100% Of Pain Studies Showed This After One Adjustment | #555
In this episode of The Evidence‑Based Chiropractor, Dr. Jeff Langmaid reviews a 2026 scoping review published in the European Journal of Neuroscience that examined how spinal adjustments and mobilizations affect the central nervous system. The review screened ~2,500 records and identified 26 studies using various neuroimaging techniques (TMS, fMRI, SEP, EEG, PET, MRS) to assess brain activity after manual therapy. Across these studies, consistent neurophysiological changes were reported: increased motor‑cortex excitability, altered functional connectivity, and modified sensory‑motor integration. Brain regions most frequently implicated included the pre‑frontal cortex, primary motor and somatosensory cortices, thalamus, anterior cingulate cortex, and periaqueductal gray—areas involved in pain processing, movement planning, emotion, and descending pain modulation. All 14 studies that measured pain reported reductions in pain scores after the intervention, though causality between brain changes and pain relief remains unproven. Dr. Langmaid emphasizes the clinical relevance of these findings, suggesting practitioners strategically sequence exercises, rehabilitation, and other interventions around the adjustment to capitalize on short‑term neurophysiological windows. He also highlights the broader public‑health burden of neck and low‑back pain, the challenges of non‑specific diagnoses, and the potential for chiropractic care to influence central nervous system mechanisms. The episode concludes with practical take‑aways, sponsor acknowledgments, and a call to integrate these insights into everyday practice.
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Hello and welcome to The Evidence-Based Chiropractor. I am your host, Dr. Jeff Langmaid. This week we are back with more brand new research all about the adjustment and the brain. Brand new study. We're going to highlight what it says, what it means, how you can use it in your practice, and more. Before we get started, big shout out to Leander Tables. You can save $750 off their Series 950 by using the code EBC2026 or connect with their teams who are looking to upgrade that clinical gear. Speaking of that, Shockwave Centers of America, $500 off and a free cart for being a listener. Big savings right there, right at the top of the show. But as I said, for today's episode, it's all about the research, and we are going to discuss a study titled Neurophysiological Response of Spinal Mobilization and Manipulation in Individuals with and Without Musculoskeletal spine disorders. And this is a scoping review. So we probably have all had patients come in, we deliver care, we deliver that awesome adjustment. They get up and they feel different. They feel better, but it's like this opaque feeling. And the question often is, well, what exactly changed? It wasn't that a degenerative disc magically regenerated or that their arthritis disappeared by any stretch of the imagination, but something else Happened. You know, you delivered a specific mechanical input, the adjustment, and their nervous system responded in a very direct manner. And that's really the concept and idea at the center of this study. So published in 2026, European Journal of Neuroscience, we'll drop that link down below. And the review asks a pretty interesting question, you know, what happens in the brain after a spinal adjustment or mobilization? Yeah. Not just what happens to range of motion, not just what happens to pain scores, but what, you know, what can the researchers actually detect using things like functional MRI, transcranial magnetic stimulation, EEG, PET scans, other forms of brain imaging? And the answer is, it's pretty cool. So the broad takeaway is that spinal adjustments appear to be definitively capable of changing activity and connectivity in areas of the brain involved in pain processing, movement, sensory integration, motor control. We don't have strong evidence yet that prove that these specific brain changes are directly responsible for clinical improvement. So this is the start of, I think, a longer, really cool story that's going to unfold in the literature over time, as we can start to understand more and more about As I like to say, the breadth and depth of what happens when an adjustment is delivered. So if we kind of take it from the foundations, you know, neck and low back pain, big public health problems, as you're well aware of. The authors of this study note that together, neck and low back pain account for approximately 10% of the total years lived with disability around the world. So it's a pretty staggering burden. And one of the persistent challenges that we see is many people with neck or back pain do not receive like a neat, wicked-specific structural diagnosis, right? Non-specific low back pain is one of the most common things. So non-specific neck pain. So the patient has the pain, the patient comes in, they have the functional limitations, but there's always— there's not always a clearly identifiable tissue or source that explains the entire experience. Now, I personally think us as chiropractors do as good of a job as anybody, probably some of the best job out there in terms of being able to assess function, structure, movement assessments, and being able to delineate that far better than many other types of clinicians out there. But it still can be pretty challenging. And often it's not just one thing, right? It's a constellation of items. And that matters because pain, and especially chronic or persistent pain, It's not always a direct readout of tissue damage. The pain can involve things like sensory information, movement, expectations, emotions, attention, memory, perceived threat, all of those things. And quite often, people with chronic neck or low back pain also demonstrate structural, functional, and neurochemical changes within the brain. So it does not mean that their pain is imaginary. It means that their nervous system is adapting In a negative way, often when the pain persists, when acute becomes chronic, et cetera. Brought to you by CarePlan Pro. Build care plans in seconds, present them with confidence, and grow your recurring revenue through memberships and concierge. See how at careplanpro.ai. The researchers in this study wanted to understand whether spinal adjustments might influence— spinal manual therapy might influence some of those central nervous system processes. So they kind of split this down into buckets, as you heard at the top, spinal adjustments and spinal mobilization. Both approaches super common. And ultimately, they were seeing a joint restricted, a segment wasn't moving properly, the muscle was tight. The care and treatment could change the mechanics, and often we see that patient improve, but that's not the whole story. So many of the contemporary models that you probably studied, you recognize that manual intervention can create a cascade of items, mechanical, neurological, neuromuscular, neurophysiological, all of those effects. And when your hands contact your patient's body, the nervous system interprets that input and something different and special happens again when we get into that paraphysiological space. So this review followed the PRISMA guidelines and they identified nearly 2,500 records. They obviously chopped that down quite a bit. So there's 2,500 records, they ended up with 26 studies. So it's an emerging area of research. And it also shows us that they're really specific in what they were looking at. So of those 26 studies, 8 used transcranial magnetic stimulation for assessment, 7 used functional MRI, 5 somatosensory evoked potentials, 2 used EEG, and 2 used PET scans. And then a couple others used proton magnetic resonance spectroscopy. Wow, that's a mouthful. So the studies varied widely in design. Some were crossover trials, randomized controlled, et cetera. That variety gives us a really nice broad picture. In terms of what was going on. So most of the 26 studies reported a measurable neurophysiological change after spinal manipulation or mobilization. The strongest and most consistent patterns were found in 3 areas directly, changes in the motor cortex excitability, changes in brain activity and functional connectivity, and changes in sensory motor integration. So the brain regions that appeared most consistently across the research included things like the prefrontal cortex, Primary motor and somatosensory cortices, thalamus, anterior cingulate cortex, and the periaqueductal gray. So all of those, as you probably know, have dramatically different jobs, but collectively, they're involved in things like sensory processing, movement planning. Some of this should sound really familiar as a chiropractor. Attention, emotion, threat evaluation, and descending pain modulation. So all of those things that are just the infrastructure that are critically important to somebody being able to live their life properly by not having that overexcited, but also critically important for us as chiropractors because man, these are things that we live and breathe all day, every day in our practice, being able to influence those things, being able to assess those items to the best of our ability, whether through direct or indirect means, and ultimately being able to guide our patients towards a better life. If we want to break down a few of the numbers from the study, across the 8 TMS studies, there are about 200 total participants. 6 of those 8 studies reported significant changes in their primary neurophysiological outcomes after the adjustment. So that's 75% of the TMS studies right there. Across the 7 functional MRI studies, there was about 283 participants. Every one of those 7 studies reported a significant change in brain region activity. Oh, wow. or functional connectivity following spinal manual therapy. So it, it's pretty intense. And one interpretation is kind of, quote, across multiple studies and multiple imaging approaches, spinal manual therapy appears to influence brain networks involved in pain sensation, movement, and emotional processing. Like, how powerful is that to think about what you're doing can impact all of those items? This goes so far beyond The segment itself or the region itself, which, hey, that's important. You need to get those segments moving appropriately, get the body regions moving to the best of their ability. But man, being able to make this massive impact at a brain level, it's just, just so important. There were 14 studies that assessed some form of pain, like pain intensity or unpleasantness. Every study measuring pain after the intervention showed a reduction in pain scores. I'll repeat that. Wow. every study measuring pain showed a reduction in pain scores. So not every score reduction was statistically significant, but all of them lowered it. So, you know, none of the studies directly established that observed brain changes caused the reduction, but that would be a heck of a coincidence if it didn't have an impact on it, as you can imagine. So what did the different technologies show? We've highlighted some of it, but if we want to dive deeper into TMS, transcranial magnetic stimulation, it uses a magnetic pulse over the skull to stimulate areas of the motor cortex. And then the researchers can measure that response in a muscle. So there were several TMS studies that found changes in motor evoked potentials, cortical inhibition, or cortical spinal output after an adjustment. So basically in plain English, the adjustments appear to temporarily change how readily the nervous system could activate certain muscles. So I think that's really, really cool. Other studies examined lumbocanal adjustments and found an increase in excitability that disappeared rapidly, like Super rapidly. So like within seconds. So it's fascinating to see the bursts of activity that occur after an adjustment is given. And some of it kind of falls off quickly. Some of it, you know, it takes a little bit longer. Some of it has more long-term effect. And it's fascinating to see as they get more and more specificity with these studies, what are the short-term effects? What are the midterm effects? What are the long-term effects? And when you stack adjustments throughout a care plan, how does that impact things as well? Yeah. That goes beyond this study today, but man, it's going to be super cool to see this knowledge base continue to evolve as time goes on. Functional MRI, as I mentioned, gives another perspective. Instead of directly stimulating the motor cortex, functional MRI measures changes in blood flow associated with brain activity. So all 7 functional MRI studies found changes following the spinal adjustment. The changes appeared in networks associated with sensory processing, excuse me, motor control, pain evaluation, emotional responses, movement-related fear, and descending pain inhibition. So again, fascinating to see these, these show up. In another study of chronic low back pain, the researchers found differences between manipulation mobilization in brain regions in pain expectation, sensory integration, emotional regulation, and fear of movement. So, you know, patients don't experience pain in a vacuum, right? People might have different thresholds in terms of what they can expect or what they are fearing throughout their motion. We see that all day, every day. So it's interesting to see how the different ways to test brain activity were showcasing the different ways of impact through the adjustment after it was delivered. And if we looked at sensory, somatosensory evoked potentials, all 5 SEP studies reported changes consistent with altered sensory motor integration. So these findings were associated with cervical or whole spine adjustments and involved people with recurrent neck pain, chronic neck pain, and spinal dysfunction. So the authors interpreted those findings as support for the hypothesis that adjustments can induce neuroplastic changes within sensory motor networks. How cool and powerful is that? So— That is important. Neuroplasticity means the nervous system can change in response to the input and experience. And then the final batch was those EEGs, PET scans, magnetic resonance, and they showed, I'll say, kind of a mixed bag. Ultimately, there were 2 PET studies and 2 spectroscopy studies that did show impact in the neurochemical activity in areas involved in pain processing. So these were just really, really cool studies, and it showcases to us— I think this is another peek into the future of chiropractic research, understanding how the brain is impacted, understanding what's going on to the best of our ability, and now being able to say, okay, great, now let's continue to to pull on that thread. Let's continue to understand more and more about how what we do with, you know, care that you can deliver with your hands is impacting the segment, it's impacting the region, it's impacting the brain. It's literally impacting, you know, a multitude of areas on the individual. And in many cases, you know, we start to look at some of these Studies like this. And man, it's bringing about all of the items that if we can have a wish list, you know, in terms of saying, wow, if, if an adjustment could impact X, Y, and Z, I would love to have it. And this just shows it time and time again— motor control, sensory processing, pain inhibition. All of these items are being impacted by the care that you deliver. It also, in my opinion, is a nice kick for us to say, take advantage of that while you can. Now, what do I mean by that? When you deliver an adjustment in your practice, there are a— it's a burst of input to that individual. So when you are thinking about exercise, when you're thinking about rehab, when you're thinking about any other care that you'd be delivering, think about it thoughtfully. When should you position that, before or after the adjustment? How do you want to reinforce movement is safe? How do you want to reinforce the exercise and the movement assessments that you're doing pre and/or post? And being able to sequence that in a way that maximizes the patient's benefit is a really good idea because there is something to be said in terms of the clock ticking once you deliver that adjustment. Again, there are long-term effects and long-term ramifications, but there are some short-term items that you can take advantage of as well. So ensuring that your approach clinically through the care you deliver is sequenced correctly, I think, is a really good opportunity To who knows how much bump up your results, 5%, 50%, who knows, depends upon the patient, the sequencing, and what they need. But that's a really important component of all of this. So I love this study because it showcases that spinal adjustments and mobilization appear capable of producing true measurable changes in the central nervous system across all of these studies measured in different ways. I'll drop a link down in the show notes so you can check it out. Also, big shout out to 2 other partners, Dr. Grant Elliott with the RehabFix Hybrid Program. If you're looking to help people beyond the 4 walls of your practice, keeping your brick and mortar, but expanding your ability to help people beyond that, there's nobody better than Grant to help you with that. They call it the RehabFix Hybrid Program. You can create a lot of revenue and help a lot of people using this program. Have a conversation if you're interested. I'll drop that link down below, as well as the NovoPulse OA Recovery Program, hardware and software to take care of individuals with osteoarthritis. And they have a new managed service option that enables you to bring NovoPulse into your practice, zero out-of-pocket expense. Yes, you heard that right, zero out-of-pocket expense. Literally no reason not to check it out. I'll drop that link down in the show notes as well. Whether this is your first episode tuning in or 550th episode tuning in, thank you so much for doing so. If you have not left a rating or review, I would deeply appreciate it if you would do so. Thanks for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice, and I will talk to you soon. Bye. Thank you for joining us on this episode of The Evidence-Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD marketing membership today. Thank you.
