New Research Shows Concussion + Neck Injury = Longer Recovery

If you’re a reader of our blog, then you’re aware of our stance that an injury strong enough to concuss is strong enough to also injure the neck. You can read some of our thoughts on this subject here:

2 Reasons Why Your Concussion Symptoms Aren’t Going Away

Head Injury, Chronic Dizziness, Concentration Problems, and the Atlas – A Case Study

What a 10 mph car accident does to the neck

You can find a lot more by using the search tool on the website, but that should get you started.

 After years of research, we now know that injuries to the neck can mimic symptoms seen in concussion. This is a big reason why patients with chronic whiplash look really similar to patients with post-concussion syndrome when you’re just looking at symptoms alone [source]. However, many clinicians have suspected that when patients have both a neck injury and a brain injury, that it can take longer for the patient to recover and return to sport.

A study published in the Journal of Head Trauma Rehabilitation is helping to shed light on this concept. THe study looked at patients in a multidisciplinary pediatric concussion clinic with sports related concussion. A total of 246 patients were included and were assessed for neck pain, headache, dizziness, and abnormal cervical spine exam findings. Out of the 246 patients with concussion, 80 met the criteria for a neck injury.

When reviewing the data, the authors found that patients with a neck injury took an average of 28.5 days to make a clinical recovery compared to 17 days for the patients who only showed physiologic brain injury alone. Patients with neck injury were also almost 4 times more likely to experience delayed recovery (longer than 4 weeks) from their symptoms.

So just to summarize, if you have a neck injury + concussion:

  • It will take on average 10 days longer to make a clinical recovery than a concussion alone
  • You are 4 times more likely to have symptoms beyond 30 days than a concussion alone

So you might be saying….well…maybe some of these neck injuries were really serious ones. Like the ones you might see where people have to wear a neck brace and get carted off the field. Obviously people with severe neck and spinal cord injuries can drastically skew the number of days it takes for people to recover and some may not recover at all.

The authors actually accounted for these types of injuries. One patient had a compression fracture and 5 patients had spinal cord injury or cord neuropraxia. All of these patients were taken out of the data analysis. So that leaves us with patients with a neck injury, but an injury that compromises the spinal cord.

Protect the Neck

The role of the neck has become a growing area of research in the field of head trauma. One study looking at the relationship between neck strength and risk for concussion showed that for every pound of increase in neck strength, there was a 5% reduction in risk of concussion. Another study shows a rehabilitation program that includes treating the neck in patients with post-concussion symptoms can accelerate a patients return to normal activity.

The neck is a neurologically important and inherently mobile area that can be prone to injury. When it is injured, people with a combination of brain and neck injuries may have higher levels of sensitivity than patients with more routine neck pain. That means that people who suffer concussions and neck injuries may benefit from more precise and gentle care than approaches that take a more aggressive style of treatment.

 

Podcast Archives: Heart Rate Variability and Human Performance with Dr. Mike Nelson

 

Dr. Mike Nelson is a human performance expert and faculty member for the Carrick Institute. In this episode Mike discusses some of the hidden ways an athlete can get more from their bodies by modifying their training to match the demands of the brain and nervous system. We also get into the concept of metabolic flexibility. A great listen for anyone that is involved in training athletes or are aspiring athletes themselves.

Podcast Archives – Looking Beyond the Brain in Concussion with Dr. John Leddy

Podcast Archives – Episode 23b – 2015

Looking Beyond the Brain in Concussion with Dr. John Leddy

University of Buffalo Concussion Management Clinic

With the high school, NCAA, and NFL seasons right around the corner, I decided that we re-visit my favorite topic; concussions. This week we have a 2-episode special on concussions featuring one of the most sought after clinician experts in the country, and a fast growing name in the research of post-concussion syndrome. Dr. John Leddy is a concussion researcher with a sports medicine background out of the University of Buffalo. He’ll be talking about future considerations in concussion management that goes beyond treating the brain and making sure that we protect the neck.

Podcast Archive – Pro-Brain and Pro-Sports with Dr. Tad Seifert

Heal Yourself Radio Archives – Episode 23a- 2015

Pro-Brains and Pro-Sports with Headache and Concussion Expert Dr. Tad Seifert

Show Notes:

With the high school, NCAA, and NFL seasons right around the corner, I decided that we re-visit my favorite topic; concussions. This week we have a 2-episode special on concussions featuring one of the most sought after clinician experts in the country, and a fast growing name in the research of post-concussion syndrome. Episode 23a features Dr. Tad Seifert an expert in neurology and sports medicine. He’s combined his passion for sports and the brain to be a leader in the field of sports concussion. He’ll talk about his experience and what the evidence says about head injuries, and what you can do to better help prepare your athlete for their sports season.

What are the risk factors for poor outcomes after a concussion?

When patients suffer a concussion, the vast majority of patients will have symptoms for 10 days or less. About 10-15% of concussed patients will develop persistent symptoms and be diagnosed with post-concussion syndrome.

Thanks to an explosion in concussion research in the last 20 years, we know a lot more about these head injuries than we have in the past. While we don’t know the exact physical reasons why some people are more likely to suffer from post-concussion syndrome, we do know some specific risk factors for people developing persistent symptoms.

Here’s a short but important list of factors that may make a young athlete more susceptible to chronic concussion symptoms:

  1. Patients with a history of migraine headache
  2. Patients with a history bipolar or anxiety disorder
  3. Patients with a family history of bipolar or anxiety disorder
  4. Patients with a previous concussion

There’s a few interesting things to take away from this:

  • Having a history of migraine likely means that your nervous system will be more vulnerable to the headache and nausea experienced with concussion symptoms. It may also signal that you have a sensitivity in your neck to issues that may stimulate the headache process and can be worsened by head trauma.
  • The first is that mental health seems to be a major player in the future expression of post-concussive symptoms like headache and dizziness. It shows us the power that mental health can have on physical health problems.
  • There’s no association with the severity of the concussion or losing consciousness. While a more severe hit to the head or getting knocked out seem like they would predict worse recovery, the data suggests that it doesn’t play a significant role in the development of persistent symptoms.
  • A lot of people get their physical symptoms treated for post concussion symptoms by a variety of providers, but a lot of people ignore their psychological and cognitive treatments. Having someone that can help manage their anxiety appropriately and use cognitive behavioral interventions can help many patients benefit from their physical symptoms.

Don’t Forget: Health Is A 3 Legged Stool

It’s easy to think about health in terms of physical ailments, but your overall well being is dependent on physical, mental, and emotional health. There’s a reason why people with depression and anxiety have worse outcomes for every physical ailment that exists. If you have a poor mental and emotional outlook, your brain simply doesn’t mobilize it’s repairing and recuperative resources as effectively.

In the world of concussion we often talk about getting the right care for concussions linking it to cervical spine problems, vestibular problems, or brain problems. What we sometimes forget is that some of our susceptibility to illness is related to our belief in the fragility or resilience of our bodies. Let’s restore faith in the strength of our bodies and make ourselves more robust healing machines.

Cracking the Code on Lightheaded Dizziness

When people say that they feel dizzy, most people, even healthcare providers usually think that you’re talking about the room spinning sensation of vertigo. However, there are thousands of people around the country describe themselves as having dizziness but don’t have the characteristic sensation of vertigo. Many patients may describe their dizziness as a rocking, swaying, floating, or disoriented feeling. More than anything, people with dizziness have a feeling of being out of sorts if it’s not specifically related to vertigo.

In this article, we are going to breakdown a specific and very common feeling that people associate with dizziness. We are going to talk about lightheaded dizziness.

Orthostatic Intolerance – a blood flow issue

Most people have had a feeling of light headedness at some point in their life. It’s most commonly felt when people go from laying down to standing too quickly. Your head feels funny and you might feel your vision get dark for a moment. After a few seconds, the feeling passes and you probably won’t even think twice about it.

This sensation of feeling light headed on standing is called orthostatic hypotension or orthostatic intolerance.These are terms used to describe the fact that when you change positions, your blood pressure didn’t meet the brain’s demand for blood in that moment in time.

Your brain is a greedy organ when it comes to blood flow. Although it only makes up about 2-3% of the body’s total mass, the brain hogs about 20% of the body’s blood flow. Your blood pressure is not just a marker for the health of your heart, but the purpose of a tightly regulated blood pressure is to make sure that your brain is getting that 20% blood flow at all times. 

While people generally think of their heart as the main controller of blood pressure, it is actually your nervous system that keeps it tightly regulated. It’s so regulated, that in the moments right before you stand (when the idea of standing was just a thought), your brain is sending messages to your muscles and arteries to tighten up so it can keep your blood pressure constant when you are changing postures.

Pretty neat right?

While most people can have moments of lightheadedness like this from time to time, it usually goes away on its own. However, some people feel this sensation on a regular basis. It’s been estimated that anywhere between 4% young adults and 30% of older adults experience orthostatic intolerance. About 42% of people with a complaint of dizziness have a complaint of light headed dizziness related to standing. [Source]

Whether you feel like you’re  spinning, rocking, or light headed, a persistent feeling of dizziness can lead to feelings of anxiety and depression because of the impact on your daily life activities. Orthostatic hypotension is also associated with increased incidence of cardiovascular events and overall mortality, especially in the aging population where feinting and dizziness can lead to falls

Why Does Orthostatic Intolerance Happen?

So far, research has shown that the light headed feeling from orthostatic intolerance is a blood flow issue in the brain. We also know that the autonomic nervous system is a major role player in this problem as many patients with this form of dizziness will have abnormal findings on head upright table tilt testing as well as abnormal blood pressure findings when using a valsava maneuver. [Source]

For many of these cases, there is a problem in the regulation of the sympathetic or parasympathetic nervous system. This gets further complicated by the fact that people who experience orthostatic hypotension may have the same symptoms, but the neurological mechanism that is causing the symptoms are different. [Source]. In general terms, the sympathetic nervous system may have problems constricting your arteries on standing, or the parasympathetic system may have difficulties in regulating your cardiac output. That’s why many patients with orthostatic issues may get evidence-based treatment for the condition.

How Is It Treated?

This part is difficult, because unless you’re in an area that does specialized autonomic laboratories, many people don’t even know this condition exists. Many people get misdiagnosed with vertigo. Many others will just have their condition brushed off.

If you’re lucky enough to have someone that understands orthostatic issues, then you will likely be managed with a regiment of blood pressure medication and IV’s to help keep your blood pressure from tanking. This gets complicated if a patient has HYPERtension when they lie down which is obviously problematic to give therapies that will non-specifically increase your blood pressure.

A Neurological Approach

While many doctors are concerned with blood pressure numbers in of themselves, from a chiropractic perspective we ask why the body is having an abnormal autonomic response to changes in posture. This is particularly important when we are thinking about the head.

When the head and neck shift, it can disrupt normal proprioception into the brainstem and have wide ranging effects of the autonomic nervous system. Excessive twisting or rotation of the Atlas vertebrae may also affect the jugular vein and how blood flow returns to the heart leading to problems with the vagus nerve and cardiac output.

We have also seen patients with dysautonomia have small disturbances in the function of their vestibular system. In some cases patients with orthostatic hypotension can experience vertigo, but in many cases it simply makes head and eye movement far less efficient.

When we put this all together, we have found that a cervical-vestibular approach has the potential to create important improvements in the autonomic nervous system which can help patients overcome their poor relationship with gravity.

Tell us about your dizziness

Why is Cranio-facial pain worse than everything else?

Read time: 7-8 minutes

Outline:

  • Pain is weird
  • Chronic head and face pain and suicidality
  • Why head and face pain feels worse
  • The neuroscience of suffering

Pain is complicated. It’s even more complicated as a doctor because the expectation from years and years of conditioning is that when you have pain, then something about that painful body part must be damaged to cause it. When people are in pain, doctors are typically trained to identify things like a ruptured disc, broken bone, or torn muscle to validate a patients’ sense of suffering.

In this model, the more damage that is present = more pain. Less damage = less pain.

However, the experience of pain can be way more complex than finding damaged tissue. The experience of pain is an emotional response to ‘painful’ sensory receptors called nociceptors. Tissue damage can cause a lot of pain receptorsto fire, and trigger increased pain, but it is far from the only factor in the pain equation. We have to take pain into the context of cultural, social, cognitive, and experiential factors.

Which takes us to an important point.

The amount of pain you experience can also depend on what body part is injured. As we’ll see today, there are hardwired circuits in your brain that can make the experience of pain in the head/face a different and perhaps worse experience then pain from the body as a whole.

Chronic Facial Pain and Suicidality

Chronic pain is a known risk for suicidal ideation, and has been documented in numerous studies [source]. These thoughts have a higher chance of turning into behavior when you have chronic pain and a co-morbid mental health disorder [source].

This effect seems most pronounced when the source of the pain is coming from the head or face. Two disorders in particular are highly associated with suicidal thoughts and behavior; trigeminal neuralgia and cluster headaches. Trigeminal neuralgia has a high enough association that it was historically dubbed the ‘suicide disease’, while cluster headache has been known to be called the ‘suicide headache’.

Both of these illnesses are associated with some of the most intense pain that human beings can experience. The severity of the pain combined with the chronicity of the pain lead to a sense of despair because these disorders can be difficult to treat, so there is always a fear of the next attack.

Scientists have recently uncovered some neurological pathways that might explain why conditions like trigeminal neuralgia and cluster headaches can cause such disproportionate suffering compared to other body pains.

The Trigeminal Complex and the Limbic System

It’s been known that pain experienced in the head and face activate the emotional centers of the brain more than pain felt in the periphery of the body [source]. From an evolutionary standpoint, a higher state of pain in the head and neck region may have served a  purpose so that there would be extra vigilance in protecting this region of the body from injury. What was unknown was weather this heightened sense of protection was derived from a psycho-social factors, or if it was something that was hard wired into our nervous system.

Duke University scientists may have some answers. A 2017 study in Nature Neuroscience showed that neurons in the head and face have a direct pathway to the emotional circuits in the brain.

Scientists identified a direct connection between sensory fibers of the trigeminal nerve into a part of the brainstem called the parabrachial nucleus. The parabrachial nucleus has direct connections into the emotional hub of the brain in the amygdala, which is highly tied to fear and avoidance behavior.

Why is this important? Because direct, aka, monosynaptic connections are way more powerful sensory stimuli than indirect pathways.

Think of it this way:

Let’s say you were mailing a time-sensitive package that needed to get to it’s destination as soon as possible. Would you choose to overnight it by plane, or would you choose regular first-class mail?

Cranio-facial pain uses direct and indirect pathways that tap into the brain’s emotional responses to pain.

You probably chose to overnight it right? Why? Because it’s going to get there faster, and because the person receiving it is going to perceive that package as more important because it was sent with all of this overnight labeling implying it’s importance.

These direct pathways are like your overnight deliveries, where the indirect pathways are like ground shipping.

Our brains place a higher priority on signals coming from these monosynaptic pathways.

While other body regions only use an indirect path to the parabrachial nucleus, the trigeminal distribution uses both indirect AND direct pathways to stimulate this emotional hub.

That means that firing from nociceptive pain fibers in the trigeminal distribution, or even pathways that share trigeminal distribution will have a higher chance of driving an emotional response than pain fibers from the shoulder, back, hip, etc.

The Emotional Brain’s Influence On Pain

How big of an influence does emotion make in the experience of pain? In this study, the researchers stimulated pain receptors in the paw or in the face of mice using a chemical called formalin. Using a technique called optogenetics, researchers can selectively activate brain activity in a mouse model using different light frequencies.

When light activated the direct pathway, the mice showed more intense avoidance behavior to the formalin on the face. When light was used to knock out this pathway, the mice didn’t react as strongly.

So you have the same amount of pain stimulus, the same mouse, and it experiences pain differently because the path to the parabrachial nucleus was turned off.

It suggests that our emotional brain’s connection to a painful stimulus plays a substantial role in the experience of pain.

Biology vs Psychology

There’s always a debate about nature vs nurture when confronted with the struggles of human existence. In recent years, it has evolved into a debate between biomechanical/orthopedic search to treat identifiable lesions vs a biopsychosocial approach which generally tends to lean heavily on the psycho and social components of the pain experience.

Here is some evidence that suggests that the two are inseparably linked together.

The experience of pain is intimately tied to our thoughts, memories, expectations, and current mental state. If the experience of pain is tied to some of these neural circuits, then changing our mind activating our different neural circuits in the brain can change our experience of pain.

It also means that fear/avoidance behavior, and repetitive responses to painful stimuli may reinforce the neural circuits that generate the same pain over and over again.

Changing thoughts and behavior can have a significant impact on the perception of pain and the feelings of suffering for a persistent pain patient.

That doesn’t mean that we are just telling people in the midst of a terrible trigeminal neuralgia or cluster headache attack that they have to suck it up and think differently about their pain.

It means that when people have persistent pain disorders, in the process of treating patients with various interventions, we have to help and guide a patient through the process of re-framing their pain and illness.

This is really hard for patients with persistent pain. It means that sometimes we are walking a line where a patient may feel like we are telling them that the pain is just in their head. Sometimes it means that the patient is going to ask the same question, or tell you the same symptom over and over again because they’re looking for you to just understand that what they are feeling and that know that they’re being heard.

Trying to help a patient disassociate themselves from their chronic pain emotionally is challenging. After all, most of us didn’t become doctors and therapists to be a patient’s psychologist. However, empowering a patient with a stronger belief in the resilience of their body can be extremely fulfilling, and in my opinion puts people on the path to recovery while they’re in the process of receiving quality care.

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Why Does Balance Break With Parkinson’s?

Balance and postural control are some of the most challenging areas to deal with in Parkinson’s Disease. Dopaminergic treatments that are typically given for PD have not shown much benefit for the stooped posture and unsteady feeling that PD patients commonly experience. This suggests that other parts of the brain may be causing these balance problems, and that other forms of therapy may be required to improve balance and posture in PD patients.

The good news is that basic exercise programs that simply get the body moving have been shown to have lasting improvements in patients with PD. This includes things like Tai Chi, resistance training, and even boxing training have been shown to have positive lasting effects in people with early to moderate symptoms.

How does something as simple as exercise improve the symptoms of a brain disease like PD? How can we use some of these concepts to help patients with PD overcome plateaus in their improvement? That’s what I’ll try to answer today.

Proprioception: The Underdog of the Senses

It’s hard to appreciate just how complicated balance is until you start to lose it. The maintenance of posture and balance is so important and complex in the human body that some of the largest and fastest tracts in your spinal cord are dedicated to the use of your back muscles.

In order for balance to work properly, it requires the use of 3 super important sensory systems. This includes your vision from your eyes, the vestibular system from your inner ears, and your proprioceptive system from your skin and joints. Most of use can understand how important your vision and vesibular system are to your sense of balance so I won’t get into that much, but many people have no idea what proprioception is.

The 3 super systems that maintain your balance

Proprioception is a sense dictated by movement detected by your skin, muscles, and joints. If you were to close your eyes and raise your hand over your head, you can reach up with your other hand and touch that body part without looking at it. How does your body know? Because there are sensors in your skin and joints telling your brain where it is in space all of the time.

When it comes to balance, these same sensors that exist in your spine and in your ankles play an enormous role in keeping you upright, and it is the breakdown in this system that commonly leads to balance and posture problems in people with PD.

When Proprioception Breaks Down

Research has shown that patients with Parkinson’s Disease typically have a balance system that is overly reliant on vision and has mostly normal inner ear function. This implies that it is the proprioceptive system that breaks down leading to a heavier reliance on vision to compensate.

Why does this break down? Because the basal ganglia (the area of the brain affected by Parkinson’s) plays a really important role in your body’s joint position awareness. The basal ganglia is a really important relay station for proprioceptive information to get to the higher parts of the brain in the cortex. When the brain can’t integrate this proprioception, then it can’t provide feedback to the muscular system to make appropriate adjustments.

This can be problematic because in people without balance problems need proprioception to stay upright and balanced with stability. If you can’t make adjustments to your muscular system, especially in the dark, then your likelihood for falling increases dramatically with a little push from an unexpected source.

Teaching an Old Brain New Tricks

Proprioception is a big fancy word that sounds like it requires tools and advanced therapies, but in reality it is generated by simple movement. Every time your muscles contract or a joint moves, you are increasing proprioception into the brain!

That’s why exercise of all shapes and sizes tends to help patients with Parkinson’s Disease. 

In addition to standard exercise programs, patients with PD may benefit from therapies that help their brain better integrate sensory stimuli. This can include different types of proprioceptive therapies that include visual feedback training, eye movement training, and vestibular rehabilitation from a functional neurology perspective.

Plus the impact that a specifically targeted chiropractic adjustment has on the the proprioceptive system of the brain is becoming more well documented as a reason it can help people maintain better balance.

The right combination of therapies may help patients with PD improve posture, gait, and general difficulties with movement. While we can’t fix the area of the brain that is damaged, because the brain has the ability to change itself, we can teach different parts of the brain new tricks to help the brain better adapt to the environment.

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What Happens in Vagus: Chronic Pain and Dysautonomia

I’ve been doing a lot of reading lately about the vagus nerve and the autonomic nervous system. We’ve been super fortunate to work with a handful of patients with POTS in the past 6 months with some really great and surprising results from taking a cervical and vestibular approach to care, and it’s driven me to learn more about this unconscious super system in the body.

While dysautonomia is considered a rare problem, there are actually certain types of patients that have a higher risk of having dysautonomia as a co-morbid condition. This includes neurodegenerative disorders like multiple sclerosis and Parkinson’s Disease, but the ground I want to cover is something that affects people as an invisible illness.

Today we’re going to breakdown the relationship between chronic pain and the vagus nerve.

Fibromyalgia, Chronic Fatigue, and Dysautonomia

Fibromyalgia and chronic fatigue syndrome (aka myalgic encephalomyelitis) are 2 conditions that are frequently associated with each other. Estimates as high as 75% of of fibromyalgia patients report fatigue as a major symptom and 20% of chronic fatigue patients also report having widespread body pain [source].

What’s unique about these disorders is that they both show an unusually high amount of dysautonomia compared to the general population. A review in the Journal of Clinical Rheumatology showed that patients with fibromyalgia frequently show scores reflecting autonomic dysfunction along with non-pain symptoms like light-headedness on standing (orthostatic intolerance), digestive complaints, excess sweating, and fatigue.

It’s also been reported in the Journal of Internal Medicine that patients with chronic fatigue syndrome frequently have postural orthostatic tachycardia syndrome (POTS) enough to classify the POTS patients as a distinct subgroup of chronic fatigue.

So why is chronic pain associated with this breakdown of the autonomic nervous system?

What Happens in Vagus….

The nervous system is classified into different branches. For ease of understanding, you have one branch that controls all of your muscles like your biceps, triceps, and quads called the somatic nervous system. You also have another branch that controls your organ systems called the autonomic nervous system.

The autonomic nervous system is further divided into the sympathetic nervous system and the parasympathetic nervous system. The sympathetic system is the one that causes the things you feel when you get stressed out. Rapid heart beat, sweating, high blood pressure, along with increased blood flow to your muscles. It helps you prepare to fight or escape danger. The sympathetic system is primarily driven by a bundle of nerves called the sympathetic chain.

The parasympathetic does the opposite. It forces you to breathe slowly, digest, breathe slowly, and think about reproducing. The parasympathetic system is mainly driven by your vagus nerve.

The Vagus Nerve has a direct connection to most of your body’s internal organ systems

These systems generally work in opposition to each other to set the tone for how your body is going to operate.

The vagus nerve is an special and unique nerve that travels from your brainstem into the bulk of your internal organ systems. It gives the brain a direct line of communication with your organ systems because your body generally wants to spend most of it’s time being parasympathetic. 

Why?

Because when your body is more parasympathetic it is able to breath easier, digest better, engage in sexual intercourse, sleep, and heal from injury.

The sympathetic system is designed to help you survive from an imminent threat, but your parasympathetic system is there to ensure that you can adequately heal and recover from that threat.

The more active the Vagus nerve is, the more likely your body is able to heal and recover. This isn’t just some pleasant billboard sticker either. Research has shown that increased parasympathetic activity is associated with higher survival heart disease and cancer. It’s also associated with improved recovery and decreased injury in athletes.

Most importantly for the patient in chronic pain, lower vagus nerve activity was associated with chronic pain compared to healthy controls. [Source] It’s also been shown that lower vagus activity can be associated with intensity of symptoms in patients with fibromyalgia. [Source]

Weak Vagus and Chronic Stress

Vagal activity is measured using something called heart rate variability (HRV). Many years ago, you could only measure heart rate variability from electrocardiograms (EKG) and measuring the distance between each heart beat. Today, there is no shortage of computer and even smart phone applications that have brought HRV to a wide audience.

In general terms, the higher your HRV is over time, the higher your vagal or parasympathetic activity. The lower your HRV is over time, the higher your stress or sympathetic activity.

If your body is in a chronically high state of stress, then it is going to:

  • Decrease blood flow to your organs
  • Increase exposure to your stress hormones (adrenaline and noradrenaline)
  • Decrease your stores of serotonin (feel good neurotransmitter)
  • Increase your blood sugar (diabetes)
  • Increase your blood pressure
  • Decrease your immune system
  • Decrease tissue healing

Why? Because if your brain thinks that it is in danger from attack, then it does not care about healing and immune function. It is strictly concerned about getting you out of danger.

When you have low HRV and high sympathetic activity, your body is at a distinct disadvantage when it comes to healing and resilience. While low HRV isn’t necessarily the cause of heart disease, cancer, fibromyalgia, or chronic fatigue, but if you have a low HRV then your body’s ability to adapt and overcome these conditions is compromised.

I’ll put that in bold text because that’s an important distinction:

When you have low HRV and high sympathetic activity, your body is at a distinct disadvantage when it comes to healing and resilience. While low HRV isn’t necessarily the cause of heart disease, cancer, fibromyalgia, or chronic fatigue, but if you have a low HRV then your body’s ability to adapt and overcome these conditions is compromised.

Bringing Vagus Back

There was an interesting study published in 2014 that used strength exercise as a treatment for patients with fibromyalgia. The study showed that patients with Fibromyalgia had significant improvements in pain and quality of life through a regiment of strength training, but no significant changes in HRV. The study was surprising, because exercise is one of the best, easiest, and cheapest ways you can improve your HRV, but the biggest surprise was in the conclusion. The study concluded that strength training was an effective therapy for patients with fibromyalgia, which is absolutely true, but also said that changing the autonomic nervous system is not a goal worth achieving in patients with fibromyalgia.

Knowing what you know now about the autonomic nervous system, it seems like a rational and reasonable goal for any patient because improving the autonomic nervous system improves the health and survival of patients regardless of what condition they have.

The best part is that vagal tone can be improved using non-invasive methods that include cardiovascular exercise, resistance exercise, breathing exercise, mindfulness training, non-invasive vagal nerve stimulation, and yes even upper cervical chiropractic.

By taking the focus away from just addressing the pain, and making the focus of care on the autonomic nervous system, it gives us the ability to affect the person as a whole, instead of just addressing a symptom. By taking people away from their condition, and returning them to their bodies.

 

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The Link Between the Neck and the Jaw

Temporomandibular joint disorder (TMD) is a difficult condition to deal with. It is the most common non-dental cause of orofacial pain. It is characterized by a change to the joint of the jaw bone, which effects the chewing muscles involved and the person’s bite. TMD is a condition that causes a number of problems such as headache, neck pain, face ache, and ear ache. This condition affects more than 10 million people in the United States and is more common in women than men. Besides suffering from neck pain and jaw pain, people commonly report stiffness, popping, clicking, or locking of the jaw. This can make activities such as eating, singing, or talking difficult. [1]

The TMJ connects the jaw to the rest of your head. It’s purpose is to help guide the jaw, so that the bottom teeth are in alignment with the top teeth resulting in an even bite. When the misalignment of the TMJ occurs, the jaw muscles preform differently which causes the the muscles of the head and neck perform differently as well. If this happens, it will effect the person’s bite and possibly lead to an early break down of the joint.

How does the neck play into TMD?

The TMJ might not be the root cause for the disorder and research suggests that the structure of the head and neck plays a factor.  Evidence suggests that when there is an increase in cervical spine disorders it perpetuates factors for TMD. A cervical spine disorder being caused my repetitive motions and postural alterations of the head and neck. Another study showed that alterations in the TMJ can shift the vertebrae in the neck, especially the Atlas bone. This demonstrates their close relationship and when one of these structures shifts it can cause the others to shift as well. When this happens it puts abnormal stress on these structures where they’re connected effecting their proper function. That’s why it’s not too uncommon for a person to develop TMD after a traumatic event such as whiplash from a car accident.

The severity of TMD can vary from person to person. Some will find their TMD to be just an annoying click while others may feel a severe amount of pain and extremely limited ability to open or close their jaw. Patients who suffer with severe TMD are usually faced with the prospect of splints or surgery to fix their problem.

While some types of TMD may require surgery, many cases respond well to a structural approach to chiropractic using the NUCCA protocol. A gentle correction of the top vertebrae may be enough to decrease the jaw, neck, and headache pain as well as encourage some relaxation of the jaw muscles. When done in conjunction with a specialist in neuromuscular dentistry, many patients can experience a tremendous amount of relief.

If you are looking for conservative options to help address TMD, a Complimentary Consultation with our office can help you see if you a good candidate for this type of treatment.

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