Emotional stress: Anxiety, Depression and Panic Attacks: A neurologic and psychiatric like condition caused by cervical spine instability

Ross Hauser, MD.

If you have been battling chronic illness, you probably do not need a scientific article to convince you that your challenges come with an emotional price. However, it may be helpful to have some science that says your emotional stress is something more than “illness fatigue.”

When we see patients, they rarely have one or two challenges facing them. In the case of emotional stress, this problem is usually listed at the end of a long line of symptoms and conditions. At the end of this list of neck pain, digestion problems, ear tubes, hearing problems, vision problems, and other neurologic-like, vascular-like symptoms and psychiatric-like conditions to name just a few, they tell us about their inability to stop taking opioids and antidepressants, and their inability to regulate or control their stress, anxiety, and emotions.

“I have treatment resistant depression”

This is an email we received. It has been edited for clarity.

“I have treatment resistant depression, chronic fatigue, anxiety, depersonalization, cranial pressure, dark cloud, neck/shoulder pain. I was searching online and found your videos which lead me to seek out an upper cervical spine doctor. Finally, it was discovered that I have a subluxation of my atlas probably stuck in misalignment a very long time. I’ve been searching for relief over 30 years.”

For many of these people, reassuring talk centered around their conditions and symptoms causing their emotional challenges would be helpful in explaining the benefits of cognitive behavior management, stress reduction, the benefit of meditation, and the benefit of spirituality and prayer. However, there is also a physical manifestation in emotional stress that can come from cervical spine instability killing nerve cells. It would, for many, be equally beneficial to help them understand the possible mechanisms of the physical manifestation of their challenges.

If you are like many of the people who reach out to us you are facing challenges that may sound similar:

I am always dizzy, I have a ringing sensation in my ears, my vision is impaired, I have emotional disorders.

I have had many failed spinal surgeries. I have extreme pain it is affecting me emotionally.

My doctors think I am too symptomatic. All these things cannot be wrong with me. It’s wearing on me emotionally.

I was in a car accident and ever since I have been dealing with neck, low back, hip, and pelvic pain. The biggest problem is my cervical spine. It pops out of place all the time. I also believe my neck is the root cause of many of the cardiovascular and gastrointestinal problems I face.  I have been to countless doctors nothing has given me relief that is long-lasting. I am currently still getting medical tests looking for answers. I have been to the emergency room recently with heart palpitation. I was prescribed beta-blockers for hypertension and recommended getting some type of anxiety medication. I had already been told to get anxiety medication but I do not think these medications will be helpful to me. This is really getting inside of my head emotionally.

Sometimes emotional stress “is not all in your head” it is “all in your neck.”

Suddenly, a few months ago, without warning I began to have anxiety and depression. I tried to convince my doctors that this started with a sudden and terrible neck pain and an inside the head pressure shortly following a head trauma which impacted by jaw and snapped my neck. But so far nothing is being seen on MRI. As time went by, my neck began to feel very weak and I had the sensation that my head was too heavy for my body. I am having memory issues, anxiety, and panic attacks. I am changing as a person and not for the better.

“I was involved in a major car accident a year ago. I can almost no longer work and as a result I have serious anxiety and depression. I am struggling with serious blurry vision, extreme fatigue, mental fog, my brain is slowly leaving me, like I have Alzheimer’s. It’s at the point where I struggle to think. I have seen so many doctors and none of them have been able to tell me what is wrong with me. All blood tests come back normal and my MRI’s have also came back normal. I struggle with mostly lower back pain as well.”

What are we seeing in this image? The understanding of how exaggerated emotions or emotional stress can be “not all in your head” but rather, all in your neck.

The neurology-like and psychiatric-like conditions caused by cervical spine instability:  Vagal ganglion neuron destruction from emotional stress.

  • In this article, we will discuss the nodose ganglion of the vagus nerve and how dysfunction in this ganglion (a nerve message center) can move misinformation messages between the brain and body. In this image, we see the nodose ganglion at the base of the skull.
  • We also see the vagus nerve as it winds its way through the C1-C2 vertebrae. The vagus nerve, as we will see below, is important in many functions of the body. If the nerve is compressed, stretched, or damaged by cervical spine instability, a myriad of problems, including runaway emotions can occur.

In this article, we are going to take a small journey of understanding how cervical spine instability can physically manifest emotional stress on the cellular, chemical level of distorted messages from nerve to brain and back. This article will deal with how emotional stress damages the vagus nerve and how cervical spine instability and compression of the vital structures that run through the neck from the brain to body will once again take us to the place where we can tell patients, “it is not all in your head,” it is “all in your neck.”

I have been diagnosed with Major Depressive Disorder

A story: “I have been diagnosed with Major Depressive Disorder with psychotic features, chronic fatigue, anxiety, PTSD, sinusitis, fibromyalgia, seizures, to name a few. I have tried multiple medications but nothing seems to work or they work for a very small period of time. I have no energy, my mood is in anger all the time, I have no rest from pain ever (even with Vicodin or anesthesia injections), my head pounds ALL THE TIME like if my sinuses were stuffed with mucus, my vision gets blurry, brain fogginess, my heart muscle aches, my whole left arm is always in pain or numbed, as too is my left leg all the way to the tiny toe. So, I googled exactly what I felt: what runs from the brain stem (right from where the neck starts), comes down towards my left arm, circles around the heart, pinches the lower back, and goes down the left leg ending with numbness of the toes? And that is when I discovered it was the vagus nerve. And of course after that, I googled how do I get treated? I am taking Lyrica 200 mg twice a day, cymbalta 60 mg, tizanidine 4 mg as needed, Vicodin 10/325 mg every eight hours, clonazepam 1 mg as needed once a day, and an abilify shot every month for depression, and levetiracetam for seizures. However, nothing seems to help or get anywhere near my healing. It’s been seven years now trying different antidepressants, all sorts of medication, spiritual journeys, different diagnosis, chiropractors, massages, ECT in my brain (seizure induction therapy with electricity), MRI’s, EEG’s, sleep studies, etc. and am here on this day defenseless asking for another opinion or a new hope towards recovery.”

Personality changes and emotional health problems often seen in patients with cervical dysstructure

Ross Hauser, MD discusses emotional symptoms and personality changes that may have a structural link to the neck in some cases.

This video is on one of the most important topics we see in patients. How ligamentous cervical instability, that is how weak and damaged neck ligaments are not able to support and hold the neck and head in place, allowing the neck bones to compress on the neurologic (nerve) processes that run trough the neck and cervical spine.

This affects a person’s emotional stability and personality. Many patients have shared with us how psychological diagnosis such as bipolar disorders or personality disorders have been radically changed for the better once their neck and cervical spine instability or “dysstructure” a broken down neck structure, has been treated and natural structure, curvature, and stability has been restored.

Anyone who’s had a change in emotional status or change in personality, that in some cases seems to have happened overnight, has to wonder why did this happen? What can happen is that a person’s brain pressure can reach certain levels where certain parts of the brain will no longer function correctly or the brain’s nerve impulses and messages are not reaching other parts of the body, or when those messages do arrive, they are jumbled and distorted and nothing makes sense. They will have a sudden change in emotional stability, for instance they could have new onset of anxiety. If know somebody whose personality is absolutely changed, almost overnight,  more irritability or lack of interest in things, they don’t care about the future, all of a sudden they’re very depressed or all of a sudden they have bipolar disorder, you have to think, this is night right? What is going on? It could be cervical spine instability.

This is the background slide in the introduction of the video. A brief summary is given below.

Negative changes in personality and psychological status could be due to ligamentous cervical instability or cervical dysstructure

Negative changes in personality and psychological status

Negative changes in personality and psychological status could be due to ligamentous cervical instability or cervical dysstructure.

  1. Definite change in personality or emotional stability.
    1. Article for further resources please see Ross Hauser, MD Reviews Cervical Spine Instability and Potential Effects on Brain Physiology
  2. Other signs of cervical instability: popping clicking and grinding of neck
    1. neck pain
    2. muscle spasms
    3. muscle fatigue
    4. numbness in arms or hands
  3. Other symptoms suggestive of intracranial hypertension.
    1. blurred vision
    2. head pressure
    3. headaches
      1. Article for further understanding and information: Cervical Spine Instability, fluid build up and intracranial hypertension.
  4. Other symptoms suggestive of vagus nerve degeneration.
    1. swallowing difficulty – Cervical disc disease and difficulty swallowing – cervicogenic dysphagia
    2. increase stress – Emotional stress: Anxiety, Depression and Panic Attacks: A neurologic and psychiatric like condition caused by cervical spine instability.
    3. emotional lability – offered described as an “emotional roller coaster.”
    4. Digestive. See articles:
      1. How neck pain and cervical spine instability cause nausea, gastroparesis and other digestive problems
      2. Cervical spine instability and digestive disorders: Indigestion and irritable bowel syndrome caused by cervical spondylosis
  5. Symptoms of Anhedonia – the inability to feel pleasure
    1. reduce motivation
    2. diminished pleasure derived from daily activities
    3. social withdrawal
  6. loss of libido. Also see Sexual function and cervical spine instability.

A rabbit, a 1981 study and you. The journey of understanding and answers may start here.

It is important to understand that in this article I will be presenting a possible medical answer to the myriad of problems that people may face with vascular, neurologic, and psychiatric-like type disorders. The complexity of some cases people have with these symptoms and conditions may require a multi-discipline or multi-pronged medical approach. This article will focus on the concept of cervical spine instability and the destruction of nerve cells as a cause for the psychiatric-like type disorders aspect of problems these people face. This may be an answer for some people for those parts of their symptoms and conditions that include stress, anxiety, depression, dissociation, and emotional disorders or emotional dysfunction.

What are we seeing in this image? How acute emotional stress can be an “atomic bomb” that destroys neuron cells and damages the vagus nerves and initiates and progresses psychiatric-like type disorders.

The image below with the picture of the rabbit is the starting point of our examination of the research on this topic. It reflects a landmark 1980 study that examined what happened to rabbit’s neuron cells, Nodose ganglion, and vagus nerve when the rabbits were exposed to chemically induced emotional stress. We will bring this research currently to 2021 and explain how what happened to these rabbits can be happening to you and present you with a possible understanding as to why for no reason, you once lead a stress-free life, and now you are a person filled with anxiety and emotional disorders. The possible understanding may be found in your neck.

Underneath this image is explanatory notes that explain the image’s learning points and how this image relates to you.

First, let’s look at this 1981 study (1) for a brief understanding of our starting point on acute emotion stress damaging the vagal neurons.

Neurons are, of course, nerve cells. Ganglia or a ganglion is a place where nerve cells congregate to form a nerve messaging relay station. In this section of this article, we are going to look at the obvious answer to “what happens to cell phone signals if you blow up cell phone towers.” What do you think happens? The calls do not go through. In that same regard the call from the nerve centers and nerves to the brain do not get through and the ones who do, “drop” and distort.

In this study, the researchers used electric stimulation to recreate conditions of severe and acute emotional stress in the rabbit’s neurons. What the experiment showed was that the simulated acute emotional stress episodes were like an “atomic bomb” going off in the neuron cells. Widespread and significant destruction was noted in the nerve cells.

Widespread and significant destruction was noted in the nerve cells. There was tremendous mitochondrial damage.

What we find in many patients that we see, is that they have not only been on a long road of medical treatments and medical hypothesis trying to alleviate or explain their situation, but they themselves have been on a long road of medical discovery. Some of these patients and their loved ones have not only spent hundreds of hours in medical offices, but they have also spent hundreds of hours online looking for information and education that may help them. Many are very aware of the function of the cell mitochondria, the “power plant,” that supplies energy to the cells. Mitochondria damage has long been implicated in problems of cellular function and of course, fatigue.

Here is a list of symptoms that may occur with chronic and significant mitochondrial damage. Notice the common symptoms and conditions with Craniocervical Instability.

What are we seeing in this image? Upper Cervical Instability and stress are two main sources of vagus nerve destruction at the nodose ganglion.

Above we spoke about rabbits who were electrical stimulated to duplicate the impact of emotional stress on their nervous system. In human beings, emotional stress is triggered by chemical function and can be triggered by “events.” In this illustration some of these events are listed as:

  • Death of a loved one
  • Traumatic event
  • Working long hours
  • Loss of job or reduced income

My doctors think I am too symptomatic. All these things cannot be wrong with me. It’s wearing on me emotionally.

Above we described some of the stories we hear from people. Some of these people are being affected by a double burden. The physical manifestation of symptoms from cervical spine instability and the emotional stress of their illness. In this illustration, we see the two sources, stress and cervical spine instability side by side and their emotional and physical influences on the inferior ganglion of the Vagus Nerve.

There was tremendous damage to the Golgi apparatus and an increase in lysosomes and autophagosomes. What does this mean? Nerve cell death

The Golgi apparatus is a very complex structure, explaining it simply here will not give it the understanding it deserves but for the purpose of this article and the conditions and symptoms you may be suffering from a brief outline will do.

The Golgi apparatus in a cell receives processed proteins and lipids, processes them further, sometimes combines carbohydrates, and then sends them on their way to other areas of the cell and to areas outside the cell. These proteins, lipids, and carbohydrates provide energy, transportation networks to get themselves and nutrients to other areas of the call and outside the cell. This network also moves enzymes, proteins, and other chemicals around the body. Equally important, they provide a network to get rid of waste. Lysosomes contain digestive enzymes that break down and remove the byproducts of the Golgi apparatus metabolism of proteins, lipids, and carbohydrates. Autophagosomes collect and gather cellular debris to deliver to the lysosomes. A dysfunction in this system will lead to a backup of waste in the cellular innards.

The vagal ganglion neurons were self-destructing

Disruption of the Golgi apparatus metabolism and lysosome function creates a backup of waste. Further, this dysfunction causes the breakdown and destruction of neurons. If there is a backup of waste in the cell, the Lysosomes recognize that this cell is unhealthy, the lysosomes will now embark on a suicide mission. They will “explode” within the cell, releases their digestive enzymes to eat the cell from within. In this rabbit study, this is what was happening to the vagal ganglion nerve cells.

Above I gave a brief analogy of what would happen if a cell tower blew up. What would happen to the cell phones? Well if you used your cell phone to call to get rid of your garbage and waste and your cell phone did not work, your garbage and waste will pile up. When your nerve communication network is compromised, waste backs up. The waste will kill the living cells.

Where emotions live in the neck and upper cervical spine and how emotions can be impacted by runaway vertebrae

The vagus nerve cell bodies are primary in the nodose ganglion which sits right at the level of C1. Upper cervical instability in the C1 area can cause compression on the vagus nerve.

In this image, we see the closeness of the glossopharyngeal nerve (CN IX), the main function of which is swallowing, the gag response, and movements of the tongue. The Spinal accessory nerves (CN XI) control the shoulder muscles and head movements, and the Vagus nerve (CN X) is said to control everything. The Vagus, glossopharyngeal, and spinal accessory nerves can be easily damaged, compressed, and function altered by the excessive motions of the upper cervical vertebrae.

In this image we see the closeness of the glossopharyngeal nerve (CN IX), the main function of which is swallowing, the gag response and movements of the tongue. The Spinal accessory nerves (CN XI) which control the shoulder muscles and head movements, and the Vagus nerve (CN X) which is said to control everything. The Vagus, glossopharyngeal, and spinal accessory nerves can be easily damaged, compressed, and function altered by the excessive motions of the upper cervical vertabrae.

The vagus, which is said to control everything

In the illustration below, the many things the vagus nerve is responsible for. Highlighted among these functions is the Vagus nerve’s role in managing coping skills in situations of anxiety, depression, and stress.

In this illustration, the many things the vagus nerve is responsible for is outlined. In the illustration below, the many things the vagus nerve is responsible for. Highlighted among these functions is the Vagus nerves role in managing coping skills in situations of anxiety, depression, and stress

Emotions can live in the nodose ganglion of the vagus nerve

There is a misunderstanding in the medical community about that the part of the autonomic nervous system which impacts changes to severe emotional stress. This part of the autonomic nervous system is not in the sympathetic ganglia but in the structures of the nodose ganglion of the vagus nerve.

In the nodose ganglion of the vagus nerve, the nerve cells and proteins we spoke about above, these essential components of a well functioning autonomic nervous system, can be destroyed by vagal nerve compression.

In the rabbit study above, the rabbits did not have neck instability. The researchers put the rabbits under acute emotional stress (simulated electronically as noted above) and then looked at the various sympathetic and parasympathetic nerve ganglion (the vagus nerve is among the parasympathetic nerve ganglion) under light microscopy. There were significant changes as described above in the vagus nerve nodose ganglion.

Hearing are the understanding points of this study:

  • The rabbits suffered physical stress that can be explained as an “atomic bomb.”
  • The changes from stress arose and developed in the Golgi apparatus of the neurons (nerve cells) of the nodose ganglion of the vagus nerve.
  • These changes led to the sudden formation of new and large numbers of lysosomes. The cellular waste removal cells. The phenomena of new rapidly producing lysosomes were only seen in the neurons of the nodose ganglion. These changes can and do if severe enough, cause the death of the vagal nerve cells.

The amygdala – stress and emotions

Stress always has an emotional component. The stronger the emotions are, the greater the stress will affect the person. The amygdala is the seat of emotions in the brain. It is where emotions such as sadness, fear, anger, anxiety, bitterness, and the rest of the ‘bad’ emotions live. People with stress have hyperactive enlarged amygdalas. When the amygdala is stimulated a host of defensive behaviors occur including increased cortisol, heart rate, and blood pressure. It is the brain’s ventromedial prefrontal cortex area that acts to inhibit the amygdala’s intense emotional reactions so a person can make a decision rationally.

A study in the Journal of Affective Disorders (2) showed that vagus nerve stimulation could reduce depression by regulating amygdala function. Here are the summary learning points of that study:

“The amygdala is a key region in emotion processing, and studies have suggested that amygdala-frontal functional connectivity deficits (correct function) could be modulated by antidepressants in major depressive disorder. Transcutaneous (skin stimulation ) vagus nerve stimulation, a non-invasive, peripheral neuromodulation method at the ear, has shown promising results in treating a major depressive disorder in several pilot studies.”

In this study, the researchers investigated how transcutaneous vagus nerve stimulation can modulate the amygdala-lateral prefrontal network resting-state functional connectivity (prevent the amygdala from overreacting to stress stimuli) in mild or moderate major depressive disorder patients.

What the researchers found that after one month of transcutaneous vagus nerve stimulation treatment, depression scores were reduced significantly.

To someone with strong vagus nerve function or vagal tone, stress can be managed. To someone with a low vagal tone, even the smallest stress can become emotionally and physically devastating.

Above I gave a brief example of someone who feels that: “My doctors think I am too symptomatic. All these things cannot be wrong with me. It’s wearing on me emotionally.” Let’s put some science behind explaining what is happening here. Let’s return to the rabbits of the study we began this article with. The rabbits may be telling you a lot about how your stress. Here is what the researchers said:

Under intense stressful conditions, sympathetic ganglion (sympathetic ganglion are the components of the central nervous system that collect and distribute information to the body about possible risks, stress and dangers. Sympathetic ganglion help control the fight or flight response) such as the cervical superior ganglion and stellate ganglion show no or little ill effects, but the nodose ganglion shows pronounced changes within the neuronal cell bodies and cytoplasmic organelles (the fluid of the cell innards on which all messaging is relayed). Likewise, the most important parts of the brain for rational decision making such as the prefrontal cortex (the prefrontal cortex uses short-term memory and life experience or memory storage to help make these decisions)  and the anterior cingulate gyrus (that portion of the brain that regulates emotion and decision-making) shrink and the emotional centers such as the amygdala and other limbic structures handle it fine and even prosper.

What does all this mean to you? You get emotional for “no reason.” You have panic attacks, anxiety, depression, and hostility. You have negative emotions and negative thoughts.

I had panic attack from out of nowhere one night. Then, for the next month my body began doing abnormal things, heart palpation, excessive sweating, creaking/squishing sounds in my neck, fatigue, headache, loss of sleep, tremors of my whole body, stiffness when waking up. Doctors have been leaning towards anxiety but I have never had this diagnosis before nor do I have any reason to suffer from such a thing.

What is being suggested in the research above is a possible pathway to understanding why you get emotional, depressed, or have panic attacks for “no reason.” It is in your neck and it is impacting the normal function of your vagus nerve. Disrupting the normal function of the vagus nerve can cause anxiety, depression, hostility, negative emotions and negative thoughts. In other words, a person with a strong vagal tone can handle a myriad of stressors and be peaceful, whereas those with low vagus nerve function can become emotionally overwhelmed by the smallest of stress or “for no reason.” People who can’t handle stress by in large have low vagus nerve function.

This was demonstrated in a series of studies on affective, cognitive, and autonomic regulations showing that persons with higher levels of HRV (Heart Rate Variability) are more stress-tolerant and more adaptive in the face of diverse environmental challenges. Basically, when a person has a low HRV, they are hypervigilant in looking for what can go wrong (versus what can go right) and inefficient at properly allocating their attention and cognition to reach their goals.

To take it one step further. The studies just referred to were collected and reviewed in the book chapter A Neurovisceral Integration Model of Health Disparities in Aging (3) from Critical Perspectives on Racial and Ethnic Differences in Health in Late Life.

The focus here will be on the heart rate variable

This from the book: “Another way in which perseverative (survival) thinking maybe causally (causing the problem) related to autonomic imbalance and disease is by decreased vagally mediated HRV. (A problem with the vagus nerve is causing a problem with the heart rate variable). Diminished tonic (lower vagal tone related) HRV and the associated reduction of vagally mediated cardiovascular control has been associated with a variety of pathological states and dispositions, including diabetes, myocardial infarction, congestive heart failure, and hypertension. As an index of vagally mediated cardiovascular activity, HRV reflects a negative feedback mechanism that is crucial for the self-regulation of behavior. Vagal activity has negative cardiac chronotropic (disruption or change of the heart rate) and dromotropic (racing) effects that promote efficient cardiovascular function by restraining cardiac rate and electrical conduction speed, which is vital to attain cardiac stability, responsiveness, and flexibility.

Several lines of research point to the significance of HRV in emotions and health. Decreased HRV is linked with a number of disease states, including cardiovascular disease, diabetes, obesity, and lack of physical exercise. Reduced vagally mediated HRV is also associated with a number of psychological disease states, such as anxiety, depression, and hostility. For example, low HRV is consistent with the cardiac symptoms of panic anxiety as well as with its psychological expressions in poor attentional control and emotion regulation, and behavioral inflexibility. Similar reductions in HRV have been found in depression, generalized anxiety disorder, and posttraumatic stress disorder.”

Basically, when a person has a low HRV, they are hypervigilant in looking for what can go wrong (versus what can go right) and inefficient at properly allocating their attention and cognition to reach their goals. This was suggested by a 2005 study in the journal Psychoneuroendocrinology (4) which stated: “HRV is associated with a range of psychological and somatic pathological conditions, including immune dysfunction.” Further: “(there is supportive evidence to suggest) reflexive startle blink (This is what it describes – a rapid or startled eye blinking response to something that startles or frightens you), attention and working memory, which shows that low HRV predicts hypervigilance and inefficient allocation of attentional and cognitive resources.”

heart rate variability testing

A resting HRV slows down bad emotions

The 2005 study I just alluded to has been used by over 600 research papers to explain, among other challenges that face people like yourself, the role of the vagus nerve and HRV in emotional stress. This includes an August 2020 study in the journal Cognitive, Affective & Behavioral Neuroscience. (5)

Before we get this study’s observations, let us take a moment to explain the Neurovisceral Integration Model we have been discussing. For this, let’s refer to a paper published in the journal Frontiers in Psychology. (6) This how this model is described and has been built upon.

The neurovisceral integration model (Thayer and Lane, 2000) posits that cardiac vagal tone, indexed by heart rate variability (HRV), can indicate the functional integrity of the neural networks implicated in emotion-cognition interactions. (This study’s authors) recent findings begin to disentangle how HRV is associated with both top-down and bottom-up cognitive processing of emotional stimuli.

Higher resting HRV is associated with more adaptive and functional top-down and bottom-up cognitive modulation of emotional stimuli, which may facilitate effective emotion regulation.

Conversely, lower resting HRV is associated with hyper-vigilant and maladaptive cognitive responses to emotional stimuli, which may impede emotion regulation”

And now for the 2020 paper:

“The neurovisceral integration model aims to account for the complex interplay between physiological, cognitive, and emotion regulation processes through their support by common cortico-subcortical neural circuits. According to the model, vagally mediated heart rate variability (HRV) serves as a peripheral index of the functioning of these circuits, with higher levels of resting HRV reflecting more optimal functioning, to support goal-directed behavior and adaptability to environmental demands.

Although increased cognitive flexibility has been related to higher resting HRV, this has not been assessed in the context of emotional information to examine the interplay between cognition and emotion. . . The avoidance theory of worry and anxiety, as well as empirical evidence, links anxiety to attentional avoidance of negative information. Our findings, therefore, support the neurovisceral integration model such that when greater flexibility can facilitate attentional avoidance of negative information-as seen in anxiety-it is related to lower resting HRV.”

A further discussion on heart rate variable

We have more extensive information on heart rate variability or HRV. Below we will summarize two of our articles. The first is from our article Heart Rate Variability.

The clinical importance of HRV cannot be overestimated. A low HRV has been confirmed in numerous studies to be a strong, independent predictor of future health problems and as a correlate of all-cause mortality. Reduced HRV has been shown to occur in almost every illness. Low HRV is a predictor of both physical and emotional diseases. It also is an indicator of psychological resiliency and behavioral flexibility, reflecting an individual’s capacity to adapt effectively to changing social and environmental demands and stressors.

When a person is relaxed, the heart rate is low due to increased vagal tone. In this relaxed, calm, and restful state, breathing is slow and deep (belly or yoga breathing). Normally, during inspiration the R-R intervals are shortened as the heart rate speeds up so more blood is oxygenated, and they are lengthened during exhalation, so the maximum amount of blood is pumped out of the heart to the various parts of the body. Any breathing, therefore, is going to cause some variability in the time frame between successive heartbeats. When vagal tone is high, the influence of breathing on this variability is maximized. The combination of a low heart rate and a large amount of time between heartbeats; along with a large amount of time taken to breathe slowly and deeply, enhances the influence on the beat to beat variability.

Many Caring Medical patients, especially those with systemic illnesses and/or cervical instability find monitoring and improving their HRV important to regaining their health.

Sometimes emotional stress “is not all in your head” it is “all in your neck.” Autonomic nervous system (ANS) regulation and Heart Rate Variability – Is this the answer for some?

Above we talked about emotional stress being a possible “neck problem” not a “head case.” In our article, Can cervical spine instability cause heart palpitations and blood pressure problems? We discuss how chest pain, a racing heartbeat, panic attacks, and anxiety may be coming from a cervical spine and neck instability pressing on the vagus nerve. It is important to realize that this may only be one possible explanation as to why seemingly healthy individuals, having been checked out by their cardiologist, have cardiovascular-type symptoms with seemingly no explanation. Below is a brief summary of that article:

If the C1 vertebra is unstable and causes problems of “nerve pinching” this is how upper cervical instability can affect heart rate variable.

There is a difference between Heart Rate and Heart Rate Variability.

  • Heart Rate measures the number of heartbeats per minute.
  • Heart Rate Variability measures the time between individual heartbeats.

The majority of work the vagus nerve does is getting messages back and forth from brain to heart  These afferents (messages in) go through the nodose ganglion (nerve bundle) which sits in front of the atlas (C1 vertebra). If the C1 vertebra is unstable and causes problems of “nerve pinching” this is how upper cervical instability can affect heart rate variable.

The idea that upper cervical spine instability impacts heart rate variability and this may be a culprit of your symptoms, is not a new idea. In our 28 years of helping patients with problems related to the cervical spine, we have seen these symptoms many times. Yet medical research is not yet that abundant. In our own peer-reviewed published studies we have been able to document cervical neck ligament damage as a possible cause of low HRV as to when cervical neck ligaments are damaged or weakened by wear and tear damage or injury, they allow the upper cervical instability that can impinge on the cervical nerves.

Caring Medical measures both the time- and frequency-domain indices of HRV. Once baseline measurements are taken, they can be compared with those taken when with the patient under various stressors. As health improves, the changes in HRV from baseline lessen.

Emotional stress and vascular-like disorders

A 2000 study in the medical journal Stress (7) evaluate the reactions of autonomic neurons of the nodose ganglion of the vagus nerve, and the stellate and superior cervical ganglia in rabbits under emotional stress, and correlate with these reactions with the individual variations in responses to the stressor.

Emotional stress was induced in the rabbits by electrical stimulation. During the experiment (3 hours) arterial blood pressure was recorded.

  • One group of rabbits showed small fluctuations of blood pressure throughout the experiment and were defined as resistant to stress, whereas in the other group (predisposed to stress) blood pressure progressively decreased.
  • The predisposed rabbits showed earlier and greater increases in circulating norepinephrine concentrations than the resistant rabbits, indicating sustained sympathetic activation. The data indicate that the ganglia of the sympathetic nervous system are part of a major mechanism of blood pressure regulation under acute experimental emotional/painful stress. The nodose ganglion participates in the maintenance of stable cardiovascular function in extreme conditions.

Mice with gastrointestinal problems – stress and the vagus nerve

A December 2019 study published in the journal Neurogastroenterology and Motility (8) lead by doctors at the Vagal Afferent Research Group, Centre for Nutrition and Gastrointestinal Disease, Adelaide Medical School, University of Adelaide made a mechanical connection between the gastric vagal afferents and stress.

Here are the learning points

  • Stress exposure is known to trigger and exacerbate functional dyspepsia symptoms.
    • Stomach pain, bloating, belching, and nausea
  • Increased gastric sensitivity to food is widely observed in functional dyspepsia patients and is associated with stress and psychological disorders.
  • The mechanisms underlying the hypersensitivity are not clear.
  • Gastric vagal afferents play an important role in sensing meal-related mechanical stimulation to modulate gastrointestinal function and food intake.

In this study, mice were subjected to stress. The had exacerbated functional dyspepsia symptoms. Gastric vagal afferents mechanosensitivity, which may contribute to the gastric hypersensitivity in functional dyspepsia.

What are Gastric vagal afferents?

What are Gastric vagal afferents?

A paper in the Journal of Neuroscience Online (9) explains:

“Vagal afferents are an important neuronal component of the gut–brain axis allowing bottom-up information flow from the viscera (the internal gut organs) to the Central Nervous System. In addition to its role in ingestive behavior, vagal afferent signaling has been implicated modulating mood and affect, including distinct forms of anxiety and fear.”

In this study, the researchers used mice to add to the growing evidence suggesting vagus nerve-related signal disruption from organs to the brain in the dysregulation of emotional behavior.

The blood flow to and from the brain – emotional stress and cervical spine instability.

There are considerable variations in the blood supply in the head and neck and these can have major clinical significance, especially if a person has cervical instability.  It is important to exam the blood flow that goes to the various structures involved in the neurology of a patient’s problem because it will be important to make sure the blood flow is improved with treatment. Our website is filled with articles that discuss problems of blood flow to the brain and the neurological-like and emotional consequences that many face with their challenges of diminished blood flow.

Please see these articles:

Dissociation, Anxiety and Depression – Uncontrolled emotion in cervical spine instability patients. Many of the patients who we see in our neck center have conditions of anxiety, depression, and dissociation. These challenges can be termed psychiatric-like because, in some people, these problems are a manifestation of the cervical spine and craniocervical instability and are symptoms of nerve, vein, and arterial compression caused by the unstable bones of the neck pressing and compressing these vital structures.

Cervical spine compression causes internal jugular vein stenosis. We have been helping people with “mystery symptoms” and “mystery diagnosis” for approaching three decades. When we sit in the examination room with new patients, even after a careful screening process to assess their candidacy for the treatments we offer, we still sometimes get the look of confusion in patient’s eyes when we suggest a problem that has not been suggested to them before. Sometimes such is the case with internal jugular vein stenosis… In this article, we discuss the many symptoms and conditions including emotional stress, and how these problems can be helped by treating neck instability.

What are we seeing in this image?

Dr. Hauser is using ultrasound to examine the blood flow through the carotid artery. Blood in and out of the brain has to pass through the neck in its journey back and forth to the heart.

How cervical spine instability disrupts blood flow into the brain and causes many neurological problems

In the above research, we have made the case that the complexity of your problems may be caused by cervical instability caused by weakened and damaged cervical spine ligaments. Now we will begin to make the case that your symptoms may be alleviated on a long-term more permanent basis with the use of Prolotherapy.

Prolotherapy is a regenerative injection technique that utilizes substances as simple as dextrose to repair and regenerate damaged ligaments.

In 2015, Caring Medical published findings in the European Journal of Preventive Medicine investigating the role of Prolotherapy in the reduction of pain and symptoms associated with increased cervical intervertebral motion, structural deformity, and irritation of nerve roots. We concluded that statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability. (11)

C2 Malrotation

Ross Hauser, MD discusses C2 Malrotation and the symptoms associated with it, as well as why we like adjustments, curve correction, and Prolotherapy to help restore spinal integrity and resolve symptoms.

Video learning points:

The malrotation of the C2 vertebrae or the axis, is often what I call the the Missing Link into what is causing a person’s symptoms.

  • Rotated C2 can compress the vagus nerve that can cause digestive problems seen in some upper cervical instability patients.
  • Rotated C2 can cause compression on the  glossopharyngeal nerve which can cause dysfunction of the larynx muscles and cause swallowing difficulties.
  • Rotated C2 can cause compression of the spinal accessory nerve cause cramping into the sternocleidomastoid muscle or the trapezius muscle and creating a situation of torticollis.
  • Rotated C2 can cause compression and obstruct right jugular vein causing increased brain pressure and problems of cognitive decline and mood disorders.
  • Rotated C2 can compress the carotid sheath causing compression on  jugular veins and carotid arteries causing intracranial hypertension.

One of the most revealing tests we do in our office for upper cervical instability is a digital motion x-ray (DMX), which includes looking at how the C1 and C2 vertebrae align when tilting the head. In this video, Ross Hauser, MD shows an unstable and stable upper cervical digital motion x-ray.

How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding the challenges that you may be facing. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form


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This article was updated November 25, 2022


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You deserve the best possible results from your treatment. Let’s make this happen! Talk to our team about your case to find out if you are a good candidate.