A Look into George Floyd’s Cause of Death, From an Anatomical Perspective

A Look into George Floyd’s Cause of Death, From an Anatomical Perspective

On May 25, 2020 an African-American man named George Floyd was apprehended by four police officers in Minneapolis, Minnesota.  During the apprehension, a police officer named Derek Chauvin placed the handcuffed Floyd prone on the street, then knelt over him, placing his left knee on top of Mr. Floyd’s neck.  From the image circulated in the media, it appears that Chauvin exerted his full weight over his bent knee.  He kept his knee in position for 8 minutes and 46 seconds despite please from Floyd that he could not breathe.  Tragically, Mr. Floyd died at the scene.  Two autopsies on Mr. Floyd ruled the death a homicide.  The county version “revealed no physical findings that support a diagnosis of traumatic asphyxia or strangulation” while a private autopsy ruled he died of “asphyxiation due to neck and back compression.”  Asphyxiation is the deprivation of oxgyen to the body, resulting in death.  Chauvin was fired and arrested shortly after the incident, and charged with 3rd degree murder and second degree manslaughter.

This tragic and awful case spurred protests and civil disobedience throughout major cities in the U.S., against systemic police brutality and racism towards African-American men, which continues as I write this.  It is also a case that has drawn interest in the medical and forensics community, as to how exactly George Floyd died.  This is important to investigate, as it has consequences for the trial and also provides information to police forces to help them determine which types of restraints should and should not be used.

Before discussing the medical aspects of Mr. Floyd’s death, I want to emphasize that the most important thing about this incident is that a man unnecessarily lost his life to a trusted law enforcement officer, in a most inhumane way.  It is especially bad because of the systemic racism element to it, and the fact that Chauvin had several opportunities to get off of him in time after being warned by another officer at the scene and multiple witnesses, but failed to do so.  This was a textbook lesson on how not to subdue a person, and the price of this lesson is going to play out for weeks to months and will be costly to society in more ways than one.

That being said, I will discuss the anatomical and physiological factors involved in Mr. Floyd’s death.  There is some controversy over how he died, which will determine what sentence, if any, Derek Chauvin will receive. 

As you will see, the neck contains several structures directly tied to sustaining life, which is why the neck is a logical target when it comes to martial arts/ self-defense, and yes, murder.

Mr. Floyd was lying prone (stomach down) with his hands handcuffed behind his back and neck turned to his right.  So when Chauvin placed his knee over his neck it contacted the lateral (side) aspect of his neck and some of the anterior portion.  The critical structures found at the side of the neck include the vertebral arteries, cervical nerve roots, carotid arteries, jugular veins and lymphatic vessels.  Attached to the carotid artery is the carotid body, a cluster of special cells that detect oxygen saturation levels in the blood leaving the heart, and passes the information to the brain, which the brain uses to regulate heart and breathing rates accordingly.

Inside the cervical spine (the neck bones) there is the spinal cord which is comprised of the neuron axon bundles that control body movement and sensation; and lying just outside and against the cervical spine is the sympathetic chain ganglia, which play a role in innervating the heart, lungs, adrenal glands (adrenaline secretion) and other organs during “fight or flight” moments of stress.

The critical structures found in the anterior neck are the esophagus, trachea (wind pipe), larynx and thyroid gland.  Also present but not critical to life are the vocal cords.

The contact area on Mr, Floyd’s neck, based on the typical size of a bent knee, was about 4 square inches.  Chauvin weighs about 170 pounds, so I estimate that the force placed on Mr. Floyd’s lateral-anterior neck was (.9)(170 lbs)/4 in sq. =153 lbs/ 4 in sq. = 38.25 lbs./in sq.  So imagine four, 40 pound dumbells stacked and resting on the side of your neck for nearly 9 minutes.

What I believed happened is blood flow to the brain was cut off, making Mr. Floyd unconscious after a few minutes, as would happen in a martial arts choke hold.  We can assume the loss of consciousness due to restricted blood flow to the brain occured the moment he stopped talking.  Chauvin kept his knee in place for nearly 3 minutes after Floyd stopped moving.  If there was any chance of resuscitation, that chance ended with this additional time of compression.

The pressure also activated Mr. Floyd’s sympathetic chain ganglion, which caused a surge of adrenalin– a neurotransmitter secreted by the adrenal glands of the kidneys that prepares the body’s response to stress.  This increased his heart rate, increased blood pressure by vasoconstricting his arteries; dilated his pupils, and attempted to increase breathing rate.  However, with Chauvin’s knee on Floyd’s neck, the increased respiratory rate did not result in more oxygen getting to the body and the diaphragm, the sheet of muscle that pulls down and expands the lungs for breathing may have spasmed as it fought against the air blockage.

Most of Chauvin’s knee was over the side of the neck, but the front (anterior) was subject to some compression.  This likely partially collapsed the trachea, restricting air flow.  Mr. Floyd was initially able to express his inabilty to breathe, suggesting that his trachea was still patent, but his words became less and less as the seconds ticked.  Perhaps Chauvin’s knee shifted forward with his weight, slowly closing off the trachea.  This makes sense, as the neck has a curved contour which would promote such slipping.

As the knee hold persisted cutting blood flow to his brain, Mr. Floyd’s blood rapidly turned acidic as all oxygen was used up (the brain has a high metabolic rate and therefore a high rate of oxygen consumption) and CO2 levels were rapidly rising (CO2 is a byproduct of cell respiration).  This may have affected his speech center, which is supported by the fact he stopped talking a few minutes after the knee hold.  The apneustic (breathing) center in his brainstem was starting to break down as well from the hypoxia (insufficient oxygen), hampering his breathing further.

It’s not clear at what point Mr. Floyd expired.  Coroners define time of death at the point when brain activity ceases.  But the nature of Mr. Floyd’s death was so prolonged, it is likely he experienced irreversible brain damage and would have been in a vegetative state even if Chauvin had gotten off of him a little earlier and Mr. Floyd was given immediate medical attention.

One of the tell-tale signs of asphyxia by strangulation is ruptured blood vessels in the conjunctiva (whites of eyes) and face, called petechial hemmorhaging.  This information, as far as I know, is not available to the public.  If there was no evidence of this, I can see why the county autopsy reached the conclusion that he did not die of asphyxia.  In this case, it would suggest that Mr. Floyd’s primary cause of death was something else; perhaps sudden stoppage of the heart due to a breakdown in the cardioregulatory system.  But, it is not clear if you can die from asphyxia from “gradual” strangulation and not have petechial hemmorhaging.  It could also be that death was from a combination of both asphyxia and heart stoppage.

The autopsy did not mention fractured cervical vertebrae, which I could see happening if it were a smaller-framed person.  The force Chauvin exerted on the neck appears enough to break one or several neck bones, especially if the person had osteopenia (bone thinning).  Fractured neck vertebrae often result in spinal cord damage and paralysis.

Conclusion

George Floyd’s tragic death is a wake-up call for police forces across the country.  Knees to the neck to restrain someone must be prohibited.  There are too many ways for this to go wrong, given the high concentration of structures critical to maintaining life that reside in the neck.  I understand that safety to police officers is important and fully support it, but it must not be accomplished by jeopardizing the safety of the person being restrained.

How to Stop Tension Headaches

Headaches come in many different forms; too many to include in one post.

The causation can be neurological, vascular, mechanical, chemical and even psychosomatic.  Diagnosis can be challenging, as most headaches have the common symptom of, well, head ache.  The factors that vary include duration, location of pain (back of head, front of head, one side of head), pain pattern (constant, pulsating, repeating), and accompanying symptoms (dizziness, nausea, sensitivity to light and sound, auras).

This post is about tension headaches, perhaps the most common type.

Symptoms include constant, pressure like pain often described as a tightening band around the head.  The muscles of the back of the neck and tops of the shoulders are usually hypertonic (tense and taught).   Pain is felt behind the eyes.  Tension headaches can be mild to the point where the person goes on about his day until it wears off; or they can be intense and incapacitating, causing the person to take aspirin or Tylenol.

It is generally believed that tension headaches can be triggered by stress, dehydration, working in front of a bright computer monitor for extended periods; looking at a screen (TV, computer, movie screen) that has constantly moving images with changing light; and engaging in heavy mental tasks (studying, calculating numbers, reading conceptually-complex material like law cases, etc.).

More esoteric causes are previous trauma that affected the neck, like a car crash, and environmental stimuli (pollen, mites, carpet fumes, atomized copier toner, exposure to hazardous chemicals).

In my experience, people who have a history of severe whiplash from a car accident are more likely to have recurring tension headaches.  Even if the accident was ten or more years ago.

Whiplash is the violent, alternating extension and flexion of the neck due to a short but powerful impact force or short acceleration-deceleration.  Low impact car accidents and a jerky roller coaster ride are common examples.

The accident can leave the cervical (neck) vertebrae out of proper position relative to adjacent vertebrae, and change the dynamics of neck movement.  Nerves that regulate muscle contraction in the neck and and back of head can get injured or stretched as a result, and can cause the muscles to stiffen during certain times.

TREATMENT:

If you are engaging in heavy mental activities, give yourself a couple of hours break.  Turn off the TV; stay away from the computer and all screens for that matter.  Basically, you want to shut off excessive visual stimulation.

Seek silence and solace.  Find a nice park,  go for a nature hike.  Another option– meditate in a dark room; concentrate on deep breathing and  relaxing the muscles in the back of your neck and throughout your body.  Drink water throughout the day.  No coffee or cigarettes; they are stimulants.  No alcohol.

Place an ice pack on your forehead (put kitchen towelette on your forehead to prevent ice burn), OR one under your neck with a cervical roll supporting it (DON’T do both, the coldness may be too much stimuli).

If you have a history of a whiplash car accident, and you get tension headaches quite regularly, there’s a very good chance you have misaligned cervical vertebrae affecting your cord and/or nerve roots.   Probably a “reversed” curve, which looks like a “kink” or sudden angle change on a side-view neck x-ray. You will want to do exercises to stretch the neck and get it back to a lordotic curved shape.

Use a neck roll to bend your neck into a lordotic (reverse C- shape) curve while lying on your back on the floor.  Simply touch the floor with the back of your head ten times by arching your neck over the roll.  Then, turn and stretch your neck to the left and hold for 2 seconds; then to the right and hold for 2 seconds; 10 times to each side.  Do 3-4 times throughout the day.

You may also consider getting evaluated by an experienced chiropractor, and definitely getting a neck x-ray to visualize the shape of your cervical spine.   Adjustments, exercises, and lordotic traction can help bring your neck into proper alignment, and reduce pressure to your nerves, saving you from those annoying headaches.

Lastly, consider using red light and pulsed EMF to eliminate tension headaches.  This is a good investment if you have recurring headaches.

Red light therapy is using 630 nm wavelength light to reduce pain and inflammation.  Light at this wavelength gets absorbed by cell structures and basically increases circulation, vasodilates blood vessels and dampens inflammation.  Some tension headaches are vascular in nature, so this should help reduce symptoms.

Pulsed EMF is the application of weak electromagnetic fields to the body, to provide extra energy for cells needing it.  It tends to improve cell membrane transport of nutrients and waste, and improve molecular transport including red blood cell mobility.

Watch this video I made that explains how to do it:

When You Get Whiplash Neck Pain from a Car Accident

When You Get Whiplash Neck Pain from a Car Accident

Ever get rear-ended while waiting in traffic or at a stop sign?  It’s a scary moment:  the calmness of being out in your car is viciously interrupted by screeching tires and a loud crash and bending metal.  It’s over in two seconds, but a lot happens to your body in that one second.

If a high speed camera was available to record your mishap, it would show your body violently moving forward with the car, back sinking into your car seat, your head slowly arching backwards at an unnatural angle; your neck muscles tense up; your head coming to a  stop in its backwards path and then reversing directions to move forward again, through a complete arc until your neck is fully flexed forward in an unnatural position; coming to a stop again, and then reversing directions and fully extending a few degrees less than before, and then reversing and flexing forward again, then righting itself.  That is your basic whiplash injury.

You’ll notice your neck become stiff, but very gradually.  You may be a bit dazed, and have a headache come on in about an hour.  You’ll likely feel tired.

As the day wears on, your neck is getting increasingly stiff and painful.  You may feel the onset of soreness in your upper shoulders and upper back; even your lower back.  You may have pain in your chest wall where the seatbelt dug into.

2-3 days after the accident your neck will reach maximum stiffness.  You will have difficulty turning your neck.  You’ll find yourself turning your whole body in order to see to one side.

So what is happening?  You have sustained what’s called a cervical acceleration-deceleration sprain strain injury; commonly known as whiplash.  Car accidents are a common cause of whiplash, but they can occur on roller coasters and similar jerky rides, horse riding, sky diving, and even wild dancing.  When this happens, tiny tears develop in the muscle tissue and fascia (muscle covering) which starts to release the inflammatory products of swelling.  The swelling is gradual, like a pinhole leak, which explains why it takes 2-3 days to reach max pain.  What makes a whiplash worse than other sprain strain injuries is that, due to the flexibility of the neck, spinal ligaments also incur damage.

When your neck flexed violently forward, the capsular ligaments and interspinous ligaments likely got damaged.  The capsular ligaments hold your neck bones together from the back; the interspinous ligaments hold them together at the spinous processes (the bumps you feel along your spine are the tips of the spinous processes).

interspinous ligament rupture

When these ligaments injure, the swelling goes inside the joint space, building up pressure essentially splinting (immobilizing) the joint.  In severe cases, the ligaments can rupture (tear) causing dangerous instability, and you have a very serious condition that requires a visit to the ER.  A head halo support or neck brace is usually attached to prevent the instability from causing damage to your spinal cord.

TREATMENT:

Obviously, it’s a good idea to go to the hospital if you were involved in a significant car accident and feel you’ve been injured.  The ER doctor will rule out serious conditions like ligament rupture, bleeding in the brain (subdural hematoma), and bone fractures.  Once those are ruled out, he/she will diagnose you as having a sprain strain injury and will usually prescribe pain meds (anti inflammatories and muscle relaxants).  You will be given home care instructions.

With whiplash, the goal is to first reduce the pain and swelling.  You will do this by applying an ice pack to your neck.  Here’s a YouTube video on Whiplash Home Care – icing and stretches that illustrates the information to follow.

Buy two gel ice packs at your local drugstore (9″ x 6″ size); put in freezer.   Make a cervical roll using a small bath towel or hand towel:  roll it up tightly into a cylinder 1′ long with a radius of five inches.  Place it on the floor.

Place one ice pack on top of the roll, and one right under (next) to it.   Put a kitchen towlette on top of the ice to prevent iceburn.  Lie down, face up with the center of the back of your neck on top of the cervical roll/ice pack.  The other ice pack is for your upper back muscles.   Put a pillow under your knees for comfort, dim the lights and rest for 20 minutes.  Repeat this every two hours, for 2-3 days.

On the second day, while icing slowly turn your neck to the right as far as you can, then to the left, then to center.  Then, arch your neck and touch the carpet with the crown of your head and hold for 20 seconds.  Repeat these motions ten times.  Do this for each of your icing session, still at 20 minutes every 2 hours.  This helps to regain full neck range of motion.

On the 4th day, alternate ice with 10 minutes of moist heat using a hot water bottle with 150 degree water heated on your stove, and a wet face towel for heat conduction, on your neck and back muscles.

As the pain decreases, engage in active stretching exercises.  About two weeks post crash, or when the pain has gone down 90% and you have full range of motion in your neck, do neck strengthening exercises.  It is important to do these rehab exercises as they help align the reparative tissue in the axis of contraction of the muscles.  This will help reduce the chances of chronic pain and loss of range of motion following the accident.

Since the original publication of this article, I’ve researched a new modality called Pulsed Electromagnetic Field therapy, or Pulsed EMF, or PEMF for short.  The link explains it in detail, but basically  it is the external application of low frequency, low amplitude electromagnetic fields, similar to the natural EM fields your body produces, to impart energy to them.  EM fields are used to drive movement of molecules in and out of the cells, which includes nutrients, waste products, proteins and other factors involved in life processes.  When cells are sick or injured, this process is not efficient.  Pulsed EMF imparts a boost of energy (in fact, it is considered “Energy medicine”) which helps injured/sick cells perform their biological functions more efficiently, promoting accelerated healing and improved symptoms (less pain).

Apply PEMF to your neck three times a day for 15 minutes, for 2-3 days following the accident.  You should experience a noticeable reduction in pain each time, an hour or so after treatment.

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