Chiropractic Rehabilitation Benefits Overview for Heart Health

Chiropractic rehabilitation for heart health can play a crucial role in your wellness journey. Learn more today.

Abstract

Heart health affects much more than the heart itself. The cardiovascular system delivers oxygen, nutrients, hormones, and other essential substances to nearly every tissue in the body, including muscles, bones, joints, nerves, and connective tissues. When cardiovascular function declines, a person may experience fatigue, shortness of breath, reduced exercise tolerance, weakness, swelling, and difficulty staying physically active. Over time, these limitations can contribute to muscle loss, stiffness, poor mobility, and worsening musculoskeletal pain.

I am Dr. Alexander Jimenez, DC, APRN, FNP-BC. In my clinical work, I often view cardiovascular and musculoskeletal health as interconnected parts of a person’s overall function. Chiropractic care does not treat heart failure, coronary artery disease, cardiomyopathy, or other serious cardiovascular diseases. These conditions require appropriate medical evaluation and evidence-based cardiovascular treatment. However, when medically appropriate, chiropractic care, rehabilitation, mobility training, exercise, nutrition, and lifestyle strategies may complement a patient’s medical care by addressing musculoskeletal barriers that make movement and rehabilitation more difficult.

This article explains why heart health matters to the musculoskeletal system, how cardiovascular disease and chronic musculoskeletal pain can overlap, and how an integrative approach can help patients maintain mobility, strength, independence, and quality of life.

Why Heart Health Matters to the Entire Body

The heart is the circulatory system’s central pump. With every beat, it helps deliver oxygen-rich blood throughout the body.

Healthy circulation supports:

• Skeletal muscles
• Bones and joints
• The brain and nervous system
• Kidneys and other organs
• Connective tissues
• Exercise and recovery
• Energy production
• Tissue repair

This is one reason cardiovascular health and musculoskeletal health should not always be considered separate subjects. Cardiovascular disease remains a major health concern in the United States, and physical inactivity, obesity, diabetes, and hypertension are among the important factors associated with cardiovascular risk (American Heart Association [AHA], 2025). At the same time, regular physical activity can help improve blood pressure, blood glucose, body weight, sleep, cardiovascular fitness, and overall physical function (AHA, n.d.).

This creates an important relationship:

A healthier cardiovascular system supports movement, while the ability to move comfortably makes it easier to participate in the physical activity that supports cardiovascular health.

Pain can disrupt this relationship. A person with severe back, neck, hip, or knee pain may begin walking less. Reduced activity can lead to further weakness and deconditioning. That can make activity even more difficult and potentially contribute to a cycle of pain, inactivity, weight gain, metabolic dysfunction, and cardiovascular risk.

The Heart-Muscle Connection

One of the clearest examples of the connection between cardiovascular and musculoskeletal health is heart failure.

Heart failure is a clinical syndrome in which abnormalities of heart structure or function interfere with the heart’s ability to meet the body’s needs. Depending on the type and severity, patients may experience:

• Shortness of breath
• Fatigue
• Reduced exercise tolerance
• Swelling of the legs or ankles
• Difficulty performing everyday activities
• Weakness and deconditioning. Clinicians commonly classify heart failure by left ventricular ejection fraction and clinical presentation. Medical treatment depends on the specific type of heart failure and its underlying cause (Heidenreich et al., 2022). But there is another part of heart failure that deserves attention: skeletal muscle dysfunction. Research has shown that exercise intolerance in heart failure cannot always be explained by the heart alone. Skeletal muscles can also change, including loss of muscle mass, changes in muscle fibers, impaired mitochondrial function, reduced capillary density, and impaired oxygen use (Tucker et al., 2018). More recent research continues to identify skeletal muscle dysfunction as an important contributor to exercise intolerance in heart failure. This matters because patients do not experience cardiovascular disease only as a number on an echocardiogram. They experience it when walking across a parking lot becomes difficult, climbing stairs causes exhaustion, carrying groceries becomes harder, or weakness prevents them from doing things they once enjoyed.

When Heart Problems and Musculoskeletal Pain Occur Together

Cardiovascular disease and chronic musculoskeletal pain commonly overlap. Oliveira et al. (2020) performed a systematic review and meta-analysis examining chronic musculoskeletal pain and cardiovascular disease. Across the included population studies, people with chronic musculoskeletal pain were more likely to report cardiovascular disease than people without chronic musculoskeletal pain. This does not mean that back pain directly causes heart disease or that heart disease directly causes most back pain. The relationship is more complicated.

Several factors may overlap, including:

• Aging
• Physical inactivity
• Obesity
• Diabetes
• Hypertension
• Chronic inflammation
• Poor sleep
• Reduced physical conditioning
• Depression and psychological stress
• Smoking
• Metabolic disease

Musculoskeletal disorders themselves may also make exercise more difficult. A person with painful knee osteoarthritis, for example, may avoid walking because every step hurts. Someone with chronic low back pain may stop exercising because bending, lifting, or prolonged standing causes discomfort. Research suggests that people with musculoskeletal disorders may have an increased rate of developing other chronic diseases, including cardiovascular disease, although the mechanisms remain under investigation (Williams et al., 2018).

This illustrates why musculoskeletal rehabilitation can become an important part of whole-person health.

Cardiovascular Disease Can Also Produce or Worsen Pain

The relationship can move in the other direction. Certain cardiovascular disorders can cause pain directly or indirectly. Cardiovascular disease has been associated with pain syndromes involving ischemic pain, peripheral arterial disease, angina, post-stroke pain, and other conditions (Staudt et al., 2022). This distinction is extremely important in a chiropractic or musculoskeletal setting.

Not every painful area is mechanical. Chest, shoulder, arm, upper-back, neck, or jaw discomfort can sometimes be associated with cardiovascular disease. New or unexplained pain accompanied by symptoms such as chest pressure, shortness of breath, sweating, nausea, fainting, or unusual weakness requires appropriate medical evaluation rather than simply assuming the problem comes from the spine or muscles. That clinical screening process is an essential part of responsible integrative care.

The Pain-Inactivity-Cardiovascular Cycle

In my clinical experience, one of the most important connections between cardiovascular and musculoskeletal health is functional. Consider a patient with chronic low back and knee pain.

• Pain makes walking uncomfortable.
• The patient begins sitting more.
• Muscles gradually become weaker.
• Weight may increase.
• Blood glucose control can become more difficult.
• Blood pressure and cardiovascular risk factors may worsen.

As conditioning declines, walking becomes even more exhausting. The patient then moves even less.

This creates a cycle:

Pain -> reduced movement -> deconditioning -> weakness -> metabolic and cardiovascular stress -> poorer exercise tolerance -> less movement -> more functional limitation

Breaking that cycle may require several professionals working together.

Where Chiropractic Care Fits

Chiropractic care should not be presented as a treatment for cardiomyopathy, coronary artery disease, arrhythmias, or heart failure. Instead, its potential role is much more practical. For an appropriately screened and medically stable patient, chiropractic and musculoskeletal rehabilitation may address mechanical problems that interfere with movement.

These may include:

• Back pain
• Neck pain
• Joint stiffness
• Restricted spinal mobility
• Muscular tension
• Postural problems
• Reduced thoracic mobility
• Deconditioning
• Movement limitations

The objective is not to “adjust the heart.” The objective is to help the musculoskeletal system function well enough for the person to move, exercise, rehabilitate, and perform daily activities more comfortably when their medical team has determined those activities are safe. This distinction is fundamental.

Chiropractic Care as a Bridge to Healthy Movement

One of the most useful ways I view chiropractic care is as part of a broader movement strategy. If a patient has mechanical low back pain that prevents walking, addressing that pain may help the patient gradually return to walking. If thoracic stiffness and poor posture make everyday movement uncomfortable, mobility exercises and carefully selected manual therapies may improve mechanical function.

If weakness and prolonged inactivity have affected balance, rehabilitation can focus on strength and stability. The larger objective is improved function. This philosophy is consistent with my broader clinical approach, which combines musculoskeletal rehabilitation, chiropractic care, functional health assessment, exercise, and patient education while recognizing when medical specialists need to manage disease-specific conditions.

Why Exercise Matters for Both the Heart and Musculoskeletal System

Exercise is one of the strongest areas where cardiovascular and musculoskeletal care intersect. The 2022 AHA/ACC/HFSA heart failure guideline reports that exercise training can improve functional status, exercise performance, and quality of life in appropriately selected patients with heart failure (Heidenreich et al., 2022).

Cardiac rehabilitation is much more than simply telling someone to exercise.

Programs can include:

• Medical assessment
• Supervised physical activity
• Cardiovascular monitoring
• Patient education
• Nutrition guidance
• Medication education
• Risk-factor management
• Psychosocial support

For stable patients with heart failure, rehabilitation can also address strength, balance, mobility, and endurance. This matters because the musculoskeletal system ultimately allows cardiovascular fitness to translate into real-world function. A strong heart matters, but patients also need muscles strong enough to carry them across the room, legs strong enough to climb stairs, balance to prevent falls, and joints mobile enough to allow safe activity.

Strength Training Has a Cardiovascular Role

Resistance exercise is not only about building large muscles.

Appropriately prescribed strength training helps maintain the muscles needed for:

• Walking
• Balance
• Getting out of a chair
• Climbing stairs
• Carrying objects
• Maintaining independence

Current cardiovascular guidelines recognize resistance training as part of appropriate physical activity for many patients with stable chronic coronary disease (Virani et al., 2023). For people with heart failure, exercise must be individualized according to disease severity, symptoms, medications, blood pressure, rhythm status, and the recommendations of the patient’s cardiovascular team.

More exercise is not automatically better.

The goal is appropriate movement at the appropriate intensity for the appropriate patient.

Heart Failure, Sarcopenia, and Deconditioning

One concern I pay particular attention to is muscle loss. Sarcopenia refers to declining muscle mass and function. It can become especially problematic when chronic disease, aging, hospitalization, inactivity, poor nutrition, or exercise intolerance occur together. Heart failure can contribute to this process.

As muscle function deteriorates, the patient may notice:

• Leg weakness
• Earlier fatigue
• Slower walking
• Difficulty rising from a chair
• Poor balance
• Reduced endurance
• Greater dependence on others

The resulting inactivity can then accelerate deconditioning. For medically stable patients, a carefully developed rehabilitation program may incorporate aerobic conditioning, resistance exercises, balance work, mobility exercises, and functional movements.

Thoracic Mobility and Breathing Mechanics

Another area I commonly evaluate is the relationship between posture, rib movement, the thoracic spine, and breathing mechanics.

Patients who are short of breath may begin relying heavily on accessory breathing muscles around the neck, shoulders, and upper chest.

Over time, this may contribute to:

• Neck tension
• Upper-back discomfort
• Shoulder tightness
• Altered posture
• Chest-wall stiffness

These musculoskeletal problems do not mean that spinal treatment corrects the underlying cardiac cause of breathlessness.

Instead, after medical evaluation and stabilization, we may use gentle mobility and rehabilitation strategies to address secondary mechanical limitations.

I may focus on:

• Thoracic mobility
• Rib-cage movement
• Posture
• Diaphragmatic breathing
• Gentle stretching
• Scapular mechanics
• Progressive conditioning

The purpose is to reduce unnecessary mechanical restrictions and make movement and breathing-related activity more comfortable.

Cardiomyopathy Requires Medical Diagnosis

Cardiomyopathy refers to diseases affecting the heart muscle.

Several major forms include:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Ischemic cardiomyopathy
• Genetic cardiomyopathies
• Infiltrative cardiomyopathies

These conditions require proper cardiovascular evaluation.

Some can cause serious arrhythmias, heart failure, syncope, or sudden cardiac events. Chiropractic treatment should therefore never delay cardiac investigation when symptoms or clinical findings suggest underlying cardiovascular disease.

Medical testing may include:

• Electrocardiography
• Echocardiography
• Laboratory testing
• Stress testing
• Cardiac MRI
• Coronary imaging
• Rhythm monitoring
• Genetic evaluation

Treatment depends entirely on the underlying condition.

Heart Failure and Guideline-Directed Medical Therapy

For heart failure with reduced ejection fraction, modern medical treatment commonly includes four major medication classes:

1. ARNI, ACE inhibitor, or ARB therapy
2. Evidence-based beta-blockers
3. Mineralocorticoid receptor antagonists
4. SGLT2 inhibitors

These medications target different biological pathways involved in heart failure and can reduce hospitalization and improve clinical outcomes when appropriately prescribed (Heidenreich et al., 2022).

Chiropractic treatment does not replace these medications.

Instead, integrative musculoskeletal care may help address a different question:

How do we help the medically managed patient remain as mobile, strong, comfortable, and functionally independent as possible?

That is where collaboration becomes valuable.

Comorbidities Connect Heart and Musculoskeletal Health

Heart disease rarely exists in isolation.

Many patients also live with conditions such as:

• Obesity
• Insulin resistance
• Type 2 diabetes
• Hypertension
• Osteoarthritis
• Chronic back pain
• Sleep disorders
• Depression
• Physical deconditioning

These conditions can interact. For example, obesity can increase mechanical stress on weight-bearing joints while also contributing to hypertension, insulin resistance, and cardiovascular risk.

• Knee pain may discourage walking.
• Reduced walking can worsen conditioning.
• Poor conditioning can make exercise feel more difficult.

This can create a feedback loop in which metabolic, cardiovascular, and musculoskeletal problems reinforce one another. Research involving people with knee and hip osteoarthritis has found that greater comorbidity burden is associated with poorer physical function and, in some cases, worse pain (Calders et al., 2018). This is why I believe clinicians should ask more than, “Where does it hurt?”

We should also ask:

What is preventing this person from moving, and what other health conditions are contributing to that limitation?

A Collaborative Model of Care

The safest approach for patients with significant cardiovascular disease is coordinated care.

Depending on the patient, that team may include:

• Primary care clinicians
• Cardiologists
• Advanced practice nurses
• Chiropractors
• Physical therapists
• Cardiac rehabilitation professionals
• Dietitians
• Exercise specialists

Each discipline has a different responsibility. The cardiology team manages cardiovascular disease. The rehabilitation team helps restore physical capacity. Chiropractic care can address musculoskeletal problems that may interfere with comfortable movement. Nutrition and lifestyle interventions can address cardiovascular and metabolic risk factors. This multidisciplinary philosophy is what I emphasize in my clinical work.

Chiropractic Care & Metabolism *The Hidden Link*- Video

My Clinical Observations

In my clinical experience, patients often do better when we stop viewing their cardiovascular and musculoskeletal problems as unrelated diagnoses. A patient may have medically stable cardiovascular disease but still avoid activity because of back pain. Another patient may complete cardiac treatment but remain severely deconditioned. Someone else may have obesity, hypertension, diabetes, knee pain, and chronic low back pain simultaneously.

Treating only one part of that picture may leave major barriers unresolved. My approach is therefore to identify the musculoskeletal factors that can reasonably be improved while respecting the boundaries established by the patient’s cardiovascular condition. That may include improving joint mobility, reducing mechanical pain, restoring strength, improving balance, working on posture, encouraging safe movement, and coordinating care with the patient’s medical team. My professional and educational work reflects this broader emphasis on chiropractic rehabilitation, functional medicine, musculoskeletal health, exercise, and patient education.

When Chiropractic Treatment May Need to Wait: Some situations mean musculoskeletal treatment isn’t the priority. Patients with unstable or serious cardiovascular symptoms need medical evaluation first.

Warning signs may include:

• New chest pressure or chest pain
• Unexplained shortness of breath
• Fainting
• New severe palpitations
• Sudden weakness
• Rapidly increasing leg swelling
• Severe exercise intolerance
• New unexplained jaw or arm discomfort
• Symptoms suggesting stroke
• Suspected acute heart failure

Similarly, vigorous exercise and certain manual treatment approaches may be inappropriate for patients with unstable cardiovascular disease. Safety comes first. Once the cardiovascular condition has been evaluated and stabilized, the medical and rehabilitation teams can determine the appropriate type and intensity of activity.

The Goal Is Better Function, Not Just Less Pain

Pain relief matters, but function matters as much. A successful integrative program should ultimately help a person perform meaningful activities.

• Can the patient walk farther?
• Can they climb stairs more comfortably?
• Can they sleep better?
• Can they get out of a chair more easily?
• Can they participate in cardiac rehabilitation?
• Can they exercise without musculoskeletal pain stopping them?
• Can they maintain independence?

These functional goals connect chiropractic rehabilitation with broader cardiovascular wellness.

The Heart and Musculoskeletal System Work Together

Heart health and musculoskeletal health are deeply connected through movement, circulation, metabolism, strength, and physical activity. Cardiovascular disease can reduce exercise capacity and contribute to fatigue and skeletal muscle dysfunction. Musculoskeletal pain can make movement difficult and encourage sedentary behavior. Obesity, diabetes, hypertension, inflammation, and physical inactivity can further connect these conditions. That does not mean chiropractic care treats cardiovascular disease.

It means that musculoskeletal care can have a supportive role in the larger healthcare picture. When medically appropriate, reducing mechanical pain, improving mobility, restoring strength, addressing posture, and supporting safe physical activity may help patients participate more fully in the lifestyle and rehabilitation strategies that are important for cardiovascular health.

Conclusion

As a chiropractor and advanced practice registered nurse, I view the heart and musculoskeletal system as parts of one interconnected human body. Cardiovascular medicine remains the foundation for diagnosing and treating heart disease. Evidence-based medications, cardiac testing, specialist care, and cardiac rehabilitation can be lifesaving. Chiropractic care has a different but complementary purpose. For the appropriately screened patient, it can help address musculoskeletal pain, mobility restrictions, stiffness, weakness, and other physical barriers that make healthy movement more difficult.

This creates an integrative goal that is straightforward:

Protect the heart, preserve the muscles, restore movement, and help the patient remain as active and independent as their medical condition safely allows.

That is where cardiovascular medicine, chiropractic care, rehabilitation, nutrition, and lifestyle medicine can work together rather than compete.

References

• American Heart Association. (2025). Cardiovascular disease – CVD. American Heart Association.
• American Heart Association. (n.d.). What’s the link between physical activity and health?. American Heart Association.
• Calders, P., Van Ginckel, A., et al. (2018). Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 47(6), 805-813.
• Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, S. S., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation, 145(18), e895-e1032.
• Oliveira, C. B., Maher, C. G., Franco, M. R., Kamper, S. J., Williams, C. M., Silva, F. G., & Pinto, R. Z. (2020). Co-occurrence of chronic musculoskeletal pain and cardiovascular diseases: A systematic review with meta-analysis. Pain Medicine, 21(6), 1106-1121.
• Staudt, M. D., Prabhala, T., & Pilitsis, J. G. (2022). Chronic pain considerations in patients with cardiovascular disease. Physical Medicine and Rehabilitation Clinics of North America.
• Tucker, W. J., Haykowsky, M. J., Seo, Y., Stehling, E., & Forman, D. E. (2018). Impaired exercise tolerance in heart failure: Role of skeletal muscle morphology and function. Current Heart Failure Reports, 15(6), 323-331.
• Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., Kazi, D. S., Kolte, D., Kumbhani, D. J., LoFaso, J., Mahtta, D., Mark, D. B., Minissian, M., Navar, A. M., Patel, A. R., … Williams, M. S. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease. Circulation, 148, e9-e119.
• Williams, A., Kamper, S. J., Wiggers, J. H., O’Brien, K. M., Lee, H., Wolfenden, L., Yoong, S. L., Robson, E., McAuley, J. H., Hartvigsen, J., & Williams, C. M. (2018). Musculoskeletal conditions may increase the risk of chronic disease: A systematic review and meta-analysis of cohort studies. BMC Medicine, 16, 167.

Dr. Alexander Jimenez’s Clinical Perspective

Additional information about my clinical approach to chiropractic rehabilitation, functional medicine, musculoskeletal health, and integrative patient care is available through Push as Rx and my LinkedIn professional profile.

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