Answering the Call
For decades, the call has gone out from military medicine, from veteran service organizations, from the families of operators who came home changed, and from the athletes who retired carrying symptoms no one could explain. The call has been urgent and consistent: find a better answer for mild traumatic brain injury.
Many have responded to that call with treatments designed to make the symptoms more manageable. Medications to reduce the headaches. Therapies to address the emotional dysregulation. Protocols to help the brain adapt to what it has lost. That work matters — and it has helped many people. But it has not answered the deeper question. It has not asked why the symptoms are there in the first place. It has not traced them back to their origin.
This study answers that call differently. After sixteen years of foundational clinical work, we are ready to conduct the first full-spectrum, root-cause investigation into the persistent symptoms of mild traumatic brain injury. Not how to manage them. Where they come from. That distinction is everything.
The Purpose
The purpose of this study is straightforward, even if the science behind it is not: to determine the true root causes of the persistent symptoms that follow mild traumatic brain injury — and to map those causes with enough precision and scientific rigor that medicine and policy can no longer look past them.
We have long known that mTBI involves the brain. Real progress has been made in understanding what blast and impact do to brain tissue — the metabolic disruption, the neuroinflammation, the microstructural changes that advanced imaging is only now beginning to reveal. That science is important and it is real.
But a significant portion of the symptoms that veterans, operators, and athletes carry — often for years, often without response to any brain-focused treatment — do not fully match the brain findings. Headaches. Dizziness. Intracranial pressure sensations. Vision instability. Sleep disruption. Anxiety that feels like the body is permanently locked in fight-or-flight. Emotional dysregulation. Cognitive fog. These symptoms are real, they are debilitating, and they have resisted every treatment protocol designed around a brain-only model of injury.
The science that supports a structural contribution to these symptoms — rooted in the craniocervical junction, the region where the skull meets the upper cervical spine — has been building for years. It has never been put to a definitive, rigorous, head-to-head clinical test. That is precisely what this study is designed to do.
These wounds have been called invisible for too long. The science to explain them is more developed than most people realize. This study is designed to make that science undeniable.
The Scientific Rationale
Why the Craniocervical Junction
The craniocervical junction — commonly referred to as the CCJ — is the anatomical region where the base of the skull connects to the atlas and axis, the first and second vertebrae of the cervical spine. It is one of the most structurally unique regions in the body. Unlike the lower spine, the CCJ is stabilized primarily by ligaments designed to allow an extraordinary range of motion — not to absorb high-force mechanical events. This makes it uniquely vulnerable to the forces involved in blast exposure, repetitive sub-concussive impact, and the acceleration-deceleration events that are inherent to both special operations careers and professional contact sports.
What makes the CCJ so clinically significant in the context of mTBI is not just its mechanical vulnerability — it is its anatomical position at the center of several critical physiological systems simultaneously.
The lower brainstem sits within this region and governs balance, eye movement coordination, swallowing, facial sensation, pain regulation, posture, and autonomic control. The vertebral arteries — which supply blood to the posterior brain and cerebellum — travel through the cervical spine and enter the brain through the CCJ. The jugular veins, which drain deoxygenated blood and metabolic waste from the brain, pass through this same region. Cerebrospinal fluid dynamics and the brain's glymphatic waste-clearance system depend on the openness of this junction. And the proprioceptive input that the vestibular system depends on originates largely from the upper cervical spine.
When the CCJ is disrupted — by blast overpressure, by a career's worth of repetitive impacts, or by the cumulative mechanical forces of special operations service — the consequences do not stay local. They cascade through every system the CCJ governs, producing a wide spectrum of symptoms that have historically been attributed to the brain because no one was evaluating the structure beneath it.
This is not a claim that the brain is uninvolved. It is a recognition that the picture has been incomplete — and that completing it requires putting the structural component directly to the test alongside the best brain-focused interventions available.
Putting the Model to the Test
The central scientific question of this study is not whether brain injury or CCJ dysfunction matters more. It is how much each contributes — independently and together — to the persistent symptoms that define the chronic phase of mTBI.
To answer that question rigorously, we need to be able to isolate each mechanism and evaluate its effects directly. That is the purpose of the three-arm design. By assigning participants to treatment groups that target each mechanism independently — and a third group that addresses both simultaneously — we can observe which symptoms respond to brain-focused intervention, which respond to structural correction, and which require both. The result will be the most detailed and scientifically grounded map of mTBI symptom origins ever produced.
The Study Design
A Three-Arm Clinical Trial
This is a prospective, randomized, controlled, three-arm, parallel-group clinical trial. Four hundred participants — military veterans, Special Operations Forces operators, and NFL athletes with persistent post-concussive symptoms — will be randomly assigned to one of three treatment groups. Each group is designed to isolate and evaluate a specific therapeutic mechanism.
Arm One — Brain-Focused Intervention
Participants in this arm receive hyperbaric oxygen therapy combined with qEEG-guided photobiomodulation. Hyperbaric oxygen therapy increases systemic oxygen saturation, supporting metabolic recovery and reducing neuroinflammation within brain tissue. Photobiomodulation delivers targeted light therapy to specific regions of cortical dysfunction identified through quantitative electroencephalography. This arm evaluates whether addressing the brain's metabolic and vascular needs — without any structural intervention — produces meaningful and lasting clinical improvement.
Arm Two — Structure-Focused Intervention
Participants in this arm receive Advanced Orthogonal upper cervical care. This is a precise, image-guided correction technique delivered by a table-mounted sonic impulse instrument, calibrated to each participant's specific CCJ misalignment pattern as determined by cone beam CT imaging. The instrument-based delivery greatly reduces the human variability inherent in manual techniques, allowing the study to isolate the therapeutic effect of structural correction with scientific precision. This arm evaluates whether restoring CCJ alignment — without any brain-focused therapy — produces meaningful improvement in symptoms that have historically been attributed to brain injury.
Arm Three — Combined Intervention
Participants in this arm receive both the brain-focused and structure-focused interventions in a coordinated treatment sequence. This arm is designed to evaluate whether addressing both mechanisms together produces results that exceed either approach alone — and to identify the participants whose symptoms originate from overlapping structural and metabolic causes.
Who Is in the Study
Four hundred participants will be enrolled across all three arms. The participant population includes military veterans with a documented mTBI diagnosis and persistent post-concussive symptoms, active or former Special Operations Forces operators with blast or impact exposure history and ongoing symptoms, and a cohort from current or former NFL athletes with a history of significant head impact exposure and persistent neurological or autonomic symptoms.
All care will be delivered in the Tampa Bay, Florida region. Specialized SPECT imaging will be conducted at a dedicated facility in Hollywood, Florida.
How We Are Measuring Results
Every participant undergoes comprehensive imaging and clinical assessment at four timepoints: at baseline before any intervention begins, and again at thirty days, ninety days, and six months. This timeline allows the study to track not just whether symptoms improve, but how quickly, how durably, and in response to which intervention.
Assessments include advanced neurological imaging, vestibular function testing, autonomic nervous system evaluation, cognitive assessment, and standardized symptom outcome measures. The imaging protocol is deliberately comprehensive — because the study is designed to map the full picture of the injury, not just the portion that standard protocols have historically captured.
Who We Are
This study is led by a team assembled specifically for the demands of this research — clinicians, neurologists, research architects, and educators who together cover every dimension of what this trial requires, from precision structural correction to advanced brain-based rehabilitation to the regulatory infrastructure needed to produce findings that drive federal policy change.
Dr. Chris Slininger, DC, DCCJP — Principal Investigator. Craniocervical Specialist, Founder of Cerebral Chiropractic Center, Executive Director of the Advanced Orthogonal Institute, and U.S. Army veteran with sixteen years of foundational clinical work in craniocervical junction biomechanics. He leads all CCJ evaluations, Advanced Orthogonal interventions, and the overall scientific direction of the study.
Dr. Emily Kalambaheti, DC, DACNB, FACFN — Co-Investigator. Board-certified Chiropractic Neurologist, Fellow of the American College of Functional Neurology, and Chief Clinical Officer at Genesis Brain Institute in Tampa. She leads all brain-focused diagnostics and serves as clinical lead for the HBOT and photobiomodulation components.
José E. Cabrera — Senior Research Consultant. Twenty-five years in clinical research, regulatory strategy, and quality systems. U.S. Army veteran, 101st Airborne Division. He leads study design architecture, IRB coordination, data systems, and regulatory compliance.
Dr. Chad Billiris, DC, BCAO — Research Director, Cerebral Chiropractic Center. Board-certified Atlas Orthogonal chiropractor, Certified Orthospinologist, and national educator in upper cervical and vestibular rehabilitation. He leads CCJ-side data collection, quality assurance, and publication coordination.
Clinical Partners The clinical infrastructure of this study is built on three specialized institutions. Cerebral Chiropractic Center in St. Petersburg, Florida serves as the clinical home of the study's structural intervention arm — the practice where the Advanced Orthogonal technique has been refined and applied to complex neurological cases for over a decade. Genesis Brain Institute in Tampa provides the brain-focused diagnostic and treatment infrastructure, including qEEG, photobiomodulation, hyperbaric oxygen therapy, and vestibulo-ocular assessment. Amen Clinics, a nationally recognized network of brain health centers and the leading provider of SPECT brain imaging in the country, brings world-class neuroimaging expertise and an unparalleled SPECT database that will provide critical diagnostic depth to the study's imaging protocol.
Together, this team brings the clinical precision, neurological expertise, research infrastructure, and personal commitment to this population that a study of this scope demands. They are not simply qualified to conduct this research. They are the right people to do it.
Strategic Impact
This study is not designed to add one more paper to an already crowded literature. It is designed to produce findings of sufficient scientific weight and statistical power to drive a fundamental shift in how mild traumatic brain injury is understood, evaluated, and treated — within the Department of War, across the Veterans Affairs healthcare system, in professional sports medicine, and in clinical practice at every level.
The goal is a new standard of care. One that evaluates the full picture of the injury — brain and structure — from the moment a servicemember or athlete presents with symptoms. One that gives clinicians the diagnostic framework to identify whether symptoms are brain-driven, structurally driven, or both — and to apply the appropriate intervention accordingly. One that stops managing these wounds from the outside and starts addressing their origin.
When the findings are published, they will be delivered to the Department of War, SOCOM, CENTCOM, the VA, and the NFL working groups — not as a suggestion but as the scientific foundation for policy change. The veterans, operators, and athletes who have been carrying these wounds for years — who have been told the brain has healed and nothing more can be done — deserve nothing less than that.
The invisible wounds are more visible than medicine has been willing to admit. This study is going to prove it.
Join the Mission
The science is ready. The team is assembled. What this study needs now is the support to execute it at the level it demands.
There are four ways to be part of making the invisible wounds visible — financial contribution, organizational endorsement, research partnership, and participant referral. Every form of support moves this study forward and brings the answer closer for the veterans, operators, and athletes who have been waiting for it.