380- Adjusting the Thoracic Spine for Cervical Spine Pain

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. This week we are back with more research. This is all around how a thoracic spine adjustment can impact cervical spine or neck pain. So how does the mid back affect the neck? What is the latest research out there? We're going to take a look at a systematic review and meta analysis of randomized control trials. Great study. Pretty new. Lots of actionable take home messages. I on today's episode. Before we get started, I wanna say a few words about Patient Pilot by the Smart Chiropractor. If you're looking for the number one reactivation software, automated reactivation software in chiropractic, you wanna head over to the smartchiropractor.com and schedule a demo for patient pilot. Our average doc generates 26 reactivations per month. That means no matter what you are doing, if you're not using Patient pilot you're missing out on 300 plus potentially reactivations each and every year by showing up teach inviting automated email campaigns. Check it out. It is worth it. 3x ROI guarantee. We want to make sure you're super satisfied. We work with over 300 docs around the world. Check it all out and schedule a demo atthe smart chiropractor.com but as I said today on the top of this episode, we're talking research. This is a study that came out in the Journal of Pain Research and it is new. This came out in 2023. The full title and I'll drop a link down in the show notes is Effectiveness of Thoracic SP and manipulation on the Management of neck Pain. A systematic review and meta analysis of Randomized controlled trials. This is a good one. And they went deep. Why is it such a big deal? Well, neck pain is one of the top two to three reasons why people visit a chiropractic practice. Low back being number one, headache and neck being two and three and they can go back and forth there. Also, neck pain is a super common condition. It affects people all around the world and it's actually increasing as time goes on. Why? Probably a lot of it due to lifestyle habits, posture, lack of daily movement, et cetera. And pretty much at this point most people are gonna experience neck pain at some point during their life. And the movement pattern in Daily activities can be affected with impact on social activities and participation. And ultimately the economics of people, if they're unable to go to work due to neck pain, that's a big deal. So, so this is not only about pain, it's also about functional ability, which is the other side of the coin of disability. When you're struggling with neck pain, it can be super, super challenging. I know practicing in a multidisciplinary and orthopedic group, you see people come in in acute pain. I remember it also just in general private practice as well, you see people come in with neck pain and they can't turn their head, they're not productive at work. It's very rare that somebody, even if it's just, you know, that day or a day or two, if it's not a huge issue, but it's a spasm that has left them with really limited mobility for a day or two, that's like a big deal. Like you're not getting much done at work if you're supposed to be working on a computer or certainly if you're doing a manual job, those are probably either days out of work or you're just not getting that much done. So there's a really big deal associated with neck pain. And I think we've all literally seen it in our practices live. Now, the one year prevalence for neck pain, it is, this is the stat is almost so wide it's meaningless, but it's 17% to 75%. So over the course of a year, somewhere between 17% and 75% of people will experience neck pain. I'll put that one other way to put 100 people in a room. You'll say to those 100 people, no matter who they are, you know, somewhere between 17 and 75 of you will have a bout of neck pain within the next year. That is the prevalence there. So that is a big deal. What also is a big deal is according to the Global Burden of Disease 2010 study, neck pain ranked fourth in terms of disability as measured by years lived with disability, 21st in terms of overall burden. And in a 2015, neck pain was reported as a leading cause of disability in most countries. So we know, we've heard low back being that for years and globally it is. But neck pain is creeping right up there and especially with our sedentary lifestyles, this is a really, really big deal. Now, a lot of this neck pain, thankfully a lot of it tends not to be stenotic. A lot of it tends not to be compressive by nature. A lot of it is mechanical neck pain. And mechanical neck pain is most commonly defined as pain in the cervical spine or the cervical thoracic junction that gets worse with motion and or palpation of the, the musculature around the spine. So that's really kind of that textbook definition of mechanical pain. It's what we do as chiropractors. Of course, when we're going in and we're evaluating range of motion, number one, but number two, we're getting in there palpating, we're seeing what's going on, how does somebody feel as we're getting in those muscles. We're evaluating joint motion segmentally, regionally, of course, through whole body as well. All of those things are super impactful. And to me, yes, there are some physical therapists and some movement based specialists that do something similar, but, but I just can't think of a profession that does this with more specificity, that does it more often. So we just, we have those muscles built, those skills, because this is how we examine the definition of how we examine patients all day, every day. I can tell you that you look over towards the medical side and that's not slogging them whatsoever, but you go into a primary care doctor and that's seeing 75 patients a day. They're not doing a hands on exam to any realistic capability to any tune that somebody as a movement based healthcare specialist is doing. So we're gonna be able to extract so much more information about what's going on with the patient by actually doing a thorough examination. And I think as chiropractors we sometimes just overlook that. We take it for granted because it's just what we do. But it's not what most doctors do, it's not what most healthcare professions do. There's only a few healthcare professions, us included, that that really go about doing a really thorough movement based examination which leads into movement based care, which is the number one item that many people should be doing. So there is a lot of management techniques. As you've seen, medications are still being prescribed, which is absolute insanity most of the time. Manual therapy, exercises, of course, manual therapies have in the previous literature been shown to improve pain and function in adults with neck pain. And this is because of that biomechanical link between the thoracic and the cervical spine. And when there's changes to the biomechanics in one area, it can impact the other area. So if there's something going on in the neck, and this is why it's really important, I'LL kind of step to the side on this conversation and then we'll dive back into the research. It's really, really important for everybody listening. Always be doing a thorough examination. Don't become too myopic. I feel as though there are many quote unquote evidence based docs that are so focused on pain relief, they're so focused on analyzing exactly what's going on. Yeah, that's important. But don't become myopic to the point where you're not looking in other places. Always look at the adjacent region, always look at the adjacent body joint. That is just basic stuff, but often can be left by the wayside. And you will see the results of that in this study. So evidence has really, really been stacking up over the last few years to support thoracic spine manipulation or adjustments as an intervention for non specific neck pain and acute mechanical neck pain for that matter as well. So this study looked back, they looked at trials in full text in English language that were conducted over the last 10 years. In the last 10 years. This came out in 2023, but when they were, when they were doing the research, 2010 to 2020. So a 10 year period from 2010 to 2020, which is this, that's pretty recent. They looked at adults over in both male and female with chronic mechanical neck pain. The intervention that they were looking at was thoracic manipulation. So a lot of these studies had thoracic manipulation against something else, right? Placebo, mobilization, exercise, a variety of different things. But they were specifically looking for thoracic manipulation to be able to identify does that make an impact on neck pain. So this technique, as far as they were concerned, could be provided multiple times to a single spinal region or various regions during a single session. So they weren't looking at Was it only T6 adjusted or something to that effect. It could have been the thoracic spine adjusted throughout the thoracic spine either during a single visit or during multiple subsequent visits. So that's what they were looking at. They ultimately whittled their search down to eight randomized controlled trials that matched the objective and were included in the meta analyses. Now throughout those studies, it was about 385 people with a range from 30 to 120 in various studies, which were those eight total studies. Now the follow up times were varied. Some of the follow up was immediate, you know, basically delivering that care and then analyzing what's going on. Some of it went up to six months after that initial visit. So that's kind of the baseline of what they were looking at within the the study. Now, when we synthesize those results, what was found? There is evidence on the effectiveness of thoracic manipulation to reduce pain intensity and decrease neck disability with people that have chronic mechanical neck pain. So pain intensity was assessed in all eight studies. VAs and NPRs scores and pain relief was attained in most of them. The differences between the groups for pain was not only statistically significant but also clinically meaningful. And that is a big deal. And in one study it was maintained for the three and the six month follow up. So let's just talk about that for a moment here. One, that's awesome news. That's news to say check the thoracic spine if somebody's coming in with neck pain and don't be afraid to. If you see that there is restriction, if you see that there's limited mobility, if you see that there's a biomechanical aberration, get in there and adjust it. This is an important part of taking care of cervical spine pain. The second part about this was that it is clinically and statistically significant. Those are the words, of course everybody loves to hear. And it was, it maintained throughout three to six month follow up. So it wasn't just, oh, it feels better and tomorrow it's back. This is something that lasted. And that's also something I have seen through the unknowing pundits online, as if a chiropractic adjustment lasts for that moment, well, everything just comes right back. Well, if you go back to the same activities, doing the same thing and not changing lifestyle, it probably will. But man, the impact of what we do in the time that it can last, even in challenge circumstances, even with people going back and doing the same thing, is unbelievably impressive. So the study that investigated the acute effects of a single level manipulation and multiple level manipulations on chronic neck pain showed pain relief at rest significantly decreased after the multilevel manipulation. Manipulation. So getting in there, gating pain, you know, that's a whole separate podcast on exactly how it works. We've addressed that on previous episodes. I'm sure we'll address it on future episodes. But bottom line is you get in there and adjust the thoracic spine and the cervical spine tends to feel better. Another study compared experimental groups that received manipulation in a control group without manipulation. And the manipulation or adjusting group had a significant decrease in neck disability compared to the control group. And that was a big deal. And the difference was six to nine points. So that is a big deal. That's a big delta and that's a big win for getting in there and adjusting the thoracic spine. This review provided evidence that manipulation alone or in combination with other treatments produced immediate and short term effects to improve pain and disability in the cervical spine among patients with that chronic mechanical neck pain. So manipulation is more beneficial as they found than mobilization than of. Excuse me, let me repeat that thoracic manipulation is more beneficial than thoracic mobilization, more beneficial than cervical mobilization and standard care in the short term. I still don't, I'm totally befuddled when they talk about standard care at this point because standard care should be hands on movement based care. The fact that I feel like in this case they're referring to standard care as medications, quite frankly, should be embarrassing for anybody that's holding that to their standard of care. But I'll get off my soapbox, we can talk about that at a later date. They also found a systematic review Comparing Thoracic Manipulation vs Mobilization found that there is a significant amount of evidence for the short term benefits of thoracic manipulation in people with neck pain. And this is supporting the concept of that biomechanical link between the thoracic and cervical spine. And that disturbances in the biomechanics of the thoracic spine may actually be a contributor to neck pain. So it's not only that the altered range of motion and sensitivity in the cervical spine and is being impacted by the thoracic adjustment, but that the cervical spine issue might be playing into a thoracic spine issue. Thereby, when you adjust thoracic spine, you're kind of getting two birds with one stone, so to speak. So it's an interesting point in this study. Now they also had a great little section in this study called Implications for clinical Practice. And they had clinicians and physiotherapists can apply the techniques of high velocity, low amplitude manipulation thoracic as a choice of treatment to decrease pain and disability in the cervical spine for patients with neck pain. So basically just concluding what we had discovered earlier. So the findings in this study fully support the clinical benefit of thoracic adjustments for reducing pain and reducing disability. So as you see, what are the take home messages here? I think it's pretty clear at today, tomorrow, the next day. Number one, if you're listening to this and you are not a chiropractor and you're struggling with neck pain, ask your chiropractor, check out your mid back because adjusting the thoracic spine might make a really meaningful difference. And if You're a chiropractor listening, and you probably are. Make sure that you are examining and evaluating the thoracic spine, making make sure that things are moving appropriately in the thoracic spine for all these people that are coming in with neck pain, which is probably a significant percentage of the patients that you will see today, tomorrow, this week and this month. So keep your eyes out for that. And I will drop a link to this show or to this study in the show notes so you can get over at it right there. Before we wrap up, I want to say a few words about Zynga and a few words about power Step. With Zynga you can expect 23 Google reviews per month. 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Head over at pick up a free sample pair of Powerstep orthotics pro.powerstep.com sample use the code EBC pro.powerstep.com sample Use the code E EBC they will hook you up with a free sample pair. If you have any feedback from me, you can always hit me up. Jeffevidencebasedchiropractor.com I'd love to hear from you. If you have not left a rating or review for this podcast that helps more and more docs find out about it. So I'd love it if you scrolled on down. If you're listening on your iPhone, tap how many stars you think we earned. Let us know some feedback. If you want to type some things in there. I would absolutely love it. Thank you for being a chiropractor. Thank you for tuning in. Have an awesome week in practice and I will talk to you soon.

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