I recently had the privilege of interviewing Dr. Rosen, a Dr. of chiropractic who specializes in cranial work and who has been in active practice for 38 years. I met Dr. Rosen years ago while studying for my pediatric and pregnancy Diplomate (specialty). Dr. Rosen at the time taught a specialized cranial assessment and adjusting technique for the International Chiropractic Pediatric Association. Dr. Rosen continues has written several books and continues to teach his cranial work around the world.
I’ve condensed the interview to the information nuggets that I believe speak to the parents of children with Torticollis. For the full interview, please watch the attached video.
Dr. Anik: Do you find that there's a bigger trend toward Torticollis these days compared to say 20 years ago? Is it just that we're looking for it more or has it really become a pandemic?”
Dr. Rosen: I look back at my practice and I've always done pediatrics. It's always been part of my practice pretty much from the get go. And I noticed that over periods of years, there have been specific things for which people have brought their kids in for chiropractic. Ear infections was a really big thing at one point, asthma was another really big thing then of course autism became another thing. And now it's like this whole cranial facial distortion issue, including tongue tie, lip tie, buccal tie and plagiocepahly.
I think that the rise in head deformity came in the nineties though when the American pediatric association freaked people out about letting their kids lie on their stomach due to SIDS. I believe that this really added to the brachiocephaly.
I have found for example, patients in their twenties, forties, and fifties who actually have been tongue tied all their life. My daughter, Dr. Erin had me examine a child who came in to see her. He was in his twenties and had TMJ problems. His speech was affected. He’d been tongue tied for 20 years. I had a 50 year old woman who came in having had TMJ problems all her life. she was severely tongue tied. No one ever said anything to her.
Posterior tongue ties have probably been around for ages and in my opinion, they don't need to be cut most of the time.
In reference to distorted craniums…research is coming out now about cerebral spinal fluid mechanics and how important it is to actually diagnose developmental disorders due to the increase cerebral spinal fluid pressures. As far as the impact on the lymphatic system, you know, they came up with this great aha moment in 2015, yet I have quotes from 1972 where I was talking about it. Yes, there's a greater awareness.
Dr. Anik: Being that most of the people who are going to see this interview are the parents of children with Torticollis, can you speak to how you feel about helmets?
Dr. Rosen: Plagiocephay or brachycephaly is a condition in which the cranial bones are not growing equally. And the reason for that is often because of internal pressures, not external pressures. The dural meningeal system is basically a tube that attaches the tailbone all the way up the spine. It comes into the cranium and then it attaches into the cranial bones and comes out through these sutures in the skull and becomes actually a covering with all the periosteum of the cranium. This tube is attached to the bone. If this tube is pulled too tightly in certain areas, it puts unequal pressure on the cranial bones and that changes how they grow.
So the dural system is similar to gravitational forces. If I took my hand and pressed on an area of the head for 2 years, the bone I’m pushing on would flatten. The dural system does that from the inside. It pulls in and flattens it. In the first year of life, the cranium and the brain will grow 100%. The reason the cranium has sutures or spaces is so that they can expand twice the size. When you have this underlying tension, it causes the bones to not move correctly which causes the brain to expand. If you have too much tension in the back of the skull, the brain will continue to grow in the front. This will result in a bulging in the opposite area of the cranium, in this case, the front of the head. This is basically what plagiocephaly is.
Helmets force the issue by putting pressure on the side that's bulging while leaving a space in the opposite area.. They leave a space so that they can force the cranium to grow in the other direction. The problem with it is they're not dealing with the underlying condition, which is the dural tension and the effect that this has on the nervous system. Aesthetically, the cranium does change. The best way I can describe it is there are two thoughts in the dental world when it comes to putting on braces, There's the aesthetics, which means making the teeth look pretty. You could go to a dentist and have aesthetics corrected, and your teeth will look better. Very often however, kids have trouble down the road. TMJ problems, clicking, popping jaws. This happens just because the aesthetics and the function don't always go hand in hand.
I think the same thing happens with helmets too. When a child is wearing a helmet, it forces their head forward. When they're sitting in seats of any kind or leaning on anything, their neck posture is forward and this affects the cervical spine (neck). It puts unequal tension on it. And it also changes L the curve of the spine. The neck is supposed to have a backward curve. This curve begins to develop as we hold our head up. Well, if a child is in a helmet in a car seat or other devices in which in the head is pushed forward, it creates changes in that lordotic curve. This change in the curve then causes stretching of the spinal cord and that stretching the spinal cord causes improper nerve impulses, tension in the muscles and changes in growth patterns. This then leads to a change in the whole biomechanics of how the child walks, stands and ambulates from the rest of their life. Basically it changes proprioceptive system, which is the system that tells the body where it is in space.
Dr. Anik: The reason I wanted to ask about helmets and plagiocephaly is that there seems to be an obvious major connection between Torticollis and plagiocephaly.
Dr. Rosen: There are two things that happen with the Torticollis. One of the strongest attachments to that dural system that we talked about is at the second and third cervical vertebrae. The torsion that's occurred during the birth process can stretch or put pressure on that dura. 40% of the rotation of the neck come from the first two vertebrae in the neck.
This area gets stretched, torsioned, irritated or swollen and damage in any way is going to affect the rotational component of the neck.
Very often, birth trauma or the Torticollis itself can cause the plagiocephaly. But, in assisted births like with the use of forceps and vacuum extraction, the very opposite happens where the cranial trauma causes the Torticollis.
Dr. Anik: It seems that the most common approach outside of chiropractic offices is to really just handle it aesthetically, correct? Whether we're dealing with helmets, Torticollis colors or that sort of thing. Do you have any opinions about what the dangers or the ramifications of an unresolved Torticollis can have despite it being aesthetically “fixed”.
Dr. Rosen: Neurologically it's devastating, it’s really bad. The main processing center to the central nervous system is in the base of your skull - the cerebellum. During the first year of life, the cerebellum grows 240%. It is your mainframe. If you have a computer system anywhere, let's say in an office, there's a mainframe computer. And it sends all the information to the peripherals, which would be, you know, your handhelds or whatever the other screens, while your brain does the same thing, has a master control, et cetera, it is the cerebellum. If you don't deal with the underlying system, what you do change the way the nervous system functions. Alf Breig, who wrote up a book called Adverse Mechanical Tension, said that one of the most damaging things to nerve tissue is stretching. If you get that nerve tissue to stretch, it causes immediate pathophysiological changes in the nerve and the way it is able to transmit impulses. For example, if you have a Torticollis and you have a tight SCM muscle on one side and you don’t address the underlying issue and you just keep stretching it and stretching it. The dural tissue is connective tissue. It has a certain amount of give. It will stretch for a certain time but if you overstretch it, you'll create micro-tears which will heal with scar tissue. Now what you've created is a traumatic pattern or scar tissue in that system. That system will never be as flexible. We'll never have the same optimum potential. It's just like, if you keep straining an ankle, you get scar tissue, it's less stable.
Stretching can also overload the brain circuit. When a nerve fires too much, too often, too long, tit starts to break down. The end result, then is that it becomes harder for that nerve to function. It needs a higher threshold, higher input. Our body will adapt but with those adaptations will come compensations which will lower our adaptive threshold later on. This is why very often kids who are diagnosed with neurological issues, don't get diagnosed until they're three or four years old. The process has been set in for so long that their threshold is decreased. And when they get to an environment, say like school, where they have to learn and use their brain more, the system breaks down.
This is when we start to see disease processes.
Dr. Anik: What type of disease processes are you referring to?
Dr. Rosen: Neurological issues. Anything from Autism spectrum, ADHD, visual cortex issues, tracking issues or memory issues. nervous system.
Let's take sensory proprioceptive and sensory integrative disorder. These disorders are a reflection of the body's inability to adapt to outside stimulus. The brain can't process the information. With sensory integration disorder, very often, what happens is the child can't integrate the information. And so they shut down.
These are the kinds of kids that cure up in a ball. It's almost like someone's poking them all the time, they get very anxious and they act out.
A study done in nineties from the Arizona medical, a neurological Institute found that kids with trauma at the base of the brain affects what the pre-program proprioceptive feedback loops. In the initial stages, these kids have minor symptoms like irritation. But if the condition isn’t resolved, as they got older, the symptoms worsen and they aren’t able to concentrate. They have sleep issues and behavioral issues. This is the result of one compensation after the other. It's basically like low level neurological abuse that builds up, if not corrected.
Dr. Anik: I think one of the biggest concerns is that the child now ends up in school and the system views the them as dysfunctional or broken in some way and worried parents take that on. Parents find themselves in what seems like a hopeless behavioral situation, yet it's completely neurological.
Dr. Rosen: The amazing thing about the brain is that it has the ability to make new pathways. This is called neuroplasticity. It’s manageable but it's so much harder to create a new pathway as a child ages. It's like learning a language at age 40 compared to at age 2.
Dr. Anik: Do you find that you see more tongue tie in children with Torticollis?
Dr. Rosen: You know, someone else asked me that and I honestly have not correlated it. I see a lot of tongue tie. I believe again, that a good 30, actually 40% don't need to be resolved because they're not functionally a problem. I see a lot more tongue tie in babies than Torticollis, I can tell you that.
Dr. Anik: Do you have any resources for parents specifically and for communities at large thing?
Dr. Rosen: www.cairo.com is my office website. There's a section on pediatrics. Parents and community members can find some PDFs on pediatric topics like concussion and plagiocephaly.
Thank you so very much to Dr. Rosen for his work and his expertise. He is a wealth of knowledge. I’ve made myself a promise to go observe him in action in his practice.
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