022- Thoracic Adjustments for Cervical Spine Pain

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to touch on a very interesting piece of research. In my opinion, when it's framed properly, it is one of the most powerful pieces of research in chiropractic. It is titled Immediate Changes in Neck Pain Intensity and Widespread Pressure Pain Sensitivity in Patients with Bilateral Chronic Pain Mechanical Neck Pain A Randomized Controlled Trial of Thoracic Thrust Manipulation versus Non Thrust Mobilization. The title is a mouthful, but basically they looked at patients with chronic neck pain cervical spine pain and those patients were then treated with a thoracic spine manipulationadjustment or a non thrust mobilization. I'll get into the positioning of this paper as the podcast goes on because again, I think when framed appropriately, it's one of the most powerful pieces that we've come across. But but before we get started, let me say a few words about Rocktape. 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If you're not a member of the Evidence Based Chiropractor yet and you want to know what that means when I say that we highlighted this as a research brief, Please visit the evidencebasedchiropractor.com however, looking at this paper, I said it's one of the most powerful pieces. So here's really why. Chronic unresolving mechanical neck pain can be extremely difficult to treat in a primary care setting. And so when we're going out from the evidence based chiropractor point of view or reaching out to other providers, chronic unresolving neck pain is really a pain in the neck, no pun intended, for many practitioners out there. Fortunately, new research continues to show a variety of non farm conservative options for many patients who suffer from this condition. So really when I say that, I'm talking about medications and typical prescribed NSAIDs that you'd see in a primary care setting. So weakened or aberrant posture is often present with chronic neck pain. We see this because we see it every day, that forward flexed, I believe it's the syndrome X component or a double crush syndrome. Excuse me. When we have that hyperkyphotic nature that affects the neck in a long term seated position such as an office setting, we see it every day in practice. But it's really coupled motion of the cervical spine and the thoracic spine. Now active exercise and postural strengthening should be a part of all treatment plans. When there's segmental biomechanics in the cervical thoracic spine that are needing to be addressed, that is through a chiropractic adjustment. So let me get to the. It's a long winded way of saying what I love about this study is it shows for patients that might be not the ideal candidates for a traditional high velocity cervical spine adjustment or for that practitioner who you're looking to build a relationship with that just seems really inappropriately concerned with cervical spine safety. Research is very clear that chiropractic care high velocity low amplitude adjustments are extremely safe. But again, occasionally we run into those other practitioners or otherwise people on the street that may just have this unbelievable concern for it where it's not warranted. This study is really important because they looked again at treating the thoracic spine in a randomized control trial to influence chronic cervical spine pain. And ultimately what they found is neck pain is a common musculoskeletal complaint with point prevalence around 15% in males and 23% in females. So a good number of people are going to have some sort of neck pain at some point in their life. Secondarily, they found individuals who received thoracic thrust manipulation experienced significantly great reductions in neck pain as measured by the numerical pain rate scale at the one week follow up. So on a zero to ten pain scale, patients who had chronic neck pain who received a thoracic thrust manipulation and had a significantly great reduction in that pain. Third, they found the most likely hypothesis for Spinal thrust manipulation to act through the stimulation of descending inhibitory mechanisms, particularly the periaqueductal gray matter. This assumption is mainly based on the premise that spinal thrust manipulation exerts a mechanical hypogesic effect, thereby increasing pressure pain thresholds. That one was tough for me to get through, but basically what that quote is saying is that ultimately when that spinal adjustment is given, there's a central nervous system stimulant. It does stimulate ultimately the descending inhibitory mechanisms. And they're specifically looking at the periaqueductal gray matter. When they see that, they're then taking it one step farther and saying that's what's creating a mechanical hypoalgesic effect. So that reduction and also increasing the pain pressure thresholds. So all of the components are really key with that. So three things. Number one is that neck pain is common. Lumbar spine pain is number one of what we see in our practices, by and large as chiropractors. Number two is neck pain and headache. So when there are patients that perhaps aren't the best candidates for a high velocity, low amplitude manipulation or a chiropractic adjustment in the cervical spine. This research is important on that front because you can feel very comfortable speaking to a patient and letting them know you're going to examine, evaluate, and perhaps adjust their thoracic spine to influence their cervical spine. And not only that, but you're going to know behind the scenes, so to speak, and you might even talk about the patient that you're doing that based on the best evidence available. Truly a randomized controlled trial which showed significant differences in cervical spine pain with thoracic manipulation. Second to that, I love this paper from the point of positioning practice. So, you know, really out there in the community, if you run into a doc again who's really stuck on the safety of a chiropractic adjustment, or really stuck on, as we've discussed on the podcast earlier, when they see a patient with chronic neck pain, maybe the stiff neck, and they're just envisioning this really aggressive manipulation, and they don't have the experience that we do, so it's hard for them to piece that together. So being able to show a piece of research such as this, which really looks at a different way to go about that care while still retaining what I would call the chiropractic integrity of that care, is something that gets me excited. So when I see something like this again, ultimately what they're looking at is chronic neck pain, chiropractic adjustment, manipulation in the thoracic spine and it resulted in a significantly improved state. And their assumption theory is ultimately that that is taking place through the central nervous system and through the stimulation of the central nervous system and specifically the periaqueductal gray matter. So in this study the average age of the participant was 33. The pain duration was over 2 years. So patients had been in pain over 2 years 2.3 years and the average pain intensity was a 5.9 starting point. So these are patients that have had chronic significant pain. So again, this study, I love it. I think it's a great piece of research. For any members of the Evidence Based Chiropractor. It is available for purchase a la carte in the members vault or for anybody who is not a member. I would question or I would invite you, I would say, to come on board. Check us out@the evidencebasedchiropractor.com you probably saw a few pieces that we had posted on Facebook this week that really blew things out of the park. I would say one of them was a feature that ESPN had previously done on Kobe Bryant and how he utilizes two chiropractors and it was kind of in honor of Kobe's last game there. So he goes through an all day process to get prepared to get ready for game time, such as we do in our practice many days, really getting mentally there, getting physically there, of course, and also getting with the team and making sure it's going to be a great day. But Kobe went through a significant amount of care to get ready for each and every game 20 years into his career. It's a great piece. It highlights chiropractic. I'd check it out, visit the Evidence Based Chiropractor on Facebook to see that. Also today I put up a funny chiropractic meme. I think it's reached 10,000 people or something at this point in time. So check us out on Facebook the Evidence Based Chiropractor if you haven't had the opportunity to do so. Second to that, certainly if you've been listening and enjoy what we're bringing each and every week, I would invite you if you can take a few moments and give us feedback on itunes. It helps us out greatly and helps us reach even more chiropractors when we can be pumped up in the search engine there. So if you have the opportunity, please leave some feedback or a comment or a rating on itunes for the Evidence Based Chiropractor podcast. Also, some international speaking gigs coming up. I will be in Bournemouth, England in June. I will be in the Netherlands in September and I will be teaching in Florida this coming June. So keep your eyes peeled for more of that information. I hope you have an awesome week in practice Doc, and we will catch you soon.

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Sam.