276- Inflammatory Mediators and Chiropractic Adjustments

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 Langmead. This week we're back with the research in an incredibly important paper that was just released this year. It's all about chiropractic adjustments, inflammatory mediators and the changes that can occur. This is a paper that is actionable for practice and conversations with your patients as well as building relationships as well and as just items that you as a doc should be aware of. This is some really cool research. I cannot wait to dive in. But before we do so, what's in a name? You ask? Everything. Meet Jane. The only name you'll need to remember in the EHR world. Jane is a HIPAA compliant online platform providing clinical management capabilities, things like online booking, charting, scheduling, telehealth, invoicing and more all in one easy to use system. You can learn more and watch a demo. But but heading over right now to Jane App Cairo. I'll drop that link in the show notes and if you want a 30 day grace period to get up and running, we're gonna hook you up. You can utilize evidence based 2021 as a code to get a 30 day grace period. So head over to Jane App Cairo, hit that link, check it out and see how Jane can help change your practice for the better. As I said at the top, today on this episode we're breaking down the an unbelievable paper. The title is Effects of Spinal Manipulative Therapy on Inflammatory Mediators in Patients with Non Specific Low Back Pain. A non randomized controlled clinical trial. This study came out literally just this year in 2021 in chiropractic and manual therapies. I'm going to drop a link down below so if you want to check it out, you can do so. But let's dive into some of this research. Talk about how you can utilize it for the benefit of your patients in your practice. Previous research has showcased to us that inflammatory profiles of patients with acute and chronic non specific low back pain are distinct and different, which is pretty interesting. Our inflammatory profiles again, I'll say it one more time. Inflammatory profiles between acute and chronic low back pain are different. That's really interesting because normally we think of chronic pain as just a continuation of acute pain, but the truth is our bodies react to it differently. So spinal manipulation or adjustments have been shown to modulate the production of nociceptive chemokines differently in each of these patient cohorts. And this study attempted to further investigate whether the effects of an adjustment on inflammatory mediators are the same or different. And that is where things start, start to get interesting. So this paper, the literal first sentence of this paper is the use of spinal manipulative therapy has been recognized as an effective form of non pharmacological treatment of non specific low back pain. To me that is incredibly important. Now you might think low back pain is boring, you might think that it is not very exciting. But the bottom line IS statistics show 90% nearly of individuals will experience back pain at some point in their life. And, and the point prevalence is 30% meaning 30% of any population at any given time is dealing with a spinal issue. If we had as chiropractors the, let's say, influence or the usage that we should, in accordance with the guidelines, no chiropractor would ever be concerned about getting any new patients because your office would be overflowing with them. That's the importance of the first line of this study. They're saying hey, this is an effective non pharmacological treatment. And, and we know the guidelines. If you listen back to previous episodes, the guidelines by primary major healthcare organizations emphasize the fact that hey, before any medications, forget opioids as a first line, forget even NSAIDS as a first line. Non pharmacological care should be first. And spinal manipulation or spinal adjustments are at the top of that list. That's an exceptionally important point to keep in mind as we break down this research. Now what they talk about is elevated systemic levels of inflammatory mediators. Stuff like C reactive proteins, cytokines, tumor necrosis factor, interleukin 1, interleukin 6 have all been reported in patients with low back pain. So when there's back pain, inflammatory mediators are altered and you can tell what's going on by checking out the tumor necrosis factor. By checking out IL1, IL2, IL6, you can see what's going on with the patient and have a pretty good idea to a certain extent how much pain they're in based upon the inflammatory mediators present and the quantity of them present at any given time. So this study looked at, I don't know, about 75 people or so, 22 acute pain patients, 25 chronic low back pain patients and 24 asymptomatic subjects were the heart of this study. So a nice size subject pool, I guess you could say. And baseline pain and functional scores were about the same between the acute and chronic low back pain groups. Now, following the application of six treatments, six adjustments over the span of two weeks, three times a week times two weeks equals six scores declined significantly in both groups that were experiencing pain. So while not a primary measure or outcome of this study each, it adds even more to the ever growing pool of literature and research showcasing that chiropractic adjustments just plain work. If you have low back pain and you are looking to increase your functional ability and quality of life or decrease the amount of pain that you're in, this study showcases even more adds to that even though it wasn't the focus of this study, that whether it was acute or chronic back low back pain, functional ability increased and pain decreased for those individuals who got six adjustments over the first two weeks. Now, in the patients with the chronic low back pain, after they received the adjustment cycle, so to speak 6 adjustments, the production of IL6 declined significantly compared to baseline. Now why is this important? Well, interleukin 6, IL6 is a cytokine recognized as a strong mediator of chronic inflammation and it's involved in the pathogenesis of inflammatory pain. The association of IL6 with the severity of pain and low back pain has been reported. There's a direct association between how much pain you're in and how much IL6 is floating around in your body. And diminished production of IL6 in chronic low back pain cohort thereby might reduce its nociceptive action. So when you have chronic low back pain, chances are the more pain that you are in, the higher the levels of IL6 that are floating around your system. And what this research found was, and they did this based upon blood tests, so they drew blood and checked it out that way. What this paper found, this study found is that after this regimen of six adjustments, after two weeks of care, those individuals with chronic low back pain had a significant reduction in the IL6, thereby, there's no question that they're gonna have also a reduction in pain because these things are so highly correlated. Now, the researchers Note Importantly following SMT, a decline in the production of nociceptive chemokine CCl3, the regulation of which is linked to the strength of IL6 trans signaling, has also been observed in the chronic low back pain cohort. So it was not only the IL6 but also its counterparts. The, you know, CCL3 seems to work in conjunction with the IL6. And bottom line is after a couple weeks of adjustments, after a couple weeks of spinal manipulation, there was a stark change in that. Which is really, really cool and really, really important. Now if you think about acute low back pain, you say, okay, that's, that's the chronic cohort. How about that acute low back pain cohort? What they found with the acute low back pain cohort was that Illinois 2 was significantly upregulated. Now you might say to yourself, IL 2 is upregulated. That does not sound very good because we just talked about IL6. Illinois 2 and IL6 are completely different. So Illinois 2 has been reported to exert an analgesic effect. So the elevation of its production in response to an adjustment is consistent with hypogesic effects. So it is modulating nociceptive information. So that, that is exactly what you want. You want to increase IL2 production because that's going to decrease your pain by modulating the nociceptive activity. And you want to decrease your IL6 because that's highly correlated with inflammatory pain and nociceptive activity. So this study found, and doing one of those things would be fantastic. This study found that the difference between acute low back pain patients and in chronic low back pain patients that received chiropractic care, six adjustments over two weeks were that in the chronic low back pain, the inflammatory mediators were pulled down, thereby reducing pain. And in the acute low back pain, I wouldn't say anti inflammatory, but the analgesic mediators were increased, thereby reducing pain. And that is incredibly powerful. If you think about us as chiropractors really using spinal manipulation, using the adjustments by hand to influence inflammatory mediators, it's really astounding. We would think of that normally as something that would have to be pharmaceutically induced or medication induced to change inflammatory mediators. But that's just not true. The bottom line is we see in this study, amongst others, that what we do with our hands has such a powerful effect on the ability of our body to heal and to get well. And that's super, super powerful. These researchers concluded, quote, it could be hypothesized that SMT may provide sufficient afferent stimulus to the autonomic nervous system and provoke an anti inflammatory reflex, modulating the response of inflammatory cells. That's the take home message in a nutshell. And think about how powerful that is, that what we're doing by delivering an adjustment. There's an autonomic reflex, an autonomic nervous system anti inflammatory reflex that occurs and that is important, that is powerful. That is our take home message. They concluded by saying, quote, following a short course of SMT treatments, overall alterations in the inducible production of inflammatory mediators in acute and chronic nonspecific low back pain were limited. However, a significant reduction in the production of IL6 in chronic patients and an enhanced IL2 production in acute patients were observed along with reduction in pain and self reported functional outcomes. So this study is a great one. It's out there and it is saying for once and for all, studies tend to open more questions than they close. So maybe I shouldn't say for once and for all, but it levels the fact that a short course of care with non specific low back pain patients can really change, it can really influence and it can really alter the inflammatory mediators that are cruising around our bodies. And, and if we can do that by hand, if we can do that without the necessity for dangerous and risky medications, I think that is so, so powerful and it continues to add to our base of knowledge around how an adjustment works. We've seen the biomechanical changes, we've seen that a functional, you know, a segment, right. It moves better after an adjustment happens. Ultimately the facet joints can have adhesions in them. There's just the biomechanics of it. You go one step deeper and we've seen brain changes, we've seen spinal pathways being influenced by an adjustment and now we see inflammatory mediators altered. So all of this leads to me an excitement around what's to come in further research. And as we talked about the top stuff like this is a great paper to be able to frame with your patients. They might think that an adjustment's just about the crunch and the crack. They might think that an adjustment's just about having, you know, therapy of hands on. Right. However, bottom line is we see that there is a direct change in the inflammatory mediators in their body. That's how we get results. It continues to add to how multi pronged and multifaceted what we do is and the impacts that it can have being so far and wide than what we would normally think of or certainly what the public normally thinks of when they see a chiropractic adjustment delivered. It's also great for building relationships. This is just a great study to get out there. I'm gonna drop the link to this study down the show notes and I want to end by saying if you have not checked out the smart chiropractor, please do so. We help automate marketing for hundreds of doctors. Last month we sent over 500,000 emails. What does that mean to you? It means that for our members we were generated over 1600 patient appointments last month. So if you have trouble keeping up with social, with email, with video streaming, let us do the heavy lifting for you. We can get things straight with our monthly campaigns, our weekly topics, our daily posts. We can help you teach and invite consistently across all your channels so that you're able to have more new patients come in, have better retention on the back end and ultimately continue to communicate who you are and what you do to the people following you online. So check out the smartchiropractor.com, grab a demo if you want. We're happy to walk you through how we can help you in your practice. Make sure it's a great fit. Otherwise have a fantastic week in practice and I will talk to you soon.

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