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The Organisation of the Stress Response, and Its Relevance to Chiropractors: a Commentary Katie Hardy1 and Henry Pollard*1,2

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The Organisation of the Stress Response, and Its Relevance to Chiropractors: a Commentary Katie Hardy1 and Henry Pollard*1,2 Chiropractic & Osteopathy BioMed Central Commentary Open Access The organisation of the stress response, and its relevance to chiropractors: a commentary Katie Hardy1 and Henry Pollard*1,2 Address: 1ONE Research Foundation, Encinitas California, USA and 2Macquarie Injury Management Group, c/o PO Box 448, Cronulla NSW, 2230, Australia Email: Katie Hardy - [email protected]; Henry Pollard* - [email protected] * Corresponding author Published: 18 October 2006 Received: 20 December 2005 Accepted: 18 October 2006 Chiropractic & Osteopathy 2006, 14:25 doi:10.1186/1746-1340-14-25 This article is available from: http://www.chiroandosteo.com/content/14/1/25 © 2006 Hardy and Pollard; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The stress response is a natural reaction by the body, against potentially harmful stimuli to enhance the chance for survival. Persistent activation of the stress response can cause changes to homeostatic mechanisms. The study of stress neurophysiology, in the evaluation of the manifestation of disease in the body, suggests that these chronic changes have detrimental effects on sub cortical structures. Furthermore, there is much scientific support for the notion that chronic activation of supraspinal systems will lead to maladaptation of homeostatic mechanisms, causing the impairment of processes within the body, and ultimately leading to visceral disorders. The chiropractic profession for many years has alluded to chronic change of neurophysiological pathways as a potential explanation of visceral disorders, but the profession has typically described these in terms of somatovisceral or viscerosomatic reflex activity. Change in supraspinal neurophysiological efferent activity is increasingly being used to explain "stress" related disease. The chiropractic profession should consider investigating such stress responses by conducting spinal manipulative therapy trials that evaluate supraspinal effects of manipulation. Such research may help elucidate key mechanisms associated with the change of visceral disorders noted by some chiropractors following manipulative therapy. Background human body had a finite amount of adaptable energy, Walter Canon offered the first model of homeostasis as and opined that a stressor whether pleasant or not, was the "coordinated physiological processes which maintain irrelevant because any type of stress required adaptation most of the steady states in the organism" [1-3], and fur- to manifest. The important criterion was the intensity of ther focused on the "sympathetic nervous system as an the demand, and whether the body could meet that essential homeostatic system that served to restore stress- demand with an appropriate response. This cognitive induced disturbed homeostasis and to promote survival response came to be known as the "fight-or-flight" of the organism". From work conducted during the 1930's response [5] and involved the activation of necessary to 1950's, Hans Selye introduced the concept of stress as a physiological and behavioral responses for survival [6]. medical and scientific entity, depicting a pathological These responses are often referred to as 'stress responses' triad elicited by numerous stressors. Sleye then employed and include the activation of the hypothalamic-pituitary- this defined theory of stress as "the non-specific response adrenal axis and sympatho-adrenal system, resulting in of the body to any demand" [4]. Selye proposed that the the consequential secretion of multiple hormones includ- Page 1 of 13 (page number not for citation purposes) Chiropractic & Osteopathy 2006, 14:25 http://www.chiroandosteo.com/content/14/1/25 ing corticotrophin releasing hormone, adrenocorticotro- nucleus of the solitary tract (NTS), and terminate via mul- pin hormone, cortisol, norepinephrine and epinephrine tisynaptic pathways at the hypothalamus [14]. The NTS is [7]. Once the stress response is activated, behavioral and the first region in the central nervous system that proc- physiological changes lead the way for the organism to esses information about visceral, cardiovascular, respira- adjust homeostasis within the body, and increase its tory functions as well as taste. Neurons of the NTS project chances for survival [8]. to the paraventricular nucleus, and other hypothalamic nuclei among other destinations [15]. The NTS has other It is in times of sustained or repeated activation that the viscerosensory fibres terminating on catecholaminergic stress response may alter [7]. Due to the intricate nature of neurons, which then project to the hypothalamus [14]. the above systems, systematic changes can cause dramatic Somatosensory signals reach the hypothalamus directly via effects on organs, which otherwise would be activated in the spinohypothalamic tract [16], by axon collaterals of advantage for the organism [9]. Repeated stimulation of fibres of the spinoreticulothalamic and/or spinothalamic hormones, and neurotransmitters may render target tis- tracts in the spinal dorsal horn [17], or through the activa- sues resistant, instigating the cascade into disease and ill- tion of the brainstem catecholaminergic system [14]. ness [10]. Many pathological processes, such as chronic pain disorders, immune disorders, cardiovascular disor- Ascending medullary viscero- and somato-sensory neu- ders, metabolic disease and behaviour disorders, may be rons have been associated as carriers of autonomic signals the result of chronic activation of the hypothalamo-pitui- to the hypothalamus. Signals may directly project to the tary-adrenal axis and sympatho-adrenal system, affecting hypothalamus, or indirectly through secondary auto- tissues or biological pathways, contributing to the global nomic centres, such as the parabrachial nuclei [13]. nature of disease [11,12]. Hypothalamic efferents As stress becomes more prominent in society, trying to The output system involves the recognition of the stress understand mechanisms with which it manifests in the response, and engages both the neuroendocrine and neu- body, and potential treatment for these manifestations is ronal pathways [13]. The higher centres consisting of the imperative to the development of effective chiropractic cerebral cortex, limbic system and hypothalamus are neu- treatment strategies. This commentary attempts to address ronally connected with the brain stem, autonomic and the development of disease within in the body due to sensory centres, as well as interconnected with each other. chronic stress activation. It discusses the anatomy, physi- The higher centres do not have connections to the periph- ology and the relationship of adverse chronic stress activa- ery, though they are able to indirectly and bilaterally influ- tion on systems within the body. This is followed by ence sympathetic and parasympathetic preganglionic discussion of how these variables integrate and are poten- neurons via the efferent paraventricular pathway [18]. tially affected by the application of manipulative therapy. The hypothalamus is able to exert effects via neurohu- Discussion moral pathways through the pituitary, autonomic effects Neuroanatomy via neuronal pathways to preganglionic neurons, and able This section will outline the neuroanatomy of the stress to exert both parasympathetic and sympathetic effects response, focusing on input and output pathways. As through the medulla oblongata and spinal cord [14]. there are multiple brain structures concerned in the organ- ization of the stress response, these systems are intricately The four predominant nuclei containing descending related. A schematic representation of the stress system is hypothalamic-autonomic fibres include the paraventricu- presented in Figure 1. lar, arcuate, perifornical and dorso-lateral hypothalamic nuclei. The hypothalamic paraventricular nucleus (PVN) Hypothalamic afferents is a central site in the complex of interacting systems con- Nearly all stress-related information projected to the trolling the stress response [19]. It is the foremost source hypothalamus is congregated to the lateral hypothalamus, of descending hypothalamic pathways to autonomic cen- where combinations of numerous ascending and tres, with fibres arising from dorsal, posterior and lateral descending fibres are integrated from areas including the parvicellular subgroups containing a variety of putative limbic system, medial hypothalamus, and the autonomic neurotransmitters. Toth et al. [20] investigated the decus- nervous system containing with thousands of interneu- sations of descending fibres of the PVN by using vulgaris- rons [13]. leucoagglutinin in intact brain stem operated rats. Par- aventricular fibres descend by the length of the brainstem Numerous viscerosensory signals arise from glossopharyn- and spinal cord via two descending tracts: one from the geal (IX) and vagal (X) cranial nerves in the spinal cord lateral hypothalamus, along the lateral lemniscus and and from the lower brain stem, which project to the from the pons, moving ventrolaterally and running into Page 2 of 13 (page number not for citation purposes) Chiropractic & Osteopathy 2006, 14:25 http://www.chiroandosteo.com/content/14/1/25 AFigure schematic 1 representation of the stress response A schematic representation of the
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