Dear doctor;

I was recently reading an old copy of Healthy Times and I found some tidbits on high blood pressure and exercise. In the brief article, they said people with blood pressure are not supposed to spin or rotate their necks as in exercise. Could you please elaborate on this?

Nuwamanya.

Dear Nuwamanya, Rotation of the neck gently three or four times both in clockwise and anti-clockwise directions is a good exercise to keep the neck muscles supple. It prevents and reduces the neck strain occurring in desk workers. In those having cervical spondylosis (stiffness of neck due to advancing age) it reduces stiffness and pain. Manipulation of the neck is used by professional physiotherapists to reduce neck stiffness and also treat some head and neck disorders. Although beneficial, neck rotation  does carry some risks. The vertebral artery supplying blood to brain lies in the neck. When one has cervical spondylosis, the new bones formed in between joints (osteophytes) impinge on the vertebral artery, causing vertigo and dizziness. Other risk factors for this vertigo is deposition of fats in inner lining of vertebral arteries and its branches due to high lipids, obesity, smoking, alcohol and stress. Hypertension is also one of the risk factors. 

In severe cases of cervical spondylosis, one has recurrent vertigo making walking difficult. The blood supply to brain may be cut off transiently, causing a transient ischemic attack where  there may be  loss of consciousness or paralysis of some part for 24-48 hours. Since high blood pressure is also associated with atherosclerosis and is a risk factor for causing strokes, those with high blood pressure have to be cautious about neck rotation, more so if the blood pressure is high.

Neck rotation should be attempted when blood pressure is normal. The movements should be minimal, not more than three at a go, One needs to move the neck slowly without any jerk. The movement should be stopped if any dizziness occurs.