This week from Dr. Cerami and Utah Sports and Wellness

From: Journal of Family Medicine and Primary Care, 2018

Quick Summary:

This is a case report of a woman who experienced long-term relief from tension-type headaches and major depression following chiropractic treatment. Pain was disabling, going across the forehead to her nuchal area and right shoulder. She could not maintain daily activities without acetaminophen and aspirin. Blood tests, brain MRI, and cervical x-rays were all unremarkable.

Physiotherapy, acupuncture, traditional Chinese therapy, and other drugs all failed to help or to change her headache pattern. She began experiencing episodes of extreme low moods, characterized by feelings of overwhelming sadness, she was referred to the psychiatry services and was diagnosed with a major depressive disorder. 6 months of various drug treatments for depression fail to help her. Chiropractic Treatment: strategy was to stretch and relax the spastic muscles, restore motion in the respective segments, and to rehabilitate sensorimotor integration with diversified spinal manipulation after 3 months (41 chiropractic visits), the patient regained confidence in her health and started reducing the dose of medications. She rated her headache as 3–5/10 on the pain scale 3.

After 6 months (65 chiropractic visits) “all of her symptoms disappeared, and she was able to discontinue all medications.”  “Having enjoyed headache free and mood stability over the past 6 years, the patient continued maintenance care on a monthly basis.” This study implies that chiropractic may help depression through two mechanisms: Spinal adjustments inhibit sympathetic tone, reducing dopamine and upper cervical adjustments excite parasympathetic tone, increasing serotonin.

Abstract:

We report the case of a 44-year-old school teacher who experienced long-term relief from tension-type headache (TTH) and major depression following chiropractic treatment. It is well recognized that psychiatric comorbidity and suicide risk are commonly found in patients with painful physical symptoms such as chronic headache, backache, or joint pain. Recent studies indicated that autonomic dysfunction plays a role in the pathogenesis of TTHs and depressive disorders. The autonomic nervous system is mainly controlled by reflex centers located in the spinal cord, brain stem, and hypothalamus. This report highlights the rewarding outcomes from spinal adjustment in certain neuropsychiatric disorders. Long-term results of chiropractic adjustment in this particular case were very favorable. Further studies with larger groups are warranted to better clarify the role of chiropractic.

These authors also note:

• “Psychiatric comorbidity and suicide risk are commonly found in patients with painful physical symptoms such as chronic headache, backache, or joint pain.”
• “Autonomic dysfunction plays a role in the pathogenesis of tension-type headache and depressive disorders.”
• “The core cause of tension-type headache resides in the autonomic nervous system.”
• “Autonomic dysregulation has also been considered to play a role in the pathogenesis of depressive disorders.”
• Chiropractic cervical adjustments result primarily in parasympathetic responses.
• Chiropractic thoracic adjustments result primarily in sympathetic responses.
• Chiropractic adjustments “may lead to some therapeutic outcomes in certain neuropsychiatric disorders.”
• “Chronic pain and depression can influence one another through complex webs of connections.”
• “The autonomic nervous system is one of the major neural pathways activated by chronic stress.”
• “Under the influence of chronic stress, such as backache or headache, the sympathetic nervous system is continuously provoked without parasympathetic counteraction appropriately.”
• “Increased epinephrine and norepinephrine levels can incite an increase of proinflammatory cytokines” and neuroinflammation, which “can exert neurotoxic changes in the brain with the pathophysiology of depression.”
• Depression may be caused by an imbalance or a functional deficiency of key neurotransmitters (serotonin, norepinephrine, and dopamine).
• “Dysregulation of these transmitters is linked to both depression and pain.”
• “Elevated levels of serotonin often result in the relief of depression and anxiety, as well as substantial reduction in pain sensitivity.”
• Several antipsychotic drugs work by blocking postsynaptic dopamine receptors in the central nervous system (reducing the influence of dopamine).
• “Chiropractic care is a way to reduce the frequency of pain, and the duration and intensity of headaches.”
• Since autonomic dysfunction correlates with tension-type headache and depression, the biological mechanism of spinal adjustment benefit is probably “related to parasympathetic response.”

Blood pressure is a combination of two major factors: the amount of blood the heart pumps and how difficult it is for that blood to move through the arteries. These two are inversely related. High blood pressure results if the heart must pump higher volumes or if the arteries are narrow. This is a common condition, and the dangers are acute.

The Dangers of High Blood Pressure

Conditions that increase blood pressure cause the heart to work harder to pump blood, and unfortunately even small changes in the blood pressure metrics (i.e. 115 to 135) can double the risk of a cardiovascular event. 

Symptoms may include shortness of breath, headaches, or even nosebleeds, though most people combating high blood pressure don’t experience any symptoms. This increases the danger of the condition, since many do not know they have a problem until circumstances become serious.

Blood pressure that is severely high (referred to as hypertension) is defined when systolic pressure (the upper value in blood pressure metric) is greater than 130 mmHg and diastolic pressure (the lower value) exceeds 80 mmHg. The World Health Organization lists hypertension as a leading cause of cardiovascular disease (including heart attack) and stroke. These result in more than 15 million deaths worldwide every year.

Risk Factors

Blood pressure levels can increase with age and weight. The use of tobacco or alcohol and even increased stress can also make them rise. Blood pressure levels should be checked regularly once a person enters adulthood. While small increases in blood pressure have impactful negative dividends, reducing the numbers even a little can improve a patient’s chances.

Managing High Blood Pressure

Standard medical treatment for high blood pressure usually includes the prescription of pharmaceutical drugs and lifestyle changes. The adverse potential side effects of medication eliminates it as the best option, especially considering that the changes it makes can be nigh on insignificant. Lifestyle changes are a more lasting solution. 

Obesity and high blood pressure have a well-known link, so eating well (including lower sodium levels) and exercising regularly can keep levels down. Watch what you put in your body. Tobacco, alcohol, salt, and saturated fats are not good for reducing blood pressure levels. Staying active can ensure that blood pressure stays at healthy levels. 

Fortunately, there are some simple stretches and exercises that can be performed at home to gradually lower blood pressure levels. The few we have listed here are just a sample of those available. For exercises tailored specifically to helping your blood pressure levels, speak with your general physician or chiropractor. 

For the most accurate results of how the exercises are improving your blood pressure levels, be sure to measure them before you begin an exercise routine.

Strengthen Your Diaphragm 

The first exercise you should try focuses on breathing. Measured breaths control the amount of oxygen in the blood, lower the heart rate, and dilate the blood vessels, and all of these improve blood pressure levels. Inhale deliberately until your lungs are at 75% capacity, then exhale. Repeat this process 30 times.

This exercise is most effective when repeated at least six days per week for six weeks. A study conducted in 2019 found that participants who regularly modulated their breathing in this way experienced an average systolic loss of 10 mmHG. More research published in 2021 found that adding resistance to inspiratory muscle training dropped systolic levels by almost 16 mmHg and diastolic pressures by 7 mmHg. This kind of resistance muscle training can be facilitated by instruments such as a “BreathEasy Lung Exerciser.” These are readily commercially available.

Isometric Training

Isometric training can be performed easily at home. Using two balls of soft foam, regulate blood pressure levels by squeezing the balls continually with moderate force for two minutes. Resting for one minute between each set, repeat four times. Isometric training should be performed around three times a week for eight weeks.

Reverse Warrior Pose

The last exercise on our list requires only a doorway. The reverse warrior pose is a stretch to reduce artery stiffness. Holding onto the door frame with one hand for stability, stand with your legs apart and stretch the opposite arm outward and upward. Hold the pose for 45 seconds and briefly rest to let the blood return to your arm. 

Perform the pose at least three times on each side multiple times a week. Doing so will reduce stiffness in the femoral and brachial arteries, improving overall blood pressure levels. Consult with your chiropractor and regular doctor to regularly monitor how these exercises improve your blood pressure.

This week from Dr. Cerami and Utah Sports and Wellness

From: Journal of the American Osteopathic Association, October 2017

Quick Summary:

Concussions represent almost 9% of all injuries in high school athletics. This study was performed to determine whether female athletes in middle school and high school with a first time, sports related concussion remained symptomatic longer than their male counterparts. A significant difference was found in the median number of days female athletes remained symptomatic (28 days) when compared with male athletes (11 days). At 3 weeks post concussion, 82 of 110 male athletes (75%) and 43 of 102 female athletes (42%) experienced recovery of concussion symptoms. The difference in the recovery rates following concussion is “complex and multifactorial,” probably dependent upon biomechanical and biological differences.  A possible reason for this , “Females may be at higher risk for concussions because their necks are smaller and do not absorb shock as well as the necks of males.” The 5th International Conference on Concussion in Sport in October 2016 went on to state “that a sizeable minority of youth, high school and collegiate athletes take much longer than 10 days to clinically recover and return to sport.”

Abstract:

A retrospective medical record analysis was performed among athletes who sustained a concussion between 2011 and 2013. Inclusion criteria consisted of age between 11 and 18 years and diagnosis of first-time concussion sustained while playing organized sports. Using the documented notes in the medical record, length of time that each athlete was symptomatic from his or her concussion was calculated. A total of 110 male and 102 female athletes (N=212) met the eligibility criteria for the study. A significant difference was found in the median number of days female athletes remained symptomatic (28 days) when compared with male athletes (11 days) (P<.001). No statistically significant difference was found in symptom duration between age groups. When matched for sex, no statistically significant differences were found in symptom duration between the type of sports played. Female athletes aged 11 to 18 years with first-time, sports-related concussions remained symptomatic for a longer period when compared with male athletes of similar age, regardless of sport played. The mechanism behind this difference needs to be further elucidated.

These authors also note:

• “Concussion is one of the most common injuries in athletes.”
• 9% of all injuries in high school athletics are concussions.
• “Studies propose that female athletes are at greater risk for concussion than their male counterparts.”
• Most studies note that 80% to 90% of sports-related concussion symptoms resolve in 7 to 10 days. However, most of these studies involved male collegiate or professional football players, not adolescents and not adolescent girls.
• Mental stress plays a role in concussion recovery.
• “The most recent consensus statement [2016] recognizes that pediatric populations in general take more time to recover from a concussion than adults, and they recommend that the diagnosis of ‘concussion with persistent symptoms’ not be used in children until symptoms have been present for longer than 4 weeks.”
• “Current research states that the majority of adolescents with concussions recover within 4 weeks. The findings of the current study suggest that with first time sports-related concussions in middle school and high school athletes, female athletes remain symptomatic longer when compared with male athletes, regardless of the sport played.”
• “A significant difference was found in the median number of days female athletes remained symptomatic (28 days) when compared with male athletes (11 days).”
• “Female athletes aged 11 to 18 years with first-time, sports-related concussions remained symptomatic for a longer period when compared with male
  athletes of similar age, regardless of sport played.”