Over the past three years, Covid has infiltrated nearly every aspect of our lives, from where and how we work, how we interact with one another, and the underlying ominous feeling that at any given moment the rug can be pulled from under us again. Businesses have shuttered, people have lost jobs, some are never sure about their job security, and we have avoided loved ones and fun opportunities to decrease our risks of getting sick or potentially spreading the virus. When I started back up in an outpatient setting a few months into the pandemic, I was receiving a lot of referrals for TMJ and Vertigo patients. The majority of these patients were highly anxious (rightfully so) about managing their work, their kids being in school at home, and getting the adequate care they needed. With all of my patients I assess their nervous system by simple observations, asking questions about sleep, eating and time management, and with a few other physical tests.
With the increase in referrals of TMJD (temporomandibular joint dysfunction) and Vertigo patients, there were a lot of signs and symptoms that made what should be a “typical” evaluation more challenging. I could help with their immediate symptoms, but they would return, sometimes worse. I do enjoy a puzzle, but my goal as a Physical Therapist is to get the symptoms under control as soon as possible so my patients can go on living their lives. Once I felt my patients were a little more comfortable with me and I had earned their trust, I asked about their anxiety and how, with the pandemic, it might be heightened. All of them verbalized that they were experiencing a significant increase in anxiety. I shared my experience with them regarding my own battle with anxiety, depression and ADHD and how I am managing all of them with the help of psychiatric medications and other behavioral methods. I never forced my patients to seek out psychiatry, but knowing a kind and compassionate psychiatrist who is willing to listen and work with me made all the difference in my life so I could continue treating my patients with empathy that did not drain me. Many sought out the psychiatric referral, some went to talk therapy with psychologists, and all of them attempted to implement my recommendations for anxiety management that did not require medications.
In addition to all of that, I started working on their nervous system. This can include visceral manipulation, cranial pressure points, instruction in diaphragmatic breathing techniques, and learning how to read the cues of when their body is in chronic sympathetic nervous system regulation. I noticed a significant improvement in my patients’ signs and symptoms of TMJD and Vertigo. Bear in mind that some Vertigo is truly from an inner ear dysfunction called Benign Paroxysmal Positional Vertigo and is treated in a fairly straightforward manner. A type of Vertigo that is less common and more challenging to treat is when it is tied into the nervous system, causing blood pressure changes, tension in muscles around the head and neck, ringing in the ear (tinnitus), and even sinus congestion. The latter is what I was treating quite a number of people for. Their symptoms were not so black and white, but definitely improved with manual therapy for their nervous system, learning how to breathe and check in with their bodies, and some balance exercises to integrate the brain, nervous system and musculoskeletal systems together.
Nervous system dysfunction also shows up as gut dysfunctions. I have said in one my earliest blogs that performing visceral manipulation helps with the nervous system and studies have shown that it is helpful with people suffering with addiction. Though I’m convinced that chronic dysfunctions like IBS are linked to people being in heightened states of anxiety or from epigenetics as there is an association of genetics/heredity with IBS. Anxiety disorders can be passed down from familial lines and studies have shown that children and grandchildren whose parents/grandparents survived the Holocaust experience a similar state of anxiety despite not having the same experiences.
I could nerd out more, but the point that I want to drive home is that when our nervous system stays in a heightened state of sympathetic (fight or flight) tone, it manifests itself physically. For some, it is TMJD, for others it is Vertigo, and some it is a dysfunctional gut where they are either constipated or have diarrhea or slow stomach emptying. If my patients respond well to nervous system manual techniques and they are able to perform some behavioral changes, then I feel that is a good sign that further improvements can be made. Not everyone wants to take medications and that is fine if your symptoms are manageable without it. I just want all of my patients to know what is available to them and empower them with options to help themselves, but to also know there are people like me and others who can help.