183- Symmetry Changes After a Spinal Adjustment

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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 the research and we are touching on a study that came out just last year in the British Medical Journal and it ties together adjustments, spinal symmetry and sports performance. This has some take home messages you can utilize today with your patients. So it is a good one. Before we get started, I'll say a few words about Rock Tape. If you have not picked up your tickets to rock stock 2019, you gotta get on it. It is one of those events that you need to have on your calendar. It's all about movement. It's happening in Southern California this fall, Huntington Beach. I'm gonna be out there filming, hanging out, having a good time and they know how to put on an event. So if you have some interest in heading out and getting some continuing education credits, but more importantly, really meeting a bunch of really cool docs, having a great educational weekend, get out to Rocktape's Rock Stock 2019 and pick up your tickets now at Rocktape.com now as I said at the top, we are talking all about a study that came out in 2018 in BMJ Open in sport and Exercise Medicine and it is titled the Effects of a Single Session of Lumbar Spinal Manipulative Therapy in Terms of Physical Performance Test Symmetry in an Asymptomatic Athlete. A single blinded Randomized Controlled study. I should have said athletes, not athlete. It was more than one individual in the study and I'll repeat that one more time because it is a long title. The Effects of a Single Session of Lumbar Spinal Manipulative Therapy in Terms of Physical Performance Test Symmetry in Asymptomatic Athletes. A single blinded randomized controlled study. So what the researchers cite, which I thought was really, really interesting, were that musculoskeletal disorders in athletes, including spinal biomechanical challenges or dysfunctions, which are often asymptomatic, are believed to negatively influence physical performance in terms of symmetry. So that was interesting. I'd never really thought about it that way, but this kind of framed it in a. That made sense to me and I think you're going to like what they found as they continued to go through and do some trials and do some tests. So basically what they did is they took a bunch of individuals and they used what is called a symmetry index. So the symmetry index basically is modeled after a percentage, and that is either how symmetrical or asymmetrical you are. And the way that they tested that or looked at it was using motion capture technology. So it starts to get really, really interesting when you start to think about, man, really breaking this, no pun intended, to a science. And they looked at it in sort of three different ways. Static positioning and then in two movements, squat and a counter movement jump. And they basically did a spinal manipulation and adjustment or a sham adjustment. So that was kind of the control. And they did pre and post. So static positioning, squat and counter movement jump. So, and they measured this using motion capture technology and utilizing a item called symmetry index, which I had not heard of. So the symmetry index, which is a percentage, is the method most commonly used and cited in publications to report bilateral asymmetries in physical performance tests. I didn't know that, but here we go. They also said the symmetry index expresses a percentage with 0% representing perfect symmetry, indicating a more symmetrical pattern. And 100% representing complete asymmetry was used to assess the differences in the bilateral symmetry on these individuals. So what did they find? That is the question, right? They found, quote, before interventions, the participants presented asymmetrical values in the spinal manipulation group with mean values of 16.3%, and the sham group presented mean values of 10.7%, indicating that some participants had considerable asymmetry. Okay, so they go through their tests, they give an adjustment. What did they find? They found, in conclusion, our randomized controlled study. Statistically significant differences were found between pre and post spinal manipulation therapy and between groups for static symmetry only. So that starts to get really interesting. So basically, I'm gonna break that down exactly what that means. They randomized the groups, and it was randomized control study. And for the individuals who received an adjustment, there is a statistically significant difference in symmetry. So an improvement in symmetry post adjustment. Now, there's one caveat there. They found that with the static symmetry only. So they did not find that in that counter move jump, and they did not find it in the squat. There's a couple different reasons why that could happen. The dynamic is a lot more difficult to capture, so there could have been errors that way, or perhaps it just. There wasn't anything once somebody started moving. But from a static symmetry perspective, they found big differences, statistically significant differences with the individuals who received an adjustment. And the individuals who received sham adjustment did not. Did not have any Changes ultimately nothing that was statistically significant in terms of symmetry. So let's touch on one other aspect of it. The researchers also had quoted post spinal manipulation intervention. These values reduced significantly to what several authors such as Herzog et al considered to be the minimum level of bilateral asymmetry, with asymmetry values ranging from 4 to 13%. So if you remember what we talked about just a moment ago, some people the mean value Pre was over 16% and they pulled that down in some individuals to 4% with zero being perfect symmetry. Now, I don't think we need to get crazy, right? Our bodies are dynamic. Nobody is built perfectly symmetrical. It's just not the way it goes. But we know based upon what they cite in this literature and some other studies that have come out, that symmetry, ultimately when you are symmetrical, it really ties to overuse and it ties to compensation. And that's what they touched on at the beginning of this study. Asymmetrical athletes may show decreased physical performance or have an increased risk of injury as a result of favoring bilateral asymmetry of the body. So if you're asymmetrical, you're compensating, which is a big challenge. And you also have an increased risk of injury because of the compensations. So there is something to be said. Nobody's gonna have like these perfect X rays. Nobody's going to be perfectly symmetrical side to side. But within a small range is a good place to be. And the farther you are off that range, 1, 2, 3 standard deviations, at a certain point you just start having a drastic, well, not only gonna have performance issues, but you Dr. Increase the likelihood of injury. So it's a big deal. When we think about, and this was just a single session of a lumbar adjustment, if you remember. So that's a big deal. When we think about somebody having 16 plus percent on the symmetry index, one adjustment and they move down to perhaps 4%. That is a big, big, big difference. And if we can replicate that as future studies start to dive in and see over the course of, let's say, a care plan, over the course of more than a single adjustment, what are the changes that can take place, I wouldn't be surprised if at that point we start picking up some changes in symmetry on the dynamic assessments. So one adjustment, getting it on those static assessments, the statistically significant change, that's a big deal in my opinion. And you need to think about this from a clinical perspective. On those people that are coming in that are CrossFit athletes, on those kids that are coming in that are maybe playing travel, baseball and all sorts of crazy sports. And they have dreams of the big leagues. Whether or not they make it, there is one thing, but they're in your office very likely, number one, to prevent injury and get out of pain. But number two, for performance and when you can talk about symmetry and when you can take a look at them and analyze them, you might not have motion capture software, but you have your eyes, you have your hands, you might have an app that can help you do that. And to check that pre and post is awesome, number one. But number two, just to be able to have those engaged conversations and say, hey, after we give you an adjustment, I'm gonna take a look at the symmetry. Because what we've seen in some studies is that asymmetry, if you're asymmetrical, if things aren't balanced, it can increase the likelihood of injury. And what we're trying to do here is not only whatever the actual goal is, right? Get number one goal, get them out of pain, improve function, but we're also going to take a look and make sure that we're making some checks and balances on that static symmetry, because that's something that potentially can help you down the road. And I think that's an honest conversation to have with the young athletes and older athletes in your practice. It's something that ties to performance, not pain. I think as chiropractors, all of us have a base of pain in our practice, right? People come in because their quality of life has been affected by some challenge. Typically that challenge is pain that got to the point that it affects their quality of life. That's when they make the decision to call in. But chiropractic can be about so much more than just simply pain relief. Pain relief is the heart of it. You have to get through that. If somebody comes in for pain relief, you want to do everything you can to give them that pain relief as quickly as possible and as long lasting as possible. But the secondary component is performance. And I think that's an area where a lot of young chiropractors are going exciting. And it's a great way to keep your practice dynamic as well. It doesn't lock you into long term treatment plans or anything like that, but it really can focus you on having good, high quality conversations with where somebody wants to go with their life. And if they only want pain relief, that's great. You can be there for them, you can be their guide for that and hopefully provide it at the highest level. But if they're looking for whether it may be fitness and exercise, whether it be sports performance down the road, whether it might be injury prevention, whether it be just counteracting the repetitive stresses and the long commutes that they have day in and day out. You can be their advocate. You can not only teach, you can educate, you can entertain, and ultimately you can be their guide throughout the course of their life. Doesn't mean they'll be in your practice every day for their lifetime, but it means that when they choose to come in, you are there, you're their support and you are always top of mind as their conservative and natural healthcare expert. And that is all about performance. That's all about function. It starts with pain relief, but it doesn't mean you necessarily need to stop your practice there. So that's my big take home message with this. Don't, don't hesitate to have a conversation about symmetry. If this is a new topic for you, then hit the show notes because in the episode notes, in the show notes I will link to this study and it actually is an open source study so you can download it and check it out for yourself. But bottom line is take home message. Symmetry reduces the likelihood of injury. After a single session of adjustment, static symmetry dramatically improved. That's the first step. The next steps will be the follow up papers to this, which I am excited to read, which will start to become more dynamic, no pun intended, and give us more information on the exact context of how we can utilize it. But this is where things are going in science and research and chiropractic. It's an exciting time to be a chiropractor. Hope you can utilize this in your practice. If you have any papers or topics that you'd love for me to address here on the Evidence Based Chiropractor podcast, shoot me an email jeff the evidencebasedchiropractor.com and if you're listening on itunes, click on over right now. Give us some feedback, a rating or a review that helps us reach more and more chiropractors. Last I checked we are over about 10,500 docs listening each and every week, which is mind blowing. It is humbling and I thank you truly for tuning in. And if it's given you value, my only ask for you would be click on over, give rating or feedback. Let more docs find us and let's keep getting the information out there about what we do, expanding the knowledge base of what we can do as chiropractors and help more people in our community in the process. So I hope you have a great week in practice and I will talk to you soon.

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