184- Adjustments and Pressure Pain Thresholds

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are breaking down a really cool research study that was released by the Journal of Back and Musculoskeletal Rehabilitation just a couple years back in 2017. And they looked at essentially pressure pain thresholds and range of motion after an adjustment to the cervical thoracic spine. And they compared adjustments HVLA high velocity low amplitude adjustments to to manual stretching. So this is a really cool paper. It's actionable. It ties into what you see each and every day into your practice and we will dive into it in just a moment. Before we get started, I'll say a few words about Rocktape. Rocktape has revolutionized the soft tissue world again with Rock Blade's Mohawk. Featuring three tools in one, a surgical stainless steel hand polished tool, two attachments silicon sleeve and an ABS comb. Mohawk unlocks never before seen treatment protocols. You can pick them up for 175 bucks at Rocktape. And while you're over there, do yourself a favor and grab a ticket to Rock Stock 2019. It's taking place in September out in beautiful Huntington Beach. You guys know this is an event that I have on my calendar each and every year. This year is no exception. I'll be out there hanging out, filming, having a good time and I'd love to connect with you out there. So if you don't have anything going on in September or I would say even if you do, you should change plans and head out to Rock Stock 2019. Awesome event out there. As I said at the top, we are talking all about the cervical thoracic junction today. So the title of this paper which I'll have linked in the show notes is the immediate effects of manual stretching and cervical thoracic junction manipulation on cervical range of motion and upper trapezius pressure pain thresholds. That's a mouthful. I'm going to say it one more time. The immediate effects of manual stretching and cervicothoracic junction manipulation on cervical range of motion and upper trapezius pressure pain thresholds. So let's get some starting points set. Myofascial pain. It is common. 85% of people will deal with myofascial pain at some point in their life. How does this Occur a combination of things. We can look at mechanical stresses, metabolic deficiencies, psychological influences. All of these things contribute. And when we break that down even one step further, we can look towards trauma, right? Injuries, overuse and poor posture, hand in hand. We see this all day, every day. Being in the car for long periods of time, working on computers, not getting enough exercise and, or stretching or adjustments. So we look at overuse and poor posture again, psychological stress, mechanical overload. And then there's some interesting ones. Endocrine dysregulation, inflammatory diseases, alcohol toxicity, and even they cite constrictive clothing can all play, excuse me, a role in myofascial pain syndromes. So that's kinda the bad news. The good news is these type of things respond really, really well to what we do day in and day out as chiropractors, which I'm sure that you have seen time and time again in your practice. And some of that plays into ultimately really how an adjustment works. So we'll talk a little bit about that, but let's dive a little bit more into the background, right? So we talked about repetitive use, postural issues and trauma. Really they can precede often myofascial pain and restricted motion that all of us see day in and day out with the patients that come in with neck pain. And what we've seen in the literature is the ability of spinal manipulation to reduce pain, increase range of motion and decrease muscle sensitivity. It's been well established at this point over the last five years. Specifically, we've seen a real surge in the supporting literature around what we do with an adjustment. This study, however, really examined the effects of both high velocity low amplitude adjustments and, and stretching in a randomized setting. So that's sort of the take that the researchers had regarding this study. And the results that they have indicate that both stretching and manipulation can provide positive effects on pressure pain threshold. So both help out specifically compare. They had a control group as well with this and the control group, no findings there, but they found pressure pain thresholds were altered in a good way for both people who received adjustments and people who did some stretching. The adjustments were again, a high velocity kind of diversified adjustment and the stretching was 30 second holds of stretches in the trapezius or on the trapezius muscle. Additionally, what they found was the manipulation group had statistically significant improvements in range of motion. So only in the manipulation group did they see that increase in range of motion to a statistically significant level. That's one take home message there. So I'm sure that your Experience has been the same as me. We're really a combination of these type of modalities tends to yield the best results. Right? I know, you know, adjusting patients and doing static stretching, mixing in dynamic stretching and then all these, all the other modalities that you might utilize, it's the combination effect that typically gets the best results. This study kind of broke it down piecemeal, just the manipulation and just the stretch versus a control group. But what I've seen is really a combination effect tends to work best. So here are a few key quotes from this study. Quote Spinal manipulative therapy has been associated with onset of long term potentiation at both the spinal and supraspinal levels. So this is citing the central nervous system impact or brain impact that has been found after an adjustment and how that can mitigate pain. That's what that's referring to right there. Additionally, the researchers found previous studies have also found a reduction in inflammatory cytokines and pain mediators in surrounding joints after manipulation. So we've touched on that a little bit as well. Throughout some of these episodes where not only the biochemical markers in the brain alter or have been shown to change and alter after an adjustment, but ultimately even local to that joint reduction in inflammatory cytokines and pain mediators. This is again where we get a lot of the benefit of the adjustment that not only affects things locally, but it can also affect central nervous system all the way up spinal column, central nervous system up to the brain. And finally, they found this study demonstrates the effectiveness of HVLA thrust manipulation at the CT junction compared to manual stretching of the upper trapezius in increasing pressure pain thresholds in the upper trapezius and improving range of motion. So those are really the take home messages that they found with this paper. Now let's break it down a little bit farther. Talk about how it can impact the conversations that you have in your community and with the other physicians in town and ultimately how you can really utilize this to get the best bang for your buck out of this 15 minutes of your commute into the office. So we broke down right there. You know, some of the literature itself, right? We probably see second to low back pain. The number two reason why people visit chiropractic clinics. Chiropractic practices is due to neck pain and probably 99% of the time associated with that. You find trigger points, you find myofascial pain issues associated with the neck pain. Now these researchers touches on the fact of what we know to be true. It's chicken and Egg. Right. Which came first, the joint dysfunction and then the myofascial pain or the myofascial pain, then the joint dysfunction? I don't know. It's near impossible to figure out. But what is possible to figure out is the plan of attack to get people well. And I think this is the really important component is if, let's say a patient in your community, not a patient, but a person in your community or another physician has historically been referring, let's say only to physical therapy for individuals that they're encountering with cervical thoracic issues and neck pain. Well, if they're doing a lot of stretching and strengthening, they're not getting any joint manipulation in there. And joint manipulation is one of those things. As we talked about, it impacts multiple tissues, the stretch. Yes. Does it have multiple layers of impact? Of course it does. But it's really biomechanical in static stretching. The joke with static stretching is, you know, you static stretch and you do one thing, you get good at static stretching. In other words, there's not really any long term efficacy been associated with it. But in my opinion, when you mix in a little bit of static stretching, it's easy for people to do. Then with their exercise routine, you really motivate individuals to get into that dynamic stretching routine and you add on joint manipulation and you add on adjusting when appropriate. Now you start to create a really, really fertile ground to achieve great results. People are coming into your practice because they want results and they want benefits with care. Right. Something's impacted their quality of life to the point where they're like, man, I hate dealing with this. I want to make a change. That's usually what motivates people to pick up the phone and call. Pain is the first thing that comes. People usually deal with that for some amount of time until it starts impacting their life. Then they're picking up the phone to give a buzz and to get the or get their quality of life back. And ironically, pain is typically the first thing that goes during treatment. But they might not have really delved into performance yet. They might not have delved into really the rehab component of it. Right. Passive to active care. So in my opinion, again, I think the best way to present this and the best way to go about it, number one, this is a great tool to share and great information to share with the other docs in your community. That's why we're featuring this for all members of the evidence based chiropractor. They can utilize this one more tool in their tool belt. This is gonna their monthly brief to get out there with the other physicians in their community. So, so important to share this information and share this knowledge. Especially because this is new research. Hardly anybody knows about this stuff. So sharing it and highlighting the way that your practice really encapsulates all of the best evidence, informed care, super important to bridging the gap and building relationship. But that also holds true as you get out there and have the communication with your patients or online through your Facebook page, through your website, et cetera. You know, being able to speak the language, being able to say, hey, you know, here is what the latest literature shows. If you've been struggling with neck pain or trigger points in your trapezius muscles. Those are right here and I'm pointing to them right now. Those are right here. Let me tell you what the latest literature says on how you can get on the fast track to relief. Right now you can dive into stretching does wonders. But if you stop there, you might not be getting all of the benefit that you could. That's why we focus on not only stretching, but we also focus on making sure your joints are moving appropriately. Because when a joint is moving appropriately, not only do you have better range of motion, but now you have the ability to decrease the likelihood of re injury and the ability to feel better quicker. We love to work with our patients, getting them feeling quick as soon as possible. Then we like to work with them to make sure they stay that way with whatever their goals are. Your goal might be having better posture. Your goal might be improving your workstation. Your goal might be getting back out to those hobbies. Those are what we look for after we get you moving in the right direction. So that's a samp or an example of some language that you could utilize in starting to frame this. Because as I talk about time and time again, it's about the content, which is the research, but putting it into the proper context, which is your job. Hopefully I'm helping you with that job here at the evidence based Chiropractor with these weekly podcasts. If you haven't dove into the complete social media content creation tool that we have called the smart Chiropractor, I'd encourage you to check that out. Thesmartchiropractor.com automated emails, chiroemails.com or obviously if you're looking to build relationships with physicians in your community, you know where to find me@the evidencebasedchiropractor.com but those were the big takeaway messages. This is the piece of research that you can utilize internally and externally starting right now. If you want to see the paper, I'll have that linked in the show Notes. I hope you have a great week in practice and I will talk to you soon.

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