Dr. Kevin Leach:  Hey everyone. Dr. Kevin Leach here. Welcome to another episode of the Upper Cervical Chiropractic Research Show. If you are interested in neurodegenerative conditions. If you’re a doctor who treats these conditions. If you are someone/if you know someone with these conditions, this video is definitely for you. Okay! Welcome back everyone to The Upper Cervical Chiropractic Research Show. This is episode #4. I’m dr. Kevin Leach and I’m here once again with Dr. Tyler Evans. How are you sir? 

Dr. Tyler Evans:  I am well. Good to see you, sir. 

Dr. Leach:  Good to see you, my friend. This paper is titled “The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions” by Michael F. Flanagan published in “Neurology Research International” if you’re interested in neurodegenerative conditions, if you know someone with neurodegenerative conditions, if you treat patients with these conditions, or if you or someone you know is suffering from these neurological conditions. This can be like migraines, seizures, mood disorders and a host of other health issues. This episode is definitely for you. Dr. Evans, before we get into discussion about it can you give us a 50,000 ft overview of the paper and maybe explain the titles. There’s some big words in there and just explain what their goals were. 

Dr. Evans:  Yeah. Absolutely. I think it’s important that you understand who wrote this paper. Michael Flanagan is a chiropractor that graduated from Sherman Chiropractic College in 1978. He produced a handful of papers but this was the biggest one and it came out in 2015 I believe. Yes 2015. Before that in 2010 he produced this book “The Downside of Upright Posture” if that’s visible there. You can see it on the YouTube video if you’re interested, it’s called “The Downside of Upright Posture the Anatomical Causes of Alzheimer’s, Parkinson’s and Multiple Sclerosis”. (Neurodegenerative conditions) Now this paper is a little more of an advancement of that book and it moves forward from the concepts he presented in his book. It’s an overview of the craniocervical junction which is the base of the skull, C1, and C2 and its contents and why its contents are so important in terms of the fluid flow, cranial spinal hydrodynamics. It’s a lot. There’s a lot of big words there. Okay. The cranial spinal part is the junction between the neck and the head. Great. That’s where we upper cervical chiropractors live. That’s what we do. We correct misalignments of that craniocervical junction or upper cervical spine being C1, C2, and underneath the base of the skull there. He discusses in this paper the importance of this because of the intense emphasis that’s placed on that area by the human body. When we stood upright in gravity the human body had to develop compensation mechanisms for the weight of the head, which is roughly 10 to 15 pounds based on the person, being directly over the spine. Now that wasn’t that way before in primates and so there is a new method of movement of fluid in and out of the brain. That’s part of what makes us special as humans is our big brain, our skull, and the pressure cooker of the fluid that’s got to get in and out of that skull all the time. Every minute and every second. If it doesn’t the brain doesn’t work right and the body doesn’t work right. So that’s where this hydrodynamics comes into play of the craniospinal hydrodynamics. Lastly the neurodegenerative portion so nerd of degenerative diseases are diseases like he lists in “The Downside of Upright Posture”. They are Alzheimer’s, Parkinson’s, and Multiple Sclerosis. (Neurodegenerative conditions) There are other ones like ALS. There’s another one with Lou Gehrig’s disease. It’s a breakdown on his take and a breakdown of the literature in a narrative review from a 30,000 ft view of what he accumulated in knowledge over his lifetime. Now unfortunately this paper came out in 2015 and this is his magnum opus. He passed away 2016 so we were sad to lose him in the cervical community because he really was a visionary and a shining light. He really helped guide the research for these neurodegenerative disorders so there’s a lot to unpack here. That’s kind of the 30,000 ft view. 

Dr. Leach:  Tyler, would you explain because the paper goes through malformations and misalignments in the craniocervical junction, in the ccj, right where the head meets the neck and how that can affect the hydrodynamics? Hydrodynamics is the cerebrospinal fluid flow and blood flow in and out of the skull. Can you maybe just talk about how we as upper cervical chiropractors would be helping that and why a misalignment in that area would be detrimental to the health in the short term and in the long term? 

Dr. Evans:  Sure. First thing we can do is just read the abstract at the start of the paper here. The craniocervical junction is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis, the creation of pathological problems, and progression of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, migraine seizures, silent strokes, affective disorders, schizophrenia, and psychosis. (Neurodegenerative conditions) The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative neurological conditions. So why the upper neck might be a potential choke point is that it’s a small narrowing where everything must go down and get back up. We can put it very simply, it’s like a plumber. If the pipes are not lined up right the fluid doesn’t flow right and the head is an extreme case of sensitivity to pressure and the rest of the body is as well. The spinal cord, the dura, and the fluid that flows around it’s got to be just right. You see it in any time we have a dural leak in the spinal cord immediately there’s, or most of the time fairly quickly, there are some negative impacts. The fluid has to be balanced between the cerebrospinal fluid which is the clear liquid that floats around the brain and the spinal cord between the dura, the core, and the tissue to protect it to bring nutrients to it and away from it. Along with the arteries and the veins which bring oxygen to the brain, bring oxygen to the tissues, and then take away the toxic wastes as well. There’s a boundary and a barrier between them but that boundary and barrier can be altered by the changes in the cervical spine. When we see changes in where the cervical spine is rotated – if there’s misalignment in C1 or C2 we see this. You can see it in Dr. Rosa’s work and the upright MRI work pre and post CSF flow changes. It’s been documented and it’s in PubMed. These changes in how the brain works starts to break down the tissue and the malformations do it as well. There’s Basilar Invagination, Chiari, and a whole list of them. Those start to create neurological detriment to the brain because the brain can’t function well when the fluid is not flowing around it properly. Does that get us headed in a good direction there? 

Dr. Leach:  It does. I think it’s really important and it’s interesting to think about what you said. You said it’s like pressure inside the brain right? So that’s cerebral spinal fluid and if we can think about the head and the spine it’s almost like it’s in a capsule and that’s where the cerebral spinal fluid flow is. So when we think about normal blood pressure it’s not only do we need normal blood pressure in the body but the blood pressure affects inside the skull on the spine and the CSF actually that pressure. So it’s almost like it’s almost two pressures need to be regulated and inside the skull and inside the spine which blood pressure effects and cerebrospinal fluid flow effects. Which a misalignment in the upper neck, which we deal with and we correct all day every day, can actually affect these flows and it can create problems like these neurological conditions that we just mentioned. If left long term can start to develop and contribute to these Neurodegenerative disorders. I like your analogy regarding plumbing. Just for the listeners to get an idea for an analogy here – if you know how a faucet works you can imagine for there to be proper flow the faucet is all the way on. A misalignment malformation or something obstructing that flow would be if you just turn that faucet maybe half way off or a little bit off or a lot off it restricts that flow. That’s what the misalignment in the top of the neck is doing to that cerebral spinal fluid flow and potentially to that secondary venous outflow. Which can again create a host of problems. It was interesting when I was looking in here and I was trying to find it in my notes all five of the different ways that a misalignment and malformations can affect the health of the body. I always talked to my patients about a cascade effect of what happens. Patients say, “Oh well. You know, I have headaches but it happens when I’m stressed.” Then I try to say well if I got stressed and I got headaches maybe that would be the cause. If every person in the world when they got stressed they had headaches maybe that would be a cause but it’s an exacerbating factor. So we can think about it this way. We have a misalignment in our spine. It didn’t just get there because the body was bored. We most likely had some sort of injury or something that happened that tore loose the connective tissue in the upper neck and now we have a misalignment. That misalignment affects the hydrodynamics of the spine. That affecting and that disruption of the hydrodynamics causes five different things that they talked about in the paper. Number one being ischemia. Ischemia is lack of oxygen to the brain and to the spinal cord. Number two is edema. Edema is just excess fluid you can think about kind of like an inflammation effect. Number three is structural strain. This is like pressure and stretching. If you think about an increased or decreased pressure inside the brain in the spinal cord you could have a stressing, a straining, and a pulling of those tissues. That isn’t going to be good. Number four is pressure waves. Think about pressure waves like a water hammer effect. Every time we’ve got the blood flow and the heart beating and there’s these pulsating rhythms that happen with our cardiovascular system that helps the cerebral spinal fluid flow. If we have too much pressure/too little pressure and we have this water effect that just keeps pounding on those soft tissues of the brain and spinal cord that can create damage as well. The fifth one it’s sluggish CSF flow. It’s going to cause a problem. We need to understand the points of CSF before we get into it. Number one is CSF flow protects the brain and the spinal cord. It’s almost like a cushion effect for when we move and etc. but it also brings nutrients and takes toxins away from the brain and the spinal cord. If we have that sluggish CSF because of an obstruction in the craniocervical junction then that’s going to decrease the toxins being taken away which can cause inflammation and damage tissues. This will also not bring enough nutrients to the brain and spinal cord. Proper CSF flow can make the brain function properly and in the way that it was designed to. So when sluggish CSF flow happens we can get immediate effects like migraines and conditions like that and it can also long-term cause a breakdown. A simple explanation between maybe a neurological problem and a neurodegenerative problem is that neurological is going to be something that affects the nerve function. For example in misalignment or malnutrition etc. but it doesn’t affect the structure and the entity of the nerve so it doesn’t break down the nerve like a neurodegenerative disease does. So the neurodegenerative disease, degenerative meaning deterioration, is actually changing the structure of the actual nerve which can happen over time when there’s things like ischemia, lack of oxygen, and lack of nutrients etc. I wanted to go over that just as a basic overview of what that mechanism is doing. Any thoughts on that, Tyler? 

Dr. Evans:  Yeah. A couple of things. I think it’s really important to highlight how the CSF and the venous flow and the arterial flow work. If you want to talk, let’s first talk about the CSF. A lot of people may not even know what that is but there is this compartment in between the spinal cord and inside of the dura that is a space that is surrounded by this clear liquid. That clear liquid, cerebrospinal fluid, it is created deep inside of the brain in the ventricles. They’re called ventricles. These little red cells, they produce the fluid deep and literally in the center of the brain. In the center of the brain there’s empty space and people don’t realize this. They think your brain is a squiggly worm looking thing on the outside. No, deep inside the brain there’s actually compartments and there’s different parts to it. So what happens is this fluid is created deep inside the brain and it pushes against the tissue and that’s part of what gives the tissue its shape and size. Another thing is the brain is actually very fluid in nature. I know that you and I both have had neuroanatomy lab. We’ve dissected brains. We’ve done that. We’ve been in labs and those brains are hard because they have been hardened by chemicals but normally the structure is quite fluid. So this fluid coming out of it creates the structure partially. You need this very dynamic balance back and forth and so it’s creating this liquid and building pressure inside the brain and that’s what drives the fluid. The fluid drives down from the center, down through the upper neck, down through the rest of the spine, into the fecal sac at the bottom of the spine, and then back up and around and then it comes out through the vena system. Then that fluid gets kind of absorbed into the vena system and then it is circulated back out and reabsorbed and goes back through. Now why is that important? Well because if the upper neck is out of alignment it literally can cut off that fluid flow and now you’ve got a problem like Hydrocephaly. Now you’ve got a problem where fluid is literally pooling on the brain. We know there are papers, I can’t remember the exact name of it right now but I believe it’s “The Implications of Cerebral Spinal Fluid Stasis” it’s at least close to the name of the paper, but if you look this paper up it talks about the detrimental effects of having cerebrospinal fluid be static. It’s like a pond right rather than a river, you want flow but you don’t want too much flow. You don’t want too little and you don’t want it pounding like you said a water hammer into the tissue. That can be bad and so it’s really important to have this proper flow and when we do it takes away toxins from the brain. When those toxins sit there in stasis we get lesions. Multiple Sclerosis means multiple lesions of the brain and spinal cord. Right? So I see it all the time and I have neurologists that I work with and I love them for what they do. It’s really important and remember to have a functional perspective because the body lives in a functional world. We live in a functional world. So why are those lesions there? Where did they come from? What created them? How do we get rid of them? One way to work with that is to get that CSF to flow better. We’ve seen it in Dr. Rosa’s papers in PubMed where lesions decrease over time because we’re helping that fluid flow better. Go ahead Dr. Leach.

Dr. Leach:   Yeah. I was just going to ask, I think that paper is important but does he have one that shows this? 

Dr. Evans:  He has a paper and it’s in “The Craniocervical Syndrome and MRI” book. Yeah. As well as he just put one in the Interlochen… What it’s called inter… something. It’s a paper that he produced last year or two years ago. We can get that up 

Dr. Leach:  Got it but my question was what’s the thought process right now? This was several years ago. What’s the thought process on those plaques with multiple sclerosis being demyelination as opposed to maybe an inflammatory effect that comes up on MRIs?

Dr. Evans:  Yeah, it’s inflammation. I can’t be quoted on that right now because I don’t know exactly the nature of the lesion but I do know that they result from fluid sitting there. That is in that stasis paper that I was talking about. 

Dr. Leach:  We say that like “Oh yeah. It’s inflammation” but in the world they believe it’s demyelination. 

Dr. Evans:  Well yeah. It’s like demyelination is the downstream effect of those lesions. 

Dr. Leach:  Got it. So there’s an inflammatory effect first. 

Dr. Evans:  There’s an inflammatory process happening. It attacks. So the body attacks it, there’s inflammation and the body’s attacking it. Maybe it’s chicken or the egg, right?

Dr. Leach:  Okay.

Dr. Evans:  Which happens first? So that’s probably the struggle right now. What’s happening first? Most of the literature in the past was on the neurological demyelination because it’s studyable. You can study that. 

Dr. Leach:  Okay. Just to be clear, Scott Rosa, would he say that because of the stasis of the CSF the lack of flow/lack of toxins being pulled away creates an inflammatory process. That inflammatory process attacks the myelin on the nerves which then demyelinate the nerves which then causes symptoms of multiple sclerosis. Would that be it? 

Dr. Evans: Let’s not put that on Scott Rosa but I’ll take that one. 

Dr. Leach:  You will say that? 

Dr. Evans:  That’s what I’ve pieced together over the years. I’m not gonna put that on Scott Rosa. 

Dr. Leach:  Okay. Fair enough. 

Dr. Evans:  I’m not sure what he said in the past.

Dr. Leach:  Right. Let’s not talk for him.

Dr. Evans:  Exactly. I know that he has shown pre and post changes in these sclerosis lesions and symptomatic changes. 

Dr. Leach:  Well, let’s let’s review a paper on that 

Dr. Evans:  Oh yeah.

Dr. Leach:  We’ve got some imaging and it’s pre and post. Isn’t it pre and post adjustment..

Dr. Evans:  Yes.  

Dr. Leach:  ..where he sees that CSF flow decreased and then does it again. What’s the imaging? Is that a functional MRI? 

Dr. Evans:  That is an upright MRI. Those are created by Ray Damadian. I’m looking up the name of the paper right now and it is “The Possible Role of Craniocervical Trauma and Abnormal CSF Hydrodynamics in the Genesis of Multiple Sclerosis.”  There’s that big word again. So we can do that paper in the future.

Dr. Leach:  Yeah, let’s do that for sure.

Dr. Evans:  It breaks it down here but I’m not gonna get into it right now. Let’s focus on this because there’s again more layers to this. That first piece yes – CSF need to have it move right. Can’t be too slow. Can’t be too fast. It needs to be moving in the right ways and in the right places. If it’s not it starts to wear down the tissues. It’ll actually eat away bone! Not eat away but it wears it off. It’s not good to have it wearing like that. The other parts to this are the arterial and venous flow. The arterial flow we have 80% roughly goes through the carotid arteries and 20% goes up through the vertebral arteries. So we know that 20% of what feeds the brain – now which part of the brain is the important question. When we talk about the spine 20% of the arterial fluid flow to the brain goes through the spine through the vertebral arteries right through C1 and C2. Literally through them. It kind of forks around and then comes back up and goes right up through the base of the skull(foramen magnum) and when it does it comes together at the brainstem. What does the brainstem control? It has cranial nerves. It has the functions of digestion, heart rate, breathing, and immune function. You name it. All of that is controlled in that area so if we don’t have the proper fluid flow up to the brain which brings oxygen and nutrients we’re in trouble. So if C1 is rotated or C2 is rotated it’s going to affect how that fluid is flowing up into the brain. That’s documented in PubMed as well. I don’t have the names of the papers here but that is very well documented in PubMed. When we have we have twerking of the arteries around the vertebra and it slows down the fluid flow up into one side. So that’s pretty well-documented. Now, if I can just the last piece here?

Dr. Leach:  Yeah.

Dr. Evans:  The venous flow. It’s really important to understand the venous flow. The venous flow out of the brain is another magical variable piece here. If it’s not just right we get problems and it’s called cerebrospinal venous insufficiency, CCSVI. Cerebrospinal venous insufficiently. That is a whole other topic and a whole other problem but that’s part of what he’s talking about in here. He’s talking about having the fluid come out of the head, the proper venous drainage. When we talk about positioning we talk about that evolutionary adaptation to standing upright and gravity. Well, when we are in gravity the preferred way that venous blood flow leaves the skull and goes down through the neck is right through the vertebral venous plexus. That vertebral venous plexus travels right through the spine. It literally wraps and it’s like a vine that’s wrapped around the vertebral bodies. If you have misalignments in the vertebra you’re going to have trouble there. We know that. So that’s upright and gravity. When you’re laying down the preferred method of travel is through the internal jugular veins. Most people would think the larger vein would be the place normally that the blood flow goes out of. Well no. That’s not exactly true. So why does it do that? It does that because there has to be that right balance of fluid going up and you can’t just have all the fluid rushing out of the head. There has to be some pressure to keep it up there and that’s what that does. It slows it down coming down through the spine but if you have a misalignment in C1 and C2 you’re in trouble. You got a fluid flow back up into the brain. 

Dr. Leach:  One of the points that I wrote down is that we learn as chiropractors that we’re turning on that nervous system. We’re turning the power on. We’re restoring the nervous system back to its proper function. When we look at a paper like this and we look at the evidence of when we make, I just got goosebumps, that adjustment how many different things were affecting. Not just pressure on nerve, pressure off nerve, or even afferentation/ dysafferentation of the joints but how much we’re affecting with the health and the implicate that it can have on our health besides just mechanically in a biomechanical correction of the musculoskeletal system and the neuromusculoskeletal system. We think of ourselves, chiropractors, as neuromusculoskeletal doctors. We evaluate chiropractic subluxation and we correct chiropractic subluxation. What we’re affecting is just tremendous and who knows what we’ve helped. When a patient comes in with headaches, pain, they came in from a car accident, or whatever they come in for and we correct that upper cervical spine, the craniocervical junction, what else are we helping that they’re not really even feeling yet. There’s some sort of underlying process that they’re not even understanding what’s going on. When that craniocervical connection is off or obstructing it, where are those problems going to manifest in the brain for that particular person. It’s just incredible to know that the depth of what we’re doing without even knowing we’re actually doing it. 

Dr. Evans:  Oh absolutely. It’s a very good argument for preventative corrections/preventative alignment to prevent neurodegenerative disorders of the brain. The thing that drives the body from day one to the end. The thing that’s literally keeping you alive. We are helping the fluid balance so that it is getting nutrients in and out and it is properly keeping buoyancy in the brain and protecting that tissue. It’s unfathomable how many things could be connected to it. This is about brain health. What we do is about brain health. We didn’t talk about the spine. Yes, we’re adjusting this spine but this is all happening in the brain. All of this happens in the brain. It’s just really important to connect with that. There’s papers that obviously when we do adjustments it affects the neurology in the brain but the fluid flow is just as important because the nerves don’t work unless there is stimulation, oxygen and nutrients. So stimulation that’s one part of it but oxygen and nutrients coming from the fluid that’s also where we live. 

Dr. Leach:  Obviously Dr. Flanagan, in the conclusion he’ll talk about how we’d like to see more research done etc. Even though a lot of times with research it paints a pretty clear picture and we can come to our conclusions but more research obviously is better and is necessary especially for other professions to not just take our word for it but to see some evidence. Dr. Scott Rosa I’m sure is doing great research. I’m just hoping more research comes out like this that can really show what we can do to help that. Again, it’s important that our listeners and viewers understand we’re not saying come to us and we’re gonna cure your Alzheimer’s. No but the fact is that this is the way I look at it.. There’s evidence and there needs to be more research to show that and prove that evidence that we have a role to play with these conditions. Now meaning someone starts to have symptoms like Multiple Sclerosis. Maybe they don’t have plaque show up on their MRI. Maybe they’re not actually diagnosed with that. As a conservative approach and as a box on that list of “Hey, you’ve got these problems. You need to go get your neck checked out.” Maybe they need to get an MRI to make sure there’s not a tumor, a malformation, or something else serious going on. But a lot of times,I know you can relate to this, is we see patients after they’ve been to the medical doctor and after they’ve had their exams. They come into our office and they say “I’ve been everywhere. You’re either my last hope or you’re my next step.” So it’s important that we get to a point in the healthcare system where doctors/neurologists that they know that we’re on the list for getting screened for an upper cervical misalignment. A misalignment in the craniocervical junction. It’s huge. For our patients it has to be a checkmark on that list. Any other points, takeaways or last discussion points here? 

Dr. Evans:  I think we covered it pretty well. It’s a huge paper. It has I think 257 references. This is a beautiful paper. Like I said it was his magnum opus. Unfortunately, he passed away a few years ago but this guy really laid it out. Also check out his book “The Downside of Upright Posture.” It really goes into the nooks and crannies of everything that he could find on fluid flow in the brain. It’s just important to have that neck checked for prevention and for just overall healthcare. Helping the body work better. 

Dr. Leach: Got it. 

Dr. Evans:  That’s what I got. 

Dr. Leach:  Awesome but as usual our listeners and viewers give us feedback. Like, subscribe, and all that stuff with social media. Wherever you see this video or if you’re listening on the podcast, any sort of feedback in support is appreciated. We’re trying to help people. We’re trying to bring value and that’s about it. Anything else, Tyler? 

Dr. Evans:  Thanks again, Dr. Leach. 

Dr. Leach:  Awesome. Thank you for reading/watching/listening. Take care!