This week from Dr. Cerami and Utah Sports and Wellness

From: Medicine, March 2015

Quick Summary:

This current study, “clearly indicates that hypertension can be associated with cervical spondylosis, as a secondary condition.” These authors report 2 patients with cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. The clinical benefits remained stable a year later. “Cervical spondylosis is a common cause of chronic neck pain, radiculopathy and/or myelopathy resulting in significant disability.” “Patients with cervical spondylosis are often accompanied with vertigo.” Vertigo may be present in 50%-65% of patients with cervical spondylosis.

Abstract:

Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.

These authors also note:

• Patients with cervical spondylosis tend to have concomitant cervical vertigo symptoms such as tinnitus, headache, blurred vision, and palpitations.
• “Insufficient blood supply to posterior circulation is called vertebrobasilar insufficiency. The most common complaint in patients with vertebrobasilar
  insufficiency is vertigo.”
• The vascular supply to the vestibulocochlear organ is an end artery, making this organ “more susceptible to vertebrobasilar insufficiency.”
• Neurons, axons, and hair cells in the vestibulocochlear system “respond to ischemia by depolarizing, causing transient hyperexcitability with ectopic
  discharges, manifesting as tinnitus, vertigo, and dizziness.”
• Vertebral artery insufficiency secondary to cervical spondylosis could result in vertigo.
• Stimulation of the sympathetic nerve fibers (without vertebral artery compression) induces vertigo, tinnitus, nausea, and vomiting.
• “The mechanisms of hypertension induced by cervical spondylosis could be the same as that of cervical vertigo. It is well known that cervical discs, dura mater, and the posterior longitudinal ligament are rich in sympathetic fibers.”
• “Sympathetic nerve fibers distributed around the vertebral artery have been implicated in the autoregulation of vertebrobasilar artery blood flow and cerebral blood flow.”
• “Degenerative painful discs are always inflammatory discs.”
• Painful discs have elevated inflammatory molecules (cytokines, prostaglandins, etc.), which increase discogenic pain. And in a feedback loop, inflammatory molecules accelerate disc degeneration.
• Cervical spondylosis can cause chronic neck pain, and chronic neck pain itself can cause hypertension.
• “Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension.”
• “Chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms.”
• “Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.”

“Sit up straight! Stop slouching!” 

How many times did we hear that while we were young? The trouble with poor posture is that it is not just a reflection on one’s manners or looking one’s best. While standing tall and sitting up straight can imbue a sense of confidence in ourselves that is visible to those around us, the benefits of a good posture go much deeper than that. The health benefits are striking.

Because everything in the body is connected, each action we take or do not take has lasting effects on the rest of the system. Poor posture can cause misalignment that results in pain, while improving posture is a simple and drug-free way to reduce discomfort and pain and prevent more serious health issues. At Utah Sports and Wellness, we can help you correct your posture, which can lead to regaining your mobility, and come up with a treatment plan that best suits you.

The Manifestations of Poor Posture

In the world we live in, endorsing poor posture has never been easier. Our society is more sedentary and technology-centric than any before, and while this offers many benefits of its own, not many of them fall in the posture department. There are many different ways in which poor posture can affect the body, including the cleverly nicknamed Tech Neck. Here we focus on two others.

Upper Cross Syndrome

Upper Cross Syndrome is so named because, when the problem exists, the overactive muscles in the back form a crossing pattern over the counter-crossed underactive muscles. The overactive upper trapezius and levator muscles down through the pectorals cross over the underactive sternocleidomastoid and lower trapezius, forming an ‘X’ in a cross-section of the neck and upper back. 

The syndrome is associated with the forward and downward placement of the head, especially from the prolonged use of devices. Significant time with one’s head bent over a screen can weaken muscles and cause imbalances in toning. This puts stress and strain on the head, neck, and shoulders and can cause a number of symptoms:

• Frequent neck pain in the absence of apparent injury
• Soreness in the shoulder blades
• Difficulty moving the shoulders, arms, or neck because of tightness or pain
• Feeling like you must constantly shift positions while sitting at your desk or computer 
• Feeling like your head is continuing to roll forward
• Frequent headaches

The misalignment or disproportionate toning of muscles in the shoulders and back can trickle-down effect affecting more peripheral parts of the body, so the symptoms here are not an exhaustive list. In order to determine that symptoms are truly caused by Upper Cross Syndrome, you and your chiropractor can also look for these poor posture patterns:

• Head protruding forward
• Shoulders rounded forward
• Ears forward of the shoulders
• Inward curvature of the neck
• Protruding shoulder blades

Lower Cross Syndrome

If the pain poor posture causes is in your lower body, Lower Cross Syndrome is more likely to be the culprit. Often the result of a sedentary lifestyle, the crisscrossing of over- and underactive muscles in cases of Lower Cross Syndrome occurs across the hip region. Without corrective action, weak muscles become weaker while short muscles get shorter and tighter. The cycle perpetuates the misalignment of pelvic joints and brings a bevy of symptoms in the hips and pelvic region:

• Pain in the hips, hip flexors, pelvis, or groin not associated with injury
• Pain in the lumbar spine or buttocks
• Tightness or stiffness in the low back, hips, or hamstrings

As with Upper Cross Syndrome, Lower Cross Syndrome can be observed by a few posture tells:

• Protruding stomach from an arched lower back
• Hips lined up incorrectly, tilting forward to increase the curve in the lumbar spine

Correcting Upper and Lower Cross Syndrome

The underlying problems in these syndromes can be corrected, and we recommend looking to your chiropractor for help. A tailored corrective exercise strategy can strengthen muscles that have been weakened by habitual poor posture. It can also serve as a warm-up before more intensive exercise. Your chiropractor or physical therapist will recommend exercises that both improve flexibility in overactive muscles and strengthen underactive muscles.

Poor posture won’t be fixed overnight, but consistent care and exercise can strengthen your muscles in a way that allows them to work together harmoniously. Work with your chiropractor to strengthen weak muscles and stretch those that are overwrought. The daily small efforts build upon each other to relieve pain now and promote a healthy body moving forward.

When the major risk factors for cardiovascular disease are listed, sleep deprivation is not usually among them. However, a growing body of research suggests a link between sleep duration and cardiovascular disease. While this pairing seems unlikely, it adds urgency to having timely and restful sleep to minimize the risk of danger to the heart.

The Dangers of Cardiovascular Disease

Cardiovascular disease, disease of the heart, causes over 787,000 deaths in the United States each year. There are many different kinds of heart disease, each with varying levels of mortality and treatability: 

• Coronary heart disease
• Heart failure
• Atherosclerosis
• Arrhythmia
• Heart attack
• Stroke

The Importance of a Good Night’s Sleep

The CDC recommends that people 18 years or older should get 7 or more hours of sleep per night. The quality of sleep is also critical. Restless sleep or sleep that does not leave a person feeling rested does not have the health benefits that a night of restful sleep does, and the quality of sleep a person gets appears to contribute to cardiovascular disease risk.

There are many remedies for sleep that is not restful. These are dependent on the underlying cause of restless sleep, i.e. insomnia, sleep apnea, etc. Speak with your primary physician about how you can have more restful sleep and minimize your risk of cardiovascular disease.

Sleep Duration and Cardiovascular Disease—An Unlikely Pairing

In this article, we will focus on a meta-analysis published in the Journal of the American Heart Association in 2018. The analysis pooled the research of 74 studies representing over 3 million participants. The conclusion was a definite relationship between sleep duration and cardiovascular disease.

Is Less More?

Despite the well-known adverse effects of getting insufficient sleep, no significant difference in cardiovascular risk levels were observed for sleep duration less than 7 hours. This was true for markers of both stroke and cardiovascular disease mortality. 

That being said, short sleep duration has a known relationship with increased levels of ghrelin and leptin, and these lead to increased appetite and caloric intake in addition to reduced energy expenditure, facilitating the development of obesity and impaired glycemic control. Reduced sleep is also associated with low-grade inflammation, which may be associated with cancer and cardiovascular disease.

Don’t Overdo It

If the relationship between sleep duration and cardiovascular disease was tenuous at fewer than 8 hours of sleep, it is definitive for more than 8 hours. Despite the easy assumption that more sleep equates to better health, duration of sleep greater than 8 hours was associated with higher risk of cardiovascular event. Risk of mortality from stroke and other cardiovascular disease increased to moderate past the 8-hour mark, and the risk only rose with each hour:

• 9 hours of sleep – 14% increased risk  
• 10 hours of sleep – 30% increased risk  
• 11 hours of sleep – 47% increased risk 

From the data, we can see that “the greater the divergence from the recommended durations of sleep, the greater the association for cardiovascular harm and mortality.” Though the bell-curve remains, this is more true of longer sleep duration than of shorter duration. 

While higher risk of mortality due to cardiovascular event should be impetus enough for getting 40 winks, it should also be noted that researchers found that non-cardiovascular factors such as low physical activity, unemployment, low socioeconomic status, and depression were also associated with long sleep duration.

Quality Matters

The research shows a clear correlation between sleep duration and cardiovascular disease. It also indicates that the quality of sleep is fundamental to low risk levels. While “poor sleep quality” is a subjective metric, factors such as waking up unrefreshed were measured and discovered to be markers of elevated cardiovascular risk.

Specifically, a significant increase in coronary heart disease was observed. Abnormal sleep increased the risk of coronary heart disease by 47%. Incidence and mortality markers of other cardiovascular diseases were not observed.

Conclusions

The meta‐analysis, systematic review, and spline analysis of the cohort studies in question revealed a bell curve relationship between sleep duration and cardiovascular disease, both of incidence and mortality. Poor sleep quality was also discovered to increase risk of coronary heart disease. 

The CDC’s recommendation of 7 or more hours of sleep per night is too broad a stroke to limit the risk of cardiovascular disease. A recommendation which better incorporates the relationship between sleep duration and cardiovascular disease is between 7 and 8 hours of restful sleep each night.