Zamboni vs Schelling Research

Dr. Paulo Zamboni is a vascular surgeon. He has no special background or training in neurology or neurodegenerative diseases. Nor does he have background in the design of the human skull and the all the variations of the drainages systems. He is not a specialist in radiology or cranial hydrodynamcis either, nor is the idea of using ultrasound scans to check brain blood flow new. I was in a study group with a chiropractor in 1984 who was using plethymography doppler scans on all his patients before and after cervical care. It was a great device, but chiropractors couldn’t get reimbursed one cent for the procedure at the time. The current charges for the ultrasound exam for venous stenosis seems overly expensive compared to MR angiograms, which produce far more accuate and direct information. What Dr. Zamboni has contributed to MS research is the term CCSVI and the liberation procedure which has shown huge promise and potential. Other than that, he is a relative new comer to research into the cause of neurodegenerative disesases such as MS, including the role of venous drainage issues such as CCSVI. I have been writing about venous drainage issues for well over twenty years now.

Dr. Franz Alfons Schelling, on the other hand, is a retired Austrian physician who started in 1973 and spent his entire career studying MS. Interestingly, his investigation began when he noticed enormous differences in the venous outlets in skulls of patients with MS. His online book Multiple Sclerosis – The Image and It’s Message – The Meaning of the Classic Lesion Forms,” is a gem.

In contrast to Zamboni, Schelling belives that the cause of the lesions seen in MS are due to venous back jets into the brain; that is reverse or inversion flows. He believes the primary source of the back jets to arise from cardiorespiratory waves transmitted to the brain due to incompetant valves in th jugular veins, as well as through the vertebral veins, which unlike most veins, have no valves. He also discusses violent venous back jets from the cord into the brain due to truama as a source. Schelling’s theory of venous back jets explain the hyperintensity signal lesions seen in MS far better than Zamboni’s theory of venous stenosis, but I disagree with Schelling on the primary source coming from cardiorespiratory waves. I studied bats, whales and giraffes precisedly to study extreme inversion flows and found that they have adapted compensatory mechanisms, which I discuss in my book. Humans similarly contend with inversions flows.

In contrast to Schelling, my research began around 1984 while studying the unique designs of the bent base and special joints of the human skull called sutures. The artificially deformed skulls from Peru and Bolivia started me looking into hydrocephalus, which led to normal pressure hydrocephalus and Alzheimer’s disease. That led to Parkinson’s and later multiple sclerosis. When it came to my theory of venous drainage issues in neurodegenerative diseases, I was stumped by MS. It was difficult to explain the location of the supratentorial periventricular hyperintensity lesions seen near the core of the brain and conversely along the flanks of the cord in MS. Schelling provided the answers.

In brief, I agree in part with Zamboni on the theory of CCSVI but I disagree with him that stenosis of jugulars is the primary cause. I agree with Schelling that venous back jets most likely cause the lesions, but I disagree with him that the primary source of the back jets come from cardiorespiratory waves. I have my own theory about the cause of the CCSVI, which I think is better than either Zamboni of Schelling’s theory, but no one has all the answers, at least not yet. Nontheless, the current stir over CCSVI has been a huge leap forward for people afflicted with MS as well as other neurodegenerative diseases.

When it comes to the overall subject of the MS, Schelling is by far the expert and anyone involved in MS research should know everything in his book so that we are all on the same page. More than just describing the lesions and theories regarding their cause, Schelling make it clear what MS is not. According to Schelling and others for that matter, MS is not an immunological disease, nor is it due to inflammatory reactions. Corticosteroids most likely work on MS cases by reducing swelling and pressue, not inflammation, the same as it does in head trauma cases. But corticosteroids cause wasting and weaknesses of muscles and bones, which isn’t good considering MS patients often have problems with leg weakness, balance and falls. The last thing MS patients need is wasted muscles and broken bones. Interferon makes no sense either, since according to Scelling, except for oligoclonal bands in CSF, there is really no solid evidence to indicate that MS is an autoimmune disease.

136 Responses to Zamboni vs Schelling Research

  1. Found out your blog via bing the other day and absolutely find it irresistible. Keep up the fantastic work.

  2. Heather Loyst says:

    I just want to thank you for summarizing things in such a clear and precise manner. I actually understand what you are saying and it makes sense! How refreshing.
    My husband has MS. He just had an ultrasound to see if he qualifies for the liberation procedure. Unfortunately he only had 1 out of 5 blockages. Now we will wait for more research to be done.
    Thank you!

    • Drs Flanagan says:

      Hello Heather, Tell me more about your husband. When did his MS start? What kind of work did he do? Any history of trauma?

      • Heather Loyst says:

        After reading some of your research yesterday, I discussed it with my husband.
        He was diagnosed 14 years ago. He was in sales and traveled quite a bit. We tried to remember if there was any trauma but neither one of us could. What is interesting is that he was seeing a chiropractor at the time for back pain. We can’t remember what caused the back pain.
        Another note. His brother was diagnosed with MS recently. He sees a chiropractor for back pain regularly.
        Thanks for your interest.

      • Drs Flanagan says:

        What are his signs and symptoms? Did he play sports? What are his favorite hobbies?

    • matt says:


      Where did you get the testing done for your husband? What testing did they do?

      Do not trust the doppler. I had the doppler and it showed a minor problem. Then I had the venography and it showed that my left jugular was completely blocked and my right was 50% blocked. The doppler was dead wrong. I have since been liberated and have never felt better in my entire life.


      • Heather Loyst says:

        Thanks Matt
        I have heard that from other people although he is the only one I know of who had it done in Port Perry Ontario and wasn’t positive. Apparently they are well trained there and use Zamboni’s procedure.
        Still hesitating about doing any further testing.

  3. Heather Loyst says:

    His first notable symptom was slurred speech. Apparently this was a little unusual.
    Since then he has had some major “attacks”. We can relate all of these to increased stress in his life. For instance, he had a major set back when we traveled to Ireland 8 years ago. It was a bad trip and he was under terrible stress. He ended up in the hospital almost paralyzed. When he gets excited at all now, his speech is a little funny sounding.
    Generally right now, his Neurologist feels he is in Secondary Progressive so he doesn’t have “attacks” any more.
    His physical symptoms now are: constant feeling of bands around his lower legs, constant feeling of pressure in his lower abdomen and extreme fatigue. He has tremendous trouble concentrating and severe dizziness.
    He walks without aids, although he can only walk short distances and then his legs are too tired. Seven years ago he had a colon resection. Since then, he has had the feeling of pressure in his lower abdomen and that was when the dizziness started.
    He never really played sports. A little hockey in his very early years. Although I didn’t know him then, he did apparently get in quite a few bar fights during his late teens and early 20s!!
    I hope I am not being too lengthy in response. Thanks! , Heather

    • Drs Flanagan says:

      Hockey is notoriously bad for whiplash trauma. Michael Fox developed Parkinson’s several years after being checked hard and knocked unconscious at least once if not twice playing hockey. Boxing has long been associated with what is called pugilistic Parkinson’s. Mohammed Ali is a perfect example. Cross punches are especially good at knocking someone out as they hit across the jaw and severly twist the upper cervical spine.

      It’s interesting that your husband has slurred speach. One of the drainage routes humans use for upright posture to get to the VVP is through the hypoglosal canal, which also contains the hypoglossal nerve. The hypoglossal nerve controls the tongue. It also contains the vagus nerve which goes to all the organs of the thoracic and abdominal cavities. Among other things, the vagus nerve is very important to the regualtion of digestion. Your husband’s condition is also affecting the vertebral arteries to the brain and most likely the pressure is in the upper cervial spine.

      Your husband should definitely get specific upper cervical x-rays to rule out a problem for sure.

  4. Heather Loyst says:

    Thank You. His last MRI showed lesions on his spinal cord.
    One question. He only had slurred speech before diagnosis. It went away except for when he gets emotional or excited, he has trouble with his tongue. Is it something that would come and go in this manner?

    • Drs Flanagan says:

      It certainly can come and go. Blood flow and intracranial pressure are dynamic and change constantly according to postural and other circumstances. I will be doing a post very soon on the hypoglossal and condylar canals. They are the lowest point in drainage system of the brain. Your husband probably loses brain support and sinks slightly toward the foramen magnum, which increases pressure within the hypoglossal canal. I call it a pressure conus condition. He loses brain support because of back pressure against his vertebral veins in his upper neck, which is the same place he is compressing his vertebral arteries causing fatigue. Venous back pressure affects CSF production necessry for brain support while upright. Your husband sounds like a firey type of guy considering he used to get into bar fights and aggravation and emotions worsen his condition. Emoitons can cause significant tension in the neck so can frequent travel and sleeping in hotel beds with bad pillow and long or frequent plane flights.

      • Heather Loyst says:

        Hello again
        I very much appreciate your help and advice. I have spent the weekend researching testing for CCSVI and feel more confused than ever. Since Dave had an Ultrasound, it is my understanding that something could be missed if not done properly. I am going to ask his GP to send him for specific upper cervical xrays as you suggest. I’m pretty sure he will agree as I work with him and he is willing to do whatever may help Dave.
        I just need to know what exactly we are looking for and the reason for the request for xrays.
        Thanks, Heather

      • Drs Flanagan says:

        You are better off having an upper cervical chiropractor take them. Some prefer to use sterotaxic head clamps to take more precise x-rays. That said, you need as a minimum an AP and a lateral cervical view and an OMO (open mouth odontoid). Some chiropractors also like vertex and BP (base posterior views to image the neural canal. You are looking at the structure of the spine and looking for curvature problems, degenerative problems and most importantly, upper cervical subluxations.

  5. glenn loyst says:

    Hy,very good info ,im Dave loyst brother,i have ms started 3 years 47,my ccsvi came back 4 out of 5,don’t now were to go next

    • Drs Flanagan says:

      Hi Glenn, You probably share similar designs in skull and spine. European designs are much more susceptible to MS. Asians have a much lower incidence but get a variant that occurs lower in the spine. I believe it has to do with differences in skull design. Are you a small, medium or large frame type. How tall are you? How much do you weigh?

  6. glenn loyst says:

    im a large man,5/11 245 pounds,have a lot of heck aches,a lot of people say its from working over my head all the time in my trade ,and have had a lot of back problems,after having my first ms attack,have not had back pain so much,other then neck aches .

    • Drs Flanagan says:

      I pretty much had you figured out. You have a big head and no neck like a football lineman. Are you an auto mechanic, sheet rocker, or painter? Is your brother similar in build? Big heads with big brains can cause big problems inside the skull but they can be fixed.

      • glenn loyst says:

        yes you are right.i have lugged and and worked hard all my life,and yes i have a far size head,all thew my skull is flat on the back of my head,not round if that means anything.

      • Drs Flanagan says:

        Flatter skulls in the back are even more susceptible to problems. It puts that much more weight over the foramen magnum in the bottom where the cord exits. Tilting your head back while you work can compress the vertebral arteries that go to the back side of the brain and pass through upper cervical spine and base of the skull. There is a condition called beauty parlor syndrome in which women would get little mini strokes from leaning their head backwards over a hard salon sink while their hair gets washed. While you are leaning the base of your skull against a sink you are tilting a bowling ball backwards and compressing the arteries. In your case it is a particularly large bowling ball. It’s okay for a moment of two but if you do it day in and day out for long periods you can cause chronic little mini strokess. What does your brain scan look like?

  7. glenn loyst says:

    not shear,i was told by the doctor that i had ms,only that i had a lesson on one side

    • Drs Flanagan says:

      Tecnically, lucky for you, one lesion doesn’t qualifiy you for MS. Be thankful for that. But it’s not good either. I don’t know where the lesion is but it suggests that you have circulatory stress and it makes sense considering your case history. You need to get you upper cervical spine fixed, especially if you are a mechanic and have worked with you head tilted backwards a lot.

  8. glenn loyst says:

    thank for you’re time and information,its really to bad more doctors didn’t have youre training and for site thanks again

  9. Heather Loyst says:

    You didn’t leave me a reply button last post!!??
    I did some research in to upper cervical chiropractors in Canada. There are only a few Board Certified in Canada and all are out west. (Very far from me!)
    I see there is one in Toronto who has passed Level 1. I also see there are others who advertise this practice but aren’t on the list of certified. Any thoughts?
    Thanks, Heather

    • Drs Flanagan says:

      Hi Heather, Find out what type of upper cervical they use, when they graduated and from what college. We all got started at one time or another and a good upper cervial doctor should know who to contact for advice if necessary. They might be fine. Let me know what you find out.

  10. Karen Whitelock says:

    I just stumbled on your site today. This makes so much sense. My husband was diagnosed with MS 10 years ago and we watched his mother eventually pass away after being bed ridden for years. His first symptoms was vertigo and eyesight problems. I just started seeing an upper cervical chiropractor and armed with the information you have provided I will convince him to change from his regular chiropractor to a specialist.
    He is also scheduled for CCSVI testing and treatment in Mexico in October.

  11. Derekdadey says:

    I was diagnosed with Multiple Sclerosis back in 1983. I can hardly walk now and it seems my condition worsens every day. When I first heard about the Liberation procedure and its results from a friend, I thought United States would be the first to conduct the trials. I could never imagine the corruption involved. I ended up applying for this simple procedure in Poland and waiting.. The other options were to get it done in India. After researching the internet extensively, I came across . They are screening for CCSVI in Fargo, ND and have very affordable packages for the Liberation procedure in India. I called (404)461-9560 and spoke to their nurse administrator Lisa whose priceless support made me realize that we are not alone in the fight against MS. They are screening within the US and Canada, their medical tour package includes flight arrangements and help with the visas, world class accommodation and meals within their hospitals, the liberation procedure, a stent if needed, medications necessary, a site-seeing tour, Pre-and post-procedure supervision, Full medical file including copies of charts, screens, CDs of Venograms, blood work, EKGs, etc. Post Procedure Screenings, follow-up and consultation with surgeons for the next 6 months and so many other provisions Lisa told me about, I can’t recall however you might be able to find out more on their site.. . They are providing all of this at just $13000 as compared to the other companies that charge something like $20000 just for the procedure. You may also contact Lisa by emailing her at or calling her on (404)461-9560. I am getting liberated mid-October and I am so very thankful to everyone at CCSVI Clinic for making this happen!

    • Two points:
      (1) CSF oligoclonal bands must not be said to be peculiar to, or even speak for an autoimmune origin of, MS either. The same bands are found in all sorts of vascular, compressive or traumatic brain lesions (Cohen O, Biran I, Steiner I: CSF oligoclonal IgG bands etc. in Arch Neurol 2000; 57: 553-7).
      (2) In MS, intensifying exspiration is seen to suffice for provoking flow inversions in inner cerebral veins. Stronger efforts can be expected to intensify such events to such a degree as to traumatise the brain. What else is needed to produce Dawson-fingers and other brain lesions found exclusively in MS?

  12. The CCSVI Liberation Treatment could be the cure but fact remains that the rate of re-occlusion is stuck at 50% and MS patients being treated in the European and Asian countries end up suffering as they did, 3 months ago. While Big Pharmaceutical Corporations and governments in the US and Canada are coming up with new ideas to stop any advancements to the CCSVI theory (Like the superbugs, etc.), millions continue to travel to countries like India and Poland to get this simple procedure and no valuable data is recorded to support the CCSVI theory. Unless we get our position strong enough to support the CCSVI Theory, we will never be able to beat the Pharma Corporations or start the treatment here and many will keep suffering and dying even after having the procedure done. I lost my elder brother last month because of a blood clot in his stent. He got liberated 5 months ago in Poland. We need to prove to the government that this works. Non-profit organizations like the CCSVI Clinic are tirelessly working to develop safer protocols with teams of world renowned surgeons even though they are feeling the negative pressure from you know who. This Atlanta based Organization has started Clinical Trials for CCSVI and we need to support these groups because they are our only hope to fight for the truth. Without the valuable data that they are collecting offshore, the procedures will not be allowed here, in our own countries.

  13. Janusz Banowski says:

    I guess my question is this: If it is venous back jets that cause these lesions, wouldn’t opening up the jugular vein as well as the valve with an angioplasty (as they are doing these days, using bigger balloons, cutting balloons) , make things worse? (in effect cause an open highway between the heart and the brain for more of this backjetting to occur?) So why are people improving for the most part after treatment?

    Thank you in advance for your thoughts!

  14. Intracranial venous obstruction was shown to cause edema dotted with hemorrhages but in small, directly related venous domains. Extracranial venous obstruction, even ligature of both internal jugular vein, uses to be soon compensated – I could not trace any piece of evidence on lasting damages to the brain.
    Venous stenosis dams up blood in extracranial collecting veins, at times even causing engorgement of all related venous pathways up into the brain. Thus extracranially displaced blood may be driven at pressure peaks exceeding prestenotic venous pressure far beyond the hundredfold back into particular venous pathways of the brain. If not an event of this sort, what else can produce a Dawson finger?

    • Drs Flanagan says:

      Hello Dr. Schelling,

      Thank for the excellent points you make. When it comes to Dawson’s fingers, traumatic events and violent venous backjets make the most sense by far. I suspect that the design of the base of the European skull further relaxes the angles of the vertebral veins, sigmoid sinues, transverse sinues, straight sinues, and superior sagittal sinuses making Europeans more susceptible to venous backjets in traumatic events. Asian and African races don’t appear to get Dawson fingers as much as Europeans but they do get optic neuritis coupled with transverse myelitis. My guess is that the larger posterior fossa and sharper angles in the dural sinuses in Asian and African races are probably protective against violent venous backjets.

      As for chronic extracranial venous drainage problems not causing any visible damage around the collecting veins in the brain, I suspect chronic venous back pressure causes sluggish CSF and interstitial fluid flow. Sluggish CSF flow can cause problems indirectly related to the veins such as cytotoxic edema, normal pressure hydrocephalus and Chiari malformation signs and symptoms.

  15. P.S. The degree to which impacts upon superior cava and brachiocephalic veins are going to be transmitted upon one or the other jugular vein depends on many variables:
    on filling and intraluminal pressure being momentarily given in the intrathoracic veins, on the one hand, and in any of their major affluent veins on the other;
    on the degree of competence of especially both internal jugular and subclavian valves;
    on the degrees to which arteries, muscles and other structures momentarily impinge upon the lumen of all the venous passages involved.

    The degree to which the compression of an overfilled jugular vein is going to be transmitted upon some cerebral tributary vein cannot be mitigated in so many ways as the compression of the intrathoracic collecting veins.

    • Drs Flanagan says:

      Thanks again Dr. Schelling,

      I couldn’t agree more. There are many variables. In addition to those you mentioned, other variables that affect extra luminal pressure surrounding the veins include musculoskeletal problems such as scoliosis, kyphosis, head tilts and muscle tension, especially muscle tension in upper cervical spine and suboccipital cavernous sinus area. Scoliosis is further associated with functional stenosis, which compresses the thecal sac and vertebral veins against the inside curvature of the spine. It has also been associated with thoracic outlet syndromes, which can impede venous flow through the jugular veins. Humans are predisposed to venous drainage problems. Like you I also noted discrepancies in jugular venous foramen. I also noticed discrepancies in other accessory venous drainage outlets such as the hyaloid canal route to the vertebral veins. In my opinion, craniodyostosis of the base of the skull is more common than we currently realize and contributes to drainage problems.

  16. All too true, Dr. Flanagan.

    Thanks to the current advances of interventional radiology, I dearly hope, both the conditions favouring venous flow inversions that are injurying the brain as well as the dynamics of such events will soon be comprehensively elucidated.

    It is indeed important also to find out how far preconditions to widespread or general cerebral venous stasis can also affect the brain via venular exudation (its fluids being noxious in itself or through special constituents) and thus contribute to the development of perivenular encephalitis or hydrocephalus.

    • Drs Flanagan says:

      Again we are on the same page Dr. Schelling. In addition to interventional radiology I think upright MRI, such as the work being done by Dr. Noam Alperin of the University of Miami, will shed even more light. The technology is here now to study complex cranial hydrodymamics. Dr. Haake’s images are stunning, so are the latest color coded duplex ultrasounds.

      There has been interesting research in traumatic brain injuries that suggest that the brain is particularly susceptible to ischemic injury due to the lack of proteins in CSF which disturbs osmotic pressure gradients and subsequent clearance of edema. Chronic ischemia can initiate the glutamate cascade. Chronic edema can lead to cytotoxic edema.

  17. Janusz Banowski says:

    My other question is, could injury/trauma to the cervical/thoracic vertebral junction cause MS type symptoms? That’s the location I’ve had injury in the past, and the area that plagued me with discomfort for the last few years, on and off, leading up to my current symptoms: tingling all over, tip of tongue numbness, cold extremities, worsening fatigue for years.

    Also, could sleep position have a part to play as well? I sleep on my front, head twisted right or left.

    • Drs Flanagan says:

      Hello Janusz, Trauma to the cervicothoracic are can certainly cause MS symptoms. Sleeping on your front side with your head twisted strains the cervical spine, which can further aggravate your symptoms.

  18. Janusz Banowski says:

    thank you for the discussion above….I guess my bottom line question is this: Given early MS-like symptoms, the very real possibility of permanent neurological damage, being fairly young and with a bright future ahead of you, would either of you opt for CCSVI angioplasty with valve-plasty (still not sure how either of you feel about disruption of the jugular valve and its consequences either)?


    • Drs Flanagan says:

      Janusz, It would be wise to address the MS symptoms now while you are young and before further neurological damage is done. But I agree with Dr. Schelling. The cause of your MS symptoms needs to explored further, especially considering your history of cervical trauma.

  19. Oh, Jan B, once you speak of MS, you just need a neurologist’s recipe.
    Otherwise there must be excluded (CT, MRI) that your symptoms don’t reflect (local and remote) subdural effects of the former impact on your spine.
    Though ballooning a jugular valve needs not to render it incompetent: I’d prefer making sure your symptoms are attributable to vein-conditioned damages to medulla or brain ( before scanning for CCSVI or angioplasty.

  20. P.S. The term “subdural” was used for sake of brevity. There ought to be looked, dependent on the kind of accident / mechanism of injury, for epidural and other effects of your spinal trauma as well.

  21. P.P.S. Not to forget: a screening of vertebral and basilar arteries (S. Allan Hurvitz: Surgical treatment of vertebral artery insufficiency in patients with diagnosis of MS. Vascular surgery 1977, Sept.: 333-9)

  22. Janusz Banowski says:

    a little frightening that it could be secondary to trauma in my spine….come to think I had a lower back injury last year (fell off of my bicycle onto my side, twisting my body), which put me out of alignment completely for a few weeks with pain in my upper and lower back, until my chiropractor adjusted me in a few sessions. I hope all this can be resolved with some potential chiro visits. Here’s hoping.

  23. Janusz Banowski says:

    so i just had an upper cervical treatment. He mentioned it was out of alignment slightly near the atlas, he is a NUCCA doctor.

    As he was adjusting (3 attempts), after the second things felt “clear” in my head. Weird way of putting it, but just clear. He said the feet weren’t totally aligned, went for a third adjustment, after which things felt sort of …lightly pressurized on the left side? I figured it would go away. I left the office feeling somewhat irritable, and one hour later I lay down and closed my eyes to flashing lights, this irritability still with me. Is this normal?

    • Drs Flanagan says:

      Hello Janusz, It doesn’t happen that often but occassionally some people do have an uncomfortable reaction after the first adjustment. It is usually caused my muscles and connective tissues adjusting to a new position which can cause a mild strain. It should go away but make sure you let the doctor know.

  24. Unfortunately our perception of the cerebrospinal venous anomalies and understanding of how these anomalies modify venous outflow from cranial cavity and spinal canal is deplorably incomplete,
    especially on account of diagnostic limitations.
    A venograms depicts but a small segment of the cerebral venous drainage, depicting it in just one direction.
    The (exceptionally rare) really good MRV allows studying the cerebral venous pathways in their entirety, its spatial resolution is yet, especially in certain places, still all too low.
    Neither venography nor MRV are thus perfect: Important details, such as thin membranes having enormous hemodynamic efficacy can be easily overlooked in venography and especially MRV.

    Ideally MRV ought to be complemented with IVUS (intravascular ultrasound) imaging, and a combination of the latter with pressure and flow monitoring of the involved venous drainages critical passages, in different head positions and during different activities (such as intensified breathing).
    As yet diagnostic as well as therapy of CCSVI are, in many aspects, not to be considered complete.

  25. Janusz Banowski says:


  26. Janusz Banowski says:

    Thanks Dr. Flanagan….my concern was that he was pressing up against a blood vessel, that may already have been damaged and the one giving me my symptoms to begin with. He pressed down in a few places, I think it would be difficult to avoid blood vessels doing so. Needless to say, I’m already on a serrapeptase regimen and I don’t think it can hurt either way right now. I think that is an issue to think about though, people having MS with venous etiology….putting pressure, maybe accidentally, on these veins could potentially exacerbate symptoms. There are worse case scenarios of course, but I’m being optimistic.

    • Drs Flanagan says:

      Your welcome Janusz, If the doctor is doing upper cervical it is unlikely that there is any direct contact with arteries or veins. The contact is generally on the transverse process of Atlas/C1 or the spinous or lamina of axis/C2. On the other hand, different methods deliver different types of forces. They should never feel excessive or uncomfortable. But sometimes even the best adjustments cause some discomfort due to the nature of the irritated tissues involved and the shift in structures. If the adjustment itself feels uncomfortable or too strong, let the doctor know so that he can lighten up in your case. Everyone is a little different.

  27. Janusz Banowski says:

    I guess my concern is still there somewhat…perhaps it will go away over the coming days. I feel some pressure in my head around my left ear area, where he was pressing. Not like bruising pressure, kind of “clouding my brain” on that side pressure. Not severe, but there. Last night remember having to swallow like you would in an airplane because of that pressure. I did not have this before. Just seems like some sort of vessel blockage or something.

    • Drs Flanagan says:

      The transverse process of Atlas lies below the mastoid bone of the ear. The mastoid bone is part of the petrous portion of the temporal bone of the base of the skull, which contains the auditory canal for the different parts of the inner ear. Muscle tension is probably affecting the auditory canal and the ear drum. In any case, let the doctor know so he can put it in his notes.

  28. Dave Hunt says:

    I find this all very interesting.
    My wife was diagnosed with MS in 2000. She has decompensated significantly since that time. She was diagnosed with Remitting recurring MS but I believe that she has now gone to the next level as she never seems to get any relief at any time from the disease.
    A little history on her. She was a hairdresser by trade. She spent most of her work days on her feet working in our salon. She collapsed at work one day and was never able to return. Her symptoms included some visual problems, lack of feeling in the extremities, weakness in her legs, coordination problems, extreme fatigue and bladder problems. Some of the symptoms would come and go over time, but now they have persisted continuously. She had some relief through the time that she was pregnant, but other than that she has become progressively worse.
    I find it interesting that you mentioned trauma. She was involved i a motor vehicle accident only a few years before her symptoms started to appear. She was actually thrown into the roll bar of a jeep, upon impact. She had recieved several stitches to close a wound on her forehead as well as a mild concussion.
    To move forward here. We had gone for the CCSVI screening and she was considered a good candidate for the treatment. It was reported that she has %95 blockage in her left jugular and about %50 in her right.
    We then went for the procedure in Cosa Mesa California. There were some problems throughout her procedure. The Doctor had one of the balloons rupture in her left jugular as they attempted to open the vien. They then used a larger balloon and were successful in openning the vien. This was explained to us as being “normal” in all respects.
    As for the results of her surgery, she was feeling quite a bit better for the first three weeks. She was able to look down while being a paasenger in the car. This was something that she was never able to do. She had noticeably increased energy levels. She was able to walk short distances without aid. Her bladder had better function. She was able to feel her extremities for the first time in a long time. Her “cloudiness in the head’ went away completely. All seemed to be going great for about three weeks.
    I noticed an almost immediate change in her one day. She was decompensating very quickly. The first indication was a severe mood change. She then started to develop the dragging of her foot again, followed by bladder problems and extreme fatigue.
    We went back to the imaging center in Vancouver to get a follow up scan done. The new scan showed that she had %100 blockage in her left jugular. They told us that she had developed a blood clot in the left side? This of course has caused us alot of concern. We have contacted the Doctor that performed the surgery and he has put her back on some blood thinners to see if we can disipitate the clot??
    I am not so sure that I understand enough of this whole disease and treatment to form any educated answers to the problems?
    Anyhow, I was hoping to return her for another attempt at clearing the jugular, but she, and the Doctors seem hesitant to do this yet? I am hoping that you could shed some light on your thoughts surrounding this very frustrating situation for me?

  29. The good response on dilation and the dramatic worsening with re-occlusion of the left internal jugular vein shows that this re-occlusion ought to be overcome as quickly as possible.
    No blood thinner is able to dissipate a blood clot.

  30. Hello Dave,

    You mention the following regarding your wife’s history. “She was a hairdresser by trade. She spent most of her work days on her feet working in our salon. She collapsed at work one day and was never able to return. Her symptoms included some visual problems, lack of feeling in the extremities, weakness in her legs, coordination problems, extreme fatigue and bladder problems. Some of the symptoms would come and go over time, but now they have persisted continuously. She had some relief through the time that she was pregnant, but other than that she has become progressively worse…She was involved in a motor vehicle accident only a few years before her symptoms started to appear. She was actually thrown into the roll bar of a jeep, upon impact. She had recieved several stitches to close a wound on her forehead as well as a mild concussion.

    Several chapters in my book cover MS and trauma. You can also find more information on my website Your wife most likely misaligned her upper cervical spine when she struck her head on the roll bar. Misalignments and malfunction of the upper cervical spine can affect blood and CSF flow going in and out of the brain. It can also compress nerves and nerve pathways. It would be very inexpensive, minimally invasive and most helpful to get x-rays of her cervical spine. It would be even better to get specific upper cervical x-rays. It’s hard to imagine how she didn’t hurt her neck when she struck her head.

    Dr. Flanagan

  31. Useful, even helpful information might be additionally derived in correlating these cervical x-rays to an MRV according to Mark Haacke’s CCSVI protocol (free download, best done on good 1.5 and 3 T MR scanners).

    Franz Schelling

    • Drs Flanagan says:

      I couldn’t agree more Dr. Schelling. Dr. Woodfield of the National Upper Cervical Research Foundation and myself met with Drs. Haake, Dake and Mehta in Albany last fall to discuss incorporating plain veiw x-rays and possibly upper cervical and other methods of corrective intervention of the spine into Haake and Zamboni’s protocols. The additional cost would be miniscule and the risks negligible. Spondylosis, scoliosis, stenosis and upper cervical disorders affect the vertebral veins, arteries and subarachnoid space. Combining plain view x-rays and corrective care of the spine where appropriate could decrease the failure and restenosis rates of vascular intervention while improving the outcomes significantly. Many cases need co-management.

  32. Thank you for this remarkable widening of the horizons of both MS and CCSVI-research.
    What seemed utterly amazing to me, in these respects, was mainly this:
    In evaluating MR pictures of MS patients hardly anybody seemed as yet to care whether the patient’s lesions
    (1) exceeded from veins or venules,
    (2) were limited to venous or arterial territories,
    (3) were related to CSF spaces confined within or bathing cerebrospinal structures, of
    (4) spread exclusively/preferentially in gray or white matter, subcortically, or evenly over different/all tissue domains.
    In being, rather inconsistently, defined in trivial dysfunctional, characterized in trite histopathologically, and understood in non-specific immunological terms, MS appeared thus as chimera without any concrete physical identity.
    MS might thus, be transformed from a purely notional into a bodily identifiable disease entity.

    • Drs Flanagan says:

      1)I think your theory of venous backjets make the most sense in explaining the classic periventricular, perivenular and supratentorial lesions seen in MS. The layout and capacity of the cranial vault affect the way the brain reacts to inversion flows. This may explain the difference in incidence between races and genders due to the layout and capacity of the cranial vault. 2)Personally, I suspect certain cases of MS are actually migraine variants related to arterial problems. 3)Anything that impedes drainage of the brain likewise impedes CSF and interstitial fluid flow in the brain. This can lead to chronic cytotoxic edema and low pressure problems such as NPH which can damage the brain the same as glaucoma. 4)As you discuss in your book, MS isn’t simply a disease of myelin. There is much more to the puzzle. It may actually start in the nerve. Interestingly, the latest research shows that Alzheimer’s may start in the myelin. It appears that myelin is particularly sensitive to ischemia, cytotoxic edema and NPH. Poor blood and CSF flow is a likely cause. Venoplasty and specific upper cervical correction can improve blood and CSF flow in the brain.

      I think you come the closest to defining what classic MS is and what it isn’t based on the presence of sclerotic lesions. The problem is in categorizing patients without classic lesions or demyelination such as optic spinal MS and Devic’s disease.

  33. > Venoplasty and specific upper cervical correction can improve blood and CSF flow in the brain.

    … here we are called upon to precisely spot those instances of MS which are thus to be reliably helped, i.e. in which substantial improvements will be predictably achieved. More specifically, we need to learn, to which extent venoplasty and upper cervical correction are helpful in, inparticular, Carswell’s “peculiar diseased state (PDS)”, hypertensive hydrocephalus, or combinations of both.

    Regarding optic spinal MS and Devic’s disease, the critical task might be to find out whether their lesions do in fact correspond to Carswell’s PDS, or whether they do not.

    • Drs Flanagan says:

      Fortunately, we now have brain scans, duplex ultasound, MRA and MRV to help determine who will benefit from vascular intervention and specific upper cervical. Upright MRI will further improve findings and cine MRI is on the horizon.

      I suspect that optic neuritis, optic spinal MS and Devic’s may be due to displacement of the brain within the cranial vault similar to a Chiari malformation. Head tilts and misalignments create chronic compression, tension and shear stresses within the vault. The optic canal is particularly susceptible due to its design and location. Chiari malformations affecting the foramen magnum can interfere with blood and CSF flow between the brain and cord. They also increase surrounding fluid (CSF) pressure on motor and sensory pathways in the cervicomeduallary cord. Displacement of the brain within the vault as in Chiari malformations may explain the signs and symptoms of optic neuritis and transverse myelitis seen in MS, optic spinal MS and Devics.

  34. Thank you for alerting to be potential of cine MRI.
    Used in conjunction with venous and CSF flow monitoring, it should allow to track (part of the)venous dynamics involved in the emergence of MS symptoms, schizophrenia, ALS/Lou Gehrig’s disease, venous root compression syndromes of trigeminal neuralgia, retinal periphlebitis, Eale’s disease …………………………………………………………………………………….. if these MR techniques were exploited not just with cardiac/(arterial) pulse but also with respiratory and exertional gating.
    Thirty years already, I keep dreaming from somebody who might be bold and gifted enough to achieve some steps in this direction (complementing an early Harvard achievement (see lowermost link on the frontpage of

    • Drs Flanagan says:

      I have been waiting a long time for upright MRI as well. Upright posture poses physical challenges and potential problems to brain blood and CSF circulation. Dr. Noam Alperin of the University of Miami is currently working on upright cine MRI which includes arterial and respiratory gating.

      • Hi Dr Flanagan, I would like to add that if Upright posture poses problems to brain blood and CSF circulation, why have humans excelled more than any other species? Why has our bipedal development enhanced our capacity to learn more than any other species? Surely we should be asking how has our CSF and brain circulation benefited from the effects of gravity and does gravity have an equal affect on descending and ascending fluids within the body? We should also ask how evaporation from the respiratory tract affects blood density in the arteries when we exhale?

      • Hello Andrew,
        It’s good question but a lenghty topic. I discuss some salient points regarding the size of the human brain and intelligence in my book, The Downside of Upright Posture – The Anatomical Causes of Alzheimer’s, Parkinson’s and Multiple Sclerosis.” In brief, anthropologists contend that upright posture enhances brain circualtion, which includes CSF flow, and thus contributed to the size of the human brain. Anthropologist Dr. Dean Falk further attributes the size of the human brain to its enhanced cooling capacity, which is called the radiator theory. For the most part upright posture and bipedalism are very efficient and obviously successful as a way of getting around for our species judging by our numbers. Upright posture, however, comes at price. Among other things, upright posture is associated with weak neck muscles. It also places the spine under compressive loads. This makes humans susceptible to whiplash injuries and degeneration of the spine. Upright posture also predisposes humans to Chiari malformations and bipdealism makes us susceptible to falls. Chiari type malformations, injuries and degeneration of the spine can effect blood and CSF flow in the brain and cord, which can lead to neurodegenerative conditions and subsequent diseases.

  35. Thank you for this encouraging news!

    • Drs Flanagan says:

      Alperin’s research interests are in idiopathic intracranial hypertension, normal pressure hyrdrocephalus and Chiari malformations. His research dovetails beautifully with your theory and Zamboni’s theory regarding inversion flows. As far as the exertional studies you suggest, I think he may have added Valsalva maneuvers to his research as well. Alperin’s research also dovetails with my theory so I sent him a copy of my book which he skimmed through. His reply was, “You did an outstanding job. Like you we believe venous drainage plays a significant role in the regulation of ICP.” He will soon be working with NUCCA on a migraine study. It would be great if there were a way to bring all these experts and pieces together.

  36. I am confident the efforts of all of us could be bundled so as to amount to the long-desired breakthroughs in MS, schizophrenia, hydrocephalus research ….. if we but could agree to start our discussion from what has most consistently been hailed as the first substantial documentation on MS: Carswell’s “Peculiar diseased state” (in an attempt at closing the gap still yawning between TJ Murray’s “Robert Carswell: The first illustrator of MS” in ‘The International MS Journal’ 2009; 16: 98-101 and AD Gean-Marton ea’s “Abnormal corpus callosum: A sensitive and specific indicator of multiple sclerosis” in Radiology 1991; 180: 215-221.
    Is it really possible to find some equally hard touchstone, some nearly as basic piece of evidence, some similarly pivotal point of reference for testing the value of our work?
    If you think there is any: Please, I implore you, please tell me which!

    • Drs Flanagan says:

      It makes sense that the corpus callosum is affected in MS. The ventricles are the pistons that drive cranial hydrodynamics. The piston is primarily driven by cardiorespiratory waves. The corpus callosum takes the brunt of faulty cranial hydrodynamics. If CSF volume drops they get compressed as in slit ventricles. If volume goes up they enlarge as in NPH. Chronic tension, compression or shear forces can damage the corpus callosum. It’s also a watershed area where circulation is easily compromised.

      The increase in intracranial pressure and CSF volume that occur during systole and expiration are vented into the upper cord via the foramen magnum and upper cervical spine through the central canal and the subarachnoid space. Intracranial venous anomolies and structural hypoplasia of foramen etc., can affect the capacity of the venous drainage and CSF venting system. In certain cases extra-cranial upper cervical misalignments, spondylosis, stenosis and scoliosis can cause back pressue in the accesory drainage system of the brain as well as the CSF venting system. Inadequate venous drainage and CSF venting causes chronic stress in the ventricles and corpus callosum during cardiorespiratory expansion cycles.

      It also makes sense for the same reason that the supratentorial, periventricular and perivenular areas of the large dural sinuses are effected by either acute backjets, such as from trauma, or chronic inversion flows due to poor drainage and inadequate CSF venting during cardiorespiratory expansion cycles.

      I believe there is a unifying theory regarding MS and other neurodegenerative diseases related to faulty cranial hydrodynamics in humans as a result of upright posture. Upright cine MRI, MRA and MRV as being done by Alperin test the brain when it faces its greatest challenges to blood and CSF flow during upright posture.

  37. Can we agree that there is no other way to understand the surging up of smooth and peaked lesion waves into the corpus callosum than by venous flow inversions?
    Then we have to become clear about what causes these flow inversions, and along which ways do they become effective.
    Regarding Carswell’s specimen there yet remains another question to be answered: Which physical forces account for the bizarre forms of (apparently concurrent) lesion spread in the spinal cord?

    • Drs Flanagan says:

      In addition to venous inversion flows I suspect that sluggish or insufficient venous outflow due to chronic venous back pressure impairs CSF venting which causes cardiorespriatory expansion waves and increased intracranial pressure to be reflected back towards the corpus callosum through the ventricles and CSF.

      One of the most likely source of acute violent destructive backjets into the brain is whiplash. People living in northern climates are much more vulnerable to winter related whiplash type injuries due to slips and falls on ice etc. The design of the short base of the European skull combined with prognathic face make Europeans more susceptible to inversion flows that reach deep into the core of the brain by way of the straight sinus.

      As far as cervical lesions of the cord are concerned, I think one of the causes you suggest in your book makes the most sense. Violent traumas such as whiplash cause hyperflexion of the head and neck which strains the brain and cord to its extreme limits within the cranial vault and spinal canal. Shear forces develop within the cord at the interface of the dura, arachnoid and pia mater which accelerate and decelerate at different speeds. This strains the attachment points of the dentate ligament of the cord. The whiplash motion of the spine also sets off a tidal wave of venous and CSF inversion flows. The sudden, rapidly accelerating force of the CSF flowing backwards towards the brain through the subarachnoid space significantly amplifies the strain on the dentate ligament. This can lead to tears and subsequent formation of scars at the attachment points.

  38. Steve Williams says:

    Hi all
    A little of my history- 44 years old, symptoms 19 years, diagnosed for 9. Mild compared to others, heavy legs, lots of tingling. Vegan two years, Swank diet 9. I work out with weights and fear this causes issues as I have a Patent Foramen Ovale. Holding your breath (as you do momentarily when lifting weights or otherwise straining) can cause de-oxygenated blood to circulate via the PFO, i.e. unfiltered by the lungs. No CCSVI according to AMED’s Poland. Big head! Jutting forwards unless I make an effort, 6’4″, 210lbs. Mild Scheuermanns condition of spine.
    I desire to be cured! Suggestions please?!

    • Hi Steve,
      I need more information regarding your history, spinal x-rays and brain scans etc. Nonetheless, I suspect that your large frame and the Scheuermann’s deformation of your spine are playing a significant role in your present condition. In addition to the spine, the forward position of your head due to the kyphotic Scheuermann’s deformation also strains the cord within the spinal canal. The strained position of the cord can compress the contents within the spinal canal, especially the vertebral veins which drain the brain during upright posture. Specific chiropractic care of the upper cervical spine may be helpful in your case. Special spinal decompression tables can also be helpful. Let me know if you would like additional information.

      Dr. F

  39. Steve Williams says:

    Thank you very much, that makes a lot of sense! Please explain to a layman- “The strained position of the cord can compress the contents within the spinal canal, especially the vertebral veins which drain the brain during upright posture”. How do the vertebral veins get impinged by pressure on the cord? I shall look up some basic anatomy!

  40. Steve Williams says:

    Thanks for that but please could you reply in plain text. Regards, Steve.

  41. Aldo Alessi from Italy says:

    The theory of anomalous brain blood flow and bad brain cooling for MS is fascinating !!! I have another idea linked to MS. I think MS get a balance by destroy myelin and then stopping movements of legs because in this way it realizes low blood pressure and temperature in the brain !!!! Human being try to save himself !!!!
    What do you think about my idea?

  42. Linda says:

    I recently joined an MS Study with Dr. Raymond Damadian and Dr. Scott Rosa, both in New York. This has been an extremely interesting sight and I would love to share my experience so far. This seems to me to all be related..since I also seem to get some relief just by taking aspirin and laying down. Please give me feedback if you have any.

    Dr Raymond Damadian from Fonar Corp ( recently published a study re MS. He feels he has identified the cause of MS. (his study can be accessed by going to This is personal to me because I have MS.

    Dr Damadian is the original inventor of MRI. I worked as a stock broker for the underwriter which brought his company public in 1981. I was quite impressed with his technology. As a witness to the the ridicule he was subjected to then, I later watched all the large medical companies steal his technology. Eventually, he sued them for patent infringement. GE took it all the way to the Supreme Court…Fonar won. With his winnings, he developed the Upright MRI. Among other attributes, it can perform images in the position of gravity.

    The significance of this is to make you aware of his recent study. It was the development of the MRI that made it possible to see the scarring of the myelin coating on the nerves of people with MS which I’m sure you all know. Dr Damadian has a new head and cervical coil which along with software, has allowed him to see blockages in the CSF flow in the cervical area. He has been able to measure CSF flow rates and CSF pressure in the brain. His study describes excessive CSF pressure in the brain as a result of these blockages in the upright position in people with MS which is not present in the recumbent position. (Normal people dd not have this) He has also witnessed leakage of CSF around the ventricles in the brain. It is the leakage of the CSF that he feels is the cause of MS. (CSF is made up of water and proteins, several being antigens. These antigens lead to the creation of antibodies that attack the myelin coating on the nerves.) If the blockages are opened up, the leakage of CSF stops. The brain heals itself.

    In addition, he feels there is a benign, non invasive and relatively inexpensive way to open up these blockages

    I made the trip last February and the following is a summary of my experience:

    I just got back from New York on March 1st. Dr Damadian along with Dr Larry Minkoff (the first human ever to be scanned by an MRI) spent many hours directing the scans on my friend and me…I had about 10 hours myself in the scanner. They both analyzed the results. We both had blockages of CSF flow through the cervical spine area and showed leakage around our ventricles in the brain. Mine showed all four ventricles had leakage. I also found out I had scoliosis in the neck and lumbar spine. It was so cool to watch the most leading research scientists in the world consulting for hours over our images. We then went to be treated by Dr Scott Rosa in Rock Hill, NY. That was just as incredible. Dr Damadian came with us…about 3 hours away and Dr Rosa was just as brilliant as the other two doctors. He did his adjustments on my friend and me using an atlas orthogonal device…and I felt nothing! This was the most non invasive procedure known to man. We then were re scanned by Fonar and my neck was in perfect alignment, opening the CSF flow. (My atlas disk was diagonal and rotated and my C2 was rotated before the procedure. After… everything was perfect.) Now, I am going to keep a journal on how the healing goes. They expect the process to take about a year. We will be going for periodic adjustments here in Denver to a chiropractor under Dr Rosa’s direction, to make sure we stay in alignment. Dr Damadian and the other doctors are pretty sure that Parkinson’s, Alzheimer’s, even ALS are related to this same issue. I’ll let you know how it goes. Linda
    I have already seen some results. This is significant since I was at the slow progression stage of MS for nine years. My shoulder and neck were in great discomfort. That was gone as soon as I was adjusted by Dr Rosa. I was having some eyesight issues that had prevented me from driving due to kaleidoscope vision when I turned my head. That has been corrected and I can now drive again. I am getting some feeling back in my fingertips…which had been numb for years. Also, I am starting to have some feeling in my abdomen. I have been numb through my abdomen for many years. The real test is to get my balance and ability to walk back. I am more optimistic than I have been in so many years….and I feel so privileged to get the opportunity to be part of his study.

    Sincerely, Linda La Rowe

    • Hi LInda,
      Thank you for your sharing your story. I have sent multiple sclerosis and Parkinson’s cases to several of Dr. Rosa’s studies. It is my opinion that spondylosis (degeneration), scoliosis and stenosis of the spinal canal play a role in the caue of MS. This is due to the fact that degenerative changes of the vertebrae, cartilage and connective tissues can invade the spinal canal. In addition to degenerative changes, abnormal curvatures such as scoliosis and kyphosis and narrowing of the spinal canal compress the epidural space which contains the vertebral veins. The vertebral veins drain the brain and cord. A decrease in flow through the vertebral veins affects blood and CSF flow in the brain and cord. Chronic decreases in blood and CSF flow in the brain and cord can initiate neurodegenerative processes. Over time, it can cause neurodegenerative conditions such as Alzheimer’s, Parkinson’s, multiple sclerosis and amyotrophic lateral sclerosis (ALS).

  43. Steve Williams says:

    I have mild MS, DX 10 years ago. 20 years ago I was DX’d with Scheuermanns Degeneration in my spine. I have always believed there is a connection. Thank you for your work and website.

  44. Jackie says:

    I am interested in any information regarding new treatments available for Parkinsons. My dad was diagnosed at 43 years old – was never sick with anything. He has been involved in two research brain surgeries in Calgary, Alberta. The first was very successful and the second set him back many years. He will be 70 next month but has been a little old man for many years now. We are still hoping there is something out there that he can try!

    • Hi Jackie,

      I apologize for taking so long to reply but for reasons unknown sometimes my replies don’t get posted.

      There are new therapies on the horizon. One option that needs further exploration is upright anatomical and cine blood and CSF flow MRI studies. Upright anatomical studies are good for structure analysis such as alignment and connective tissue damage etc.. Cine blood and CSF flow studies show if there are any obstructions to flow such as due to an acquired Chiari 1 type malformation for example. Specific upper cervical correction and other methods of spinal alignment and decompression are considerations for care that can be used in conjunction with current care. Unfortunately, your father has had the condition for quite some time so there is most likely permanent damage. Nonetheless, it is worth getting x-rays of the spine, especially, specific upper cervical x-rays, as well as upright MRI and if possible cine MRI.

  45. Dr Omid says:

    Hi Dr Flanagan,

    I’m an upper cervical doctor myself and looking for some research I can get my hands on to show to some medical doctors I have been engaged with. Where do you suggest I begin?

    By the way, I love the book and the blog! Your work has been very enlightening and is an invaluable resource to my practice. Thank you!

    Quick question on craniopathy, what program would you suggest to use as an adjunct with upper cervical? The ones I know of are AK, SOT and Craniosacral. Which one would you think would be more comprehensive for cranial work?

    Thanks again

    • Hello Dr. Omid,
      Thanks for the compliment. You can suggest that medical doctors read my book. I wrote it for laypeople which makes it easy for professionals. You can also suggest they read research by Dr. Dean Falk on the role of the VVP in humans and upright posture; extensive research by Dr. JE Eckenhoff on the physiological significance of the vertebral venous plexus; Dr. Alfons Schelling’s lifetime of research into the the role of venous drainage in Multiple Sclerosis; Dr. Paulo Zamboni’s recent theory regarding the role of the venous system in MS, Dr. Mark Haake’s imaging studies on CCSVI; the research of Dr. Thomas Milhorat on on Chiari malformations and tethered cords; the research of Dr. Raymond Damadian into the connection between trauma and multiple sclerosis. There is much more as well and be sure to stayed tuned for further research being done by Dr. Scott Rosa and Dr. David Harshfield Jr. using upright MRI and cine blood and CSF flow MRI into the role of craniocervical structural abnormalities in maldirected blood and CSF flow in neurodegenerative diseases.

      There is no easy answer to your question regarding craniopathy or craniosacral except that when applied properly it is easy to incorporate into and complements upper cervical work. Craniopathy and cranial molding are fantastic for infants. My craniopathy and craniosacral is a hybrid based on years I spent in AK. What I got from AK was the importance of muscle testing as well as postural analysis and integration of systems. David Walther’s volume 1 and 2 are terrific. When it comes to the pelvic module I prefer DeJarnette’s method of category analysis using crest and dollar signs as well as medial and lateral knee palpation and psoas testing etc.. I had been doing craniopathy for awhile when I significantly improved my feel for it one day in a basic SOT craniopathy class I took many years ago. Out of the plethora of possible maneuvers I use just a select few of the classic base, face, vault and circulatory maneuvers based on McGouns work and what I learned from AK and SOT. The biggest problem with craniopathy is the highly subjective and disorganized approach many doctors use. The strain positions they describe are difficult to validate or duplicate with different doctors. I base my craniopathy in large part on my training in upper cervical listings and lines of correction. Craniocervical structural strains are easy to validate on x-ray and MRI.

  46. Aldo Alessi says:

    Hi Dr. Flanagan,
    the theory of anomalous brain blood/CSF flow and bad brain cooling for MS is fascinating !!! I have another idea linked to MS. I think MS get a balance by destroy myelin and then stopping movements of legs because in this way it realizes low blood pressure and temperature in the brain !!!! When MS rise up, in some manner, reaction of human being try to save himself !!!!
    Ms creates a loop !!!
    What do you think about my idea?

    • Hello Aldo,
      I don’t think that destroying myelin and causing weakness in the legs brings the system into better balance. There is no benefit to the brain or body from destroying myelin or causing muscle weakness. The damage is most likely the result of chronic ischemia (decreased blood flow), chronic edema (swelling) and chronic increases in CSF volume and pressure in the brain (normal pressure hydrocephalus).

  47. Aldo Alessi says:

    Hi Dr. Flanagan,
    you are right, but I think brain, after primer phase, feels benefit from destroying myelin, because the patient can’t run and therefore low blood pressure and low body temperature can’t damage (more important!) neurons and they slow other brain damages too.
    Why, otherwise, immune system doesn’t recognize myelin damages and it doesn’t stop?
    Why MS patients suffer hot climate?
    Thank you very much for your attention.
    Best Regards.

  48. Hi Mr. Alessi,
    Speculation will never find an end. I think we ought rather have a closer look on what has actually been seen in MS – either at post mortem or on (serial) MRI.

    • Hello Dr. Schelling,
      It is nice to hear from you. Your comments are always appreciated. I have had the opportunity to review some interesting upright MRI and cine CSF flow studies of cases of multiple sclerosis and Parkinson’s. The studies are being done by an Atlas Orthognoal upper cervical chiropractor Dr. Scott Rosa in Latham, New York with the help of Dr. Raymond Damadian and the FONAR Corporation. In addition to other findings such as obstruction to blood flow, all of the cases so far have been associated with Chiari 1 type malformations (cerebellar tonsillar ectopia) causing obstruction and maldirected CSF flow. The turbulance from the CSF flow batters the brainstem and cerebellum. In some cases it caused erosion of the cranial vault. I will be writing more about the studies soon.

  49. Hello Mr (suppose you are neurosurgeon) or Dr. Alessi (if you are neurologist),
    Great to learn about your CSF flow studies in MS and Parkinson’s. Please could you tell me whether you also used respiratory gating? Have been looking for such CSF flow mappings since 1985 -reason for my grappling with MR technique from 1986 to 2002.
    Best wishes, especially also to Dr. Raymond Damadian. Read about his achievements and was fascinated meeting him in Berlin in 1986!

    • Hello Dr. Schelling,
      The upright MRI and cine CSF flow studies are being done by Dr. Scott Rosa. Dr. Rosa is an Atlas Orthogonal upper cervical chiropractor. Dr. Rosa met Dr. Damadian sometime around 2005. Dr. Damadian and FONAR later developed the special coils for imaging the craniocervical junction as requested by Dr. Rosa and Dr. Chu developed the software for cine CSF flow imaging. Dr. Damadian has also sent patients to the study. The gaiting or trigger used for the cine CSF flow images are the cardiac cycle. After several unsuccessful attempts at locating the trigger they found the fingers work the best.

      Michael Flanagan D.C.

  50. I have read Dean Falk’s work and watched the video on TV when it was first broadcast, this prompted me to write to Michel Cabanac, who was the person that discovered bloodflow through emissary veins can flow in both directions, reversing when evaporation and heat loss through exercise increased. Falk attributed this to the brain deciding to reroute the flow to cool itself. This is an assumption on her part as it is unsupported by the lack of valves that could be attributed to reversing blood-flow. The brain cannot decide where it wants to send blood and this was discussed with Cabanac and sent to Falk who never replied.

    When evaporation increases through respiration rate change and heat loss through the head during Cabanac’s brilliant exercise experiment which showed blood flow reversal back from the skin through the emissary veins, he had confirmed that changes in blood density due to evaporative heat loss would be sufficient to overcome the normal flow from the heart and that the denser blood would take the most direct path with the least resistance towards the ground and this would create a molecular drag pulling the blood that would normally flow over a T junction back through the holes in the skull.
    Falk identified the change in the location of the holes in our skull as migrating towards the top of the head when we stood vertical, comparing earlier skulls (foramina)

    The error which is a grave one rests upon the literature that states: Gravity acts equally on the blood and fluid in the ascending and descending limbs of the circulation so therefore cannot influence circulation either negatively or positively.
    I don’t buy into weak neck muscles resulting from bipedalism either, there is ample evidence that neck muscles can become extraordinarily strong. The whiplash injury point is valid as one would expect a difference in injury to a spine place horizontally. But then there is the problem with the woodpecker which like ourselves stands vertical and exhibits banging its head against a brick wall in much the same way as I have since the end of 1994 when I too embarked on an unpaid research journey into neurological conditions that continues today.

    The compression load on the spine has been increased by women carrying huge clay pots filled with water, fuel for fires and food by woman in developing countries for thousands of years. So it may not be as clear cut as one might think.

    Take the degeneration of our bone structure for example. NASA and the former USSR space programme have been researching the accelerated degeneration of muscles and bone and comparing it to age related degeneration on earth. In order to make this comparison they embarked on confining healthy people to flat bed rest and head down bed rest, which replicated the accelerated de-conditioning found in astronauts to an extent.

    If standing vertical was responsible for spinal column degeneration, wouldn’t sleeping flat improve rather than accelerate this?


    • Hello Andrew,
      This is not a defense or in depth discussion of Dr. Falk’s radiator theory. Blood flow through the emissary veins is most likely determined by environmental conditions that cause skin pores to constrict or dilate. Surface cooling is further enhanced by sweating which draws by sodium concentration gradients. The emissary veins are just one part of the cooling system. The facial veins are the largest part. The facial veins cool the cavernous sinus which acts as a countercurrent heat exchanger that cools the incoming blood in the internal carotid artery. Emissary and scalp veins cool the suboccipital cavernous sinus (posterior atlantooccipital membrane) which similarly cools incoming blood in the vertebral arteries. The much smaller size and fewer emissary veins on the cranial vault most likely assist cooling the top of the skull and brain depending on environmental conditions and concentration gradients from sweat. The diploe further assist brain cooling. The emissary veins of the cranial vault help to cool the diploe.

      The human neck muscles are indeed weak relative to the size and weight of the skull. The upper cervical vertebrae are small compared to the size of the head and the extensor muscles leave very little bossing on the skull. The neck flexor muscles are very weak. Forensic evidence of whiplash trauma cases underscore the weakness of the human neck and its susceptibility to trauma. Upright posture, bibedalism and a relatively tall body pose challenges for balance and make humans susceptible to slips, falls and whiplash injuries.

      The topic of gravity free environments is far to lengthy to get into here. Astronauts face many physiological challenges including inversion flows in the brain. As for the spine, gravity shapes and strengthens the bones on earth but it also wears them down over time as internal struts called trabecula weaken with age (osteoporosis) and start to collapse. More than bones, however, it is the discs or cartilage of the spine that get compressed during upright posture due to loss of fluids. Sleeping supine allows recovery of lost fluids. Movement, especially bipedalism, however, is healthy for the cartilage compared to static loads as it facilitates imbibition of fluids.

      • tigerkewly says:

        Hello there Doctor, please can help me?
        I have had Ms now for over 14 years and I can still walk and drive but all of my friends just keep going downhill with their MS! So what do they need to take or to do to stop it going overboard?

      • Hello Tiger,
        I apologize for missing your comment previously and not responding sooner. One of most important things to do to slow down neurodegenerative processes in MS is to get control over any underlying strutural issues that may be straining the skull, spine, brain and cord, as well as obstructing hydrodynamics of blood and CSF flow in the cranial vault and spinal canal. I suspect tha many cases of MS are related to trauma. My opinion is that all patients with MS should have x-rays of their spine and complete functional orthopedic and neurological examination. High quality care of the spine by an experienced doctor who understands the pathology and uses appropriate methods for correction and rehabilitaion of the spine, as well as the connective tissues, along with sound physiotherapy tailored to the patients particular situation can go a long way in slowing down the degenerative process.

  51. Thank you Dr. Flanagan.
    What has to be realized besides is how differently human veins are impacted upon during bodily activities. And how such impacts may become directed into some particularly vulnerable venous domains of especially the brain.
    No textbook of physiology or anatomy informing on even the most critical facts, the whole subject has never been duly explored.

    • Thank-you Dr. Schelling. I completely agree. While we are just beginning to understand venous flows in the valve-less veins of the brain and cord during various bodily activities on earth interesting studies are being done on astronauts in gravity free environments. Among other things, astronauts suffer from retinal degeneration and syncope, falls and orthostatic hypotension when they return to earth. I suspect the retinal degeneration has to do with inversion flows into the facial veins. This causes venous back pressure against the eye. I suspect that astronauts with acute iridocorneal angles are predisposed to venous draingae problems and subsequent retinal degeneration. Inversion flows and the loss of fluids in space most likely decreases CSF volume in the cord. This causes the brain to sink inside the skull similar to a spinal tap (lumbar puncture) when astronauts return to earth and probably plays a role in falling, syncope and orhtostatic hypotension.

  52. Thank you for your reply Dr Flanagan,

    sodium concentrations at the skin surface, which you point out are indicative of evaporative water loss and fluid density change. Coupled with the cooling of the blood as you point out it is clear that density of the blood has changed by both evaporation and cooling of the blood by evaporative heat loss. It is difficult to imagine how this increased density in the blood will not be affected by gravity.

    The migration of denser blood through the body is through the arteries towards the kidneys where spent salts (salts that have arrived at the kidneys) are excreted via the bladder. This movement from point of evaporation towards point of exit is posture dependent and being vertical we have made more use of it than other species. This gravity improved flow towards the kidneys in upright posture induces a positive pressure in the arteries in front of the falling denser blood and an equivalent decrease in pressure and an applied molecular tension to the blood in the venous return and as the blood in the venous return is obviously less dense than the blood entering the kidneys due to the filtration process, the blood in the returning venous side of our circulation must be less dense than the arterial blood flowing into the kidneys. Therefore gravity cannot act equally on the blood in the veins and arteries and therefore gravity does influence circulation. Do you agree with this?

    • Gravity most definitely effects circulation. The location of the heart and brain above blood reservoirs has a significant impact on circulation. Gravity also influences the direction of blood flow in the valve-less veins. Circulation in astronauts, pilots, and scuba divers are effected by gravity and micro-gravity.

      • Agreed, Now the question remains how can a stenosis form in a soft walled fluid filled tube such as a vein? Could the migration of denser blood moving towards the kidneys be responsible? Could the denser blood even migrate against the pressure and flow from the heart in valveless areas of the body? And could this movement cause the vessels to collapse / narrow as the downward flow induces molecular drag and tension on the blood inside the veins? I suspect that this is plausible and worth further investigation. No one to date has offered a firm explanation of the cause of stenosis and this does fit with the reverse flow of blood in the brain of people with ms, identified by Dr Franz Schelling. I believe that solute movement by gravity in the body plays a major roll in the development of our circulation, long before the heart forms and that cerebrospinal fluid and lymphatic fluid are circulating because of density changes due to evaporation and the cooling effect that evaporation causes and rely on our alignment with the direction of gravity.
        Stenosis CCSVI Experimental model shows blood density / postural origin . Part 2

      • Veins are relatively weak-walled low pressure vessels. Stenosis of veins can occur due to decreased flow. They can also become stenosed due to increased extra-luminal pressure. Reverse flows in the veins can occur due to trauma or other causes that overcome the resistance of the check-valves. They can also occur as result of incompetent valves. Blood flow in the valveless veins is determined by pressure gradients. I like Dr. Schelling’s explanation of violent venous back-jets as a potential cause of reverse flows in the venous system and subsequent lesions. It is the best explanation so far for the supratentorial, periventricular and perivascular location of the characteristic lesions seen in MS. Solutes in blood and CSF is too lengthy a topic to get into here. I will cover it in my next book.

  53. justincamp says:

    I had come to this blog for gathering information about Multiple sclerosis, But i have learnt a lot of things from comments 🙂

  54. Dear Dr. FLanagan,
    Maybe your forthcoming book can tell its readers that oligoclonal bands seen in MS are no different than those observed after brain trauma, infarction or infection.
    From peracute, concentric or Marburg-type MS it is obvious that the lesion developments precede the immunological reactions.

    • Dr. Schelling,

      Thank-you again for your expertise and valued input. In addition to your point that lesion developments precede the immunological reactions such as the O-bands seen in CSF, some studies suggest that O-bands, bacteria, viruses, immune and inflammatoy agents may accumulate in the brain and cord in certain cases of neurodegenerative disases due to sluggish CSF flow and decreased “wash-out.”

      Congratulations on your new book CCSVI in MS: Weighing the Findings. I learned a great deal from your first book. I look forward to reading and hope to learn more from your new one.

  55. I think in there are still a few problems with the reordering and labeling of the illustrations which need to be sorted out. Please do not shun from telling me about such.

  56. Aldo Alessi says:

    Hi, Doctor Schelling, have you think about inner high temperature of brain as a possibile primary or secondary cause of inflammatory reaction of immune system? I know the brain produces heat like a computer CPU and it must be efficiently cooled. Do you think the hypothetical reduced of CSF flow and/or vein drenage can affects brain cooling too?
    Thank you very much.

  57. Hi, Aldo: In hypertensive hydrocephalus & intracranial venous obstructions the obstacles to cerebral venous and CSF drainage are far more severe. The same is true after bilateral neck dissection. Nobody ever noticed a warming of the patient’s head under such circumstances. MS lesions which are caused by a lashing back of venous blood into cerebral lesion veins will far earlier produce inflammatory reactions (as is evident from leg ulcers) than the tiny rises in temperature which might attend the problems with blood or CSF circulation observed in CCSVI.

  58. Aldo Alessi says:

    Thank you Franz for your good explaining, I agree to you. But I think the human being is a very very complex and self-curing “machine” with smart intrisic balance; one tiny problem like that normally doesn’t cause ms, but in patient with a sort of genetic predispotion (weak BBB or impossibility to workaround the problem by other manner) could cause ms.
    It’s possible or not in your opinion?
    Another argument to make a brainstormig is ms latitude distribution. Can distribution were connected to minimal gravity variations?

    • Aldo Alessi says:

      … or could be latitude distribution connected to body adaptation to climate. In southern areas, in fact, humans developed evolutionary strategies to better defend from excessive heat !

  59. In MS, it is the pattern of the damages and their development in time (as it is evident from serial MRI), which point to a plain physical – instead of genetic or microscopic – cause for the MS specific lesion developments.
    The extent to which individual venous patterns depend on genetics … and the veins’ behaviour on temperature (and so also latitude) not only known by phlebologists 🙂

    • Thanks for your insight Dr. Schelling.

      There is one genetic aspect to consider regarding venous backjets. The design of the cranial vault and layout of the brain are affected by race and gender. We inherit the design of the cranial base and face. The base and face of the skull influence each other’s development. There are significant racial differences in the design of the face. I suspect there are similar differences in the base, especially the posterior fossa.

      Skulls in females start to close sooner and they have smaller posterior fossas in general. European’s have relatively smaller posterior fossa’s and prognathic faces. The layout of the posterior fossa affects the angle of the tentorium cerebelli and straight sinus. The angle of the straight sinus affects the course, and the force of the back jets that reach the periventricular and perivenular spaces. The prognathic European face affects the swing weight of the head in whiplash. I suspect that Europeans get classic MS lesions due to the design of the posterior fossa and face. Asians and Africans have a lower prevalence of classic MS. On the other hand, Asians and Africans get optic spinal MS or Devic’s disease, which is far more severe and is often associated with transverse myelitis. The difference may be due the way the brain, cord, blood and CSF react to whiplash forces in trauma.

      On a similar note, my theory is that the former indigenous people of Peru and Bolivia passed on skull traits, such as platybasia, for example that predisposed them to hydrocephalus. Tight knit communities perpetuated the design. The shamen of the day used cranial banding and trephination to treat the hydrocephalus in children and adults.

  60. Indeed, our upright doctor. The higher the speed of venous flow inversions, the more all these constitutional factors come into play. Strangely enough, however, even those anomalies of the confluence of sinuses in which even a slower return of venous blood from the neck must far more severely endanger inner cerebral veins are hardly ever taken into account.

  61. Aldo Alessi says:

    Hi Dr. Schelling and Uprightdoctor, I just read about Dan Falk’s Radiator Theory. It’s a fascinanting and amazing theory to explain evolutionary brain cooling and growing.
    I think, we need to study in depth this theory, so it can explains the way MS rise in patient. Sure, I feel myself, brain cooling lack, could be the right way to find the MS etiology.
    Thank you for your attention.

    • Hello Aldo,
      Dr. Falk proposed the Radiator Theory to explain encephalization, which is the large size of the human brain relative to body mass. Anthropologists also suggest that encephalization was due to the improvement in brain blood flow as a result of upright posture and the design of the circulatory system of the brain. Heat intolerance in MS patients is most likely due to the effect of faulty cranial hydrodynamics (fluid mechanics) on the hypothalamus.

  62. Aldo says:

    Escuse me, Uprightdoctor, for my “english”!!! I perfectly agree to you. And I think Dr Falk’s brain cooling expertise could help us to better understand MS patient’s faulty cranial hydrodynamics.

  63. Sorry, the way in which MS lesions fradiate out from the angle of the lateral ventricles is no effect of heat but the result of plain mechanical impacts, Aldo. We had better stick to what we see on serial MRI!

  64. Aldo Alessi from Italy says:

    Dr. Schelling, cany you better explain me your point of view about “result of plain mechanical impacts”?
    However I’m sure, MS rises because some parameters go out of range and body reacts (in a wrong way, but body feels it’s all right!). It seems a strange thing, but it is a innovative idea!!!
    Thank you.

  65. Mr. Alessi, please consider which parameters have to go out of range so that lesions develop exclusively along the observed lesions’ leading structures. Any objection(s) against the suggestions given on my freely accessible online ms-info, Orlando presentation, or at ?

  66. Susan says:

    Amazing , My friend had your treatment and felt great for a few weeks. I live in the UK and have Trigeminal neuralgia very badly I was wondering if your treatment would help with that .

    • Hello Susan,
      Trigeminal neuralgia can be due to several causes. One potential cause of trigeminal neuralgia is displacement of the brain inside the cranial vault which cause tension or shear stresses on the trigeminal nerve. Another potential cause is increased pressure or compression loads on the cavernous sinus. Still another cause has to do with the design of the cranial vault and layout of the brain and blood vessels that makes the trigeminal nerve susceptible to compression by arterial pulsations or against the base of the vault. Analysis and correction of malformations and misalginments of the craniocervical junction can be helpful in treatment and management of trigeminal neuralgia. There are other equally effective non-surgical therapies worth considering as well.

      • Microsurgical decompression of particular branches of the trigeminal nerve is the most frequently curing trigeminal neuralgia. Curiously, the question of why and how besides arteries, especially in women, also veins ( do hurt trigeminal and other cerebral nerves has never been addressed.

      • I suspect it has to do with the precarious position of the semilunar ganglia in Meckel’s cave draped over the sharp ridge of the petrous portion of the temporal bone as well as its openings for the entrance and exit of the trigeminal nerve branches. Small changes in the position of the brain inside the cranial vault can affect the dura and adjacent tissues and thus narrow the connections to Meckel’s cave that can impinge the nerve. Another possible cause is venous inversion flows or back pressure in the posterior fossa that alters pressure gradients in the petrosal and cavernous sinuses and thereby increase venous pressure acting on the branches of the trigeminal nerve in the cavernous sinus. Platybasia and decreased brainstem angles may also play a role in trigeminal neuralgia. Females have smaller cranial capacities and less tolerance for blockage or back pressure against the drainage system of the brain.

  67. Our upright doctor, sharing your hunches I can only hope these topics are going to be addressed in due detail without undue delay.

  68. Right, Aldo Alessi – but little though was spent on the question of how abrupt rises in central venous pressure, rising from or via the internal jugular veins, are balanced out with a split confluence of sinuses. More specifically, what happens with a special predisposition for such excess pressure to only burden some particularly exposed cerebral veins.

    • Aldo Alessi says:

      Thank you very much, Doctor Schelling for your replay.
      What do you think about brain long period little-high temperature management ? Can immune system be activated by this one?
      Think of fever … e.g.

  69. We poor frogs had better not continue to stare at the immune serpent, dear Aldo Alessi 🙂 This cannot but prevent us from solving the decisive problems of venous hemodynamics.

    • Aldo Alessi says:

      🙂 thank you for your suggestion, but the two thing are extremely connected! Think how abnormal venus hemodynamics can cause rising of higher temperature in brain and then, as secondary effect, immune attack 😉 ( measurable effect by MR!)
      My theory explains all of MS symptoms and beheviaor and twins mistery too. If MS was only a genetic disease with tendency and abnormal venus hemodynamics why do only 60% of twins get MS? I think about a trigger event (or multiple trigger events) like ordinary fever, sudden hot climate or intensive sport practice; even obstruction of CSF caused by cranio-cervical trauma.
      Abnormal venous hydrodynamics and your backjets only predispose body to activate MS. There are many different causes but one common effect: rising of temperature and its mismanagement…
      Best regards and happy New Year !!!

  70. Dear Aldo, please don’t forget that autoimmune REactions are an ordinary, even necessary scavenging process coming about after any kind of central nervous tissue destruction.
    Central (nervous) fever, on the other hand, is simply a sequel of an irritation of particular nervous structures.

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