041- How the Chiropractic Adjustment Impacts the Central Nervous System

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Hello. Welcome to the Evidence Based Chiropractor. I am your host, Dr. Dr. Jeff Langmaid. This week we're gonna touch on a piece of research that gets to the point of what we do as chiropractors each and every day in practice. This piece of research highlights how the spinal manipulation or the chiropractic adjustment impacts the central nervous system of our patients. So it's important from a confidence building standpoint and also from a relationship building standpoint. Before we get started, I'd like to say a few words about Rock Tape. Rock Tape is proud to be a sponsor of the evidence based Chiropractor. Rock Tape offers the world's best kinesiology tape, mobility tools and pain relief topicals. New from Rock Tape is rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. Learn more and get access to your medical discount by visiting rocktape.com so for this week's piece we are looking at a highlighted piece of research peer reviewed from JMPT. It was released in the year 2002 and it was an award winning piece of research which analyzed again how the chiropractic adjustment impacts the central nervous system. We've highlighted time and time again the multifactorial way that a chiropractic adjustment can impact a patient in terms of decreasing pain, in terms of increasing function. We talked about gapping the facet joints, we have certainly talked about activating muscle spindle fibers. But perhaps most importantly, and a tenet of chiropractic going back nearly 100 or more years has been the impact on the central nervous system. So the piece of research that we'll speak of today, I'll give you the title, it is Central Motor Excitability Changes After Spinal Manipulation. A Transcranial Magnetic Stimulation Study. So that is a lot to handle and I will repeat that one more time. Central Motor Excitability Changes After Spinal Manipulation A Transcranial Magnetic Stimulation Study. So again, one of the big challenges that we have as chiropractors, of course, is making sure that we can accurately display and communicate what we do and how our care impacts a patient's health. For many years we did not have the breadth and depth of research that we're fortunate to have today. So there was a lot of myth and conjecture regarding how a chiropractic adjustment may work. Now we know as we touched on earlier, there is gapping of those facet joints, there is stimulation to the central nervous system, and of course there's activation of the muscle spindle fibers. This all results in increased range of motion, better mobility, improved function and decreased pain. So with this study they have a couple quotes that I'd like to touch on today. One of them is quote, the purpose of this study was to determine the effects of lumbar SMT spinal manipulative therapy on the central motor system by using transcranial magnetic stimulation to activate the gastrocnemius muscle. So all that sentence is telling us is basically the setup of the study. They're looking for the impact that a chiropractic adjustment will have based on transcranial magnetic stimulation. The Researchers also found MEP amplitudes were significantly facilitated from from 20 to 60 seconds after the L5S1 adjustment procedure as compared with the pre baseline value. So what that statement tells us is that there was a significant difference between the control group and between the group that received that chiropractic adjustment. So there was definitive impact on the central nervous system. These researchers also found. This data suggests that there is a post synaptic facilitation of alpha motor neuron, cortico motorcurons or both that may be specific to the high velocity low amplitude thrust. So there's a few key pieces of data there. Number one is that they're letting us know the actual fibers that are stimulated or structures that are stimulated by during that chiropractic adjustment. So they looked at again the alpha motor neuron and the corticomotor neurons secondarily they found or they highlighted that during that procedure or during that adjustment there was post synaptic facilitation. And what that tells us is that it was after the communication channel. So a stimulant had to occur for, for there to be that post synaptic facilitation. And third, they specify it with a high velocity low amplitude adjustment, an hvla. So that's a unique aspect of chiropractic care that we get into that paraphysiological range of motion, specifically with the high velocity techniques. Of course there are our activator techniques, our Cox flexion distraction techniques, network techniques, low force or non force techniques. But in your traditional diversified adjustments, your traditional gonstead adjustments, those high velocity low amplitude adjustments that chiropractors are inherently known for, they're Telling us that there may be a specific facilitation as a result of getting into that paraphysiological space. So I like this study for a number of reasons. Number one is it truly becomes laser focused in terms of the structures that we are impacting with our high velocity low amplitude adjustments. Truly from a transcranial magnetic stimulation aspect, they are literally looking at individual structures that are stimulated and postsynaptically how is that facilitation distributed. So it's exceptionally accurate in terms of how we can get that data. The other thing that they're looking at is when we look at the motor evoked potentials here, we see that there's a pre baseline and then they break it up into a 20 to 120 second post manipulation, a 5 minute post and a 10 minute post. And if you see and our members did when they received this as a research brief in April of 2016, you truly are able to see the changes associated as time goes on. So there becomes no question based upon their findings and that the chiropractic manipulation is where the true offset in the facilitation occurs. And then as time goes on, those numbers or the control group versus the active chiropractic group become a lot closer in terms of those motor evoked potentials. So that gets a little bit technical. But I think it's important to understand that the central nervous system is ultimately being affected by and in a great capacity by what we do throughout our high velocity low amplitude adjustments. Now, from a communication perspective, in my opinion, it's always important to showcase the array of what we do as chiropractors. Meaning many times medical doctors or other professionals may confuse the art of chiropractic with the profession of chiropractic. And all they see or think when they hear chiropractic is a high velocity low amplitude adjustment. Now our paper today truly showcased that technique or the bundle of techniques associated with that. However, showcasing a low velocity technique to counterpoint this is important as I speak of all the time with the chiropractors I speak to around the globe. When a medical doctor or another healthcare professional sees a patient in acute distress with a total lack of mobility, the last thing they think can help is, is a big chiropractic adjustment into that area we know as chiropractors that might be exactly what the patient needs. But being able to accurately describe a variety of high velocity as we touch on here and low velocity techniques will open up the array and the scale of the patients you can treat because it will make a lot more clinical sense to the primary care doctor, MD, or do with a rudimentary understanding of what we actually do as chiropractors. So I think this study truly highlights an aspect of how the chiropractic adjustment works in a high velocity capacity, but it also always needs to be offset against the totality of what we do as chiropractors. So the citation to this will be in the show notes, so please click below. I'll repeat the title one more time. The title of this was Central Motor Excitability Changes after Spinal Manipulation, A Transcranial Magnetic Stimulation Study. It was released again by JMPT in January of 2012 and we highlighted this in April 2016 as one of our monthly research briefs. If you want to build relationships, if you want to grow and develop your practice through referral relationships and by positioning your practice as the local leader in musculoskeletal care, then I absolutely encourage you to click and learn more about the Evidence Based Chiropractor and what we are doing. Because building referral relationships are truly items that can change the health of your community, change the health of your friends and neighbors. I hope you have a fantastic week in practice Doc and I'll talk to you soon.

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