February 17, 2025 • 27 mins
This episode illuminates the significant connection between neck injuries and concussions, and the overlapping symptoms that can occur from either. We delve into various symptoms stemming from neck trauma, explore effective therapies, and highlight the importance of functional neurological assessments and integrative treatment approaches for enhanced recovery outcomes.
• The relationship between neck injuries and concussion symptoms
• Equipping listeners with knowledge about cervicogenic dizziness
• Importance of specialized therapies for neck and brain recovery
• The link between neck trauma and vision disturbances
• The need for comprehensive eye movement evaluations
• The role of integrated therapeutic approaches in recovery
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Disclaimer:
This podcast is separate and unaffiliated from Sophia Bouwen's work and employment at the Health Partners Neuroscience Center.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ayla Wolf (00:00):
When the neck is involved, the pinwheel sensation
changes based on whether theirhead is in flexion or extension
or turn to the right or the left.
If that pinwheel sensationchanges, that's usually one of
my clues to say, okay, there'ssomething going on with the neck
that's interfering with thesensory integration of this
trigeminal nerve in the face andthe head nerve in the face and
(00:31):
the head.
Sophia Bouwens (00:31):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens and I'm herewith Dr Ayla Wolf and we will be
your guides to living your bestlife after impact.
Hi Ayla, how are you today?
Ayla Wolf (00:56):
I am good.
Somebody almost ran me off theroad on the way here.
Sophia Bouwens (01:00):
Oh my gosh, what happened?
Ayla Wolf (01:02):
I just pulled out of my driveway and obviously it
snowed last night and the roadhad not been plowed where I live
, and so there was a goodprobably four inches of snow on
the road, and this car wascoming towards me and they were
honestly speeding, given thatthere was four inches of snow on
the road, yikes and they werein the middle of the road and I
tried to get over as far as Icould and they still just like
(01:24):
would not make room for me, andso I had to literally like go
onto the shoulder of the road insnow, just so that they didn't
hit me head on people I didn'tknow, maybe their depth
perception's a little off that'sthe way night.
Sophia Bouwens (01:38):
Really nice of you to give them the benefit of
the doubt as a neurotherapist,like oh, there might be other
things going on.
Ayla Wolf (01:45):
Right, you know I hardly ever honk my horn, and
much less after a car hasalready passed you.
But I literally had a momentwhere I was like I feel like I
need to honk my horn in thissituation.
This person practically ran meoff the road in a snowstorm.
Sophia Bouwens (01:58):
After my world travels, being in countries
where they use like horn honkingas a discussion, like in Egypt,
they use horns as a way ofcommunicating on the street and
in Latin America they use themall the time.
I've gotten much more liberalwith horn using in America, so
I'm not always super shy.
I'm glad you did it, even if itwas after the fact.
(02:19):
Well, I'm excited for our topictoday on neck injuries as it
relates to brain injury, becauseit's really close to my heart
and my car accident.
When I was hit by that drunkdriver I don't remember any of
it, but I suspect my headbobbled quite a bit, hit the
steering wheel, which is why Ibroke my jaw on both sides.
I lost teeth and I think italso snapped back pretty hard,
(02:41):
which is how I broke myoccipital condyle, right where
your neck joins your head.
Ayla Wolf (02:46):
That is a serious collection of injuries.
Sophia Bouwens (02:48):
It was quite a mess but I think that in my own
recovery, paying really closeattention to my upper cervical
and my cervical proprioception,my cervical system, my neck in
particular, has been reallyhelpful, life-changing for me in
my recovery.
The brain injury component washuge, but also the neck injury
(03:12):
which drives a lot of symptoms.
And I find now in my recovery,10 years later, that if my neck
is off or out I notice andthat's my alarm to really go in
and take care of it.
I have to really prioritize myneck recovery.
So I'm excited to help ourlisteners understand how much
(03:32):
their neck can be playing intosymptoms and how it might be
missed or underemphasized.
Ayla Wolf (03:38):
Absolutely and in your recovery.
What are some of the therapiesthat you have found most
effective for you?
Sophia Bouwens (03:45):
My life-changing therapy has been Atlas
Orthogonal, which is a veryspecific adjustment to the upper
cervical C1 and C2 atlas andaxis.
I had manual adjustments of myatlas done by other
chiropractors who are great, butit did not do the same thing as
an upper cervical specificadjustment.
What I love about thisadjustment is it's very gentle
(04:07):
and very precise, but it hasbeen completely life-changing.
It gave me back my ability toswallow without choking.
It gives me a really nicerelief of anxiety and stress.
When that gets high because Inoticed that's one of my first
signs is like I get more anxiousabout things Like, oh, I wonder
if my atlas is out.
And that has been completelylife-changing.
(04:28):
I didn't believe it in thebeginning that it would be.
My friend was telling me aboutit that I should do it.
Finally I just bit the bulletand did it and it has been
amazing.
So that, in particular, I'mvery passionate about
Craniosacral, and acupuncture,of course, have been very
helpful as well.
Do you do craniosacral work inyour practice?
Ayla Wolf (04:57):
I do some of it and when I feel like people need a
lot more of it I tend to referout just because I don't have a
lot of the time to do the deepfocused you know hour long
sessions.
But I did.
I've studied it in a number ofdifferent ways through both the
Upledger Institute and then Idid some biodynamic craniosacral
training as well with ToddJackson out in Portland Oregon a
long time ago and I do find itto be very powerful.
(05:19):
I also because of yourintroduction to Atlas Orthogonal
.
I have found that to be helpfulfor me too, because I have a
what they call military neck.
I have completely lost thecervical curvature in my neck.
When you look at my x ray, it'spretty crazy.
It is just perfectly straightright, and what I have noticed
is that there are times inCrossFit where if I'm doing a
(05:42):
lot of overhead lifts, where I'mhaving to catch the barbell
above my head, you tend to landwith a bit of a forward head
posture and when I do thatrepetitively sometimes it throws
my neck out in a way where whenI try to swallow I literally
feel like I've got a vertebraejamming in the back of my neck
it's very yucky, scary feeling,and that's when I know I'm like,
(06:04):
okay, time to go to thechiropractor.
Sophia Bouwens (06:05):
Yes, a specific one, right Particular about that
.
Well, I think this is reallyimportant.
A lot of our neck injurysymptoms can mimic concussion
symptoms, which I think isoverlooked a lot by medical
providers and by patients notunderstanding fully that
connection.
So I would love to dive in justlike defining first what neck
(06:27):
injuries are I think it kind ofgoes hand in hand Many people
know but then some of thenuances about different types of
injuries, whether it's tensionor maybe a visual proprioceptive
components that are different,which is like where your head is
in space and how your eyes movewith it, and then joint
position sense.
There's a lot to dive intothere.
Ayla Wolf (06:47):
There's a ton and, I think, big picture.
It makes the most sense if westop thinking about the brain
and the neck as being twocompletely different things and
recognize that they areconstantly working together in
terms of all of our differentsensory systems, and so when we
start to look at it more from asensory integration lens, then a
(07:08):
lot of the therapies that aremost effective and most helpful
start to make more sense too.
I have come to pay much moreattention to a lot of the
research that talks about theimportance of neck strengthening
, especially for, like femalesoccer players, or just women in
general, tend to have longernecks, thinner necks and not as
much neck musculature.
Sophia Bouwens (07:30):
No, and in the PT world, where I work a lot
alongside of them, strengtheningcomponent is huge, but I think
that can't be undermined because, as you said, this study showed
that soccer players who didneck strengthening exercises had
less incidences of concussion.
Ayla Wolf (07:47):
Statistically, they were finding that the athletes
that did consistent neckstrengthening exercises ended up
not experiencing as manyconcussions.
So they were finding thatstrengthening the neck was a
preventative factor forconcussions in that sport.
And it makes perfect sense thatthe stronger your neck is, then
(08:08):
the less force you have interms of your head bobbing back
and forth, right If you canactually brace your neck muscles
.
I think that you know, when Ilook at some of these UFC
fighters that have a very longcareer in fighting, they've got
no neck right.
Like it's just literally a headand solid muscle right.
(08:28):
And so I was like, okay, likethese, these people with barely
no neck or incredible neck girth, right where it's just this
huge neck, that's all muscle.
That's actually a protectivefactor that's helping them to
have longevity in their sport,where they're getting punched in
the face repeatedly.
And so I think that, you know,the MMA world has really
(08:52):
acknowledged the importance ofneck strength and I think that,
especially with female sports,they've been a little slow to
catch up to that.
But I think that the awarenessis growing and that neck
strengthening is hopefullystarting to be a much more
regular thing within femalesports.
But so many of the patientsthat I work with were in car
accidents.
They're just average people,they're not athletes.
(09:13):
They were in bad car accidentswhere they had really bad
whiplash, like you just said.
I mean you were hit by a drunkdriver, your head slammed into
the steering wheel and backagain, possibly a couple of
times, with enough force tobreak your jaw in two places.
I mean that's a lot of traumato the ligaments in the neck,
the musculature you said youbroke the condyle in the back.
Sophia Bouwens (09:34):
Yes, I did.
That's a lot of trauma.
It is a lot, and that is enoughto drive a lot of the symptoms
that come after a head injury orconcussion as well, because the
brainstem comes out of thebrain and into the neck, so
that's where they're sointricately connected.
Those cranial nerves are thoseareas that feed all the sensory
(09:54):
information from our face andour face into our brain, make a
huge difference in how our brainoperates and how we interpret
the world, how we experience theworld and how we feel right
with our head in particular andthe rest of our body as well.
Ayla Wolf (10:11):
Yeah.
So I thought it would be a goodidea to talk about some of the
tests that we do that have alittle bit of a functional twist
on them that can tease out theintegration between some of
these different aspects between,say, headaches and neck trauma
or even eye movements in theneck, as a way of kind of
highlighting how we do things alittle bit differently to see
(10:36):
this connection.
And then, when you have a lotof different, what I call
biomarkers that you collectduring these functional exams,
those then help to check back inwith to say okay, I'm seeing
this thing in my exam.
If we then do a therapy, doesthis abnormal finding improve?
(10:56):
And the more biomarkers we cancollect, the more clues we get
to then say is our therapy theright therapy and is this person
actually getting better?
Sophia Bouwens (11:06):
Which is so important because oftentimes we
just give a broad spectrumtreatment and you get some
improvement because you're doinga little bit for some parts of
it.
But when you can tease outexactly what might be driving
what and how, then you canintervene more specifically and
possibly do less and get betteroutcomes.
Ayla Wolf (11:27):
Yeah, I mean, I well, this is kind of getting into
the weeds a little bit but I hadfound that with some of the
testing that I do, it actuallyguides me to say, oh, like, at
this point in time I should notdo acupuncture on the right side
of the neck based on this examfinding.
But I'm only going to doacupuncture on the left side of
the neck until these thingsequalize and then we can start
(11:50):
to.
You know, do both sides.
And so the clues have actuallyled me to perform very different
treatments as well, which Ithink has lent to some good
success and some good outcomes.
Sophia Bouwens (12:02):
So let's dive in yeah, let's dive into some of
the symptoms that can come fromneck trauma.
Ayla Wolf (12:08):
Yeah.
So first of all, I think one ofthe most common ones is
probably dizziness, or what wenow call cervicogenic dizziness,
which is dizziness as a resultof trauma to the neck or
something wrong with the neck,some kind of neck pathology.
Sophia Bouwens (12:25):
And why and how can that come up?
Because I don't think of theneck as being something that
drives dizziness.
You think of the head or thevestibular system.
Ayla Wolf (12:30):
Yeah, it all comes down to receptors.
So we've got different receptorsin the skin of the neck, the
muscles of the neck, the jointsin the neck and sometimes those
receptors.
If they're not functioningcorrectly, they can actually be
sending the wrong signal to thebrain in terms of how the neck
is positioned or how fast or howfar it's turning, where the
(13:06):
brain is constantly takinginformation from our visual
system, our eyes and what the,what we're seeing in the world,
as well as from our inner earand the signals from our
vestibular system in the innerear.
And then it's takinginformation from those receptors
in the neck and it's saying areall of these systems telling me
the same information?
And if they're not, becausemaybe the receptors in the neck
are giving the brain the wronginformation, and if they're not,
because maybe the receptors inthe neck are giving the brain
the wrong information because oftrauma, then all of a sudden
(13:28):
there's a sensory mismatch andthe brain is saying wait a
minute.
I'm getting two sets of datathat don't add up and now I'm
not quite sure where I am inspace and if I can trust my
balance.
Sophia Bouwens (13:40):
And that's super stressful for our system.
So we can get a lot of anxietyor other symptoms like
dysautonomia that can drive that, as well as dizziness, and the
neck locks down the muscles tocontrol one of the systems too.
So we can have a lot of necktension and neck tightness
because the brain or thebrainstem almost says this is
how I interpret it almost sayslike we can't always trust this,
(14:03):
so we're just going to controlit, lock it down, make it tight.
Ayla Wolf (14:07):
Yeah, if it's not really trusting the information
that is, this unconsciousresponse is to say let's just
shut down our neck movement asmuch as possible by tightening
all these muscles.
Or, in a sense, by tighteningup the muscles you're trying to
like the brain's almost tryingto like upregulate the
information coming from thosemuscles and by tightening them
down.
And so that's where I thinkthat when the brain is having
(14:30):
these unconscious responses thatare causing the neck tension
and they've had whiplash, and sothen they're going to get
massage therapy.
I think in some cases this iswhy people say well, I go, I get
the massage done and I feelgood for an hour or two after,
but then everything tightens upright away.
(14:51):
And so whenever I have apatient come in, I always ask
them about what therapiesthey're doing and how long of a
relief they get.
And if they're telling me that,you know they do something,
whether it's massage,acupuncture, a chiropractic
adjustment and then they're likeI feel good for a couple hours
or maybe a day, but theneverything tightens up again.
(15:11):
Usually, the things that havebeen missed in that equation are
the role of the eyes and thevisual system and eye movements,
in addition to, maybe, theinstability coming from the neck
or something going on with thevestibular system and so usually
this integration of senses.
If not, if these sensorymismatches are not cleaned up,
(15:34):
that's often a scenario wherepeople are not getting good
relief from what should be, youknow, some very great hands on
therapies that otherwise peoplewould would get really solid
relief from.
Sophia Bouwens (15:45):
And one thing not to make it any more
complicated is we're not talkingabout yet is the jaw, how the
mouth can play a big role inthat too.
So neck tension or jaw tension,clenching the teeth or having
that, can also make a big impacton balance would make a big
(16:06):
impact on balance.
Ayla Wolf (16:06):
Yeah, and one of the tests that I like to do is I
always grab my pinwheel and Itest the three different
branches of the trigeminal nerveon the face.
And I asked the patient, youknow, does this pinwheel, which
is supposed to mimic pain bybeing just kind of sharp and
pokey, but in a controlledmanner?
So I'm asking the patient, youknow, does this pinwheel
sensation feel about the same onthe left side of the forehead
(16:28):
compared to the right side, orthe right side of the cheek
compared to the left cheek orthe jaw right?
So we're doing these threeareas of the face and comparing
right to left and a lot of timesit people might say, well, yeah
, it feels equal when their headis neutral.
But then you have them turntheir head and you do the same
(16:49):
test and all of a suddensomething feels sharper right.
Or you have them open their jawand all of a sudden, maybe what
once felt sharp now actuallydoesn't feel sharp.
And so you can sometimes seethat when the neck is involved,
the pinwheel sensation changesbased on whether their head is
inflection or extension, or turnto the right or the left.
(17:11):
If that pinwheel sensationchanges.
That's usually one of my cluesto say, okay, there's something
going on with the neck that'sinterfering with the sensory
integration of this trigeminalnerve in the face and the head,
because anatomically youshouldn't really see a change in
the trigeminal nerve in theface and the head, because
anatomically you shouldn'treally see a change in the
trigeminal nerve based on headposition, and so what we're
(17:31):
really testing is more of thesensory integration at a, you
know, central nervous systemlevel.
Right, how is this informationbeing interpreted?
Diving deeper, yeah.
And with the jaw, you know ifpeople have a lot of jaw tension
, what initially clued me intothe importance of that was a
paper that was looking atbalance in people that had
(17:54):
whiplash injuries and they wereputting in an intra they call it
intraoral dental appliance.
So they were having people wearsome kind of mouth guard that
was customized to eachindividual.
It wasn't just they popped thesame one in everybody right.
So this was like individualizeddental appliance that people
were then wearing and they werehaving them stand on a balance
(18:19):
plate can give a very high levelinterpretation of how much
somebody is swaying when they'rebalancing by measuring changes
in their weight, shifting intheir feet, and so they could
measure the degree of sway assomebody was trying to balance
with their eyes closed on thisbalance plate, and then they
(18:40):
would pop the intraoral dentalappliance in and like, boom,
there was an immediateimprovement in their balance.
And so it got me wondering, assomebody that practices
acupuncture well, it's like Iknow that acupuncture is great
for TMJ dysfunction and for jawpain.
Sophia Bouwens (18:57):
And I yeah.
Ayla Wolf (18:58):
I mean, I treat jaw pain all the time.
But then I started to wonder,well, what happens if I have
somebody with poor balance andI'm doing assessments on their
jaw?
And I'm to wonder, well, whathappens if I have somebody with
poor balance and I'm doingassessments on their jaw and I'm
seeing that, oh, they have alot of jaw tension.
This pinwheel sensation ischanging based on whether their
jaws open or closed.
And then I started to doacupuncture in points on the jaw
(19:20):
and different muscles that weuse for chewing, knowing that
those muscles have anintegration into the midbrain
and then this very specificpathway into the cerebellum.
That then is involved inbalance and maintaining balance.
And so I was having people docomputerized balance testing and
then I'd get their score andthen I'd put the needles in and
(19:43):
then, with the acupunctureneedles still in their jaw, I'd
have them do the same balancetest and I'd put the needles in,
and then, with the acupunctureneedles still in their jaw, I'd
have them do the same balancetest and I'd find that their
balance immediately improvedwith these needles in their jaw.
Wow.
And so I was saying, okay, well, you know, this could be a cool
party trick if it's onlysomething that once you take the
needles out, then their balance, you know, gets worse
immediately.
(20:03):
But so that's why you knowagain, I'm not into party tricks
or magic, I'm trying to makelasting changes for people.
But what I found was that whenwe would, you know, do several
different treatments withneedles in their jaw and work on
their neck, that over time,indeed, these people's balance
were consistently improving overtime.
Sophia Bouwens (20:23):
Good.
So what do you think are someof the things that people might
not suspect are symptoms fromtheir neck?
Ayla Wolf (20:29):
Well, there is research looking at neck trauma
that says that people canactually have changes in their
vision in terms of blurry visionand changes in depth perception
from neck injuries, and I thinkthat most people might not make
that leap to say that ifthey're having blurry vision
it's because of trauma to theirneck.
So those are two that I thinkare kind of important to
(20:51):
highlight is that actual visionchanges can even arise from neck
trauma from neck alone, so notthe optometrist might not be
helpful or as helpful.
Well, I think that's where I'veheard a lot of people go in.
They say you know, I'm havingsome of this blurry vision or
these vision symptoms after myconcussion, and I went to my eye
doctor and they tested myvisual acuity and they said that
(21:14):
it's normal.
And so I think what's happeningin a lot of cases is that people
are only having one small partof an eye exam performed, which
is visual acuity, but what isn'tbeing fully assessed is these,
this broad range of differenteye movements, and so I think
that what again might be gettingmissed is that if people's eye
(21:36):
movements are not being fullyassessed, then eye movement
disorders are getting missed andthe association between how
those eye movement disordersaffect the neck are then also
getting missed.
And so, for example, if somebodyhas an ocular misalignment
where, say, their left eyebecomes positioned more outward
(21:57):
or like laterally deviated, theymight unconsciously want to
turn their head to the right totry to like bring the world back
into alignment.
And so sometimes you can havesomebody walk into your clinic
with a constant head tilt to theright, which would then, of
course, throw off the muscles inthe neck and cause chronic neck
pain plane where, if one eye ispositioned higher, somebody
(22:26):
might tilt their ear towardstheir shoulder to try, to you
know, unconsciously bring theworld into an even horizontal
plane and not even realizethey're doing it.
And so if somebody's walkingaround with either their head,
you know, turned one way ortilted one way, that's going to
cause a lot of chronic neck pain.
And if the eye alignment issueis not getting identified and
(22:47):
corrected, then that just setspeople up for chronic neck
issues.
Sophia Bouwens (22:51):
So for that kind of therapy you might intervene
with eye movement exercises orvisual components.
Neuro-optometrists oroccupational therapists who are
well-versed in eye movements,who would you think would be
some of the go-to therapists tolook for that?
Ayla Wolf (23:05):
I think it's really important that people do find
some kind of eye doctor whospecializes in concussions and
brain injuries, whether that's aneuro-ophthalmologist or
neuro-optometrist or just anoptometrist who's done
additional training and has moreexperience analyzing different
eye positions, eye movementseven within eye movement
(23:28):
disorders and kind of thisocular motor system.
I would say there's a bit of aargument, ongoing argument, over
what does it make sense to justimmediately put somebody in
prism glasses to correct amisalignment of the eyes versus
having them do vision therapy?
And for me and you know the wayI've approached medicine my
(23:52):
whole life is, even if thevision therapy is more work and
more time and more money, itmakes more sense to do that
versus giving somebody a bandaidthat corrects their vision for
them and then allows thosemuscle, the muscular imbalance
or the misalignment to remain.
And so vision therapy.
(24:13):
But again, it takes time, ittakes money, it takes commitment
, and so I think that you knowmy preference would be for
patients to do the visiontherapy and see if they can
correct their misalignments ofthe eyes through actual
exercises versus just wearingprisms.
But I also recognize that thereare times when there may be
(24:34):
other things going on that needto be addressed first and so
like for you I mean, if you haveall these broken bones and
broken jaw and you know youmight need to be like doing
other things that takeprecedence over vision therapy,
right?
Sophia Bouwens (24:48):
Right out of the gate.
Make sure I can walk and dressmyself.
Ayla Wolf (24:51):
Right, exactly, yeah, let's make sure you can walk,
talk and dress yourself and eatbefore you know, throwing you
into eye exercises.
Sophia Bouwens (24:58):
Sure, but then once you get that correction
with the visual system, a lot ofthings can get cleaned up too.
So it's a balance kind offinding the pathway forward.
Having someone who'swell-versed in those kinds of
things and helping with that canmake a big difference for
recovery.
Ayla Wolf (25:18):
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(25:38):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
When the neck is involved, the pinwheel sensation
changes based on whether theirhead is in flexion or extension
or turn to the right or the left.
If that pinwheel sensationchanges, that's usually one of
my clues to say, okay, there'ssomething going on with the neck
that's interfering with thesensory integration of this
trigeminal nerve in the face andthe head nerve in the face and
(00:31):
the head.
Sophia Bouwens (00:31):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens and I'm herewith Dr Ayla Wolf and we will be
your guides to living your bestlife after impact.
Hi Ayla, how are you today?
Ayla Wolf (00:56):
I am good.
Somebody almost ran me off theroad on the way here.
Sophia Bouwens (01:00):
Oh my gosh, what happened?
Ayla Wolf (01:02):
I just pulled out of my driveway and obviously it
snowed last night and the roadhad not been plowed where I live
, and so there was a goodprobably four inches of snow on
the road, and this car wascoming towards me and they were
honestly speeding, given thatthere was four inches of snow on
the road, yikes and they werein the middle of the road and I
tried to get over as far as Icould and they still just like
(01:24):
would not make room for me, andso I had to literally like go
onto the shoulder of the road insnow, just so that they didn't
hit me head on people I didn'tknow, maybe their depth
perception's a little off that'sthe way night.
Sophia Bouwens (01:38):
Really nice of you to give them the benefit of
the doubt as a neurotherapist,like oh, there might be other
things going on.
Ayla Wolf (01:45):
Right, you know I hardly ever honk my horn, and
much less after a car hasalready passed you.
But I literally had a momentwhere I was like I feel like I
need to honk my horn in thissituation.
This person practically ran meoff the road in a snowstorm.
Sophia Bouwens (01:58):
After my world travels, being in countries
where they use like horn honkingas a discussion, like in Egypt,
they use horns as a way ofcommunicating on the street and
in Latin America they use themall the time.
I've gotten much more liberalwith horn using in America, so
I'm not always super shy.
I'm glad you did it, even if itwas after the fact.
(02:19):
Well, I'm excited for our topictoday on neck injuries as it
relates to brain injury, becauseit's really close to my heart
and my car accident.
When I was hit by that drunkdriver I don't remember any of
it, but I suspect my headbobbled quite a bit, hit the
steering wheel, which is why Ibroke my jaw on both sides.
I lost teeth and I think italso snapped back pretty hard,
(02:41):
which is how I broke myoccipital condyle, right where
your neck joins your head.
Ayla Wolf (02:46):
That is a serious collection of injuries.
Sophia Bouwens (02:48):
It was quite a mess but I think that in my own
recovery, paying really closeattention to my upper cervical
and my cervical proprioception,my cervical system, my neck in
particular, has been reallyhelpful, life-changing for me in
my recovery.
The brain injury component washuge, but also the neck injury
(03:12):
which drives a lot of symptoms.
And I find now in my recovery,10 years later, that if my neck
is off or out I notice andthat's my alarm to really go in
and take care of it.
I have to really prioritize myneck recovery.
So I'm excited to help ourlisteners understand how much
(03:32):
their neck can be playing intosymptoms and how it might be
missed or underemphasized.
Ayla Wolf (03:38):
Absolutely and in your recovery.
What are some of the therapiesthat you have found most
effective for you?
Sophia Bouwens (03:45):
My life-changing therapy has been Atlas
Orthogonal, which is a veryspecific adjustment to the upper
cervical C1 and C2 atlas andaxis.
I had manual adjustments of myatlas done by other
chiropractors who are great, butit did not do the same thing as
an upper cervical specificadjustment.
What I love about thisadjustment is it's very gentle
(04:07):
and very precise, but it hasbeen completely life-changing.
It gave me back my ability toswallow without choking.
It gives me a really nicerelief of anxiety and stress.
When that gets high because Inoticed that's one of my first
signs is like I get more anxiousabout things Like, oh, I wonder
if my atlas is out.
And that has been completelylife-changing.
(04:28):
I didn't believe it in thebeginning that it would be.
My friend was telling me aboutit that I should do it.
Finally I just bit the bulletand did it and it has been
amazing.
So that, in particular, I'mvery passionate about
Craniosacral, and acupuncture,of course, have been very
helpful as well.
Do you do craniosacral work inyour practice?
Ayla Wolf (04:57):
I do some of it and when I feel like people need a
lot more of it I tend to referout just because I don't have a
lot of the time to do the deepfocused you know hour long
sessions.
But I did.
I've studied it in a number ofdifferent ways through both the
Upledger Institute and then Idid some biodynamic craniosacral
training as well with ToddJackson out in Portland Oregon a
long time ago and I do find itto be very powerful.
(05:19):
I also because of yourintroduction to Atlas Orthogonal
.
I have found that to be helpfulfor me too, because I have a
what they call military neck.
I have completely lost thecervical curvature in my neck.
When you look at my x ray, it'spretty crazy.
It is just perfectly straightright, and what I have noticed
is that there are times inCrossFit where if I'm doing a
(05:42):
lot of overhead lifts, where I'mhaving to catch the barbell
above my head, you tend to landwith a bit of a forward head
posture and when I do thatrepetitively sometimes it throws
my neck out in a way where whenI try to swallow I literally
feel like I've got a vertebraejamming in the back of my neck
it's very yucky, scary feeling,and that's when I know I'm like,
(06:04):
okay, time to go to thechiropractor.
Sophia Bouwens (06:05):
Yes, a specific one, right Particular about that
.
Well, I think this is reallyimportant.
A lot of our neck injurysymptoms can mimic concussion
symptoms, which I think isoverlooked a lot by medical
providers and by patients notunderstanding fully that
connection.
So I would love to dive in justlike defining first what neck
(06:27):
injuries are I think it kind ofgoes hand in hand Many people
know but then some of thenuances about different types of
injuries, whether it's tensionor maybe a visual proprioceptive
components that are different,which is like where your head is
in space and how your eyes movewith it, and then joint
position sense.
There's a lot to dive intothere.
Ayla Wolf (06:47):
There's a ton and, I think, big picture.
It makes the most sense if westop thinking about the brain
and the neck as being twocompletely different things and
recognize that they areconstantly working together in
terms of all of our differentsensory systems, and so when we
start to look at it more from asensory integration lens, then a
(07:08):
lot of the therapies that aremost effective and most helpful
start to make more sense too.
I have come to pay much moreattention to a lot of the
research that talks about theimportance of neck strengthening
, especially for, like femalesoccer players, or just women in
general, tend to have longernecks, thinner necks and not as
much neck musculature.
Sophia Bouwens (07:30):
No, and in the PT world, where I work a lot
alongside of them, strengtheningcomponent is huge, but I think
that can't be undermined because, as you said, this study showed
that soccer players who didneck strengthening exercises had
less incidences of concussion.
Ayla Wolf (07:47):
Statistically, they were finding that the athletes
that did consistent neckstrengthening exercises ended up
not experiencing as manyconcussions.
So they were finding thatstrengthening the neck was a
preventative factor forconcussions in that sport.
And it makes perfect sense thatthe stronger your neck is, then
(08:08):
the less force you have interms of your head bobbing back
and forth, right If you canactually brace your neck muscles
.
I think that you know, when Ilook at some of these UFC
fighters that have a very longcareer in fighting, they've got
no neck right.
Like it's just literally a headand solid muscle right.
(08:28):
And so I was like, okay, likethese, these people with barely
no neck or incredible neck girth, right where it's just this
huge neck, that's all muscle.
That's actually a protectivefactor that's helping them to
have longevity in their sport,where they're getting punched in
the face repeatedly.
And so I think that, you know,the MMA world has really
(08:52):
acknowledged the importance ofneck strength and I think that,
especially with female sports,they've been a little slow to
catch up to that.
But I think that the awarenessis growing and that neck
strengthening is hopefullystarting to be a much more
regular thing within femalesports.
But so many of the patientsthat I work with were in car
accidents.
They're just average people,they're not athletes.
(09:13):
They were in bad car accidentswhere they had really bad
whiplash, like you just said.
I mean you were hit by a drunkdriver, your head slammed into
the steering wheel and backagain, possibly a couple of
times, with enough force tobreak your jaw in two places.
I mean that's a lot of traumato the ligaments in the neck,
the musculature you said youbroke the condyle in the back.
Sophia Bouwens (09:34):
Yes, I did.
That's a lot of trauma.
It is a lot, and that is enoughto drive a lot of the symptoms
that come after a head injury orconcussion as well, because the
brainstem comes out of thebrain and into the neck, so
that's where they're sointricately connected.
Those cranial nerves are thoseareas that feed all the sensory
(09:54):
information from our face andour face into our brain, make a
huge difference in how our brainoperates and how we interpret
the world, how we experience theworld and how we feel right
with our head in particular andthe rest of our body as well.
Ayla Wolf (10:11):
Yeah.
So I thought it would be a goodidea to talk about some of the
tests that we do that have alittle bit of a functional twist
on them that can tease out theintegration between some of
these different aspects between,say, headaches and neck trauma
or even eye movements in theneck, as a way of kind of
highlighting how we do things alittle bit differently to see
(10:36):
this connection.
And then, when you have a lotof different, what I call
biomarkers that you collectduring these functional exams,
those then help to check back inwith to say okay, I'm seeing
this thing in my exam.
If we then do a therapy, doesthis abnormal finding improve?
(10:56):
And the more biomarkers we cancollect, the more clues we get
to then say is our therapy theright therapy and is this person
actually getting better?
Sophia Bouwens (11:06):
Which is so important because oftentimes we
just give a broad spectrumtreatment and you get some
improvement because you're doinga little bit for some parts of
it.
But when you can tease outexactly what might be driving
what and how, then you canintervene more specifically and
possibly do less and get betteroutcomes.
Ayla Wolf (11:27):
Yeah, I mean, I well, this is kind of getting into
the weeds a little bit but I hadfound that with some of the
testing that I do, it actuallyguides me to say, oh, like, at
this point in time I should notdo acupuncture on the right side
of the neck based on this examfinding.
But I'm only going to doacupuncture on the left side of
the neck until these thingsequalize and then we can start
(11:50):
to.
You know, do both sides.
And so the clues have actuallyled me to perform very different
treatments as well, which Ithink has lent to some good
success and some good outcomes.
Sophia Bouwens (12:02):
So let's dive in yeah, let's dive into some of
the symptoms that can come fromneck trauma.
Ayla Wolf (12:08):
Yeah.
So first of all, I think one ofthe most common ones is
probably dizziness, or what wenow call cervicogenic dizziness,
which is dizziness as a resultof trauma to the neck or
something wrong with the neck,some kind of neck pathology.
Sophia Bouwens (12:25):
And why and how can that come up?
Because I don't think of theneck as being something that
drives dizziness.
You think of the head or thevestibular system.
Ayla Wolf (12:30):
Yeah, it all comes down to receptors.
So we've got different receptorsin the skin of the neck, the
muscles of the neck, the jointsin the neck and sometimes those
receptors.
If they're not functioningcorrectly, they can actually be
sending the wrong signal to thebrain in terms of how the neck
is positioned or how fast or howfar it's turning, where the
(13:06):
brain is constantly takinginformation from our visual
system, our eyes and what the,what we're seeing in the world,
as well as from our inner earand the signals from our
vestibular system in the innerear.
And then it's takinginformation from those receptors
in the neck and it's saying areall of these systems telling me
the same information?
And if they're not, becausemaybe the receptors in the neck
are giving the brain the wronginformation, and if they're not,
because maybe the receptors inthe neck are giving the brain
the wrong information because oftrauma, then all of a sudden
(13:28):
there's a sensory mismatch andthe brain is saying wait a
minute.
I'm getting two sets of datathat don't add up and now I'm
not quite sure where I am inspace and if I can trust my
balance.
Sophia Bouwens (13:40):
And that's super stressful for our system.
So we can get a lot of anxietyor other symptoms like
dysautonomia that can drive that, as well as dizziness, and the
neck locks down the muscles tocontrol one of the systems too.
So we can have a lot of necktension and neck tightness
because the brain or thebrainstem almost says this is
how I interpret it almost sayslike we can't always trust this,
(14:03):
so we're just going to controlit, lock it down, make it tight.
Ayla Wolf (14:07):
Yeah, if it's not really trusting the information
that is, this unconsciousresponse is to say let's just
shut down our neck movement asmuch as possible by tightening
all these muscles.
Or, in a sense, by tighteningup the muscles you're trying to
like the brain's almost tryingto like upregulate the
information coming from thosemuscles and by tightening them
down.
And so that's where I thinkthat when the brain is having
(14:30):
these unconscious responses thatare causing the neck tension
and they've had whiplash, and sothen they're going to get
massage therapy.
I think in some cases this iswhy people say well, I go, I get
the massage done and I feelgood for an hour or two after,
but then everything tightens upright away.
(14:51):
And so whenever I have apatient come in, I always ask
them about what therapiesthey're doing and how long of a
relief they get.
And if they're telling me that,you know they do something,
whether it's massage,acupuncture, a chiropractic
adjustment and then they're likeI feel good for a couple hours
or maybe a day, but theneverything tightens up again.
(15:11):
Usually, the things that havebeen missed in that equation are
the role of the eyes and thevisual system and eye movements,
in addition to, maybe, theinstability coming from the neck
or something going on with thevestibular system and so usually
this integration of senses.
If not, if these sensorymismatches are not cleaned up,
(15:34):
that's often a scenario wherepeople are not getting good
relief from what should be, youknow, some very great hands on
therapies that otherwise peoplewould would get really solid
relief from.
Sophia Bouwens (15:45):
And one thing not to make it any more
complicated is we're not talkingabout yet is the jaw, how the
mouth can play a big role inthat too.
So neck tension or jaw tension,clenching the teeth or having
that, can also make a big impacton balance would make a big
(16:06):
impact on balance.
Ayla Wolf (16:06):
Yeah, and one of the tests that I like to do is I
always grab my pinwheel and Itest the three different
branches of the trigeminal nerveon the face.
And I asked the patient, youknow, does this pinwheel, which
is supposed to mimic pain bybeing just kind of sharp and
pokey, but in a controlledmanner?
So I'm asking the patient, youknow, does this pinwheel
sensation feel about the same onthe left side of the forehead
(16:28):
compared to the right side, orthe right side of the cheek
compared to the left cheek orthe jaw right?
So we're doing these threeareas of the face and comparing
right to left and a lot of timesit people might say, well, yeah
, it feels equal when their headis neutral.
But then you have them turntheir head and you do the same
(16:49):
test and all of a suddensomething feels sharper right.
Or you have them open their jawand all of a sudden, maybe what
once felt sharp now actuallydoesn't feel sharp.
And so you can sometimes seethat when the neck is involved,
the pinwheel sensation changesbased on whether their head is
inflection or extension, or turnto the right or the left.
(17:11):
If that pinwheel sensationchanges.
That's usually one of my cluesto say, okay, there's something
going on with the neck that'sinterfering with the sensory
integration of this trigeminalnerve in the face and the head,
because anatomically youshouldn't really see a change in
the trigeminal nerve in theface and the head, because
anatomically you shouldn'treally see a change in the
trigeminal nerve based on headposition, and so what we're
(17:31):
really testing is more of thesensory integration at a, you
know, central nervous systemlevel.
Right, how is this informationbeing interpreted?
Diving deeper, yeah.
And with the jaw, you know ifpeople have a lot of jaw tension
, what initially clued me intothe importance of that was a
paper that was looking atbalance in people that had
(17:54):
whiplash injuries and they wereputting in an intra they call it
intraoral dental appliance.
So they were having people wearsome kind of mouth guard that
was customized to eachindividual.
It wasn't just they popped thesame one in everybody right.
So this was like individualizeddental appliance that people
were then wearing and they werehaving them stand on a balance
(18:19):
plate can give a very high levelinterpretation of how much
somebody is swaying when they'rebalancing by measuring changes
in their weight, shifting intheir feet, and so they could
measure the degree of sway assomebody was trying to balance
with their eyes closed on thisbalance plate, and then they
(18:40):
would pop the intraoral dentalappliance in and like, boom,
there was an immediateimprovement in their balance.
And so it got me wondering, assomebody that practices
acupuncture well, it's like Iknow that acupuncture is great
for TMJ dysfunction and for jawpain.
Sophia Bouwens (18:57):
And I yeah.
Ayla Wolf (18:58):
I mean, I treat jaw pain all the time.
But then I started to wonder,well, what happens if I have
somebody with poor balance andI'm doing assessments on their
jaw?
And I'm to wonder, well, whathappens if I have somebody with
poor balance and I'm doingassessments on their jaw and I'm
seeing that, oh, they have alot of jaw tension.
This pinwheel sensation ischanging based on whether their
jaws open or closed.
And then I started to doacupuncture in points on the jaw
(19:20):
and different muscles that weuse for chewing, knowing that
those muscles have anintegration into the midbrain
and then this very specificpathway into the cerebellum.
That then is involved inbalance and maintaining balance.
And so I was having people docomputerized balance testing and
then I'd get their score andthen I'd put the needles in and
(19:43):
then, with the acupunctureneedles still in their jaw, I'd
have them do the same balancetest and I'd put the needles in,
and then, with the acupunctureneedles still in their jaw, I'd
have them do the same balancetest and I'd find that their
balance immediately improvedwith these needles in their jaw.
Wow.
And so I was saying, okay, well, you know, this could be a cool
party trick if it's onlysomething that once you take the
needles out, then their balance, you know, gets worse
immediately.
(20:03):
But so that's why you knowagain, I'm not into party tricks
or magic, I'm trying to makelasting changes for people.
But what I found was that whenwe would, you know, do several
different treatments withneedles in their jaw and work on
their neck, that over time,indeed, these people's balance
were consistently improving overtime.
Sophia Bouwens (20:23):
Good.
So what do you think are someof the things that people might
not suspect are symptoms fromtheir neck?
Ayla Wolf (20:29):
Well, there is research looking at neck trauma
that says that people canactually have changes in their
vision in terms of blurry visionand changes in depth perception
from neck injuries, and I thinkthat most people might not make
that leap to say that ifthey're having blurry vision
it's because of trauma to theirneck.
So those are two that I thinkare kind of important to
(20:51):
highlight is that actual visionchanges can even arise from neck
trauma from neck alone, so notthe optometrist might not be
helpful or as helpful.
Well, I think that's where I'veheard a lot of people go in.
They say you know, I'm havingsome of this blurry vision or
these vision symptoms after myconcussion, and I went to my eye
doctor and they tested myvisual acuity and they said that
(21:14):
it's normal.
And so I think what's happeningin a lot of cases is that people
are only having one small partof an eye exam performed, which
is visual acuity, but what isn'tbeing fully assessed is these,
this broad range of differenteye movements, and so I think
that what again might be gettingmissed is that if people's eye
(21:36):
movements are not being fullyassessed, then eye movement
disorders are getting missed andthe association between how
those eye movement disordersaffect the neck are then also
getting missed.
And so, for example, if somebodyhas an ocular misalignment
where, say, their left eyebecomes positioned more outward
(21:57):
or like laterally deviated, theymight unconsciously want to
turn their head to the right totry to like bring the world back
into alignment.
And so sometimes you can havesomebody walk into your clinic
with a constant head tilt to theright, which would then, of
course, throw off the muscles inthe neck and cause chronic neck
pain plane where, if one eye ispositioned higher, somebody
(22:26):
might tilt their ear towardstheir shoulder to try, to you
know, unconsciously bring theworld into an even horizontal
plane and not even realizethey're doing it.
And so if somebody's walkingaround with either their head,
you know, turned one way ortilted one way, that's going to
cause a lot of chronic neck pain.
And if the eye alignment issueis not getting identified and
(22:47):
corrected, then that just setspeople up for chronic neck
issues.
Sophia Bouwens (22:51):
So for that kind of therapy you might intervene
with eye movement exercises orvisual components.
Neuro-optometrists oroccupational therapists who are
well-versed in eye movements,who would you think would be
some of the go-to therapists tolook for that?
Ayla Wolf (23:05):
I think it's really important that people do find
some kind of eye doctor whospecializes in concussions and
brain injuries, whether that's aneuro-ophthalmologist or
neuro-optometrist or just anoptometrist who's done
additional training and has moreexperience analyzing different
eye positions, eye movementseven within eye movement
(23:28):
disorders and kind of thisocular motor system.
I would say there's a bit of aargument, ongoing argument, over
what does it make sense to justimmediately put somebody in
prism glasses to correct amisalignment of the eyes versus
having them do vision therapy?
And for me and you know the wayI've approached medicine my
(23:52):
whole life is, even if thevision therapy is more work and
more time and more money, itmakes more sense to do that
versus giving somebody a bandaidthat corrects their vision for
them and then allows thosemuscle, the muscular imbalance
or the misalignment to remain.
And so vision therapy.
(24:13):
But again, it takes time, ittakes money, it takes commitment
, and so I think that you knowmy preference would be for
patients to do the visiontherapy and see if they can
correct their misalignments ofthe eyes through actual
exercises versus just wearingprisms.
But I also recognize that thereare times when there may be
(24:34):
other things going on that needto be addressed first and so
like for you I mean, if you haveall these broken bones and
broken jaw and you know youmight need to be like doing
other things that takeprecedence over vision therapy,
right?
Sophia Bouwens (24:48):
Right out of the gate.
Make sure I can walk and dressmyself.
Ayla Wolf (24:51):
Right, exactly, yeah, let's make sure you can walk,
talk and dress yourself and eatbefore you know, throwing you
into eye exercises.
Sophia Bouwens (24:58):
Sure, but then once you get that correction
with the visual system, a lot ofthings can get cleaned up too.
So it's a balance kind offinding the pathway forward.
Having someone who'swell-versed in those kinds of
things and helping with that canmake a big difference for
recovery.
Ayla Wolf (25:18):
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(25:38):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
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