421- Inflammatory Mediator Changes After Spinal 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 Langmaid and on today's episode we have a fantastic piece of research that we're gonna highlight. I will drop a link to it down in the show notes. It is titled Effects of Spinal Manipulative therapy on Inflammatory Mediators in Patients with Non Specific Low Back pain. And this is a good one. Lot of clinical pearls, a lot of take home messages as well as some deep science stuff. Stuff. This was in chiropractic and manual therapies just a couple years back and I am happy to highlight it on today's episode. Before we get started, I want to say a few words about Patient Pilot by the smart chiropractor if you would like to see reactivations come into your practice. And let me just bottom line it, if you have hundreds, if not thousands of people on your email list, AKA people that you previously taken care of and you're not reaching out to them on a consistent basis, you're just missing opportunities. Patient Pilot makes it easy because we provide you with awesome content that's teach and invite. Teach somebody, engage, inspire, educate, invite. That's the call to action. And then we highlight who are clicking on reactivation reports. But the value goes far beyond that. Not only do some people click in those emails, but you probably would have 50% based upon our current data opening 50% open rate. So if you have a thousand people on your email list, do you think good things will happen if 500 of your patients see your name in valuable information each and every week? Yes. Yes. Will some click through yes. It's a great thing to do for your practice in 2024. Great way to invest. You can check it out@thesmartchiropractor.com again that's thesmartchiropractor.com and I'll drop a link down in the show notes. But as I said at the top, we're talking research today all about the effects of spinal manipulation on inflammatory mediators in patients with low back pain. So they kick this one off strong. They cite at the very top of this study that's spinal manipulation has been recognized as an effective form of non pharmacological treatment for low back pain. Couldn't have said it better myself. Anybody that's out there with Very rare exceptions, still prescribing medication. It's so outdated, it's so outlandish. They should be held accountable. It's just silly at this point in time, based upon the overwhelming amount of research, such as the study we're gonna highlight today, highlighting the fact that spinal manipulation, what we do with spinal adjustments, is the way to go most of the time. Now, when we look at low back pain, there's an inflammatory component. So classic inflammatory mediators. What are they? Let's review a few C reactive protein, probably heard of that. Cytokines, including tumor necrosis factor, interleukin 1, interleukin 6. They've all been reported as elevated in patients with low back pain, suggesting or maybe proving that spinal pain has an inflammatory component or most of the time. Key fact right there. So in this study they had 22 acute, 25 chronic patients, as well as 24 asymptomatic subjects. So, you know, 22 to 25 individuals in each cohort or each group, one, you know, 22 of them being acute pain, 25 of them being chronic pain, 24 of them asymptomatic. So they took baseline scores, they took follow up scores. Really, really well designed study. So baseline pain and functional scores were comparable between the acute and chronic low pain groups. So these are really good to compare. And following, what did they do? Well, they did six treatments of spinal adjustments within the span of two weeks. And they found significantly significant decreases in pain scores with both low, low back group patients. That was an awkward way to put it, but both the acute and chronic pain patients, they found a significant decrease. Now let's dive deeper because what we're really after are these inflammatory mediators and understanding how do these things play in with what we're doing with our spinal adjustments. So they saw differences in the change scores of tumor necrosis factor production with both acute patients and chronic patients after spinal manipulation. Very impactful. Let's unpack this and continue to unpack it. It'll get a little technical for a few minutes here, then we'll kind of round it out on the backside. But I want to get through all of the individual changes to highlight them and be complete. So with the patients that had acute low back pain, spinal manipulation treatments had no significant effect on the production levels of IL6 interleukin 6. So no changes. But in the low back pain, the chronic low back pain patients post SMT, production of IL6 decreased and was significantly reduced due to baseline. So why is this the case? Why would it change with chronic and not change with acute. Well, here's why. Differences in change scores of the level of IL6 between the, between the control and chronic as well as acute and chronic were statistically significant. Why is this? Because, and this is kind of weird in my opinion, but it makes sense. But it just is. It was surprising when I first read this in a study a few years ago. The differences in inflammatory mediators between acute patients and chronic patients, that profile is dramatically different. And a lot of this if. Now let me take that and really dive a little bit deeper. As we dive deeper, it can start to make a lot of sense. Meaning people who are in acute pain, they have a lot of inflammation going on. It's super high, right. So being able to cut that down in half or being able to cut that down significantly when these things are elevated, super high acute pain, it hurts right now, it's inflamed. Cutting that down is different than somebody that's, let's say, settled in to chronic pain, where the inflammatory profile might be lower than somebody in acute pain and therefore you have less to zero. Right. If you're at zero inflammatory mediator, so to speak, and you're at a 10 if you're acute and you're at a 5 if you're chronic, I'm throwing not real numbers out there. If you go, if you took 5 off of 10, you've cut it in half. If you take a 5 off of 5, obviously you've gone back down to zero. So my point of saying that is the profiles of acute low back pain patients and chronic low back pain patients, inflammatory profiles are wildly different. That is one of the reasons why a spinal adjustment can have a different differing effect on the inflammatory mediators depending upon if you're asymptomatic, acute or chronic. Very, very interesting. So they additionally found following spinal adjustments, the levels of IL2 in acute low back pain patients increased and became significantly higher compared to those in the asymptomatic controls and the patients with chronic low back pain as well. The difference in this score was was for the cytokine was significant as they highlight production levels of IFN in the chronic cohort was also significant in patients with acute low back pain. Self assessed pain scores and baseline levels of IFN Production have been shown to be positively correlated. So there we go. What does all this mean? It means a couple different things. One, it means the production of inflammatory mediators differs significantly between those acute and chronic low back pain patients and in comparison of course course to asymptomatic patients as well. So we see post spinal adjustment values of individual mediators. They have a trend towards lowering the production of pro inflammatory cytokines. Now what do we also know? Well, we know that IL2 production in the acute low back pain cohort and reduced IL6 production in the chronic low back pain group took place. And this is consistent with significant effects of spinal adjustments on the production of those cytokines relative to baseline. And in patients with acute low back pain, a significant increase after adjustments in IL2 was observed compared with both the control and the chronic low back pain groups. As well, the IL6 decreased significantly compared with baseline, though it remains slightly elevated compared to the controls that was in the chronic low back pain group. So IL6 really important because it's a cytokine recognized as a strong mediator of chronic inflammation. You, you can see chronic inflammation, different cytokine than acute inflammation. That makes things confusing, but it does also make a lot of sense. So diminished production of IL6 in the chronic low back pain cohort, therefore they're saying could reduce its nociceptive action. There we go. Now we're tying things together. Additionally, after receiving a spinal adjustment, a decline in the production of the nociceptive chemokine CCl3 was noted. Now, spinal manipulation associated decreases in IL6 they highlight could possibly modify the classic anti inflammatory pathway of IL6 signaling its membrane bound receptor. IL2 additionally has been reported to exert an analgesic effect in some neuropathic pain models. So the elevation of IL2 in response to an SMT can be consistent with the hypoalgesic effects of manual therapy and the modulation of nociception. That's a lot of technical stuff. But the bottom line is this study highlights the fact that with a short course of spinal manipulation, the production of inflammatory mediators in both acute and chronic low back pain patients did occur. Now in some cases they were more limited. In other cases there is a significant reduction. For example with IL6, significant reduction in chronic pain patients, enhanced IL2 production in acute patients as well. So these give us a clue, they give us an insight into what I'm going to call the mechanism of action. Like what happens when you put your hands on somebody when you deliver a spinal adjustment. What's really going on? And this gets exciting to me outside of there's a lot of technical details. IL tumor necrosis, that's a lot of detail and quite frankly it can become confusing at times. However, what we take out of studies like this is an understanding that what we do when we deliver a spinal adjustment it can and it does influence the inflammatory mediators differently in acute pain versus chronic pain, but across the board nonetheless. There also can be. Asymptomatic studies are kind of different than this one. But there are changes that occur in asymptomatic patients as well. But most importantly, decreasing inflammatory mediators without the need for, for drugs and medications and prescriptions. That's impactful. When you think about the hands on application of what we do, delivering an adjustment and not only helping biomechanically that joint function at a higher level, but literally creating inflammatory mediator changes at that level with what we do by hand is so incredibly powerful. And it is really important to take that in, to understand it and also to help people understand that that's part of what happens. Now. There's no such thing as a chiropractic aspirin, right? You're not going to deliver an adjustment and say you're going to the same thing with an aspirin. You wouldn't be able to say you're going to get from an 8 out of 10 to a 2 out of 10 pain with one adjustment, with 1.5 adjustments. That's not the way things work in real life. Our bodies are too dynamic. People are coming in, you know, as we like to say, gravity and age are undefeated, right? So as people go through their life, as they suffer with injuries, as they might have suboptimal biomechanics, all of those things play a role in gravity. On top of all of that, those are really important items and that's why people respond differently. But when we can showcase and highlight through research such as this that we can make a change at a fundamental level to the inflammatory mediators that are contributing to, if not causing their pain. I love to see that. I think that is one of the most powerful things that we can do and it's one of the, one of the deepest items, so to speak, outside of increasing range of motion, which can be a very good thing outside of your movement assessments, which are great to do, really being able to change the biochemistry at a fundamental level or at least influence it with what we do by hand. I love seeing research like this and there are more studies in and around this one that will continue to highlight throughout the year. I'm super excited at the research we have lined up for 2024 and I can't wait to see what comes out as we start going through the year that we get to expedite to the front of the line. I received an awesome email highlighting a study to highlight on a future episode. So if you have something you'd love to see highlighted on an episode of the Evidence Based Chiropractor podcast, hit me up jeff@the evidencebasedchiropractor.com Additionally, if you are looking to add a pillow, quite frankly to your own bed or in your practice as a revenue generator, head over to Align of Sleep. These are the pillows I use in my house. Dr. Mike Pound. Great guy, awesome chiropractor, entrepreneurial and doing his best to provide literally the best pillow there is on the marketplace. Alignasleep.com, i'll drop the link down below. Head on over, check it out. Buy one for yourself, buy one for a friend. Have it in your practice if you want to have that. But the bottom line is these are awesome pillows that I can't recommend high enough myself. Number two is if you're thinking about Shockwave technology in your practice, I can't recommend stemwave enough. Go stemwave.com the evidence basedchiropractor will hook you up with their team. Both of these companies support this podcast. I'll ask you to support them. And stemwave is the primary technology we utilize in the practice that I own and I can't speak high enough about it. Go stemwave.com the evidence based chiropractor that will hook you up with the best service, the best deal. And I can't recommend that technology enough. It works. It's awesome, patients love it and it's a fantastic revenue generator or practice as well. So if you have not left a rating review for this podcast, I would love it if you take a minute and do so. Otherwise, thank you for being a chiropractor. I'll speak to you next week. Have a fantastic week in practice and I will talk to you soon.

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