In the last three weeks, we have covered many aspects of chiropractic’s interaction with consciousness, all involving the brain. The brain and consciousness have some level of interaction, and chiropractic could impact that interaction via neurological pathways (as has been reviewed in the previous articles) as well as via other mechanisms, which is the focus of today’s discussion. Chiropractic potentially impacts systems and functions that, in turn, could impact consciousness, such as the autonomic nervous system, glucose metabolism, the endocrine system, and our mental and emotional perception of our environment. These all impact our experience of life (i.e. consciousness) in a unique and powerful way.
The Vascular Correlates
As we delve into the non-neurological implications of chiropractic on consciousness, once again we start with neck and back pain. Chiropractic’s therapeutic benefit for back and neck pain is well referenced in literature; we know that. But a quick look at the basic science surrounding these issues can show us that there is much more to it than pain alone.
One example is an article that appeared in the Journal of Manipulative and Physiological Therapeutics which examined cerebral perfusion in patients with chronic neck and upper back pain [1]. The study took 45 adult patients with chronic neck and upper thoracic pain, measured them against a neck disability index and analysed cerebral blood flow in their brains. While it was a preliminary observational study, the results were significant: a decrease in cerebral perfusion of 20-35% was observed, “predominantly in the parietal and frontal zones.” Furthermore, “a significant difference was found between NDI [neck disability index] groups (“moderate” and “severe” showed significantly greater hypoperfusion than “mild”). [1].”
Remember that both the parietal and frontal cortices are involved in consciousness, so a vascular (cerebral perfusion) change to those areas could impact consciousness too.
The researchers’ conclusion included a statement that NDI scores “strongly predicted cerebral hypoperfusion,” and that “spinal joint dysfunction may be involved via hyperactivity in the regional sympathetic nervous system.”
Both statements are interesting, and laden with implications for chiropractic. Firstly, we know that cerebral hypoperfusion is significant, because it impacts brain function and intracranial pressure, which in turn links to the flow of cerebral spinal fluid and glympathic drainage from the brain [2]. As researcher Antoine Louveau recently postulated, this glympathic drainage could be significant for things like Parkinson’s and Alzheimer’s Disease [2].
But we also know that sympathetic hyperactivity can manifest in physical symptoms such as hypertension, sweating, increased adrenal activity (adrenaline/norepinephrine), and have a flow on effect that impacts many systems within the body. Frankly, if we are talking about consciousness as involving pain and sensation as well as thoughts and emotions, then even a decrease in pain or on the NDI would mean an elevation in consciousness. But when we start to impact sympathetic hyperactivity, it’s a whole new ballgame.
This is not the first piece of research on the effects of neck and back pain on the brain. But it does create some interesting links for chiropractic: When we adjust the spine, we may normalise sympathetic function and increase blood flow to areas of the brain significant for executive functions and sensorimotor/somatosensory integration. Our patient may walk out of our clinics feeling clearer and ‘just better’, but there’s a very good reason why.
Of course the vascular system doesn’t just involve blood flow to the brain. It involves blood flow everywhere else. Over the course of the last year, we have read some interesting case studies and a case series from chiropractor Dr Amy Haas, as she delved into the ramifications and uses of heart rate variability (HRV) in chiropractic. Her work presented a number of cases where a patient’s heart rate variability improved under care [4].
Why is this significant? Many interventions including exercise and meditation can improve HRV temporarily, however Haas’s paper reported sustained, rather than temporary, increases in HRV, suggestive of the possibility that the intervention Haas reported on created neuroplastic changes. In this case, the intervention was a series of adjustments intended to correct vertebral subluxations.
In an earlier interview with ASRF, Haas explained:
“There are plenty of outcome indicators available to look at pain or range of motion. There are a few that are fantastic for physiology – Heart rate proper and blood pressure for example. But HRV really caught my attention because it is a window into the three arms of the safety pin cycle. It requires input, integration in the brain, and then execution of an adaptive response. In a nutshell, that’s adaptation.
Because HRV requires all three of those components, and the nervous system is the centre of integration, it presents a unique opportunity for chiropractors. One of our explanations of subluxation is the dysafferentation theory where you have a disturbance in the safety pin cycle. That can be any of those three arms: inaccurate information going into the brain, inaccurate integration or execution of the response. HRV can’t distinguish between those per se but it can suggest a breakdown of that safety pin cycle.”
HRV may be an indicator of improved adaptability under chiropractic care, and adaptability is our ability to respond to our internal and external environment. That is, as the brain changes under chiropractic care, HRV may be able to help us measure improvements in adaptability – a manifestation of consciousness if you will.
Glucose Metabolism and Neuroendocrine Effects
In 2011, a study found cerebral metabolic changes in men following chiropractic care for neck pain [6]. The study, published in the journal Alternative Therapies, demonstrated increased glucose metabolism in the inferior prefrontal cortex, anterior cingulated cortex and the middle temporal gyrus. These regions were all activated in the study, under chiropractic care.
What does this mean on a practical front? The cingulate cortex is involved in the generation of autonomic responses (such as blood pressure and heart rate among many other functions as we know). It appears that performance of relaxation tasks may elicit maximal activation in the anterior cingulate region. Interestingly, through its part in the limbic cortex, this region of the brain is also involved in decision-making, cognitive processing, evaluation and emotional regulation [7], and as part of the midline attentional system that involves the dorsolateral prefrontal cortex.
Hence, its significance for consciousness is substantial. The cingulated cortex interacts with our feelings and emotions, and our thoughts in various ways – all components of consciousness.
We haven’t even touched on how the neuroendocrine system might respond to chiropractic care and impact consciousness. While chiropractic research hasn’t yet illuminated this area for us, there are voices within the chiro-neuro space who argue that chiropractic care may have a significant impact on the endocrine system. These arguments are backed by basic science and a firm understanding of how the chiropractic adjustment impacts nociception, dysafferentation and various systems in the body including the adrenal cortices and the endocrine system. Only time and further research will move these areas out of the realms of ‘hypothesis’ and into the realms of scientific certainty.
Quality of Life
Examining the ways in which chiropractic may influence and elevate consciousness is a little like falling down the proverbial rabbit hole. There are many connections and roads we could take, but the final one for this series, at least, is the simple issue of quality of life (QoL). Measured by tools such as the SF36, it is perhaps easily misunderstood because it has been hard to measure in an objective way. Yet self-reported quality of life matters, because it tells us how the patient feels. Do they feel less pain, more energy, more mental clarity, less stress? While to a researcher, these terms may be grey, to a patient they are everything.
A 1997 network study published in the journal Vertebral Subluxation Research revealed that over 76% of respondents receiving chiropractic care reported positive, clinically significant wellness coefficients incorporating perceived changes in:
- Their physical state,
- Their mental and emotional state,
- Stress evaluation, and;
- Life enjoyment
In recent years, we have seen a surge of case reports claiming (among other things) improvements in quality of life, especially for elderly patients [8]. While the QoL benefit is certainly not limited to that age group, or even to people who presented at chiropractic clinics for pain management, it does represent a tool by which we can look at the patient’s experience of consciousness (stress, mental and emotional wellbeing) and function (physical wellbeing, independence and ability to interact with daily life tasks).
It’s an often overlooked data set, but the anecdotal and subjective evidence we have so far often repeats a familiar story: Many, many people feel better under chiropractor care. The details vary, as do the measurement tools. But if we are talking about consciousness as every waking feeling, sensation, thought or imagining, then there are many aspects of consciousness that link in here.
Why the understanding of chiropractic and consciousness matters:
Why talk about chiropractic and consciousness, bridging the scientific and philosophical aspects of it all? The answer is two-fold. First of all, as we just mentioned, the subjective, personal experience of consciousness is everything to each individual person we care for. There is nothing else that relates to how rich and meaningful we feel our life is.
Secondly, the plain and simple truth is that discussing chiropractic and consciousness illustrates just how far we have come, and also how far we have to go. Despite advances in understanding, technology and research, we still run the risk of being pushed into a reductionist paradigm that deals only in pain and remedy. Yet what we do has so much more to offer when it comes to brain, body and expression of life.
When we embarked on our research agenda, we knew we had a lot left to do. It started with a definition of the subluxation, but where is the endpoint? Perhaps there isn’t one. But look at what we have achieved so far! ASRF has been honoured to be able to help fund some of the groundbreaking studies that have graced the reference list in this series. We are proud to be able to support talented, dedicated researchers as they undertake this important work. Yet there is so much left to be done.
If you want more research that clearly illustrates how chiropractic facilitates the everyday magic you see in your clinic, then donate. We all need to support this cause if we are to forge forward as a profession. In a world of regulation, social media and political pressures, research is currency.
Thank you for being part of a tribe that seeks to elevate the consciousness of society through research, and of course through chiropractic care.
References
- Bakhtadze M, Vernon H, Karalkin A, Pasha S, Tomashevskij I and Soave D (2012), “Cerebral perfusion in patients with chronic neck and upper back pain: preliminary observations, JMPT, doi: 10.1016/j.jmpt.2011.12.006
- Staff Writer (2018), “The Posture Series Part 2: CSF flow,” Australian Spinal Research Foundation, https://spinalresearch.com.au/the-posture-series-part-2/ retrieved 23 January 2019
- Staff writer (2018), “The stress series: Stress and posture,” Australian Spinal Research Foundation, https://spinalresearch.com.au/the-stress-series-part-3-stress-and-posture/ retrieved 23 January 2018
- Haas A, Russell D (2018), “Sustained improvement of heart rate variability in patients undergoing a program of chiropractic care: a retrospective case series,” Chiropractic Journal of Australia, Volume 45, Number 4, pp. 339-358
- Staff Writer (2018), “Improvements in HRV under Chiropractic Care,” Australian Spinal Research Foundation (interview with Dr Amy Haas), https://spinalresearch.com.au/improvements-in-hrv-under-chiropractic-care/ retrieved 23 January 2018
- Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain, Journal Alternative Therapies, Nov/Dec 2011, Vo. 17, No 6
- Moss S, “Anterior Cingulate Cortex,” SICO Tests, sicotests.com/psyarticle.asp?id=263
- Staff Writer (2017), “Chiropractic Care and Quality of life, what the research has to say,” Australian Spinal Research Foundation, https://spinalresearch.com.au/chiropractic-care-quality-life-research-say/ retrieved 23 January 2019
