Whole Body-Whole Brain: The Future Model of Wellness Care
PERSPECTIVE
Monika Buerger
BA, DC
According to the World Health Organization, health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.”
People are becoming increasingly concerned about the future of their health, and the health of their loved ones, especially since the COVID-19 pandemic that began in 2019 in China and hit the United States in early 2020. Google reports that it receives over one billion health-related searches per day, which equates to about 70,000 per minute. In a 2019 study by Eligibility.com, they found 89% of patients nationwide google their health symptoms before going to their doctor.1
Anxiety or excessive worry about physical health because of reading online health information is known as “cyberchondria.” A study reviewed in Comprehensive Psychiatry showed that googling symptoms results in an escalation of concerns and excessive worrying about symptoms. The study involved 515 participants and their search experiences and found that 20% of respondents experienced an escalation of concerns. Behavioral problems occurred in 40% of participants, including more frequent consultations with medical specialists and physicians, more page visits, and increased internet searches.2
Know Your Audience
In the age of “Dr. Google,” partnering with and guiding the patient population seeking answers and information online is becoming increasingly important for the practicing chiropractor. To better connect and communicate with patients, it is helpful to understand the various types of healthcare consumers and their specific wants and needs. Not only will you better serve your community, but by understanding each patient’s healthcare views and values, you also will minimize stress in your practice.
“Psychographics” is a term that pertains to people’s attitudes, values, beliefs, lifestyles, and personalities. They are core to consumers’ motivations, priorities, and communication preferences. According to PatientBond,3 there are five types of healthcare consumers:
1. Self-Achievers strive to go above and beyond. They are all about enhancing and improving their health. They monitor their diet and exercise regimen as well as any chronic conditions, making sure their bodies are working as efficiently as possible.
2. Balance Seekers approach being healthy from a holistic perspective. Other than diet and exercise, they also look at their mental and spiritual health. They are eager to try alternative approaches to staying healthy that are not related to traditional medicine. They are also willing to question what their doctor tells them and put effort into pulling information from multiple sources to know what’s best for their health.
3. Priority Jugglers focus on keeping their family members healthy before focusing on their own health. If they do work on their own health, they prioritize certain areas they know they can control.
4. Direction Takers are eager to follow their doctor’s orders, including how to be healthy and what’s healthy for them. They don’t question their doctor’s advice and insight because they trust their doctor(s).
5. Willful Endurers want the most they can get out of life, and “healthy” is taking care of themselves on their terms. Being healthy means enjoying the things they love, even if they are considered bad habits, and they do not want to restrict themselves to a diet and/ or exercise regimen. They will generally avoid the doctor unless they absolutely must go. They make up 31% of all healthcare consumers.
Hot Topics
Some of the most reported “hot topics” in 2022 that consumers consulted Dr. Google for were mood disorders, cognitive disorders, and sleep disorders. It is important that chiropractors understand the connection between such disorders and the spine, vertebral subluxations, and posture. Understanding these connections is also a great way to enhance one’s practice demographics.
Mood Disorders
The World Health Organization (WHO) has called attention to a “massive” increase in anxiety and depression globally. According to a scientific brief, prevalence shot up 25% in the first year of the pandemic. Director-General Dr. Tedros Adhanom Ghebreyesus of the WHO called it “just the tip of the iceberg” in understanding the toll the pandemic took on the world’s mental health4 In the United States, nearly one in four adults aged 18 to 44 received treatment for mental health in 2021, a jump of nearly five percentage points from 2019.5
Cognitive Disorders
According to the Alzheimer’s Association, about one in nine people aged 65 and older has Alzheimer’s dementia. It is well accepted that Alzheimer’s begins at least 20 years before the onset of symptoms, but prevalence studies for younger-onset dementia in the United States are limited. Researchers believe about 110 of every 100,000 people, or about 200,000 Americans, have younger-onset dementia.6
In the first nationally representative study, researchers at Columbia University looked at the prevalence of dementia and mild cognitive impairment (MCI) in the United States in 2016. It was the first study looking at cognitive impairment prevalence in more than 20 years. Researchers found that one in 10, or almost 10%, of U.S. adults aged 65 and older had dementia, while another 22% had mild cognitive impairment. Those with dementia and mild cognitive impairment were more likely to be older, have lower levels of education, and be racialized as Black or Hispanic. Men and women had similar rates of dementia and mild cognitive impairment.7
Sleep Disorders
A study in the American Journal of Managed Care in 2020 reported that 30 to 40% of adults in the U.S. report symptoms of insomnia every year at some point annually.8 Insomnia, whether short term or chronic, is a common condition with a negative impact on all aspects of health.
According to the American Sleep Association, the average person gets less than seven hours of sleep every night, and in 2021, 50 to 70 million adults in the U.S. were affected by a sleep disorder. They also stated that 25 million adults in the U.S. had obstructive sleep apnea in 2021.
Mood, Cognition, Sleep, and Posture
One commonality of all these disorders that is central to the chiropractic profession is posture.
Mood and Posture
A San Francisco State University study examined how students recalled and thought about past experiences, both good and bad. The group was told to recall both negative and positive experiences twice — once while sitting up straight and the other while slouching over. The results showed that 86% of the students who were in a slumped position found it easier to recall negative emotions/experiences. On the contrary, 87% of the students found it much easier to recall positive experiences when sitting up straight.9 Matsui and Fujimoto found that repetitive strain on the neck and cervical spine may trigger cervical neuromuscular syndrome that involves chronic neck pain, autonomic imbalance, and concomitant depression and anxiety.10
In a study hypothesizing that body posture may be important in the initiation and modulation of emotions, the researcher aimed to investigate whether an upright seated posture could influence affective and cardiovascular responses to a psychological stress task, relative to a slumped seated posture. Their results showed that upright participants reported higher self-esteem, more arousal, better mood, and lower fear, compared to slumped participants. Linguistic analysis showed slumped participants used more negative emotion words, first-person singular pronouns, affective process words, sadness words, and fewer positive emotion words and total words during the speech.11
PERSPECTIVE
Cognition and Posture
The question of whether cognitive decline may be identified by sagittal spinal balance assessment based on X-ray findings was investigated via a large-scale survey of persons aged 50 to 89. Researchers at Shinshu University discovered links between sagittal vertical axis (SVA) anteriorization and older age and worse cognitive performance. Subjects were more likely to have signs of moderate cognitive decline the more the head and neck protruded anterior to the pelvis when seen from lateral X-ray.12
Anterior head posture can also impede diaphragmatic breathing. Every breath a person takes sends “interoceptive” signals to the brain from the lungs, heart, and other organs. Interoceptive information is internal sensory input to tell the brain the physiological status of the body. Diaphragmatic breathing is linked to improved cognitive performance and reduced negative subjective and physiological consequences of stress in healthy adults. Physiological evidence has indicated that even a single breathing practice significantly reduces blood pressure, increases heart rate variability (HRV) and oxygenation, enhances pulmonary function, and improves cardiorespiratory fitness, and respiratory muscle strength.13
Sleep and Posture
Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. In a case-control study, they evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Their findings showed that the OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.14
In a recently published case study, a 28-year-old female patient presenting for chiropractic care reported musculoskeletal symptoms, sleep disturbance, and anxiety disorder. She was evaluated and treated for vertebral subluxations using Diversified and Thompson drop-style adjustments. The patient was assessed preand post-care for (1) neurostructural adaptive abnormalities by surface EMG analysis and weight-bearing radiographic analysis; (2) autonomic adaptive abnormalities by paraspinal thermography analysis; and (3) by Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety (HAM-A) questionnaires for changes in sleep disability and anxiety manifestations, respectively. After three months of consistent chiropractic care, the patient reported subjective improvements in both musculoskeletal and nonmusculoskeletal complaints. Vertebral subluxations were corrected or reduced in severity as measured by reduction or amelioration of vertebral subluxation indicators. The patient also demonstrated marked reduction of sleep disorder as measured by Global PSQI score and marked reduction of anxiety disorder.15
Advancing Care for “Advanced Patients”
As discussed earlier, Dr. Google patients tend to do their homework when it comes to their health. Utilizing cutting-edge technology for diagnosing and managing care to better meet the chiropractic needs of an ever-changing population can evolve your practice into a whole body-whole brain waiting-list practice of the future.
Some considerations to help better educate and serve this population group would be surface EMG analysis, weight-bearing radiographic analysis, measuring heart rate variability (or educating patients on home heart rate variability technology), custom foot analysis and stabilization technology, and posturography.
Summary
The future model of wellness care is an exciting opportunity to engage even the sawiest of healthcare consumers. Understanding the different types of psychographics in health care is a helpful way to know where to best focus when implementing some of the previously discussed options for the “advanced consumer.”
Next, understanding the spinal and vertebral subluxation connection to various disorders can set you apart from other practitioners in your community. Offering advanced technology and services is a great way to educate and manage the needs of the ever-challenging population groups now presenting to offices.
In addition to spinal adjustments, offering care plans that include such things as balance-based posture exercises, heart rate variability monitoring, vagal tone exercises (such as humming, diaphragmatic breathing, and mindfulness), and custom-made three-arch support orthotics to create optimal functional support for the foundation of good posture are great options to include in a whole body-whole brain wellness approach to care.
Dr. Monika Buerger, a 1991 graduate of Life Chiropractic College West, is the owner of Eagle Canyon Wellness & Sensory Development Center in Ammon, Idaho. She is a teacher, international lecturer, author, and the founder of lntersect4Life Educational Seminars and developingMINDS certification program in childhood and adolescent neurodevelopment. For additional information, visit www.intersect4life.com and www.devmindsu.com.
References
1. Bhagath Kumar Potu, Kumar MR Bhat, Muddanna S Rao, Gopalan Kit tty Nampurath, Mallikarjuna Rao Chamallamudi, Soubhagya Ranjan Nayak, Manjunatha S Muttigi. Petroleum Ether Extract of Cissus Ouadrangularis (Linn.) Enhances Bone Marrow Mesenchymal Stem Cell Proliferation and Facilitates Osteoblastogenesis. Clinics (Sao Paulo). 2009; 64(10): 993—998.
2. Potu, B. K; Rao, M. S.; Nampurath, G. K.; Chamallamudi, M. R.; Prasad, K; Nayak, S. R.; Dharmavarapu, P. K.; Kedage, V; Bhat, K. M. R. (2009). “Evidence-based assessment of antiosteoporotic activity of petroleum-ether extract of Cissus quadrangularis Linn. On ovariectomy-induced osteoporosis. ” Upsala Journal of Medical Sciences. 114 (3): 140—8.
3. Deka, DK, Lahon LC, SaikiaJ, MukitA. Effect of Cissus Ouadrangularis in Accelerating Healing Process of Experimentally Fracture Radius-Ulna of Dog: A Preliminary Study. Indian Journal of Pharmacology 1994;26:44-45.
4. Jainu M, Mohan K]' Devi CSS. Protective effect of Cissus quadrangularis on neutrophil mediated tissue injury induced by aspirin in rats. J Ethnopharmacology 2006; 104:302—305. https://doi.org/10.1016/j.jep.2005.08.076
5. Bhujade, A. “Evaluation of Cissus quadrangularis extracts as an inhibitor of COX, 5-LOX, and proinflammatory mediators. ” Journal of Ethnopharmacology. 2012;141 (3): 986-96. doi: 10.1016/j.jep.2012.03.044. PMID 22484053
6. Singh SP, Mishra N Dixit KS, et al. An experimental study of analgesic ac-
tivity of Cissus quadrangularis. Indian J of Pharmacol. 1984; 79:162—63p.
7. Jainu M, Devi CSS. Effect of Cissus quadrangularis on Gastric Mucosal Defensive Factors in Experimentally Induced Gastric Ulcer—A Comparative Study with Sucralfate. J Medicinal Food 2004:372—376. http://doi. org/10.1089/jmf.2004. 7.3 72
8. Murthy KN et al. Antioxidant activity of Cissus quadrangularis Linn. J. Med. Food. 2003; 6(2): 99-105p.
9. Ruangsuriya J, Charumanee S, Jiranusornkul S, et al. Depletion of f-sitosterol and enrichment of quercetin and rutin in Cissus quadrangularis Linn fi'action enhanced osteogenic but reduced osteoclastogenic marker expression. BMC Complementary Medicine and Therapies 2020;20:105. https:// doi.org/10.1186/s12906-020-02892-w
10. Potu BK, Bhat KMR, Rao MS, Nampurath GK, Chamallamudi MR, Nayak SR, Muttigi MS. Petroleum ether extract of cissus quadrangularis (linn.) enhances bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis. Clinics. 2009;64(10):993—8.
11. Sirasanagandla SR, Pai KSR, Bhat KMR. Preventive Role of Emblica Officinalis and Cissus Ouadrangularis on Bone Loss in Osteoporosis. Int J Pharmacy and Pharmaceutical Sciences 2013;5:122-127.
12. Singh S, Kumar S, Singh S, et al. Estrogenic Effect of Asparagus racemosus, Cissus quadrangularis, Punica granatum and Pueraria tuberosa in Post-menopausal Syndrome. Pharmacogn Res. 2021; 13(4):238—245
13. Benjawan S, Nimitphong H, Tragulpeankit P, et al. The effect of Cissus quadrangularis L. on delaying bone loss in postmenopausal women with osteopenia: A randomized placebo-controlled trial. Phytomedicine 2022; 101:154115. https://d0i.0rg/l 0.1016/j.phymed. 2022.154115
14. Piccin CF, Pozzebon D, Scapini F, Correa EC. Craniocervical Posture in Patients with Obstructive Sleep Apnea. Int Arch Otorhinolaryngol. 2016 Jul;20(3):189-95. doi: 10.1055/S-0036-1584295. Epub 2016 Jul 1. PMID: 27413397; PMCID: PMC4942290.
15. Amy Louise Haas, PhD, DC. Annals of Vertebral Subluxation Research. November 15, 2022 . Volume 2022. Pages 101-113 .
