In pursuit of the underlying mechanisms and importance of proper spinal segmental function and alignment, Dr Evan Katz and his wife, Dr. Seana Katz, set out to assess the influence of the cervical curve on blood flow. As a result, they conducted a study that demonstrated significantly enhanced blood flow to the entire brain. Furthermore, they attributed this effect to an unimpeded flow from the vertebral arteries, which could potentially have significance in the general population by improving the cervical curve, a challenge more critical than ever with today’s mobile phone-induced pandemic of forward head posture. Although the study is the first of its kind, we at The American Chiropractor magazine (TAC) were able to catch up with Dr. Evan Katz (EK) to get his thoughts on the study, the impact that it may have on chiropractic care, and how to achieve excellent results in our patients..
TAC: What techniques do you use in your clinic to treat patients?
EK: We use CBP primarily, and then Ell add some soft tissue. A lot of times, I will do seated adjustment — seated cervical, based on what we find or what’s best for that patient.
TAC: Do you use any specific exams in your evaluation?
EK: Yeah, I do a full, detailed history and initial exam where we do what I think are things that many people leave out, like using a pinwheel on the back of the head, stuff like that. Then we also use our digital motion X-ray to really determine where the structural and segmental pathologies may be.
TAC: Are you using static X-rays?
EK: I usually start with static X-rays, especially of the thoracic and lumbar region, because we don’t usually use digital motion X-ray for those. But I typically start with static, unless there are some signs that I believe need to be evaluated quicker that could be more likely seen on a digital motion X-ray.
TAC: Do you think you could ever do this the type of treatment without doing X-rays?
EK: No, I don’t, not to the degree or specificity. And again, whether this sounds completely wrong, I think I just know too much not to use X-ray. I know what I could be missing. I’ve seen way too many things that were missed and not picked up, things that we were able to identify that dramatically changed our treatment. Because of that, it dramatically changed the outcomes for the better.
TAC: So what made you think of the impact of circulation on the cervical curve of the brain?
EK: Well, there was a study done using ultrasound looking at cervical curves and blood flow on ultrasound on the vertebral arteries, and they did show that an abnormal curve decreased hemodynamics.
I’m a black belt in jujitsu. As a black belt coming up the ranks, I’ve been choked unconscious, and I’ve choked other people unconscious. A really good blood choke causes you to slowly start to black out. I had a lot of patients kind of describe some of their symptoms that way. And my wife and I, because we practice together, started talking about it. We started thinking there’s evidence that an abnormal curve can do that.
Then the fly fisherman in me thought, “Well, if there’s a kink in the river, the flow is going to be changed where that kink is.” So I wondered, let’s see what happens upstream, so to speak, from where that kyphotic angulation is that could be affecting the vertebral artery. And let’s not just look at that spot but see how it affects the flow above in the brain. That’s how we got the idea.
TAC: Does general diversified chiropractic care improve the forward head carriage cervical lordosis?
EK: No. And there have been studies that have shown that an adjustment is great for certain things, but it’s not going to fix the structural component on any form of consistency. That’s been shown in the research.
TAC: What implications do you think these findings have on the practice of chiropractic?
EK: Well, I think there are a lot of implications. I think it pushes us forward. I think, as chiropractors, we have the science, philosophy, and art, and when we continue to use science like this, it just validates our philosophy. What this does is push us forward to say, “Look, we’re not just for pain. We’re not just for stiffness and tightness.” There’s a true neurovascular component that we can look at.
If we start to go in these different directions, we can realize that we can have more evidence — not just clinically but scientifically — to back up our philosophical thoughts and beliefs to continue to show why we’re getting better outcomes.
Then I think we can start to look in other fields about how, if we do treatment to improve the curve, we can start looking at these patients who may have issues due to abnormal blood flow to the brain. And one of the main hypotheses for dementia and Alzheimer’s is decreased blood flow to the brain.
Dr. Evan Katz is an East Coast native, and has an uncle and a cousin who are also chiropractors. He was a Life Chiropractic College West graduate in 2000. Evan started a solo practice in Boulder, (as a big skier he dreamed of living in Colorado). Almost 20 years later Dr. Katz and his wife have a busy practice, their focus is on improving the normal structure and function of patient's spines. Dr. Katz has testified as an expert in court over 20 times explaining the complex, sometimes devastating injuries that happen in car crashes and the importance of chiropractic care. Dr. Katz has published in multiple peer reviewed journals. As of 2019, he has been published in the journal Brain Circulation, and in 2020 published in the International Journal of Environmental Research and Public Health on spinal instability in injured vs non-injured population. Dr. Katz was one of the primaries establishing the new 2019 ICA certification program AMTI. Evan started Professionallyintegrated.com which allows doctors to have access to spinal information to help educate, document and improve patient outcomes.
In his free time he loves being with his family, fly fishing and is a black belt in Brazilian Jiu Jitsu.
TAC: Have you seen this in your patient population? Do you treat Alzheimer’s or dementia?
EK: So we don’t treat it that much because in order to get a dementia patient, we have to get in contact with their caretaker to really understand how it is going. Now, that would be something I would love to do — to get patients who are suffering from dementia. We have treated patients with dementia, but I would love to get them in a control population and do this study again to determine what we are seeing specifically.
In our paper, we’re careful to say this doesn’t cause dementia. We don’t know that. What we do use is what the evidence has suggested — that decreased blood flow to the brain can be causing it. Now, this could be one link to that, and it’s something I think we should continue to investigate.
TAC: What do you think is the biggest risk to the chiropractic profession?
EK: It’s amazing to me how my wife and I can invest our own time, our own money, our own whatever, and I have no product to sell, right? I have no product to sell. I didn’t develop a traction device that did this. I have nothing to sell.
When we did this, the biggest blowback we got was from my own profession. We have friends who are double-board-certified in neurology and spine surgery who said it really makes sense. But our own profession — and there’s really only a couple, but they have loud voices — they just fought with us. Instead of saying, “Wow, this is really cool. How do we make it better, and how can we help?” they just attacked the process of what we did, even though 90% of them have never been published. Half of them don’t even practice anymore.
I think that instead of us uniting, we fight amongst ourselves. A lot of those same doctors don’t just argue about blood flow or the paper we did but will argue that the sagittal alignment has no clinical evidence. Chiropractors are really the only profession that works with the spine that will argue that. And we’re just killing ourselves that way. Or they’re killing themselves. They’re not harming me. But instead of working together to say, “This makes sense because here are the studies that came before it to show it,” they try to quash it. They try to say that what we have doesn’t make sense. I think the biggest trouble we have in our own profession is our own profession.
And it’s interesting because we show this to the neurosurgeons and the pain management doctors who have published papers, and it makes complete sense. So we get referrals from them. But then our own profession fights tooth and nail to put it down on many levels.
TAC: Yeah. So, what is the biggest opportunity you see in the profession?
EK: Oh, the biggest opportunity is to use the evidence and the research to continue to educate the public, the community for better public health outcomes and to show what we’re truly capable of, what our profession can do. I don’t mean to do a plug, but it’s why I put together Professionally Integrated and professionallyintegrated.com. I have hundreds of articles on there that support chiropractic care. I have webinars with some of the most published doctors only supporting what we do. When we use evidence that is out there in peer-reviewed scientific journals to show what some of these spinal pathologies can do to patients’ quality of life and then show chiropractic techniques that can improve it or slow it down, as well as the positive effect that makes on quality of life and outcome, what we can do and show is endless. We just have to stop fighting these certain, proven things. It’s making us look stupid.
TAC: What are the weaknesses of this paper regarding vertebral artery circulation and the cervical curve?
EK: So the weakness obviously is that we would like a larger sample, but this was something we did on our own. I rented an MRI center. We did angiograms. I hired a PhD from Colorado University, so there’s only so much we could do.
The other limitation that people always mention but don’t understand because they never want to listen to me is, “Oh, well, all you did was extend someone’s head back. If I extended my head back over a stair, I’m going to get more blood flow in my head.” What they’re not understanding is the process. If you’ve ever been in an MRI machine, it’s a hard, flat surface. When we put them into a more normal lordosis, we minimize skull extension. Their head couldn’t extend below their shoulders. They were at the exact same angle from head to shoulders. There wasn’t a posterior translation with extension occurring.
I’ve heard a number of people say, “All you did was extend their head back.” Well, it’s great that you feel that way, but it’s been proven that what you’re saying is false and inaccurate. So you can rely on your false and inaccurate statement to make yourself feel better, but what you’re saying is not true, nor was it published. We can show how we did it in terms of our procedures. They’re just ignoring that fact, for whatever reason.
To contact Dr. Katz yon may call 303-594-8969 or visit professionallyintegrated.com
