180- Fear of Movement and Chiropractic Adjustments

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are back with another piece of awesome research. We have all had those patients in our practice that are scared to move and it becomes a really challenging proposition when you see somebody who's in chronic pain who has that fear avoidance behavior, they don't want to move, they're scared to move. It is a real thing. And there's a new piece of research which is awesome. It was put out by the Journal of Pain and it is titled Brain mechanisms of Anticipated Painful movements and their Modulation by Manual Therapy and Chronic Low Back Pain. The researchers took a look at, hey, how does an adjustment or a spinal manipulation, can it affect the brain mechanisms? Can it affect the brain processes and help people get moving who are avoiding it like the plague? I think you're gonna really love the results of this one and we'll dive in momentarily. 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So if this has been something you've been putting off, a decision you been unsure of, if you're willing to make, I think I can make it worth your while and I would love to see you here in Tampa June 7th through June 9th. So hit me up at jeffevidence basedchiropractor.com, i'll communicate with you and make sure you get hooked up with one of those last two tickets. But as I said at the top, we are talking all about fear, avoidance behavior and how an adjustment or spinal manipulation can impact that. And this is a big, big topic we have all seen. I mean, I have seen a lot of patients gone through physical therapy and not getting results because they're not willing to do any of the active care. They're scared, they were injured doing emotion, they're terr to do any of those motions or associated motions again. And this can stunt recovery. It is a big, big deal. I'm gonna repeat the title of this paper. You can also check it out directly by hitting those episode show notes and there'll be a direct link down there. So the title of the paper was Brain mechanisms of Anticipated Painful Movements and their Modulation by Manual Therapy in Chronic Low Back Pain. This was put out by the Journal of pain in 2018 and it was featured. I featured it just for all members of the evidence based chiropractor because I know this is a paper you should be getting out and having conversations around. This is a paper that can open up some eyes and this is a paper that can stimulate referrals into your practice by communicating. So if that's what you're interested in, hit us up@the evidencebasedchiropractor.com and see what we have going on. So we all know anticipation and fear of movement related pain is a significant challenge when treating patients with chronic low back pain. It's one of the reasons why pain becomes chronic. People are unable to get the recovery so often. This fear of avoidance behavior can lead to negative, negative impact on quality of life, negative impact on overall health. And as we've discussed, it can really negative impact any recovery. So spinal manipulation has been proposed as a way to break this behavior by disrupting the relationship between fear, movement and pain anticipation. This study published by the American Pain Society in the Journal of Pain, examined the brain mechanisms of pain anticipation and how spinal manipulation can reduce fear avoidance behavior. Now the interesting thing is they found the brain process involved in the expectation of painful movement can be altered by spinal manipulation that is super powerful. So let's take a look at a few quotes here. These researchers found, quote, elevated anticipation of movement related pain is common in chronic low back pain and is associated with fear of movement and excessive avoidance behavior, which can be detrimental to health, quality of life and prevent recovery. Some of the couple things that we touched on at the top, people that are in chronic pain, they are scared to move because they feel like they can Only go downhill. When you're in that chronic state of pain, you're really in that negative cycle. You end up quite often being depressed. You end up being really scared about your body. You feel fragile, not resilient. And these are all things that we can address as chiropractors through how we speak with the patient and our interactions. But really, what gets me jazzed is when we learn of research like this that showcases it can also happen through the act of what we do as chiropractors, through that adjust. That's super impactful. The researchers also found, quote, a significant mixed design analysis of variance main effect of time indicated that expected pain from the exercises was reduced after spinal manipulation relative to before. A significant main effect of time indicated that fearfulness was reduced after spinal manipulation relative to before. So, again, some of that's technical jargon in terms of how they measured things. When I say a mixed design analysis and when I talk about main effect of time, time. But the big deal with that is ultimately, they found that the expected pain from exercises was reduced after a manipulation. They also found that a fearfulness was reduced after manipulation. And generally speaking, the way that the researchers, you know, did this was they showed patients, you know, exercises that might be deemed painful. And then they asked them, you know, are you scared? I'm simplifying the process. But they kind of ask them, hey, are you scared to do an exercise like this? And then, you know, so that was one group. The other group, those individuals, they gave a spinal manipulation. They showed them the video, and they said, would you be scared? And then they measured brain activity. So it wasn't just subjective, like, hey, are you scared to do this? You know, it was really also measuring the brain activity. And what they found was a decrease in those areas of the brain that light up with anticipation, emotion, or fearfulness. And consequently, the patients also reported that they were much more apt to do those exercises. And they also reported that they were much less fearful to do those exercises. And that is super powerful. Imagine, imagine taking somebody who's been scared of moving chronic pain. Who Cares how long? 1 year, 3 year, 5 year? This is significant life impact that people are dealing with. And you can turn that around and get them moving with a manipulation, man, that can change somebody's life. Finally, the researchers found, quote, spinal manipulation, reduced clinical pain, fear of movement, and expected pain from the back straining exercise. So this is so impactful. Again, I keep using that word because I don't know any other one to use when we talk about reducing clinical pain. So not only Did a manipulation reduce pain? We already know that, but it also reduced that fear of movement. It also reduced the expected pain that starts to become something that you can really take advantage of in your practice. It's also something that you can really take advantage of. Think of how many people are going to great physical therapists day in and day out and failing the care because they're not engaged, failing that care because the care is built on active exercise, typically in a physical therapy office. And if the patient's unhealthy, unwilling to engage with that, these are where physical therapy clinics potentially have huge drop offs, 20, 30% or more. Imagine the referrals you could get if you were that safety net. Imagine the lives that you could change if you were getting out in front of this story, having conversations with the other healthcare providers in your community, exposing them to what you can do as a chiropractor, not only through the modalities that you offer, not only through your unique selling proposition and how you guide patients with back through the recovery process, but when we dive deep into the literature, when we dive deep into how an adjustment, how is spinal manipulation as we've talked about, how can it affect the disc? How can it affect the facet joint, how can it affect the central nervous system? How can it affect biochemical markers? And how can it affect, in this case brain mechanisms and processes that are relative to fear, avoidance behavior that becomes a really big deal as you get out and communicate with other healthcare providers. Incidentally, brought up a bunch of things there, right facet I brought up central nervous system. Check back on previous episodes of the evidence based Chiropractor podcast where we dive deep into all of those mechanisms of action, so to speak, regarding a manipulation or an adjustment. But I hope this really gets you jazzed. I hope it gets you excited to get into practice this week. Hope it gets you excited to take on those challenging cases. And most importantly, I hope it gets you excited to reach out to the other healthcare providers in your community. I see so many chiropractors that just, just aren't taking that bull by the horns. They're not the onus, they're not taking that onus on themselves. To get out there and constantly communicate, to get out there and do some of that grind, to get out there and showcase what you do every day, all day, with a few very simple changes to probably how you're doing things. And I don't mean technique and I don't mean practice. I mean simple changes like getting case notes out in a simple and effective manner to showcase the results that you get. I mean simple changes like getting research out monthly to these other healthcare provider to stay top of mind, to showcase who you are, what you do and what you stand for and then to get out there, this other simple change, the third one, to get out there and take some meetings, have a nice framework to do. So we give all of the scripting for that, we give all of the frameworks, we give all of the material, all of the reports, templates and guides to all of our members of the evidence based Chiropractor. So if this is something that you've thought about, something that you've considered, something you've known you have to do that is reaching out to other healthcare providers, there is nobody that's done it longer, there's nobody that's guided more chiropractors and quite frankly there's nobody that's gotten out more positive communications about chiropractic than we have at the evidence based chiropractor. I believe I tallied it up and we had last year put out something like 500 half a million positive communications, updated research briefs showcasing chiropractic clinics to other healthcare providers. Half a million. That's something I'm exquisitely proud of. I couldn't do it without every single member of the evidence based chiropractor across four different continents getting out to the docs in their community. And it's something that in my opinion it's the first step of change. So if this it's is information that excites you, if it's information that you know you need to share, visit us at the Evidence Based Chiropractor. If it's something you continue to want to think about, that's cool too. I'd invite you keep on listening to the podcast where we're going to be putting out good material. As I always think about, the evidence based chiropractor is that intersection of marketing and research. And if at any point you have questions about anything to do with marketing or research, feel free to shoot me an email. Jeffevidencebasedchiropractor.com I'm here to support you. I'm here to be your guide and help you the best ways that I can to achieve what you want in your practice. Anything I can help you on the marketing or research front, hit me up jeff@the evidencebasedchiropractor.com and kind of the burning fire behind that. If you want to come down and work with me one on one June 7th through June 9th here in Tampa, Florida. As I said at the top, I have two tickets that just opened up, so shoot me an email and I'll work everything out with you. Jeffevidencebasedchirofractor.com I hope you have a great week in practice and I will talk to you soon.

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