295- Where Spinal Structure Meets Function

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's episode, we are back at it with the research and this is a paper that has been getting a ton of press. It was just released in Scientific Reports. The title is Demonstration of Cervical Conduction Time and Neuroplastic Changes after Cervical Lordosis Rehab in Asymptomatic Subjects. It's a randomized placebo controlled trial. I think there is a lot to this study. It's probably going to bring up a lot more questions than it answers and that's not a bad thing. So we're gonna break it down on today's episode. Kind of hit home those talking points, hopefully ask a few questions that you think about throughout this week, in the coming weeks. And there's just a lot of good stuff that I think can get all of us as chiropractors to think about how we approach our clinical and patient care. So we're gonna dive into this and much more on today's episode. Before we get started, I wanna say a few words about the smart chiropractor. The smart chiropractor is optimizing, empowering and automating your patient's journey. Taking a patient with from a potential patient to an active patient into a proactive patient on the back end is super important. Everybody's going through a journey in your practice. The question is, are you having them go through an optimized or a smart patient journey? When somebody is a potential patient, making sure that you teach and invite to create that fertile ground to become an active patient where you can educate, where you can retain is critical. And then when they become a proactive patient, are you enrolling them and are you reactivating them? That's what all the tools within the Smart Chiropractor are designed to do for you. That's why we focus on email, social, video streaming, patient handouts, you name it, all of that and more. You can check it out for yourself@the smartchiropractor.com demo. Hop on right there. Schedule a demo. See if what we're doing is right for you. Thesmartchiropractor.com demo we're working with hundreds of docs around the world. We're impacting millions of people each and every month through email and social and we'd love to see if it's an opportunity to work with you. So check us out@the smartchiropractor.com demo. But as I said at the top of today's episode, we're talking all about the research. And the title of the study again was Demonstration of Central Conduction Time in Neuroplastic Changes after Cervical Lordosis Rehab in Asymptomatic Subjects. And it's a randomized placebo controlled trial. So basically, the study at the highest level is they were saying, what's going on in the brain? What's going on with central conduction time? What's going on with neuroplastic changes when cervical lordosis is altered or influenced in people that have no symptoms whatsoever? So that's an interesting topic. I think for over 100 years, all of us as chiropractors have looked and said, hey, what's that balance between structure and function? This study really honed in on that and is taking a look at when there are structural changes, when the cervical lordosis changes, what do we see in functionality influences? And that's an important question I think, to ask. And there's a lot of good stuff in this study, and let's dive right in. So we know low back is really that biggest challenge in the world as far as disability is concerned. But cervical spine doesn't rank too far behind. And disorders in the cervical spine and neck, they're some of the greatest contributors to spine pain, disability, and work loss worldwide. So, you know, this study looked at asymptomatic individuals, but the cervical spine is an important part of what's going on here. There's no question about that. And in addition to just having pain syndromes and all the pain associated with cervical spine issues, it's been thought that abnormal cervical sagittal alignment can play a role in altered neurophysiological changes, specifically with somatosensory processing and sensory motor control. Now, all of us probably have a range of normalcy, I'm gonna say, right? So I'm somebody who believes there's probably not a perfect cervical curve for everybody. We. But that everybody likely has what would be perfect for them. And that's an ideal. But the beauty of who we are as dynamic beings is that there's a dynamic range, right? But when we get really far off, when we go out of our dynamic range, we're pushing beyond that. I think that's where we start to see somatosensory processing issues. We see sensory motor control issues, essentially. That's a Fancy way of saying we see functional issues, and quite often that comes in with pain as well. So one of the things they also brought up in the study title was neuroplasticity. So let's break down exactly what that means, and here's kind of the technical definition. It's an inherent ability of the brain and nervous system to develop and modify synaptic connections, resulting in changes in structure, function, and organization within the nervous system. Basically, it's our dynamic abilities, right? Neuroplasticity is the dynamic ability for your brain and nervous system to modify synaptic connections that can create alterations in structure, function, and organization. So at a micro. A level, that can get super, super complex at a high level, I think it makes a lot of sense. Now, what can contribute and neuroplastic changes, what goes on there? What can contribute to changes there? Well, pain is one of the biggest things. So pain is considered to be one of those strong contributing factors to triggering neuroplastic changes. And there's a ton of studies out there that suggest that these changes are an adaptive process due to continuous and noxious nociceptive impulses in the spinal, subcortical and cortical areas of the central nervous. And I'm going to take my. I'm going to go my way with this and say, in my understanding, this is where a lot of acute pain becomes chronic pain, right? A noxious stimulus or impulse that creates pain. There's some sort of event, bang, there's some sort of injury. There's something that occurs that causes pain, acute pain. But our bodies become sensitized to that very quickly. And as we become sensitized to that, now you take away that stimulus. And now very ordinary things can cause pain. And this is not telling anything you don't know. As a healthcare provider, we see this all day, every single day, right? Individuals in chronic pain that are super scared to move, you know, you're barely touching them and they're jumping off the table. And you're like, golly, I'm not touching this person. I'm barely doing light touch. And they're jumping off the table. They are sensitized, right? So that is the brain's ability. That's neuroplasticity on the negative side of things, right? Their synaptic connections have altered and their function at least, or their organization has changed, where just simple light touch is causing abject pain. And breaking that cycle is a lot of what we do each and every day. So that altered afferent input is considered to be one of the Best explanations for the development of abnormal neuroplastic alterations in the central nervous system. That makes sense. And that's a lot of what we see with chronic pain. So the question is, restoring that normal sagittal plane posture and cervical spine alignment, is that important for a better affrontation process? Right. Can that go the other direction? Not necessarily due to input alone, but can we change that function with structural changes? That's really the question, and it's a good one because I think it's a question that's been asked for many, many moons. So this study took an approach of being a prospective investigator, blinded, parallel group, randomized clinical trial. So great study architecture as far as I'm concerned. They took a bunch of people about a little bit less than a hundred that were between 18 and 25 years old and had no current or previous complaints of neck pain within the past year. And they basically split these people off into two groups. And both the goal was to use what I'm just gonna call a cervical orthotic odenterol or a hydroculator pack. The hydroculator pack was not hot or cold, not filled up with anything. It basically. That was the sham treatment, right? It basically was just like putting a less than a T shirt underneath your head. Whereas the Denerol is sort of that extension traction orthotic that you can lay on and it's supposed to unload the disc, as we'll see. So the participants in the intervention group, of course, received the dentoroll cervical orthotic. The people in the control or the placebo group received just the hydroculator pack that basically didn't barely even touch their cervical spine. So this study took place over the course of multiple weeks. During each session, they began with 3 minutes per session and then they added an increase of 1 to 2 minutes per session until the goal of 20 minutes total time on the orthotic per session was attained. And this went. This was applied three weeks. Excuse me, three times per week for 10 weeks. So there's 30 total sessions. And this was in a supervised setting. So that's really the way that it went down. Now, what's the goal of using this dentiroll? Well, the goal is, as they say, it's to cause viscoelastic creep deformation of the anterior soft tissues, the musculature, the longitudinal ligament and the discs. So what does that mean? They're trying to unload the disc and normalize load sharing on the cervical column. So that's really, really the goal of using a dental orthotic traction Type device. So if you know, so how did it work out, right? That's the question. Well, in the intervention group that got the dental traction, cervical lordosis increased by a mean of 13 degrees after 30 treatment sessions. And then it was maintained at three months. Now in the control group, no significant improvement in lordosis. So that's pretty staggering. When we look at that and say 30 mean of 13 degrees after 30 treatments and it was maintained after three months, that's pretty staggering to me. And I think that that's something that all of us, you know, can take into account now, you know, this study doesn't get into, you know, I think of the over the door traction units versus a dental traction unit. There's a whole bunch of cervical traction units out there. It'd be interesting to compare a B test, right, These traction units one to another. But man, I mean, the ability for attraction unit to increase or normalize that cervical curve, that amount degrees in 30 treatments and then maintain that three months post. That's pretty interesting. And I think this is where we're starting to understand that play between structure and function and how can it impact who we are, what we do, right? Because it's all about living your life. Ultimately, structure and function come down to what's your quality of life? Are you able to do those things you'd love to do? Are you able to get out there and function at your highest level? That's what it's all about. And the interplay between structure and function with that is fascinating. So, as these researchers say, regardless of the exact correlation between spine degeneration and the presence of pain, there is preliminary evidence that spine degeneration can compromise the neuromuscular stabilizing system of the spine. Additionally, disc degeneration, altered cervical lordosis, and forward head translation can all contribute to a reduced range of movement and altered segmental cervical spinal kinematic pattern. And we've all seen this, right? People come in and that degenerative cascade is complex. It's not isolated to one thing. However, when we see a disc starting to collapse, when we see load on the facet joints, we might see segmental kyphosis. That person might not have pain. But quite often pain might not be too far around the corner as that continues. And functionally, they probably aren't functioning at their highest level. There is a biomechanical component to all this that is important. Now, again, the beauty of our bodies is the neuroplasticity, is the dynamics and is the range that we all have where we can function at A pretty darn high level. When we have negative alterations, that could be negative alteration in structure. And that is important. However, it's also the flip side of that is important where maintaining the best structure that we can is only going to, as this study would sort of peek into that window, is only going to help us function at our highest level. So I think that's an important part of it. Now, how does all this work? Why is that the case? Well, they're basically saying that a lack of motion or increased strain might increase the viscosity and slow or impair neural transport mechanisms, which is an interesting way to look at it. They are hypothesizing that neural tissue needs ample amounts of oxygen and nutrients to maintain optimal structure and function. I don't think there's anything wrong with that. And there's evidence to suggest that abnormal cervical alignment may place a constant increased strain on neural and vascular elements in the cervical spine, directly impairing the blood flow to the spinal cord, nerve roots, and cerebral areas. So it's kind of getting down to, hey, when there's structural changes, as they're saying, there's structural changes, this can dramatically impact the function of our ability to deliver nutrients. And ultimately that's the functional output, then changes of our brain, central nervous system, et cetera. So their conclusion was we identified a reduced cervical lordosis and anterior head translation is associated with differences in neural activity at several regions of the somatosensory system. Restoration of the cervical sagittal alignment in terms of cervical lordosis and anterior head translation has a direct influence on the central conduction time. Clinical interventions directed at improving central processing through restoring the normal sagittal alignment could be added to the clinical interventions targeting specific spinal disorders. So in interesting conclusion, again, as I said at the top of this podcast, I think this is going to stimulate probably a lot more questions than answers, and I think that is a good thing for a research paper. So is structure important? Yes. Is function important? Absolutely. How does the balance of these two hang with each other? Well, there's a lot of factors that influence that, and it depends on the individual. That is a dynamic system. But ultimately, when we start to see, you know, traction and things like that that can change or, you know, influence structure, that then we see a direct output in the ability to influence function. That becomes interesting to me. And I think all of us as healthcare providers, specifically in the neuromusculoskeletal space, need to heed that, need to stay up to date on what's going on with this and hey, maybe if there's an individual in your practice, this is for you to make that clinical decision based upon that individual, their goals and what you're finding during your eval. But if there's somebody that maybe you've been taken care of through adjustments, maybe you've been taken care of even through reh, but you haven't really done anything in the traction space. This is my big take home from this. And they're having just this functional issue. They either have, maybe they're in chronic pain, this was asymptomatic in this study. But your patient might have chronic pain or they have a functional disability that they're just really trying to get over that last little bit. Whatever that functional challenge might be, adding in traction might be a good idea. If you haven't yet, if you're going through adjustments, if you're going through range of motion exercises, if you're going through balance between strength and flexibility and rehabilitation and you haven't added in traction, maybe it's a good idea to see what happens. Now I'm not suggesting necessarily you need to take pre and post X rays and measure the changes, but you certainly can keep an eye on those functional improvements. So getting them on a traction device, seeing if that changes and improves their outcomes and improves your outcomes in your practice might not be a bad idea. I think all of us hear about traction sometimes. It's thought of as old school, but I can tell you sometimes things come right back around. And the ability for potentially attraction device to change that structure which can improve the functional ability, that's just one more tool you can have in your tool belt. When you're taking care of an individual, think about what's going on with them, determine what might be the best solution. And maybe this is one of those things you lean into a little more than you have in the past. So those are my big take homes. If you have any questions about this, hit me up. Jeff the evidencebasedchirofractor.com Also if you are going to be out of your practice at all over the next few months, check out Chiromatchmakers.com we have a bunch of locum docs coverage available ready to work throughout the United States. So if you are going to be out, do not shut your doors. You don't have to lose that revenue and interrupt your patients care plans. You can stay revenue positive, keep your patients on track. Use chiro matchmakers for your coverage services. Chiromatchmakers.com have a fantastic week in practice and I will talk to you soon.

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