury of performance. Take the right steps to prevent injuries of negligence or careless behavior like not wearing a helmet.
  2. Know what to do after a head injury so that you can ensure maximum brain health and recovery.

 

Taking Care of the Concussed Brain – Performance Over Pathology

When talking about the long-term health consequences of head injury, it’s best NOT to get your stance from places like Will Smith’s recent film, Concussion. The brain illnesses discussed in that movie are pretty rare, and apply to very specific types of athletes.

However, that doesn’t mean that concussion is free of long-term consequences. Studies of athletes with a history of concussion have shown slightly slower cognition and reaction time 30 years later, even if there are no symptoms of head injury. Studies of previous football players have shown that athletes with a history of concussion are more likely to have back and leg injuries after retirement because of the way concussions affect control of your own joints.

Here’s where getting the right treatment after concussion can make all the difference in the world for an equestrian athlete. While most athletes aren’t overly concerned about something abstract like brain health, athletes are VERY interested in anything that can affect their performance on the field or rink.

The Equestrian Advantage

While equestrians are at a higher risk of head injury than most sports, the unique features of equestrian sports may help confer protection from some of the chronic problems associated with concussion.

From a neuroscience perspective, horseback riding requires a tremendous amount of work from the parts of your brain that control balance. Your sense of balance is made up of a delicate interplay between your inner ear (vestibular system), eyes (ocular), and joints (proprioception). Your brain takes information from these 3 systems and paints the image in your mind of where you are in space.

The 3 super systems that maintain your balance

The 3 super systems that maintain your balance

When you ride a horse, your body is constantly bobbing in a way that far exceeds the normal force of walking. Your brain has a magnificent system in place to help keep your vision in focus even though your head is moving all over the place. If this system gets corrupted, then really simple movement makes us feel off balance or dizzy. In other cases, this system also affects our emotional control and cause headaches.

The brain, like any other part of the body gets stronger and adapts the more that you use it and challenge it. Between simple riding, jumping, and dressage, equestrian athletes have to challenge their vestibular system more than almost all people, including many athletes. That means that many equestrians are likely to have a stronger sense of balance than most people, and research is actually starting to demonstrate that1. The effects that horseback riding has on balance or so strong that they are even being suggested for the treatment of balance problems in the elderly2 and in stroke patients3.

No Symptoms No Problems In Concussion Patients

So why is that important for a concussion? Most people associate concussion with your ability to think, but concussions actually have the strongest and most immediate impact on this balance system. When people suffer with concussions, you’ll often see that their ability to stand still and walk is affected even if they don’t have any cognitive symptoms at all. The brain hates when the balance system is broken. Overtime, as balance issues fail to get fixed, it spills over into problems leading to vision disturbances, headaches, and brain fog.

One of the things that I notice in my experience with equestrian patients is that many won’t show signs of head injury in their normal daily activities, due to their strong sense of balance. When your body feels like it has a good sense of balance, some of the cognitive and pain symptoms from a concussion don’t impact you quite as badly. This is a great thing in that a head injury won’t cause an obvious deficiency in your quality of life.

However, many times this is due to a compensation strategy by the brain. When you suffer a concussion, the parts of the brain that control the eyes, cognition, balance, and movement become compromised. When the brain suffers damage to one area, then other areas of the brain will start to work harder to perform the duties of the damaged region. This is driven by a concept called neuroplasticity. This is what allows blind people to have a heightened sense of hearing, or deaf people to have a more focused visual sense.

As a rider, a concussion may damage the regions of the brain that control neck and eye movements, which can be detrimental to your balance. However, your balance system from the inner ear is so strong that it can take over the task of keeping you upright without much of a hitch. Even though you feel good and your balance seems strong, there’s only so long that the brain can manage these compensation strategies before it starts to fail.

Compensated Performance = Suboptimal Performance

 So now we’re going to bring it all back together.

When you suffer a concussion and parts of this comprehensive balance system breaks, many equestrians are fortunate enough to bounce back without prolonged symptomatic consequences because of a well-trained balance system in the brain.

The problem is that our brain is designed to work with contributions from all of our sensory systems. If we partially lose a system like proprioception from the joints and the inner ear system works overtime, then we will gradually lose more and more function from the joint position system. It won’t affect us immediately, but it may start to show up as back pain and knee injuries later on in life. If we lose some of our visual sense, then things like double vision or blurry vision can become long-term consequences.

You can even perform simple tests to see if some of your balance systems are not working well. Something as simple as standing with your eyes closed vs standing with your eyes open helps to see if your inner ear and joint position sense are working. If you start having difficulty concentrating while reading, your ocular system may be compromised.

The good news is that the same plasticity that helps us compensate is what allows us to develop strategies to rehabilitate the brain when we know which system is compromised. A thorough structura and neurological exam can help ensure that your brain does not just survive after a concussion, but to get it back to thriving again.

  1. Kim SH, Lee C, Lee I. Comparison between the effects of horseback riding exercise and trunk stability exercise on the balance of normal adults. Journal of Physical Therapy Science. 2014 Sep; 26(9): 1325-1327
  2. Kang K. Effects of mechanical horseback riding on the balance ability of the elderly. Journal of Physical Therapy Science. 2015 Aug; 27(8): 2499-2500
  3. Kang K. Effects of horseback riding simulator exercise on postural balance of chronic stroke patients. Journal of Phhysical Therapy Science. 2013 Sep; 25(9): 1169-1172.

 

protecting from falls

A New Way to Protect People from Falling?

 

protecting from falls

 

Read Time: [6 minutes]

Osteoporosis, falls, and broken hips are one of the biggest concerns of people 55 and up. The fear is real and justified, as falls are a leading cause of death and disability once you hit the age of 60. To combat this, conventional wisdom has suggested that older adults focus on increasing calcium, taking bone hardening drugs, and to keep monitoring your your bone scans.

This isn’t to say that bone density is unimportant. Bone density is really important! But bone density is REALLY, REALLY, REALLY hard to change once you’re at the age of risk. Your only source of protection are drugs like Fosamax. The problem with that is that bone hardening drugs like Fosamax have come under scrutiny for waning effects after 3-4 years.

Prestigious medical journals like the New England Journal of Medicine have shown that you may actually have a greater risk of thigh fractures if you stay on the medication for 5 years compared to placebo. [source]

Once you have osteoporosis, you are basically going to have it throughout your life. It’s not like you can just take the drug for 3 years, stop, and still be protected. You are expected to take this drug for the rest of your life, but doing that will increase your fracture risk.

It’s just one of those ironic moments in medicine when the cure can eventually cause the problem.

Addressing Balance and Coordination

The best time to address bone density problems is likely in early adult hood. Resistance training combined with a diet high in calcium and magnesium can help build thick and strong bone during your 20’s and 30’s. Trying to build bone in your 50’s and 60’s as a post-menopausal woman can be a losing battle. For many it’s way too late to try to increase bone density naturally.

However there is more to blame in for the devastating impact of falls beyond just soft bones. We also have to look at why people fall to begin with. Research suggests that just 15% of falls occur due to some external event (wet floor, pushed over, etc) and 15% of falls are a result of an underlying disease process (MS, diabetes, epilepsy).

That leaves a whopping 70% of falls are a result of a combination of factors that lead to poor balance and poor mobility.

Unlike soft bones, balance and mobility are traits that can be trained and improved upon throughout your life.

Common Way to Improve Balance

When it comes to balance, you have to address 3 parts of the nervous system. The visual system, the vestibular system, and the proprioceptive system. For ease of understanding, we’ll just call them your eyes, your ears, and your joints/muscles/skin.

balance and dizziness

By identifying which system is deficient, you can design interventions that can improve the balance of a human being. Some of these therapies include:

  • Vision therapy
  • Physical therapy
  • Strength training
  • Occupational therapy
  • Vestibular therapy

These are the most commonly prescribed recommendations for people with balance problems. But what if these therapies don’t work well for you? Many people are told that they just have to live with their balance issue.

New Research on Spinal Health and Balance

A recent study published in the Journal of Manipulative and Physiologic Therapeutics suggests that chiropractors may play a large role in helping people get their sense of balance back. The study looked at 30 patients receiving chiropractic care versus 30 controls. Both groups had measurements taken of various balance metrics and were tested at 4 weeks and 12 weeks.

Here are some of the charts from the paper:

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

The patients in the chiropractic group had a significant decrease in errors in joint position tests.

 

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

Patients in the chiropractic group had higher scores in a sound flash illusion test.

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

Link to paper: http://www.jmptonline.org/article/S0161-4754(16)00050-6/abstract

 Patients in the chiropractic group had a significant improvement in health related quality of life scores.

Do Tests Translate  to the Real World

So here’s the thing. The results look good on the charts, and seem to be significant. However, we can’t really make the leap that people will fall less by getting adjusted based on the results of this study. It’s just a good place to start.

What this study does tell us is that there’s something about patients who get adjusted seem to have a better sense of their own body. That’s the proprioception idea that we talked about earlier. If you have a better awareness of your body, then you will generally have better balance.

While we can’t make a leap based on this study, we do know that many patients under chiropractic care see some astounding changes in their balance and quality of life when they start getting their brain and spine connected.

Check out one of my favorite patient success stories below:

I am a 72 y.o. retired R.N. with history of Vertigo and Poor Balance.
Having had this problem for more than 20 years; I have seen many Doctors with little or no improvement.
On April 11, 2014, I walked into Dr. Chung’s office holding onto walls or anything available to keep from falling. After my first visit, I knew that I had finally met someone that truly cared. After my first adjustment, I was able to stand on my own.
Fast forward to 12 weeks of treatment, I am now able to go out without fear of falling.
I am now on the Maintenance Program and feeling stronger and able to “LIVE” and not merely :SURVIVE”.
Thank You Dr. Chung
You are the BEST !!!!!!

- Peggy McDaniel

Many doctors didn’t go into chiropractic because they want to be a quick solution for pain. They went into chiropractic because it can dramatically change the quality of someone’s life.

When you lose their sense of control over their surroundings, it can become devastating to your sense of independence. Our job is to find a way to give that sense back to you.

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Head tilt

Why Does My Head Always Tilt to the Side?

Head tilt

Read Time: [5-7 minutes]

How do I know if someone has an Atlas problem? Can a regular person see it?

Head tilting posture is something we’re used to seeing with curious puppies, but it may be a sign of a problem in the central nervous system. This can be one of the most important signs of poor neurological activity even in the absence of pain or symptoms.

Head tilt

Image from paper in the journal Laterality. Source: http://www3.canisius.edu/~noonan/research/researchreports/human_head_tilt.htm

Poor Head Position = Poor Interpretation of Gravity

Poor head positioning is one of the most important postural findings I look for in a Structural Chiropractic Examination. From a clinical perspective, it’s a lot more important than something like slouching. For the most part, people have the ability to recognize and correct a slouching posture when they want to. When it comes to a persistent head tilt, most people have no idea when it’s happening. It’s also a posture that is related to things like head injury, whiplash, or a balance problem.

When you have a persistent head tilt, you typically don’t know that your head is tilting because in your mind, it’s perfectly straight. This is an underlying indicator that your brain is working inefficienctly.

When you really think about it, posture is primarily your brain’s response to gravity. Whatever your body experesses as a straight posture is how your brain thinks it needs to exist in a gravitational environment. That means that a crooked head position means that the brain is getting bad input, which is leading to poor output.

Garbage in, garbage out

What does garbage out look like to the body? Garbage out expresses itself as Secondary Conditions like:

  • Headaches
  • Facial pain
  • TMJ
  • Vertigo
  • Balance Problems
  • Syncope (Dysautonomia)

All common problems experienced after a concussion or whiplash injury.

Why Head Tilt?

So what does head tilt have to do with concussion, whiplash, and all of these Secondary Conditions?

When your head and neck is exposed to a force, it can affect one of 3 systems in the body that control and regulate your balance and posture.

  1. Visual and Ocular system
  2. Inner ear/vestibular system
  3. Neck/Spine Proprioceptive system

Together these 3 systems integrate into your brain so that your brain knows how to regulate your body in space.

Your vision and movement of your eyes make sure that your head stays level. Your ears tell your brain if your head is moving. Your joints provide information on if your limbs or your spine are moving.

This system works best when all 3 give the same information. If your eyes and muscles say one thing, but your ears say another, then it creates a problem for the brain to process.

The 3 systems that form the Balance Triad

The 3 systems that form the Balance Triad

When you take a blow to the head or neck, then these structures can become damaged and start to malfunction.  We can see this malfunction manifest as a persistent head tilt to the side.

Head tilt may not be the cause of these problems, but it is a clear and obvious sign of a breakdown in this system.

It’s easy to see how a blow to the head can affect the neck because the two structures are connected via the top bone in your neck called the Atlas. In our Wellington office, we handle this problem by re-centering the head on top of the neck again utilizing the NUCCA procedure.

When the head is centered, then it’s almost like a re-boot to the system to make the brain work normally again.

Not All Head Tilts Cause Pain

Notice that not all head tilts cause pain, but head tilt is almost always a sign of a problem in the brain. Lots of people can go through a bad car wreck and not feel any pain immediately. However, the structure of their spine and the function of the brain has changed. This means that a problem can develop over time due to chronic malfunction of the nervous system.

That’s why everyone should get checked for a Atlas Displacement after an injury even if there’s no pain or symptoms present.

Not All Head Tilts Are a Neck Problem

Not every head tilt is related to a problem in the neck, though there is almost always at least some contribution from the neck. As we discussed earlier, there are 3 main systems that dictate your sense of balance.

There are times when I have done my best effort in correcting someone’s neck that a head tilt persists. That’s why it’s important to work with a team of professionals that are capable of addressing this problem.

  • Optometrists/Vision Therapy/Neuro-opthamology – These professionals are trained in addressing the ocular system. It’s a rapidly growing field thanks to our growing knowledge of concussion and how it affects the eyes.
  • Vestibular Therapist / Functional Neurologist – Special types of chiropractors and physical therapists are trained at rehabilitating problems in the inner ear. They use special assessments and exercises to restore normal function of the inner ear.

Remember: No one therapy cures all. An interdisciplinary approach is often the best way to solve many of these complex cases.