What is the Brainstem & Autonomic Nervous System Dysfunction and use of the Treadmill Test for Sub-Clinical Progressive Exercise Training
During a concussion or traumatic brain injury, the soft jelly-like brain tissue is bumped against the inside of the skull causing injury to the nerve tissue of the brain or hemispheres. What is often overlooked is that the two brain hemispheres receive information via a long tube of nerves called the spinal cord. At the very top, just before this cord blends with the two hemispheres there is a section called the brainstem.
The brainstem has integrative functions being involved in cardiovascular system control, respiratory control, pain sensitivity control, alertness and awareness. Thus, brainstem damage is a very serious and often life-threatening problem. It also regulates the central nervous system, and is pivotal in maintaining consciousness and regulating the sleep cycle. So, the brainstem has many basic functions including heart rate, breathing, sleeping, and eating. Damage of the brainstem can result in abnormalities in the function of cranial nerves that may lead to visual disturbances, pupil abnormalities, changes in sensation, muscle weakness, hearing problems, vertigo, swallowing and speech difficulty, migraine, voice change and co-ordination problems.
This brainstem or tail-like structure at the bottom of the rounded brain hemispheres gets stretched and pulled when the head and the brain inside the head gets flicked forwards and backwards during a fall or a blow to the head. The brainstem is like a cord or rope that is attached to a ball. When the ball gets thrown or kicked that rope or cord gets yanked and pulled where it joins the ball.
The difference between a rope and ball versus the brain and the spinal cord is that the spinal cord is made of clusters of soft jelly strings similar in function to telephone wires carrying information to and from the brain to the body. The brainstem starts level with the bottom of the first neck bone which is 2-3 cm below the bottom of the head. So, the brainstem is not all contained nor protected by the skull. Therefore, the sudden rapid stretching and pulling on the brainstem and spinal cord damages those information pathways.
The brainstem is critical in that most of the bodies automatic activities are controlled from here. Such things as blood pressure, body temperature regulation, breath rate, heart rate, blood flow to and activity of the digestive organs such as the stomach, spleen, liver, kidney, pancreas, the large and small intestines and more. The brainstem even has a direct effect on the hormonal system.
A key control system for the organs is the autonomic nervous system which originates in the brainstem. This autonomic system has two parts: the sympathetic part that is like the accelerator in the car which speeds up and readies all the organs, blood flow etc. for action while the other part, the parasympathetic system, is like the brake in a car; it slows everything down and starts the rest and repair phase after a period of high activity. These two parts dance a continuous dance; one responding to the other; one speeding things up the other controlling and slowing things down.
When the autonomic system is out of balance, concussion clients can have trouble controlling body temperature so they will be cold and sweating or they might have low energy because one or the other part of that system does not do its complementary part to balance heart rate or blood pressure. This is tiring and makes people feel unwell and unmotivated or they can’t think straight because their brains are trying to make sense of information that it can’t correct or control. Often concussion clients can feel like they are going to black out but never quite do. Other symptoms can be lethargy or in a constant state of high alert or panic. These are just some of the symptoms of autonomic nervous system dysfunction.
How does this get assessed?
A simple three-minute test with a plethysmograph gives a pretty good clue if one part of the system is not working nor enough power to bring the system back into balance.
The plethysmograph is followed up with a treadmill test or the treadmill test can be carried out on its own. This is a test where the client’s heart rate, concussion symptoms and how hard they feel like they are working are closely monitored. If there are sudden changes in any one of those three things; heart rate, effort or symptoms such as headaches increasing, then the test is stopped and a baseline or starting point for treatment using a treadmill or exercycle for a progressive sub-clinical exercise program has been found.
The idea behind the exercise program is to keep the heart working at a set rate forcing the two parts of the autonomic nervous system to work/dance as a complementary inseparable duo again.
The Max Pulse is a simple, user-friendly, non-invasive, FDA Class
II medical screening device. This simple 3-minute
plethysmograph reading which measures arterial plaque and
aging vascular health, heart rate variability, autonomic nervous
system readout of the overall balance between the sympathetic
and para-sympathetic system and physical stress readings of
stress. This gives us better information to more accurately
prescribe a comprehensive treatment protocol, especially when
rehabilitating from injuries.
Do you still have ongoing head, neck or shoulder pain?
Do you hurt while you drive and are you kept awake at night? Do you make your neck crack and a little while later rub at that sore hard spot that just does not want to go away?
When your head is not balanced on your neck properly the results are not just local neck and head pain but discomfort in many other places as well. An unbalanced head on neck can be the cause of low energy levels and reduce your sense of well being
Your atlas is the top neck bone and forms the foundation for your head to rest on. The Atlas is located behind your jaw, below the ear hole, under the earlobe and in front of the base of your head. In the right place the head and the atlas fit snugly one on top of the other. When your head does not rest on the first neck bone correctly, then your head gets shifted forwards, rotated and tilted off centre.
The result — your head is not on straight.
To use a car analogy; it is like not having your wheels aligned. You steer to go in one direction while the wheels and the rest of the car is set to go in another. When this happens in your car… you as the driver get tired because if you let go of the steering wheel the car veers off the road. Not only that… it causes wear and tear on tires, suspension and increases fuel consumption.
It is the same for the head except there are many more sensitive structures involved.
A mal-aligned head affects nerves to and from the brain; it also affects reflexes between your neck, eyes and balance system which can make you feel off balance, nauseous and sore.
Your unbalanced head / neck affect blood vessels to and from the brain and strain the muscles and ligaments that hold your 5kg head on top of your neck.
Your five kg head is literally balanced on two small surfaces the size of the pad of the tip of your little finger.
Your unbalanced head causes other vertebrae or spinal bones to compensate by twisting and turning. This twisting compensation is called a scoliosis and your compensatory scoliosis often gets blamed for the pain and discomfort you have.
Additionally your spinal muscles have to work hard so that your feet and head both go in the same direction. The scoliosis makes it difficult to line your head up with your feet.
Over time your muscles, ligaments and nerves become overworked and sore …causing discomfort in places other than close to the neck.
For example, there is one nerve called the vagus nerve, (vagus means wandering….. you guessed it the vagus nerve goes to many places). Your vagus nerve goes to the ears, the lungs, the heart, large intestine, small intestine and that is not all!
The vagus nerve passes just in front of the atlas bone.
In the mal aligned twisted position the atlas can put pressure or stretch the vagus nerve so it can’t work properly.
Can you now more clearly see why a small mal positioned bone under your head can cause a problem as far away as your large intestine?
The vagus nerve is just one nerve; there are more nerves, muscles and ligaments which connect to the head and atlas that have connections a long way away from your head.
There is evidence that not having your head on straight can affect your moods, your ability to concentrate, your sleep and energy levels.
So it is vital to have your high neck checked out particularly since many practitioners don’t do so even if they are allied health practitioners focusing on spinal problems.
No, it’s not a cure all but unless you get your head positioned straight, you will never know if your head, neck, shoulder and tummy pain are all linked to your unbalanced head and atlas.
First Get Assessed for your Head and Neck by a Certified and Trained Practitioner who knows Atlas work.
Next post: What is the brainstem and the autonomic nervous system?
A seasoned vestibular & neuro physiotherapist with close to 40 yrs clinical experience with a special focus on concussion, head, neck and upper spine pain.