How Head Position & Neck Alignment Impact Mental Health

The Role of the Atlas, Flexibility, Neck Injury, Posture, Upper Cervical Instability, and the Vagus in Brain Symptoms

I like to think of the heron as my spirit animal. I love their patience, their stillness and their quiet confidence embodied by their beautifully aligned neck. Though this one paid me a visit in Florida, I’m always especially happy to see them here in Kentucky.

In these modern times with cell phones and laptops, we look down A LOT.  This raises our likelihood of having problems that originate in our neck.  A previous neck injury and/or a tendency to be flexible can make us even more vulnerable.  Flexibility is especially common in those with brain related or psychiatric conditions.  I’ll elaborate on this in an upcoming newsletter.  In the meantime, know that misalignment of the upper part of the spine is an often overlooked problem for those with brain symptoms, chronic complex illness and/or mysterious health issues.  

Here are 10 thoughts:

1. The Atlas or C1 - Our First Cervical Vertebra: This bone sits between the head/skull and our spine.  In Greek Mythology - Atlas was a Titan and demigod who was condemned by Zeus to forever carry the world upon his shoulders. Our atlas bone also has a heavy burden to bear, as our heads weigh about 5 kg or 11 lbs. Most newborn babies weigh between 5-8 lbs.  When our head is not straight, including being tilted forward (such as when we look at our cell phone), the force on the atlas increases.  At a 15 degree tilt, the force from the head increases to 27 lbs, and at 45 degrees that force can be 49 lbs.

2. Neck Structures Impacted By Misalignment:  Because our spinal cord runs through our vertebrae (including the atlas), misalignment can pinch on nerves and the spinal cord. Tension on the spinal cord can pull on the brain stem causing nausea and changes in heart rate and blood pressure. We also have cranial nerves that supply the head and neck in this area. One of these is the incredible vagus nerve. It interacts with many of the other cranial nerves, innervates almost all of our organs and has more jobs than I can cover here. The vagus runs along the front part of C1, C2, C3, and C4.  Just a few extra millimeters of movement can cause compression of the vagus nerve leading to a mix of symptoms.  There are also veins and arteries carrying blood to and from the head in this area of the neck.   Malrotation of the atlas or poor head posture can thus lead to lead to increased head pressure or a decrease in blood supply to the brain. Also present is the lymphatic system, which helps remove toxic waste from the head.  How aligned our head can also impact the movement of air into and out of our lungs.

3. Ligaments.  These are bands of “connective tissue” that hold our bones, in this case C1 and C2, together. The strength of these ligaments depend on the laxity (or flexibility) of our connective tissue.  Ehlers Danlos Syndrome or EDS is a connective tissue disorder that results in severe hypermobility. We can be hypermobile and flexible (or double jointed) and not meet criteria for EDS. This tendency toward hypermobility is especially common in those with brain related conditions.  Increased movement at C1-C2 is referred to as upper cervical instability.  While genetics appear to be the biggest contributor, the strength of our connective tissue can also be impacted by hormone levels and  inflammation. There is evidence that a microbial presence can be play in some cases.

4. Physical Injury to the Head or Neck:  Flexible or not, injury can cause the atlas to shift out of alignment.  Possible factors could be a car accident, fall, assault, high impact sports (football, hockey), but also soccer (heading the ball), and overextension or strain in gymnastics, tumbling and other activities.  Misalignment could even be from a procedure such as intubation for surgery (where the head is tilted back significantly) or any situation where the neck is strained, overly stretched or jolted.

5. Forward Head Posture.  This results from having our head down too much and for too long, such as when we use a cell phone, laptop, poorly positioned computer or even read a book or write for extended periods. These activities can result in stretching of the ligaments, which can eventually can become permanent.  The result is a loss of cervical curvature of the upper spine.  Some experts argue that it has become increasingly rare for someone to have normal curvature of their cervical spine.  Normal, however, doesn’t mean inevitable or healthy. Aside from this face down posture, we can also have a forward chin posture that can strain the neck.

6. Emotional Stress:  Stanley Rosenberg’s book, “Accessing the Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism”, nicely describes how an emotional stress response, which could be a distressing thought or memory, can result in tightening of specific muscles, which shift the atlas in such a way as to impact the “dorsal” vagus. As per Polyvagal theory, the dorsal aspect of the vagus (now a seeming evolutionary remnant) exists to protect us from overwhelming threat. This response can look like fainting or even dissociating or checking out, as opposed to a fight or flight response when under threat.

7. Multiple Symptoms: If just the vagus were impacted, there would be a long list of symptoms from many body systems.  But there is also possible impedence of the flow of cerebrospinal fluid, blood and lymph. Symptoms of misalignment can be persistent or episodic and can included: Neck pain or stiffness (common but not always present), cracking, popping at the base of the neck, difficulty holding head up, shoulder pain, jaw pain, facial pain, aching in rib cage, arm or leg pain, teeth clenching, headaches, migraine, head pressure, nausea, bloating, vertigo, dizziness, fainting, balance problems, ringing in ears, eustachian tube dysfunction, fullness in the ears, changes in speech, problems swallowing, changes in vision and hearing, changes in blood pressure and heart rate, POTS or postural orthostatic tachycardia syndrome, leaky gut, mast cell activation and thus autoimmune disease. Torticollis and cervical dystonia -  movement disorders can also be due to upper cervical misalignment.   The main reason, however, that I am sharing all of this is because brain symptoms are common and wide ranging. They can include fatigue, brain fog, high anxiety, rage, depression, insomnia and even impaired social communication (our ability to engage socially).

8. Evaluation:  Because I am a psychiatrist (and not an expert on the head and neck), my job is to notice if misalignment may be a contributing root cause and know when someone should see a specialist.  Aside from a detailed history, an interesting way to know if the atlas may have shifted out of place and be impacting the vagus is to look at the back of the throat and say “Ahhh”.  The uvula is the piece of tissue that hangs in the back of our throat. When we say “Ahh”, the surrounding muscles should cause it to rise straight up.  If the uvula is pulled to one side, that indicates the vagus is not working optimally. This is often due to upper cervical instability or cranial cervical instability (CCI).  Normal imaging (x-ray, CT or MRI) does not necessarily identify this issue, partly because it can be position dependent.  A digital motion x-ray (not covered by insurance) can help diagnostically, as can an MRI in which multiple measures are taken and in varying positions. An MRI is more likely to be covered by insurance. 

9. Treatment: Research has found that some advanced cultures of antiquity - Mayan and Egyptians - regularly practiced manual repositioning techniques of the atlas. Today we have varying approaches available. The approach used can depend on the severity of the misalignment and on the type of local specialists available. Examples of specialists include osteopathic doctors who specialize in craniosacral manipulation (not the same as craniosacral therapy), chiropractors who specialize in “atlas orthogonal” or other upper cervical interventions and physical therapists who are extremely specialized in the upper cervical spine. Getting the atlas in place, however, doesn’t mean that it stays in place, especially if the foundation isn’t being addressed. Foundational tools would include strengthening the supportive muscles in the area and addressing inflammation, toxicity, nutrition, stress and emotional trauma. Those who have significant hypermobility and upper cervical instability and even some with chronic forward head posture, may need interventions to strengthen the ligaments, such as prolotherapy or platelet rich plasma (PRP).

10. Posture: Because we are all impacted by our lifestyle, we can all make some subtle adjustments to improve our posture at our desk and in our car. We can be mindful about how our shoes impact our posture when stand and walk.  We can limit the amount of time we spend with our head down and thus stretching those important ligaments.  Most of us can also benefit from strengthening the supporting muscles of our neck, upper back and even our core.

I hope this gives you a greater appreciation of a well aligned neck - not only for understanding and preventing symptoms, but for enhancing mood, energy, confidence and even our dignity. 

Because this topic has been an important one for me personally, in this week's paid newsletter, I’ll briefly share my atlas story and what I do to keep my head on straight.

If you’ve had your own neck related experiences and want to add to the conversation, please consider commenting.

Until next time,

Courtney

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Medical Disclaimer: This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical and psychiatric issues that you may be having.