238- Somatosensory Activation After an 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 Langmaid. And on today's episode we have an awesome piece of research that we are going to break down. It's called Spinal Manipulative Therapy and somatosensory Activation. We're going to talk about the neurophysiological effects of an adjustment, how it impacts a patient, and how you could communicate this in your practice. Before we get started, I'll ask if you have not left us any feedback or a rating or review on itunes for this podcast, please. If you're listening on your iPhone, you can scroll down, tap that button and let us know how we're doing. Additionally, if you are looking to set your chiropractic marketing on autopilot, check out the Smart Chiropractor. It is my social media service, but it's so much more than that. It's automated social posting, it's automated email. All of the content, all of the automations are built out. We have reactivation sequences, video streaming straight to your office. You don't need to mess with anything. We update that all the time. YouTube posting, Instagram posting, Facebook posting, videos, video scripts, patient education handouts, video streaming email campaigns, you name it. It's a part of the Smart Chiropractor. We have help docs and we do each and every week add 5, 6, 7 patients into their practice each and every week. Our Success Blast email campaign typically generates over a dozen patient activations. It is something you need to check out. If you have not yet, please do so@thesmartchiropractor.com now, as I said at the top on today's episode, we are talking all about a study released in 2012 from the journal of Electromyography and Kinesiology and it's titled Spinal Manipulative Therapy and Somatosensory Activation. We use this one as our research brief for all members of the Evidence Based Chiropractor in June because I think it's really, really important. We have noticed time and time again in the research that adjustments or estim smt. It's safe and effective for a variety of neuromusculoskeletal issues. We can talk about headaches, we can talk about disc issues, we can talk about neck issues, thoracic issues, extremity issues. Low back issues. Whether pain related or functionally, you know, dysfunctionally related, There is no question that adjustments or manipulations can make positive impacts on pretty much our entire neuromusculoskeletal system. Not every time, but, gosh, is our record pretty darn good. But the specific mechanism of action that leads to these therapeutic effects has been pretty difficult to pinpoint. Now, some of that's a good thing. Some of that becomes a challenge over time. The good news about why it's been difficult to pinpoint is the fact that there's just a lot going on when an adjustment is delivered. There's a lot that goes on. The impact on the tissue immediately. If you're looking at the spine, the facet joint's impacted, the disc space is impacted, the peripheral nervous system is impacted, the central nervous system is impacted. There's a lot that goes into it, which is a great thing. But it's made it really, really difficult to accurately describe exactly what happens during an adjustment, because there's a lot of stuff that happens. So we know adjustments typically applied to dysfunctional areas of the spine and extremities. How do we determine that? It could be pain, it could be palpation that you do in your practice, tenderness that's noted, asymmetries, whether just visually or whether ultimately through imaging, dysfunctional deficits, restrictions in spinal joint motion, all of these are potential indicators for, for applying spinal manipulation. Now, this study found that spinal manipulation can affect the muscle spindle, it can affect the golgi tendon organs, the paraspinal afferents, and reduce the temporal summation of pain through the action on the nervous system and through the actions on the segmental biomechanics. So it's really, really clear at this point in time. I don't think there's any question that people and patients struggling with spinal pain or dysfunction should be seeing a chiropractor unless they have red flags. There's a tremendous amount of benefits, and there's a really deep series of actions that provide the effects that we all like. And what are the effects? The effects typically are improved function and reduced pain. Right. Why do people come into your practice? It's really for a couple things. Number one is pain. But more so than pain is, is the impact that pain has had on their lifestyle. And please keep that in mind, because people can deal with pain and they do deal with pain. I mean, how many times have you asked somebody, how long have you been dealing with this? Oh, 25 years. Right. You know, it's crazy what people will put up with until it gets to the point that there's an impact on some aspect of their lifestyle, Then they are ready to go to the races and find out where they can find relief for from, right? So when we look at why people come in and the benefits we can provide, as you have conversations during your report of findings, even before that, as you're going through your intake, be sure that you're understanding the life impact and life effect that the challenge why did the patient come in? Why they came in is not low back pain. Why they came in is because the low back pain has kept them out of the gym, they've gained weight and they're unhappy about that. Right? So there's always a deeper level, but you have to ask the right questions to get the best answers. So let's take a look at a couple of the quotes that I found super interesting from this study. We'll continue to break down more how we communicate this. The researchers found, quote, spinal manipulative therapy may produce a sustained change in the synaptic efficiency of central neurons by evoking a high frequency bursting discharge from several types of dynamically sensitive mechanosensitive paraspinal neurons. Wow, that is a mouthful. And I barely got through it. Bottom line is, we have impact on mechanoreceptors, we have impact on central nervous system neurons, and a lot of that takes place through a high frequency bursting discharge. It's almost like that sort of action potential. We'll talk about that in the next quote. And the next quote is quote, spinal manipulation like movements produce a short lasting, high frequency barrage of action potential, which raises possibility that adjustment may induce longer term effects by modulating the central nervous system. So one of the big questions is, okay, an adjustment's delivered, right? It takes a second, less than a second. So how is it that the effect the pain relief might last for days, week? It could last a long time, right? It could last even just hours. Think about that. The fact that the movement took less than a second, but the relief lasts a long time. How does, how does that happen? And they are theorizing that this is because of the high frequency barrage of action potentials, that that's what modulates the central nervous system and ultimately produces those longer term effects. And finally, the researchers found, quote, the impulse thrust may alter segmental biomechanics by releasing trapped meniscus, releasing adhesions, or by diminishing distortion in the intervertebral disc. So that's just straight up biomechanics, right? When you put A thrust into a joint, you are going to essentially, most of the time, gap the facet joints. You're going to release any, you know, adhesions intra, you know, intra facet adhesions. And they're saying they can diminish the distortion on the intervertebral disc. Now, I think that depends upon technique to a certain degree and the amount of thrust that's given on how much you're really going to impact the shape, so to speak, of the disc, even just during the event of the thrust itself. But something interesting to consider. So the researchers basically break this down as the neurophysiological effects of spinal manipulation come down to two big buckets. There's a lot more to it, but there's sort of two big buckets to start from. One is spinal biomechanics. So adjustments can relieve mechanical compression on transmission pathways and induce beneficial changes in the chemical milo of neurons. Right. So when we see a nerve that's irritated, radiculopathy, right. There's two ways that that occurs. One, direct compression on the nerve, literally, IVF closing down, disc, bone, or ligament getting in the space, providing mechanical compression. Now, when that occurs, that also stimulates inflammatory response in the area, and we get chemical irritation. But that goes to stand that even without the mechanical compression, you can have chemical irritation and inflammation in and around an ivf, a dorsal root ganglion, and that can cause pain. And challenge. It's not always structural, which is why, again, we always talk about, hey, you are not your mri. As you get older, you're gonna find a lot of stuff on an mri, but not all of that stuff ultimately causes challenge. I used to say to my patients, you know, we're gonna see all of the not perfects on your imaging. My job is to find the problem amongst those not perfects. Again, just trying to continue to drill back to what are the benefits you're providing, what are the challenges that the patient's having, and how can you help them get where they want to go? Second piece of that was activation of the somatosensory receptors. So, again, changes in the synaptic efficacy provide a basis for understanding how the neural response outlasts the intervention itself. So, bottom line, with all of this, there is a lot that goes on and into delivering an adjustment, delivering manipulation, and there's a lot of different things that we impact. Muscle spindle stretch response, golgi tendon organs, paraspinal afferents, temporal summation of pain, central nervous system itself, peripheral nervous system, and segmental biomechanics. All Have a piece of the pie in terms of how do we get the pain relief and the improved functional capacity that we expect after delivering the adjustment. So a lot to dive into there. But when we break it down into how do you communicate this to a patient? Well, depends on the patient, right? Engineer. I've dealt with so many engineers in reading MRIs pre surgically and they want to know like every structural detail. It's like, oh my gosh, I'm like teaching somebody how to be a physician right now. But for a majority, let those be the exceptions, right? Not the rule. A majority of individuals want to understand, can you help them? What are you gonna do? How long is it going to take? And how much is it going to cost? My friend Jason Deitch always brings up those four questions as the primary items that every and he's so correct that every patient has. When somebody walks into your practice, that's really all they want to can you help me? What's going on? What are you gonna do about it? How much is it gonna cost and how long is this gonna take? If you can get that through, then you are gonna be in great shape during your report of findings and you're gonna notice that there's just so much less confusion. I find that docs who, you know, let's say you know, that are really into movement assessments, they're really into evidence, informed practice, they're into rehab, they're into doing all these things, man. Sometimes the conversations that they're having with their patients are like 27 levels over the head of the patient and it actually hinders your ability to deliver care because they get confused, they go somewhere else, they're non compliant. It happens all the time. So please keep an eye on those conversations you're having. It's not easy. It's a constant work in progress. Communication is one of those core tenants that all of us just need to continually, just like our skillset delivering the adjustment, we need to continually refine our communication. So hopefully this helps frame some of how a chiropractic adjustment works, pushes that knowledge forward a little bit more. If you have any questions, hit me up. Jeff the evidencebasedchiropractor.com ask you again. Please leave a rating or feedback or review on this podcast within itunes. And if you are looking to improve the marketing in your practice, B2C, right? Business to consumer. Check out the smart chiropractor. I do two things, the evidence, basically two things. The evidence based chiropractor, which is B2B. How do you bridge the gap and build referrals business to business marketing and then the smart chiropractor which is B to C business to consumer Smart Chiropractor if you are looking for a ROI machine if you are looking to automate all of your marketing if you would like to have your email, your social your in office firing on all cylinders that are built off of research based monthly campaigns, weekly topics and daily posting we have please check out the smart chiropractor.com I am passionate about helping as many docs as possible. We work with hundreds of docs around the world, but I know that we've barely scratched the surface in terms of really being able to get out there and help docs. So if that's of any interest to you, check out the smart chiropractor.com if you have any questions about that whatsoever, hit me up. Jeff the evidencebasedchiropractor.com and I hope you have a great week in practice and I'll talk to you soon.

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