191- Kinematics of a Chiropractic Adjustment

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today we are talking about an unbelievably important topic. We're talking about intervertebral kinematics of the cervical spine before, during and after a high velocity low amplitude manipulation. It is. We're just gonna cite and dive into an awesome paper that was released in spine journal in 2018 and really dive into the implications on how you can communicate this with with patience in your practice starting today. Before I get started, I'll say a few words about Rock tape. Rock stock 2019 is coming up super soon. It's happening in Beautiful Huntington Beach September 13th and 14th. I'm gonna be out there filming, hanging out, learning and having a great time. I'd encourage you to do the same. If you have not picked up your tickets yet. Rock Tape's Rock Stock is happening in September. You can check it out@rocktape.com rockstock and I hope to see you out there. Additionally, I had a little bit time open up on my schedule next week and if you've been listening to the podcast and like what we talk about, I'd love to spend 15 minutes and chat with you. I'm opening up three kind of 15 minute strategy consultation calls basically just to learn about your practice, answer questions and see if I can help you. If you'd love to pick up one of those slots, just shoot me an email. You'll be the first three people. Jeff@the evidencebasedchiropractor.com Again, that's Jeff. The evidencebasedchiropractor.com I'll tell you the times I have available in the first three. We have thousands of listeners so you gotta be fast on your phone right now. First three people to get to me. I'd love to talk and strategize about your practice and see where I can help. But as I said at the top, today's episode is all about the research. This paper, you can check it out in the show notes. It was released by the spine journal in 2018 and it is titled exactly what I said at the top. Intervertebral Kinematics of the Cervical Spine before, during and After High Velocity Low Amplitude Manipulation. So let's dive into this. They kind of looked at people and they're Obviously, looking at cervical spine, they looked at people with neck pain. So we know lifetime prevalence of neck pain is up to 70% of people. And it's one of the most common symptoms reported in a chiropractic practice, in a primary care practice, it's an urgent care setting. I mean, it's just one of those things that drive people to go into the quote, unquote, doctor's office. We also know, based upon everything that we talked about over the last few years on this podcast and many other places, cervical adjustments, it's a common treatment for neck pain. In a series of systematic reviews and practice guidelines have shown that it's clinically effective and recommended. So we have seen organizations, you know, Johns Hopkins University, Harvard Health, we've seen American Pain Society and more really support what we do with the manipulation or an adjustment, which is the hallmark of what we do as chiropractors. It's really, you know, that exact hallmark treatment. We've seen the efficacy proven time and time again. We've seen the safety proven time and time again. And we've seen more and more guidelines coming out showcasing the benefits of what we do with an adjustment or manipulation. Now, the interesting thing about this study is it's the first to quantify the facet joint gapping and the intervertebral kinematics before, during and after cervical manipulation is the first to really take a good, good hard look at that. The researchers found facet gapping up to 9, 10 of a millimeter, so 0.9 millimeters during manipulation and multiplanar increases in range of motion post manipulation. So with flexion extension, with lateral bend, with rotation, they saw in every one of those planes. So in lateral bend, in rotation and flexion extension, they saw increases in range of motion post manipulation. And incidentally, ironically or not ironically, the average reported pain was reduced by nearly 50%. So not only they were kind of not looking at that specifically, they were saying, what's going on with the facets? Okay, we see that those gap. We've seen that in the lumbar spine. Now it's proven in the cervical spine. Important to actually prove it live, as I say, so proving that live through imaging, super important. This was the first study to do that. They also found increases in range of motion that they kind of quantified and measured pre and post. And then, oh, by the way, we saw pain reduced by 50%, which would be. It put it at the top of the heap in terms of efficacy of anything regarding neck pain if it was just that alone. So let's dive into a couple key quotes that start to frame the conversation, and then I'll break down what I see as some of the most important points for the conversations you have with your practice, in your practice, with your patients. This week, the researchers found, quote, several theories have been proposed as to the possible mechanisms by which spinal manipulation decreases pain and improves function, including biomechanical changes in segmental facet joint motion, psychological relaxation effect from personal interaction and or manual contact by a provider, inhibition of ascending nociceptive sensory neural pathways or reflex changes in muscle tone and motor neural pathways. So this is kind of reciting some of the literature that we've actually explored on this podcast. So basically, how does an adjustment work? How are we getting these decreases in pain? How are you able to get those improvements in function? And they look at it from a couple different angles, right? One, biomechanical changes. So facet joints, gapping, breaking down adhesions, that is a good thing. So the literal biomechanics of giving an adjustment or manipulation has positive effect. Secondly, they found psychological relaxation effect. So human touch, right? That's a real thing. People are, you know, there's human connection, there is human touch going on, there is manual contact, there is, you know, proven benefit from. And for that they also found inhibition of ascending nociceptive neural pathways. So we're, you know, pain gating, essentially, as we kind of learned in school, simplified version, right? Big time. Mechanoreceptive input gates or stops the nociceptive input. Therefore there is a reduction in pain. Those pain signals, quote, unquote, can't get where they'd like to be, but the motion signals are overwhelming the pathway. Therefore there is a perceived decrease in pain. Because, of course, pain is something that's kind of experienced in the mind, not something that occurs at the site of injury, so to speak. And then finally, reflex changes in muscle tone and motor neural pathways. So this dives into a whole new realm that we've kind of explored over the last 212 months, excuse me, with stretch reflex response, muscle spindle response, post adjustment or manipulation, and the motor neural pathways again, tying back to your peripheral nervous system, tying into central nervous system, tying into biochemical marker changes, as we've talked about amongst a plethora of other dimensions. So it starts to get really exciting and really interesting, although a little bit technical. And I'll read one more quote from the researchers. They found, quote, the novel and important findings of this study are that facet joint gapping occurs on a contralateral side of the targeted joint and adjacent motion segments during high velocity, low amplitude manipulation, and that the intervertebral range of motion significantly increases in all three planes of motion in the target and inferior adjacent motion segments after manipulation. So let me break that down a little bit. Right. What are the important findings of this study? They are saying important findings are facet joint gapped on the contralateral side. Interesting to think about from a clinical sense. When we identify, okay, you know, you're doing your palpation and there's, you know, supreme tenderness on one side or restricted range of motion, this really started to identify the facet gapping happens on the contralateral side. Interesting. They also found that the range of motion increases in all three planes at that level and the adjacent inferior level. So something to keep in mind as you go through your adjustments. So what's the takeaway message? How does this convert into conversations that you can have with your patients? Well, I think there's a couple different things. Number one is we're actually featuring this paper as our research brief for all members of the evidence based Chiropractor in August, because I think this is a fantastic paper to get out to the other healthcare professionals in your community that are probably sitting there saying, hey, how the heck does an adjustment. This kind of ties a lot of that together and it shows some new things as well. It's a brand new study. It came out in Spine Journal. Lot of positives to getting this research out to the people or other healthcare providers in your community to build those referral relationships. If you want to dive deep on that, then become a member of the evidence based chiropractor. That's what we do every day, all day, and we do it better than everybody else, dare I say. But when we talk about how do you communicate this with your patients, that's where it starts to get a little bit more nuanced. Right? Because clearly a lot of the terminology that we've broken down over the last 10 minutes or so on this podcast episode probably is over the head of the average patient that walks in your front door. But there are some key points that I think really can drive the message home about what you do. Number one is increased range of motion. People come in all the time with decreased range of motion, especially in the cervical spine. It's really easy to identify, right, look left, look right, look up, look down, you know, bend your ear to the shoulder, those three primary planes of motion. It is pretty easy to see great restrictions in that. So when you have the research here that shows, hey, increases in range of motion, don't be afraid to do those pre and post. Right? You give an adjustment, you do a manipulation. Let's check out that range of motion again. That's like social proof in the patient's mind. Now, not every time do they have to have a 10 degree increase or a 15 degree increase, and not every time are they gonna have an increase at all. But certainly individuals early on in their care or with severely restricted range of motion, you know that this can be set up to have a great conversation. Okay, let's check that range of motion adjustment. Let's check that range of motion again to see if today we had any increases. I have a sneaking suspicion that a majority of the time you are gonna see increases in range of motion. That's a great thing to show off. The other thing is you can use either. I love dynamic disc designs, but you could use a model and showcase the facet joints or just I always pointed to my finger if I didn't have a model around. Hey, there's these little knuckles on the backside of your spine. They're called the facet joints. They allow motion and restrict motion. Just like your knuckle. It's meant to bend a certain amount, but if you bend it too far, it can become injured. Also, as you age your joints, those fingers might not, those knuckles might not move the same way they did when you were six in terms of their fluid motion. You probably, your grip has changed and your range of motion's change in your hands. If you're speaking to somebody that's 80 years old, they'll definitely know what you're talking about compared to when you were, you know, 6, 12 or 18 years old. And the same thing happens in your spine, which is why it's so important that we keep as best as we can, that we keep great range of motion in your spine because it's easier to maintain than to gain back. And it's okay. Sometimes you're not gonna have perfect range of motion every day in, day out. Sometimes injuries occur. That might be why you're here in our practice today. So one of our goals amongst a host is to improve the range of motion to the best that we can. So it enables you at home to be able to maintain that great range of mot. Because everything in your body, specifically your spine, is designed to move. The more that it moves, the more that it's balanced. And the more that we can facilitate that motion through exercise, the better off you're gonna be. These are just sample conversations, but you could dive in a variety of different ways regarding range of motion, regarding facet joint gapping, and regarding the impact that ultimately your care can provide to these people that are coming into your practice. So don't hesitate to dive into those conversations to don't hesitate to get into your pre and your post checks, and don't hesitate to use research like this as we learn more about how chiropractic adjustments, how chiropractic manipulations impact the spine to bring that into the conversations that you're having in your practice, empower your patients with more knowledge, and most importantly, get out there to those other healthcare providers. I believe chiropractors should be receiving a ton more referrals from the other healthcare providers in their community, but it does take a little bit of work. It does take some outreach. It doesn't have to be hard, but you need to have a system and a process. So if you want that, check out the evidence basedchiropractor.com Other than that, I hope you have a great week in practice and I'll talk to you soon.

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Sam.