Unified Health

Manual Osteopathic Treatment for Post-Traumatic Stress Disorder

Talking about our mental health can be daunting. There is still a very real stigma around mental health related conditions. But it is also important for people who are suffering to realize that they aren’t alone. I can’t think of a single person I’ve spoken with over the years who hasn’t had some kind of traumatic experience themselves or have supported a loved one through the aftermath of a trauma. 

Treating trauma related conditions can be as varied as the causes of trauma itself – from traumatic accidents, combat, surgeries, life-threatening illness, abusive situations, natural disasters, criminal activity – the list is actually quite long for what could potentially cause a trauma response in someone. 

The development of post-traumatic stress disorder (PTSD) can be quite common (approximately 70% of Canadians experience at least one traumatic event in their lifetimes, and 9.2% of Canadians will suffer PTSD in their lifetimes – the highest of 24 countries studied) and it often goes unrecognized and left untreated for years. Since PTSD can remain latent, only to be activated years later, it can take repeated instances of PTSD symptoms (i.e., unexpected rage or tears, shortness of breath, increased heart rate, shaking, memory loss, concentration challenges, insomnia, nightmares and emotional numbing) before someone recognizes that their current symptoms are related to their past trauma. 

The four categories of PTSD symptoms include: intrusive thoughts (unwanted memories); mood alterations (shame, blame, persistent negativity); hypervigilance (exaggerated startle response); and avoidance (of all sensory and emotional trauma-related material).  Often these symptoms can be mistaken for other conditions, which can delay getting proper treatment for the underlying trauma. 

So how can manual osteopathic treatment help? 

First, it’s important to note that every person is unique and what works for one person might not work for someone else. Also, a combined treatment approach with multiple modalities to address the physical, mental, emotional and life/social impacts of PTSD is often more effective than just trying to address a single component. That said, I’m going to focus this discussion on how addressing the physical changes that occur to the nervous system can aid in the recovery from traumatic events, as it’s often a missed component of the recovery and rehabilitation process. 

The first thing that’s important to understand is how the nervous system responds to traumatic events, especially to repeated traumatic events, because it’s a key to the treatment of the underlying nervous system ‘stuck-ness’ that tends to occur in PTSD and associated conditions. 

In simple terms, the body reacts to a stressful event in a few different ways – this is the fight/flight/freeze/collapse response. We often talk about the fight or flight response, but tend to forget about the freeze and collapse ends of this spectrum. 

If you think about these responses as a continuum of how your physiology is going to respond, fight and flight occur when you can still do something about the threat. These are active processes. You either fight the bear, or you try to run away from the bear. But when you can’t fight the threat or remove yourself from a life-threatening situation – a severe car accident, a disaster situation, sexual violence – your body goes to the far end of the continuum and begins to shut down to prepare for death. This is the spectrum of freeze and collapse stress responses. It’s this spectrum of stress response that tends to be the most likely to cause a post-trauma condition. Let me tell you why: that ‘freeze’ response – it’s like one big ol’ nervous system muscle spasm. And it becomes much more likely to happen when the nervous system has already been ‘primed’ by previous traumatic circumstances. That’s why people with multiple traumatic experiences are more likely to develop PTSD than someone after just 1 traumatic event

Now, I need to explain something here that we often forget or don’t know or realize. Neurons themselves aren’t contractile structures, but the membranes that surround the brain and the glia – the supporting cell types of the brain that actually outnumber neurons – some of them do actually have some contractility. The function of the musculoskeletal system is to support and provide locomotion and offer some protection from injury. The brain has a similar system to protect it, feed it, cushion it, etc. Whenever you have a tissue that has contractile ability, you can get what amounts to a muscle spasm in that tissue. This happens all the time in ligaments, joint capsules, etc., and can often lead to chronic delays in healing until someone addresses that tissue. Same concept for the micro-spasm occurring in the supporting tissue and membranes of the brain - this is going to alter the functioning of the nervous tissue that that spasm is protecting and/or the tissue just adjacent to the spasm. So, just like when you get a ‘charley horse’ in your calf, it can take some time for that muscle spasm to dissipate and for the muscle to return to normal functioning. If you get a charley horse in your brain, that spasm can lead to the typical symptoms that you see with PTSD. It takes a little while for that to dissipate, and most treatment is aimed at mitigating the effects of that charley horse while you wait for the spasm to pass. But, again, much like with a muscle spasm in your calf, you can help speed up that healing process with the proper physical therapy treatments. And luckily, neuro-rehabilitation practices are becoming much more common. Some branches of the field are focused on brain injury repair – such as from a stroke or accident – some are more focused on sports injury rehabilitation – retraining the proprioceptive nervous system to help prevent a similar future injury – some are focused on nervous system imbalances – things like anxiety, PTSD etc. 

Now, I recognize that your brain is housed within the hard structure of your bony cranium, so you can’t directly massage the brain tissue to relieve that tissue spasm (not that you’d even want to), but what you CAN do is indirectly cause a relaxation reaction in the tissue by communicating with the nervous system. We do this all the time with acute muscle injuries – there are techniques like the Golgi tendon organ release, or the muscle spindle release, etc., that can cause an indirect relaxation of the spasmed muscle by communicating with the nervous system structures that innervate that muscle. You can do similar things with the innervation of the support tissue for the brain. It’s just a matter of knowing what to communicate with and how that receptor ‘talks’ – does it require deep, sustained pressure? Vibrations? Soft pressure? A shortening of the tissue? A stretch of the tissue? Etc etc. Every nervous tissue has a way that it ‘talks’, basically – both how it receives information and how it sends information. The ‘language’ is just one of sensory stimuli. So, knowing this, you can ‘hack’ that system. 

If you want to think of neuronal receptors like telephones, the nerves themselves like the telephone lines, then the ganglia of the body are like those old school telephone relay stations. They receive information from either the bottom up or the top down and pass it along to wherever it needs to go. The stellate ganglion is the one that sends sensory information from the body up to the head, neck, and upper extremeties in the form of ‘excited chatter’, basically. So, the stellate ganglion block injection (SGB), works similarly to how/why cortisone injections work – you’re breaking a continuous sensory loop that is causing a constant ‘nattering’ within the system. 

Cortisone injections, if you’re unfamiliar, work by breaking the inflammation/irritation cycle. See, there are a few areas where the body is just kind of poorly designed. Nerves often have to pass thru the muscle tissue that they are innervating. If there is an injury to a muscle, or a joint gets slightly nudged out of alignment, as an example, then that muscle can go into a protective spasm. Think about when you have a cut on your knuckle – you tear that sucker open every time you bend your finger, so keeping the area surrounding the injury shortened helps the fibers repair themselves. There is a complex communication system coordinating this effort so that the muscles stay contracted to allow for the healing process to occur. What can happen sometimes, however, is if the inflammation from that process is too close to the nerve, or the muscle contracts too tightly and squishes the nerve too much, you can set up a feedback loop whereby the nerve is now constantly telling the muscle to stay contracted. Depending on the location where this occurs, it can cause a situation where a joint that that muscle crosses to decrease in space because the muscle pulls those two bone surfaces closer together, which can lead to further inflammation, further irritating the already irritated structures, and this cycle just keeps repeating. So, the cortisone injection works by breaking the inflammation loop long enough for everything to relax, notice that everything is healed and okay now, or give the tissue time to heal, so everything can then go back to normal. 

These SGB injections work in a similar way. By injecting the ganglia with a substance that anesthetizes it, it chills out that excited ‘chatter’, which gives the brain structures receiving this chatter the time to heal and calm down that they need. You can also use other nervous structures, like other ganglia and nerve clusters, to communicate with the freaking out brain tissue in a similar way. Now, the trick here is to note whether or not that ganglia is ‘chattering’ because it’s being squished by surrounding structures. Anxiety, for instance, generally makes your neck and shoulder muscles tighten. Given the location of the stallate ganglion, this is going to ‘squish’ the ganglia. And since that ganglia, for some reason, seems to work similarly to the cortisone-inflammation loop situation described above, when that ganglia is being compressed or irritated due to the shortening of the neck and shoulder muscles, it can feedback to the brain tissue that is in spasm during PTSD, keeping that brain tissue stuck in a constant state of activation, which continually tells those neck and shoulder muscles to stay shortened, perpetuating the cycle. So, anything that breaks that feedback loop can allow the system to return to normal. 

Manual osteopaths can achieve similar results without the injection, using manual therapy techniques. Same way we can help the inflammation cycle situation without the cortisone injection. 

Now, this doesn’t work for everyone, and it works best when coupled with your traditional PTSD treatments like cognitive behavioural therapy (CBT), eye-movement desensitization and reprocessing (EMDR) etc. But we can help provide the physical support necessary to ensure that those feedback loop situations either don’t occur or aren’t occurring while the brain tissue heals from the trauma. 

Look for a manual osteopath who specializes in craniosacral therapy who treats PTSD for the best results. 

Lizane Tan