Back Clinic Stress And Anxiety Chiropractic Functional Medicine Team. People experience stress and anxiety from time to time. Stress is any demand placed on our brain or physical body. People can report feeling stressed with multiple demands placed on them. It can be triggered by an event that makes one feel frustrated or nervous. Anxiety is a feeling of fear, worry, or unease. This can be a reaction, and it can also happen in people who cannot identify significant stressors and are not sure of what to do.
Stress and anxiety are not always bad. They help overcome challenges or dangerous situations. Examples of everyday anxiety include worrying about finding a job, feeling nervous before a big test, or being embarrassed in certain social situations. If there were no anxiety, there would be no motivation to do certain things that need to be done ( i.e., studying for a big test).
However, if stress and anxiety start to interfere with one’s daily life, it may indicate a much more serious issue. For example, if avoiding situations due to irrational fears, constantly worrying, or experiencing severe anxiety about traumatic event/s weeks after it happened, it may be time to seek help.
Stress and anxiety treatments can include a range of therapies, including talking therapy, meditation techniques, and medication. Chiropractic care, adjustments, and massage are also used as a treatment plan to de-stress. Whether diagnosed with an anxiety disorder or experiencing intense stress, chiropractic functional medicine can address the physical symptoms to rebalance the mind and body.
De-Stress
Physical and mental health are connected. Stress and anxiety can cause tension, fatigue, headaches, and aches and pains. It can make sleeping and/or relaxing difficult, affecting mental and physical health. Signs of stress include:
Blood sugar level changes
Every day or almost every day, tension headaches
Teeth grinding
Backaches
Muscle tension
Digestive problems
Skin irritation
Hair loss
Heart issues
The spine is the conduit for the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system activates when the brain thinks sudden action or important stressful decisions needs to be taken.
The fight or flight response speeds up the heart rate and releases adrenaline.
The parasympathetic system deactivates the fight or flight response, calming the body into a more relaxed state.
Problems arise when the sympathetic nervous system gets activated repeatedly, causing the fight or flight system to remain semi-active. This can come from long commutes, traffic jams, loud music, deadlines, sports practice, rehearsals, etc. The parasympathetic nervous system never gets a chance to activate and settle the mind and body. The result is constantly feeling stressed and agitated.
Chiropractic Care
Chiropractic care to de-stress decreases stress hormones and releases feel-good hormones like oxytocin, dopamine, and serotonin, which allow healing and help the body relax. Chiropractic adjustments let the brain know it’s time to activate the parasympathetic nervous system and ease down. Chiropractic helps by:
Relieving Muscle Tension
When the body is under stress, the muscles tense up, causing discomfort, aches, and pains.
The continued stress can lead to health issues, panic attacks, anxiety disorders, and depression.
Chiropractic relieves tension restoring the body to its natural balance.
Chiropractic can help effectively restore bodily functions.
Adjustments and massage rebalance blood circulation and energy flow, allowing clear nervous system transmission.
Lowering Blood Pressure
Chiropractic care has shown positive results in lowering blood pressure.
Improving Quality Sleep
Chiropractic care improves sleep patterns by correcting spinal misalignments.
Increasing Relaxation
Chiropractic adjustments can release and relax muscle activity, allowing the body to relax and de-stress completely.
Health Voice
References
Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of manipulative and physiological therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8
Kültür, Turgut, et al. “Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction.” Turkish journal of physical medicine and rehabilitation vol. 66,2 176-183. 18 May. 2020, doi:10.5606/tftrd.2020.3301
Mariotti, Agnese. “The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication.” Future science OA vol. 1,3 FSO23. 1 Nov. 2015, doi:10.4155/fso.15.21
Stefanaki, Charikleia, et al. “Chronic stress, and body composition disorders: implications for health and disease.” Hormones (Athens, Greece) vol. 17,1 (2018): 33-43. doi:10.1007/s42000-018-0023-7
Yaribeygi, Habib et al. “The impact of stress on body function: A review.” EXCLI journal vol. 16 1057-1072. 21 Jul. 2017, doi:10.17179/excli2017-480
Individuals that have experienced a muscle strain, pull, spasm, etc., that has healed can begin to behave overly cautious, avoiding putting full weight on the area or using full motion out of fear of re-injuring it. This can and does strain other body areas because of the imbalance and awkward positioning. It also leads to anxiety, emotional distress, and decreased self-confidence in everyday movement. Adjustments, massage, and decompression therapy can maintain musculoskeletal health, and a chiropractor can help retrain individuals on healthy posture and confident movement.
Muscle Guarding
Muscles can be held in a position of readiness to act, like the stress response of fight or flight. When this happens, the muscles are partially contracted in preparation for action and is a form of muscle-guarding. But once the fight or flight passes, the muscles relax into their normal position. With injury muscle guarding, the fears and stresses after recovering from an injury can cause the injured and non-injured muscles to stay in the guarded/semi-contracted position. The longer the muscle guarding continues, fatigue begins to set in, decreasing function, restricting mobility, and making the body more vulnerable to damage and injury.
The Brain
The discomfort, pain, or just the thought reinforces the need to guard the area. The brain will find a way to move without causing pain and create compensating but unhealthy movement patterns that strain the other areas of the body. The body adapts to not using the formerly injured muscles and now relies on the other muscles to perform the functions in a non-relaxed state that can become normal, causing stiffness, soreness, tenderness, tendon tension, and pain.
An example is a hip strain, pull or spasm that has been treated and has healed, but the individual is fearful of another injury or going through the painful experience again and begins walking by shifting all their weight to the other side and steps with a limp or some abnormal motion that strains and/or injures the rest of the body.
Chiropractic Treatment and Retraining
Individuals experiencing muscle guarding can find help through chiropractic to retrain their muscles to return to their normal position and regain confidence in their movements. The body will be rebalanced by releasing and relaxing the tight muscles. Then therapeutic repetitive movements, specialized exercises, stretches, and relaxation techniques will help the individual relearn to use the muscles without fear.
Protective Muscle Guarding
References
Hanlon, Shawn et al. “Examining Ankle-Joint Laxity Using 2 Knee Positions and With Simulated Muscle Guarding.” Journal of athletic training vol. 51,2 (2016): 111-7. doi:10.4085/1062-6050-51.3.06
Olugbade, Temitayo et al. “The relationship between guarding, pain, and emotion.” Pain reports vol. 4,4 e770. 22 Jul. 2019, doi:10.1097/PR9.0000000000000770
Prkachin, Kenneth M et al. “Pain behavior and the development of pain-related disability: the importance of guarding.” The Clinical journal of pain vol. 23,3 (2007): 270-7. doi:10.1097/AJP.0b013e3180308d28
Athletes train and practice constantly to prepare their mind and bodies for the big games, matches, etc. When the game is on, it is normal/natural to feel anxious and nervous, especially at the beginning, but then the athlete settles in and relaxes, letting their training take over. However, for some athletes, the anxiousness and nervousness doesn’t go away but intensifies, the heart starts racing, and the individual can’t stop thinking about choking, failing, and losing. This is known as sports performance anxiety, or competitive anxiety, and is common.
Competitive Anxiety
Research shows that 30 to 60 percent of athletes experience the disorder. Doctors divide the signs and symptoms into mental and physical categories.
Physical Symptoms
Rapid Heartbeat
The stress can cause overproduction of adrenaline and cortisol, making the heart beat rapidly.
Muscle Tension
The muscles can tighten up, become painful, and cause tension and pain in the head.
Trembling
The hands could shake while holding the ball, bat, racket, or foot twitching could present.
Hyperventilation
Individuals report a sensation of choking or being unable to catch their breath.
Digestion Issues
The stress can cause foods to be quickly digested, causing cramping and/or the sudden urge to use the bathroom.
Mental Symptoms
Fear of Failing
The athlete imagines themselves losing all the time.
Worrying about letting the coach and team down or the audience or other athletes criticizing and laughing at your performance.
Unable to Focus
The athlete may have concentration issues and become absorbed in how others react to their performance.
Overthinking
The athlete can temporarily forget how to perform specific actions that are typically automatic.
Self-confidence issues
The athlete can start doubting their abilities.
Stress and Anxiety
The Yerkes-Dodson law explains how stress, anxiety, and arousal levels affect performance and how stress levels must be maintained within a range to perform well.
Low Arousal
It could be the athlete is not as into the sport as when they began, so they do not put forth the total effort.
High Arousal
This means the sport could be causing so much stress that the athlete panics or freezes up.
Competitive anxiety sets in.
Optimal Arousal
This means the athlete is fully engaged in pushing themselves to the fullest.
This can be applied to any performing task like play rehearsals to a tennis match.
Some recommended steps can be taken to handle and prevent sports competitive anxiety when trying to overcome those overwhelming feelings of nervousness and tension.
Positive self-talk
Self-talk is having a positive conversation with yourself.
Athletes who practiced positive self-talk reported:
Improved self-confidence
Reduced physical anxiety symptoms
Improved sports performance
Listen to Music
When anxious before a meet, game, match, etc., consider listening to some favorite or relaxing music.
Meditation
Meditation has been found to reduce all types of anxiety, including sports.
Chiropractic
Chiropractic treatment specializes in the musculoskeletal system and can realign the body and release any muscle tension and restriction through hands-on manipulation techniques and mechanical decompression. Treatment involves manipulating the muscles, ligaments, tendons, fascia, and soft tissues to relieve pain through therapeutic muscle therapies that include:
One or a combination of therapies can alleviate symptoms related to muscle spasms, delayed onset muscle soreness, fascia restrictions, soft tissue injuries, and pain and dysfunction throughout the body, restoring function, movement, and strength.
Using The DRX9000 For Spinal Decompression
References
Elliott, Dave, et al. “The effects of relaxing music for anxiety control on competitive sport anxiety.” European journal of sports science vol. 14 Suppl 1 (2014): S296-301. doi:10.1080/17461391.2012.693952
Ford, Jessica L et al. “Sport-related anxiety: current insights.” Open access journal of sports medicine vol. 8 205-212. 27 Oct. 2017, doi:10.2147/OAJSM.S125845
Rice, Simon M et al. “Determinants of anxiety in elite athletes: a systematic review and meta-analysis.” British journal of sports medicine vol. 53,11 (2019): 722-730. doi:10.1136/bjsports-2019-100620
Rowland, David L, and Jacques J D M van Lankveld. “Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground.” Frontiers in psychology vol. 10 1615. 16 Jul. 2019, doi:10.3389/fpsyg.2019.01615
Walter N, et al. (2019). Effects of self-talk training on competitive anxiety, self-efficacy, volitional skills, and performance: An intervention study with junior sub-elite athletes. mdpi.com/2075-4663/7/6/148
After traveling, body/musculoskeletal aches and pains can present from continual standing in line, sitting, staying in the same position, carrying a heavy bag or pulling a suitcase, and sleeping in an unfamiliar bed with different pillows, on a plane or car can cause body imbalances, jerking the spine out of alignment, straining the neck, shoulders, and back causing headaches, soreness, stiffness, back pain, and compression. Chiropractic massage and decompression will relieve travel pains, loosen stiff and sore joints, soothe aching muscles, realign the spine, and restore body health and comfort.
Musculoskeletal Health
The musculoskeletal system is comprised of:
Muscles
Tendons
Ligaments
Bones
Joints
Tissues that move the body and help maintain structure and form.
The health of the musculoskeletal system is defined as the absence of injury, disease, or illness within the system. Keeping this system healthy is crucial for the health of the other body systems.
Common Muskuloskeletal Conditions
Musculoskeletal injuries – work-related, personal, automobile, sports, or physical activity
Musculoskeletal health is enhanced by increased circulation that increases oxygen flow that relaxes the mind and body. Overworked sore, tired muscles after traveling can keep the body tense which could lead to chronic stress symptoms. Chiropractic massage therapy effectively reduces stress and anxiety by manipulating the body tissues like the muscles, tendons, connective tissues, and ligaments, increasing blood circulation and improving flexibility.
Jet-Lag
The body is weak after traveling into different time zones, which can cause jet lag, stress, and relaxation problems.
Jet lag can cause sleep problems, leading to extreme fatigue, headaches, and nausea.
Chiropractic can alleviate jet lag effects quickly by working/massaging/stretching out the muscles, increasing blood flow, flushing out toxins, and calming the body.
Travel Stress
The stress starts right before the trip when preparing, packing, and setting up the house while away.
The body tenses up when traveling to maintain focus, stay alert, and be ready for surprises.
When on vacation, having fun and doing all kinds of activities can make individuals forget to relax.
Waking up early and going to bed late can contribute to travel stress.
Chiropractic therapy will relieve all the strain and return the body to a relaxed state.
Relieve Back Pressure
Sitting for hours can increase pressure on the spine.
The muscles become stiff from the immobility accumulating pressure on the body and the mind, increasing the risk for other pains.
Chiropractic therapy will help lower heart rate and blood pressure relieving discomfort and stiffness.
Relax and Sleep
The internal body clock can get thrown off when traveling, resulting in little to no sleep and irritability.
Driving or flying will drain the body and mind, which can cause fatigue and anxiety.
Chiropractic will restore body and mind functions resulting in sleep and relaxation.
Spinal Decompression Texas
References
Crofford, Leslie J. “Chronic Pain: Where the Body Meets the Brain.” Transactions of the American Clinical and Climatological Association vol. 126 (2015): 167-83.
Sadler, Sean G et al. “Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies.” BMC musculoskeletal disorders vol. 18,1 179. 5 May. 2017, doi:10.1186/s12891-017-1534-0
Waterhouse, J et al. “The stress of travel.” Journal of sports sciences vol. 22,10 (2004): 946-65; discussion 965-6. doi:10.1080/02640410400000264
Everybody deals with stress at some point in their lives. Whether it be a job interview, a huge deadline, a project, or even a test, stress is there to keep the body functioning in each scenario that the body is going through. Stress can help regulate the body’s immune system and help metabolize homeostasis as the body increases its energy throughout the day. When dealing with chronic stress can cause metabolic dysfunction in the body like gut disorders, inflammation, and an increase in blood glucose levels. Chronic stress can also affect a person’s mood and health, eating habits, and sleep quality. Today’s article will look at if stress is a good thing or a bad thing, how it affects the body, and the effects of what chronic stress does to the body. Refer patients to certified, skilled providers specializing in gut treatments for individuals that suffer from autonomic neuropathy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900
Is Having Stress Good Or Bad?
Do you feel anxious all the time? How about feeling headaches that are constantly being a nuisance? Feeling overwhelmed and losing focus or motivation? All these signs are stressful situations that a person is going through. Research studies have defined stress or cortisol as the body’s hormone that provides a variety of effects on different functions in each system. Cortisol is the primary glucocorticoid that is from the adrenal cortex. At the same time, the HPA (hypothalamus-pituitary-adrenal) axis helps regulates the production and secretion of this hormone to the rest of the body. Now cortisol can be beneficial and harmful to the body, depending on the situation a person is in. Additional research studies have mentioned that cortisol begins and affects the brain and the rest of the body as stress in its acute form can cause the body to adapt and survive. The acute responses from cortisol allow neural, cardiovascular, immune, and metabolic function in the body.
How Does It Affect The Body’s Metabolism?
Now cortisol affects the body’s metabolism when controlled in a slow, steady sleep cycle that decreases corticotropin‐releasing hormone (CRH) and increases growth hormone (GH). Research studies have shown that when the adrenal glands secrete cortisol, it starts to have a complex interaction with the hypothalamus and pituitary glands in the nervous and endocrine systems. This causes the adrenal and thyroid function in the body to be closely linked while under the control of the hypothalamus and tropic hormones. The thyroid competes with the adrenal organs for tyrosine. Research studies have found that tyrosine is used to produce cortisol under stress while preventing cognitive function decline that is responsive to physical stress. However, when the body can not produce enough tyrosine, it can cause hypothyroidism and cause the cortisol hormone to become chronic.
An Overview About Stress-Video
Have you experienced headaches that randomly show up out of nowhere? Have you constantly gained weight or lost weight? Do you feel anxious or stressed out always that it is affecting your sleep? These are all signs and symptoms of your cortisol levels turning into their chronic state. The video above shows what stress does to your body and how it can cause unwanted symptoms. When there is chronic stress in the body, the HPA axis (neuro‐endocrine) is imbalanced due to the stress‐mediated activators involved in autoimmune thyroid diseases (AITD). When there is chronic stress in the body, it can cause excessive production of inflammatory compounds in the body can generate IR. The inflammatory substances can damage or inactivate insulin receptors leading to insulin resistance. This then contributes to the breakdown of one or more factors needed to complete the glucose transport process in the body.
The Effects Of Chronic Cortisol In The Body
When there is chronic stress in the body and has not been treated or reduced right away, it can lead to something known as allostatic load. Allostatic load is defined as wear and tear of the body and brain due to chronic overactivity or inactivity of the body systems typically involved in environmental challenges and adaptation. Research studies have shown that allostatic load causes excess secretion of hormones like cortisol and catecholamine to respond to chronic stressors affecting the body. This causes the HPA axis to do one of two things: being overworked or failing to shut off after stressful events causing sleep disturbances. Other issues that chronic stress does to the body can include:
Increased insulin secretion and fat deposition
Altered immune function
Hypothyroidism (adrenal exhaustion)
Sodium and water retention
Loss of REM sleep
Mental and Emotional instability
Increase in cardiovascular risk factors
These symptoms cause the body to become dysfunctional, and research studies have pointed out that various stressors can damage the body. This can make it extremely difficult for a person to cope with stress and alleviate it.
Conclusion
Overall, stress or cortisol is a hormone the body needs to function correctly. Chronic stress in the body from various stressors can cause many metabolic dysfunctions like hypothyroidism, weight gain, insulin resistance, and metabolic syndrome, to name a few. Chronic stress can also cause sleep disorders since the HPA axis is wired up and can seem to calm down the slightest. When people start to find ways of dealing with these various stressors, they can reduce their stress levels back to normal and be stress-free.
References
Jones, Carol, and Christopher Gwenin. “Cortisol Level Dysregulation and Its Prevalence-Is It Nature’s Alarm Clock?” Physiological Reports, John Wiley and Sons Inc., Jan. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7749606/.
McEwen, Bruce S. “Central Effects of Stress Hormones in Health and Disease: Understanding the Protective and Damaging Effects of Stress and Stress Mediators.” European Journal of Pharmacology, U.S. National Library of Medicine, 7 Apr. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2474765/.
McEwen, Bruce S. “Stressed or Stressed out: What Is the Difference?” Journal of Psychiatry & Neuroscience : JPN, U.S. National Library of Medicine, Sept. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1197275/.
Rodriquez, Erik J, et al. “Allostatic Load: Importance, Markers, and Score Determination in Minority and Disparity Populations.” Journal of Urban Health : Bulletin of the New York Academy of Medicine, Springer US, Mar. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6430278/.
Young, Simon N. “L-Tyrosine to Alleviate the Effects of Stress?” Journal of Psychiatry & Neuroscience : JPN, U.S. National Library of Medicine, May 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1863555/.
Maintaining a healthy weight is challenging, especially Fridays, Saturdays, Sundays, and extended weekends, increasing the risk of binge eating and weight gain. This is where healthy cheat meals and snacks come into play to help individuals stick to their diet while enjoying healthy junk food. Plus, finding the proper high-calorie carb-packed meal can help optimize the body’s hormones to prevent adverse effects on metabolism and hunger.
Cheat Meals
One way to look at a diet and still have the flexibility for sweet or savory foods is to set up the flexibility. To maintain health, practice portion control and eat healthy foods 80% of the time, allowing a 20% margin for the junk foods. To improve health, eat healthy foods 90% of the time, and allow a 10% margin until a health goal is reached.
Cheeseburger without the Buns and Sweet Potato Fries
They can be made healthy with lean ground beef, beans, peppers, cheese, avocado, tomatoes, and jalapeños for a meal that incorporates quality protein and healthy fats.
It can be made vegetarian by removing the meat and adding more beans and vegetables.
Dark chocolate contains monounsaturated fats that can help improve cholesterol, blood sugar, and insulin levels.
Dark chocolate also supplies vitamins, minerals, and antioxidants for heart and brain health.
Dietician Nutritionist
These are a few examples; the objective is to get individuals to learn to create their healthy cheat meals A diet or adjusting for a more nutritional food plan should always start with a nutritionist, dietician, or health care provider. They can help develop a customized plan that fits an individual’s specific needs. It is about finding the balance and creating a positive relationship with food.
Fibromyalgia Food Choices Nutraceutical Options
References
Coelho de Vale R, et al. (2016). The benefits of behaving badly on occasion: Successful regulation by planned hedonic deviations.
doi.org/10.1016/j.jcps.2015.05.001
Kuijer RG, et al. (2014). Chocolate cake. Guilt or celebration? Associations with healthy eating attitudes, perceived behavioral control, intentions, and weight loss. DOI:
10.1016/j.appet.2013.11.013
Murray SB, et al. (2018). Cheat meals: A benign or ominous variant of binge eating behavior? DOI:
10.1016/j.appet.2018.08.026
Warren JM, et al. (2017). A structured literature review on the role of mindfulness, mindful eating, and intuitive eating in changing eating behaviors: Effectiveness and associated potential mechanisms. DOI:
10.1017/S0954422417000154
Stress health recognizes how stress affects the body, thoughts, feelings, and behavior. Stress that’s left untreated can contribute to various health problems. These include:
Chiropractic serves as a powerful intervention for anxiety-related symptoms.
Stress Health Blood Pressure and Heart Rate Balance
Chiropractic benefits cardiovascular health as it directly affects the nervous and other body systems that include the spinal system, the bones, joints, and muscular system, affecting the function of the cardiovascular system. Chiropractic regulates these system’s functions allowing for a moderate heart rate and blood pressure. Balanced blood pressure and heart rate can help minimize stress and anxiety, making it much easier to stay relaxed and focused. Individuals report experiencing decreased blood pressure and lower heart rate with long-term chiropractic treatment.
Mental Clarity
Cerebrospinal fluid/CSF is necessary for detoxifying the brain and helping to protect the brain. CSF transports oxygen and nutrients to the brain, helping to increase brain function efficiency. Chiropractic has been shown to increase the amount of cerebrospinal fluid delivered to the brain. This is because the spine is aligned correctly, allowing for a smooth flow of blood and nerve energy from the brain through the spine to the rest of the body. This provides:
Chiropractic can help increase energy levels in different ways for different individuals.
For some, this works by eliminating headaches, migraines, and other nerve dysfunction/s.
For others, this happens by decreasing or eliminating pain symptoms.
These conditions can contribute to lowered energy levels. Constant stress can change the body’s chemistry, leading to increased stress hormones like cortisol. Over time, these hormone releases can decrease energy, causing interference with the body/brain’s natural rejuvenating processes that reduce stress. With chiropractic, the therapeutic effects help correct body chemistry and improve energy levels.
Body Composition
Increase Immune Function
Lymphatic fluid has a vital role in stress health and the function of the immune system. Lymphatic fluid helps separate and release:
Toxins
Viruses
Fungus
Bacteria from the body.
When lymphatic fluid flows smoothly and is not impeded or trapped in tissues, joints, or muscles, the immune system operates at a high level. Chiropractic helps drive lymphatic fluid out of the tissues, joints, and muscles of the body, facilitating optimal immune function.
References
Dragoş, Dorin, and Maria Daniela Tănăsescu. “The effect of stress on the defense systems.” Journal of medicine and life vol. 3,1 (2010): 10-8.
Meier, Jacqueline Katharina et al. “Stress Alters the Neural Context for Building New Memories.” Journal of cognitive neuroscience vol. 32,12 (2020): 2226-2240. doi:10.1162/jocn_a_01613
Pickar, Joel G. “Neurophysiological effects of spinal manipulation.” The spine journal: official journal of the North American Spine Society vol. 2,5 (2002): 357-71. doi:10.1016/s1529-9430(02)00400-x
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