Blog 10: Upper cervical subluxations, physiology and implications for mental health
Updated: Jun 14, 2021
"You have anxiety. I'm going to prescribe Lexapro. It's a new drug that appears to have fewer side effects", my Washington D.C.-based neurologist told me about two months into my three-year health ordeal. That was Fall 2007 and at the time I was just grateful that the MRI and other exams had come back negative for brain tumor. The only anxiety I felt was an eagerness to figure out what was causing the multitude of symptoms I'd come to develop seemingly overnight. As the months and years passed, my rapid heart rate, shallow breathing, sweaty arms, body-wide fasciculations and especially my insomnia among many other issues would indeed make me anxious and irritable. But my anxiety was the function of something else and whatever it was, I knew it was way beyond Lexapro.
If you've read my previous entries, you know that upper cervical subluxations lead to a state of chronic sympathetic overdrive as a result of our bodies being unable to deal with those two vertebrae locked beneath the skull and the global dysfunction this creates. Our sympathetic nervous system engages our "fight or flight" stress response and this leads to a cascade of neurologic, physiologic and metabolic repercussions that eventually manifest as symptoms like the ones I mentioned above. More on that later but first let's dive into neurotransmitters for a bit.
Neurotransmitters/hormones are chemical substances that relay signals between nerve endings and some of the most researched neurotransmitters are those involved with mood regulation such as serotonin, dopamine and norepinephrine. Serotonin is secreted by the raphe nuclei of the brainstem and is thought to help stabilize our mood and keep us focused. Dopamine is produced in the substantia nigra of the brainstem, the ventral tegmental area and the hypothalamus and is secreted in response to pleasure and feelings of satisfaction. Norepinephrine meanwhile is produced in the adrenal medulla and is secreted to keep us aware and alert during stressful situations. Unfortunately, resolving depression or anxiety is not as simple as prescribing selective serotonin reuptake inhibitors. The functions and interactions of these substances are sometimes overlapping, sometimes synergistic, sometimes inversely-related and infinitely complex.
So let's consider two different ways that the Upper Cervical Subluxation Complex can alter this delicate balance. The first is quite simply the direct physical and biomechanical interruption it causes to the anatomy. These chemical messengers travel through the body across nerve endings as well as blood and cerebral spinal fluid and a UC subluxation compromises each and every one of these pathways. The brainstem at the level of the C1 vertebra is about 18 mm across while the neural canal is about 24 mm in diameter, which means that there's about 3 mm of leeway between the brainstem and the inside of the vertebral bodies. However, this space is tightly occupied by layers of dura and within one of these, the subarachnoid space, flows cerebral spinal fluid. Think of the stagnating effects a 3 or 4 mm subluxation can have on your ability to pump this fluid through the brain, it's ventricles, cisterns and around the spinal cord. Furthermore, winding in and around these vertebrae we find the carotid, basilar and vertebral arteries carrying nutrient-rich, oxygenated blood to and from the brain. And of course, chiropractic is based on the premise that compromised nerve transmission leads to disease so last but not least we have a brainstem/spinal cord that is taking direct pressure from anatomy that is locked out of place. The brain requires glucose, oxygen, proper nerve flow and to be able to dump waste byproducts in order to function properly. By straining these pathways, a UC subluxation can directly impair the secretion and delivery of neurotransmitters throughout the brain. Not to mention that many of these substances are produced in structures immediately above the C1 vertebra -- so direct pressure to the area may affect not only dispersal but production of these substances.
As critical as direct, physical compromise may be, I think it's actually this next aspect that has far deeper, more complex and wide-ranging consequences. An upper cervical
subluxation affects the neurology and biomechanics of the body and as such alters physiology at cellular and systemic levels in response to increased stress signals. For example, in the presence of a UC subluxation, muscles and vertebrae down the spine lose mobility and go into a maladaptive state in order to keep the head level. This alone causes joints and tissues to send pain and incongruent balance signals up the dorsal tracts of the spinal cord which the brain interprets as stress signals. This is known in chiropractic as dysafferentiation. This triggers a sympathetic response from the body which in turn engages our "fight or flight" response. As a result, adrenalin, cortisol and norepinephrine are secreted in order to keep you alert and awake during the stressful period. While stress in small bursts -- eustress -- is normal and can even be beneficial, you may see how remaining in this stressful state for prolonged periods leads to a vicious cycle of dysfunction in which all kinds of negative and positive feed back loops lose their ability to regulate homeostasis. As a result of increased pain signals and norepinephrine secretion, the brain may reduce secretion of dopamine or melatonin, which are associated with pleasure and rest, respectively. When the body's in sympathetic overdrive, parasympathetic-dominant functions such as these are put on the back burner. And eventually your reserves of norepinephrine or serotonin or dopamine become unbalanced or depleted. However, mental health conditions likely occur not in a vacuum but as a function and response to something else -- in this case in response to the neuropathophysiology caused by Upper Cervical Subluxation Complex. And the above scenario is but one cursory, over-simplified example of the infinite possibilities in which neurotransmitters can be affected by compromised neurology and physiology.
Research shows that mental health conditions such as depression, anxiety and all of their iterations have a very high rate of comorbidity, meaning they're usually accompanied by other conditions. According to a 2020 study in BMC Psychiatry:
Neurotic, stress-related and somatoform disorders (F4) were by far the most prevalent comorbidity in depression, irrespective of depression severity; 65% of severe depression cases (52% of mild and 61% of moderate cases) had additionally received an F4-diagnosis.
Somatoform disorders is physical pain with no known origin. Additionally, studies find that depression quite often has other mental health comorbidities such as anxiety. This particular study found that 64 percent of people with mild depression also suffered from another mental health condition. That percentage increased to 72 and 78 percent in moderate and severe cases, respectively. This gives us insights into the inextricable relationship between pain and mental health.
While UC Specific does not treat symptoms or conditions, it does restore neurologic, physiologic and biomechanical function and offers a viable explanation for how dysfunction in the body, including chemical imbalances, may occur.