by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 29, 2026 | Chiropractic, Health
Which fingers go numb tells us where to start looking and it may not be your wrist.
Jeffrey Ptak, DC, DSS, MSS, MA
Nighttime hand numbness does not automatically mean carpal tunnel. The first useful question is much simpler: which fingers? The classic median-nerve pattern involves the thumb, index and middle fingers and part of the ring finger. A different pattern points somewhere else along the nerve pathway and that pathway begins at your neck.
You wake up in the middle of the night and your hand is numb or tingling.
You shake it. Change positions. Maybe straighten your wrist or move your arm. It settles down, you go back to sleep — and then it happens again the next night.
It happens twice a week. Then four. Then you notice it while driving or holding your phone.
Eventually someone says, “Probably carpal tunnel.”
Maybe. But nighttime hand numbness does not automatically mean carpal tunnel. The first useful question is much simpler:
Which fingers?
Start With the Fingers
Carpal tunnel syndrome involves compression of the median nerve at the wrist. Its classic sensory pattern involves the thumb, index and middle fingers and part of the ring finger. Symptoms commonly wake people at night, and shaking the hand may temporarily relieve them.
If the little finger and the other side of the ring finger are involved, we begin thinking about a different nerve pathway, including the ulnar nerve. And symptoms that extend into the arm, change with neck position, or occur with weakness may point us toward still another part of the pathway.
You do not need to interpret the pattern. Just notice it.
And why at night? Because of how we sleep. Many people spend hours with a wrist bent, an elbow fully flexed, or a hand tucked beneath a pillow or under their own body — positions nobody would hold voluntarily while awake. Sustained wrist flexion or extension can provoke median-nerve symptoms, and a fully bent elbow can do the same for the ulnar nerve.
Which is also why shaking your hand helps. You have changed the position.
Which fingers and where exactly does the numbness stop? If you can remember, what position were your arm, elbow and wrist in when it happened?
Your Hand Is Where You Feel It. That Doesn’t Mean It’s Where the Problem Begins.
The nerves supplying your hand travel through a pathway that includes the neck and upper extremity before reaching the fingers. A nerve can be irritated or compressed at different places along that route.
That is why examining only the wrist can miss important information.
A good examination should ask a more useful question:
Where along the pathway can we find something that relates to the symptoms you actually feel?
Let’s Examine the Whole Pathway
At Ptak Family Chiropractic in Santa Monica, checking potential areas of nerve irritation or entrapment is a routine part of our examination when someone comes in with hand numbness or tingling.
Depending on your symptoms, we may examine the neck, clavicle region, shoulder, arm, elbow, wrist and hand.
But we are not simply looking for something abnormal. We are looking for findings that relate to your symptoms.
Does a particular position reproduce the numbness? Does changing the position reduce it? Does loading or releasing part of the nerve pathway change what you feel? Is there a corresponding change in strength, sensation or reflexes?
Specific wrist tests may be useful when carpal tunnel is suspected, but no single maneuver should replace the history and the rest of the examination. Current clinical guidance supports examining the entire upper extremity — including the neck, shoulder, elbow and wrist — because other problems can resemble carpal tunnel syndrome.
Now we have more than “my hand falls asleep.” We have a pattern — and findings we can relate to it.
If Someone Recommends a Night Splint
Night splinting is a common and reasonable first step when carpal tunnel is suspected. But the position matters, and it is easy to buy the wrong one.
Pressure inside the carpal tunnel is lowest with the wrist in neutral. Both bending and extending the wrist raise it. A cock-up splint holds the wrist in roughly twenty degrees of extension — and in trials comparing the two, neutral splints gave better symptom relief than splints set at twenty degrees of extension.
Both styles are widely sold at similar prices, so if a splint is recommended, the neutral one is worth asking for.
Two other things worth knowing. Relief, when it comes, tends to appear within the first couple of weeks rather than building slowly over months. And a splint is not a diagnosis it does nothing for an ulnar nerve irritated at the elbow, and nothing for a nerve root irritated in the neck.
What We Find Determines What We Do
If the findings suggest something within our scope that we can help change, we will explain what we found and what we can do.
If the pattern suggests that nerve-conduction testing, medical evaluation or another specialist is appropriate, we will tell you and refer you.
The goal is not to assume carpal tunnel. The goal is to determine where the symptoms may be coming from and what, if anything, can be done about them.
When It Shouldn’t Wait
Most nighttime hand numbness is not an emergency. Some findings change that.
Arrange prompt evaluation for weakness rather than numbness alone dropping things, difficulty with buttons, keys or jar lids; visible thinning of the muscle at the base of the thumb; numbness that has become constant rather than intermittent; numbness in both hands and both feet; or symptoms following an injury.
And seek urgent care for sudden numbness or weakness in a hand or arm accompanied by facial droop, difficulty speaking, or weakness elsewhere.
Numbness that comes and goes is generally easier to help than numbness that has become permanent, which is why weakness and muscle wasting move the timeline.
Tonight, Notice One Thing
If your hand wakes you tonight, you do not need to diagnose yourself.
Notice which fingers go numb.
If you can, notice the position of your arm, elbow or wrist too.
Then let us do the rest.
If your hands keep going numb while you sleep, let’s check you. We never charge you to sit down and talk about your needs. Call Ptak Family Chiropractic at 310.473.7991 and make an appointment.
You do not need to decide whether it is carpal tunnel before you come in. That is what the examination is for.
Selected References
American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. 2024.
Wipperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis and Management. American Family Physician. 2016;94(12):993–999.
LeBlanc KE, Cestia W. Carpal Tunnel Syndrome. American Family Physician. 2011;83(8):952–958.
Burke DT et al. Splinting for carpal tunnel syndrome: in search of the optimal angle. Archives of Physical Medicine and Rehabilitation, 1994.
Beutler A, Stephens M. Letter: Best Treatment Approaches for Carpal Tunnel Syndrome — neutral versus cock-up splints. American Family Physician, 2012.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA, is the founder of Ptak Family Chiropractic in Santa Monica, where he has practiced since 1986. His postgraduate study includes Chiropractic Functional Neurology through the Carrick Institute and advanced training through the International Association of Functional Neurology and Rehabilitation. He is the author of the forthcoming book It’s Like You Never Left, to be published by Indigo River Publishing.
Educational purposes only. This article does not diagnose any condition and is not a substitute for medical care. Seek urgent care for sudden numbness or weakness in an arm or hand accompanied by facial droop, difficulty speaking or weakness elsewhere. Arrange prompt evaluation for weakness, visible muscle thinning at the base of the thumb, constant rather than intermittent numbness, numbness in both hands and feet, or symptoms following injury. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
Mon / Wed / Thurs 8:00–12:15 and 2:00–6:00 · Tues / Fri 8:00–12:00 · Sat 10:00–12:00
by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 24, 2026 | Chiropractic, Health
Don’t just tell me you wake up stiff. Tell me how long it takes to loosen up.
Almost everyone is somewhat stiff on waking. The useful information is how long it takes to loosen up, where you feel it, and whether moving helps. That number won’t diagnose you, but it tells us a great deal about what to examine and it helps separate a mechanical problem we may be able to change from a pattern that needs medical evaluation.
You get out of bed and everything needs a minute.
Your back is stiff. Your neck doesn’t want to turn. Your hips need a few steps before they cooperate.
Then you move around, shower, make coffee and somewhere along the way you loosen up.
Tomorrow morning, don’t just notice it.
Time it.
Five minutes? Twenty? Forty-five? More than an hour?
That number won’t diagnose you. But it can tell us a great deal about what to examine next.
What the Time Tells Us
Stiffness that eases within a few minutes of moving is a common pattern in mechanical and age-related joint problems. The joint has been still for seven or eight hours. It needs input, and movement provides it.
Stiffness that lasts considerably longer, involves several joints, appears on both sides, or comes with swelling means something different. Prolonged morning stiffness is one of the features clinicians look for in inflammatory conditions such as rheumatoid arthritis, polymyalgia rheumatica, and inflammatory back conditions like ankylosing spondylitis.
Roughly half an hour to an hour is the figure often quoted. Treat it as a clue rather than a dividing line — a useful signal, not a diagnosis.
Then notice what makes it better. Mechanical stiffness usually rewards movement. Inflammatory stiffness often improves with movement and worsens with rest, which sounds the same until you notice it also lasts far longer and rarely travels alone.
As for the mattress: it is the first thing most people change and occasionally it helps, but the position may matter more than the surface — a joint held near the end of its range for seven hours is likely to have an opinion about it in the morning.
When the Pattern Needs Medical Evaluation
Have this properly evaluated rather than pushing through it if:
- the stiffness regularly lasts longer than an hour, or several joints are involved, especially symmetrically or in the small joints of the hands and feet
- joints are swollen, warm or visibly red
- you are over fifty and have developed sudden, severe stiffness and aching in the shoulders and hips, particularly with difficulty raising your arms
- there is new headache, scalp tenderness, jaw pain with chewing, or any change in vision — in an older adult that combination needs urgent medical attention
- there is fever, night sweats or unexplained weight loss
- back pain wakes you in the second half of the night and improves with movement rather than rest, especially if it began before age forty-five
- there is progressive weakness or numbness, or any change in bladder or bowel control
Widespread pain with poor sleep and fatigue also deserves proper evaluation rather than a shrug — fibromyalgia and related conditions are recognized medical diagnoses.
None of that is meant to frighten you. It is meant to make sure the right person is looking at the right thing.
What We Can Actually Do
At Ptak Family Chiropractic in Santa Monica, we don’t treat morning stiffness as though everyone has the same problem.
We examine where you’re stiff, which movements are restricted, whether movement reproduces or relieves it, and whether weakness, poor mobility or the way you’re loading an area is contributing.
What we find determines what we do.
If a joint isn’t moving well, chiropractic care may help restore movement. If muscles are weak or lack endurance, strengthening becomes part of the solution. If the problem is how you’re sleeping, sitting or repeatedly loading the area, we work on changing that too.
The goal isn’t simply to make you feel looser for an hour.
It’s to identify what is making you stiff every morning and determine what can actually be changed.
And if the pattern suggests inflammatory arthritis or another medical condition rather than a mechanical problem, we’ll tell you and help direct you to the appropriate specialist.
“I Guess This Is Just My Age”
Recovery does change over a lifetime. But age is not a diagnosis. Plenty of seventy-year-olds get out of bed easily, and plenty of thirty-five-year-olds don’t.
If your body now needs twenty-five minutes and a hot shower before it will cooperate, something specific has changed. Strength. Range of motion. Sleep. Load. Something.
“Age” is the word we reach for when we have stopped looking for the specific thing.
Bring Us the Number
Tomorrow morning, time your stiffness.
Where is it?
How long before you loosen up?
What makes it better?
Bring us those answers. They give us something useful to examine.
Come and talk with us. We never charge you to sit down and talk about your needs. Bring the three answers above, and note what position you wake up in. We’ll examine what is ours to examine and tell you honestly whether this looks like something we can change — and if several joints are involved, or they’re swelling, or the stiffness lasts more than an hour, we’ll tell you that belongs with your physician and why.
A little stiffness on waking is ordinary. A morning built entirely around getting your body to work is not.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA, is the founder of Ptak Family Chiropractic in Santa Monica, where he has practiced since 1986. His postgraduate study includes Chiropractic Functional Neurology through the Carrick Institute and advanced training through the International Association of Functional Neurology and Rehabilitation. He is the author of the forthcoming book It’s Like You Never Left, to be published by Indigo River Publishing.
Educational purposes only. This article does not diagnose any condition and is not a substitute for medical care. Morning stiffness and body aching have many possible causes, some requiring medical diagnosis and treatment. Prolonged stiffness, joint swelling, fever, unexplained weight loss, new neurological symptoms, or severe or rapidly worsening symptoms warrant prompt medical evaluation. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
Mon / Wed / Thurs 8:00–12:15 and 2:00–6:00 · Tues / Fri 8:00–12:00 · Sat 10:00–12:00
by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 23, 2026 | Chiropractic
Feeling bloated doesn’t necessarily mean you have too much gas. Notice when it happens the pattern may tell us far more than the word bloating ever could.
Feeling bloated doesn’t necessarily mean you have too much gas. Before eliminating another food or trying another supplement, let us first figure out what your “bloating” actually is pressure, visible swelling, gas, belching, constipation, or some combination and then let’s find out why it may be happening. Notice when it happens. The pattern may tell us far more than the word bloating ever could.
By late afternoon your waistband is uncomfortable.
You’ve cut out bread. Then dairy. Then onions. You’ve tried a probiotic, then a different probiotic, then enzymes. Something helps for a week and then stops.
And somewhere along the way, breakfast became six foods you still trust.
Before you remove anything else, there’s a better question.
Do You Actually Mean Gas?
This is the question I ask first, and it opens the whole picture.
When you say you’re bloated, do you actually mean gas?
Someone can feel extremely bloated without a dramatic increase in intestinal gas. Someone else genuinely is producing more — from swallowed air, or from fermentation further down.
So tell me which of these describes you.
- Are you actually passing more gas than usual?
- Does your abdomen visibly enlarge — do clothes fit differently, can you see it?
- Do you feel pressure and fullness without any visible change?
- Are you belching?
- Are you constipated?
Those distinctions matter far more than a general explanation about gut health. Bloating, visible distention and belching are treated as related but separate problems clinically, because they lead to different thinking.
Notice When It Starts
This is the one thing worth doing before your appointment.
Notice when the bloating begins not just what you ate.
Morning, before eating? Immediately after eating? Thirty minutes later? Several hours later? Progressively through the day? Better after a bowel movement? Better after passing gas? Worse after particular foods? And does the abdomen actually look larger?
A simple food-and-symptom record can reveal relationships between what you eat, how you eat and what follows.
One request, though.
Don’t eliminate ten foods at once.
If you change everything, you may feel different and learn almost nothing about what mattered.
Observation first. Theory later.
What the Pattern Can Tell Us
Timing does real work. If your abdomen swells five minutes after eating, that food hasn’t reached your large intestine and fermented it can’t have, because food takes hours to get there. Eating itself triggers reflexes, changes motility and produces sensations from a digestive tract already carrying earlier meals.
Symptoms beginning within minutes of eating are unlikely to be caused by that meal already fermenting in the colon. Symptoms appearing hours later may fit fermentation better. Timing doesn’t make the diagnosis, but it gives us a useful clue.
Persistent bloating can also occur with constipation, carbohydrate intolerance, irritable bowel syndrome and other disorders of gut-brain interaction, celiac disease, small intestinal bacterial overgrowth and other conditions. Which is why the evaluation should be targeted rather than scattershot: dietary restriction or breath testing where carbohydrate intolerance is suspected, celiac serology where appropriate, bacterial overgrowth testing reserved for selected patients, and imaging or endoscopy when there are alarm features, recent worsening, or abnormal examination findings.
Two practical notes, because both come up constantly. Probiotics are not recommended as a treatment for abdominal bloating and distention. And where substantial dietary restriction such as a low-FODMAP approach is appropriate, it should be done with a dietitian rather than alone from the internet.
Also worth knowing: don’t remove gluten before asking about celiac testing. Those tests are generally most useful while gluten is still being eaten.
Let’s Check You
I’m not going to assume that because you’re bloated, the answer is chiropractic.
But that doesn’t make the examination irrelevant.
People arrive saying they’re bloated all the time while also describing abdominal or rib discomfort, back pain, restricted movement, altered breathing mechanics, constipation, or symptoms that change substantially with position and movement.
Bloating doesn’t always stay in the abdomen. As the abdomen distends, pressure and mechanics can change. The diaphragm sits above the abdominal organs and attaches to the back and ribs, so changes in abdominal pressure can affect breathing mechanics, rib movement and how the back feels. The nervous system also carries sensory information from the abdominal organs, which is one reason abdominal symptoms can sometimes be felt in other areas.
That doesn’t tell us which structure is responsible for your symptoms. It tells us why examining the whole pattern matters.
What we find determines what we do. If what we find is something we can help, we’ll explain what we can do. If it isn’t, we’ll tell you and refer you to the appropriate physician or specialist.
And because I’m the clinician sitting in front of you, I can recognize when the history doesn’t look like something that should end with chiropractic care.
When It Needs Medical Evaluation
New or persistent bloating deserves medical attention when it comes with unexplained weight loss, blood or black stool, persistent vomiting, difficulty swallowing, fever, anemia, significant or worsening abdominal pain, or a substantial unexplained change in bowel habits. A markedly swollen abdomen with significant pain, vomiting and inability to pass stool or gas is not ordinary bloating.
And one situation deserves saying plainly.
For women, persistent new bloating or increasing abdominal size — particularly with pelvic or abdominal pain, feeling full unusually quickly, or new urinary urgency or frequency — deserves medical evaluation. Those symptoms usually do not mean ovarian cancer. But ovarian cancer can present that way, which is exactly why persistent new symptoms shouldn’t be dismissed as gas.
Let’s Find Out What’s Actually Happening
Bloating is a symptom, not an explanation.
Notice when it starts, whether your abdomen actually changes size, what else happens with it, and what makes it better.
Then let us help determine what those observations mean and whether there’s something we can actually help change.
If we can help, we’ll tell you how. If we can’t, we’ll refer you to someone who can.
We never charge you to sit down and talk about your needs. Call Ptak Family Chiropractic at 310.473.7991 and make an appointment.
You don’t need to work out the cause before you come in. That’s what the examination is for.
Selected References
American Gastroenterological Association. Clinical Practice Update on the Evaluation and Management of Abdominal Bloating and Distention.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gas in the Digestive Tract; Bloating — definition, symptoms and causes; Diagnosis of Celiac Disease.
American College of Obstetricians and Gynecologists (ACOG). Ovarian Cancer — signs and symptoms warranting evaluation.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA, is the founder of Ptak Family Chiropractic in Santa Monica, where he has practiced since 1986. His postgraduate study includes Chiropractic Functional Neurology through the Carrick Institute and advanced training through the International Association of Functional Neurology and Rehabilitation. He is the author of the forthcoming book It’s Like You Never Left, to be published by Indigo River Publishing.
Educational purposes only. This article does not diagnose any condition and is not a substitute for medical care. Seek prompt medical evaluation for bloating accompanied by unexplained weight loss, blood or black stool, persistent vomiting, difficulty swallowing, fever, anemia, significant or worsening abdominal pain, or a substantial change in bowel habits, and for persistent new bloating with pelvic pain, early fullness or urinary changes. Do not remove gluten from your diet before celiac testing, as doing so can make the tests inaccurate. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
Mon / Wed / Thurs 8:00–12:15 and 2:00–6:00 · Tues / Fri 8:00–12:00 · Sat 10:00–12:00
by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 22, 2026 | Chiropractic
You don’t need to figure out why it’s happening. Two things give us surprisingly useful information: how long does it last, and what seems to set it off?
When the room suddenly spins or you feel as though you’re moving when you aren’t it can be frightening. And if you’re watching someone you love go through it, it can be frightening for you too. You don’t need to figure out why it’s happening. Two things can give us surprisingly useful information: how long does it last, and what seems to set it off?
You roll over in bed and suddenly the room moves.
You look up. Bend down. Turn your head.
For a few seconds, everything seems to spin.
You grab the wall. Close your eyes. Wait.
And afterward, you may be afraid to make the same movement again.
Or perhaps this isn’t happening to you at all. You’re reading this because someone you love is experiencing it, and you’re trying to figure out how to help.
“Dizzy” doesn’t tell us enough.
What Do You Mean by Dizzy?
People use dizzy to describe very different experiences.
Some feel as though the room is spinning around them. Others feel as though they are moving when they’re actually still. Some feel pulled to one side or unsteady on their feet.
Others mean lightheaded — as though they might faint — which is a different experience and deserves a different investigation.
When there is a false sensation of movement or spinning, we commonly call that vertigo.
Whether you say “the room is spinning” or “I am spinning” does not, by itself, tell us where the problem is coming from.
Modern approaches to dizziness place greater emphasis on when it happens, how long it lasts, what triggers it, and what we find on examination.
So you don’t have to find the perfect word. We need the pattern.
How Long and What Set It Off?
This is the useful thing to notice.
Did it last seconds, minutes, hours — or has it been continuous?
And what happened immediately before it began?
Did you roll over in bed? Look upward? Bend down? Turn your head? Did it begin without any obvious movement at all?
Those answers don’t diagnose you. But they help determine what should happen next.
Brief episodes of vertigo repeatedly triggered by changes in head position are characteristic of benign paroxysmal positional vertigo — BPPV — one of the most common causes of positional vertigo. Other timing and trigger patterns can point the examination in very different directions.
You don’t need to interpret any of it. That’s our job.
Sometimes We Can Actually Reproduce What You’re Feeling
BPPV occurs when tiny calcium-carbonate particles in the inner ear become displaced into one of the semicircular canals.
When your head moves into certain positions, those particles can create an abnormal signal of movement. That’s why someone can be perfectly still one moment, roll over in bed — and suddenly feel as though the room is moving.
If your history sounds like positional vertigo, we can test for it.
One of the primary tests is called the Dix-Hallpike maneuver.
We carefully position your head and body while watching your eyes. In posterior-canal BPPV, the maneuver can reproduce the vertigo along with a characteristic involuntary eye movement called nystagmus. Clinical guidelines recommend Dix-Hallpike testing for diagnosing posterior-canal BPPV.
Now we have more than the word dizzy. We have a finding.
Let’s Check You
At Ptak Family Chiropractic in Santa Monica, we start by listening to exactly what happened.
Depending on the pattern, the examination may include positional testing, eye movements, balance, gait, coordination and an appropriate neurological examination.
We’re trying to determine whether this behaves like BPPV, whether there is another vestibular pattern, and whether there are findings that suggest something neurological or otherwise outside what should be managed here.
And most importantly: what can we actually do about what we find?
If the examination demonstrates posterior-canal BPPV, a canalith-repositioning procedure such as the Epley maneuver may be appropriate. Rather than simply suppressing the sensation, the maneuver is designed to reposition the displaced particles. Clinical guidelines recommend canalith repositioning for posterior-canal BPPV.
If we find something else within our scope that can reasonably be addressed, we’ll explain what we found and what we recommend. And if the findings indicate that you need medical evaluation, imaging or another specialist, we’ll tell you.
What we find determines what we do.
When Vertigo Shouldn’t Wait
Most positional vertigo isn’t a medical emergency. But sudden dizziness or vertigo can occasionally accompany a neurological emergency, including stroke.
New spinning or severe dizziness accompanied by difficulty speaking, new facial or limb weakness or numbness, double vision, severe difficulty walking, loss of consciousness, or a sudden severe headache deserves urgent medical assessment.
Continuous new vertigo or dizziness — particularly when accompanied by neurological abnormalities or marked difficulty walking — also requires appropriate medical evaluation rather than assuming it is BPPV.
Let’s Find Out Why You’re Spinning
If the room has been spinning — or you feel as though you’re spinning — and you don’t understand why, let’s check you.
If you’re reading this because it’s happening to someone you love, bring them in.
We never charge you to sit down and talk about your needs. We’ll listen to what happened, examine the appropriate systems and determine what the findings tell us. If it’s something we can help, we’ll explain what we can do. If it belongs with another specialist, we’ll tell you that too. Call Ptak Family Chiropractic at 310.473.7991 and make an appointment.
You don’t have to figure out why the world is spinning before you come in. That’s what the examination is for.
Selected References
Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017.
Rogers TS, Noel MA, Garcia B. Dizziness: Evaluation and Management. American Family Physician. 2023.
Edlow JA, et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department 3 (GRACE-3): Acute Dizziness and Vertigo in the Emergency Department. Academic Emergency Medicine. 2023.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA, is the founder of Ptak Family Chiropractic in Santa Monica, where he has practiced since 1986. His postgraduate study includes Chiropractic Functional Neurology through the Carrick Institute and advanced training through the International Association of Functional Neurology and Rehabilitation. He is the author of the forthcoming book It’s Like You Never Left, to be published by Indigo River Publishing.
Educational purposes only. This article does not diagnose any condition and is not a substitute for medical care. Seek urgent medical assessment for new severe dizziness or vertigo accompanied by difficulty speaking, new facial or limb weakness or numbness, double vision, severe difficulty walking, loss of consciousness, or a sudden severe headache. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
Mon / Wed / Thurs 8:00–12:15 and 2:00–6:00 · Tues / Fri 8:00–12:00 · Sat 10:00–12:00
by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 19, 2026 | Chiropractic, Health
Your heart started beating before a single nerve reached it. Here is the physiology
behind chiropractic’s oldest idea — and what it does and doesn’t prove.
Jeffrey Ptak, DC, DSS, MSS, MA
Yesterday marked 131 years since the day chiropractic traces its beginning, September
18, 1895. So today seems like the right time to talk about one of the oldest — and most
misunderstood — ideas in chiropractic: innate intelligence.
Innate intelligence is chiropractic’s name for the body’s built-in capacity to
organize, regulate and repair itself. It is a philosophical idea, not a
laboratory measurement. But the physiology it points to is real: the body
begins organizing itself before the nervous system exists, and once the
nervous system is in place, it becomes woven into how the body regulates,
heals and defends itself.
You cut your finger. You do nothing. Within minutes the bleeding stops. Within days the
gap closes. Within weeks you can barely find the scar.
You didn’t tell your platelets where to go. You didn’t schedule the inflammation or order
new skin. Something organized all of it without asking you.
Chiropractic has had a name for that something for more than a century.
A Word Chiropractic Has Used Since 1910
D.D. Palmer gave the first chiropractic adjustment in Davenport, Iowa, in 1895. Fifteen
years later he wrote about “innate intelligence”: the organizing wisdom by which a living
body maintains and heals itself. Chiropractors have repeated a shorter version ever since:
the power that made the body heals the body.
Palmer meant it in an explicitly spiritual sense. Modern chiropractic historians, most
notably Simon Senzon, have argued that today’s systems biology offers another way to
understand his idea of a body that organizes itself.
Medicine arrived at the same observation by a different road. In 1932 the Harvard
physiologist Walter Cannon published The Wisdom of the Body and gave the body’s self-
regulation a scientific name: homeostasis.
Innate intelligence is a philosophy. You can’t put it under a microscope. But you can test the
physiology it points to, and that physiology is remarkable.
Your Heart Started Before Its Nerves Did
About three to four weeks after conception, the human heart begins to beat. At that stage it
is a simple tube of cells. No nerve directs it. The rhythm is generated by the heart muscle
itself, in specialized pacemaker cells that fire on their own.
The nerves that will later speed the heart up and slow it down arrive afterward.
Organization comes first. The body does not wait for wiring before it begins to live.
Then the Nerves Take Over the Fine Tuning
A transplanted heart shows the other half of the story.
When a heart is transplanted, the nerves connecting it to the brain and spinal cord are cut.
The heart still beats. But it no longer beats the same way. Its resting rate is typically faster,
because the vagus nerve is no longer slowing it. During exercise it can only speed up slowly,
waiting for adrenaline to arrive through the bloodstream instead of receiving an immediate
nerve signal. Over months and years some nerve fibers grow back, usually incompletely.
Life continues without the connection. Regulation suffers without it.
The Salamander’s Lesson
Salamanders can regrow a lost limb. In 1823 the Scottish physician Tweedy John Todd
noticed something about that ability: if he cut the nerves to the limb, it didn’t grow back. In
the 1940s and 1950s the biologist Marcus Singer showed that regeneration requires a
threshold amount of nerve supply.
Then researchers found a twist. Salamanders raised so that their limbs never received
nerves can regenerate those limbs without them. It is only after a limb has been innervated
that its regeneration comes to depend on the nerve.
That may be the clearest picture of innate intelligence in biology. The capacity to organize is
present from the beginning. Once the nervous system arrives, the body builds it into the way
it maintains and repairs itself — and from then on, it relies on it.
The Nervous System Is Woven Into Healing
This isn’t limited to salamanders. Over the past twenty-five years, research has shown the
nervous system taking part in processes once thought to run entirely on their own.
- Wound healing. In mice, removing a group of sensory nerve cells impaired both skin
wound repair and muscle regeneration. Those nerves help steer immune cells from
the inflammatory phase of healing into the repair phase.
- Inflammation. The vagus nerve senses inflammation and signals back to restrain it in
real time, a circuit its discoverer named the inflammatory reflex.
- Bone. In mice, a signal from the brain acting through the sympathetic nervous
system helps regulate how much bone is formed.
- Blood stem cells. Also in mice, sympathetic nerves in the bone marrow release blood-
forming stem cells into circulation on a daily rhythm.
- Digestion. The gut contains its own nervous system, with more neurons than the
spinal cord. An isolated segment of intestine can still move its contents along.
The pattern repeats. Cells can do a great deal on their own. But the nervous system is
involved in coordinating, timing and tuning what they do.
What These Examples Show — and What They Don’t
These findings show that the body is self-organizing, and that the nervous system is deeply
involved in regulation, repair and defense.
They do not prove that a chiropractic adjustment will improve any one of those processes in
any one person. Much of the research above was done in animals, and research on how
spinal care influences these systems is still early. Anyone who tells you otherwise is claiming
more than the evidence shows.
What they do support is the premise chiropractic was built on: how well the nervous system
is working matters to how well the body is working.
Where Chiropractic Fits
Your spine houses and protects the spinal cord, and its joints are richly supplied with
sensory receptors that report position and movement to your nervous system, continuously.
The chiropractic premise is that when spinal joints aren’t moving well, the information the
nervous system receives changes, and so can the way it responds. Research has begun to
look at this directly. In one study, people with recurring neck problems showed measurable
changes in how the brain processed sensory input after a cervical adjustment, changes that
lasted about twenty minutes and did not occur in a control group.
That’s a beginning, not a final answer. But it points in the direction chiropractic has always
pointed.
After forty years in practice, this is what I believe: whatever else is going on in your body,
you are better off with a nervous system working without interference than with it. That is
not a promise about any particular condition. It is the reason I examine the nervous system
in every patient who walks through my door.
Good regulation isn’t simply more drive. The nervous system needs a gas pedal and a brake,
and it needs the signals to both to come through clearly.
Let’s Check You
At Ptak Family Chiropractic in Santa Monica, we examine how your spine moves and how
your nervous system is functioning: reflexes, sensation, strength, balance and coordination,
along with the joints and muscles involved in whatever brought you in.
What we find determines what we do. If we find something we can help change, we’ll show
you what it is and what we plan to do about it. If it belongs with your physician or another
specialist, we’ll tell you that too.
If you want to know how well your nervous system is doing its job, let’s check you. We
never charge you to sit down and talk about your needs. Call Ptak Family Chiropractic at
310.473.7991 and make an appointment.
You don’t need to believe in innate intelligence before you come in. That’s what the
examination is for.
Selected References
Palmer DD. The Science, Art and Philosophy of Chiropractic (The Chiropractor’s Adjuster). Portland Printing
House; 1910.Cannon WB. The Wisdom of the Body. W.W. Norton; 1932.
Senzon SA. Constructing a philosophy of chiropractic: evolving worldviews and premodern roots. Journal of
Chiropractic Humanities. 2011;18(1). Wenban AB, Denis FL. Innate intelligence in the philosophy of chiropractic: a comparative analysis. Journal of Contemporary Chiropractic. 2026;9(1):185–206. Männer J. When does the human embryonic heart start beating? A review of contemporary and historical sources of knowledge about the onset of blood circulation in man. Journal of Cardiovascular Development and Disease. 2022;9(6):187.
Kumar A, Brockes JP. Nerve dependence in tissue, organ, and appendage regeneration. Trends in
Neurosciences. 2012;35(11):691–699.
Lu YZ et al. CGRP sensory neurons promote tissue healing via neutrophils and macrophages. Nature.
2024;628:604–611.
Tracey KJ. The inflammatory reflex. Nature. 2002;420:853–859.
Takeda S et al. Leptin regulates bone formation via the sympathetic nervous system. Cell. 2002;111(3):305–317.
Méndez-Ferrer S, Lucas D, Battista M, Frenette PS. Haematopoietic stem cell release is regulated by circadian
oscillations. Nature. 2008;452:442–447.
Purves D et al., eds. Neuroscience. 2nd ed. Sinauer Associates; 2001. The Enteric Nervous System.
Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory
evoked potential study. Clinical Neurophysiology. 2007;118(2):391–402.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA, is the founder of Ptak Family Chiropractic in Santa
Monica, where he has practiced since 1986. His postgraduate study includes Chiropractic Functional Neurology
through the Carrick Institute and advanced training through the International Association of Functional
Neurology and Rehabilitation. He is the author of the forthcoming book It’s Like You Never Left, to be
published by Indigo River Publishing.
Educational purposes only. This article describes a philosophy of health and summarizes published research; it does not
diagnose any condition, is not a substitute for medical care, and does not claim that chiropractic care treats or cures any
disease. Several studies described were conducted in animals. Do not start, stop or change any prescribed treatment
without consulting your physician. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
Mon / Wed / Thurs 8:00–12:15 and 2:00–6:00 · Tues / Fri 8:00–12:00 · Sat 10:00–12:00
by Dr. Jeffrey Ptak, DC, DSS, MSS, MA | Sep 19, 2026 | Chiropractic
“Dizzy” can mean several very different things. Describing what you actually feel is
often the first step toward figuring out why it is happening.
If you feel lightheaded, your vision greys or narrows, or you feel as though
you might faint when you stand, the first question is what happens to your
blood pressure and heart rate when you change position. If the room spins,
you are describing something different. Before anyone can make sense of
dizziness, we have to know what you mean by “dizzy.”
You get up out of a chair.
For a few seconds the room goes grey and swimmy. Sound seems farther away. You put a hand on the counter and wait.
Then it passes.
Five seconds. Maybe fifteen.
It happens getting out of bed. Standing after working in the garden. After a hot shower.
Eventually you stop mentioning it because it always goes away.
But those few seconds matter.
At thirty-five, you steady yourself on the counter.
At seventy-five, you may land on the floor.
Same few seconds. Very different consequence.
What Do You Mean by “Dizzy”?
Everyone says dizzy. Almost nobody means exactly the same thing.
Lightheaded or faint. Your vision greys or narrows. Sounds seem distant. You may feel
warm, weak, clammy or as though you might pass out. If it happens after standing, blood pressure and circulation are among the first things to investigate.
Vertigo. You or the room seem to be moving when nothing is moving. That’s different from feeling faint and points us toward the vestibular — or balance — system and sometimes the brain. If that is your experience, it has its own article: “Is It Me Spinning or the Room?
Why?”
Unsteady. You don’t feel faint and nothing is spinning, but you drift, veer or feel less secure when you walk. Balance depends on information from your eyes, inner ears, joints, muscles and nervous system.
Floaty, foggy or disconnected. Harder to describe, but still useful information.
The point isn’t to diagnose yourself.
The point is to stop using one word for four different experiences.
If It Happens When You Stand, Measure What Happens When You Stand
When you stand, gravity shifts blood toward your legs and abdomen. Your nervous and cardiovascular systems normally compensate quickly by changing blood-vessel tone and heart rate so that adequate blood flow reaches your brain.
When that response isn’t adequate, you may experience lightheadedness when standing, a head rush, fading or blackening vision, weakness or even fainting.
One possibility is orthostatic hypotension, also called postural hypotension. The conventional definition is a sustained blood-pressure drop of at least 20 mm Hg systolic or 10 mm Hg diastolic within three minutes of standing. A standard bedside assessment measures blood pressure and heart rate after lying down and again after standing.
That doesn’t tell us why it happened.
It tells us something happened that deserves an explanation.
The Number Is a Clue, Not the Diagnosis
Dehydration, heat, prolonged bed rest and certain medications can contribute to dizziness or low blood pressure on standing. So can anemia, blood loss, heart problems, endocrine conditions and disorders affecting autonomic nervous-system control.
That is why simply saying “my blood pressure runs low” isn’t enough.
The better question is:
What happens to my blood pressure and pulse when I stand — and why?
Treatment depends on the cause, not merely on producing a higher blood-pressure reading.
What We Can Actually Examine
At Ptak Family Chiropractic in Santa Monica, we start by defining the experience.
If standing brings it on, we can measure blood pressure and pulse lying down and again after standing, and compare the numbers with what you actually feel.
But dizziness isn’t only a blood-pressure question.
If you describe spinning, unsteadiness, visual difficulty or problems with movement, the examination changes. Depending on your history, we may examine balance, gait, eye movements, coordination, sensation, cervical function and aspects of vestibular and neurological function.
The finding determines the next step.
A blood-pressure change needs to be understood in the context of your history, medications and other health factors.
A balance or vestibular finding leads us in a different direction.
A neurological finding changes the examination again.
And if what we find needs medical evaluation or another specialist, we’ll tell you and help point you in the right direction.
When Not to Wait
Frequent lightheadedness when standing deserves evaluation, particularly if it is getting worse or causing falls. Losing consciousness, even briefly, should be medically evaluated.
Seek urgent medical care when dizziness or fainting occurs with symptoms such as chest pain, severe shortness of breath, a new severe headache, weakness or numbness, difficulty speaking, significant vision changes, or other sudden neurological symptoms.
Bring Us the Experience, Not Just the Word
The next time it happens, notice four things.
What did “dizzy” actually feel like?
What were you doing when it started?
How long did it last?
What made it stop?
“I’m dizzy” gives us one word.
“When I stand up, my vision goes grey for about ten seconds and I feel as though I might faint” gives us a pattern.
And patterns are much more useful.
A Better Question
Instead of asking:
“Why am I dizzy?”
start with:
“What do I mean by dizzy?”
Then tell us when it happens.
If standing is the trigger, let’s measure what happens when you stand. If spinning, balance, vision or movement is part of the experience, let’s examine those systems.
You don’t need to arrive knowing the diagnosis.
You need to arrive able to describe the experience.
That’s where a useful examination begins.
Come and talk with us. We never charge you to sit down and talk about your needs. Bring the four answers above and your complete medication list, including anything over the counter. We’ll define the experience, measure what can be measured, examine what is ours to examine, and tell you honestly where this belongs — with us, with your physician, or with another specialist. And if it came on suddenly, or with any of the symptoms above, don’t wait for an appointment with anyone. Be seen today.
About the author. Dr. Jeffrey Ptak, DC, DSS, MSS, MA. Bachelor of Science in Psychology, The American University, 1977. Neuroscience research at the Laboratory of Neuropsychology, National Institutes of Health, 1977 to 1980, with peer-reviewed publications in Physiology & Behavior in 1977 and in Catecholamines: Basic and Clinical Frontiers in 1979. Doctoral study in behavioral neuroscience at the City University of New York. Doctor of Chiropractic, Los Angeles College of Chiropractic, 1985 — the professional degree under which he practices. Founder of Ptak Family Chiropractic, Santa Monica, since 1986. Postgraduate study in Chiropractic Functional Neurology through the Carrick Institute, and advanced training through the International Association of Functional Neurology and Rehabilitation. Graduate coursework in Traditional Chinese Medicine at Emperor’s College. Master of Arts in Spiritual Psychology, University of Santa Monica, 2012, and Master of Arts in Spiritual Psychology with an emphasis in Consciousness, Health and Healing, 2016. Master of Spiritual Science, 2021, and Doctor of Spiritual Science, 2025, Peace Theological Seminary & College of Philosophy.
Educational purposes only. This article does not diagnose any condition and is not a substitute for medical care. Seek urgent medical care for dizziness or fainting accompanied by chest pain, severe shortness of breath, a new severe headache, weakness or numbness, difficulty speaking, significant vision changes, or other sudden neurological symptoms. Any loss of consciousness, even brief, should be medically evaluated. Do not start, stop or change any prescribed medication without consulting the prescribing physician. Individual results vary and no particular outcome is promised.
Ptak Family Chiropractic
We listen… We care… We get results…
Chiropractic for Adults and Children
3122 Santa Monica Blvd., Suite 102 · Santa Monica, CA 90404
310.473.7991 · ptakfamilychiropractic.com
