FEATURE Just last June, the Journal of the American Medical Association published a systematic review and meta-analysis for the use of cannabinoids, which had moderate-quality evidence in the treat-ment of chronic pain and spasticity. Sleep has always been of interest to me. It is a time of physical and mental restoration. We know the spine under-goes significant diurnal hydraulic var-iations, with recovery of compression being recuperated in sleep – cycling a loss and gain of 20 to 25 per cent of hydraulic structure from intervertebral discs (N. Boos, A. Wallin, T. Gbedegbeg-non, M. Aebi, and C. Boesch. 1993. Quantitative MR imaging of lumbar in-tervertebral disks and vertebral bodies: Influence of diurnal water content varia-tions. Radiology, 188351-354). Sleep plays a role in recharging these discs to prepare for the upcoming day. Within sleep’s architecture, however, there are many stages. Rapid eye movement (REM) is one of the most unusual stages experienced by all mammals, except cetaceans. In 1998, I read an article in Discover Magazine about an alternate theory of REM. Dr. David Maurice, an ophthal-mologist and professor of ocular phys-iology at Columbia University, pro-posed that rapid eye movements had a mechanobiological role of providing a circulating function to the aqueous and vitreous humor of the eye. Maurice, who passed away in 2002, presented his hypothesis at The Von Sallmann Lec-ture in 1996. He believed the rapid eye movement shakes the eyeball around to promote circulation to the eye. To date, researchers continue to explore his theories, which got me thinking about the inactive state of the core muscles and its possible influence on cartilage. Theorists believe the primary reason for the muscle shut-off is to prevent us from acting out our dreams. I wanted to offer an alternative perspective look-ing at the mechanical effects of REM atonia as a purpose to help re-imbibe the intervertebral discs. In 2007, I submitted a hypothesis paper to The Lancet , which made it through to reviews. My hypothesis looked at REM and its relationship to the spine. At the root of it is the obser-vation of something peculiar which happens to our muscles during REM. They shut off and are neurologically PATIENT CARE You snooze you win How sleep may be playing a role in vertebral disc regeneration A BY JEROME FRYER DR. JEROME FRYER, DC, is a chiropractor and researcher based in Nanaimo, B.C. He develops spine education models through Dynamic Disc Designs. Contact him at [email protected]. 34 Canadian Chiropractor October 2015 www.canadianchiropractor.ca Photo: fotolia patient in her late 50s presented with back and left leg pain. This had been a problem for decades as the de-generative scoliosis was catching up to her quickly. Her pain prevented her from sleep. Her symptoms became constant and nagging, especially with walking and prolonged sitting. I began treating her with the methods that I often employ using a flexion-dis-traction table but instead, using exten-sion-distraction. Treatments were weekly, with some gaining resolve but not entirely. To my surprise, her medical doctor prescribed medical marijuana and told her to take it just before bed. After a week, she was pain-free and doing walks that she dreaded doing prior to beginning treatment. This article aims to suggest a possi-ble mechanism regarding the results seen with particular highlight to the regenerative sleep cycle and possible hydraulic mechanisms on the interver-tebral discs. First, let’s talk a little about medical marijuana. There has been a surge of interest on this topic, spawning re-search and debates all over the world about its clinical application. Despite being labelled as an illegal substance without medical value in 1928, medical marijuana has been used for thousands of years prior to that and continues to be used to this day.
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