209- Adjustments and Brain Neurometabolites

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 Langmaid. In today's episode we have an awesome cutting edge research study that just came out last month in the Irish Journal of Medical Sciences and it looks at brain neurometabolites after an adjustment or a manipulation. It's a cool study. I think it is a tease into what's to come in the future of how what we do works. And we're gonna dive into the specifics of that on today's episode. Before I get started, I'll say a few words about Rock Tape. Roc Tape has revolutionized the soft tissue world again with Rock Blade's Mohawk. You it has three tools in one, a surgical stainless steel hand polish tool and two attachments silicon sleeve and an ABS comb. You can see all of the educational courses that they have lined up for 2020, which are awesome and exceptionally robust. Chances are they're going to have a course near you. You can check that out@rocktape.com mohawk again rocktape.com mohawk and you can pick up the tool itself, Rockblades Mohawk for $175 bucks. So for today, what are we diving into and what are we talking about? Today's episode is all about, as I said at the top, a paper titled the effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain. And this was a randomized clinical trial. So hallmark of non specific chronic low back pain. Let's start right there. Nonspecific chronic low back pain is a diagnosis that includes no neurological signs or specific reasons. So no neurological signs or symptoms, so to speak, when we are talking about true non specific chronic low back pain, Chronic low back pain or non specific chronic low back pain accounts for 90% of chronic LBP. And when we break down these stats, there's a lot of 90s out there, right? About 90% of individuals with deal with with a musculoskeletal spinal back issue at some point in their life. Roughly 10 to 15% of those individuals will go on to develop a chronic condition. And 90% of those individuals have what would be defined as non specific chronic low back pain, no neurological signs. So this disorder associated with pain disability, it negatively affects the quality of life of many individuals. As you well Know, and studies have shown that chronic non specific low back pain ultimately causes central sensitization. And patients with chronic low back pain are hypersensitive to painful stimulus due to neuroplastic changes. And that's really what we're gonna talk about today. It's really, this study comes down to me. It talks about the hard wiringsoftwiring of the brain and central nervous system. It's all about sensitization. Typically, a painful episode starts with an acute injury. Yes, there are degenerative changes that happen over time, but for many people there's sort of an injury, right, that's a noxious stimulus, something occurs, bang, a fall, a slip, a trip, whatever it might be, there's a noxious stimulus and the body rightfully says, hey, something's going on down here, you better pay attention, right? An acute injury. But that pattern or that pathway, once activated, that pathway, once activated, can unfortunately become a pattern within the nervous system. That pattern ultimately can slide downhill to non noxious stimulus, meaning non painful stimulus, elicit the same pathway, same response, pain experience. And as if it was a noxious, actually painful, hey, five alarm fire type situation. And that pathway, that cyclical nature, that pattern, however you wanna define that, that's where a lot of people end up with chronic pain. They're unable to really move, they're unable to exercise, they're fearful of movement. And you really start to get some pretty substantial negative consequences throughout time, which is why people look towards medication, they look towards all of these highly interventional high danger type treatments because they're just looking to break that pattern. And what we learn in this study is I'm gonna read you the conclusion, then we'll dive into the nuts and bolts. These researchers found spinal manipulation with effect on the central nervous system leads to change and increase metabolite concentrations in specific brain regions, thereby relieving pain and disability following chronic low back pain. So in short, what they found is if you have chronic nonspecific low back pain, seeing a chiropractor and getting adjustment, barring any red flags and contraindications, is a really good idea. Not only can we affect the mechanical nature of the segmental unit, meaning you gap the facets, you get motion into area, but we affect the central nervous system to the point that brain neurometabolite levels can alter or change, or have been shown to alter or change after an adjustment. And that, that's, you know, that scatter, that pattern break can be very, very important in overcoming chronic low back pain. So the researchers here they did adjustments or manipulations to the low back, obviously in chronic low back pain, and also to the SI joint, which basically looked like diversified adjustments when I looked at the pictures in the study. Additionally, they measured this by using what I'll refer to as kind of a specialized brain mri. So there's more technicality to it than that. But when I look at the pictures, that's sort of what it looks like to me, just to frame it for you. So the researchers noted the neurophysiological mechanism of manipulation refers to the ability of the central nervous system to modulate sensory information. Right? Which basically is a fancy way of saying what we've already talked about. Sensory information comes in, the central nervous system takes in that information, but. And then we experience that in however it's processed, if that makes sense. So that's sort of what they're outlying. Now, what the researchers also found was, quote, there was no significant difference in the NRS and ODI between groups at baseline, between the manipulation group and the sham placebo group. But five weeks after the treatment, the difference became significant and more than minimally clinically important. So, therefore is another way to say it, it became clinically important. Moreover, five weeks after the treatment, the NRS and ODI of the treatment groups were reduced by 3.6 and 16 units, respectively, which is more than the minimally clinically important level. While there was no minimally clinically important level difference in the sham group. In other words, there were positive changes in the adjustment or the manipulation group that were not seen in the placebo or the sham group. So let's dive into a little bit of the technicality behind this. I'm gonna read a little bit from the paper because it does get pretty heady in terms of how we break down the nervous system itself. So here we go. Studies have further demonstrated that the level of neurochemical metabolites was decreased in patients with chronic low back pain compared with healthy people. And what we found, or what they found in the study, I should say, was that those neurometabolites increased when somebody had a spinal manipulation. So they also said, or found the neurophysiologic mechanism of manipulation is the result of the CNS's ability to modulate sensory information. Sensory afferents from the receptors of the tissue surrounding the vertebra are activated by the spinal manipulation, affecting the transmission of painful signals and motor function from the spinal cord to the cerebral cortex. So right there, that kind of encapsulates everything that we're talking about in one statement or sentence, right? An impulse is given. With the adjustment you give, a force is introduced into the body. Right. And what does our body do with that? Well, there's a couple different things. There's the mechanical components of it. The facet gaps, as we've seen in studies, potentially facet adhesions breakup, the IVFs, depending upon, I guess specifically what adjustment technique you're utilizing. The ivfs, intervertebral foramen can open up, it can bring blood flow to the area. It could create negative pressure type situations in the disc space. All of those things are very, very mechanical. But there's a secondary component of that and it might be actually the most important. And that is when you introduce that force, that force is picked up on by the central nervous system. As far as saying, hey, is this noxious stimulus? Is this non noxious stimulus? And one of the things that I think the research has teased out over the last little while is the special item about an adjustment or getting into the paraphysiological space is sort of the speed of it, this is my opinion here. But the speed of it creates a high influx of sensory information. Now we used to think of that in terms of just gating pain, right? There's so much sensory information coming in that the pain pathway sort of turns off and the sensory pathway speeds up. And that is where relief is found. And there probably is truth to that. But what, what we're also seeing is even if that occurs, the sensory information that happens within adjustment or manipulation when it reaches the brain, there's actually downstream changes or upstream changes there as well. And that's where we start to look. Earlier this year, we looked at the biochemical marker changes in the brain. Now we're looking at the neural metabolite changes. So this is where it starts to get really interesting because again, our bodies are unbelievably dynamic and our brains are constantly playing through our peripheral nervous system to our central nervous system, brain to body. And what we see is that of course, as we could probably all imagine, hey, physical changes to our body can make and do make really chemical type changes in our brain. And in some cases, in this case specifically with chronic low back pain, breaking that cycle, introducing new information can be very beneficial because ultimately it's not only the changes in these neurochemical markers and these neuropeptides that are important, it's what happens because of that. Right? And what happens because of that is a decrease in pain, a decrease in disability, and an increase in function, which is really what we're after from a patient centric approach, yes, it's nice to geek out on the specifics of what's going on, but the real heart of the question is, does it work? And what we're seeing time and time again in literature is absolutely, that is the case. And now we're seeing the papers catch up with, well, why and how does it work? And that's what gets me so excited about papers like this. I think there's a ton more to come on exactly this type of paper where we're using advanced MRI scans and analyzing what's going on in and with the brain around what we're doing from a physical standpoint, whether it's exercise, whether it's an adjustment, whether it's tape, whatever it might be. And that starts to become really exciting because now we're starting to really put things together, in my opinion, in a holistic fashion. So this paper was exciting to me. I think it's another little touchstone as far as our understanding of how a manipulation and an adjustment works. I think it's a great conversation starter for the patients that you have in your practice that have chronic low back pain, that, hey, it's not just about the crunch and the crack, right? That is what's going on at the joint level. But what might be even more important is what happens in and with your brain when this adjustment is given and how you're moving your body as you get up from the table and continue on with your day. Those are the things that have really long term impact besides a momentary gap in the facet joint. So I love all this stuff. I think you love it too. If you tune in each and every week. I appreciate everybody tuning in each and every week. We have tens of thousands of docs who tuned into the Evidence Based Chiropractor podcast, which is so astounding for me. I love it when I get the emails and the messages, people saying, hey, I listen in. I love it. It starts my week off right. I truly, truly appreciate that we're closing in. We're over 200 episodes now on this podcast and we're not looking to slow down anytime soon. There is a ton of great research that I'm looking forward to getting to as we roll into 2020. But you have a great week in practice. If I can answer or help you answer any questions for you or help you in any way whatsoever, reach out to me, Jeff, the evidencebasedchiropractor.com and I will talk to you soon.

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Sam.