Sub-Concussive Forces & Upper Cervical Injury (Part 2): Safe Correction & Sideline Decision-Making

In Part 1 of this ICA Sports & Fitness Science Council podcast series, Dr. Brant Hulsebus and Dr. Kevin Jackson established how sub-concussive forces can be identified on the sideline using objective, real-time assessment.

Part 2 takes the next critical step: what happens AFTER sub-concussive upper cervical injury is identified.

In this episode, Dr. Jackson explains his conservative, science-based approach to safely correcting upper cervical dysfunction on the sideline and how chiropractors should make responsible return-to-play decisions in high-pressure environments.

This conversation focuses on precision, safety, and decision-making—not aggressive techniques or guesswork.

In this episode, you’ll learn:
• What chiropractors should and should NOT do on the sideline  
• Why upper cervical correction must be gentle, specific, and defensible  
• How instrument-based correction reduces risk and improves acceptance  
• Common biomechanical patterns seen after sub-concussive impacts  
• Why immediate correction may matter more than waiting until the clinic  
• How objective post-testing confirms neurological improvement  
• When an athlete must be removed from play—no debate  
• How calm, data-driven care builds trust with parents and coaches  

This episode is essential for chiropractors working with contact and collision sports who want to operate responsibly, protect athletes, and elevate the profession.

🎧 If you haven’t listened to Part 1, we strongly recommend starting there to understand the assessment framework before diving into correction and sideline decision-making.

Presented by the International Chiropractic Association (ICA) and the ICA Sports & Fitness Science Council.

Transcript

0:06

welcome to another edition of the ICA Sports and Fitness Science Podcast. Like Chirocast, the ICA Chiro Cast. This is the one that's about the Sports and Fitness Council. There's lots of different topics in Chirocast, but I wanted to let you know which one you're listening to. I'm Dr. Brant Hulsebus chiropractor here from Rockford, Illinois, and I'm on the board of the ICA Sports and Fitness Science Council, and I'm joined by my good friend Dr. Kevin Jackson, who's also a board member Out of York, Pennsylvania. You want to say hello again? Hello, and thank you for having me again, Brant. Well, we dove into a topic that's really on the front runner of everything going on with chiropractic and sports. Everyone's talking about head injuries and I know that you've always talked about concussions are a big deal, but so concussive stuff is really stuff that's right up the chiropractor's alley and not being noticed. So I would invite you, if you're just tuning in to this podcast to go back and listen to the previous podcast. We talked about some concussive injuries versus concussions. We talked about sideline evaluations. How do you, if you're at the sporting event, if you're at a little league baseball game and you suspect someone has concussive injury, how do you go about assessing them? Did I leave anything out that we covered last time? Nope. I think that's it. Okay, so we, we ended last time right before Dr. Jackson was gonna tell us about how he goes about now. Looking at this ad now, we found the subluxation, we did our sideline evaluation. Now we want to do a chiropractic adjustment. And we talked a, we wanna talk a little bit about what we don't wanna do on the sideline for someone we've never seen before, and what we do wanna do on the sideline for someone we've never seen before. And, so why don't you go ahead and walk us through. You've done your, you've done your analysis, you found out this person has a injury to their upper cervical spine, and now you wanna help them. Okay. So just to backtrack a little bit, run a sideline., It's football. Could be any, any game. Could be rugby, could be soccer. Okay. And so we have a situation that arose and you wanna do a quick assessment. So in the. technique. Essentially what we're gonna do, the first thing is we're gonna see if there's any neurological interference. We don't really have the ability on a sideline to do a, tron scan up the back of the spine, but we do have the ability to have a portable thermo, thermo, thermometer because we do do thermography as well. So I tripped over my tongue there a little bit, but a, a portable thermometer, infrared, and hopefully it's a really, really good one. There's ones that, , I recommend are usually by Exergen. They're up to a thousand dollars or so, but they, they're really, really accurate and they have a new, a numeric display on them. So we're gonna check the left side. Versus the right side. And we're gonna see is there any need, is there a physiological difference between a left and the right? Is there a, is there a need for an adjustment? And that's the big thing at first. And, and, and before, just to, to set the stage a little bit, if you're in that situation where you're on a sideline, hopefully you would've had a chance to have all the paper signed. For informed consent. Consent. And hopefully you would have. Let everybody know exactly what you are doing there. You are a chiropractor, so you're not really doing physical therapy, you're not doing, , injury care. You're gonna do chiropractic care. In this case, it's gonna be upper cervical care and they're gonna be upper, assessing the cranial cervical junction. So once you establish that someone was in an impact and they wanna get checked, and, knowing that there's all the eyes of the, all these spectators on you, and the parents and the coaches and the other kids., What I really like about this technique is that it's gentle, it's precise, and it's using an instrument. If there's no electricity available, it's gonna be an activator that you can use. If you do have, you know, power available to you and you have a little station, let's say on the sidelines, you can use your ortho stem or an electronic type device. So essentially what you do is you go through the ranges of motion. I'm just gonna go over that real quick. let's say there was a deficit between the left and right and you establish that, hey, there is, there is heat, more heat on one side versus the other. We're gonna put them through a really quick range of motion analysis and if you're working with kids, you're gonna have to lead them through the whole thing. The first one to access, the occiput is gonna be just extension as far as you can possibly go and inflection as far as you can possibly go. If there's any biomechanical,, interference, you're gonna either have stiffness when you go back or stiffness when you go forward. And what happens is what, what, what the, , biomechanics that are, are most affected by extension. Reflection is gonna be the occiput is rocking backwards on the atlas, or is rocking forward or into flexion on the atlas. But if there is stiffness in that area, if it's in extension, you're gonna adjust the extension. And if it's into flexion, you're gonna adjust the ox, but into flexion. Okay. And the protocol for that is this is if, let's say you establish that there is a, a stiffness in extension, you're gonna adjust, at. T one C five and all into extension. And if it is into flexion, you're gonna adjust it C one, C five, and all into flexion. And if you want more details on the on that, you'd have to take a look at my website and we can give it to you at the end of the podcast. If that didn't work, let's say you went ahead and you did extension and, , they were stuck in extension. You, you went ahead and adjusted them into extension and it didn't clear, then you would move down to Atlas. because the primary mover into extension reflection is gonna be the occiput, the secondary's gonna be the atlas. And let's just say for sake of. today that you're stuck in extension, the person goes put their head back and it's really kind of stiff going back then what you would do is you would contact the site of laterality of, of, the atlas and you would rotate or torque into extension. the hope is, is that once you torque and you did the laterality on that one side, that would take care of Atlas. There's a lot of discussion of why and how that needs to be, but that's just how easy it can be. That a, that a kid comes off and they're, they're stuck in extension. You go ahead and you adjust them into extension with the atlas and it clears out, and then you do a post-test with the Atlas facet testing and it was clear. But what we just gave an example of is a, is a clear biomechanical restriction and a clear neurological dysfunction. And that's important for patients to know. There's so much that needs to be learned to communicate that. But let's say you were successful at communicating to, the player themselves, the coaches and the parents. You would have yourself quite an accomplishment if you could acco, if you could do that a lot better than, let's say you laid a patient down and you did a double rotary break after palpating them and someone fainted in the crowd, someone got turned off and they left. Someone started yelling at you from the crowd. But basically what is, if you set the stage as to what chiropractic is and what chiropractic isn't. a subluxation or a sub-concussive impact is and what it isn't, what a neurological assessment is and what it isn't, and what a biomechanical adjustment is and what it isn't. Then you got yourself some good, good stuff going on. I, I found this and I still have it today, and I haven't taken care of the little league football team for two years. I still have just last week, just on Friday. I had three people that came in just from that football team and one, one, both. Both. I had two parents and the, the children wasn't even there and the other one was a child who did come in and, is still under care from that. But if you can educate what it is that the cranial cervical junction is. What it does and how important it is as far as athletic performance is concerned, academic performance, emotional performance. You have patience for life. And, this is something that no one's doing in chiropractic, and I wish everybody would do in chiropractic, but that's again, what we're on this podcast for is to teach you all about that. It's a, it's a really fun technique to learn., Let me go into number. Do you wanna do number two? Adjustment. Yeah, that's for sure. Okay, we got time. Well, I'll just do another one. There's many of them. There's many types of, misalignments that you can have or subluxation patterns that you can have. But another common one is this person comes out, they got, they're playing rugby and they got their head crushed one way, or they were, it was a female and she was playing soccer and she, she got, went, had a ball, and now she has a, a headache. Now here's the deal in concussions. With concussions, you're probably gonna get. A migraine type headache onset. When they come off of the field with a, upper cervical subluxation, they're gonna have like a tension based headache that's coming out of the pu in Atlas area. Just a, just a clinical pearl that I wanted to give you because it's totally different. But let's say that we did the biomechanical assessment and we're assessing Atlas and Axis and we went into rotation. They went, they went right, and they held it and went a little further. They went left and went a little further and they could feel a deficit or a stiffness or a tugging or some type of, some type of difference. When they went to the left, let's just say for. Sake of argument. They have a left rotational subluxation. They cannot move as good to left. And you did the Atlas Faucet testing and it was positive, and you went one step further and you did the grip dynamometer. It was weak around one side. You had two neurological things that you're actually able to assess with. Everybody's around you, everybody's looking at you. And so what you did is you went into, you made the, the call where it was a, rotational subluxation. In order to be subluxated on that side, you have to have Atlas involved on the right side posteriority. But there's a kinetic chain that's involved that includes C five and T one. There's lots of explanation that has to be given. my chiropractors, that's what we teach in the course. But let's say that you adjusted the person into left rotation and you moved everything into left rotation, including T one C five, which is into extension and rotation. And you did the posterior arch with the activator and or the ortho stem. And now the person did the post biomechanical test where they turned to the right and then they turned to the left and they said much better, which is almost. A hundred percent of the time of what happens is that they had a clearing of the biomechanical restriction, and then when you went back, and this is, this is the most phenomenal thing. When they, when we use the dynamometer and they do the left and right comparison, it's almost always a spot on where it's equal strength from the left to the right and almost always stronger too. That's the most amazing thing. And then if you clear out the Atlas fossa. It's, icing on the cake too, but that's just how quick the assessment and adjustment can be and it's so, so, so valuable and so helpful. There's another cool test that you can do on, on the sideline if you really were into this and you got neurology involved to it, but it's called the grip test. And what you do is you, you have the player hold, you're holding a. ruler and they have their they have their fingers ready to go and you drop it and they, they grab it. And if you knew what the response rate was beforehand, most, most kids are gonna be really quick. They're like into it like a video game and they're gonna get it before it barely drops. But if they've had their bell rung and they have a subluxation, it's gonna show a di di diminishment with that. So it's another cool one. I don't know if that one's necessary. That one can maybe be done at halftime or so. But, just the quick test of the Atlas fossa and the grip strength that is, it's, it's, it's, it's gold. It is gold. And to adjust someone very gently and then have them shake their head. You see how you're shaking your head, Brant, and you're saying, yeah, that sounds good. But basically when a subluxation clears out and someone is gonna let you know that they can move better, they'll be shaking their head. And this is one of the most important clinical signs that I could ever, ever teach anyone, is that when someone's shaking their head, their neurology is in agreement that, Hey, you know what, yes, that was cleared out. Yes, I'm happy with that. You know? because a lot of times when you do the double rotary, they're like, woo. You know, it's still stiff here. Still attached. Yeah. That's just from being adjusted. Give, give the body time to heal up, you know, give the body time to act, you know, to, to get back to normal. But that's one of the greatest things. And if someone sees their temperature, differential, change out the, the digital temperature, display. Or if they can see with the, with the dynamometer that it's either stronger or even more balanced, they'll be shaking their head, and that's a neurological agreement. But I'll tell you how powerful the marketing is for that. When someone sees a kid give you the thumbs up and like, yeah, they're good. That's what they're thinking. You'll look over into the crowd sometimes or the bench and you'll see other people kind of ching and moving their head. And you know what, that's not a bad way. Yes. Subluxation is more involved than that. Yes. We're on a sideline. We don't have x-rays right at the moment, you know, and I have to remind people that X-rays are like a static picture of how it was when you did the x-ray, and they're very important X-rays, but they might be different once the kid gets their, their head, you know, twist and torqued and, and turned a little bit so., What I found with the whole technique is that. know, subluxation patterns can change. When I was initially,, I, I'm certified in the kale technique and I always had a body left at C two and it was forever my listing., When you play sports and you get torqued and twisted and, and beat up a little bit, that the relationship of Atlas with CC two can change, the occupant can get involved, you can have, , connective tissue. Where the kinetic chain from, , C3, 4, 5, 6, and seven, all involved. So this protocol, it's an upper cervical protocol, but it does involve assessing the T one rib thoracic rotation, all the facet joints., So it's pretty complex, but I, I not because I. I'm the one who's promoting it or discovered it, or, , I'm sure it's bits and pieces from a bunch of other techniques, but I'm telling you, I, I think sports is the greatest avenue to promote chiropractic. I think when you have something that's really clinically strong, I mean, there's no guesswork with this. You know, it's either black and white. You're black and white. You're either in, you're out, you do the grip test test. You're either in, you're out, there's no room for interpretation. Either you got a stiff neck or you don't. So it's, it's, it's pretty rock solid as far as that's concerned. It doesn't, , it doesn't leave a lot of term, , a lot of room for interpretation from the crowd, so to speak, but sorry for taking up the whole time. Good. Well, I wanted to ask you a question though, because you developed a technique that you use on the sideline. yeah. There's a reason why using the sideline and not in your office on Monday morning. So you'll have a lot of people that probably look at you and say, well, this is, this is of a serious thing, shouldn't we wait? So how do you answer that question? Why is it so important to do right now? And obviously on Monday you can do a deeper dive into your clinic, a lot more testing and a lot more tools available to you. But why the necessity of right then and there? Well, like I say to everybody, nerve dysfunction, nerve, the nervous system is what runs your body. It, , is the functional component for breathing, for reaction time for your, you know, for your heart working. I mean, it's just very, very important. And, , there's no, , it's like holding your breath and not getting oxygen if you don't get nerve supply. You need to have it restored as quickly as possible. And if we can do it under safe circumstances, if, if we're safe, if we are able to determine when, you know, a head impact is actually an emergency versus a subluxation, you know, and if you can restore that function back to normal, it has to be restored right away. without nerve supply for one second is too long my books, and that's what I like to teach people is that nerve supply is an emergency situation. Yeah. So you've come across some people over time that said, well, why don't we just wait until tomorrow when the clinic's open? Why don't we wait to have somebody else look at this and trying to stress the importance of the faster we take care of this, the less damage it's gonna cause. absolutely. Even, even if you left nerve supply out of it and you just talked about ligaments and tendons and, and the healing process, of course, the quicker that you can get alignment back where it needs to be the the better it's gonna heal into a better bio biomechanical position. I read a sideline with you, you'll have to remind me that you want people to watch you. because in the professional level, when the medical doctors go on the ice to help somebody, my job is to stick my rear end out so nobody can record them while they're working on the player. I've learned to get in the way. So I will promise I will try my hardest. Remember to stay outta your way so you have an audience. Yeah, audience is very, very important with this one because optics are very good and, , or they should, you should make the optics of what you're doing very attractive. And that's what this is all about too, is it's safe, it's, it's,, objective and it's, , it's just nice. It looks nice too., If I wanna learn more about this technique and learn more about learning this, where can I go about learning this? You can go to my I. Thank you for asking, and it's jackson ccj method.com. We'll put a link out for sure for everybody. Okay. Alrighty. And this is part of our ICA Sports and Fitness Science Council program that we're working on too for a big symposium, , where we're gonna have various chiropractors like Dr. Jackson come and teach us what he does and get used to fishing on it so you can help out on your sidelines, wherever you are in your practice. because we can't be everywhere. That's right. I hope this is, , you know, if you're listening to this and you're, you're on the fence of whether wanna be involved, whether you wanna be involved in sports, I think the best way to move chiropractic forward in the future is gonna be through sports, believe it or not. And it's through making an, , it's not from duplicating physical therapy or, , you know, occupational therapy or massage therapy or training, , therapy. It's, it's just pure chiropractic and it's, it's, no one else has the ability, the training or the foresight to do it. So, this is a very special technique and I, it's all through the ICA Sports and Fitness Council and I, I just can't wait to teach people. I invite everyone to make sure you like and follow us. And if you haven't joined the ICA Sports and Fitness Science Council, it's a great time to do it., We're gonna keep bringing you these great podcasts with great guests and. Teaching the newest stuff in chiropractic on the sidelines. And what I find is that I work with Dr. Jackson here and he is got this great upper cervical protocol. I work with Dr. Todd, who's got a great strong man technique, how to adjust them before they go on to compete. And I got Dr. Joe and his extremity work and it's, it's really fun bringing everyone together and having this, this group of people to create these. Chiropractic sports package for the the chiropractor on the sideline. So Dr. Jackson, I'm gonna give you the microphone for your final thoughts like I always do. Anything you'd like to add? I. I, I'd like to add this. Chiropractors are. Very separate, unique and distinct. there's many ways to practice chiropractic. We like to invite everybody. This is an all inclusive club here. It doesn't matter what it is that you do in your office. We want you to be part of our association. We think the more chiropractors that work together, the quicker we're gonna move the chiropractic concept forward., We just invite everybody to be with us. There's a reason why everybody has a picture of Lance Armstrong on their clinic, the picture of Joel Montana in their clinic, and Emmett Smith in their clinic, and Arnold Schwarzenegger. Because everyone knows that sports gets the message out. There's a reason why there's activism in sports. So if every team had a chiropractor in every level and every league, it would be an amazing way to spread our word. So thank you for what you do, Dr. Jackson. We appreciate you and , like I said, please like and subscribe and come back and we'll do more of this podcast. Thank you. Thank you, Brant, for everything that you do. you much.