267- Brain Activity Changes After 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 Langmaid. And today we are talking about a super cool piece of research that came out just last year in the journal called Frontiers in Integrative Neuroscience. It's titled Spinal Manipulative therapy alters brain activity in patients with Chronic Low Back pain. A longitudinal brain MRI study. So if you geek out on brain changes after an adjustment, this episode is for you. There is a lot of clinical pearls here that are gonna be interesting to see emerge. These are the seedlings of them that we're gonna see emerge over the coming years in terms of changes in brain activity, which I think is a very, very exciting topic as we continue down the path of better understanding how an adjustment works. Before we get started, I wanna say a few things about Jane. What's in a name? You ask everything you if you haven't checked out Jane, please do so. It's the only name you'll need to remember in the EHR world. Jane's a HIPAA compliant online platform provides clinical management capabilities such as online booking. You definitely need that. Charting, scheduling, secure telehealth and invoicing all in one easy to use system with features like smart options in a narrative and dictation. They make things super easy for you. You can learn more and watch a demo by heading to Jane App Cairo. That is Jane App Cairo. And if you want a 30 day grace period, I see a lot of chatter groups about switching EHRs. If you want to switch over to Jane and grab a 30 day grace period. Evidence Based Chiropractor 2021 evidence based chiropractor 2021 is the code that you can use to get 30 day grace period. As you get up and running, check it out. You will be glad you did. As I said at the top today on the research side talking about brain activity and we're talking about changes in brain activity after an adjustment. So some of the background here we know spinal manipulative therapy helps reduce chronic low back pain. There's. There's no question about that. We talked about that a ton of times and will continue to do so. However, the underlying mechanisms of pain relief and the neurological response to an adjustment seem to still be about as clear as mud. So that's where it's great that studies like this continue to showcase things. So what they did was they take brain MRIs for two groups of people. Group one was at three time points, but before an adjustment, after the first adjustment session and after the sixth adjustment session. So two groups of people. Here again, MRIs taken before an adjustment, after the first one, after the sixth one, that's one group. The second group, the healthy controls, did not receive any adjustments whatsoever and only received one scan. So before the spinal manipulation, before the adjustment, there was no significant differences in brain activity between groups one and two. So we're starting starting lines at the same place. In other words, after the first spinal manipulation session, group one showed significantly greater brain activity in the right hippocampal gyrus and the right dorsolateral prefrontal cortex and the left prenucleus compared to group two. After the sixth SMT session, group one showed significantly greater brain activity in the posterior cingulate gyrus in the right inferior frontal gyrus compared to group two. And after the first and sixth sessions, group one had significantly lower pain scores than they started with. So that's really the conclusion of the story. Let's break down what that science means, how you can apply it in practice, and really dive into the specifics. So we know the prevalence of chronic low back pain increases significantly with age. Here's one thing I did not know, and I think this is something that you should know. From 4.2% between the ages of 24 and 39 to almost 20%. 19.6% between the ages of 20 and so up to age 39 got about 4% chance of experiencing chronic low back pain by the time you get to 59, about a 20% chance. So that is pretty crazy. That is a four fold increase between the ages of, you know, 24, 39 and 20 and 59. So it's a big deal. And it's affecting a lot of people. 300 million people, 330 million people in the United States, 20% of them between the ages of 20, 59 have chronic low back pain. Big market there. Spinal ambition not only helps to reduce pain, but also improves the physical functioning of patients with chronic low back pain. They state that in this paper, and I love it because you look back papers 10, 15 years ago, these statements weren't there at this point. Now, as they're stating in the beginning of the study, hey, we know this helps reduce chronic low back pain as if it's a given and it is a given. But if you look online, there's still a lot of confusion. And a lot of, let's say, and maybe not conspiracy theories, but there's people that do not believe it. It's a sham. It's only about. And it's just not true. The studies continue to reinforce that and continue to build the knowledge base that we know what chiropractic can help with. We're continuing to learn the extent of what it can help with, but we certainly know the basics. Chronic low back pain is one of those. Now, all participants in this study were in the prone position and they were taken on the same 3T MRI system. So same 3 Tesla system. All the patients were in the prone position. Kind of. You're now at baseline before the adjustments were given, there was no significant differences in brain activity between group one and group two. Talked about that earlier as we kind of gotten started. So everything started out the same. So what the researchers found was that alterations to the dmn. So you might be saying, what the heck is the dmn? And that is a really good question. The DMN is the default mode network. The default mode network. I had never heard of that before, but it was cited in this study. Alterations to the DMN have previously been reported in patients with chronic low back pain. The DMN consists of three major subdivisions in the brain. The ventral portion of the median prefrontal cortex, the dorsal portion of the medial prefrontal cortex, and the posterior cingulate cortex and adjacent precleans nucleus. This network functions to regulate emotions and retrieve memories. So think about this alterations to the DMN we just said, previously reported. Then we broke down. Well, what is. The DMN consisted of three major subdivisions. Ventral portion of the medial prefrontal cortex, dorsal portion, as well as the posterior cingulate cortex. This network functions to regulate emotions and retrieve memories. The tie in between chronic low back pain and emotions and memory, that's powerful. I've never seen that laid out in a study before, and I think that's super powerful. We need to be very, very aware of that. We know when people talk about a biopsychosocial model popular the last few years, some people poke holes in it, some people fully believe in it. But there's a psychological component to this, and I don't think there's any question about that. It's not that the pain is made up, but when we see that this is, you know, altering chronic low back pain alters the exact regions of the brain that function to regulate emotions and retrieve memories, that's really, really important because we talk a lot and I see this time and time again, this sort of sensitization. People have fear of movement. We see all of these things in our movement analysis is how we go about things when we literally watch people moving around. And there's reasons for it. And it ties right into their neurology. The researchers found, quote, therefore, our results support the notion that activity in the DMN is a neural correlate of chronic low back pain. And the DMN may be involved in the analgesic effect of spinal manipulative therapy and the brain responses to pain management in patients with chronic low back pain after an adjustment is given. So really, really impactful. So they're saying, not only let's set the baseline right, not only is the DMN really, really important to chronic low back pain, it's a big component of it. But what they're suggesting is, is there can be changes to that based upon an adjustment given direct right there. That's so powerful. They also found our study detected greater activity in the thalamus in patients with chronic low back pain after SMT compared to healthy controls, indicating the subcortical structures may also be involved in the response of the brain to pain. So pain affects those subcortical structures. And we've seen a lot of this come up, especially in recent studies. Again, years ago, these studies, man, trying to think about. You try to show this study to a chiropractor in the 70s, they'd probably fall down, forget about the 1920s or 30s. The ability to analyze what's going on in the brain after an adjustment given is incredibly impactful. And as I said at the beginning, papers like this, these are the seeds by which our knowledge is gonna grow tremendously over the coming months, years and decades. And to me, that is super exciting. The more that we learn about, for lack of a better way to say it, the neurology of chronic pain, how does it affect the brain and body? Where's that connection? What's the push and pull and then the secondary piece of it that's really impactful for us as chiropractors. How can we influence that? And the more that we learn and the more I continue to see in the research, hey, biochemical markers are changed after an adjustment is given. Cortical drive can change, the spinal pathways can be influenced and things. Brain activity ultimately in the DMN network can be influenced by what we do by delivering a chiropractic adjustment that is super, super impactful. Because again, you think about the other side of this. Sometimes I think we take it for granted that yeah, an adjustment's great, get them moving. Okay, they're gonna get a crunch, so to speak. But let's really take into accord the effect that we're having, the effects that we're delivering. You know, some people are seeking things like medication, they're seeking surgical interventions, they're seeking, you know, not only oral medications, but they might be seeking injection, they might be seeking all of these things to, to influence their system to drive the same result as what we're able to, or a similar result than what we're able to do with our hands and without any of those risks, those potential side effects, those dangers of all of the other things available and on the table to them, that's incredibly powerful and for many people that's life changing. As we come out of this opioid epidemic, as we come out of, you know, a haze of over medication for years relative to chronic pain and non cancer based pain, the ability to showcase studies like this and the ability to take the take advantage of this new research is incredible. These researchers concluded by saying, quote, in conclusion, our study identified significant alterations in the brain activity in the DMN regions of patients with chronic low back pain after SMT treatment. In addition, our data support activity in the DMN as the underlying neural correlate of chronic low back pain and alterations to the DMN may be a potential neuroimaging biomarker for assessing brain responses to back pain management. That paragraph says it all. Ultimately, there's a lot that we still have to learn about how an adjustment works and specifically about how it affects the brain, how it affects the neurology, quote unquote of the entire individual. Part of the challenge with that is we are dynamic beings and thought, especially when we get into biochemical markers, changes in brain activity, we're really dynamic. Things happen quick and to be able to quantify that, to be able to study that is exceptionally difficult task. But it seems like researchers are getting there and are up to the task. They're taking advantage of the newest technologies like MRIs, like functional MRIs, they're taking advantage of the opportunity to showcase conservative, non drug, non surgical solutions for people struggling with chronic pain. And if we come really full circle to where we started, there's millions of those individuals, there are probably thousands in your community. If you live in a large community, there might even be hundreds of thousands. There are tens of millions of those individuals living just here in the United States, nevermind worldwide and abroad. So the market is there, people are looking for solutions in research like this, why I get so passionate about it is research like this continues to substantiate what we do, continues to refine our knowledge. The more we're able to refine our knowledge, the more we're able to explain that knowledge to the people in our community. And hopefully now you know, hey, a lot of people deal with chronic low back pain and not only is an adjustment good for the area, it hurt my back, my back hurts less. That's an important thing. But, but there's a lot more to it than that and that is very, very impactful. So get out there, share this information. This is going in the queue. It's gonna be shared with members of the Evidence Based Chiropractor so they can continue to build referral relationships with other healthcare providers in their community. If you're interested in bridging the gap and building relationships with other healthcare providers, check out the evidencebasedchiropractor.com if you wanna automate all of your email, all your social get your in office screens all on lockdown in a great way, check out the smartchiropractor.com we can automate all of your digital marketing for you. And incredibly impactful. Email is definitely our super power tool there, so be sure to check it out. And I want to close by talking a little bit about shield. If you're looking to get factory direct pricing for your braces, tens, units and more, check out shield@supersecretsales.com ebc@supersecretsales.com EBC Dr. Steven Brown is a great guy. He was on this podcast not too long ago and he's offering you, listener to this podcast, a complimentary SHIELD TENS and E stim unit plus free shipping. On your first order, pick up that complimentary TENS and E stim unit and get free shipping. It's fast. Shipping's fast. It's factory directed pricing and a great selection of products. It's all available right now at supersecretsales.com ebc. Be sure to check it out. If you have any questions about the study that I talked about today, you can hit me up. Jeff, the evidencebasedchiropractor.com, make it a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.