By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
The Body Beyond Low Back Pain and Whiplash
Years ago as an emergency room cardiologist I frequently encountered cases of puzzling chest pain unrelated to the heart or occluded coronary arteries.
There might also be shortness of breath, nausea, and pressure radiating around to the back.
Diagnostics would show the cardiovascular system in working order. Sometimes the problem was an esophageal spasm or a hiatal hernia with gastroesophageal reflux (GERD). Often, though, we were left scratching our heads with no idea why this was happening.
Since we couldn’t find any clues for the symptom, we would clear such patients, who were still experiencing chest pain, and send them to their doctor for further testing. These additional tests typically would also come up normal. Patients would frequently emerge with a bottle of some kind of medication − perhaps a beta blocker, aspirin, or nitroglycerin, or maybe some pain medication because of continuing tenderness in the chest wall or rib cage.
This situation is a common occurrence in medicine today, and, interestingly, as people age, more prevalent.
I had forgotten about these mystery cases until I spoke in 2010 with Martin Gallagher, M.D., D.C., a very rare breed of physician – both a medical doctor and a chiropractor.
One thing Dr. Gallagher did right off the bat in our conversation was to clear up the mystery of non-cardiovascular chest pain.
Spinal Angina – An Overlooked Misalignment
“The majority of these cases involve spinal mechanical problems and are not due to loss of blood supply to the heart because of coronary artery problems,” Dr. Gallagher related. “Rather, the vertebrae in the upper part of the neck, the middle of the back, or even the ribs may be misaligned and locked, affecting the nerves so that the chest wall starts to tighten.
“The chest muscles, ribs, heart, lungs, and stomach are controlled directly and indirectly by spinal nerves. Misalignments can interfere with these nerves and cause chest pain similar to cardiovascular angina. We call this spinal angina. Sometimes it may even produce tachycardia and other arrhythmias. Few people know about spinal angina and it is rarely diagnosed by medical doctors.”
This was an amazing revelation to me because I had seen so many of these baffling cases years ago that we medical doctors failed to figure out.
“Individuals with spinal angina may experience the usual kind of cardiovascular signs and symptoms,” Dr. Gallagher said. “The pain may be stabbing or radiating, reproduced by putting pressure on the sides of the ribs or by taking a deep breath or by turning over in bed. Activities such as riding in a car over a bumpy surface, coughing hard, raising your arm on the side you have the pain, bending forward, and pushing or pulling may increase the pain.
“An evaluation by a qualified chiropractor, and spinal manipulation, if needed, can provide effective relief. There are at least a hundred different types of manipulations for fixing the situation. If, for instance, there are acid reflux symptoms associated with the spinal angina, we can do soft tissue manipulation. The patient lies on his or her back. Right below the sternum there is a point that we press down on as the patient breathes out. You can actually feel the stomach moving out of the diaphragm. It corrects a hiatal hernia and can instantly relieve chest pain.”
Both Dr. Gallagher and I are well aware that a chiropractic maneuver, or referring a patient to a chiropractor to check out a possible spinal connection, would be the furthest thing in the mind of an emergency room physician. It’s just not on the ER radar screen.
“Today, with an aging population, this problem surfaces increasingly in ERs and medical clinics and physicians don’t know what to do with it,” Dr. Gallagher commented. “The docs just tell patients to take anti-inflammatories, do some stretching exercises, take some GERD medication, and decrease stress. All of these are legitimate recommendations, but the missing component is often a proper spinal manipulation.”
What Chiropractic is all About
Chiropractic is the largest, most regulated, and recognized profession in the complementary medicine field. Numerous studies have shown that chiropractic treatment is both safe and effective.
Modern chiropractic dates back 110 years to Daniel Palmer, an Iowa healer. He described how misaligned spinal vertebrae block the flow of energy and messages − “innate intelligence,” he called it − in our nervous systems, that in turn lead to disease and loss of vitality.
Doctors of chiropractic are uniquely trained to recognize the existence of this flow to determine a connection to health problems.
A properly functioning nervous system is at the core of health, controlling and coordinating the entire body. The nervous system hardware includes the brain, the spinal column, and spinal nerves. Flowing down from the brain is the spinal cord of nervous tissue, sort of like the cables inside the walls of your house that contain the electrical wiring. The cord runs through a central spinal column of 24 flexible bones, called vertebrae, to your tailbone. The column protects the cord. Between each vertebra, nerves branch out, just like a tree, to control and coordinate the many organs and muscles of the body. The brain sends messages down the spinal cord and out to the organs, muscles. and cells. These parts, in turn, send messages back to the spinal cord and up to the brain. It’s a wondrous communication system that we are just beginning to understand.
“There are many ways this structure can become disturbed,” says Dr. Gallagher. “Trauma is one obvious way, but emotional and nutritional stresses can also cause misalignments. A slight misalignment of one or more vertebrae can trigger malfunctions in the nervous system.”
Most people believe that chiropractic manipulation is solely a treatment for neck or back pain.
“Surprisingly, pain may not be present at all, as a result of spinal misalignment,” he says. “In fact, loss of energy and function, not pain, are the primary signs or symptoms of a mechanical misalignment. This is one of the great misunderstandings about chiropractic. One person with a misalignment may have head, neck, or back pain. Another with a misalignment in the same place may not have any pain at all, but rather a ‘silent complaint,’ that is, the blocked energy has impacted their digestive, reproductive, cardiovascular, immune or other systems. Anything is possible. Misalignments are ‘silent robbers’ of health. They do so much more than just create back or neck pain.
“Chiropractic realigns the vertebrae, recreating motion where the vertebrae are locked, and allowing the innate intelligence to flow again to heal the body and maintain it in a normal manner.
“If you could stand next to me as I work and watch what goes on, you would be amazed at the remarkable effect that adjustments have on patients, many of whom have spent years on the medical treadmill, seen multiple specialists, taken drug after drug, and have almost given up because they haven’t been helped. The role of spinal misalignment as a cause of unwellness is grossly unrecognized.”
Misalignments can manifest in multiple ways, including the following:
Spinal Adjustment – A Surprising Remedy for Many Ills
For more than thirty years, Martin Gallagher directed a highly-successful chiropractic clinic in Jeannette, a suburb of Pittsburgh. He ventured far beyond treating low back pain and injuries, the staple of many chiropractic clinics, and applied the multiple techniques of his profession to seek relief, and even cures, for an A to Z of common illnesses. At the start of his healing career, he also obtained a master’s degree in nutrition and, similar to my own clinical approach, fully integrated nutritional medicine into his practice. He frequently lectures on nutrition to doctors and nurses at hospitals.
In 2002, at the age of 50, he decided to obtain a medical degree. He accomplished this challenging mid-career objective in five years, juggling clinical obligations with intense medical training.
Today, he practices as a preventive-oriented chiropractor, nutritional therapist, and board-certified family medical doctor who also works with homeopathy, acupuncture, and prolotherapy. Integrative medicine doesn’t get much broader than that.
First as a chiropractor, and then as a rare medical doctor-who-is-also-a-chiropractor, Dr. Gallagher has developed vast experience in “missing link medicine.” By that I mean he has found spinal adjustments to be a common missing link to problems that few doctors would ever relate to spinal health.
“Many people suffer a lifetime with undiagnosed spinal misalignments, some actually resulting from trauma during the birthing process, others from accidents, and still others from just the daily stresses of life,” he explained to me. “Misalignments can pinch or otherwise interfere with important nerves coming out of the spine, from the neck down to the lower back, so there’s big potential for many disturbances in the body. Not just pain, but chronic organ dysfunction and a host of unresolved symptoms can result until such disturbances are identified and corrected through proper adjustment.”
A Need for Medical-Chiropractic Cooperation
In the past the medical establishment has been largely hostile to chiropractic, even declaring it unethical for medical doctors to associate professionally with chiropractic physicians. A nationwide boycott of chiropractic by the American Medical Association was censured as “lawless” by the U.S. Supreme Court in 1990, a major setback for organized conventional medicine’s disgraceful pattern of squelching and denigrating alternative practices − a greed-motivated practice that unfortunately still continues to this day to one degree or another.
“For the welfare of patients, there has to be a relationship between the medical and chiropractic communities so that these problems can be evaluated and treated properly,” Dr. Gallagher told me. “A candidate for chiropractic care should be able to get a series of manipulations and have the problem fixed. Medical doctors prescribe physical therapy all the time. Why not chiropractic? When I was in my medical training residency, staff physicians gave anti-inflammatories and muscle relaxants to patients with back or neck pain and sent them off for weeks of physical therapy. These were situations that could often be easily solved with a few chiropractic adjustments. The patients usually felt stronger but they’d inevitably come back with the same kind of mechanical problems because the physical therapists weren’t trained to correct spinal irregularities.
“During my medical residency stints in the emergency room, it turned out that the ER director’s uncle was a chiropractor. She was open to alternatives and invited me to use chiropractic and nutritional approaches where I thought they could help. I was thus able to give patients an extra, but needed level of healing care. The integrative approach can make a big difference to patients, even in emergency situations.”
Hearing Dr. Gallagher say this, my only comment was “amen.” Integrative medicine is clearly the most cost-effective and beneficial approach for health care.
How Chiropractic Can Help You
In my conversation with Dr. Gallagher I explored common conditions where chiropractic could be of particular benefit or a missing treatment link. Following are some of the major points we covered, starting with several “non-cardiac cardiovascular issues.” The message here is that if a cardiac evaluation for symptoms turns out negative it makes sense to consider a spinal evaluation.
- Hypertension. Such an evaluation of the atlas vertebrae − located at the top of the spinal column in the neck – may detect a misalignment contributing to high blood pressure. When the atlas is out of proper alignment you can get altered blood flow to the brain and increased sympathetic stimulation in the nervous system that can drive up blood pressure. Dr. Gallagher’s experience is that blood pressure in many of his hypertensive patients was markedly lowered, and their need for medication reduced or eliminated, after cervical manipulation. I agree with him that this modality is almost totally overlooked in the treatment of high blood pressure.
- Intense heart palpitations. Dr. Gallagher described to me a case of a young female patient with recurring chest pressure and racing heart. Medication was not helping her. She finally wound up in his office because, as she told him, she thought the source of her problem was related to her back. When she drove she noticed that her heart would start racing. When she sat back and pressed against the driver’s seat, the racing would subside. She experimented, sitting forward and then back again a number of times, both in her car and at home, and found she could turn the symptoms off, then back on, just by positioning herself.
“The upper part of her thoracic spine was misaligned,” Dr. Gallagher said. “I adjusted her five or six times and the problem was gone. You don’t see this in the medical literature but I have treated many similar cases.”
Most doctors, myself included, would be inclined to think cardiac right off the bat in any case of arrhythmia with chest pain. In a way it is cardiac, but cardiac here plays second fiddle to the sympathetic overdrive caused by spinal misalignment. The spine may also be a contributor to atrial fibrillation, where there is a wild quivering of the atrium from loss of normal electrical conduction. I don’t think there’s a cardiologist on the planet who thinks about spinal abnormality causing atrial fibrillation. But I did read recently about atrial fib occurring with misalignment. Dr. Gallagher told me he had a couple of current cases of atrial fibrillation secondary to spinal dysfunction.
- Thoracic Outlet Syndrome. Over the years, I have had some odd cases where patients see me, after going from doctor to doctor, with complaints of numbness, funny sensations, weakness, coldness, or discomfort in the left hand or arm. Some people have chest tightness as well.
In a 50-year-old male patient, for instance, this scenario is considered a myocardial infarction until proven otherwise and would merit a full cardiac workup, and sometimes even a cardiac catheterization if the symptoms were disabling. But often results are negative. Everything appears fine, yet the symptoms can be reproduced by a simple manipulation of the affected arm. These cases are actually caused by thoracic outlet syndrome and typically involve a combination of pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip.
The problem usually relates to compression of the nerves coming from the spine—and blood supply as well—where both pass through a narrow space called the thoracic outlet, located between the rib cage and collar bone. Conventional treatment includes physical therapy, pain medication, and even surgery.
According to Dr. Gallagher, a lockup in the upper part of the spine between the shoulder blades is often the culprit. Sometimes the first or second rib may be locked to the sternum or vertebrae and not moving freely. The situation requires analysis of how the ribs move. Often when the first rib and upper part of the thoracic spine are manipulated, nerve and blood supply to the arm and hand can be restored, and patients can usually avoid surgery.
- Vertigo. Many seniors develop balance problems. They may feel unsteady on their feet, as if they were out on a boat. Or they may lean to one side or another when walking or feel lightheaded when going from sitting to standing. They may faint or have near fainting episodes. Many of these situations, said Dr. Gallagher, are related to misalignments of the atlas and occiput, the skull bone at the back of the head. “I have often resolved mild or full-blown vertigo, even in cases 25 years old, with atlas and occiput manipulation,” he said.
- Tinnitus and hearing loss. It pays to have a chiropractic evaluation for hearing issues, Dr. Gallagher told me. Upper cervical or skull misalignments are commonly involved.
- Prostate enlargement and frequent urination. Manipulation of the sacroiliac joint and lumbar spine is often helpful for these problems, according to Dr. Gallagher. “I get patients complaining of urinating five or six times at night, including women with so-called urge incontinence who have to pee immediately,” he said. “The problem oftentimes can be markedly reduced or eliminated by adjusting the base of the back and/or adjusting the sacroiliac joint.”
There is also a neurological situation where the brain will stimulate the bladder to void when one hears an actively moving fluid. For a sensitive individual, just hearing running water—in my case, putting gasoline in the car—can create a sudden need to urinate. This, too, can be assuaged by chiropractic adjustment of the sacroiliac area.
- Chronic pelvic pain (in women). Women may develop variations of pelvic, vaginal, labial, or lower abdominal pain, or pain with intercourse. Oftentimes, they undergo gynecological testing, yet everything turns out “normal.” In some cases they may be treated for a possible psychological disorder. “Frequently,” said Dr. Gallagher, “this is a pelvic mechanical problem. The sacroiliac joint may be misaligned. Manipulation of the sacroiliac joint or lower lumber spine often relieves or markedly improves the problem.”
The Sinatra Spin
My conversation with Martin Gallagher was an eye-opener for me − a reminder not to fail to include the backbone as part of your personal health equation. Your spine is connected to all of your body and an underlying structural misalignment could be the cause of an unresolved problem. A chiropractic checkup makes good sense. To find a good chiropractor, ask friends or family members for a referral, or ask at your favorite health food store. When you have a consultation, see if the physician’s approach makes sense to you. Trust your intuition, just as you would with any doctor. Then see how you feel afterward.
Be aware that some chiropractors are musculoskeletal specialists who do not look at the spinal connection to organ function. They are called chiropractic orthopedists, often specializing in sports medicine and injury work. Look for a more holistic chiropractor involved with nutrition, someone like Martin Gallagher. I was so impressed with him that I made an appointment to see him myself.
If you would like to contact his clinic − Medical Wellness Associates − for a consultation, call 800-834-4325. Dr. Gallagher also has written a comprehensive book − Dr. Gallagher’s Guide to 21st Century Medicine − that outlines in great detail the multiple ways that chiropractic can prevent and resolve many common health disorders. I highly recommend it.
Looking for a good chiropractor in your area? Check out my list of Top Docs – physicians and other health professionals I’ve personally met and recommend for integrative care.
© 2013 HeartMD Institute. All rights reserved.