How Can Osteopathy Help With Chronic Pain, Stress And Inflammation? Part 1
Caryn Seniscal DOMP
Vancouver Osteopathy Centre 2020
“Motion is the first and only evidence of life...Osteopathy is the law of mind, matter and motion.”
A. T. Still, founder of Osteopathy
There is a relationship between dysfunction and/or dis-ease and Body, Mind and Spirit. A problem in any one will compromise health and may be expressed through dysfunction in another. Many common complaints can potentially become chronic and affect all aspects of health and well-being. Pain is deemed chronic if it lasts more than 3 months or past the time of normal healing.
Chronic pain seems to be increasingly prevalent today and there is a lot of research being done on this topic. Persistent and prolonged pain can cause changes to occur within the central nervous system (CNS) creating a ‘central sensitization,’ amplifying pain and creating a state of “hyperalgesia”.
Brain plasticity (the ability to adapt as a result of experience) is a wonderful thing when you’re trying to learn something new but the brain also changes in response to prolonged pain. It’s as if it learns that the pain is important and facilitates it. The brain reorganizes anatomically and metabolically by lowering nerve pain thresholds, recruiting other neurons and wiring faster, stronger pain pathways. This process is known as ‘windup,’ which means that the pain pathway fires easily in response to all types of stimuli painful or not but interpreted by the brain as painful. The level of perceived pain also becomes greater than what would be expected and persists even after the original injury has healed.
Osteopathy is extremely well suited to help people in chronic pain. Our way of treating is gentle—we follow rather than force the body as it releases restrictions. This is important because we’re are not stimulating the sympathetic nervous system (SNS) and putting the body ‘on guard.’ If you are experiencing chronic pain, the treatment should not to be painful.
Osteopathic treatment is ‘wholistic’ in its philosophy and methodology. While we seek to find the root cause of your dysfunction, we treat you as a whole person, using different techniques to address your body’s structures and tissues on many levels. The treatment for chronic pain targets the central nervous system and calms and rebalances the autonomic nervous system. The goal is to desensitize the nervous system and dampen amplification of pain pathways using Craniosacral Therapy, OMT and Visceral Manipulation (see: Our Services). All these techniques support each other and open doorways to access and influence the nervous system. If a central sensitization has occurred, Craniosacral Therapy (see: Craniosacral Therapy) is one of the best hands on, non-invasive treatments available because of its effect on the nervous system.
Hypothalamus-Pituitary-Adrenal Axis (HPA Axis)
Coping with chronic pain is stressful and there are often emotional responses accompanied with it such as fear, depression and anxiety. The pain and emotions can trigger the Hypothalamic-Pituitary-Adrenal (HPA) Axis, causing elevated cortisol levels to be released from the adrenal glands, and a prolonged sympathetic nervous system (SNS) ‘fight or flight’ response. You can eventually become exhausted, experience insomnia, muscle tension, guarding and fear of movement—all exacerbating the pain.
Anatomy of the Hypothalamus-Pituitary-Adrenal Axis (HPA Axis)
The hypothalamus and the pituitary gland are interconnected. The pituitary gland sits in a ‘saddle shaped’ indent in the sphenoid bone at the centre of the cranium and the hypothalamus is just above it. The hypothalamus-pituitary-adrenal axis (HPA Axis) is the link between the nervous, endocrine (hormonal) and immune systems forming the neuro-endocrine-immune axis; considered the core “stress axis” of the body.
The pituitary gland is often dubbed the ‘master gland’ but it is under the command of the hypothalamus. The pituitary gland signals other endocrine glands to either stimulate or inhibit their hormone production. It prompts the thyroid to produce hormones, the adrenal glands to produce cortisol and it signals the kidneys to produce a hormone regulating blood pressure.
The hypothalamus is part of the limbic system, the ‘feeling and reacting brain.’ It responds to emotion and it controls the endocrine and the autonomic nervous systems. The autonomic nervous system (ANS) consists of the sympathetic nervous system (SNS) that governs the ‘flight or fight’ response and the parasympathetic nervous system (PNS) that controls the ‘rest and digest’ response.
The SNS has some fascinating anatomy–it has fibers going directly into the thymus, spleen and bone marrow (which are production sites of immune cells) and also to lymph nodes. The SNS not only influences the immune response by modifying blood flow but also appears to regulate all the cells involved with inflammation. Excessive activation of the HPA axis has been associated with increased levels of inflammation.
Osteopathic Treatment of Chronic Pain
Osteopathic Treatment, especially Craniosacral Therapy (see: Craniosacral Therapy) offers a therapeutic option that is safe and has a calming effect on both the HPA Axis and the SNS.
A few examples of Cranial or Craniosacral Techniques
Craniosacral Therapy has a calming effect on the nervous system. It can improve the circulation and physiological environment around neurological centers in your brain to help them function optimally. This is accomplished by freeing cranial bone restrictions and the connective tissue structures of the head (the ‘dura’ or the ‘meninges’) that surround and support the brain and spinal cord. Cerebrospinal fluid (CSF) flows between the layers of the neuro-meninges. It is essential that cerebrospinal fluid (CSF) flow not be impaired. It bathes the neurons and the glial cells with nutrients and hormones to promote healing at an intercellular level. It plays a lymphatic role, assisting the glial cells to remove metabolic waste products and toxic substances from brain tissue. It also buoys and cushions the brain and protects it from injury. “If an area of the brain tissue is deprived of the fluid motion and flow, that brain area will be forced into some degree of functional compromise” (John Upledger, DO).
Cranial bones can become jammed at the sutures (where cranial bones meet) because of a trauma and/or a strain on the meninges. This can shut down the craniosacral rhythm. The cranial bones normally have a minute, rhythmic movement of expansion (dilatation) and retraction about ten thousand times a day which acts as a pump, moving all fluids. If the skull is deprived of this movement, there can be a general lack of vitality in the body. Many osteopathic techniques work on freeing the cranial bones, especially the sphenoid and the occiput because they form the base of the cranium and help ‘drive’ the craniosacral system. The rocking motion of the sphenoid and the occiput helps circulate the CSF and nourishes the pituitary gland (riding in the ‘saddle of the sphenoid’) and the hypothalamus; promoting normal function of the HPA Axis.
Chronic pain can cause cognitive impairment affecting memory and attention. One explanation for this is that when a central sensitization occurs, the pain pathway recruits other neurons—taking them away from tasks they might otherwise be doing. Another theory is that the chronic pain impinges on the fronto-parietal (cranial bones) networks–-so there is less brain power available in a sense. People in chronic pain often say that they have ‘brain fog’. The frontal lobes are responsible for cognition, memory and emotional expression. We have osteopathic techniques that subtly lift the frontal bones (your forehead), relieving pressure on the neuro-meninges and the cranial nerves, promoting circulation of CSF. Often, patients will say that they can think more clearly after a cranial treatment.
The Troublesome Trigeminal Nerve: all pain in the face and neck affects the trigeminal nerve which has connections with the upper cervical nerves, C1 - C3. The trigeminal nerve supplies jaw muscles responsible for chewing, mouth opening and swallowing. One branch supplies most of the sensitive neuro-meninges where one experiences headaches. An unhappy triad of pain can occur between the head, neck and jaw when people clench or grind their teeth (bruxism). The constant contraction of the jaw and neck muscles sends pain signals to the trigeminal nerve - bombarding the sympathetic nervous system (SNS) day and night. These tight muscles and the fascia wrapping around them tug at the cranial bones and can cause restrictions in the neuro-meninges. “Persistent contracture in the cranio-cervical junction results in a loss of cranial resiliency and an increase in sutural rigidity” (Magoun, DO, 1968a, pg. 650). We help release compression on the trigeminal nerve both in the cranium and the neck and we treat the jaw (see: Jaw/Headaches/Migraines) (see: Neck and Back Pain Treatment) (see: Whiplash/Nerve Pain/ Concussion).
Osteopathic Practitioners use a technique called ‘CV4,’ which refers to compression of the fourth ventricle. The fourth ventricle is one of several ventricles in the brain that are little cavities filled with cerebrospinal fluid (CSF). The CV4 technique increases hydrostatic pressure and boosts CSF circulation. Major cranial nerves, including the vagus nerve are located in the floor of this ventricle and they all benefit from the increase flow of CSF. The CV4 technique has been shown to synchronise the sympathetic and parasympathetic nervous systems. It provides a relaxing effect - lowering the tone of the sympathetic nervous system (SNS) and improving sleep patterns.
Sleeping deeply is crucial to healing. The brain cleanses itself and the muscles and fascia of the body relax. Our organs carry out digestion, remove toxins and regenerate while we sleep. With an over-active HPA Axis, sleep is often disturbed. Pain itself can wake you up. If you don’t sleep well, you don’t pass through all the sleep cycles during which healing occurs.
Craniosacral therapy can produce a parasympathetic response and a profound state of relaxation. Some people fall asleep which is fine - the treatment is still effective and many others fall into a dream-like state somewhere between wakefulness and sleep. They describe it as wonderfully pleasant, or “I haven’t been that relaxed in years”. During treatment, very still, quiet moments often occur, called ‘still points,’ where the cranial rhythm stops. This is when the body is subtly active correcting a dysfunction. The nervous system re-sets and there can be an improvement in mood. Once correction is achieved, the cranial rhythm will re-commence. EEG measurements have been taken during cranial sessions where a still point has occurred with the CV4 technique. Dr. Paul Swingle writes, “I've witnessed a marked increase in theta and alpha brainwave amplitude in the back of the brain associated with the induction of a still point…such changes in theta amplitude can have deep effects on brain quieting and healing” (John Upledger, DO, articles 5/29/2009).
Osteopathic Manipulative Treatment (OMT) of the Autonomic Nervous System (ANS)
The autonomic nervous system (ANS) consists of the sympathetic and parasympathetic nervous systems. Each system is dominant under certain conditions. The sympathetic nervous system (SNS) is stimulated by pain and stress and intensifies organ reactions whereas the parasympathetic nervous system (PNS) predominates during quiet, restful conditions and allows regeneration and healing to occur. Osteopathic treatment can help facilitate a parasympathetic response. We achieve this by freeing up spinal restrictions, the body’s diaphragms, the suboccipital area at the very top of your neck (just below the occiput) and the sacrum (see: Osteopathic Manipulative Treatment (OMT). “Several OMT techniques, including suboccipital inhibition and rib raising are associated with…improved autonomic homeostasis, decreased muscular tension, and reduced perception of stress” (doi:10.7556/jaoa.2018.028).
The SNS has a chain of ganglia or nerve cell bodies that synapse together and run up both sides of the spine. Releasing myofascial or vertebral restrictions here calms the chain of ganglia and an elevated SNS response. Osteopathic techniques such as gently rocking the spinal vertebrae and ‘rib raising’ or gently lifting the ribs are particularly effective.
The PNS has nerves located in the cranium and also in the suboccipital area and the sacrum. The suboccipital area has many layers of muscle and fascia and is often restricted. This can interfere with blood flow to and from the cranium and compress the vagus nerve and upper cervical nerves. Releasing the subocciput and ‘de-compacting’ or ‘floating’ the sacrum away from the lumbar spine (lower back) and the iliacs (bones in the pelvis) releases tension in the meninges at both ends of the spinal cord, promoting a parasympathetic response.
Most of us know about the thoracic diaphragm and the pelvic diaphragm but there is a third ‘tent shaped’ diaphragm located in the cranium which is part of the neuro-meninges. These horizontal diaphragms normally rise and fall in sync affecting each other; changing pressures in the brain and the body, circulating fluids, massaging organs and soothing the nervous system. The phrenic nerve which innervates the thoracic diaphragm exits cervical vertebrae: C3, 4 and 5. There is a saying, “C3, 4 and 5 keeps you alive”. We have osteopathic techniques to gently mobilise cervical vertebrae and soft tissues to free the path of the phrenic nerve. We have direct techniques to help all these diaphragms move in harmony, assisting homeostasis and helping you to take a deep breath.
Breathing deeply brings more oxygen to the blood, brain and tissues. In contrast, breathing shallowly lowers blood pH, which affects the cerebrospinal fluid (CSF) and makes our body more acidic. It also increases myofascial tension and anxiety. Filling our lungs with air and slowing down the exhale induces a parasympathetic response and promotes vascular and CSF circulation