A family friend of mine is a highly regarded chiropractor. He did an assessment of me today and believes that my neck issue and to some degree, the concussion symptoms are related to a nervous systems issue in my upper neck at the base of my skull.

He is going to examine some x-rays and I am going to see him again on Friday. He wants to do adjustments and massage on my neck and wants to use an activator-like adjustment tool on my neck.

Any opinion on this idea and the risks given the concussion?

I have lots of experience with the activator. It can be very good but was not much help with C-1 for me. C-1 does not have facets like the lower vertebra. C-1 is held in place mostly by ligaments. One value of the activator is simply that it is gentle, especially when compared to the twist the head and pop the neck. The risk is low.

I bet the issue is more inflammation that interrupts blood flow that can impacts the brain stem (autonomic nervous system) and blood flow that supplies 25% of the brain. There may be some radiculopathy (nerve impingement) if you have neck muscle spasms. Radiculopathy would usually be C-1 to C-2 and lower, not C-1 to occiput (skull).

Ok that makes sense. Just to clarify, the activator might not be particularly useful with c-1, but the risk is low even if it's being used right at the base of the skull/upper neck?

In other words, the activator isn't likely to aggravate any brain swelling even if it's used right up there in that area?

And twisting of the neck type of adjustment might pose a slightly greater risk? And if so, this risk is just a general risk about doing those type of adjustments in the neck, or is it more risky in regards to the concussion specifically?

The twist the head and pop the neck is too aggressive for many subtle upper neck injuries. It's like using a shotgun to shoot an ant. It may help the lower vertebra but can cause inflammation higher up.

The activator does not force anything. It just sets the vertebra in motion with the muscles/tendons and ligaments pulling the vertebra into position. Even cranked up, it is gentle compared to the other. Low risk.

You don't likely have brain swelling. You have joint inflammation. It may put pressure on the blood vessels and reduce blood flow.

Chiro has little impact on the concussion other than allowing better blood flow by reducing inflammation.

You need to understand that you likely have two injuries. A concussion that has limited treatments available. And a neck injury that has many treatments available. But, you need to also take care of you neck. The chiro can't do his work if you don't follow up with good discipline to not aggravate the neck.

With the neck getting better, many concussion symptoms will be likely to improve.

Great explanation. More of my gratitude.

Follow up questions. You said that the activator wasn't great for c-1 in your experience. Does that mean that it's probably not effective in general for any upper neck issue? If so, and if neck twisting adjustments aren't a great idea in general, would it make sense to say that a chiropractor isn't the best option for dealing with an upper neck issue? Or can they be as effective with manual/massage techniques as other therapists/modalities?

Secondly, and sorry to dwell on this point, I wanted to check if it seems normal that my neck and head are still a little bit sore in the area surrounding where he worked yesterday with the activator and massage. You mentioned that it's low risk, but I just thought it would be prudent to say that he was using it at the very top of my neck/occipital and was angling it slightly "upward", or in other words, pointing it somewhat towards my brain.

Finally, you mention that there are two things at play in my case. Neck and concussion. The neck issues seems to be joint swelling causing a loss in blood flow etc. What do you think is the relevant physiological thing going on in the case of the concussion? For example, is it a bruise on the brain? More inflammation? I understand that the concussion doesn't really have active treatments but I was just trying to figure out how to conceptualize it.

jtoronto,

You are going to continue to struggle if you do not develop a way to keep track of and understand things you have been told.

I said C-1 does not have facets like the lower vertebra. It does not settle into those facets like the lower vertebra.

I did not say head twist and neck pop is not good in general. I said it can be too aggressive for people with subtle injuries that involve C-1. 'Popping' lower vertebra can stress C-1.

"Or can they be as effective with manual/massage techniques as other therapists/modalities?"

What are 'manual/massage techniques as other therapists/modalities' ?

It sounds like you think a chiro or therapist will fix your neck. They only reduce conflict,spasm, etc so your neck can heal. It takes weeks and even months for subtle neck injuries to heal.

"What do you think is the relevant physiological thing going on in the case of the concussion? For example, is it a bruise on the brain? More inflammation?"
Nobody can say. There are no diagnostics to define the physiology.

Conceptualize this. You break a bone. The doctor sets or aligns the broken bones. He fixes them with a cast that prevents you from misaligning those bones with excessive movement. Over time, the bone heals so the cast can be removed and you can start rehabilitating the bone and related joints. Over time, you regain most or all of the use.

The chiro or other therapist properly aligns your cervical vertebra. You work to not misalign them. Inflammation goes down improving blood flow to your brain. The chiro or therapist checks the alignment from time to time. You continue to work to not misalign them. The improved blood flow slowly helps your brain improve.

Pain just means you are sore. Is the massage painful? Did he tell you to ice after the adjustment and massage ? "Pointing the activator toward your brain" is a meaningless comment. Don't fret about everything.

btw, 'Highly regarded chiro' just means he is good at getting and keeping patients. This is usually defined by financial success and lots of touchy-feely systems to make patients feel like they are getting good care. I've known many successful chiros who were worthless to me. As my favorite chiro says. They are good at show and sell.

Thanks for the clarification.

The chiropractor went over some x-rays with me and they showed a significant loss of the curvature of the upper neck/spine. He wants to use the activator to adjust my c-1. He has also prescribed a set of flexibility and strength exercises for the neck and he has given me a cervical neck stretch pillow to use.

His practices seem to run contrary to what you have been saying. I am leaning towards discontinuing with him. I just wonder if the issue that the x-ray illuminates is one that is crucial to correct in order to progress with healing. Or maybe it is just a marketing tool and either that issue is common or is being caused by stiff muscles or some other factors. While the chiropractor admits that there are other ways to treat my neck related symptoms, he believes that chiropractic is the only way to fix the neck curvature problem and that problem and the resulting nervous system issues are the core of my injury.

I think if you go to any chiropractor, they are going to do X-rays, tell you spine is curved, and needs to be fixed. I truly wonder if anyone has ever gone into a chiro's office, gotten x rays, and they said, "looks good, I can't help you".

I'm not against alternative therapies and know mark disagrees that there are in fact honest chiro's that truly know what they are doing. i don't know how you find them and am 99.9% sure I've spent upwards of 10k on quackery. My Dr. at Rush University in Chicago agrees with me but I didn't consult with him first as I was desperate for relief.

I agree the neck component seems very important and makes sense a chiro would be the guy to go to. I can just echo similar experiences of being sore for days in certain spots and feeling very dizzy afterwards and just not right.

The AMA (American Medical Association) actually lost a law suit for their wholesale defamation of chiros. The AMA was enjoined from speaking against chiros.

The problem is many chiros focus on billings, not healing. Many have a philosophy that every health issue is chiro related. Others know the limits of chiro. I was doubter until nobody could help me until I tried a chiro.

Most chiros are good at the common lower vertebra (T and L) issues using a Palmer, Diversified or Gonstead protocol.

Gonstead chiros will often depend on X-rays or temperature differential. They are not looking for curved spines. They look for subluxated vertebra that have slipped out of position in the facets. Using X-rays is not the best diagnostic technique.

Many use x-rays as show and sell by drawing lines and saying, "We need to fix this." The good chiros only use X-rays to rule out conditions that make chiro risky, cracked vertebra, arthritis, serious disk herniation.

Leg check and manual toggling are better. In my experience, the gentle protocols work best but they take patience. Chiro adjusting thoracic vertebra can result in quick improvements for many with a quick pop. Neck adjustments often take longer because the aggressive adjustments can cause inflammation. The gentler adjustments slowly help the neck stabilize.

Even the best chiros only help your body heal. It take the patient's discipline to finish the healing process. Too many say, "I paid you money, why did you not fix me?"

jtoronto,

If the chiro does not have prior x-rays of your neck, how does he claim the loss of curvature ? Every neck is different. Chiro is about the relationship between neighboring vertebra. If they are properly aligned and seated in the facets, any curvature would usually be your normal.

Using the Activator on C-1 may help. It just didn't for me. It did not do any harm, though. No reason to not try but you will still need to be disciplined. I'm not a believer in using a pillow to stretch the neck if it puts one in an uncomfortable position. One wants the neck to find its own position by not straining it. Remember to ice your neck after each adjustment.