121- Adjusting the Thoracic Spine for Neck Pain

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we have a great piece of research that is applicable to your practice. Probably today and definitely this week we are going to talk about a piece of research that showcased the impact that thoracic adjustments can have on cervical pain. Very good study. We probably have all had patients come in that have had a lot of fusion work done in the cervical spine. Perhaps there are other reasons why the cervical spine is off limits. This showcases the impact that thoracic adjustments can have for those patients. A very nice piece of research and one that is certainly applicable to your practice. Before we get started, I will say a few words about Rock Tape. Rock Tape is revolutionizing the soft tissue world again with the new Rock Blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polish tool and two attachments silicon sleeve and an ABS comb. Rockblade's Mohawk unlock never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide and neuropathy. You can pick them up for 175 bucks. You can learn more and explore educational courses@rocktape.com Mohawk but as we talked about at the top this is going to be today is going to be all about cervical pain, neck pain and how a thoracic adjustment can impact that. So the title of this piece is called Immediate changes in Neck Pain Intensity and Widespread Pressure Pain Sensitivity in patients with Bilateral Chronic Mechanical neck Pain. A randomized controlled trial of Thoracic thrust manipulation versus non thrust manipulation. So a couple things there it touches on our favorite rct, our randomized controlled trials. This was released by JMPT in June of 2014 and I will link it as well in the show notes. So we all know chronic unresolving mechanical neck pain extremely difficult to treat in the medical world, right? From a primary care perspective, even a patient, let's say that has had some work done. As we touched on at the top, I certainly have seen C1 and C2 fusions straight on through to T2, T3. It's not something that any of us like to see in practice. But if you've been out a little while, you probably have seen it come across your, you know, your desk, so to speak, that patient walk in your office and you know for us There are a few options that we have, including looking towards the thoracic spine, as we'll talk about. But if you think about it from the other side of the coin, a primary care doctor, a surgeon, a physiatrist, once that work has been done, there is no going back. So we are absolutely the best option many times for these individuals. And having a nice tool set, knowing some of the research behind it and being confident, taking care of these people can go a long way towards improving their quality of life, which is what it's all about. So, and you know, this goes on, the avalanche that we've seen lately of hey, non pharmacological, conservative options are many times the best, the best way to go, you know, whether it's the beginning, whether it's, you know, cute, whether it's chronic or anything in between. So, you know, you know, for patients that maybe haven't had a lot of work done, surgically weakened and aberrant posture is often present. And these two things go hand in hand because when we think about the coupled motion between the cervical spine and the thoracic spine, they play together. This is when we see, you know, hyperkyphotic thoracic spine. And we certainly see changes in that, you know, whether it's hypo or hyperlordotic in the cervical spine as a result of a long term kind of hunchback, that classic positioning in the office that far too many people are doing these days, spending 6, 8, 10 hours at a desk, hunched over, looking at a computer, then they get off of that. And what do we know that they do, including us? Sometimes we're looking at the smartphones, we're looking at the iPads, further contributing to that aberrant posture. And that's a big deal because over time we see again muscles that become spasmed and shortened. Over time, we see a decrease in strength of other supporting muscles of those areas. And this plays a huge role in pain patterns long term. And many times again, structure and function work together. So we start functioning at a lower level, the structures start changing over time. We can see osteophytes grow advanced degenerative changes as our posture deteriorates, which is why it's so important to get on that early. But again, we've all seen many people come through our practices that are working on decades of degenerative change. So active exercise, postural strengthening should be a part of the treatment plan. But please don't forget, segmental biomechanics have to be addressed. And that is where I believe the Chiropractic adjustment comes in so crucial for these individuals. So let's take a look at a few quotes that the researchers found. Again, these researchers looked at. I'm gonna repeat the title one more time. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain. Randomized control trial of thoracic thrust manipulation versus non thrust manipulation. So the researchers found a couple interesting things. They found first, quote, neck pain is a common musculoskeletal complaint with a point prevalence of around 15% in males and 23% in females. Point prevalence, of course, is the percentage of a given population at a given moment in time that is suffering from it. So if you took 100 males and put them in a room at 30, at that moment, 15 of them would be suffering from this type of pain. Bilateral chronic mechanical neck pain, very important there. 23% of females, 23 out of 100, you take 100 females, 23 have neck pain right there. So you tell me there's not a good need for chiropractic in the marketplace? You gotta be kidding me. Because we just look at these numbers and they become astronomical. You throw low back pain in there, it goes through the roof. But anyhow, additionally, the researchers found, quote, individuals who received thoracic thrust manipulation experienced significantly great reductions in neck pain as measured by the numerical pain scale at one week. Follow up. Very important words there, right? So these patients received a thoracic thrust manipulation, high velocity, low amplitude manipulation, and they experienced significantly great reductions in neck pain at one week. Significant is important in the literature. They don't throw that around. It has to meet a threshold to get that statement behind it. And, and finally, the researchers also found the most likely hypothesis for spinal thrust manipulation to act is through the stimulation of descending inhibitory mechanisms, particularly the periaqueductyl gray matter. This assumption is mainly based on the premise that spinal thrust manipulation exerts a mechanical hypoalgesic effect, thereby increasing pressure pain thresholds. Lot to digest in that statement. I'm gonna repeat it one more time, then we'll dive in. Bit by. Researchers found the most likely hypothesis for spinal thrust manipulation to act is through the stimulation of descending inhibitory mechanisms, particularly the periaqueducty gray matter. This assumption is mainly based on the premise that spinal thrust manipulation exerts a mechanical hypoalgesic effect, thereby increasing pressure pain threshold. So let's break that down a little bit. Lot to chew on with that. They're talking about a spinal thrust manipulation and they are talking about the periaqueductal gray matter, something we probably all vaguely remember from chiropractic school. But basically that's a descending inhibitory mechanism in the gray matter. So it is impacting the nervous system. Makes sense. Additionally, if we break down the back half of that statement, it is talking about the spinal thrust manipulation exerting a mechanical hypoalgesic effect. That means that physical nature of it needs to take place, right? Mechanical. There's a mechanical effect that provides pain relief, a hypoalgesic effect, thereby also, as they say at the end, increasing pressure pain thresholds. So again, I think of this like an old fashioned. This is maybe really going to date me. But if you go to a fair or something like that and you have the bell on the top of this, you know, you hit the, you hit the mechanism with a big huge hammer and the lead goes up and taps the bell. Or if you don't hit the button hard enough, it never reaches it. I think of pressure pain. That might be the worst explanation ever. I apologize for that. But if you get that, bear with me here, the pressure pain threshold, I think of like that. If you can bring up that threshold, that's like taking that bell and driving it another 10ft higher in the air. Meaning it takes a lot more force, it takes a lot more with that hammer to get the lead up there to hit the bell. And that is a good thing in many situations, right? You have a great, their threshold is high. That means your body is able to adapt and deal with a lot of things, you know, potential irritants without causing pain. Whereas if you are hypersensitive, right, you know, fight or flight, if your sympathetic nervous system is all frizzled out and you know, on 10, well now you are hypersensitive to stimulus. And if you're hypersensitive to stimulus, it's not going to take much of that stimulus to cause a reaction or overreaction in this case, which would be the result of pain. So long story short with this paper, I like it. I think it's a great one to use in your practice. The average person in this study was 33 years old. The average pain was over 2 years. So this chronic pain for many people had been sticking around a while. Important to remember that, hey, if there is that patient that walks in your front door who, whether it's by them, whether it's by you, whether it's by circumstance, you cannot get in and really adjust that cervical spine and don't hesitate. The research stands behind you, don't hesitate to look towards the thoracic spine. Now that's not saying anything about the documentation side of things, so make sure your documentation's tight. Make sure that you are crossing your T's and dotting your eyes as far as that's concerned. But I have no doubt we've probably all seen it before. When you can impact somebody's cervical thoracic spine, you can improve their quality of life dramatically. And with the coupled motion between those two with the upper Cross syndrome, with every everything that we see each and every day in practice, it is an absolute game changer for many people when you can start adjusting different regions of their spine, get better motion in the regions next door, and help return their quality of life. So that is it for this week. Don't hesitate to look at that thoracic spine on patients with cervical spine complaints. Utilize the research, check out the link to it in the episode show notes and please leave us some ratings, feedback or comments on itunes. It helps us reach more and more chiropractors each and every week. I hope you have a fantastic week in practice and I will talk to you soon.

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