031- Tissue Damage After Chiropractic Adjustments: Fact or Fiction?

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Hello, welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we have another episode diving deep into the research of chiropractic care. We're going to look at a study that was released just a couple years back in 2014 and it's titled Tissue Damage Markers after a Spinal Manipulation in Healthy A Preliminary Report of a Randomized Controlled Trial. So if you've been following us each and every week, this one should get you excited for a couple different reasons. Number one is that it is a new research article. In other words, it was released again in 2014. Number two is it is an RCT. It's a randomized controlled trial which is the absolute top tier of research. The third component is it touches on an interesting aspect of our career which are ultimately tissue damage markers after an adjustment or a spinal manipulation in healthy subjects. So it's a really compelling piece of research, number one. And number two, it was released by Disease Markers, which is a research journal that has not published a lot on chiropractic care or spinal manipulation in the past. But this is a good one to get started for them for sure. So before we dive in, I'll 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 Rocktape is Rocksauce Chill Powerfully Cool Pain Relief topical in a convenient roll on with 6% menthol. It's stronger than the freeze competition. They are more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape dot. So let's dive into the research again. The research article this week was titled Tissue Damage Markers After a Spinal Manipulation in Healthy A Preliminary report of an RCT. It was released by disease markers in 2014 and you can find a direct link to that in the Show Notes as well. So if you go to the evidencebasechiropractor.com or if you are on itunes, you should be able to get to the show notes and there'll be a direct link to the PubMed journal entry for this. So the importance is the safety of chiropractic Spinal manipulation is very much of primary importance to both the treating chiropractor. All of us as chiropractors, as well as any referring physicians, we all know that there's been a lot of challenge or a lot of misinformation regarding the safety of chiropractic care, more specifically as it relates to stroke. But the safety of a chiropractic adjustment is something that's always top of mind for all practitioners. I was speaking to an evidence based chiropractic member about this just last week and really it gets down to you have to put yourself outside of the chiropractic shoes and in the shoes of perhaps, let's say a primary care doctor, just from the point of view of this. They might see a patient who comes in with completely acute pain and radiculopathy, perhaps and the patient has muscle spasm, they have limited range of motion, they're in exquisite pain. And for that physician to, when they think of chiropractic, they might often be confusing the practice of chiropractic with the profession. So they're thinking of just strictly that high velocity adjustment. And they're probably thinking to themselves, it's all happening momentarily in their head. But how possibly, if this patient that has zero range of motion, that's in exquisite pain, how could a high velocity adjustment set them in the right direction and not set them in the wrong direction? So that's the truth of the matter, as we know, is that the proof is somewhere in between. In other words, we may choose on some of those patients to actually go ahead with a high velocity adjustment. But often we may start with a low velocity technique or maybe some ancillary modalities. If you do that in your practice, and that's really the difference between the practice of chiropractic and the profession of chiropractic, really, we have a vast gamut of treatment options available, but often it's difficult for primary care doctors, internal medicine doctors, to visualize the gamut of what we offer unless we're out there telling them what we offer, which of course is what we get down to each and every week here on the evidence based chiropractor podcast and in a more robust fashion with all the membership options of the evidence based chiropractor. But previous research has proven the chiropractic adjustment to be safe and effective healthcare procedure with risk factors lower than the use of over the counter anti inflammatories. So we've looked at previous NSAID versus manipulation and there is a variety of studies available that pit chiropractic adjustments, manipulations against a plethora of other treatment options. And I have not seen a single study that's actually shown a chiropractic adjustment to be less safe or even perhaps less effective than other treatment options. It is one of the most safe and most effective options, healthcare options available for patients of all ages. This study examines the specific tissue damage indicators before and after a chiropractic manipulation. So it really gets down to a micro level, so to speak. There were no significant changes found in the creatine, phosphokinase, lactate dehydrogenase, C reactive protein, tropopin L myoglobin, neurospecific annuals or atalose blood levels after treatment. I am certainly not a chemist, but those were all of the items or tissue damage markers, inflammatory markers that the researchers were looking at and absolutely none of them were elevated post manipulation. This study does not negate, of course, any importance of a physician decision making when choosing proper technique based on evidence based guidelines, patient history, diagnostics, clinical presentation, all of the things that we touched on a moment ago. However, the research further emphasizes the well documented safety of chiropractic care. And let's take a look at a few quotes from this study that really frame what these researchers found. They found the aim of this preliminary study is to determine the possible noxious effects of spinal manipulation that gives a very distinct and very direct isolated goal of this study. They found spine manipulation is a manual therapy technique commonly applied which presents benefits for patients such as an anti inflammatory effect, pain relief and reduction of drug consumption. So interesting statement here and something that I really want to step out on for a moment. The researchers found, again this is such common knowledge that now in papers that are not even directly addressing these concerns, this sort of statement is stated as fact. Spinal manipulation is a manual therapy technique commonly applied which presents benefits for patients such as the anti inflammatory effect, pain relief, relief and reduction of drug consumption. These are very important milestones that the research has backed up regarding what we do every day as chiropractors. The research has also found our data show no changes in any of the studied damage markers. So these patients were receiving chiropractic adjustments. And these researchers found throughout all of those specific chemical compounds that were addressed that we spoke of earlier, they found our data show no changes in any of the studied damage markers. So again, not even, I mean they went through 1, 2, 3, 4, 5, 6, over half a dozen damage markers and none of them were elevated post adjustment. They also found, quote, lower cervical and thoracic manipulation techniques seem to be safe manual therapy which caused no harm to the health of a subject. So that really wraps up their findings as far as this goes. They found absolutely no indication or any increase in levels of tissue damage markers on a cellular level post adjustment. They emphasized the fact that spinal manipulation has been proven to have an anti inflammatory effect, provide pain relief and reduce drug consumption. And they also found unequivocally that there was zero indication of any harm to the health of any subject. So we highlighted this in February 2015 as one of our monthly research briefs. The research is out there. The research is extremely powerful. Whether you go with the evidence based chiropractor or you go alone. I just highly suggest, I cannot emphasize it enough. You are doing a disservice to your practice and potential patients by not reaching out to other physicians and emphasizing and highlighting the breadth and depth of the research supporting what we do as chiropractors. And that goes a long way towards building referral relationships. So here is, this is just another example of a research study which supports chiropractic care. And this supports it in an indirect fashion. It supports it in the manner that it shows that the chiropractic adjustment is a very safe and potentially, as they say, a very effective health care treatment option. So I like this study a lot. I like the fact that it's in disease markers, really a different journal, something that's not used to seeing chiropractic literature. I love the fact, again that it's in 2014. And I think it's a really interesting study that looked at a randomized control trial, cervical manipulation, thoracic manipulation, and a control group. And they found absolutely no indication post treatment that there was any damage whatsoever, thereby concluding that chiropractic care is an extraordinarily safe treatment option for patients out there. I'll also touch on just a couple other housekeeping items before we wrap up today. Number one, there are literally over 1,000 chiropractors listening to this podcast each and every week. Thank you for listening. If you would do me a huge favor if you have listened to this podcast, I would love to hear feedback on itunes, give some comments, give a rating. I think I have six or seven ratings out there and 1,000 docs listening per week. So if you have the opportunity, I would greatly, greatly appreciate it if you could take a moment and rate the podcast or give your thoughts on itunes. Especially if you've been enjoying this over the last six, seven months that we've been doing these podcasts. Weekly. That would be absolutely fantastic and I would greatly, greatly appreciate it. A second point is if you did receive your new Chiropractic economics magazine or publication in the mail, you will also find another article that they were gracious enough to have me write. So Daniel, thank you. At Chiropractic Economics I have a few articles in the last few episodes of Chiropractic Last few episodes, the last few issues of Chiropractic Economics. They are available. Those articles are available online. I've linked them from the Facebook page at the Evidence Based Chiropractor. I know that Chiropractic Economics has also promoted them across their social platforms, but you can find it But Tried and True in the print edition that come to your mailbox. So please check that out and if you like it, don't hesitate to let Chiropractic Economics know. I'm absolutely grateful to for them to look to me to be able to write those pieces. I look forward to doing plenty more as time goes on. So without further ado, I hope you have a absolutely fantastic Week in Practice doc. I'll be back next week with another fantastic podcast and until then, have a great week in practice and we will talk to you soon.

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Sam.