024- How a Chiropractic Adjustment Works

Welcome to the Evidence Based Chiropractor providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth courtesy of your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to touch on a study from Spine Journal which looks at essentially how a chiropractic adjustment works. So it is titled Preliminary Investigation of the Mechanisms Underlying the Effects of Manipulation and it was put out in 2011. Before we get started, I'd like to say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief, topicals, mobility tools and functional fitness accessories. New from Rock Tape is rocksauce Chill Powerfully Cool Pain Relief Topical in a convenient roll on with 6% menthol. It's stronger than the freeze competition. They're more than just a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com also with Rock Tape I was on a kind of exclusive webinar where they did a big reveal for the Rock Blade soft tissue tools that will be coming out. I'm going to be teasing some of that as time goes on, but they are awesome. If you've seen the side view or the images they've been putting out, wait until you see the whole thing. They look absolutely great. The other thing I wanted to touch on up top is I am extremely.

Happy, proud and just very giving a lot of gratitude for the fact that I have some articles coming up in Chiropractic Economics magazine. It should be next issue. The first one will come out. I got a few copies in the mail here myself at home already, but I believe it's going to hit the press in a few weeks and you'll see some follow up articles as well. Thank you to everybody at Chiropractic Economic and please check it out if you don't get the chance and I'll be sure to post about it on Facebook as well. But today we are going to talk about the preliminary investigation of the mechanisms underlying the effects of manipulation. It's from Spine Journal, Volume 36, Number 21 in the year 2011. You'll see that linked in the show notes if you want a direct citation to PubMed. So a vast array of journals and evidence based guidelines have strongly supported the Use of spinal manipulative therapy for a variety of spine complaints. Essentially, the research supports chiropractic care. It's what we talk about each and every week on the evidence based Chiropractor podcast. This study from Spine not only shows beneficial outcomes, but it also begins to explore the mechanisms by which an adjustment or manipulation achieves these results. MRIs of the lumbar spine with degenerative joint disease often show fatty infiltration of the multifidus. This study supports the theory that multifidus recruitment plays a large role in low back pain. Additionally, the findings suggest that adjustments can have a direct positive effect on multifidus recruitment. While the focus of the study was on subacute pain, I'd like to point out that previous studies have showed of course, positive outcomes for chronic spine pain as well. So really, from a chiropractic point of view, I know we've been focusing on erector spinae muscles, multifidus, and how that supports intrinsically and ultimately the low back, as weeks become months, become years, become decades, and fatty infiltration of that multifidus. I look at probably somewhere between 400 to 500 MRIs per month and I see fatty infiltration that's not age appropriate in a vast majority of those cases. Deconditioned people, essentially. And what I've found really is that primary care doctors, internal medicine doctors, but certainly from the surgical world, they are taking a very keen interest in sacral base angle and ultimately also in multifidus recruitment because it directly plays into their outcomes. If the patient is of course deconditioned or they have a lack of stability in the area, then during a surgery, the expectation may be a diminished outcome. So chiropractors have been keenly focused on muscle tone, on angle, and certainly on the biomechanics of the spine for a long time. But as we can see with this study from spine, it's starting to take interest across the board for all spine practitioners. So let's dive into a few quotes from this study. They found high velocity low amplitude spinal manipulative therapy is an intervention for low back pain supported by several systematic reviews and practice guidelines. Good to get that out of the way, we know that they are again reinforcing, supporting chiropractic care and ultimately the chiropractic adjustment. They also found an SMT force has been shown to stimulate peripheral afference, altering central nervous system input and enhancing motor neuron excitability. So this again, it's a great statement here and let's break it down. Chiropractic adjustment has been shown to stimulate peripheral afferent nerves. So that's good information to know. We're putting in a stimulus with the adjustment and ultimately it is affecting the central nervous system, which is something that we've been interested in for over 100 years now. But the research is coming to support that now. And we're enhancing motor neuron excitability, which is a good thing. We also found, quote we found a significant relationship between immediate post SMT stiffness decrease and clinical outcome. This finding may suggest a relationship between stiffness change and outcome for thrust SMT that is not present if non thrust mobilization techniques are employed. So this again is a nice statement that's really clean and wraps up what we do when we provide a chiropractic adjustment, it essentially directly afterward they are finding a decrease in stiffness and relating that ultimately to the clinical outcome, improved range of motion, ultimately the muscle reflex response I think is what they're getting at there. But it's against taking what we know and what we've thought and believed for many years and really putting it into high quality peer reviewed foundation. The research has also found the underlying mechanisms of explaining the benefits of SMT appear to be multifactoral. Both spinal stiffness characteristics and lumbar multifidus recruitment changes appear to play a role. So they are saying again things that we well know, but this is reinforcing with top tier research that ultimately when a chiropractic adjustment or a manipulation is performed, it is multifactorial in nature for the recipient, for the patient, practice member, client and person. Meaning that when they're getting an adjustment, it's going to affect their peripheral afference, it's going to affect their central nervous system and it ultimately is going to give reflex response. The decrease in stiffness and the increase in multifidus recruitment are two big things that play ultimately a role with outcomes. So when they're able to have better range of motion and a decreased stiffness, that's good. Our body likes motion. That's how the pump of the intrinsic system of the spine works ultimately. And second to that when there's increased multifidus recruitment, that's good because in my opinion they're extrapolating that it provides more stability to the area and ultimately when there's more stability, that's less stress and strain on the load bearing joints, which we know of course are the facet joints and the disc itself. Facet arthrosis, facet disease and facet hypertrophy again are things that I see every day when we see Fatty infiltration in the multifidus and a lack of recruitment, those facet joints over time become degenerative. They can become painful locally, but as they hypertrophy, they can start to get into that foraminal canal and ultimately cause a sciatic like complaint. Now, those patients still can respond well to chiropractic care, but it's really nice when you can get on top of that early, meaning when you can address some of these concerns earlier on in the process. Earlier on in the degenerative process, you really set that patient up for really a better outcome for life ultimately for the next week, month, year and decade, as far as that goes. So they found. One other chart I'd like to talk about is they've made a list of clinical prediction rule criteria for identifying likely responders to smt. So this is a nice little recap because it provides what they feel in the research supports the type of patient which would benefit best from SMT or an adjustment. And the duration of the current episode, less than 16 days. So they find acute pain works better than chronic, but we know chronic support it as well. Number two, they found no symptoms distal to the knee. So if there's a radicular symptom, but it's not true sciatica, those patients can respond easier and quicker with conservative care. Fear avoidance beliefs questionnaire of less than 19 points. So fear avoidance questionnaire, of course, is a psychological state and fear of movement, and they're saying less than 19 points. You can find that fear avoidance questionnaire online. At least one lumbar segment judged to be hypomobile. Well, that doesn't surprise us because mobility and stiffness, reduction in stiffness and an increase in mobility is one of the things that we are after. And finally, they found at least one hip with greater than 35 degrees range of motion. So if the patient's starting with good hip flexion, ultimately with a good range of motion in the hip, it really helps the mobility of that lumbar spine and can help with conservative care. So I love this study. We released this as one of our monthly research briefs in May of 2014. So if you're a current member, you can access this or pick it up in the member's Vault. It is May 2014, and we had highlighted this paper at that point in time as part of our monthly research briefs. Also, if you are a member, I'd like to thank you. At this point, we have members across four continents and we literally have members in some countries that I did not hear of previous to the member joining so I'm overwhelmed with that. I thank you for trusting me and the Evidence based Chiropractor with providing your chiropractic research. And if you're listening to the podcast I'd like to thank you as well. If you have the opportunity and you are listening to the podcast and you like it and you listen every week, please go on itunes, leave us some feedback and certainly you can rate the podcast as well. That helps keep us near the top of the charts and it helps other chiropractors for find what we're doing each and every week. Furthermore, I know I haven't touched on this in a while, but Marketing Chiropractic to Medical Doctors is still on Amazon. It is still one of the hot sellers in the chiropractic category and we have shipped those worldwide as well. So thank you to everybody that's picked that up. Docs, I hope you have a fantastic week in practice. We will be back next week with more hard hitting research. Have a great week in practice.

We appreciate you joining us for this episode of the Evidence.