#WeCanFixThat: The one with the vagus nerve.

Sometimes things are pretty straightforward – A skier injured her knee doing something crazy on a butter box (whatever that is) and has ACL surgery. They come to us with a whole stack of paperwork from their surgeon, including pictures of their injury and a couple of tell-tale scars from an arthroscope. Sometimes… it’s not so straightforward, though.

The first of our patient spotlight series gave us a wonderful real-life illustration of all the 10th cranial nerve has to offer.

We had been treating Jim for neck pain.  He had fallen on the ice and essentially sustained a whiplash injury to his neck. He had a decreased range of motion, headaches, and some weakness into his arm.  After 8 weeks of treatment he was doing much better and pain had localized to his neck. It was no longer referring into his arm. Progress.

Then… one particular day, Jim developed throat pain, laryngitis, and difficulty swallowing. A few days later his body added an array of digestive symptoms to the mix.  Things happen.  It’s flu season.

More than a week later, though, it was pretty clear that this wasn’t a virus… and it wasn’t improving.  An ENT confirmed that Jim’s vocal cords were paralyzed with no clear cause. Doctors in other disciplines were also struggling to come up with a clear diagnosis.  By this point, now 4 months after his initial injury, he was experiencing some pretty scary symptoms - muscle cramps, episodes of fainting, difficulty coordinating speech and swallowing, and a worsening of those GI symptoms. No one could put a finger on it.

Damn it, Jim, we’re doctors… not magicians.

I’m not quite sure how it began, but in our research, Cara and I found that one could damage cranial nerve function with whiplash injuries.  The cranial nerve in question, in this case, was “cranial nerve X”, the vagus nerve. This particular bundle of neurons is often referred to as “The Wanderer” because of its long path and its vast functions throughout the body.  The vagus nerve is responsible for a cadre of important things; including some basic necessities like heart rate, GI peristalsis, swallowing, and the muscles that enable speech.

When we looked deeper, we realized that almost all of Jim’s symptoms could be explained by compression to the vagus nerve!  This knowledge took the ball away from David Blaine and put it, potentially, back in our court… so Cara and I quickly got to researching how we could fix it.

We had a hypothesis. In Jim’s case, we believe what happened was that, while he was improving elsewhere, the very top level of his spine (where his skull sits) became incredibly hypomobile (or stiff) following the injury.  While we were seeing improvement on all of the other levels of his spine, we had not yet seen success freeing up the highest sections of his cervical spine, leaving the fibers of the vagus nerve compressed and unable to function properly.  It was a hunch, but we got to work.

Our following visits with Jim focused on mobilizing the top of his spine, stretching and gliding his sciatic nerve (because the head bone’s connected to the… leg bone!), massaging muscles in the neck and jaw, and improving general mobility in his legs, back, neck, and shoulders.  We also coached Jim on how to stimulate his vagus nerve through dietary changes, deep breathing techniques, and exercise. 

Our hunch worked out. Jim gradually but steadily improved in all regards once his vagus nerve fully recovered. While it was a challenging few months (especially for Jim!), Cara and I took away some valuable information which has advised our practice as we endeavor to help future patients. 

Our new found understanding of vagus nerve function has certainly added to our “think outside the box” mentality. It also granted us a broader understanding of good health, normal function, and an appreciation for the body as a self-contained ecosphere, where every single system can affect any other… even if they are not seemingly related at first glance. 

The take home message for you, dear reader, is that your physical therapist is an excellent person to ask when you are having health issues.  Our wide base of knowledge helps us troubleshoot your symptoms, and the fact that we spend more time with you than pretty much any other specialist (on average, you see us 2 hours per week!) is advantageous when trying to diagnose.  We are trained to refer to the correct specialists, so when in doubt, let us check you out!

If you don’t need that kind of thing right now… feel free to ask about our card tricks.

*Patient name and some information have been changed to protect anonymity.

*For more information on the vagus nerve and its functions, click here or here.