In terms of stress and adaptation, few examples are so emotive as the currently-topical issue of Post Traumatic Stress Disorder (PTSD). It is estimated that 1.4 million Australians have PTSD at any one time, this number making up 6.4% of the population. Not all of these cases are combat related either. In fact, they come from all walks of life [1]. Common flow-on effects of the disorder include depression, suicide or suicidal ideation, drug and alcohol problems and many social, economical and functional impacts.
Current research and practice is taking us away from the idea that mental illness is ‘all in your head.’ We now know there are physiological and neurobiological aspects of mental illnesses such as PTSD that make it very much a tangible, quantifiable issue.
A diagnosis of PTSD requires a history of exposure to a traumatic event, and “symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity [2].”
In addition to these key clusters, there are marked differences in the brain scans of PTSD sufferers in comparison to the scans of those without the disorder [3]. Here’s the interesting thing though: the vast majority of people will experience or witness trauma over the course of their lifetime but not all of them will go on to develop PTSD.
This leads researchers such as Sherin and Nemeroff to the following conclusion: “The signs and symptoms of PTSD appear to reflect a persistent, abnormal adaptation of neurobiological systems to the stress of witnessed trauma. The neurobiological systems that regulate stress responses include certain endocrine and neurotransmitter pathways as well as a network of brain regions known to regulate fear behavior at both conscious and unconscious levels [4].”
Hence we may deduce that setting the body up for optimal neurological and endocrine function is important, both preventatively and otherwise.
Once upon a time, we believed that PTSD (originally called shellshock) represented a downstream effect. i.e. the trauma occurred and then triggered the disorder. Scientists now believe that the problem is also very much an ‘upstream’ one as well. There are strong indications that pre-existing factors can lie dormant until they are released by trauma exposure.
“Along these lines, recent interest has focused on factors that seem to modulate outcome variation in neurobiological systems following trauma exposure including genetic susceptibility factors, female gender, prior trauma, early developmental stage at the time of traumatic exposure, and physical injury (including traumatic brain injury – TBI) at the time of psychological trauma; these parameters likely contribute to vulnerability for, versus resilience against, developing PTSD [4].”
We cannot impact whether or not someone experiences trauma. This seems to be the unfortunate reality of life on the unpredictable planet that we share with other imperfect people. Where then should the compassionate chiropractor’s interest lie?
Perhaps it is in supporting neuroplasticity, thus empowering the person towards faster recovery. Perhaps it is in supporting optimal neurological function before the trauma occurs. The reality could even be a combination of both, with an extra emphasis on compassionate care. Either way, further research needs to be done.
So far, only minimal studies have been done on the effectiveness of chiropractic in helping people with PTSD. One such study focused on the effectiveness of chiropractic on combat-related PTSD sufferers. Of these, 61% of cases reported improvement [5]. However, many of these improvements were due to comorbid musculoskeletal complaints such as thoracic pain. The impact of chiropractic care on the person’s sleep was flagged, but no analysis occurred as to how this may have then impacted their overall health, including their mental health. No comprehensive study has looked at the impacts of chiropractic on the neuroplasticity of the brain alone.
The research that is available tells us that adjusting subluxations plays a role in supporting adaptation. We also have strong indications that adjusting subluxations can assist the brain in sending and receiving information without distortion.
We cannot yet say that chiropractic can help people with PTSD. Before we fully understand the role of brain plasticity, sleep and co-morbid musculoskeletal conditions in PTSD, it may remain a long bow to draw. What we can say is that compassionate care that allows the body to improve the physical condition, offers the person a better chance at restorative sleep, and supports brain plasticity is important. These can make the chiropractor a special part of the support crew for people with PTSD, during their road to recovery – however long or short that road may be.
References
[1] http://www.pickingupthepeaces.org.au
[2] American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.
[3] Bremner, J (2009), “Neuroimaging in Post Traumatic Stress Disorder and Other Stress-Related Disorders,” Neuroimaging Clin N Am. 2007 Nov; 17(4): 523–ix.doi: 10.1016/j.nic.2007.07.003PMCID: PMC2729089
[4] Sherin, J, and Nemeroff, C (2011), ‘Post-traumatic stress disorder: the neurobiological impact of psychological trauma,’ Dialogues in Clinical Neuroscience, 2011 Sep; 13(3): 263–278. PMCID: PMC3182008
[5] Lisi, A, “Management of Operation Iraqi Freedom and Operation Enduring Freedom veterans in a Veterans Health Administration chiropractic clinic: a case series,” J Rehabil Res Dev 2010;47(10):1-6 PMID 20437322
