EPISODE SUMMARY
Guest: Dr. Al Cobb
Dr. Al Cobb is a board-certified Blair Upper Cervical Chiropractor. His background is in sports. Playing football as a quarterback and playing soccer, he sustained multiple concussions. His personal and professional perspective on concussions and post-concussion syndrome gives him a unique perspective to speak to these prevalent issues.
We can sustain concussions throughout our whole life.
You don't have to be struck in the head to sustain a concussion.
What is a traumatic brain injury (TBI)?
What are some of the symptoms of post-concussion syndrome?
Preventing concussions.
Scheduling routine checkups for children and youth who play sports to prevent long term damage.
What to do if you have a concussion.
How to get ahead of the symptoms in order to shorten and minimize the symptoms.
Why the neck always gets injured when there is a brain injury, the consequences of an unresolved neck-injury to the symptoms in the brain, and how to fix it.
Using food as medicine for the brain.
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E-mail: drcobb@blairclinic.com
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TRANSCRIPT
Welcome, welcome, welcome to what pain in the neck. I'm Ruth Elder, your host. And in this podcast episode, I'm so pleased to invite back my good friend now, Dr. Al Cobb.
Welcome. Thank you. Thanks for having me. I'm excited to talk.
Yeah. So if you want to go back and find out who Dr. Cobb is, go back and listen to the episode from April 12th.
That show was all about his background, who he is, why he is an upper cervical doctor, and how he got to be here at the Blair clinic. Dr. Cobb, you are an upper cervical Blair chiropractor here at the Blair Chiropractic Clinic. Recently, you gave a fantastic lecture on everything concussion.
Yeah, I tried to scratch the surface.
Yes. Obviously, in an episode like this, we can only cover so much, but let's try to hit the important points. There's a lot of focus on concussion and post-concussion syndrome. And yet there are so many people who are still suffering and not finding the solutions you need. You yourself have suffered multiple concussions. Is that right?
That's right.
So how did that happen?
So I grew up playing football among a bunch of other sports, but football was the one that really stuck with me. It's where I found my most passion and probably my most giftedness. And so I played quarterback, and obviously, everybody loves to hit the quarterback as much as they can. So, unfortunately, I was on the back end of some of those hits. But, I did find myself trying to lead with my head a whole lot. When I got tackled, sometimes my head would hit the ground. So, there's a lot of implications, and that's where my story with concussions really started.
So that's where your passion for understanding and treating and teaching about this topic comes from.
Absolutely.
Football is the obvious one that we hear about. But what about people like me? Do you have to play football to have a concussion?
No, you don't, actually. I mean, we can sustain concussions throughout our whole entire life. And one of the interesting things that I started to see when I did the research was that you don't have to be even struck in the head to gain a concussion, or to sustain a concussion.
Whoa, so how does that work?
A lot of times, it's really just a force that enters the body that can jar the neck or the head enough. So if I fell, or if I was in a car accident, I don't actually have to hit my head on something. The force that is created in a whiplash type of forward and back movement with the head can actually jar the nervous tissue and the muscles and the ligaments enough to create a concussion.
So it has more to do with rattling the brain inside the skull, is that correct?
That's correct.
How would I know if I had a concussion or not?
So we try to distinguish what we call a traumatic brain injury, a TBI, and that's something that you need an emergency evaluation for. You need to go to the emergency room. So if you are struck in the head, neck, or anywhere in the body that causes you to lose consciousness. You need to go to the emergency room and/or call an ambulance to come pick you up. And outside of that, we will find lingering symptoms, whether it be a headache, confusion, inability to recall memory. You can see yourself foggy-brained, really irritable when you're not irritable. You can find yourself having trouble sleeping and just that chronic neck pain as well. A lot of the -, and dizziness, we see a lot of those types of things. And unfortunately, those are a lot of symptoms for a bunch of other things. So we can go through life and we can have concussions and not even really know that we're -, the main thing we're struggling with is post-concussion syndrome.
So you mentioned if you get struck in the head or you pass out, do you have to pass out? Like that's how you know you have a concussion, you pass out. That's how you know?
Oh no.
So how do you know if you have a concussion?
You would experience a lot of those same symptoms. A lot of times if you're stuck enough, you'll, what they say, see stars. “I'm seeing stars right now.” What you'd see in like Looney Tunes or something like that or Tom and Jerry. That type of idea.
Unfortunately, I have had a couple of those myself.
Absolutely, I have too. And I've, and I only have had one diagnosed concussion. So, I've had tons of small concussions that compiled over time. But I had one that really took me out of the game. And I would argue that I, those other ones should have taken me out of the game too. I just didn't want to stop. But you would experience, like I said, that neck pain, headache. Confusion, some nausea could be very common as well, dizziness, brain fog, change in your mood.
So if I'm experiencing some of those, what do I do? Or maybe let's say I'm a parent, which I am, let's say one of my kids are experiencing some of those. Or someone I am close to, or maybe I'm a coach or a teacher or something like that. What should I do?
So what we like to do is we think of it in two terms, pretty much immediate care, and then long term chronic or subacute type of care. What we like to classify, either it just happened within the last week or two weeks, or it's happened four weeks or longer. And it can even be -, we see patients that come in with concussions that happened a year ago and they're still struggling with some of these symptoms.
Or 20 years ago.
20 years ago, for sure.
Or 40 years ago.
Absolutely.
Yeah, so I think the reason we're having this, this conversation is concussions can have lifelong consequences. Unless you fix it. So what are some of the keys to fixing it? Because it doesn't have to be lifelong, right?
So let's talk about, first of all, when you think you have a concussion or you definitely have a diagnosed concussion by an athletic trainer, by a physical therapist, by an MD, or by someone like me in the office. The first thing you want to do, and I think a lot of times we're not really informed on the best steps, because people have told us our whole lives as athletes, or as just lay people, if you have a concussion, just don't do anything. Don't look at the screens, don't go outside, don't exercise. And I think there's a lot of truth to that, but what I'm seeing more and more in the research is that you don't want to rest too long. So immediately after your concussion, they say about 48 hours, about 2 days, is the amount of time max that you want to spend doing absolutely nothing. Obviously, if your symptoms are extremely bad, you may be monitored more closely. But if that's the case, you're probably in a hospital setting anyways. So I'm talking more about what we call mild traumatic brain injury, MTBI, or what we would also call concussion. So immediately you want to rest for about two days and then slowly over time, over the first several weeks, you want to start walking and start progressively giving your brain some useful information because the brain thrives on information or activity.
So what is useful information?
Moving your joints. Increasing your heart rate just a little bit and making sure that you're getting just a little bit of cardio
So a little movement.
A little movement, that’s right.
At what point do we need to see a doctor?
You would need to see a doctor. Like I said immediately if you pass out or more than several minutes, especially if it's longer than that.
Yeah, but if you didn't pass out or you're not sure it's like Let's say you took a spill. You fell but you didn't hurt your head. You didn't hit your head but you're feeling unwell, you have a headache, maybe you saw some bursts of stars, and you're not sleeping, you're grumpy, it's like something's definitely wrong, but you're not sure what to put your finger on it. How long is it -, is it safe to wait, should I just call you immediately?
Oh, yeah, absolutely. I think you should. If you're experiencing any of those symptoms that are on that list you just put out.
“But I thought it would go away!”
Exactly. And maybe it will. But I don't think that the rest and let it fade away is the best-case scenario nowadays. We're just continually bombarded with traumas in our life. You want to get ahead of that immediately, as soon as you can. If you're having any of those symptoms, you don't want to wait until it's four months, or a year, or ten years down the road.
So, good advice. Like, you really only have one brain, and we'll get into some of the consequences of having an unresolved, long-term, post-concussion syndrome and some of the consequences of that. That is later, a little bit later. Let's say I call you and I've never been to a chiropractor before. And I'm a little bit nervous about it. What does your process look like?
Our process here in the office is we start out with about a 30-minute appointment just to explore options to see is what we provide here in the office, which is specific and really gentle upper cervical care. Is that going to be beneficial for you? Or do we need to send you somewhere else for more treatment, more care? But likely the case is, if you've had a concussion, we already know, and we've talked about this offline, we already know that the amount of force that needs to be created to sustain a concussion, which is about 85 Gs of force and higher.
That's a lot.
That's a lot. I mean, it takes a whole lot.
To injure the brain?
Relatively. And then, we know that it takes anywhere 4 to 5 G's to injure something in the neck. Injure some of the ligaments in the neck. We can already assume if you've had a concussion or some type of whiplash injury, you really, really, really need to be seen by a chiropractor specifically an upper cervical chiropractor because that's all that we do is deal with the neck and we're gentle and we're specific and we're gonna take a really really good history.
So what you're saying is if you have injured the head you have for sure injured the neck.
It's very likely.
And if it's likely that you've injured the neck, go to see someone who specializes in the neck.
Exactly.
Yeah.
Common sense.
Common sense. Right.
Yes. If you chip a tooth, you call a dentist. If you injure the neck, you call a cervical doctor.
Right. Exactly.
So, you determined this person, “yeah, you definitely had a concussion, and you also injured the neck.” Where do you go from there? If I come to see you as my doctor?
The biggest thing is, we're going to want to see what's going on with the neck. Especially if there is some mechanism of injury that actually happened to the neck. We want to make sure that nothing is fractured. We want to make sure that the ligaments aren't injured enough to where the bones are moving more than they normally would.
Yeah, when you say see, “we want to see what's going on with the neck.” You literally mean look at it.
We want to see it on an x-ray and here in the office. We have maybe the only one in Texas, definitely the only one in Lubbock -
We're not the only one in Texas. I think there's two or three other chiropractors that may have that in Texas, but we're the only one in West Texas.
Right, we take a 3D x-ray called a cone beam CT. You'll pretty much see it in dentist's office because they like to look at the 3D models of the teeth and of the mouth. But we utilize it for the neck as well.
And head too, right?
The head and neck. Yes. And we like to visualize that because it's all that we're working with. And we don't want to put our hands on something that we haven't seen yet. And also some general advice that I would give to anybody with post-concussion syndrome is you want to decrease the inflammation in the brain, really in the whole body. And therefore the brain. And you want to do that by controlling the food and drinks that you take in. So you want to eat a whole food diet. I think Kerry Thuett just talked about that recently.
Yeah, last week!
Taking care of your health, taking care of your body, with an anti-inflammatory type of diet. And that's going to be free of refined sugars and starches like gluten, corn, dairy, soy. Those things are generally inflammatory for people.
Yeah. Okay. So the way I like to look at it, I agree that those things are best to stay away from, but it can be really overwhelming. Like what can I eat? So personally, I like to focus on what can I eat? So lots of protein, right? So that's eggs, chicken, black beans, things like that.
And particularly fish, especially salmon, because it'd be really high and omega 3 fatty acids, which are really helpful for the brain in this time of inflammation.
Yeah, so those are really good. And then also lots of berries, right?
Yeah, absolutely.
So instead of eating the refined sugars and say, ice cream, have some frozen berries.
That's exactly right.
So if you focus on eating lots of fresh things, that will help you. Absolutely. Okay, I interrupted you. What else?
Oh, you're fine. And a couple other things that could be helpful too that I continue to see in the research are things like magnesium. Magnesium is, is a nutrient that, that we need to get it through our food. And one of the most available forms of it is what we call Magnesium L-Threonate. You can find that online. You want to get a good source. But it's extremely important for the health of the cells and the tissues. I've seen a lot of really good research as well on creatine, which is mainly, something that's been really popular for the last 20 years in...
Bodybuilding.
Bodybuilding. But what we've seen now is just the amount of energy that it gives all of the cells and the muscles is outstanding. And one of the first things that happens if you have a concussion is the little cells in your brain, we call them neurons, they go into pretty much cell death, because they're excreting a bunch of energy, and the brain is trying to, for lack of a better term, clean itself up. And that's why there's inflammation in the brain. And when there's inflammation, the first thing we try to do is clean it all up. And so, the mitochondria, which is a small cell inside of those cells, it gives it energy. If you remember the biology classes, the mitochondria is the powerhouse of the cell. It does that, and it needs more and more energy in those states of concussion. I think that's a lot of time why we feel really lazy or really sleepy because we just don't have the energy that we need. And that creatine gives those specific cells the energy that it needs.
Yeah, so, whole food, fresh food, Magnesium. Creatine.
Creatine. And I'll, and I'll say creatine monohydrate.
Don't go to Walmart and buy like the fruit version of creatine from the supplement section. You want to find a good one that says creatine monohydrate. And then, I mentioned this already, like I said, some of the other really good things are Omega 3 fatty acids. DHA and EPA. You wanna have both of those in those.
So that would be fish oils, right?
Fish oils, pretty much. And those are really, really good for the brain in general.
You can get those in supplements or like you said, you can eat salmon, or cod.
Sardines.
Sardines. I love sardines.
Me too. They don't always smell the greatest, but.
We keep sardines on hand here at the clinic.
Oh, we sure do.
Let's see. What have we missed? Is there anything else that you feel like everyone needs to know about concussion?
I think the biggest thing is getting informed on it. You want to be informed as best you can. And I've had a lot of conversations with parents who have their kids in youth sports right now, even soccer. Soccer is more dangerous when it comes to head concussions than what we see in football or hockey.
Really?
If you look at the stats, maybe it's because more people play soccer worldwide, but more people who play soccer, get concussions, and they head the ball at really, really high speeds. And that's how I got my last, what I think was a concussion, about two weeks before my panic attack. And so there's this really interesting interplay between concussions and things like anxiety, panic attacks, because it really is just signs of a brain and a body that's on fire.
Yeah, so actually, on that note, here at the Blair Clinic, I think it's standard across all upper cervical chiropractors. If you have a child that's involved in sports, just have your child get checked every six months, just to be on the safe side, just like you do, go and check the teeth and the growth curve and all of that, go and get the neck checked out. And here at the Blair Clinic, we do that at no charge.
Yep. If you're under the age of 18, I guess 18 and younger, we'll check you for free. We want to just provide that service to make sure as we're growing and adapting, as long as we don't have to do anything, we'll do it for free. Because we want to make sure that our kids are growing as healthily as possible.
Because catching it early is really key to avoid long-term damage. Talk to us before we close a little bit about the long-term consequences of not treating a concussion. Like, this is kind of the scare you section, but nevertheless, here's a case of what you don't know really can hurt you. So by knowing this, you can actually avoid some of the long-term effects.
Exactly. There are a couple of really interesting correlations that we see. Not that it's completely a causal effect, but there's some really important things that we need to take care of.
And when you say 100 percent causal effect, part of that is it's early days when it comes to research, right? There's lots of people researching this, but research can take 10 to 20 years sometimes.
Exactly. So one of the things that we see is chronic neck pain, chronic migraines Some nerve conditions in the neck. And a lot of times they come from car accidents or years playing sports. A lot of times there are a lot of upper cervical chiropractors, particularly in the Blair community, the Blair upper cervical community that we practice, who have been affected by concussions and they were desperate, they were depressed and they were ready to take their own life. And they didn't know anything about the care that chiropractic could provide them in recovering recovering. and getting their life back. So, those are some of the scarier sides. And then you can also look at some research that's starting to be done. There is a group that released a paper in the Annals of Neurology in 2017, and they started to see that there is some correlation in the data between multiple sclerosis and concussions in teens. They saw that if a teenager sustained a concussion, They had a 22 percent chance of gaining eventually a multiple sclerosis diagnosis. And I think they did that by seeing, - they saw people who had multiple sclerosis and backtracked they had ever had a concussion. So it's not one for one cause, but it's pointing to some data. And it's pointing to some stuff that we've seen as well. When there's trauma to the neck, it can cause that inflammation in the brain. And if that inflammation in the brain continues to stay stagnant or chronic or low grade in the background paired with problems in the neck that aren't allowing the blood and the spinal fluid that the brain floats in and cleans itself with, we see that that stagnation can be the cause of some plaques and some dysfunction in the actual brain, so we've seen and started to theorize that an upper cervical misalignment, stuff that we see every day, can actually stagnate some of that fluid in the brain, and when it stagnates or stays right there, it doesn't allow all of the waste to go out of the brain that the brain just uses all day. And that's where some of that plaque can start to build up. It's just theorized at the moment, but it could be something that we see even more and more in the research.
Yeah. And we do know that there are smart doctors who are devoting themselves to doing that research.
Absolutely.
So stay tuned for that.
Absolutely.
And in the meantime, if you suspect that you've had one of those injuries, or you're not sure, give me a call. We'll have the information in the show notes, but what I love to do is direct suffering people to the right kind of help. And you don't have to be here in Lubbock, Texas to get help. We have a whole network of neck specialists all through the country and a little tiny bit starting around the world. So if you've had a concussion for a long time, give me a call and we'll see if we can find a solution for you.
Yeah, especially if you've been dealing with those low-grade migraines, dizziness, trouble sleeping, chronic neck pain or migraines or headaches of the sort, and you've had some type of trauma in the past, it's likely that this is your issue. And it's very likely that we can help you or someone we know can help you.
Yeah. And it can make a huge differenceWe've seen lots of people really get their life back. I'm one. And, you know, some people can get better really quickly and it's almost like all of that pain and fog, it just drains away, for other people is more of a slow and gradual process.
Exactly.
Is there anything that you feel like you need to share that I haven't asked you about?
I don't think so. I think we've pretty much hit all the basics. I would love to continue to provide information to the general public, so if you are a parent or a coach on a sports team, and you want me to come and give a talk, I'll do it free of charge. I just want to provide that so that our youth, and so that our college students can be as safe and prepared as they possibly could.
Yeah. Okay, great. So, if you want to book Dr. Cobb as a teacher, a lecture on practical things on what to do with post-concussion, whether it's for kids. Or for adults, for your, - let's say your, maybe your Rotary Club or, maybe your employees, give me a call and I'll set you up. I'm in charge of booking here at the Blair Clinic. And also you have created a resource. So there's an email in the show notes, just say concussion resource sheet and we will send that to you.
Perfect. Yeah, that would be awesome. I'd love to share that.
Great. Thank you so much for your time today. Dr. Cobb.
Thank you for having me on.