Thread by @BadgleyLaurence

SCOLIOSIS & DYSAUTONOMIAS
FUNCTIONAL SCOLIOSIS was a post of 12/5/20, & wherein I discussed etiology & exam for what I call “functional scoliosis”. I showed how this disorder, common in women with Hypermobility Syndrome, potentiates evolution of Costochondritis.

Functional scoliosis also underlies etiology of many dysautonomias, such as Migraine, Thoracic Outlet Syndrome (TOS), POTS, Panic Attacks, Hyperventilation, & Gastroparesis. In this essay, I will describe my views of the pathophysiology of these disorders.

In my opinion, dysautonomias of the lower body, such as Interstitial Cystitis (IC), Irritable Bowel Syndrome (IBS), & perhaps Endometriosis, arise from neural impingements affecting autonomic nervous system tracts that regulate the tissues of these organs.

Autonomic neural tact impingements that arouse lower body dysautonomias occur as result of hyper-mobile tissues inciting sacroiliac joint subluxations that impinge contiguous autonomic neural tracts of the pre-sacral plexus; based on my theories, observations, & data collections.

Pelvic girdle joint ligament laxities that generate disordered neural messages to organs of the abdomen & pelvis are reported within discussions found in several essays in my library of threadreader tweets, & they will not be offered within this current writing.

In this essay, I will discuss relationship of upper body dysautonomias to functional scoliosis. Insights into the true nature of functional disorders of upper body organs requires an understanding of bio-mechanical functions of the human body in relation to gravitational vectors.

A Principle to keep in mind is that all body parts have mass that is falling to center of the earth at 32 feet per second per second, the velocity imparted to mass by the force of gravity: basic Physics.

Scoliosis seen in many women with Hypermobility Syndrome is subtle & discerned by the clinical examiner running fingers down both sides of the vertebral spine. Ligaments of women with Hypermobility Syndrome are excessively flexible. Vertebral disks are specialized ligaments.

When women with Hypermobility Syndrome assume upright postures, their body towers are wobbly. Scoliosis is manifestation of vertebral spine attempting to maintain a medial station of upper body mass & preserve a central center of gravity.

Proprioceptive feedback loops within the musculoskeletal systems undoubtedly effect masterful motor control in maintaining the significant tissue mass of the upright body tower.

The degrees of curvature being included in the category of functional scoliosis are minimal & subtle. Most persons with functional scoliosis seem to enter middle age without even knowing they have these curvatures.

I have given the name “functional scoliosis” to these curvatures because they are detected when the person is upright, but not when the person is prone; when gravitational effects are minimal. The scoliosis is a “function” of posture.

My speculation is that Radiologists commonly view these slight curvatures of functional scoliosis when they read thoracolumbar X-rays, but regard these minimal curvatures to be within the range of normal variations.

It is a curious circumstance that the largest joints in the spine, the sacroiliac joints (each 17 cm squared in area) can rotate about their central axes a few degrees, but there is no way to read these shifts on static two dimensional X-rays.

Ligament systems that tether the sacroiliac joints are radiolucent, so that mechanical damage to these tissues is not readily viewed, even on MRI’s. Persons, especially women with Hypermobility Syndrome, often have loose sacroiliac joints.

Loose sacroiliac joints in women are due to a morphology structured for expansion during childbirth. Estrogens have an effect to soften ligaments & render them more flexible.

Women have delicate pelvic girdles compared to men, & women can more easily injure their pelvic girdles & incur permanent sacroiliac joint subluxation syndromes.

Despite speculative disregard by Radiologists, slight spinal curvatures of functional scoliosis are significant. These curvatures persist from one exam to next. These spine curves are commonly associated with distinct body postures uniquely observed in hypermobile patients.

Clinical data I have gathered suggests that those persons with functional scoliosis often have dysautonomias. Impingement of para-vertebral autonomic tracts, including the vagus nerve, causes organ dysfunctions and dysautonomic symptoms.

Radiologists are hardly ever trained by examinations of living/breathing patients in clinic exam rooms. Radiologists’ training & career-long patient encounters consist of looking at two dimensional images of patients. Radiologists are generally not facile at clinical diagnosis.

As Radiologists review patient images they do so while seated alone in dark rooms nearly wholly ignorant of symptoms & medical histories of patients whose images they are viewing. Therefore, Radiologists are bereft of opportunity to discover associations I am reporting herein.

My experience with countless patients has been that scoliosis curves are commonly associated with asymmetric shoulder girdles (2/patient), with one lower; the same asymmetric dynamic seen in horizontal beams fixed atop non-vertical support posts in building constructions.

There is an easy & dramatic way for clinicians to demonstrate to patients that their shoulders are of unequal heights. The clinician stands facing the patient & places one index finger on each Acromio-Clavicle (AC) joint (at the lateral shoulder edge).

As the clinician holds the fingers rigidly at these stations of the AC joints, the patient is asked to step back two paces & then to view the clinician’s fingertips suspended in space. The patients can easily view the shoulder asymmetry, with one shoulder lower.

Another way to demonstrate shoulder asymmetry to patients is to station the patient’s back against a wall onto which a broad piece of exam table paper has been taped to the wall at shoulder height.

Next, the clinician uses a sharpie to mark the station of each Acromion-Clavicular (AC) joint, or alternatively uses the sharpie to trace the shoulder contours. The asymmetries drawn on the paper can usually be viewed from across the exam room.

Another way to demonstrate shoulder asymmetry is to photocopy patient’s driver’s license photo & then draw an horizontal line across photo using the higher AC joint as starting point of the line. A greater area of blue background will be seen between lower shoulder & the line.

While the clinician is marking the driver’s license photocopy to show shoulder asymmetry, then the clinician draws a vertical line using the mid-points of the chin and nose. This line will define the degree of head tilt, which is usually a tilt toward the lower shoulder side.

Functional scoliosis causes chronic head tilt. Functional scoliosis induces asymmetric shoulder girdles: upper scoliosis curves approach horizontal axis of shoulders obliquely. Shoulder asymmetry imbalances head (~10#), which usually chronically tilts toward lower shoulder side.

Chronic head tilt imparts a pulling down of the blouse on one side, with more skin showing between collar & neck base on the lower shoulder side. I call this the “T-shirt Sign”.

Chronic head tilt can often be seen in driver license photos (see above). Chronic unilateral head tilt evokes two dysautonomias: Migraines & Thoracic Outlet Syndrome (TOS).

MIGRAINE
These severe headaches are common in patients who complain of daily muscle tension headaches & chronic cervicalgia. Muscle spasm is usually greatest & most painful within Superior trapezius muscle mass on higher shoulder side.

After performing hundreds of clinical examinations of asymmetric shoulder girdles in people with chronic cervicalgia & muscle tendon headaches, clinicians will note that girth of anterior leading edges of these muscles is 2-3 x’s that of contralateral paired companions.

Reason for greater muscle girth on the higher shoulder side is that this is side of the Superior trapezium muscles that is most exercised supporting a tilted head each day; since the head usually tilts towards the lower shoulder side; as a consequence of gravitational pull.

After examining a few hundred patients with functional scoliosis, observant clinicians will learn this pattern of asymmetric shoulder stations & head tilt postures are so common that they might properly be regarded as a bio-mechanical Principle of human pathological morphology.

It also seems to be a Principle of soft tissue Physiology that chronic tension & spasm of a Superior trapezius muscle is associated with frequent (several per month) Migraine attacks. I came to this understanding after seeing this relationship so commonly in patients.

The common association of chronic muscle tension headache & frequent Migraines suggests a biofeedback loop between chronic spastic skeletal muscle (Superior trapezius) & spasm of cerebral artery vessel walls; the speculated cause of the Migraine phenomenon.

Migraines have long been considered to result from transient cerebral arteriolar vessel smooth muscle spasms & vessel lumen constrictions that incite brain tissue ischemia, which then secondarily leads to reactive arteriolar vessel dilation in brain tissue starved for oxygen.

As a Migraine headache evolves, the arteriolar constriction phase precedes the dilation phase; when autonomic controls induce dilation to increase cerebral blood flow & oxygen delivery to brain tissue.

Brain tissue starved for oxygen induces brain arterioles to dilate. During the arteriolar dilation phase, brain meninges congested by global arteriolar dilation evoke marked pain in the brain. At least this is the theory.

Clinical data of Superior trapezius muscle spasm combined with the above described sequence of physiological arteriolar events suggests an autonomic neural feedback loop between neck muscle spasm & brain tissue swelling. At least this is my theory.

Perhaps chronic spasm & constriction of neck muscles compromises carotid artery function, causing reduced blood delivery to brain, a signal that brain arteriolar vessels need to dilate. My speculation is that reduced muscle spasm within neck muscles would reduce Migraines.

My prediction is that Botox injected into spastic Superior trapezium muscles to relax them will abort cerebral arteriolar vessel smooth muscle (vessel wall) constriction via an autonomic neural feedback loop & forestall Migraines (my observations & data collection underway).

CONCLUSION: functional scoliosis leads to asymmetric shoulders & chronic unilateral Superior trapezius muscle spasm. Concomitant cervical autonomic nervous system soft tissue impingements and/or cervical artery impingements induce brain tissue arteriolar spasm/dilation & Migraine

THORACIC OUTLET SYNDROME (TOS) is included amongst the collection of syndromes that have dysautonomic qualities & relationships to functional scoliosis; in these cases TOS has etiologic relationship to functional scoliosis curves within the Thoracic spine.

The functional scoliosis-TOS relationship is subtle, & includes speculation that Thoracic Outlet Syndrome also seems to be an early phase of bio-mechanical dysfunction that sometimes proceeds & leads to Chronic Regional Pain Syndrome (CRPS) (unreported clinical data).

Formerly, CRPS of arm was called “Shoulder-Arm-Hand Syndrome”. Later called Reflex Sympathetic Dystrophy (RSD). The CRPS syndrome includes autonomic-controlled soft tissue dysfunctions whereby appendage has temperature & color abnormalities & generates severe pain.

In a few of these severely painful appendage CRPS cases, my observations have been that an escalation of early symptoms into CRPS autonomic dysfunction involves evolution into CRPS after “double crush” injuries have afflicted the appendage.

The “double crush” phenomenon includes magnification of symptoms when nerves leaving spine & neural ganglia are impinged at more than one locus/region along course of neural tracts within arm & hand; for example at Thoracic Outlet &/or elbow ulnar nerve tunnel, &/or carpal tunnel

I have seen autonomic dysregulation in distal arms & hands like Reynauds Syndrome: vasoconstriction, skin color changes, temperature changes, & constant aching pain. My impression is these symptoms reflect long-term periods of neural double crushes that include unrecognized TOS.

Thoracic Outlet Syndrome results from functional scoliosis via asymmetric shoulder girdles (scoliosis caused) inducing Superior trapezius hypertrophy & chronic muscle spasm in higher shoulder side, where muscles supporting a chronically tilted head become hyper dynamic & spastic.

When a Superior trapezius becomes hyperdynamic, then the opposing & inferiorly stationed Pectoralis minor muscle, which inserts on the distal clavicle, becomes similarly hyperdynamic; a type of Crossed Muscle Syndrome.

Proper bio-dynamic shoulder girdle function requires balance between muscles of shoulder superior draw (S. trapezius) & muscles of inferior draw (P. minor). Spastic & hyperdynamic Pectoralis minor muscles have been demonstrated to be etiologic for Thoracic Outlet Syndrome (TOS).

Newly favored surgical procedure for severe TOS: release attachment of Pectoralis minor muscle from distal clavicle, thereby reducing closure of costo-clavicular dimension. I was gratified to learn of this operation because it supports my long-held theory about how TOS evolves.

TOS evolves when tilted head arouses chronic unilateral Superior trapezius muscle spasm, which in turn arouses chronic muscle spasm within companion Pectoralis minor muscle; causing clavicle dysfunction & inferior shift of distal clavicle during arm/shoulder abduction; my theory.

Geometric analysis of distal clavicle shift (proximal end of the 18 cm clavicle has a fixed pivot at sterno-clavicle joint) demonstrates that ~1cm inferior shift of the distal clavicle evokes ~30% greater closure of the costo-clavicular dimension, the true Thoracic Outlet.

Instead of surgery, I encourage Thoracic Outlet Syndrome sufferers to seek acupuncture, bio-feedback, massage, topical Cannabis lotions, Physical Therapy, heat, etc. It is always better to heal with natural Principles rather than surgery, which might beget painful tissue scars.

POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS). Sufferers oft have recurrent syncope. Ask hyper-mobile women lifetime number of syncopal episodes; they usually know. Syncope is commonly accompanied by dystonic random flailing of arms/legs (rhythmic jerkings occur in seizures).

I often advise the relatives of women with POTS to keep a smart phone at hand to video capture the non-rhythmic flailing of arms/legs to provide proof that these flailing episodes are syncope related and not true seizures.

In these women with syncope & arm/leg flailing, the electroencephalograph (EEG) is usually negative & “Pseudo- seizures” are often the definitive diagnosis provided by the Neurologist consultant.

Many doctors, ignorant of the pathophysiology of syncope in POTS, regard these women with recurrent syncope and Pseudo-seizures as having mental disorders/conversion reactions. If pain is involved theses women are often branded “drug seeking”.

Women with POTS & Pseudoseizures often end up at Psychology/Psychiatry offices; branded forever as pitiful psychological truants & “functional disorders”. This is so tragic. What they need are understanding Cardiologists, who know when/how to do a tilt test; most do not.

HYPERVENTILATION
Women with Hyper-mobility & sluggish compensatory leg venous vessel wall constriction experience compensatory autonomic nervous system alarms when they stand too fast; sudden speeding of heart pump (tachycardia) & increased respiration rate (⬆️oxygen into blood)

Often in women who hyperventilate the compensatory effects of increased respiration are sudden blood ph change & diminished blood calcium levels that induce sudden painful muscle (chest wall) tetony-like contractions. At least this is my theory.

Chest pain, which is common during Panic Attacks, is likely due to the blood ph & calcium changes caused by hyperventilation. The chest pain might also be explained by precedent chronic bio-mechanical strain on the chest wall as occurs in some hyper-mobile women.

In women with Hypermobility Syndrome, the chest wall is often asymmetric due to an underlying functional scoliosis; with skewed ribs & stressed costochondral junctions (see in-depth discussion of Costochondritis in a companion threadreader).

PANIC ATTACKS
These events include subtle physiological events, which are often due to compensatory changes in response to decrease forward flow of blood to the brain. The body does not tolerate decreased brain blood flow.

When deprived of blood, brain suddenly pushes sympathetic nervous system alarm button. Tachycardia & hyperventilation occur to push more Oxygen into the brain. Panic Attacks are true dysautonomias, & often seen in women with Hypermobility Syndrome.

Women with Hypermobility Syndrome often have decrease compensatory vein tone, so that sudden or prolonged standing causes the blood column to pool in the lower extremities. This derives the brain of blood, & syncope and Pseudoseizures can result (see above).

Another physiological dynamic related to Panic Attacks: heart mitral valve (MV) function. MV is structured from cartilaginous tissue; oft hyper-elastic in people with Hypermobility Syndrome. There is a known clinical relationship between mitral valve prolapse & Panic Attacks.

In those with Hypermobility Syndrome, the mitral valve (MV) can be floppy & prolapse during diastolic phase of heart function; compromising water seal of MV; leading to decrease forward flow of blood to the brain. The brain has an absolute need for a constant oxygen supply.

Compensatory physiological events occur as Panic Attacks progress: orthostatic blood pressure changes, tachycardia, hyperventilation, sweating, chest pain, & feelings of fear/doom; as body attempts to push more oxygen-laden blood toward brain.

Unfortunately, the clinical appearance of Panic Attacks suggests, to observers ignorant of the subtle physiological changes, that events are caused by anxiety & psychological disarray. Women with Panic Attacks often end up branded as neurotic & are shuffled off to Psychologists.

Women with Panic Attacks are cases that exemplify mistakes of putting the cart (anxiety & fear) before the horse (mitral valve prolapse). What these women need instead of Psychologists are echocardiograms to show the underlying mitral valve prolapse.

A word of caution here. Best way to show mitral valve prolapse is in a standing person, where gravity weights blood column. Standing echocardiograms do not exist. If echo shows trace of mitral prolapse in lying person (exam posture) that finding is enough supportive data for me.

The distress experienced by those who have severe Panic Attacks becomes embarrassingly obvious to others. After a few of these unannounced episodes, these women often begin to shun public events (Agoraphobia). They often undertake reclusive lifestyles.

GASTROPARESIS
A dysautonomia often found in women with Hypermobility Syndrome & functional scoliosis. Sluggish gastric motility delays gastric emptying: feels full of food, bloating, & “gas”. In severe cases recurrent vomiting causes weight loss, a Wasting Syndrome, & even death.

My theory is that Thoracic spine functional scoliosis causes autonomic nerve impingements. Sympathetic nerves parallel & are contiguous to the thoracic spine. Scoliosis causes the Sympathetic arm of the autonomic nervous system to become stimulated & dominant.

Sympathetic dominance shuts down gastrointestinal functions. During fight/fright/flight, the animal needs glycogen, oxygen, hyper-vigilance, & hyper-dynamic musculoskeletal. Food consumption & digestion are put on hold.

Hunger, digestion, gastric activity, & fecal & urine eliminations are pleasure functions; which are motivated by Parasympathetic nervous system activity. What women with Gastroparesis need is heightened Parasympathetic activity to counter balance Sympathetic dominance.

Unfortunately, doctors upon encountering Gastroparesis, often prescribe (in knee jerk fashion) stomach acid reducers (Prilosec, Nexium, Protonix, etc.), which probably worsen problem. Stomach acid potentiates digestion & a relaxing glass of wine induces stomach acid & digestion.

There are other medications that can enhance favorable digestive functions. Perhaps the safest & most efficacious is Cannabis, which promotes the “munchies”. Certain Cannabis cultivars promote Parasympathetic functions; thereby ameliorating Sympathetic dominance.

Cannabis Indica seems (knowledge resulting from my researches) to promote Parasympathetic functions. Cannabis Sativa cultivars promote Sympathetic physiologic functions. These are my theories based on my clinical data.

Cannabis is administered in oil-based elutions (olive oil, coconut oil) or in glycerol & taken by ingesting. Cannabinoid chemicals are poorly solubilized by water (teas). Persons need to use Cannabis as a medication & under direction of a physician who knows Cannabis Medicine.

Other therapies for Gastroparesis: Acupuncture, biofeedback, & aqua therapy in warm water to begin a rehabilitation of muscles that support the spinal column & to counteract functional scoliosis. Vitamin D is likely deficient from reclusiveness indoors & sunbathing is recommended

One of my threadreaders of recent vintage discussed what I call the “Wasting Syndromes”; wherein I discussed use of hormone supplementation in attempt to assist jumpstarting physiology of rebuilding body tissues & strength & inducing feelings of well-being.

PROTEIN: is an essential nutrient for optimum tissue revitalization. Growth hormone, a master hormone for tissue wellbeing, is created via a peptide (small protein) cascade. Fruits, vegetables, & grains are relatively devoid of protein. Meat, milk, & eggs are protein dense.

CHOLESTEROL: Every body cells (1 trillion) is encased in a cholesterol membrane, which as gateway to the cell controls many cellular functions. Hormones that potentiate sexuality (Testosterone/Estrogen) are generated from cholesterol molecules. Meat has cholesterol.

Diets missing dense nutrients, complete amino acids, & proper essential fats are poorly used in rehabilitation programs for Wasting Diseases. Hemp seeds, milk, & eggs whites contain complete essential amino acid profiles. Cold water fish contain the best essential oils.

PIGMENTS: Plant pigments are potent free radical scavengers so that dark berries, dark grape extracts, tumaric, cinnamon, cocoa, moderate coffee, chlorophyll, & lycopene (tomato paste) are highly recommended.

MENTAL FOCUS: Certainly the mind is a potent force to foster positive body functions. Meditative practices are advised along with progressive relaxation therapies & autogenic training.

Positive thoughts & love promote function of the body’s own endocannabinoid system & blissful feelings of Parasympathetic pleasure. Negative thoughts & fear promote adrenaline overdrive & Sympathetic suffering.

CONCLUSIONS:
Women with Hypermobility commonly have a functional scoliosis, which presents a non-vertical spinal axis to the gravitational field; leading to a sequence of musculoskeletal disorders manifest as dysautonomias.

The Super-Syndrome of Fibromyalgia has many manifestations of dysautonomias & chronic pain. Chronic pain prevents sound, deep, & refreshing sleep. Non-restorative sleep leads to daytime fatigue, depression & fibro-fog, keynote symptoms of Fibromyalgia.

Over the years, the diagnosis of Fibromyalgia has been regarded, by many doctors, to be expressions of neurotic behavior. Sadly, many of these widespread misperceptions amongst doctors seem still with us.

The dynamic dysautonomic physiological events described in this essay are common keynote symptoms of Fibromyalgia. Healing from Fibromyalgia requires a multifaceted program of natural non-toxic practices and therapies.

Most of the ideas described herein about the genesis of various dysautonomias & methods of action of cannabinoids are my own inventions, and my supportive clinical data has already been published on the world stage.

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